National Black HIV/AIDS Awareness Day Puts Focus on Need to Address Equity and Drivers of HIV Disparities in U.S.

From HIV.gov

By: Harold J. Phillips, MRP, Senior HIV Advisor and Chief Operating Officer for Ending the HIV Epidemic: A Plan for America, Office of Infectious Disease and HIV/AIDS Policy, U.S. Department of Health and Human Services.

This year’s National Black HIV/AIDS Awareness Day (NBHAAD) observance comes amidst a national dialogue on systemic racism and calls for a greater focus on equity in all our work. We should use this opportunity to examine and address historic inequities experienced by Black Americans. For the HIV community, this means working to understand and address the circumstances that put people at risk for HIV or that create barriers to HIV care and treatment.

Black Americans continue to be disproportionately affected by HIV compared to other racial/ethnic groups. According to CDC data,

  • Black Americans represent 13% of the U.S. population, but 41% of people with HIV in the U.S. in 2018.
  • 42% of new HIV infections in 2018 were among Black Americans.
  • Among the estimated 161,800 people in the U.S. with undiagnosed HIV, 42% (67,800) are Black. That means that nearly one in seven Black Americans with HIV are unaware of their HIV status and are not receiving the care they need to stay healthy and prevent transmission to others.

Fewer Black Americans in HIV care are virally suppressed: In 2018, 60% of Blacks, 64% of Latinos, and 71% of whites with diagnosed HIV were virally suppressed.

The recently released HIV National Strategic Plan (HIV Plan) makes clear the disproportionate impact of HIV among Black Americans, and includes Black women, transgender women, people who inject drugs, and Black gay, bisexual, and other men who have sex with men among its designated priority populations. The HIV Plan notes that focusing efforts on priority populations will reduce HIV-related disparities, which is essential to the nation’s effort to end the HIV epidemic by 2030.

Read the full article.

How the COVID-19 pandemic is affecting another epidemic among teens: STDs | Expert Opinion

2020 marks the fifth consecutive year of increasing rates of gonorrhea, chlamydia and syphilis in the U.S.

From The Philadelphia Inquirer

While the eyes of the nation are on the coronavirus pandemic, another threat to public health has been steadily growing in the United States. We’ve been battling rising rates of sexually transmitted infections (STI) for the last several years. In fact, 2020 marks the fifth consecutive year of increasing rates of gonorrhea, chlamydia and syphilis in the U.S., due in part to significant funding cuts to more than 50% of the nation’s public health STI programs. And now the COVID-19 pandemic has placed an even greater burden on our strained public health system and supply chains, shifting focus from one major public health issue to another.

virus and bacteria images

We can’t risk losing one critical resource that will be essential to ending the STI epidemic — the availability of free and confidential STI testing for adolescents. Prior to the pandemic, national public health efforts were scaling up to improve STI and HIV testing, and quickly link youth to prevention services.  Rapid identification and treatment of STIs not only has public health benefits in terms of lowering transmission, but when left untreated, STIs increase the risk of infertility, severe pelvic infection, chronic pelvic pain, ectopic pregnancy and HIV transmission.

While accounting for 25% of the population, adolescents and young adults comprise over 50% of STIs in the U.S. each year. Black, Latinx, and LGBT youth face the greatest burden of infections and risk of complications. Fortunately, significant advances have been made over the last several decades to improve rates of STI and HIV testing among adolescents and young adults. The American Academy of Pediatrics now recommends HIV screening by the age of 16-18 years for all youth regardless of their sexual activity.

Read the full article.

Transmission of HIV through oral sex is rare — here’s how to reduce your risk

From insider.com

HIV does not reproduce outside a human host and cannot be transmitted through saliva, tears, or sweat. It is a common misconception that sharing dishes, shaking hands, or hugging can transmit HIV, says Anne M. Neilan, MD, MPH, Infectious Disease Physician at Massachusetts General Hospital.

Generally, it’s unlikely that you will contract HIV from oral sex. However, there are some circumstances in which this could happen, though uncommon. This article will discuss the likelihood of getting HIV through oral sex and how to avoid contracting or transmitting it.

