HIV Infection in Men Who Have Sex with Men, New York City Department of Health Sexually Transmitted Disease Clinics, 1990-1999: A Decade of Serosurveillance Finds that Racial Disparities and Associations Between HIV and Gonorrhea Persist

Background: Previous data indicating wide racial disparities in HIV seroprevalence, associations between sentinel sexually transmitted diseases (STDs) and HIV infection, and recent reports of STD outbreaks among men who have sex with men (MSM) have raised concerns that HTV may be resurgent among MSM. Goal: To measure trends in HIV seroprevalence and describe racial disparities among MSM presenting to New York City Department of Health STD clinics, 1990-1999 (n = 4076). Study Design: This blinded HIV-1 serosurvey used remnant serum originally drawn for routine serologic tests for syphilis. Demographic, risk factor, clinical and laboratory data were abstracted from clinic charts of patients whose medical records documented sexual contact with men or with both men and women ("bisexual" men). Data were matched to the specimens, and all personal identifiers were removed before testing. Patients were not interviewed. Results: The sample was 41% black, 20% Hispanic, 31% white, and 9% of other or mixed race/ethnicity. Sixty-one percent of the patients were >30 years of age; 21% were ≥40 years of age. One-third had sex with women as well as men. For 60%, laboratory-confirmed STD diagnosis was made on the serosurvey visit. Overall, HTV seroprevalence declined from 47% in 1990 to 18% in 1999 (P < 0.01). Seroprevalence declined from 34% to 11% among white men (n = 1250), from 47% to 19% among Hispanic men (n = 795), from 56% to 28% among black men (n = 1656), and from 43% to 14% among men who had sex with both men and women (n = 1447). Seroprevalence among MSM with gonorrhea (n = 507) declined but remained high (57-34%; P < 0.05). In contrast, seroprevalence among MSM with nongonococcal urethritis (n = 953) declined from 36% to 16% (P < 0.01), and seroprevalence among MSM who had no STD (n = 1650) dropped from 48% to 12% (P < 0.01). Gonorrhea was diagnosed almost twice as frequently among seropositive versus seronegative MSM (19% versus 10%; P < 0.05). Black MSM were not more or less likely to have been tested for HIV or to be diagnosed with acute STD than were MSM in the other-race/ethnicity group. Positive serostatus was associated with black race/ethnicity (odds ratio [OR], 2.5; 95% CI, 2.1-2.9), age >25 years (OR, 2.5; 95% CI, 1.9-3.1), and a diagnosis of gonorrhea (OR, 2.4; 95% CI, 2.0-2.8). Sixty percent of seropositive MSM knew their serostatus from confidential or anonymous HIV testing at this or a previous visit. Two thirds of the known seropositive men had a