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Using HIV Incidence Surveillance Data to Examine Racial/Ethnic Disparities in HIV Testing Behaviors Among YMSM
in Los Angeles County
S Nakelsky, V Hu, E Kahn, Z Sheng, L Taylor, T BinghamHIV Epidemiology Program
Los Angeles County Department of Public Health
Overview• Background• Study population• Methods
– Core HIV Surveillance System– HIV Incidence Surveillance System
• Results– New HIV cases diagnosed– HIV testing behaviors and frequency by race/ethnicity– HIV incidence estimates for all MSM
• Conclusions and recommendations
Background• CDC testing recommendations:
– At least annual HIV testing for those at high risk
• MSM in LAC are not adhering to guidelines:– Concurrent HIV and AIDS diagnoses (13%)– 24% diagnosed with AIDS within 6 months of HIV– 2008 NHBS-MSM2 data (mean= 12.1 months)– New indicator: testing and treatment history data
collected for HIV Incidence Surveillance
Why young MSM?
• The majority (~84%) of people diagnosed with HIV annually in LAC are MSM.
• In 2008, MSM aged 13-29 years were the group most frequently diagnosed with HIV.
• Identifying strategies to increase HIV diagnosis and to decrease transmission in YMSM will have a large impact on LAC’s epidemic.
Methods• Data were obtained from existing HIV
surveillance systems
• Eligibility for analysis: – 13-29 years of age– Diagnosed in 2008– Resided in LAC at the time of diagnosis– Reported sex with males as a risk factor
• Denominators for rates assumed 4% of males aged 13-29 years were MSM
Data Sources (1)
• Enhanced HIV/AIDS Reporting System (EHARS)– Age– Race/ethnicity– Mode of transmission– HIV diagnosis date– Proportion of cases diagnosed with AIDS within 6
months of HIV diagnosis (late detection)
• HIV Incidence Surveillance – Uses statistical methods to estimate # of new
infections among those who do and don’t test– Serologic Testing Algorithm for Recent HIV
Seroconversion (STARHS) • Remnant sera of new HIV diagnoses tested with BED
assay to estimate # of cases acquiring HIV in 12 months – HIV testing and treatment history
• History of previous negative test results• Date of most recent negative test result• Time between last negative and first positive test
Data Sources (2)
Results from EHARS
Results: Overview of YMSM in LAC, 2008
• 563 MSM aged 13-29 years were newly diagnosed with HIV
• Latinos represented the largest number of new diagnoses among YMSM
• Rates of new HIV diagnoses:– 31 per 1,000 for Blacks– 10 per 1,000 for Whites – 9 per 1,000 for Latinos
Proportion of YMSM in Los Angeles County by Race, 2008
Black, 9.0%
Latino,55.9%
White,23.1%
Other, 12.0%
Total Population
Black 26.3%
Latino44.9%
White21.0%
Other7.8%
New HIV Diagnoses
% diagnosed with AIDS within 6 months of HIV Diagnosis
18.3% 17.4%15.3%
0%
5%
10%
15%
20%
Black (n=148) Latino (n=253) White (n=118)
Late Detection
Results from HIS data
STARHS Results by Race
37% 37%
50%
63% 63%50%
0%
10%
20%
30%
40%
50%
60%
70%
Black (n=78) Latino (n=116) White (n=50)
Recent
Longterm
First Time versus Repeat Testers by Race
13%26%
11%
87%74%
89%
0%
20%
40%
60%
80%
100%
Black (n=82) Latino (n=151)
White(n=64)
Repeat Tester
New Tester
Latino vs. Black p=0.02; Latino vs. White p=0.01
Months between Last Negative and First Positive Test by Race
1314
9
0
2
4
6
8
10
12
14
16
Black (n=70) Latino (n=106) White (n=56)
Mea
n N
umbe
r of M
onth
s
White vs. Latino p=0.02; white vs. black p=0.04
Months since Last HIV Test by Race, YMSM enrolled in 2008 NHBS
12.8 12.610.8
13579
111315
Black Latino White
Mea
n N
umbe
r of M
onth
s
Estimated HIV Incidence Rates for all MSM in LAC, 2008
10
7
11
16
98
0
2
4
6
8
10
12
14
16
18
Age Race13-29 30-39 40-49 White
17
Rat
e pe
r 1,0
00
Black Latino
Summary• STARHS results indicate <50% of YMSM
adhere to annual HIV testing recommendations• Frequency of HIV testing varies by race/eth.
– Latino YMSM reported highest: • Average months between last negative and first positive• Proportion of new HIV diagnoses at first test
– Black YMSM reported lower testing frequency compared with White YMSM
• Black YMSM are disproportionately impacted– Findings observed in both surveillance systems
18
Limitations
• Establishing HIS within LAC has proven challenging
• HIS data for 2008 are marginally complete– Of the men diagnosed with non-AIDS HIV, 244
(51%) had a STARHS result available– 435 cases (71%) had some but not all testing
history data elements available
Conclusions
• HIS provides additional insight for monitoring HIV testing behaviors and rate of new infections
• In LAC, all YMSM—but especially Blacks and Latinos—would benefit from increased HIV testing to detect new infections
Moving Forward• Future research should focus on identifying
specific barriers (e.g., stigma, access, acceptable modes) to HIV testing among YMSM
• Revised testing recommendations, social marketing campaigns, and other approaches must consider racial/ethnic differences in testing norms and HIV incidence rates to support more appropriate testing intervals
Thank You!
For more information contact: Shoshanna Nakelsky
HIV Incidence Surveillance [email protected]
213.351.8154
22