“The likelihood of acquiring HIV from oral sex is far lower than vaginal or anal sex,” says Neilan. The risk is so low that scientists have not established a conclusive statistic, but a 1999 study estimates a 0.04% risk among male sexual partners. 

Saliva contains secretory leukocyte protease inhibitors that inactivate the virus. Because of this HIV inhibitor, the virus reproduces less than it would in the blood cells. 

Although the risk is low, unprotected oral sex still carries the risk of transmitting HIV, as well as sexually transmitted infections (STI). “Protection against HIV does not mean protection against all sexually transmitted infections,” says Neilan.

A person without HIV may contract the virus by giving or receiving any type of oral sex to or from a partner with HIV. Some risk factors increase the likelihood of contracting HIV through oral sex, which include:

The risk of HIV from oral sex may be minimal, but it’s still important to know how to avoid contracting and transmitting the virus.

Using dental dams, male and female condoms during oral sex reduces the likelihood of contracting HIV, but you must use them correctly, says Neilan. Refraining from oral sex when risk factors are present, and avoiding seminal or vaginal fluids in the mouth also lessen the risk, but does not completely eliminate it.

STIs like gonorrhea or syphilis can cause sores on the mucous membrane, increasing the chances of getting or transmitting HIV, so get tested regularly and seek treatment if needed. 

Read the full story.

CDC 2018 report: Black/African American gay and bi men still have the highest rates of new HIV infections.

From the Centers for Disease Control and Prevention

In 2018, 37,968 people received an HIV diagnosis in the United States (US) and dependent areas. From 2014 to 2018, HIV diagnoses decreased 7% among adults and adolescents. However, annual diagnoses have increased among some groups.

Info graphic showing Black / African American men still have the highest rates of H I V infection as of 2018 according to the latest C D C report
click to enlarge graph

Gay and bisexual men are the population most affected by HIV, with Black/African American, Hispanic/Latino gay and bi men having the highest rates of new infections.

The number of new HIV diagnoses was highest among people aged 25 to 34.

Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated)HIV Surveillance Report 2020;31.

HRC is mailing sex positive kits as part of its “My Body” HIV campaign to celebrate Black and Latino LGBT people

From Poz.com

“Embrace your body and your sexuality. Taking precautions against HIV doesn’t mean you should be ashamed of your sexuality or not enjoy sex—you can love your body and stay safe.”

Find out how you can get your box of goodies…

That’s the opening message of “My Body,” a new HIV awareness and education campaign by the Human Rights Campaign (HRC), a national LGBT advocacy group. Recognizing that nearly a quarter of young queer adults lack proper evidence-based sex education about HIV, the campaign is geared to empowering Black and Latino LGBT people between ages 16 and 35.

You can learn more about the boxes in the video and request one at HRC.im/MyBody.

Read the full article on Poz.com.

Latino Gay/Bi men’s health rally to focus on U=U during COVID-19

From Poz.com

Spearheaded by the Hispanic Health Network, this year’s rally includes two panel discussions. “HIV Stigma and COVID-19” takes place at 1 p.m. ET Monday, November 9. According to the rally’s website, “panelists will share and discuss information about the importance of U=U in the times of COVID-19, how U=U is used to combat stigma and barriers to reach an undetectable viral load. They will also discuss how COVID-19 has impacted Latinx Gay/Bi Men’s Communities and HIV-related stigma connected to U=U. During this panel, speakers will explore the role of religion to interrupt stigma.”

U=U stands for Undetectable Equals Untransmittable, which refers to the fact that people living with HIV who maintain a suppressed viral load cannot transmit HIV via sex, even when condoms are not used.

The second virtual panel, “Strengthening of the Latinx Gay/Bi Men’s Communities,” is scheduled for 1 p.m. ET, Tuesday, November 10. “The panelists will discuss racism colorism, machismo and heteronormativity in Hispanic/Latinx communities,” according to the website. “Panelists will also touch upon how to address these issues through diversity acceptance. Panelists will talk about the impact of Black Lives Matter on the Hispanic/Latinx communities and the importance of developing leadership to strengthen communities for a healthier future.”

