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Interim Guidance for Clinicians Considering the Use of Preexposure Prophylaxis for the Prevention of HIV Infection in Heterosexually Active Adults
Interim Guidance for Clinicians Considering the Use of Preexposure Prophylaxis for the Prevention of HIV Infection in Heterosexually Active Adults
Source: Morbidity and Mortality Weekly Report (CDC)
In the United States, an estimated 48,100 new human immunodeficiency virus (HIV) infections occurred in 2009 (1). Of these, 27% were in heterosexual men and women who did not inject drugs, and 64% were in men who have sex with men (MSM), including 3% in MSM who inject drugs. In January 2011, following publication of evidence of safety and efficacy of daily oral tenofovir disoproxil fumarate 300 mg (TDF)/emtricitabine 200 mg (FTC) (Truvada, Gilead Sciences) as antiretroviral preexposure prophylaxis (PrEP) to reduce the risk for HIV acquisition among MSM in the iPrEx trial, CDC issued interim guidance to make available information and important initial cautions on the use of PrEP in this population. Those recommendations remain valid for MSM, including MSM who also have sex with women (2). Since January 2011, data from studies of PrEP among heterosexual men and women have become available, and on July 16, 2012, the Food and Drug Administration (FDA) approved a label indication for reduction of risk for sexual acquisition of HIV infection among adults, including both heterosexuals and MSM.* This interim guidance includes consideration of the new information and addresses pregnancy and safety issues for heterosexually active adults at very high risk for sexual HIV acquisition that were not discussed in the previous interim guidance for the use of PrEP in MSM.
Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis
Source: The Lancet
Background
We did a meta-analysis to assess factors associated with disparities in HIV infection in black men who have sex with men (MSM) in Canada, the UK, and the USA.
Methods
We searched Embase, Medline, Google Scholar, and online conference proceedings from Jan 1, 1981, to Dec 31, 2011, for racial comparative studies with quantitative outcomes associated with HIV risk or HIV infection. Key words and Medical Subject Headings (US National Library of Medicine) relevant to race were cross-referenced with citations pertinent to homosexuality in Canada, the UK, and the USA. Data were aggregated across studies for every outcome of interest to estimate overall effect sizes, which were converted into summary ORs for 106 148 black MSM relative to 581 577 other MSM.
Finding
We analysed seven studies from Canada, 13 from the UK, and 174 from the USA. In every country, black MSM were as likely to engage similarly in serodiscordant unprotected sex as other MSM. Black MSM in Canada and the USA were less likely than other MSM to have a history of substance use (odds ratio, OR, 0·53, 95% CI 0·38–0·75, for Canada and 0·67, 0·50–0·92, for the USA). Black MSM in the UK (1·86, 1·58–2·18) and the USA (3·00, 2·06–4·40) were more likely to be HIV positive than were other MSM, but HIV-positive black MSM in each country were less likely (22% in the UK and 60% in the USA) to initiate combination antiretroviral therapy (cART) than other HIV-positive MSM. US HIV-positive black MSM were also less likely to have health insurance, have a high CD4 count, adhere to cART, or be virally suppressed than were other US HIV-positive MSM. Notably, despite a two-fold greater odds of having any structural barrier that increases HIV risk (eg, unemployment, low income, previous incarceration, or less education) compared with other US MSM, US black MSM were more likely to report any preventive behaviour against HIV infection (1·39, 1·23–1·57). For outcomes associated with HIV infection, disparities were greatest for US black MSM versus other MSM for structural barriers, sex partner demographics (eg, age, race), and HIV care outcomes, whereas disparities were least for sexual risk outcomes.
Interpretation
Similar racial disparities in HIV and sexually transmitted infections and cART initiation are seen in MSM in the UK and the USA. Elimination of disparities in HIV infection in black MSM cannot be accomplished without addressing structural barriers or differences in HIV clinical care access and outcomes.
