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.

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.

NASTAD: People living with HIV on antiretroviral therapy (ART) do not transmit the virus

From LGBTweekley.com

nastad-300x195WASHINGTON, D.C. – NASTAD (National Alliance of State & Territorial AIDS Directors), a leading non-partisan non-profit association that represents public health officials who administer HIV and hepatitis programs in the U.S. and around the world, published a new statement affirming that durably virally suppressed people living with HIV on antiretroviral therapy (ART) do not sexually transmit the virus. The statement accelerates NASTAD’s longstanding work to end HIV and promote policies and public health practice grounded in science.

”The science is clear that people living with HIV with a sustained undetectable viral load do not transmit the virus to others. What’s also clear is that we have the tools to end the HIV epidemic and HIV-related stigma and make new infections a thing of the past. Today, we tackle a major part of this work by raising awareness about the latest science of HIV transmission risk,” remarked NASTAD Executive Director Murray Penner.

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Professor Matt G. Mutchler examines HIV prevention with focus on communication among young Black gay and bisexual men

From csudhnews.com

Professor of sociology Matt G. Mutchler’s research over the past 20 years into HIV prevention and treatment issues, especially within the African American community, has garnered him more than 15 external research awards and respect as an expert in the field. In addition to serving as a faculty member at California State University, Dominguez Hills, he is currently a visiting professor with the Center for AIDS Prevention and Study at University of California, San Francisco, and director of community-based research with AIDS Project Los Angeles.

Mutchler’s more recent work addresses sexual communication among African-American gay and bisexual males and their close friends, and other sexual health issues related to gay men. He also investigates HIV treatment adherence programs.

Mutchler brings his expertise in community-based research to the CSUDH’s Urban Community Research Center (UCRC), where he serves as director. The multi-disciplinary, sociology-based applied research center focuses on the needs, problems and solutions that arise in urban areas. The center also offers CSUDH students hand-on research experience as they collaborate with CSUDH faculty, and a number of governmental, community-based, and university/research institutions, such as AIDS Project Los Angeles (APLA), Charles R. Drew University, Spectrum, REACH LA, and the RAND Corporation.

Mutchler recently shared insights about his studies and findings, the challenges and rewards of conducting his research within the African American community, and his latest work.

Read the interview with Professor Mutchler on csudhnews.com.

 

Gay men headed for an STD epidemic?

From Slate.com

Earlier this month, Poz magazine’s Benjamin Ryan drew attention to a concerning new study out of Northern California’s health system: Using data gathered from July 2012 through June 2015, researchers found that, among a cohort consisting mostly of same-sex–attracted men on the HIV-prevention regimen PrEP, “quarterly rates of rectal gonorrhea and urethral chlamydia increased steadily and about doubled after one year.” In other words, guys on the fantastically effective pill-a-day Truvada program were avoiding HIV infection—there were no new transmissions for regimen-adherent patients over the study period, in fact—but they seemed to be getting other sexually transmitted diseases relatively often.

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New research suggest that stigma and discrimination may alter gay men’s cortisol balance resulting in stress

From PscyhCentral

New research suggest that stigma and discrimination may alter gay men’s cortisol balance resulting in stress. Moreover, black gay men, a double minority, are likely to experience more stress that white gay men.

gay men and stressInvestigators explain that research over the past two decades has shown that cortisol is a life sustaining adrenal hormone essential to maintaining the natural balance of the body. Cortisol is often referred to as “the stress hormone,” as it influences, regulates, and modulates many of the changes that occur in the body in response to stress.

New studies measure cortisol at various times during the day on a 24-hour basis to examine possible adrenal imbalances. The majority of these diurnal cortisol studies have been conducted among white heterosexuals, with very little research examining HPA-axis functioning between different minorities.

However, individuals who identify as both sexual and racial minorities may experience increased stigma and discrimination that can affect this HPA-axis functioning.

To address this need for more expansive research, investigators led by Stephanie H. Cook, DrPH, conducted a study, “Cortisol profiles differ by race/ethnicity among young sexual minority men”, examining differences in diurnal cortisol rhythm between young, self-identified, white gay men (WGM) and black gay men (BGM).

The research appears in the journal Psychoneuroendocrinology.

Read the full article.