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Emerging Regional and Racial Disparities in the Lifetime Risk of Human Immunodeficiency Virus Infection Among Men who Have Sex With Men: A Comparative Life Table Analysis in King County, WA and Mississippi

Chan, Galant A. MD, MPH; Johnson, Kendra L. MPH; Mosca, Nicholas G. DDS; Dobbs, Thomas E. MD; Dombrowski, Julia C. MD, MPH; Bennett, Amy B. MPH; Buskin, Susan E. MPH, MPH, PhD; Golden, Matthew R. MD, MPH

Sexually Transmitted Diseases: April 2017 - Volume 44 - Issue 4 - p 227–232
doi: 10.1097/OLQ.0000000000000589
Original Studies

Background: Little is known about the lifetime risk of human immunodeficiency virus (HIV) diagnosis among US men who have sex with men (MSM), trends in risk and how risk varies between populations.

Methods: We used census and HIV surveillance data to construct life tables to estimate the cumulative risk of HIV diagnosis among cohorts of MSM born 1940 to 1994 in King County, Washington (KC) and Mississippi (MS).

Results: The cumulative risk of HIV diagnosis progressed in 3 phases. In phase 1, risk increased among MSM in successive cohorts born 1940 to 1964. Among men born 1955 to 1965 (the peak risk cohort), by age 55 years, 45% of white KC MSM, 65% of black KC MSM, 22% of white MS MSM, and 51% of black MS MSM had been diagnosed with HIV. In phase 2, men born 1965 to 1984, risk of diagnosis among KC MSM declined almost 60% relative to the peak risk cohort. A similar pattern of decline occurred in white MS MSM, with a somewhat smaller decline observed in black MS MSM. In phase 3, men born 1985 to 1994, the pattern of risk diverged. Among white KC MSM, black KC MSM, and white MS MSM, HIV risk increased slightly compared with men born 1975 to 1984, with 6%, 14%, and 2% diagnosed by age 27 years, respectively. Among black MS MSM born 1985 to 1994, HIV risk rose dramatically, with 35% HIV diagnosed by age 27 years.

Conclusions: The lifetime risk of HIV diagnosis has substantially declined among MSM in KC and among white MSM in MS, but is rising dramatically among black MSM in MS.

The estimated lifetime risk of human immunodeficiency virus (HIV) infection among men who have sex with men in King County, WA, peaked among men born in the early 1960s and has since declined, whereas the risk among men who have sex with men in Mississippi initially declined, but has recently skyrocketed among young black men who have sex with men.

From the *Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA; †Mississippi State Department of Health, Jackson, MS; ‡Public Health-Seattle & King County, Seattle, WA; §Center for AIDS and STD, University of Washington, Seattle, WA; and ¶Department of Epidemiology, University of Washington, Seattle, WA

Funding: Research reported in this publication was supported in part by NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS, NIDDK of the National Institutes of Health under award number AI027757. Dr. Chan was supported by NIH grant T32 AI07140.

Conflict of interest: None declared.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (http://www.stdjournal.com).

Correspondence: Matthew R. Golden, MD, MPH, Harborview Medical Center Box 359777, 325 9th Ave, Seattle, WA, 98105. E-mail: golden@uw.edu.

Received for publication June 30, 2016, and accepted December 9, 2016.

© Copyright 2017 American Sexually Transmitted Diseases Association