Inside This Issue: Updates on the U.S. opioid epidemic, the global HIV epidemic, World AIDS Day Commemorations, Healthy People 2030, and health communication.
The U.S. Opioid Epidemic
U.S. Drug Overdose Deaths Exceeded 70,000 in 2017
In 2017, an estimated 70,237 people in the U.S. died as a result of drug overdose, according to a new report, Drug Overdose Deaths in the United States, 1999-2017. The report from the U.S. National Center for Health Statistics (NCHS) indicates that the age-adjusted rate of drug overdose deaths in 2017 (21.7 per 100,000) was 9.6% higher than the rate in 2016 (19.8 per 100,000). This marked rise in drug overdose deaths was largely the result of a dramatic increase in deaths involving synthetic opioids other than methadone – drugs such as fentanyl, fentanyl analogs, and tramadol. The age-adjusted death rate for synthetic opioids other than methadone rose 45% between 2016 and 2017, from 6.2 to 9.0 per 100,000.
According to NCHS, adults between the ages of 25 and 54 had higher drug overdose death rates in 2017 than both adolescents and young adults aged 15 to 24 years and adults aged 55 years or older.
In 2017, 20 states and the District of Columbia had age-adjusted drug overdose death rates that were statistically higher than the national rate. The highest rates per 100,000 population were recorded in West Virginia (57.8), Ohio (46.3), Pennsylvania (44.3), and the District of Columbia (44.0). In each of these jurisdictions, the age-adjusted drug overdose death rates were more than twice the national average.
The full NCHS report includes detailed information on trends in drug overdose deaths from 1999 through 2017, with breakdowns by gender, age group, state, and opioid category. Since the report focuses entirely on overdose data, it does not include any recommendations for addressing the growing opioid epidemic.
The Global HIV Epidemic
New UNAIDS Report Finds That 25% of All People Living with HIV Still Don’t Know Their HIV Status
Although intensified HIV testing and treatment efforts are reaching more people living with HIV, approximately one-quarter of persons living with the virus globally still do not know their HIV status, according to Knowledge Is Power, a new report from UNAIDS. In 2017, 75% of people living with HIV knew their HIV status, compared to 67% in 2015. In addition, 21.7 million people living with HIV (59%) had access to antiretroviral therapy, up from 17.2 million in 2015. The new UNAIDS report indicates, however, that 9.4 million people living with HIV still do not know they are living with the virus and therefore urgently need to be linked to HIV testing and treatment services.
The report also reveals that, while the number of people living with HIV who are virally suppressed has risen about 10% in three years, reaching 47% in 2017, approximately 19.4 million people living with HIV still do not have a suppressed viral load.
In addition, the report finds that access to viral load testing is mixed. In some parts of the world, getting a viral load test is easy and is fully integrated into a person’s HIV treatment regime, but in other areas, there may be only one facility with the capacity to measure viral load in an entire country. “Viral load testing is the gold standard in HIV treatment monitoring,” notes Michel Sidibé, UNAIDS executive director. “It shows that treatment is working, keeping people alive and well and keeping the virus firmly under control.”
UNICEF Report Examines Current and Projected Impacts of HIV on Children
“The world pledged to end AIDS by 2030. While we have seen remarkable progress in the past decade among children aged 0-9 years, adolescents have been left behind in HIV prevention efforts,” according to a new online report from UNICEF. The agency warns that, unless additional investments are made in HIV prevention, testing, and treatment programs, “a staggering 360,000 adolescents are projected to die of AIDS-related diseases between 2018 and 2030.”
The report, which was released on World AIDS Day, includes both global and regional snapshots of the current impacts of HIV on the world’s children as well as projections for 2030. Globally, in 2017, a total of:
- 3.0 million children and adolescents were living with HIV;
- 430,000 children and adolescents became newly infected with the virus; and
- 130,000 children and adolescents died from AIDS-related causes.
- In addition, in Eastern and Southern Africa alone, a total of 12.2 million children have lost one or both parents due to AIDS related causes.
UNICEF projects that the impact of HIV on children will be reduced in the coming decade. However, without additional investments, by 2030:
- 1.9 million children and adolescents will be living with HIV;
- 270,000 children and adolescents will become newly infected with the virus annually; and
- 56,000 children and adolescents will die as a result of AIDS-related causes annually.
UNICEF estimates that 2.0 million new HIV infections could be averted between 2018 and 2030 if global goals are met – and that three-quarters (1.5 million) of these averted infections would be among adolescents.
World AIDS Day Commemorations
United Nations Officials Call for Continued Action to End the Global Epidemic
“Thirty years after the first World AIDS Day (WAD), the response to HIV stands at a crossroads,” according to United Nations Secretary General António Guterres. “Which way we turn may define the course of the epidemic – whether we will end AIDS by 2030, or whether future generations will carry on bearing the burden of this devastating disease.”
