Health Alert: Return of the AIDS epidemic

From voanews.com

Thirty-six million people currently live with AIDS, a disease that claimed the lives of nearly 1 million people last year. Experts predict that by 2030, 100 million people will have been infected with the HIV virus.

Despite the alarming numbers, there have been great strides in treatment. HIV is no longer a death sentence, and researchers say people receiving treatment for HIV are able to live normal lives and do not pose a risk to others when they are being treated proactively.

But success carries a price: complacency. Funding for AIDS research and treatment has declined, and in some places, so has government interest.

“When we talk to ministers of finance, they always say to me, ‘I thought HIV was over because I don’t see anybody dying,’” said Dr. Deborah Birx, a U.S. Global AIDS coordinator who oversees the President’s Emergency Plan for AIDS Relief (PEPFAR).

J. Stephen Morrison of the Center for Strategic and International Studies, said, “We’re not reaching goals.” He added, “There’s going to be a struggle to hold ground. … There’s a widening deficit of political will and financial capacity that we face some really daunting challenges in prevention.”

Dr. Chris Beyrer, with Johns Hopkins Medicine, predicted that things will get worse if governments and civilians continue their complacency.

“We are not done with AIDS,” he said. “It is much too early to declare victory, and the risks of a resurgent epidemic are real.”

Read the full article.

Gay teens at least twice as likely to use illegal drugs, study suggests

From NBC News online

Lesbian, gay, bisexual and questioning (LGBQ) teens are at least twice as likely as their heterosexual peers to use illegal drugs like cocaine, ecstasy, heroin and methamphetamines, a U.S. study suggests. Previous research suggests that stressors related to being closeted or coming out and being rejected by family or friends could contribute to an increased risk of substance use among sexual minority teens, senior study author John Ayers of San Diego State University in California said.

For the new study, researchers looked at data from roughly 14,703 high school students who had been surveyed about their lifetime and prior-month use of 15 different substances, including illegal drugs as well as tobacco, alcohol and prescription drugs that weren’t given to them by a physician.

LGBQ youth were more than three times more likely to try heroin or methamphetamines at least once, and more than twice as likely to try ecstasy or cocaine, the study also found.

Stressors faced by LGBQ teens, such as stigma and isolation, “may make drugs foolishly appear attractive as a coping mechanism,” Ayers said by email. “Even experimentation with these harder drugs can derail a teen’s future,” he said.

The vast majority of teens didn’t use illegal drugs, regardless of sexual orientation, researchers report in the American Journal of Public Health.

Read the full article on NBC News.

Why STDs are on the rise in America

From the Economist online

Much of the increase in STDs has come from gay and bisexual men. Although a relatively small share of the population, they accounted for 81% of male syphilis cases in 2016, according to the Centres for Disease Control. As with heterosexuals, this seems to be because sex is now seen as less risky. That is due to the advent of PrEP, a prophylactic drug cocktail which gay men can take to nearly inoculate themselves from HIV. The reduced chances of catching HIV—along with the fact that a positive diagnosis is no longer a death sentence—seems to encourage men to drop their guard. A recent study of gay and bisexual men, published in the Lancet, a medical journal, found that as more began taking PrEP, rates of consistent condom usage dropped from 46% to 31%. Recent studies have shown that uptake of PrEP is strongly associated with increased rates of STD infection.

All this shows that changing sexual mores, and a reduced fear of the risks of unprotected sex, seem to be at fault—especially since the problem is not just limited to America. England experienced a 20% increase in syphilis diagnoses in 2017 and a 22% increase in those of gonorrhoea. Other countries in western Europe have seen ever worse outbreaks, sometimes exceeding 50%. Dwindling public spending on STD prevention—which in America has fallen by 40% in real terms since 2003—is not helping matters. Yet the chief methods of prevention, abstinence and condoms, are tried and true. Should these options seem too chaste or chaffing, then prospective partners ought to get an STD test (especially since most infections can be cleared up with a simple course of antibiotics). Verified testing is vital since verbal assurances, especially on the cusp of a liaison, can be misleading.

Read the full article.

CDC’s Eugene McCray discusses HIV prevention advances from AIDS 2018 in Amsterdam

Eugene McCray MD

From AIDS.gov

Advances in HIV prevention and program implementation were among the topics in the spotlight at the 22nd International AIDS Conference (AIDS 2018) this week. Eugene McCray, MD, Director of CDC’s Division of HIV/AIDS Prevention (DHAP)

reflects on some of the conference highlights. The division he oversees works to prevent HIV infections and reduce the incidence of HIV-related illness and death across the United States. Read more about their work.

