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      Increases in HIV Testing among Men Who Have Sex with Men — National HIV Behavioral Surveillance System, 20 U.S. Metropolitan Statistical Areas, 2008 and 2011

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      * , , , , , , for the NHBS Study Group
      PLoS ONE
      Public Library of Science

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          Abstract

          In 2011, 62% of estimated new HIV diagnoses in the United States were attributed to male-to-male sexual contact (men who have sex with men, MSM); 39% of these MSM were black or African American. HIV testing, recommended at least annually by CDC for sexually active MSM, is an essential first step in HIV care and treatment for HIV-positive individuals. A variety of HIV testing initiatives, designed to reach populations disproportionately affected by HIV, have been developed at both national and local levels. We assessed changes in HIV testing behavior among MSM participating in the National HIV Behavioral Surveillance System in 2008 and 2011. We compared the percentages tested in the previous 12 months in 2008 and 2011, overall and by race/ethnicity and age group. In unadjusted analyses, recent HIV testing increased from 63% in 2008 to 67% in 2011 overall ( P<0.001), from 63% to 71% among black MSM ( P<0.001), and from 63% to 75% among MSM of other/multiple races ( P<0.001); testing did not increase significantly for white or Hispanic/Latino MSM. Multivariable model results indicated an overall increase in recent HIV testing (adjusted prevalence ratio [aPR] = 1.07, P<0.001). Increases were largest for black MSM (aPR = 1.12, P<0.001) and MSM of other/multiple races (aPR = 1.20, P<0.001). Among MSM aged 18–19 years, recent HIV testing was shown to increase significantly among black MSM (aPR = 1.20, P = 0.007), but not among MSM of other racial/ethnic groups. Increases in recent HIV testing among populations most affected by HIV are encouraging, but despite these increases, improved testing coverage is needed to meet CDC recommendations.

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          Most cited references10

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          Sexually transmitted diseases treatment guidelines, 2010.

          These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 18-30, 2009. The information in this report updates the 2006 Guidelines for Treatment of Sexually Transmitted Diseases (MMWR 2006;55[No. RR-11]). Included in these updated guidelines is new information regarding 1) the expanded diagnostic evaluation for cervicitis and trichomoniasis; 2) new treatment recommendations for bacterial vaginosis and genital warts; 3) the clinical efficacy of azithromycin for chlamydial infections in pregnancy; 4) the role of Mycoplasma genitalium and trichomoniasis in urethritis/cervicitis and treatment-related implications; 5) lymphogranuloma venereum proctocolitis among men who have sex with men; 6) the criteria for spinal fluid examination to evaluate for neurosyphilis; 7) the emergence of azithromycin-resistant Treponema pallidum; 8) the increasing prevalence of antimicrobial-resistant Neisseria gonorrhoeae; 9) the sexual transmission of hepatitis C; 10) diagnostic evaluation after sexual assault; and 11) STD prevention approaches.
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            Estimating the Population Size of Men Who Have Sex with Men in the United States to Obtain HIV and Syphilis Rates§

            Background: CDC has not previously calculated disease rates for men who have sex with men (MSM) because there is no single comprehensive source of data on population size. To inform prevention planning, CDC developed a national population size estimate for MSM to calculate disease metrics for HIV and syphilis. Methods: We conducted a systematic literature search and identified seven surveys that provided data on same-sex behavior in nationally representative samples. Data were pooled by three recall periods and combined using meta-analytic procedures. We applied the proportion of men reporting same-sex behavior in the past 5 years to U.S. census data to produce a population size estimate. We then calculated three disease metrics using CDC HIV and STD surveillance data and rate ratios comparing MSM to other men and to women. Results: Estimates of the proportion of men who engaged in same-sex behavior differed by recall period: past year = 2.9% (95%CI, 2.6–3.2); past five years = 3.9% (3.5–4.4); ever = 6.9% (5.1–8.6). Rates on all 3 disease metrics were much higher among MSM than among either other men or women (38 to 109 times as high). Conclusions: Estimating the population size for MSM allowed us to calculate rates for disease metrics and to develop rate ratios showing dramatically higher rates among MSM than among other men or women. These data greatly improve our understanding of the disproportionate impact of these diseases among MSM in the U.S. and help with prevention planning.
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              Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985-1997.

              This study examined whether HIV counseling and testing leads to reductions in sexual risk behavior. The meta-analysis included 27 published studies that provided sexual behavior outcome data, assessed behavior before and after counseling and testing, and provided details sufficient for the calculation of effect sizes. The studies involved 19,597 participants. After counseling and testing, HIV-positive participants and HIV-serodiscordant couples reduced unprotected intercourse and increased condom use more than HIV-negative and untested participants. HIV-negative participants did not modify their behavior more than untested participants. Participants' age, volition for testing, and injection drug use treatment status, as well as the sample seroprevalence and length of the follow-up, explained the variance in results. HIV counseling and testing appears to provide an effective means of secondary prevention for HIV-positive individuals but, as conducted in the reviewed studies, is not an effective primary prevention strategy for uninfected participants. Theory-driven research with attention given to the context of testing is needed to further explicate the determinants of behavior change resulting from HIV counseling and testing, and the effectiveness of specific counseling approaches.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                2 September 2014
                : 9
                : 9
                : e104162
                Affiliations
                [1]Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
                Public Health Agency of Barcelona, Spain
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: LAC AMO CW GPB. Analyzed the data: LAC AMO CER CW BCL GPB. Contributed to the writing of the manuscript: LAC AMO CW GPB.

                ¶ Membership of the NHBS Study Group is provided in the Acknowledgments.

                Article
                PONE-D-14-13667
                10.1371/journal.pone.0104162
                4151966
                25180514
                d51797b2-f574-4976-8ba3-1449dd1692f6
                Copyright @ 2014

                This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                History
                : 27 March 2014
                : 28 June 2014
                Page count
                Pages: 9
                Funding
                These authors have no support or funding to report. The National HIV Behavioral Surveillance System is funded by the Centers for Disease Control and Prevention (CDC). Study design and data collection are conducted by funded sites in accordance with a standardized protocol developed by CDC. Data analysis and preparation of the manuscript were conducted by CDC staff.
                Categories
                Research Article
                Biology and Life Sciences
                Psychology
                Sexual Identity
                Homosexuality
                Medicine and health sciences
                Epidemiology
                HIV epidemiology
                Health Care
                Health Care Policy
                Screening Guidelines
                People and places
                Population groupings
                Ethnicities
                African Americans
                Custom metadata
                The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. To access NHBS data, non-CDC investigators should submit a concept proposal to Gabriela Paz-Bailey, MD, PhD, MSc (Team Lead for the Behavioral Surveillance Team, BCSB/DHAP/NCHHSTP/CDC. Non-CDC investigators with approved concept proposals must apply for guest researcher status in order to obtain access to a CDC workstation and secure data server, to complete data security and confidentiality training, and to sign data use and nondisclosure agreements.

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