title: The continuing HIV epidemic among men who have sex with men.
abstract: OBJECTIVE
  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 years and older) from New York, Los Angeles, Chicago, and San Francisco, and HIV status was determined through self-report and biological measures.
  
  
  RESULTS
  HIV prevalence was 17% (95% confidence interval = 15%, 19%) overall, with extremely high levels in African Americans (29%), MSM who used injection drugs (40%), "ultraheavy" noninjection drug users (32%), and less educated men (< high school, 37%). City-level HIV differences were non-significant once these other factors were controlled for. In comparing the present findings with historical data based on public records and modeling, HIV prevalence appears to have declined as a result of high mortality (69%) and stable, 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 United States approximate those of sub-Saharan countries (e.g., 14%-25%) and are extremely high in many population subsegments. Despite years of progress, the AIDS epidemic continues unabated among subsegments of the MSM community.
authors.affiliation: Center for AIDS Prevention Studies, University of California, San Francisco, 74 New Montgomery, Suite 600, San Francisco, CA 94105, USA. jcatania@psg.ucsf.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Catania
authors.forename: D
authors.initials: D
authors.lastname: Osmond
authors.forename: R D
authors.initials: RD
authors.lastname: Stall
authors.forename: L
authors.initials: L
authors.lastname: Pollack
authors.forename: J P
authors.initials: JP
authors.lastname: Paul
authors.forename: S
authors.initials: S
authors.lastname: Blower
authors.forename: D
authors.initials: D
authors.lastname: Binson
authors.forename: J A
authors.initials: JA
authors.lastname: Canchola
authors.forename: T C
authors.initials: TC
authors.lastname: Mills
authors.forename: L
authors.initials: L
authors.lastname: Fisher
authors.forename: K H
authors.initials: KH
authors.lastname: Choi
authors.forename: T
authors.initials: T
authors.lastname: Porco
authors.forename: C
authors.initials: C
authors.lastname: Turner
authors.forename: J
authors.initials: J
authors.lastname: Blair
authors.forename: J
authors.initials: J
authors.lastname: Henne
authors.forename: L L
authors.initials: LL
authors.lastname: Bye
authors.forename: T J
authors.initials: TJ
authors.lastname: Coates
mesh_terms: D000293:Adolescent; D000328:Adult; D004196:Disease Outbreaks; D005006:Ethnicity / Q000706:statistics & numerical data; D015658:HIV Infections / Q000453:epidemiology*; D006306:Health Surveys; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data