Increased Number of HIV-Positive MSM Being Tested Annually but Needs for Ancillary Services Going Unmet

The human immunodeficiency virus (HIV) continues to be a public health problem as more than 1.2 million people are living with the infection in the United States. The actual number of those infected could be even higher as about 1 out of 8 people are not aware that they are infected. These data make testing for HIV infection important for sexually active individuals, and even more so for those individuals who are at a higher risk for infection, such as men who have sex with men (MSM). MSM are most affected by the virus, and if left undiagnosed and untreated, the infection can lead to serious health implications.

The US Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) recently shared two reports that specifically focus on MSM living with HIV in the latest Morbidity and Mortality Weekly Report (MMWR).

The first report provides a close examination of HIV incidence surveillance data supplied by the CDC’s National HIV Surveillance System (NHSS) that was taken from MSM over 13 years of age between 2007 and 2013 in 21 different US jurisdictions. Using this data, the CDC sought to find how many of these men had previously been tested for HIV and if they are getting tested as frequently as the CDC recommends (annually).

The researchers found that 16,788 MSM over the age of 13 years had been diagnosed in 2007 and 15,951 had been diagnosed in 2013. They witnessed an increase in the number of MSM who had previously been tested before diagnosis, with 51% of MSM tested in 2007 and 69% in 2013. In those who had been previously tested, they noted a “significant” increase in the percentage of MSM who had previously tested negative for the virus: 70% in 2007 to 74% in 2013, according to the report.

Taking this a step further, the researchers teased out the data to look into specific race/ethnicity or age trends to understand any testing patterns. In terms of the different races in the study group, all experienced “significant” increases in the number of MSM who went for testing: 64% to 73% for black MSM, 75%-77% for white MSM, and 73% to 77% for “other races.” When looking at the data pertaining to age groups, the researchers reported “significant increases” in testing within the time frame for all age groups of MSM, except for those over 55 years of age.

According to the report, “The trend in the percentage of those with a negative test < 12 months before diagnosis increased overall from 48% in 2007 to 56% in 2013.” This notable increase in percentage indicates that MSM might be going for annual testing as had been recommended by the CDC in 2006. Annual testing can provide earlier diagnoses of the virus which might reduce the risk of transmission to others.

However, despite these promising data on HIV testing, information included in a second report published in the MMWR indicates that many needs are not being met in MSM who have been diagnosed with HIV and are receiving outpatient medical care. In this report, the CDC utilized data provided by the Medical Monitoring Project (MMP) as a way to measure not only how many needs remain unmet by MSM, but also, what the needs are and why they remain unmet.

These needs pertain to what the CDC refers to as ‘ancillary services’, which are “services that support retention in HIV medical care and assist with day-to-day living.” According to the report, the populations that reported the most unmet needs were MSM who were “non-Hispanic black and Hispanic/Latino.” The most prevalent needs pertained to services that were “for non-HIV medical care,” such as dental care (23%) and eye/vision care (19%). These ancillary services are particularly important for those diagnosed with HIV because many individuals who are infected develop a number of conditions that impair their oral faculties or their sight, such as candidiasis and Kaposi’s sarcoma. Those individuals with these conditions need additional medical care.

Among the other unmet needs reported were the needs for: mental health care (6%), an HIV support group (8%), food/nutrition services (12%), assistance pertaining to transportation (7%), and shelter/housing (7%). The researchers added that these services can influence adherence to treatment.

When assessing the reasons why these needs remained unmet, the MSM cited the following reasons: a lack of knowledge on how to acquire the services they needed; inability to afford what they needed; issues with health insurance; or they were told they were “ineligible for, perceived themselves to be ineligible for, or were denied these services.”

Currently, there are different programs and goals set by the CDC to reduce the number of unmet needs in HIV-positive individuals, among them are the National HIV/AIDS Strategy goal and The Ryan White HIV/AIDS Program. Increased access to these ancillary services may result in a better health outcome for those living with HIV, a virus that once acquired, is with the individual for life.