Synopsis for June 24, 2005

The MMWR is embargoed until Thursday, 12 PM EDT.

1. HIV Prevalence, Unrecognized Infection, and HIV Testing Among Men Who Have Sex with Men ― Five U.S. Cities, June 2004-April 2005
2. Use of Social Networks to Identify Persons with Undiagnosed HIV Infection ― Seven U.S. Cities, October 2003-September 2004
3. Human Tuberculosis Caused by Mycobacterium bovis ― New York City, 2001-2004

HIV Prevalence, Unrecognized Infection, and HIV Testing Among Men Who Have Sex with Men ― Five U.S. Cities, June 2004-April 2005

The level of undiagnosed HIV infection is extremely high among black men who have sex with men (MSM) in five U.S. cities.

A more detailed CDC analysis of data released at last week’s 2005 National HIV Prevention Conference suggests that undiagnosed HIV infection continues to play a significant role in high levels of HIV among African-American MSM. The study, which surveyed MSM in five cities from June 2004 through April 2005, found that while prevalence varied by city, black MSM overall were more than twice as likely to be infected with HIV than MSM of other races. Forty-six percent of black MSM in the study were HIV-positive, compared to 21 percent of white MSM and 17 percent of Hispanic MSM. Among HIV-infected MSM, roughly half overall --and more than two thirds of black men -- were unaware of their infection. Although 84 percent of all MSM who were unaware of their infection had previously been tested for HIV, 58 percent had not been tested in the past year, highlighting the importance of testing on at least an annual basis for this population. Many of these men reported fear of learning test results, and authors note that prevention efforts must address this and other barriers to testing.

Use of Social Networks to Identify Persons with Undiagnosed HIV Infection ― Seven U.S. Cities, October 2003-September 2004

Outreach through social networks effective in reaching high risk populations with HIV counseling and testing.

Approximately one fourth of the estimated one million Americans living with HIV are not aware of their infection. To help increase knowledge of HIV status, CDC recently funded nine community-based organizations to implement a social network approach to reach high-risk individuals with HIV counseling, testing, and referral services. The program trains HIV-positive and high-risk individuals in communities of color to reach out through their social, sexual, and drug-using networks and encourage their peers who may be at risk to be tested. In the first 12 months of the program, which began in September 2003, 133 recruiters in seven U.S. cities referred 814 high-risk individuals for counseling and testing. Of those, 46 were newly diagnosed as HIV positive, representing a prevalence of 5.7 percent—almost six times that typically seen in publicly funded HIV counseling and testing sites. Researchers believe these findings demonstrate the value of a targeted approach, particularly to peer networks of men who have sex with men and transgender individuals, since the highest rates of undiagnosed infection were found in these populations.

Human Tuberculosis Caused by Mycobacterium bovis ― New York City, 2001-2004

Unusual tuberculosis cases in New York City residents linked to unpasteurized fresh cheeses from Mexico.

In 2001 through 2004, New York City health officials identified 35 cases of tuberculosis (TB) caused by Mycobacterium bovis, the form of the TB bacterium usually found in cattle. A 15-month old child died from the disease, but the other patients recovered after treatment. The ongoing investigation by the New York City Department of Health and Mental Hygiene, CDC and other agencies has linked these cases to fresh cheese made from unpasteurized milk and privately brought to the United States from Mexico. Of 23 patients interviewed about recent possible exposures to M. bovis, 19 reported eating cheeses made in Mexico, and 18 were unable to say whether the cheeses had been made from unpasteurized milk. No evidence of human-to-human transmission was found, and the investigators suspect that cheeses were the probable source of infection for the 35 cases. Although M. bovis was once common in the U.S., control of the disease in cattle and pasteurization of milk have virtually eliminated transmission to humans. However, investigators note that privately imported products made from unpasteurized milk may still be a risk factor for this form of TB in New York City’s growing Mexican community, and they recommend against eating products made from unpasteurized cow's milk.

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