Global Commission on HIV and the Law: HIV and the Law: Risks, Rights and Health
Global Commission on HIV and the Law: HIV and the Law: Risks, Rights and Health (PDF)
Source: United Nations Programme on HIV/AIDS
From press release (PDF):
Punitive laws and human rights abuses are costing lives, wasting money and stifling the global AIDS response, according to a report by the Global Commission on HIV and the Law, an independent body of global leaders and experts. The Commission report, “HIV and the Law: Risks, Rights and Health,” finds evidence that governments in every region of the world have wasted the potential of legal systems in the fight against HIV. The report also concludes that laws based on evidence and human rights strengthen the global AIDS response – these laws exist and must be brought to scale urgently.
Bad laws should not be allowed to stand in the way of effective HIV responses,” said Helen Clark, United Nations Development Programme Administrator. “In the 2011 Political Declaration on HIV and AIDS, Member States committed to reviewing laws and policies which impede effective HIV responses. One of the key contributions of the Commission’s work has been to stimulate review processes and change in a number of countries.”
The Global Commission on HIV and the Law—comprising former heads of state and leading legal, human rights and HIV experts—based its report on extensive research and first-hand accounts from more than 1,000 people in 140 countries. The Commission, supported by the United Nations Development Programme on behalf of the Joint United Nations Programme on HIV/AIDS, found that punitive laws and discriminatory practices in many countries undermine progress against HIV.
For example, laws and legally condoned customs that fail to protect women and girls from violence deepen gender inequalities and increase their vulnerability to HIV. Some intellectual property laws and policies are not consistent with international human rights law and impede access to lifesaving treatment and prevention. Laws that criminalise and dehumanise populations at highest risk of HIV— including men who have sex with men, sex workers, transgender people and injecting drug users—drive people underground, away from essential health services and heighten their risk of HIV. Laws that criminalise HIV transmission, exposure or non-disclosure of HIV status discourage people from getting tested and treated.
Independent high-level commission finds that an epidemic of bad laws and human rights abuses is stifling the global AIDS response
Punitive laws and human rights abuses are costing lives, wasting money and stifling the global AIDS response, according to a report by the Global Commission on HIV and the Law, an independent body of global leaders and experts. The Commission report, “HIV and the Law: Risks, Rights and Health,” finds evidence that governments in every region of the world have wasted the potential of legal systems in the fight against HIV. The report also concludes that laws based on evidence and human rights strengthen the global AIDS response – these laws exist and must be brought to scale urgently.…The Global Commission on HIV and the Law—comprising former heads of state and leading legal, human rights and HIV experts—based its report on extensive research and first-hand accounts from more than 1,000 people in 140 countries. The Commission, supported by the United Nations Development Programme on behalf of the Joint United Nations Programme on HIV/AIDS, found that punitive laws and discriminatory practices in many countries undermine progress against HIV.For example, laws and legally condoned customs that fail to protect women and girls from violence deepen gender inequalities and increase their vulnerability to HIV. Some intellectual property laws and policies are not consistent with international human rights law and impede access to lifesaving treatment and prevention. Laws that criminalise and dehumanise populations at highest risk of HIV—including men who have sex with men, sex workers, transgender people and injecting drug users—drive people underground, away from essential health services and heighten their risk of HIV. Laws that criminalise HIV transmission, exposure or non-disclosure of HIV status discourage people from getting tested and treated.
