By Ethan Covey
Most large clusters of HIV transmission taking place in the United States occur among men who have sex with men (MSM), many of whom are minorities, according to a CDC report.
The clusters are characterized by rapid growth and HIV transmission rates more than six times those of estimated national rates (MMWR Morb Mortal Wkly Rep 2022;71[38]:1201-1206).
“HIV continues to disproportionately affect gay and bisexual men, even though new HIV infections declined among this population during the last decade,” said Stephen M. Perez, PhD, a nurse epidemiologist in the CDC‘s Division of HIV Prevention and lead author of the MMWR article.
“Also, progress in reducing new HIV infections among gay and bisexual men has not been equal—with factors like stigma, racism, discrimination, homophobia and others contributing to an unequal reach of HIV prevention and treatment and continued disparities.”
During 2018-2019, the CDC identified a number of concerning HIV clusters among MSM. By December 2021, 38 clusters that had been initially identified during 2018-2019 grew to include more than 25 people.
“The presence of a cluster suggests that HIV prevention and treatment have failed to reach a particular community, and that HIV is transmitting rapidly within that community,” Dr. Perez told Infectious Disease Special Edition.
Of these clusters, analysis showed that 29 occurred primarily among MSM, taking place in diverse groups of gay and bisexual men, with rapid transmission occurring among Black/African American, Hispanic/Latino, and white gay and bisexual men. The clusters were found in different regions of the country, and in communities of varying size. Six clusters primarily involved people who inject drugs, and three had no identified primary transmission category. Many of the clusters included people from multiple states.
“These findings tell us that many gay and bisexual men continue to face significant stigma and barriers to accessing highly effective HIV prevention and treatment services that are available,” Dr. Perez added. “Cluster detection and response efforts can help identify communities experiencing rapid HIV transmission among gay and bisexual men, and help implement robust response interventions to improve access to HIV prevention and care—and ultimately slow or stop transmission.”
The authors of the report noted the importance of identifying rapid HIV transmission quickly, thus allowing for HIV prevention and care services to be implemented early.
“These interventions should improve access and strengthen linkages to HIV testing, pre-exposure prophylaxis and timely HIV treatment,” Dr. Perez said. “Response interventions should be implemented in collaboration with local community partners who can best inform jurisdictions about the needs of gay and bisexual men in their own communities.”
Cluster detection and response activities are a core strategy of the federal Ending the HIV Epidemic in the U.S. initiative, and an important tool that can help identify rapid HIV transmission.
“These activities can also help local communities experiencing rapid HIV transmission tailor HIV interventions specifically to affected populations, including diverse groups of gay and bisexual men,” Dr. Perez added.
“Interventions should aim to eliminate barriers and address stigma to provide the services needed to stop transmission.”
