Determinants of HIV Incidence Disparities Among Young and Older Men Who Have Sex with Men in the United States

Abstract

This study sought to determine why young men who have sex with men (MSM) have higher HIV incidence rates than older MSM in the United States. We developed hypotheses that may explain this disparity. Data came from peer-reviewed studies published during 1996-2016. We compared young and older MSM with respect to behavioral, clinical, psychosocial, and structural factors that promote HIV vulnerability. Compared with older MSM, young MSM were more likely to have HIV-discordant condomless receptive intercourse. Young MSM also were more likely to have "any" sexually transmitted infection and gonorrhea. Among HIV-positive MSM, young MSM were less likely to be virally suppressed, use antiretroviral therapy, and be aware of their infection. Moreover, young MSM were more likely than older MSM to experience depression, polysubstance use, low income, decreased health care access, and early ages of sexual expression. These factors likely converge to exacerbate age-associated HIV incidence disparities among MSM.

Low socioeconomic status is associated with self-reported HIV positive status among young MSM in Brazil and Peru

“…Data from the U.S. found that socioeconomic disparities were related to age among MSM, with YMSM having less income, less access and use of health care services compared to their older counterparts [ 30 ]. In addition, socio demographic characteristics, such as race and education, were more strongly associated with HIV infection than individual risk behavior among YMSM [ 31 ].…”

HIV Prevention Interventions for Adolescents

“…Among youth, there are key populations who bear disproportionate burdens of HIV and are the most vulnerable, including young men who have sex with men (MSM), transgender youth, those who inject drugs, and adolescent girls and young women in Africa. Among young men who have sex with men (YMSM) in the United States, psychosocial and structural factors substantially contribute to age-associated HIV incidence disparities, including depression, substance use, STI infections, poverty, decreased health care access and early sexual debut [14]. For adolescent girls and young women (AGYW), many of the same drivers of increased risk for young MSM are also relevant, including poverty, lack of access to school and health care, depression, and gender power imbalances and sexual violence.…”

Age-Associated Trends in Diagnosis and Prevalence of Infection with HIV Among Men Who Have Sex with Men — United States, 2008–2016

“…In 2016, two thirds of diagnosed human immunodeficiency virus (HIV) infections in the United States were attributed to male-to-male sexual contact ( 1 ). The risk for sexual acquisition and transmission of HIV changes through the lifespan ( 2 ); to better guide prevention efforts for gay, bisexual, and other men who have sex with men (MSM * ), CDC analyzed National HIV Surveillance System † (NHSS) data for MSM aged ≥13 years by age group (13–29, 30–49, and ≥50 years) in 50 states and the District of Columbia (DC). During 2008–2016, the annual number of diagnoses of HIV infection increased 3% per year among MSM aged 13–29 years, decreased 4% per year among those aged 30–49 years and was stable for MSM aged ≥50 years.…”