Trends in HIV-Related Risk Behaviors Among High School Students — United States, 1991–2011
Trends in HIV-Related Risk Behaviors Among High School Students — United States, 1991–2011
Source: Morbidity and Mortality Weekly Report (CDC)
One of the three primary goals of the National HIV/AIDS Strategy for the United States is to reduce the number of persons who become infected with human immunodeficiency virus (HIV) (1). In 2009, persons aged 15–29 years comprised 21% of the U.S. population but accounted for 39% of all new HIV infections (2). Sexual intercourse, sexual intercourse with multiple partners, sexual intercourse without using a condom, and injection drug use are behaviors that increase risk for HIV infection. To describe trends in the prevalence of HIV-related risk behaviors among high school students, CDC analyzed data from the biennial national Youth Risk Behavior Survey (YRBS) for the period 1991–2011. The results of that analysis indicated that, although the percentage of students overall who had ever had sexual intercourse decreased significantly from 54.1% in 1991 to 47.4% in 2011, the prevalence of ever having had sexual intercourse did not change significantly after reaching 45.6% in 2001. Similarly, although the percentage of students who had four or more sex partners decreased significantly from 18.7% in 1991 to 15.3% in 2011, the prevalence of having four or more sex partners did not change significantly after reaching 14.2% in 2001. Condom use at most recent sexual intercourse among students currently having sexual intercourse increased from 46.2% in 1991 to 60.2% in 2011. However, the prevalence of condom use did not change significantly beginning in 2003 (63.0%). The prevalence of injection drug use among students overall did not change significantly from 1995 (2.1%) to 2011 (2.3%). The results suggest that progress in reducing some HIV-related risk behaviors among high school students overall and in certain populations stalled in the past decade. To reduce the number of young persons who become infected with HIV, renewed educational efforts and other risk reduction interventions are warranted.
Youth Risk Behavior Surveillance — United States, 2011
Youth Risk Behavior Surveillance — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)
Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable.
Reporting Period Covered: September 2010–December 2011.
Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2011 national survey, 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9–12.
Results: Results from the 2011 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. During the 30 days before the survey, 32.8% of high school students nationwide had texted or e-mailed while driving, 38.7% had drunk alcohol, and 23.1% had used marijuana. During the 12 months before the survey, 32.8% of students had been in a physical fight, 20.1% had ever been bullied on school property, and 7.8% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors associated with unintended pregnancies and STDs, including HIV infection. Nearly half (47.4%) of students had ever had sexual intercourse, 33.7% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.3% had had sexual intercourse with four or more people during their life. Among currently sexually active students, 60.2% had used a condom during their last sexual intercourse. Results from the 2011 national YRBS also indicate many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥25 years in the United States. During the 30 days before the survey, 18.1% of high school students had smoked cigarettes and 7.7% had used smokeless tobacco. During the 7 days before the survey, 4.8% of high school students had not eaten fruit or drunk 100% fruit juices and 5.7% had not eaten vegetables. Nearly one-third (31.1%) had played video or computer games for 3 or more hours on an average school day.
Interpretation: Since 1991, the prevalence of many priority health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Variations were observed in many health-risk behaviors by sex, race/ethnicity, and grade. The prevalence of some health-risk behaviors varied substantially among states and large urban school districts.
Public Health Action: YRBS data are used to measure progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; to assess trends in priority health-risk behaviors among high school students; and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.
CRS — U.S. Response to the Global Threat of Malaria: Basic Facts
U.S. Response to the Global Threat of Malaria: Basic Facts (PDF)
Source: Congressional Research Service (via Federation of American Scientists)
In 2010, malaria infected an estimated 216 million people and killed 655,000 people, most of whom were children under the age of five in sub-Saharan Africa. Despite the current burden of disease, malaria is preventable and treatable. Congress has increasingly recognized malaria as an important foreign policy issue, and the United States has become a major player in the global response to the disease. In its second session, the 112 th Congress will likely debate the appropriate funding levels and optimum strategy for addressing the continued challenge of global malaria.
Congress has enacted several key pieces of legislation related to global malaria control. These include the Assistance for International Malaria Control Act of 2000 (P.L. 106-570); the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25); and the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (P.L. 110-293). These acts have authorized funds to be used in the fight against malaria and have shaped the ways in which U.S. malaria programs are coordinated and managed, including through the creation of the U.S. Global Malaria Coordinator at the United States Agency for International Development (USAID).