You can register for both events and read speaker bios on the Rally 2020 site.

9 FAQs for when your partner has HIV

From Everyday Health

If you’re in a new relationship with someone who has HIV or you’ve recently found out that your longtime partner is HIV positive, you may be experiencing a whirlwind of emotions — possibly fear, sadness, or even anger, depending on the context. You may be concerned that you’ll get HIV from your partner or wonder how being with an HIV-positive person will affect your relationship or daily life.

As you begin to emotionally adjust to your situation, it’s important to get the facts about being with a partner who has HIV. Certain fears about having an HIV-positive partner may be outdated, but there may also be precautions you weren’t aware of that you could take to avoid HIV

Here are some questions you may have if your partner has HIV, and answers from leading experts on the virus.

Meet the queer artists changing the way we think about owning our sexual health

From Queerty.com

So it’s no surprise that James, like thousands of others, has turned to OraQuick’s in-home HIV test as a key part of their sexual health toolkit. James Falciano is a champion of their queer community, something that is reflected in their art, activism, and everyday life.

It’s the simplest way to get accurate, fast results without waiting in line at the clinic or doctor’s office – if you can even get one these days. In as little as 20 minutes, in the privacy of your own home, you obtain your results, along with access to 24/7 support.

It’s the way to take control of your own sexual health and to own your own sex life.

James and two other fabulous queer artists, Preston Nelson and Kitsch Harris, are partnering with OraQuick to encourage HIV self-testing.

Here are samples of their art to explore along with conversations about their work (and read more at Queerty.com).

  • James Falciano

Switching HIV treatment to delstrigo is safe and effective

From Poz. com

People with HIV who switch from a stable antiretroviral (ARV) regimen to Delstrigo (doravirine/tenofovir disoproxil fumarate/lamivudine) had a high rate of full suppression of the virus at the three-year mark in a large Phase III clinical trial.

Princy Kumar, MD, of Georgetown University, presented findings from the open-label, randomized, active-controlled, noninferiority DRIVE-SHIFT trial at the virtual HIV Drug Therapy Glasgow meeting.

Delstrigo contains the relatively new non-nucleoside reverse transcriptase inhibitor (NNRTI) Pifeltro (doravirine), which, like Delstrigo, was approved in September 2019.

Read the full article.

The single biggest risk factor for gay, bi men becoming HIV-positive

From the Advocate.com
Of all those who became HIV-positive, over a third (36 percent) were persistent meth users. Men aged 36-45 reported the most meth use, and those living in Western states had the highest incidence of the drug.

Persistent meth use is the biggest factor for seroconversion, researchers stated, followed by Black ethnicity and a syphilis diagnosis.

Researchers detailed the correlation between meth and HIV.

“Methamphetamine exacerbates HIV risk via increasing sexual libido while simultaneously reducing inhibitions,” the authors stated, according to AIDSMap. “Our findings highlight the need to address methamphetamine use and its associated risks among sexual and gender minorities, the likes of which may also serve to help end the HIV epidemic.”

Read the full article.

Has the COVID-19 pandemic marked the end of casual sex?

From Boston Magazine online

by 

Not long after the virus first hit, I was in a committed relationship, so casual sex wasn’t really an issue. When the relationship ended, though, I realized the impact of the disease on my sex life. Sleeping with random guys was off the table. Even making out with someone at a bar seemed risky. I felt ripped off. I’d been faithful, but he’d cheated, and after kicking him out of our apartment and getting tested (and, I believe, paying extra to expedite the lab results), I wanted to cut loose. I’ve always thought that beyond it being consensual and not involving minors or dire physical harm, there are no moral imperatives connected to sex, and because being a “gay man” means being at least partially defined by your sexuality, I believe it’s a gay man’s birthright and prerogative to exercise that sexuality freely.

