Characteristics of Sexual Partnerships Among Men With Diagnosed HIV Who Have Sex With Men, United States and Puerto Rico-2015-2019.

BACKGROUND: Understanding sexual partnerships of HIV-positive persons, particularly at the dyad level, can help in quantifying HIV transmission risk. We described sexual partnerships among HIV-positive men who have sex with men (MSM), including partnerships with a high risk for sexual HIV transmission. SETTING: The Medical Monitoring Project is an annual, cross-sectional study that reports representative estimates on U.S. HIV-positive adults. METHODS: During 2015-2019, we assessed sexual behaviors by interview, and viral load results from medical records. Among sexually active HIV-positive MSM (n = 4923), we described prevalence of high-risk sex, defined as: (1) not having sustained viral suppression, and (2) having condomless sex with an HIV-negative partner not known to be taking pre-exposure prophylaxis or an HIV-unknown partner. We described sexual partnerships among HIV-positive MSM (n = 13,024 partnerships among 4923 MSM). For HIV-discordant partnerships (n = 7768), we reported the proportion involved in high-risk sex, and associations with high-risk sex using prevalence ratios with predicted marginal means, controlling for age of the HIV-positive partner (P < 0.05). RESULTS: More than half (66%) of sexually active HIV-positive MSM had condomless sex; 11% had high-risk sex. Blacks were more likely to have detectable viral loads, but less likely to have condomless sex, making prevalence of high-risk sex comparable between racial/ethnic groups. Dyad-level analyses among HIV-discordant partnerships indicated that prevalence of high-risk sex was higher among partnerships with HIV-positive white MSM, which was not observed using person-level data alone. CONCLUSIONS: In the context of ending the HIV epidemic, behavioral and clinical surveillance data can help monitor HIV transmission risk and target prevention efforts to reduce transmission among populations at disproportionate risk.

Trends in ART Prescription and Viral Suppression Among HIV-Positive Young Adults in Care in the United States, 2009-2013.

BACKGROUND: Only 13% of HIV-positive young adults are estimated to be virally suppressed and, even among those receiving medical care, HIV-positive young adults are less likely than older adults to take antiretroviral therapy (ART), be adherent, and be virally suppressed. We sought to examine trends in treatment and health outcomes from 2009 to 2013 among HIV-positive young adults (aged 18-24 years) in care. SETTING: The Medical Monitoring Project is a complex sample survey of HIV-infected adults receiving medical care in the United States. METHODS: We used weighted interview and medical record data collected from June 2009 to May 2014 to estimate trends in the prevalence of ART prescription, adherence, side effects, single-tablet ART regimens, regular care utilization, and viral suppression among young adults. RESULTS: From 2009 to 2013, there were significant increases in ART prescription (76%-87%) and the proportion of young adults taking ART who reported taking single-tablet regimens (49%-62%). There was no significant change in adherence, side effects, or regular care utilization. Although viral suppression at last test did not change (65% at both time periods), the proportion of young adults who were sustainably virally suppressed significantly increased (29%-46%). Accounting for ART prescription and single-tablet regimen use attenuated the sustained viral suppression trend. CONCLUSIONS: Although the level of viral suppression among young adults in care remains suboptimal, the observed increases in ART prescription and sustained viral suppression may be a cause for optimism regarding efforts to improve outcomes for this vulnerable population.

Trends in Racial and Ethnic Disparities in Antiretroviral Therapy Prescription and Viral Suppression in the United States, 2009-2013.

OBJECTIVES: To examine trends in racial/ethnic disparities in antiretroviral therapy (ART) prescription and viral suppression among HIV-infected persons in care, overall and among men who have sex with men (MSM), from 2009 to 2013. DESIGN: The Medical Monitoring Project (MMP) is a complex sample survey of HIV-infected adults receiving medical care in the United States. METHODS: We used weighted interview and medical record data collected June 2009-May 2014 to estimate the prevalence of ART prescription and viral suppression among racial/ethnic groups overall and among MSM. RESULTS: We found significant increases in ART prescription and viral suppression among all racial/ethnic groups from 2009 to 2013, both overall and among MSM. By 2013, overall and among MSM, the Hispanic-white disparity in ART prescription was nonexistent, and the black-white disparity was not significant after accounting for differences between blacks and whites in age and length of HIV diagnosis. Despite reductions in racial/ethnic disparities in viral suppression over the time period, significant disparities remained among the total population, even after adjusting for differences in racial/ethnic group characteristics. Encouragingly, however, there was no significant Hispanic-white disparity in viral suppression among MSM by 2013. CONCLUSIONS: Despite significant improvements in ART prescription and viral suppression in recent years, racial and ethnic disparities persist, particularly for black persons. If the United States is to achieve the National HIV/AIDS Strategy goal of reducing HIV-related health disparities, continued efforts to accelerate the rate of improvement in ART prescription and viral suppression among Hispanic and black persons may need to be prioritized.