In 2005, in response to growing international calls for global malaria control and to the success of the President’s Emergency Plan for AIDS Relief (PEPFAR), President George W. Bush launched the President’s Malaria Initiative (PMI), which aims to halve the burden of malaria morbidity and mortality in 70% of at-risk populations in sub-Saharan Africa by 2014. PMI brought significant new attention and funding to U.S. malaria programs and made the United States one of the largest donors for malaria efforts. While U.S. funding for global malaria programs has increased each fiscal year since FY2004, support for malaria interventions increased most precipitously beginning in FY2007 as PMI has expanded into new countries. President Obama has continued to support PMI through the Global Health Initiative (GHI).
There is evidence that the growing international response to malaria has had some success in controlling the epidemic. Since 2000, global malaria incidence has decreased by 17% and malaria mortality by 26%. Since 2000, 43 countries have reported a reduction in reported malaria cases of more than 50%, including eight African countries that have experienced 50% reduction in either confirmed malaria cases or malaria admissions and deaths. The decreases in each of these African countries are associated with intense malaria control activities. Despite these successes, several key issues pose challenges to an effective scale-up of the response to malaria.
First, increasing reports of drug-resistant malaria in Southeast Asia and insecticide-resistant mosquitoes, largely in Africa, threaten the success of malaria control programs. Second, weak health systems, including shortages in health care personnel and inadequate supply chain networks, have limited the delivery of essential commodities for malaria control. There is also debate within the global health community over whether malaria efforts should increasingly target areas where malaria elimination is possible or whether efforts should remain concentrated on malaria control. This report outlines basic facts related to global malaria, including characteristics of the epidemic and U.S. legislation, programs, funding, and partnerships related to the global response to malaria. The report will be updated as events warrant.
See also: U.S. Response to the Global Threat of Tuberculosis: Basic Facts (PDF)
See also: U.S. Response to the Global Threat of HIV/AIDS: Basic Facts (PDF)
New From the GAO
New GAO ReportsSource: Government Accountability Office
1. DOD Strategic Communication: Integrating Foreign Audience Perceptions into Policy Making, Plans, and Operations. GAO-12-612R, May 24.
http://www.gao.gov/products/GAO-12-612R
2. Inspectors General: HUD Office of Inspector General Resources and Results. GAO-12-618, May 31.
http://www.gao.gov/products/GAO-12-618
Highlights – http://www.gao.gov/assets/600/591273.pdf
3. Managing for Results: GAO’s Work Related to the Interim Crosscutting Priority Goals under the GPRA Modernization Act. GAO-12-620R, May 31.
http://www.gao.gov/products/GAO-12-620R
4. Mental Health and Substance Use: Treatment Exclusions in Employers’ Health Insurance Coverage. GAO-12-761R, May 31.
http://www.gao.gov/products/GAO-12-761R
5. Human Rights: State Department Followed an Extensive Process to Prepare Annual Country Reports. GAO-12-561R, May 31.
http://www.gao.gov/products/GAO-12-561R
6. Force Structure: Army and Marine Corps Efforts to Review Nonstandard Equipment for Future Usefulness. GAO-12-532R, May 31.
http://www.gao.gov/products/GAO-12-532R
7. Observations on the Coast Guard’s and the Department of Homeland Security’s Fleet Studies. GAO-12-751R, May 31.
http://www.gao.gov/products/GAO-12-751R
8. President’s Emergency Plan for AIDS Relief: Agencies Can Enhance Evaluation Quality, Planning, and Dissemination. GAO-12-673, May 31.
http://www-dev.gao.gov/products/GAO-12-673
Highlights – http://www.gao.gov/assets/600/591285.pdf
Keeping the Faith: African American Faith Leaders’ Perspectives and Recommendations for Reducing Racial Disparities in HIV/AIDS Infection
Keeping the Faith: African American Faith Leaders’ Perspectives and Recommendations for Reducing Racial Disparities in HIV/AIDS Infection
Source: PLoS ONE
In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia’s most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia’s racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations’ existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in clinical settings; integrate HIV/AIDS topics into health messaging and sermons; couch HIV/AIDS in social justice, human rights and public health language rather than in sexual risk behavior terms; embrace diverse approaches to HIV prevention in their houses of worship; conduct community outreach and host educational sessions for youth; and collaborate on a citywide, interfaith HIV testing and prevention campaign to combat stigma and raise awareness about the African American epidemic. Many African American faith-based leaders are poised to address racial disparities in HIV infection. HIV prevention campaigns should integrate leaders’ recommendations for tailoring HIV prevention for a faith-based audience.
