More gay, bi men with HIV receiving care, disparities remain

From Reuters Health

Gay and bisexual men in the United States who are diagnosed with HIV are promptly receiving the necessary treatments more often than in the past, according to a new report from the Centers for Disease Control and Prevention (CDC).

Still, black gay and bisexual men are less likely than their white counterparts to receive antiretroviral therapy (ART) to keep the human immunodeficiency virus in check, the researchers found.

They write in the Journal of Infectious Diseases that one goal of the National HIV/AIDS Strategy was to get 85 percent of people to a healthcare facility within three months of being diagnosed with HIV by 2015. By 2020, the goal is to get 85 percent of people diagnosed with HIV to care within one month.

The study team previously published 2008 and 2011 results from the CDC’s National HIV Behavioral Surveillance, which includes data from 20 cities on adult HIV-positive men who have sex with men – a group at particular risk for HIV infection. The new study adds data from 2014.

Altogether, 1,144 men provided data in 2008, 1,338 in 2011 and 1,716 in 2014. The proportion of white men taking the survey fell 14 percentage points between 2008 and 2014, but the proportion of black men participating increased by 13 percentage points during the same period.

The average age of the men dropped over the study period, too. Insurance coverage increased from 75 percent in 2008 to 86 percent in 2014, which was the first year of coverage expansion under the Affordable Care Act.

In 2008, 79 percent of the men were seen at a healthcare facility within three months of their diagnosis. That measure – known as linkage to care – increased to 87 percent by 2014.

With the 2020 goal in mind, the researchers analyzed how many men were seen at a healthcare facility within one month of their HIV diagnosis. In 2014, 78 percent of men were linked to care within one month, which the researchers say suggests the 2020 goal is feasible.

When the researchers looked at how many of the men were receiving ART, they found the rate increased from 69 percent in 2008 to 88 percent in 2014.

People with insurance or with higher levels of education or income were more likely to be linked to care within a short amount of time and be on ART.

In all years, a higher percentage of ARV treatment was observed among whites, according to the researchers – and this disparity persisted in 2014. The proportion of white men on ART were 9 percentage points higher than the proportion of black men.

“We’re moving in the right direction, but the fact that the disparities are persisting in 2014 when we’ve had access to antiretroviral therapy for so long is troubling,” said Jennifer Kates, who is vice president and director of global health and HIV policy at the Kaiser Family Foundation in Washington, D.C.

The findings suggest black men are being linked to care at roughly the same rate as white men, but they’re not getting equal access to ART, said Kates, who wasn’t involved in the new study.

“There are some systemic issues on the healthcare system side – from providers to insurance – that this study wasn’t designed to look at,” she told Reuters Health.

Read the full article.

Gay men syphilis rates over 100x greater than straight men

From medpagetoday.com

The first state-specific analysis of syphilis among men who have sex with men (MSM) shows they have dramatically higher incidence than men whose only sexual partners are female, the CDC is reporting.

Data from 2015, analyzed with a new methodology, show that the incidence of primary and secondary syphilis among MSM was 309.0 cases per 100,000 people, compared with 2.9 per 100,000 among men who reported sex with women only, according to Alex de Voux, PhD, of the CDC’s epidemic intelligence service, and colleagues at the CDC and Emory University in Atlanta.

The disparity was even more marked when the rate among MSM was compared with the 1.8 cases per 100,000 population seen among women, the researchers reported in the April 7 issue of Morbidity and Mortality Weekly Report.

County-by-county data from the U.S. Census Bureau’s American Community Survey included the number of households with a male head-of-household and a male partner, De Voux and colleagues reported, and that information could be used to estimate the MSM population per county.

For the syphilis analysis, the researchers used data from the 44 states that had information on the sex of partners in at least 70% of reported cases. Those states accounted for 83.4% of all 23,872 reported cases in 2015, De Voux and colleagues reported.

State-specific incidence rates among MSM ranged from 73.1 per 100,000 population in Alaska to 748.3 in North Carolina, the investigators found. Syphilis incidence among MSM was highest in the South and West and four of the five states with the highest rates among MSM — Louisiana, Mississippi, North Carolina, South Carolina, and New Mexico — were in the South.

The overall syphilis among MSM was 167.5 times the rate among women, with state-specific rate ratios ranging from 63.7 in Louisiana to 2,140.3 in Hawaii, De Voux and colleagues reported.

Interestingly, the highest overall syphilis rate in the U.S., seen in 1946, was 70.9 cases per 100,000 population — a rate exceeded by the lowest state-specific rate among MSM in 2015: the 73.1 cases per 100,000 observed in Alaska.

The researchers cautioned that the data are based on 44 states and might not reflect the nation as a whole. Similarly, the estimates rely on the American Community Survey data; under-reporting of same-sex households would skew the outcome.

As well, they noted, the analysis did not include cases in which the sex of partners was unknown and if MSM are less likely than other men to report the sex of their partners, the findings might under-estimate the rate of disease among MSM.

Finally, De Voux and colleagues cautioned, not all cases of syphilis are diagnosed and reported.

Three reasons why language is important in media coverage of HIV

From the HRC… (by Diego Mora Bello, HRC Global Fellow)

Stigma and discrimination continue to be common barriers for people living with HIV. Fortunately, the media can play an important role in helping to remove these and other barriers. In my own survey of Latin American news articles mentioning HIV and AIDS, and in meeting with media professionals and advocates, I found that Latin American Media has room to improve its use of correct and destigmatizing language when talking about people living with HIV. Covering HIV both correctly and responsibly is important, because doing so is an essential part of raising awareness, debunking common myths, and giving voice to an already marginalized group of people.

The importance of using correct and responsible language in journalistic coverage of HIV inspired me to research this topic and share my findings. The ultimate goal of HIV in the Media is to report on this subject in a scientifically accurate and responsible way that inspires others to follow suit.