In his 2018 WAD message, Guterres noted that, since the beginning of the epidemic, more than 77 million people have become infected with HIV, and more than 35 million have died of an AIDS-related illness. Fortunately, great strides in HIV prevention, diagnosis, and treatment have avoided millions of new HIV infections and extended and improved the lives of persons living with the virus. “Yet the pace of progress is not matching global ambition,” according to Guterres. “New HIV infections are not falling rapidly enough. Some regions are lagging behind, and financial resources are insufficient. Stigma and discrimination are still holding people back, especially key populations – including gay men and other men who have sex with men, sex workers, transgenders, people who inject drugs, prisoners and migrants – and young women and adolescent girls. Moreover, one in four people living with HIV do not know that they have the virus, impeding them from making informed decisions on prevention, treatment and other care and support services.”
“There is still time – to scale-up testing for HIV; to enable more people to access treatment; to increase resources needed to prevent new infections; and to end the stigma. At this critical juncture, we need to take the right turn now.”
UNAIDS Executive Director Michel Sidibé echoed some of these themes in his 2018 WAD message. He also emphasized the importance of people knowing their HIV status and, if infected, their viral load. “In 2017, 9.4 million people were simply unaware that they are living with a potentially deadly, but treatable, disease,” according to Sidibé. “If people don’t know their HIV status, people who are living with HIV can’t start treatment, and people who are HIV-negative can’t get the knowledge and skills they need to keep that way. If people don’t know their HIV status, they can’t protect themselves, their families, their partners. If people living with HIV don’t know their viral load, they won’t be sure that the treatment is effective, protecting their health and stopping HIV transmission.”
Statements from U.S. Agencies Commemorating World AIDS Day
In the run-up to World AIDS Day on December 1, the HIV.gov site published a series of blog posts related to the HIV epidemic in the U.S. and globally. These brief reports include program updates, information about new initiatives, and statements from government agencies that play a critical role in the U.S. HIV response. For your convenience, we've included the titles and hyperlinks for these recent posts below:
From the U.S. Department of Health and Human Services:
- Statement from HHS Secretary Alex Azar ahead of World AIDS Day
- Successes, Challenges, Opportunities: World AIDS Day 2018
From the U.S. National Institutes of Health:
From the U.S. Centers for Disease Control and Prevention:
- HIV & AIDS in the United States Update: Dear Colleague Letter
- World AIDS Day 2018: Updates from the CDC Center for Global Health
- World AIDS Day – December 1, 2018 (from the Morbidity and Mortality Weekly Report)
From the President's Emergency Plan for AIDS Relief (PEPFAR):
- PEPFAR Will Invest $100 Million to Address Key Gaps Toward Achieving HIV Epidemic Control Including Through Faith-Based Organizations and Communities
- Secretary Pompeo Announces Latest Lifesaving PEPFAR Results
From the U.S. Food and Drug Administration:
- FDA in Brief: FDA Announces Pilot Program with World Health Organization to Expedite Review of HIV Drug Applications
From the U.S. Department of Veterans Affairs:
From the U.S. Indian Health Service:
Requests for Comments
HHS Seeks Input on “Healthy People 2030” Objectives on HIV, Viral Hepatitis, and Other Topics
Every decade, the Healthy People initiative develops a new set of science-based, 10-year national objectives with the goal of improving the health of all Americans. The development of Healthy People 2030 (HP2030), which is now under way, includes establishing a framework for the initiative – the vision, mission, foundational principles, plan of action, and overarching goals – and identifying new objectives. The HHS Office of Disease Prevention and Health Promotion (ODPHP) is now soliciting written comments on its proposed objectives for HP2030. During the comment period, which extends through January 17, 2019, members of the public can provide input on ODPHP’s proposed core objectives for HP2030 or recommend their own objectives. The document Proposed Objectives for Inclusion in Healthy People 2030 lists ODPHP’s proposed objectives in more than 40 different health topic areas, including HIV, immunization and infectious disease, and a host of other issues related to the U.S. national responses to HIV and viral hepatitis – adolescent health, family planning, LGBT health, STDs, social determinants of health, mental health, and substance use.
The six proposed objectives for HIV are to:
- reduce the number of new HIV infections among adolescents and adults;
- increase the proportion of persons 13 years and older who know their HIV status;
- reduce the number of new HIV diagnoses among persons of all ages;
- increase the percentage of persons 13 years and older with newly diagnosed HIV infection linked to HIV medical care within one month;
- increase the percentage of persons 13 years and older with diagnosed HIV infection who are virally suppressed; and
- reduce the rate of newly diagnosed perinatally acquired HIV infections.