See: Clergy Can Fight HIV On Faith-Friendly Terms (Science Daily)
World leaders launch plan to eliminate new HIV infections among children by 2015
World leaders launch plan to eliminate new HIV infections among children by 2015
Source: United Nations
World leaders gathered in New York for the 2011 United Nations High Level Meeting on AIDS have today launched a Global Plan that will make significant strides towards eliminating new HIV infections among children by 2015 and keeping their mothers alive.
…
Providing pregnant women living with HIV with antiretroviral prevention and treatment reduces the risk of a child being born with the virus to less than 5%—and keeps their mothers alive to raise them. Neither technical nor scientific barriers stand in the way of responding to this global call to action. The plan notes that what is needed is leadership, shared responsibility and concerted action among donor nations, recipient countries and the private sector to make an AIDS-free generation a reality.In answering the Global Plan’s call to action, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) announced an additional US$ 75 million to preventing mother-to-child transmission of HIV (PMTCT) efforts. This funding will be on top of the approximately US$ 300 million that PEPFAR already provides annually for PMTCT.
The Bill & Melinda Gates Foundation pledged US$ 40 million, Chevron committed to US$ 20 million and Johnson & Johnson pledged US$ 15 million.
+ Full Document (PDF)
Is Food Insecurity Associated with HIV Risk? Cross-Sectional Evidence from Sexually Active Women in Brazil
BackgroundUnderstanding how food insecurity among women gives rise to differential patterning in HIV risks is critical for policy and programming in resource-limited settings. This is particularly the case in Brazil, which has undergone successive changes in the gender and socio-geographic composition of its complex epidemic over the past three decades. We used data from a national survey of Brazilian women to estimate the relationship between food insecurity and HIV risk.Methods and FindingsWe used data on 12,684 sexually active women from a national survey conducted in Brazil in 2006–2007. Self-reported outcomes were (a) consistent condom use, defined as using a condom at each occasion of sexual intercourse in the previous 12 mo; (b) recent condom use, less stringently defined as using a condom with the most recent sexual partner; and (c) itchy vaginal discharge in the previous 30 d, possibly indicating presence of a sexually transmitted infection. The primary explanatory variable of interest was food insecurity, measured using the culturally adapted and validated Escala Brasiliera de Segurança Alimentar. In multivariable logistic regression models, severe food insecurity with hunger was associated with a reduced odds of consistent condom use in the past 12 mo (adjusted odds ratio [AOR] = 0.67; 95% CI, 0.48–0.92) and condom use at last sexual intercourse (AOR = 0.75; 95% CI, 0.57–0.98). Self-reported itchy vaginal discharge was associated with all categories of food insecurity (with AORs ranging from 1.46 to 1.94). In absolute terms, the effect sizes were large in magnitude across all outcomes. Underweight and/or lack of control in sexual relations did not appear to mediate the observed associations.ConclusionsSevere food insecurity with hunger was associated with reduced odds of condom use and increased odds of itchy vaginal discharge, which is potentially indicative of sexually transmitted infection, among sexually active women in Brazil. Interventions targeting food insecurity may have beneficial implications for HIV prevention in resource-limited settings.
