HIV Epidemic Growing In Young MSM Population, CDC Warns

While the HIV rate remains relatively stable among most heterosexual populations, it continues to grow among the population subgroup of young men who have sex with men (MSM), according to recent data from the U.S. Centers for Disease Control and Prevention (CDC).

Young MSM, aged 13 to 29 years, account for more than one-quarter of all new HIV infections in the United States, according to the authors. Young MSM also account for more than 70 percent of all new HIV infections among youths. One very obvious reason for this, according to research published in JAMA Pediatrics, is that young MSM with detectable levels of the human immunodeficiency virus are, for an unidentified reason, more likely to have sex without using a condom, even with partners who are HIV negative.

When the data is broken down even further, though, the waters are muddied.

Young black MSM are even more at risk. This is a strange paradox. Black YMSM made up 61 percent of all new HIV infections in the U.S. in 2009, according to the latest report, yet black survey respondents reported less unprotected sex. Earlier research also showed that risky sexual behavior is actually lower among young black MSM, but for some unexplained reason, “this population is more heavily impacted by HIV than any other group.”

Those with detectable levels were more likely to engage in risky behavior than those with no detectable HIV in their blood. More than half (54.7 percent) of young MSM with detectable HIV reported condomless anal intercourse, compared with 44.4 percent of young MSM who were either virologically suppressed or without detectable HIV.

Among young MSM with HIV, men with substance abuse problems were more likely to report not using a condom, even with partners of a different HIV status. Strangely, when young men in the MSM subgroup told their partners that they had HIV, they were less likely to use condoms than compared to young men in the MSM subgroup who did not tell their partners about their HIV status. Being employed was also a factor in whether a person in the MSM subgroup engaged in risky behavior, according to the report. YMSM who were employed were more likely to use condoms than their unemployed counterparts.

The authors of the new study argue that several strategies need to be implemented to reduce the transmission of HIV.

“Combination HIV prevention and treatment interventions, which include behavioral, biomedical and structural strategies to increase viral suppression and reduce HIV transmission risk behaviors, that target HIV-infected YMSM are needed. To truly curb HIV incidence among YMSM, we cannot solely rely on one strategy to prevent and treat HIV.”

The authors caution that results could be affected by the fact that all the young MSM with HIV involved in the study were receiving care but concluded that interventions for this population subgroup are critical for controlling the spread of HIV.

“Targeted multilevel interventions are needed to reduce HIV transmission risk behaviors among YMSM living with HIV.”

Earlier research examined possible outside-the-box interventions such as male circumcision, treating other STDs, and substance abuse treatment. According to an article entitled “Biomedical Approaches To HIV Prevention,” not much success was reported. Circumcision for the MSM population was found to provide essentially no protective benefits against HIV. Similarly, treating other STDs had no effect on HIV transmission, despite the theory that open infection would make a person more susceptible to acquiring and transmitting HIV. Substance abuse treatment, however, remains an important HIV-prevention strategy because people in substance abuse treatment are less likely to engage in risky sexual behaviors.

According to the National Institute on Drug abuse, “more research is needed to understand how socioeconomic factors, like unemployment, are related to factors like sexual risk-taking that affect HIV transmission.”

Eugene McCray, director of the CDC’s Division of HIV/AIDS Prevention, says that Americans “are now equipped with major prevention and treatment advances — so we know what works. Our challenge today is to make sure that everyone is benefitting.”

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