This was the late ’80s. Not 10 years earlier, bathhouses and tricking were accepted and celebrated parts of gay life. In 1978, at the hormonally supercharged age of 13, I visited my uncle in San Francisco and had to hide my titillation walking down Polk Street, with all the leather-clad men who looked like Tom of Finland had drawn them. I secretly purchased a steamy memoir about hedonistic gay sex in Paris nightclubs, and snuck over to a convenience store on the other side of town to buy copies of Blueboy and Mandate magazines. Then, not long after, HIV slammed the door shut on all of that, delivering a sharp slap in the face to a horny twentysomething. Now, a possible death sentence came along with getting physically intimate with a stranger. It was unspeakably unfair, and frightening.

Fast-forward to today, and here we are again, it seems. Although I’m now happily married, I was pleased to know that casual sex was beginning to steam up in recent years, thanks to pre-exposure prophylaxis and hookup apps such as Grindr, allowing sex parties and cruising the dunes of P-town to once again become possibilities. But then the novel coronavirus came roaring in. As self-isolation became the new normal, I was reminded of my experiences as a young man during the dark days of the HIV/AIDS crisis, and I sympathized with my uncoupled friends who were suddenly saddled with unsought chastity belts, their libidos on lockdown. Not to make light of it, but among its many horrors, COVID-19 has turned out to be a total cock block. Once again, the idea of physical contact is married to mortal danger, making me wonder whether and how COVID-19 has affected singles’ sexual behavior. Are we headed right toward another pandemic-induced Victorian era?

Read the full article.

14 Things I Wish Queer Men Were Taught in Sex Ed By Zachary Zane

From Pride.com (By Zachary Zane)…

Oh, sex ed. A decade later, and the only thing I remember “learning” from it is “wear a condom.” I honestly don’t think I could tell you another single bit of information they “taught” me except for that men have a vas deferens, which is somewhere in the penis. (Testicles, maybe?)

Imagine how nice it would have been if they actually taught us something useful! Imagine if instead of scaring us and making us fear our own sexuality, sex ed courses taught us how to embrace and explore our sexuality safely! Can you imagine??

So here are 14 things I wish sex ed courses taught me! (And all queer men and queer folks, for that matter. Screw it—everyone can benefit from this!)

Health screening for gay men on PrEP falling behind recommended standards

From aidsmap.com

Levels of sexual health screening among gay men taking PrEP fall well below recommended levels, investigators from the United States report in the online edition of Clinical Infectious Diseases.  Rates of testing for sexually transmitted infections (STIs) in the rectum and throat – which can be asymptomatic – were especially low, so too testing coverage in south-eastern US states which have an especially high burden of HIV and STI infections among gay and other men who have sex with men.

“Consistency of STI screening at PrEP care visits was lower than recommended, especially for rectal and pharyngeal infections that are mostly asymptomatic,” write the authors. “Our findings also highlight the regional variation in gaps between recommendations and PrEP clinical practice overall, and raise concerns about whether comprehensive PrEP care as currently practiced would be effective for STI control.”

Tenofovir-based PrEP is highly effective at preventing infection with HIV but the treatment provides no protection against STIs. Pre-existing research shows elevated STI rates among PrEP-using gay men, probably the result of increased surveillance and sexual risk behaviour. The Centers for Disease Control and Prevention (CDC) therefore recommends that gay men taking PrEP should have comprehensive check-ups for bacterial STIs every three to six months. These sexual health screens should include tests for chlamydia, gonorrhoea and syphilis, with swabs or samples taken from the urethra, throat and rectum.

Read the full article.

New study supports more frequent HIV screening among high-risk young men who have sex with men

From medicalexpress.com

A new study has found that HIV screening every three months compared to annually will improve clinical outcomes and be cost-effective among high-risk young men who have sex with men (YMSM) in the United States. The report, led by researchers at the Massachusetts General Hospital (MGH), is being published online in Clinical Infectious Diseases.

“Young men who have sex with men account for one in five new HIV infections in the United States. Yet, more than half of young men who have sex with men and who are living with HIV don’t even know that they have it,” says Anne Neilan, MD, MPH, investigator in the MGH Division of Infectious Diseases and the Medical Practice Evaluation Center, who led the study.