HIV Infection and HIV-Associated Behaviors Among Injecting Drug Users — 20 Cities, United States, 2009
HIV Infection and HIV-Associated Behaviors Among Injecting Drug Users — 20 Cities, United States, 2009
Source: Morbidity and Mortality Weekly Report (CDC)
Despite a recent reduction in the number of human immunodeficiency virus (HIV) infections attributed to injecting drug use in the United States (1), 9% of new U.S. HIV infections in 2009 occurred among injecting drug users (IDUs) (2). To monitor HIV-associated behaviors and HIV prevalence among IDUs, CDC’s National HIV Behavioral Surveillance System (NHBS) conducts interviews and HIV testing in selected metropolitan statistical areas (MSAs). This report summarizes data from 10,073 IDUs interviewed and tested in 20 MSAs in 2009. Of IDUs tested, 9% had a positive HIV test result, and 45% of those testing positive were unaware of their infection. Among the 9,565 IDUs with HIV negative or unknown HIV status before the survey, 69% reported having unprotected vaginal sex, 34% reported sharing syringes, and 23% reported having unprotected heterosexual anal sex during the 12 previous months. Although these risk behavior prevalences appear to warrant increased access to HIV testing and prevention services, for the previous 12-month period, only 49% of the IDUs at risk for acquiring HIV infection reported having been tested for HIV, and 19% reported participating in a behavioral intervention. Increased HIV prevention and testing efforts are needed to further reduce HIV infections among IDUs.
Voluntary Medical Male Circumcision for HIV Prevention: The Cost, Impact, and Challenges of Accelerated Scale-Up in Southern and Eastern Africa
Voluntary Medical Male Circumcision for HIV Prevention: The Cost, Impact, and Challenges of Accelerated Scale-Up in Southern and Eastern Africa
Source: PLoS Medicine/PLoS ONE
This sponsored collection of nine new articles, includes four reviews and five research articles, published in PLoS Medicine and PLoS ONE, in conjunction with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR). The collection highlights how scaling up voluntary medical male circumcision (VMMC) for HIV prevention in eastern and southern Africa can help prevent HIV, not only at individual but also at community and population level, as well as leading to substantial cost savings for countries as a result of averted treatment and care costs. The views expressed in this collection are those of the authors and do not necessarily reflect the official policy or position of the U.S. Government and UNAIDS. http://www.ploscollections.org/VMMC2011
Produced with support from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR). The PLoS Medicine editors have sole editorial responsibility for the content of this collection.
New Hope for Stopping HIV: Testing and Medical Care Save Lives
New Hope for Stopping HIV: Testing and Medical Care Save Lives
Source: Centers for Disease Control and Prevention
Too many people don’t know they have HIV (human immunodeficiency virus). About 1.2 million people are living with HIV in the US but about 240,000 don’t know they are infected. Each year, about 50,000 people get infected with HIV in the US. Getting an HIV test is the first step to finding out if you have HIV and getting medical care. Without medical care, HIV leads to AIDS (acquired immunodeficiency syndrome) and early death.
There’s new hope today for stopping HIV in the US. Medicines (antiretroviral therapy or ART) can lower the level of virus in the body. ART helps people with HIV live longer, healthier lives and also lowers the chances of passing HIV on to others. However, only 28% are getting the care they need to manage the disease and keep the virus under control. To help stop HIV, get tested. If you have HIV, get medical care and work with your health care provider to control the virus and not pass it on to others.
Learn what you can do to prevent HIV through testing and medical care.
