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 Still, black gay and bisexual men are less likely than their white
counterparts to receive antiretroviral therapy (ART) to keep the
human immunodeficiency virus in check, the researchers found.
They write in the Journal of Infectious Diseases that one goal of
the National HIV/AIDS Strategy was to get 85 percent of people to a
healthcare facility within three months of being diagnosed with HIV
by 2015. By 2020, the goal is to get 85 percent of people diagnosed
with HIV to care within one month.
The study team previously published 2008 and 2011 results from the
CDC's National HIV Behavioral Surveillance, which includes data from
20 cities on adult HIV-positive men who have sex with men - a group
at particular risk for HIV infection. The new study adds data from
2014.
Altogether, 1,144 men provided data in 2008, 1,338 in 2011 and 1,716
in 2014. The proportion of white men taking the survey fell 14
percentage points between 2008 and 2014, but the proportion of black
men participating increased by 13 percentage points during the same
period.
The average age of the men dropped over the study period, too.
Insurance coverage increased from 75 percent in 2008 to 86 percent
in 2014, which was the first year of coverage expansion under the
Affordable Care Act.
In 2008, 79 percent of the men were seen at a healthcare facility
within three months of their diagnosis. That measure - known as
linkage to care - increased to 87 percent by 2014.
With the 2020 goal in mind, the researchers analyzed how many men
were seen at a healthcare facility within one month of their HIV
diagnosis. In 2014, 78 percent of men were linked to care within one
month, which the researchers say suggests the 2020 goal is feasible.
When the researchers looked at how many of the men were receiving
ART, they found the rate increased from 69 percent in 2008 to 88
percent in 2014.
People with insurance or with higher levels of education or income
were more likely to be linked to care within a short amount of time
and be on ART.
In all years, a higher percentage of ARV treatment was observed
among whites, according to the researchers - and this disparity
persisted in 2014. The proportion of white men on ART were 9
percentage points higher than the proportion of black men.
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"We’re moving in the right direction, but the fact that the
disparities are persisting in 2014 when we’ve had access to
antiretroviral therapy for so long is troubling," said Jennifer
Kates, who is vice president and director of global health and HIV
policy at the Kaiser Family Foundation in Washington, D.C.
The findings suggest black men are being linked to care at roughly
the same rate as white men, but they're not getting equal access to
ART, said Kates, who wasn't involved in the new study.
"There are some systemic issues on the healthcare system side – from
providers to insurance – that this study wasn’t designed to look
at," she told Reuters Health.
For example, it could be that doctors are writing the prescriptions
for ART, but lack of insurance or other social services is creating
a barrier.
In an editorial accompanying the new study, Sten Vermund of the
Vanderbilt University School of Medicine in Nashville, Tennessee,
writes that many organizations are working to find better and more
effective outreach methods for HIV testing and care.
"Still, jurisdictions struggle with only limited success to solve
their black-Hispanic-white disparities in HIV risk and access to
care," Vermund writes.
The authors caution that the results are not nationally
representative. Additionally, they relied on face-to-face interviews
that may lead men to report higher levels of linkage to care and ART
use since those would be the more socially desired answers.
Lead author Brooke Hoots, of the CDC's division of HIV/AIDS
Prevention in Atlanta, was not available for comment by press time.
SOURCE: http://bit.ly/2owk28W and http://bit.ly/2owvMrL The Journal
of Infectious Diseases, online March 29, 2017.
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