“With so many youth with HIV being unaware of their status, this is an area where there are opportunities not only to improve care for individual youth but also to curb the HIV epidemic in the U.S. Despite these numbers, the Centers for Disease Control and Prevention previously determined that there was insufficient youth-specific evidence to warrant changing their 2006 recommendation of an annual HIV screening among men who have sex with men.”

Read the full article.

Sex and COVID-19

It may seem obvious that if a person is infected with COVID-19, they risk infecting others during sex. But people still have a lot of questions. Here’s an excerpt on the topic form the Mayo Clinic Website:

The virus spreads by respiratory droplets released when someone with the virus coughs, sneezes or talks. These droplets can be inhaled or land in the mouth or nose of a person nearby. Coming into contact with a person’s spit through kissing or other sexual activities could expose you to the virus. People who have COVID-19 could also spread respiratory droplets onto their skin and personal belongings. A sexual partner could get the virus by touching these surfaces and then touching his or her mouth, nose or eyes. In addition, the COVID-19 virus can spread through contact with feces. It’s possible that you could get the COVID-19 virus from sexual activities that expose you to fecal matter.

There is currently no evidence that the COVID-19 virus is transmitted through semen or vaginal fluids, but the virus has been detected in the semen of people who have or are recovering from the virus. Further research is needed to determine if the COVID-19 virus could be transmitted sexually.

Since some people who have COVID-19 show no symptoms, it’s important to keep distance between yourself and others if the COVID-19 virus is spreading in your community. This includes avoiding sexual contact with anybody who doesn’t live with you. If you or your partner isn’t feeling well or think you might have COVID-19, don’t kiss or have sex with each other until you’re both feeling better. Also, if you or your partner is at higher risk of serious illness with COVID-19 due to an existing chronic condition, you might want to avoid sex.

In case that wasn’t clear, The National Coalition of STD Directors (NCSD), in partnership with National Alliance of State and Territorial AIDS Directors (NASTAD), released a frequently asked questions resource regarding sex and COVID-19. In short, if you’re in the same room with someone who has the virus, you can get infected–sex or no sex.

If you have questions about getting tested, talk to your doctor or health care provider. You can also find testing in your area via a Google search. In Pennsylvania, call the Health Department at 1-877-PA-HEALTH (1-877-724-3258).

LGBT-friendly primary care improves STD screening rates

From medicalxpress.com

Bruce W. Furness, M.D., M.P.H., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues developed and evaluated a quality improvement initiative (Transforming Primary Care for LGBT People) to enhance the capacity of 10 federally qualified health centers (FQHCs; 123 clinical sites in nine states) to provide culturally affirming care.

The researchers found that FQHCs reported increases in culturally affirming practices, including collecting patient pronoun information (42.9 percent increase) and identifying LGBT patient liaisons (300.0 percent increase). Based on  and  (SOGI) from  among nine FQHCs, SOGI documentation increased from 13.5 to 50.8 percent of patients. Screening of LGBT patients increased from 22.3 to 34.6 percent for syphilis, from 25.3 to 44.1 percent for chlamydia and gonorrhea, and from 14.8 to 30.5 percent for HIV among the eight FQHCs reporting the number of LGBT patients.

“FQHCs participating in this initiative reported improved capacity to provide culturally affirming care and targeted screening for LGBT patients,” the authors write.

Read the full article.

Age of sexual debut among young gay-identified sexual minority men

From MedicalExpress.com...

Young gay sexual minority men—especially Black and Latino youth—have their first sexual experiences at younger ages, emphasizing a need for comprehensive and inclusive sex education, according to Rutgers researchers.

The study, published in the Journal of Sex Research, examined consensual sex behaviors to better understand same-sex sexual debut, or the age at which people first engage in sexual behaviors.

The researchers, part of the Rutgers School of Public Health’s Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), found that 19 percent of participants had their first sexual experience before the age of 13.

The researchers also found that same-sex sexual encounters first happen, on average, at 14.5 years, with Hispanic/Latinx and Black non-Hispanic participants reporting a younger age for their first time performing  or engaging in , compared to their peers.