ODPHP’s Developing Healthy People 2030 web page provides extensive information about the initiative, including ways interested parties can comment on the proposed objectives for 2030 or suggest new objectives for consideration.
Request for Comments on Draft USPSTF Recommendations on HIV Screening and PrEP
In late November, the U.S. Preventive Services Task Force (USPSTF) issued draft Grade A recommendation statements on HIV screening and pre-exposure prophylaxis (PrEP). USPSTF now recommends that clinicians screen for HIV in adolescents and adults between the ages of 15 and 65, and all pregnant women, regardless of risk. The Task Force also recommends HIV screening in younger adolescents and older adults who are at increased risk for HIV infection. In addition, for the first time, the USPSTF is recommending that clinicians offer PrEP to people at high risk of HIV, including gay, bisexual, and other men who have sex with men, as well as heterosexual women and men whose sexual behavior, sex partners, or drug use place them at high risk of contracting HIV infection.
Educational Programs and Resources
Black AIDS Institute Launches Health Ambassador Program for Black Women
The Black AIDS Institute (BAI) recently launched an ambassador program “to build engagement and movement around HIV and sexual health for Black women.” The program will create a cohort of 20 Black cis and trans women – including both women living with HIV and HIV-negative women – who will receive training about HIV and sexual health. After completing their training, these health ambassadors will use social media to expand knowledge of and access to biomedical tools among other Black women. Some important goals of the program include destigmatizing conversations about sexual health and HIV, normalizing the use of biomedical interventions among Black women through social media, and empowering the women ambassadors and their social networks. BAI has developed an online application for Black women interested in joining the ambassador program. Applications are due by January 15, 2019.
NASTAD Compiles Directory of Jurisdictional Plans for Ending the HIV Epidemic
A growing number of U.S. states, counties, and cities are developing plans to end the HIV epidemic in their jurisdiction. To facilitate access to planning documents, NASTAD has created an online directory of jurisdictional plans for ending the HIV epidemic and an associated map indicating where such plans have been adopted or are under development. Since these jurisdictional plans are continually evolving, NASTAD expects to update its directory as needed to include new plans and modifications to existing plans. “We consider these Ending the Epidemic plans to be really instructive for the community to build because it can be a galvanizing process for the whole community,” NASTAD’s Ann Lefert and Natalie Cramer note in an interview on the AIDSVu website. “It allows the community, health department, funded partners, clinicians, and a lot of other people who are working on this issue to have some difficult conversations about what is needed in order to move forward in a different, more productive way. Once those conversations take place, everyone is in a place where they feel good about the recommendations and where the plan is heading. Then, concrete actions can take place.” NASTAD has been working closely with the ACT NOW: End AIDS Coalition and other groups involved in developing jurisdictional plans or providing technical assistance. “Although each jurisdiction is unique, most of the plans have some real similarities. Successful plans have used similar processes so jurisdictions should be talking to each other – and NASTAD and ACT NOW: End AIDS Coalition can help with that! A first step should be having conversations with others who have done this and asking them what worked well and what didn’t.”
Special AJPH Issue Focuses on Health Disparities in HIV and Other Infectious Diseases
The CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention recently sponsored a special supplement to the American Journal of Public Health on the theme of monitoring progress in reducing health disparities in HIV, hepatitis, sexually transmitted diseases (STDs), and tuberculosis (TB). The 20 research articles and opinion pieces in the supplement are all available for free download. “This supplement presents emerging and best-available methods, metrics, and indicators for monitoring health disparities and preventing HIV, viral hepatitis, STDs, and TB,” according to HIV.gov. “The authors examined health disparities related to age, sex, race/ethnicity, sexual orientation, gender identity, geographic location, and nativity and how these factors affect health outcomes in HIV, hepatitis B virus, syphilis, and TB infections, as well as youth risk behaviors. Together, these articles provide a broad view of disease trends and analytical methods for monitoring health disparities and disease prevention.”
More Digital Tools and Tips from HIV.gov
As part of its ongoing digital marketing and health communication series, HHS’s HIV.gov blog site has published several new posts to help agencies and organizations learn more about digital tools and harness their potential. These include:
How to Use Web Analytics to Get Your Visitors to Engage More – This post describes HIV.gov’s 13 years of health communication experience through its interactive website, including the metrics used to track visitor engagement.
Using Snapchat to Extend In-Person Health Education – This discusses the potential benefits and challenges of using Snapchat to provide health information to young people, as well as tips for using it successfully.
Is Anyone Reading Our Blog Posts? – In this post, HIV.gov staff describe approaches for evaluating how much of their blog posts are read by site visitors. This information may help organizations similarly evaluate visitor engagement with their own blogs or other web-based content.
Cyberbullying – What Can You Do? – This post includes descriptions and links to several cyberbullying resources available from StopBullying.gov.