Based on my research, here are the top three reasons why language is important when covering HIV and AIDS in the media.

Read the full article on the HRC Website.

Campus environment tied to sexual assault risk for LGBT people

From Reuters.com

College students in the U.S. who say their campus is welcoming to lesbian, gay, bisexual and transgender people are less likely to be victims of sexual assaults at school, a new study suggests.

The researchers found that students who perceived their campus as an inclusive environment for LGBT people were significantly less likely to be the victims of sexual assault. “I believe this study provides proof of concept for how environment may influence sexual assault violence,” said lead author Robert Coulter, a researcher at the University of Pittsburgh Graduate School of Public Health. Coulter and colleagues write in the Journal of Interpersonal Violence that sexual assault affects 2 to 15 percent of U.S. undergraduates.

In earlier research, they found that certain groups are more at risk of sexual assault than others. For example, women and transgender people in general are at greater risk of sexual assault than non-transgender men.

To see whether campus environment is tied to the risk of sexual assault, the researchers analyzed survey data collected in 2010 from 1,925 undergraduates who were LGBT or questioning their sexual orientation. Overall, 5.2 percent reported that they had been sexually assaulted on campus.

Read the full article.

HIV activist learning modules: engaging our community in HIV prevention policy advocacy

From thebody.com and the Treatment Action Group

While many of us who come from communities highly impacted by HIV have the lived experiences and the passion required for HIV prevention advocacy, developing an advocacy agenda and getting up to speed on the current state of HIV prevention science is not always easy. In order to support the efforts of prevention advocates across the United States, Treatment Action Group has developed a series of modules to help support activists’ capacity needs and to develop advocacy action plans. The slides, handouts, and webinars in each module focus on how to identify and change the governmental, organizational, and institutional policies that create roadblocks to comprehensive HIV prevention in our communities. The materials are useful for personal education or group discussion on HIV prevention and policy advocacy.

Go to thebody.com to find links to each of the learning modules.

New HIV testing, treatment and prevention clinic opens in Washington

From the Observer Reporter in Washington County…

An HIV/AIDS medical clinic is operating in Washington, focusing not only on assisting people who are HIV positive, but testing for the virus and preventing those at high risk from contracting it.

Central Outreach Wellness Center South opened three months ago at 95 Leonard Ave., Washington. It is in Suite 203 in an office building adjacent to Washington Hospital, but it is not affiliated with the facility. For now, the center is open Wednesdays and Thursdays, or by appointment. Walk-ins are accepted.

Initial screenings for and treatment of sexually transmitted diseases is conducted at the clinic, and is covered by the state Department of Health. Central Outreach is filling a need in the Washington area, which did not have an STD clinic since one closed more than a year ago.

Nurse practitioner Carol Priest of Arden is running the office. She is assisted by Braden Bash, who has been trained as a physician assistant and is waiting to take his boards.

Nurse practitioner Carol Priest and physician assistant trainee Braden Bash oversee operations at Central Outreach Wellness Center South

“We hope to be open Monday through Friday by summer,” Priest said.

Stacy Lane, a physician and Washington & Jefferson College graduate, opened the clinic by appointment only in December. It is a “satellite” of the Central Outreach Wellness Center she launched two years ago – and still operates – on Pittsburgh’s North Shore, near the Andy Warhol Museum. She said there was an urgent need for the Washington facility.

“We noticed there were more than 50 people driving from West Virginia to the North Shore, and that wasn’t counting Washington and Canonsburg folks,” Lane said.

“There were no STD options in that area. There was a huge deficit.”

That deficit was underscored by the drug crisis that engulfed the region in recent times. “HIV can be transmitted by drug use,” Priest said.

A major weapon being used to combat HIV, Priest said, is a pill called PrEP, which stands for pre-exposure prophylaxis and has the brand name Truvada. It was used as a treatment for HIV, but is now used as a preventative for people who have been diagnosed as HIV negative and others who are at high risk of getting the virus. “These are people who use (intravenous) drugs and share needles, gay men not using condoms,” Lane said.

PrEP, according to results, has been a huge success.

“Of 200,000 people who were HIV negative and are on that pill, there have been only three cases of HIV,” Lane said.

Lane specializes in infectious diseases and was motivated to do so years ago. An uncle died from AIDS while she was in high school and pondering a medical career.

Read the full article.

AIDS United: Republicans’ American Health Care Act will “worsen treatment and care for people living with HIV”

Press release from AIDS United

AIDS United opposes the American Health Care Act as released by House Republicans on March 6th. The American Health Care Act would, if passed, strongly affect and potentially worsen treatment and care for people living with HIV and the provision of HIV prevention services for people at risk for infection. AIDS United works toward an end to the HIV epidemic by reaching outcomes described in the National HIV/AIDS Strategy and the many state-specific efforts to curb and finally end the epidemic. These outcomes include reducing HIV incidence, increasing access to care and improving health outcomes for people living with HIV, and reducing HIV-related health disparities.

The American Health Care Act undermines these goals. The replacement of premium subsidies with refundable tax credits will hurt the ability of low income people, including people living with HIV, to afford up-front payment of health plan premiums. Under this system thousands of people will lose coverage. These people will then be subject to a 30 percent penalty in their future cost of coverage because of continuous coverage requirements. These same requirements will hurt people who lose their jobs and will also make it more difficult for people to change jobs or move across the country. The bill also places a higher cost burden on older Americans by allowing higher premium as people age. This will result in much higher costs and lower access to care for lower income people. Finally, the bill effectively repeals Medicaid expansion in under three years at the end of 2019. Such a repeal will result in a loss of health coverage for millions of Americans, including people living with HIV and other chronic conditions.

Read the full press release.