title: Sustained Reduction in HIV Diagnoses in Massachusetts, 2000-2014.
abstract: To describe secular trends in reported HIV diagnoses in Massachusetts concurrent with treatment access expansion.
  
  
  
  We characterized cases of HIV infection reported to the Massachusetts HIV/AIDS Surveillance Program between 2000 and 2014 by sex, age, race/ethnicity, and exposure mode. We used Poisson regression to test the statistical significance of trends in diagnoses.
  
  
  
  Between 2000 and 2014, annual new HIV infections diagnosed in Massachusetts decreased by 47% (P < .001 for trend). We observed significant reductions in diagnoses among women (58% when comparing 2000 with 2014), men (42%), Whites (54%), Blacks (51%), and Hispanics (35%; P < .001 for trend). New diagnoses decreased significantly among men who have sex with men (19%), persons who inject drugs (91%), and heterosexuals (86%; P < .001 for trend). We saw statistically significant downward trends among all men by race/ethnicity, but the trend among Black men who have sex with men was nonsignificant.
  
  
  
  Sustained reduction in new HIV diagnoses was concurrent with Massachusetts's Medicaid expansion, state health care reform, and public health strategies to improve care access. A contributory effect of expanded HIV treatment and population-level viral suppression is hypothesized for future research.
authors.affiliation: Kevin Cranston, Betsey John, H. Dawn Fukuda, Liisa M. Randall, and Alfred DeMaria Jr are with Massachusetts Department of Public Health, Boston. Jonathan Mermin is with Centers for Disease Control and Prevention, Atlanta, GA. Kenneth H. Mayer is with The Fenway Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston.
authors.forename: Kevin
authors.initials: K
authors.lastname: Cranston
authors.affiliation: Kevin Cranston, Betsey John, H. Dawn Fukuda, Liisa M. Randall, and Alfred DeMaria Jr are with Massachusetts Department of Public Health, Boston. Jonathan Mermin is with Centers for Disease Control and Prevention, Atlanta, GA. Kenneth H. Mayer is with The Fenway Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston.
authors.forename: Betsey
authors.initials: B
authors.lastname: John
authors.affiliation: Kevin Cranston, Betsey John, H. Dawn Fukuda, Liisa M. Randall, and Alfred DeMaria Jr are with Massachusetts Department of Public Health, Boston. Jonathan Mermin is with Centers for Disease Control and Prevention, Atlanta, GA. Kenneth H. Mayer is with The Fenway Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston.
authors.forename: H Dawn
authors.initials: HD
authors.lastname: Fukuda
authors.affiliation: Kevin Cranston, Betsey John, H. Dawn Fukuda, Liisa M. Randall, and Alfred DeMaria Jr are with Massachusetts Department of Public Health, Boston. Jonathan Mermin is with Centers for Disease Control and Prevention, Atlanta, GA. Kenneth H. Mayer is with The Fenway Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston.
authors.forename: Liisa M
authors.initials: LM
authors.lastname: Randall
authors.affiliation: Kevin Cranston, Betsey John, H. Dawn Fukuda, Liisa M. Randall, and Alfred DeMaria Jr are with Massachusetts Department of Public Health, Boston. Jonathan Mermin is with Centers for Disease Control and Prevention, Atlanta, GA. Kenneth H. Mayer is with The Fenway Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mermin
authors.affiliation: Kevin Cranston, Betsey John, H. Dawn Fukuda, Liisa M. Randall, and Alfred DeMaria Jr are with Massachusetts Department of Public Health, Boston. Jonathan Mermin is with Centers for Disease Control and Prevention, Atlanta, GA. Kenneth H. Mayer is with The Fenway Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: Kevin Cranston, Betsey John, H. Dawn Fukuda, Liisa M. Randall, and Alfred DeMaria Jr are with Massachusetts Department of Public Health, Boston. Jonathan Mermin is with Centers for Disease Control and Prevention, Atlanta, GA. Kenneth H. Mayer is with The Fenway Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston.
authors.forename: Alfred
authors.initials: A
authors.lastname: DeMaria
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000208:ethnology; D018166:Health Care Reform; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008484:Medicaid; D008875:Middle Aged; D011159:Population Surveillance; D014481:United States