During a live interview on Facebook, Dr. McCray discussed research being presented by CDC researchers at the conference, other HIV prevention research findings shared here at the conference, and shares his personal reflection on what how it feels like to be at this conference at this stage of the epidemic.

Watch the video.

Gay or bi men who disclose sexual history may get better healthcare

From Reuters online

Young men who have sex with men (MSM) who disclose their sexual orientation or behavior to a health care provider are more likely to receive appropriate healthcare, new data suggest.

Dr. Elissa Meites of the Centers for Disease Control and Prevention (CDC) and her colleagues studied 817 MSM, ages 18 to 26, who had seen a healthcare provider in the past year. Men who had disclosed were more than twice as likely as those who had not to have received the full panel of recommended screenings and vaccines, the researchers found.

The CDC and the Advisory Committee on Immunization Practices recommend that MSM be screened for HIV, syphilis, gonorrhea and chlamydia at least once a year, and immunized against hepatitis A and B and human papillomavirus (HPV), Meites and her colleagues note the journal Sexually Transmitted Diseases. Overall, 67 percent of the study participants had received all four recommended STI screenings, but that was true for only 51 percent of the MSM who had never disclosed. Nine percent overall had received all vaccinations, compared to six percent of those who hadn’t disclosed.

The pattern was similar when researchers looked to see how many participants received all seven recommended services. The rate was just seven percent for the overall study population, but it was even lower – at less than four percent – for the MSM who hadn’t disclosed.

Read the full article.

Opinion: Why don’t more Americans use PrEP?

From the New York Times

Truvada was approved by the Food and Drug Administration in 2012. But over six years later, the United States is failing miserably in expanding its use. Less than 10 percent of the 1.2 million Americans who might benefit from PrEP are actually getting it. The major reason is quite clear: pricing. With a list price over $20,000 a year, Truvada, the only PrEP drug available in the United States, is simply too expensive to become the public health tool it should be.

[…] The disparities in PrEP access are astounding: Its use in black and Hispanic populations is a small fraction of that among whites. In the South, where a majority of H.I.V. infections occur, use is half what it is in the Northeast. Women use PrEP at drastically lower rates than men, and while there’s no national data on PrEP and transgender Americans, it’s almost certainly underused. The issue of PrEP access has become an issue of privilege.

The ability of PrEP to greatly reduce new H.I.V. infections is no longer in question. In New South Wales, Australia, a program providing free access to PrEP led to a drop in H.I.V. diagnoses in the most vulnerable communities by a third in just six months, one of the fastest declines recorded since the global AIDS crisis began.

Read the full article on New York Times online.

High numbers of HIV-positive MSM not being tested for syphilis

From healio.com

Nearly one-third of sexually active HIV-positive men who have sex with men are not tested for syphilis at least annually, researchers reported in a recent study, calling the finding “concerning.”

Alex de Voux, PhDan Epidemiologist in the CDC’s Division of STD Prevention, and colleagues sought to examine the proportion of sexually active HIV-positive men who have sex with men (MSM) currently in care who were tested for syphilis in the past 3, 6 and 12 months by their HIV care provider.

A 2017 study showed that MSM accounted for more than 60% of syphilis cases nationwide in 2015. In that study, researchers determined that the rate of primary and secondary syphilis in the United States among MSM was 106 times that of men who have sex with women only.

In the current study, the authors noted that guidelines recommend that sexually active MSM, including HIV-positive MSM, be tested at least annually for syphilis, with testing every 3 to 6 months for MSM at elevated risk, and used this timeline to evaluate the group.

De Voux and colleagues used the most recent medical record and interview data collected by the Medical Monitoring Project, a population-based HIV surveillance system, from 2013 to 2014. The data showed that 71% of all sexually active HIV-positive MSM had at least one test for syphilis in the past 12 months. In the past 6 months, only 43% had been tested, and the number dropped to 22% in the past 3 months.

Researchers also examined the frequency of testing in MSM who reported risk factors, including having condomless sex and having sex with two or more partners.

Read the full article.

To find free syphilis testing near you, search by zip code on the CDC testing Website: gettested.cdc.gov

For more information about syphilis, its symptoms and treatment, click here.