The continuing HIV epidemic among men who have sex with men

Objectives. This study characterized the AIDS epidemic among urban men who have sex with men (MSM). Methods. A probability sample of MSM was obtained in 1997 (n = 2881; 18 yea rs and older) from New York, Los Angeles, Chicago, and San Francisco, and H IV status was determined through self-report and biological measures. Results. HIV prevalence was 17% (95% confidence interval = 15%, 19%) overal l, with-extremely high levels in African Americans (29%), MSM who used inje ction drugs (40%), "ultraheavy" noninjection drug users (32%), and less edu cated men (< high school, 37%). City-level HIV differences were nonsignific ant once these other factors were controlled for. In comparing the present findings with historical data based on public records and modeling, HIV pre valence appears to have declined as a result of high mortality (69%) and st able, but high, incidence rates (1% 2%). Conclusions. Although the findings suggest that HIV prevalence has declined significantly from the mid-1980s, current levels among urban MSM in the Un ited States approximate those of sub-Saharan countries (e.g., 14%-25%) and are extremely high in many population subsegments. Despite years of progres s, the AIDS epidemic continues unabated among subsegments of the MSM commun ity.