HIV and syphilis on the rise among MSM

Rates of HIV and syphilis are very high and rising among men who have sex with men (MSM) in New York City, reports a study in the November issue of JAIDS: Journal of Acquired Immune Deficiency Syndromes. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The new research finds "alarmingly high rates" of HIV and syphilis among New York City's large MSM population. "Intensified, innovative efforts to implement and evaluate prevention programs are required," concludes the new report, led by Preeti Pathela, DrPH, of the New York City Department of Health and Mental Hygiene.

HIV and Syphilis Rates More than 140 Times Higher among MSM in New York
The study combined multiple data sources to analyze trends in HIV and other sexually transmitted infections among MSM in New York City. To calculate risk, the researchers needed accurate estimates of the size of the MSM population. Researchers and policymakers use the term MSM rather than gay, as many men who engage in same-sex sexual activity don't identify themselves as gay. In the new study, 15 percent of MSM described themselves as heterosexual/straight.

The overall rate of same-sex behavior among sexually active men in New York was estimated as five percent. The rate was more than three times higher in (non-Hispanic) white men than in black men, although this may partly reflect racial/ethnic differences in willingness to report MSM activity.

Compared to men who have sex with women (MSW), MSM were more likely to use condoms and to have been tested for HIV in the past year. However, they were also more likely to have multiple sex partners. This was part of a pattern of "ongoing sexual risk behaviors" among MSM, according to Dr. Pathela and colleagues.

The data showed worrisome increases in HIV as well as primary and secondary syphilis among MSM. There was a 5.4 percent increase in the rate of new HIV diagnoses in MSM from 2005 to 2008—a time when the HIV rate among MSW decreased by 30.1 percent. Rate of HIV among MSM were highest in the youngest age group (18 to 29 years) and among black men.

The risk of syphilis—which is rising in New York and is closely linked to HIV—also increased dramatically in MSM. The overall rate of new syphilis cases rose by about 80 percent in MSM, compared to a 36 percent increase in MSW.

For both HIV and syphilis, the risk of infection was more than 140 times higher in MSM compared to MSW. Particularly in HIV-uninfected young MSM, "Increases in syphilis diagnoses indicate ongoing unprotected sex and signal the potential for increases in HIV acquisition," the researchers note.

"The population of MSM in NYC is large, diverse, and has high rates of risky sexual behaviors," Dr. Pathela and coauthors conclude. Their findings raise urgent concerns about the rising rates of HIV and syphilis: for both sexually transmitted infections, rates appear more than twice as high in New York City as for MSM elsewhere in the United States.

The data will guide efforts to address the rising rates of sexually transmitted infections among MSM in New York. Improving access to screening and testing for HIV and other sexually transmitted infections will be a critical step—making people aware of their infections can lead them to change their behavior, decreasing the risk of further transmission and enabling care, treatment, and prevention services. Current guidelines call for annual screening for HIV and sexually transmitted diseases for sexually active MSM, and more frequent screening for those who report high-risk behaviors.

Healthcare providers play a critical role in encouraging regular screening for HIV in MSM—including those who don't identify themselves as gay. Dr. Pathela and colleagues conclude, "Providers need to be competent at taking a nonjudgmental sexual history that ascertains sex of sex partners and specific sexual practices with all partners."