Earlier age of sexual debut among sexual minority men is associated with a range of sexual and health risk behaviors, including increased likelihood of condomless sex; tobacco, alcohol, and other substance use; psychological distress; suicidality; and earlier age of HIV diagnosis.

[…] “As many schools are forced to redesign their classrooms and curricula to accommodate socially distanced or remote learning for COVID-19, this may be the perfect time to consider implementing comprehensive sex education programming to provide age-appropriate sexual health education for people of all genders and sexual orientations,” said Caleb LoSchiavo, doctoral student at the Rutgers School of Public Health and co-author.

Read the full article.

Alternative PrEP injection, dosed every other month, beats daily PrEP pill

From thebodypro.com

Taken every 2 months, the long-acting injectable drug cabotegravir (CAB-LA) prevented more HIV infections than daily oral pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC), according to newly announced results from a major Phase 3 study. The results were released originally in May due to the overwhelmingly positive data on CAB-LA for PrEP, but researchers presented their final data in early July at the 23rd International AIDS Conference (AIDS 2020).

The data show that the experimental drug is superior to the current standard-of-care PrEP regien, which may open the door for a new biomedical HIV prevention option aimed at those who would prefer a shot six times a year over taking a daily pill.

“The HPTN 083 results demonstrating the superiority of CAB to TDF/FTC have the potential to transform the landscape of HIV prevention for cisgender MSM and transgender women,” said HPTN 083 protocol chair Raphael J. Landovitz, M.D. “We know that some people have difficulty with or prefer not to take pills, and an injectable product such as long-acting CAB [cabotegravir] could be a very important option for them. We want to thank the study participants and research staff, as this study would not have been possible without their dedication and commitment.”

Read the full article.

The dudes who won’t wear masks

From the Atlantic

Americans are figuring out how to live with a deadly new virus now, just as gay men did in the early years of AIDS. Abstinence from sex wasn’t sustainable, and condoms became a ticket to greater sexual freedom. Likewise, Americans can’t abstain from human interaction forever, and widespread masking may be a ticket to more social and economic freedom. But trying to shame people into wearing condoms didn’t work—and it won’t work for masks either.

The public-health messaging around masks during the coronavirus pandemic has been muddled and confusing. The federal government recommended against face coverings for the public in March, with some public-health officials positing that they may even cause more harm than good. But a growing body of science, including evidence that people can transmit the virus when they don’t have symptoms, indicates that masks are an important tool for mitigating coronavirus transmission, especially in combination with physical distancing, hand hygiene, and other preventive strategies. Indeed, public-health concerns may justify mask mandates in some settings, including indoor spaces where many people gather for extended periods of time. But mandates have major downsides: Any enforcement is likely to disproportionately affect communities that are already marginalized, and some Americans—including some elected leaders in states facing serious coronavirus outbreaks—believe that requiring people to wear masks is an infringement on civil liberties. In practice, if Americans are going to mask up, public-health officials will have to cajole, not compel.

Read the full article.

Health Alert: HHS rule encourages discrimination and endangers LGBTQ health

A message from the Gay and Lesbian Medical Association

Earlier today the Department of Health and Human Services released a final rule that eliminates federal regulations ensuring nondiscrimination in healthcare for transgender people and LGB people, people who are pregnant or seeking an abortion, those who require healthcare services in a language other than English, and other marginalized communities. In its announcement, HHS noted it was “restoring the rule of law” by interpreting sex discrimination “according to the plain meaning of the word ‘sex’ as male or female and as determined by biology.”

GLMA President Scott Nass, MD, MPA, issued the following statement in response:

“It is unconscionable that the Administration would take this action to encourage and promote discrimination during a pandemic that is already severely impacting vulnerable communities, including LGBTQ people. The fear of discrimination can have very real health consequences, especially in a public health crisis. These discriminatory measures are not only cruel, they also undermine public health and will assuredly result in poorer health outcomes for LGBTQ people.

“The rule stands in contradiction to prevailing medical science regarding transgender health and the consensus of all the leading health professional associations who have consistently opposed this measure. Healthcare providers in fact are united by the evidence in their support for nondiscrimination protections in healthcare for transgender and LGBQ people.