HIV Risk, Prevention, and Testing Behaviors Among Men Who Have Sex With Men — National HIV Behavioral Surveillance System, 21 U.S. Cities, United States, 2008
HIV Risk, Prevention, and Testing Behaviors Among Men Who Have Sex With Men — National HIV Behavioral Surveillance System, 21 U.S. Cities, United States, 2008
Source: Morbidity and Mortality Weekly Report (CDC)
This report summarizes data gathered from 8,175 MSM during the second data collection cycle of NHBS. In addition to having at least one male sex partner, 14% of participants had at least one female sex partner during the past 12 months. Unprotected anal intercourse with a male partner was reported by 54% of the participants; 37% reported having unprotected anal sex with a main male partner (someone with whom the participant had sex and to whom he felt most committed, such as a boyfriend, spouse, significant other, or life partner), and 25% reported having unprotected anal sex with a casual male partner (someone with whom the participant had sex but with whom he did not feel committed, did not know very well, or had sex with in exchange for something such as money or drugs). Noninjection drug use during the past 12 months was reported by 46% of participants. Specifically, 38% used marijuana, 18% cocaine, 13% poppers (amyl nitrate), and 11% ecstasy. Two percent of the participants reported injecting drugs for nonmedical purposes in the past 12 months. Of the participants surveyed, 90% had been tested for HIV during their lifetime, 62% had been tested during the past 12 months, 51% had received a hepatitis vaccination, 35% had been tested for syphilis during the past 12 months, and 18% had participated in an individual- or group-level HIV behavioral intervention.
Clinical and Behavioral Characteristics of Adults Receiving Medical Care for HIV Infection — Medical Monitoring Project, United States, 2007
Clinical and Behavioral Characteristics of Adults Receiving Medical Care for HIV Infection — Medical Monitoring Project, United States, 2007
Source: Morbidity and Mortality Weekly Report (CDC)
The results from the 2007 MMP cycle indicated that among 3,643 participants, a total of 3,040 (84%) had some form of health insurance or coverage during the 12 months before the interview; of these, 45% reported having Medicaid, 37% reported having private health insurance or coverage through a health maintenance organization, and 30% reported having Medicare. A total of 3,091 (85%) of the participants were currently taking antiretroviral medications. Among 3,609 participants who reported ever having a CD4 T-lymphocyte test, 2,996 (83%) reported having three or more CD4 T-lymphocyte tests in the 12 months before the interview. Among 3,567 participants who reported ever having an HIV viral load test, 2,946 (83%) reported having three or more HIV viral load tests in the 12 months before the interview. Among 3,643 participants, 45% needed HIV case management, 33% needed mental health counseling, and 32% needed assistance finding dental services during the 12 months before the interview; 8%, 13%, and 25% of these participants who needed the services, respectively, had not received these services by the time of the interview.
Noninjection drugs were used for nonmedical purposes by 1,117 (31%) participants during the 12 months before the interview, and 122 (3%) participants had used injection drugs for nonmedical purposes. Unprotected anal intercourse was reported by 527 (54%) of 970 men who reported having anal sex with a man during the 12 months before the interview. Unprotected anal or vaginal intercourse was reported by 176 (32%) of the 553 men who reported having anal or vaginal intercourse with a woman during the 12 months before the interview. Unprotected anal or vaginal intercourse was reported by 216 (42%) of the 516 women who reported having anal or vaginal intercourse with a man during the 12 months before the interview.
Men Who Have Sex With Men, Risk Behavior, and HIV Infection: Integrative Analysis of Clinical, Epidemiological, and Laboratory Databases
Men Who Have Sex With Men, Risk Behavior, and HIV Infection: Integrative Analysis of Clinical, Epidemiological, and Laboratory Databases
Source: Clinical Infectious Diseases
Together, our findings suggest that the sexual behavior of MSM, both HIV-infected and uninfected, has become riskier, contributing to the number of those seeking early clarification of status, to syphilis comorbidity, and to the spread of drug resistance. These findings call for action by public health planners and community-based organizations aimed at increasing awareness of the risks, bringing a change in attitude and establishing safe sex norms.
Characteristics Associated with HIV Infection Among Heterosexuals in Urban Areas with High AIDS Prevalence — 24 Cities, United States, 2006–2007
Characteristics Associated with HIV Infection Among Heterosexuals in Urban Areas with High AIDS Prevalence — 24 Cities, United States, 2006–2007
Source: Morbidity and Mortality Weekly Report (CDC)
In the United States, approximately one in three new human immunodeficiency virus (HIV) infections are transmitted via heterosexual contact (1). To monitor HIV risk behaviors and HIV prevalence among heterosexuals and other populations, CDC surveys persons in selected metropolitan statistical areas (MSAs), using the National HIV Behavioral Surveillance System (NHBS). This report summarizes data collected from heterosexuals in 24 MSAs with a high prevalence of acquired immunodeficiency syndrome (AIDS) that participated in NHBS during 2006–2007. Of 14,837 heterosexuals aged 18–50 years who were interviewed and tested, 2.0% were HIV infected. HIV prevalence was higher among those with lower socioeconomic status (SES). For example, HIV prevalence was 2.8% among participants with less than a high school education compared with 1.2% among those with more than a high school education, 2.6% among participants who were unemployed compared with 1.0% among those who were employed, and 2.3% among participants with annual household incomes at or below the poverty level compared with 1.0% among those with incomes above the poverty level. This association between HIV prevalence and SES could not be attributed to factors commonly associated with HIV infection risk in heterosexuals, such as using crack cocaine, exchanging sex for things such as money or drugs, or being diagnosed with a sexually transmitted disease (STD). Based on the association observed between HIV prevalence and SES, HIV prevention activities targeted at heterosexuals in urban areas with high AIDS prevalence should be focused on those with lower SES.
Sexual Transmission of Hepatitis C Virus Among HIV-Infected Men Who Have Sex with Men — New York City, 2005–2010
Sexual Transmission of Hepatitis C Virus Among HIV-Infected Men Who Have Sex with Men — New York City, 2005–2010
Source: Morbidity and Mortality Weekly Report (CDC)
In the United States, an estimated 3.2 million persons are living with hepatitis C virus (HCV) infection (1). HCV transmission occurs primarily through percutaneous exposure to blood, and persons who inject drugs are at greatest risk for infection. The role of sexual transmission of HCV has not been well defined. However, reports over the past decade, mainly from Europe, have implicated sexual transmission of HCV among human immunodeficiency virus (HIV)–infected men who have sex with men (MSM). In late 2005, two HIV-infected MSM, each with acute HCV infection that was suspected to have been acquired sexually, were evaluated at Mount Sinai Medical Center in New York City, prompting Mount Sinai to request referrals of similar patients (2). During 2005–2010, a total of 74 HIV-infected MSM with recently acquired HCV infection and no reported history of injection-drug use were evaluated. To examine the role of sexual transmission, a matched case-control study and viral analysis were conducted. Results from the case-control study showed that high-risk sexual behavior was the most likely mode of transmission among these men. Phylogenetic analyses revealed five clusters of closely related HCV variants, suggesting networks of transmission among these men. The findings underscore the importance of screening HIV-infected MSM for HCV, particularly those engaged in high-risk sexual behavior.
HIV/AIDS At 30: A Public Opinion Perspective
HIV/AIDS At 30: A Public Opinion Perspective
Source: Kaiser Family Foundation
As the HIV/AIDS epidemic marks its thirtieth year, the Kaiser Family Foundation conducted its eighth large-scale national survey of Americans on HIV/AIDS.
Key findings include:
- Black Americans, and particularly young blacks, express much higher levels of concern about HIV infection than whites.
- Reported HIV testing rates are flat since 1997, including among some key groups at higher risk.
- Thirty years into the epidemic, there is a declining sense of national urgency and visibility of HIV/AIDS.
- At the same time, after nearly a decade of decline, the share of Americans who say they are personally “very concerned” about becoming infected ticked up for the first time in this year’s survey.
- Many Americans still hold attitudes that may stigmatize people with HIV/AIDS, but such reported attitudes have declined in recent years.
- Despite continuing economic problems, more than half of Americans support increased funding for HIV/AIDS, and fewer than one in ten say the federal government spends too much in this area.
- Media, which includes radio, television, newspapers and online sources, is the top information source on HIV across racial/ethnic groups and for younger and older adults alike.
- Three-quarters of Americans could not name an individual who stands out as a national leader in the fight against HIV/AIDS, and no person who was mentioned makes it into double digits.
