Inside This Issue: HIV in U.S. Metro areas, HIV index testing, criminalization, co-morbidities, syringe services programs, and more.
U.S. HIV Epidemic
New HIV Diagnosis and Prevalence Rates Remain Substantially Higher in MSAs Than in Smaller Cities and Nonurban Areas
The U.S. Centers for Disease Control and Prevention (CDC) recently published a new surveillance report that provides detailed data on new HIV diagnoses in 2017, as well as HIV prevalence data at the end of 2016 for Metropolitan Statistical Areas (MSAs). MSAs are urban areas with a population of 500,000 or more. The report also contains summary information for smaller metropolitan areas (population 50,000 to 499,999) and nonmetropolitan areas (population less than 50,000). The 87-page HIV surveillance report also includes breakdowns by age, race/ethnicity, sex, and transmission category in each MSA, as well as summary data for less populous areas.
In 2017, the overall HIV diagnosis rate for MSAs in the U.S. and Puerto Rico was 16.6 per 100,000 population, and HIV prevalence was 422.8 per 100,000 population at year-end 2016. The MSA figures for HIV diagnosis rates and HIV prevalence per 100,000 population are approximately 2 times the rates among persons residing in smaller metropolitan areas (9.9 and 203.2, respectively), and approximately 3 times the rates among persons residing in nonmetropolitan areas (5.8 and 140.0, respectively).
The five MSAs with the highest HIV diagnosis rates per 100,000 population in 2017 were all located in the South, and their rates were approximately twice the average for MSAs overall: Miami-Fort Lauderdale-West Palm Beach, FL (40.1), Atlanta-Sandy Springs-Roswell, GA (33.3), Orlando-Kissimmee-Sanford, FL (31.5), Baton Rouge, LA (31.4), and New Orleans-Metairie, LA (31.1).
In MSAs, the highest HIV diagnosis rates seen among males in 2017 were roughly three to four times higher than the highest rates observed among females. The five highest diagnosis rates per 100,000 population among males were in: Miami-Fort Lauderdale-West Palm Beach, FL (65.5), Atlanta-Sandy Springs-Roswell, GA (56.9), Orlando-Kissimmee-Sanford, FL (52.2), New Orleans-Metairie, LA (48.9), and Baton Rouge, LA (47.0). For females, the five MSAs with the highest HIV diagnosis rates per 100,000 were: Jackson, MS (17.0), Baton Rouge, LA (16.6), Miami-Fort Lauderdale-West Palm Beach, FL (16.4), New Orleans-Metairie, LA (14.9), and Jacksonville, FL (14.4).
The highest HIV prevalence rates per 100,000 population for both male and female adults and adolescents were reported in Miami-Fort Lauderdale-West Palm Beach, FL (1,519.2 and 550.8, respectively). The Miami-Fort Lauderdale-West Palm Beach MSA also had the highest death rate (23.4) among adult and adolescent males. The MSA with the highest death rate among adult and adolescent females was Baton Rouge, LA (11.8).
CDC has created a 14-slide set that summarizes highlights from the report with top 5 or 10 rankings in HIV diagnosis rates, prevalence rates, and death rates broken down by age, race/ethnicity, and sex.
HIV Testing and Prevention
Index Testing Increases HIV Diagnosis Rates in PEPFAR Countries
Index testing, also known as partner notification or contact tracing, is an effective case-finding strategy for HIV. This approach involves identifying the exposed partners and biologic children of persons with diagnosed HIV infection and offering these contacts HIV testing services. A recent report from CDC researchers and African colleagues summarizes data from HIV index testing in 20 countries supported by CDC through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) from October 2016 through March 2018. During this 18-month period, a total of about 1.7 million HIV tests with over 99,000 (5.8%) positive results were reported using index testing.
The HIV positivity rate for index testing was 9.8% among persons aged 15 years or older and 1.5% among persons younger than 15. During the reporting period, HIV positivity increased 64% among persons aged 15 years or older (from 7.6% to 12.5%) and rose 67% among persons aged under 15 years (from 1.2% to 2.0%).
“With an HIV positive rate that is more than twice that of all HIV testing approaches combined, index testing was found to be a more efficient approach to HIV case finding,” according to the report. “Expanding index testing services could help increase the number of persons with HIV infection who know their status, are initiated onto antiretroviral treatment, and consequently reduce the number of persons who can transmit the virus.”
CDC Publishes New State HIV Prevention Profiles
CDC has recently published new state HIV prevention profiles that highlight current HIV prevention challenges, opportunities, and investments in jurisdictions across the country. The profiles provide recent epidemiological data, including the number of people living with HIV, the number of new HIV diagnoses, and the percentage of people living with HIV who are unaware they are infected. The profiles also provide information on the number of individuals who have been prescribed pre-exposure prophylaxis (PrEP) in each jurisdiction. As of June 9, the prevention profiles were available for a total of 26 states, the District of Columbia, and Puerto Rico. Links to all currently available profiles are available in the HIV Prevention Profiles section of CDC’s Policy, Planning, and Strategic Communication web page.
New Report Examines Successes and Challenges of the Global Movement Against HIV Criminalization
During the past three years, there has been substantial progress globally in efforts to challenge laws that criminalize HIV, according to a new report, Advancing HIV Justice 3, published by the HIV Justice Network (HJN). “Across the globe, laws used for HIV criminalization are often written or applied based on myths and misconceptions about HIV and its modes of transmission,” according to the report. In addition, “a significant proportion of prosecutions [are] for acts that constitute no or very little risk of HIV transmission, including: vaginal and anal sex when condoms had been used or the person with HIV had a low viral load; oral sex; and single acts of breastfeeding, biting, scratching, or spitting.”
HJN conducted a global audit of HIV-specific laws and arrests during the three-year period from October 2015 through December 2018. The audit revealed that a total of 75 countries (103 jurisdictions) have laws that are HIV-specific or specify HIV as a disease covered by the law. During the audit period, there were at least 913 arrests, prosecutions, appeals, and/or acquittals under HIV laws in 49 countries. The highest number of cases were reported in: the Russian Federation (at least 314), Belarus (at least 249), United States (at least 158), Ukraine (at least 29), and Canada (at least 27).
Although HIV criminalization laws remain in effect in many countries, “Promising and exciting developments in case law, law reform, and policy took place in many jurisdictions,” during the HJN audit period. In particular, “two HIV criminalization laws were repealed; two HIV criminalization laws were found to be unconstitutional; seven laws were modernized; and at least four proposed laws were withdrawn. In addition, six countries saw precedent-setting cases limiting the overly broad application of the law through the use of up-to-date science.”
Living with HIV
NIH Renews Its Focus on Reducing Chronic HIV-Related Co-Morbidities
During the early years of the AIDS epidemic, the median survival of a person with an AIDS diagnosis was just one to two years. Today, thanks to advances in biomedical research, people living with HIV (PLWH) typically survive for decades after diagnosis. In fact, the life expectancies of persons who are diagnosed and treated promptly with antiretroviral therapy (ART) are now nearly the same as those for uninfected individuals.
Nevertheless, PLWH continue to experience a variety of health complications as they manage what has become a chronic disease. In particular, PLWH have a higher prevalence of chronic conditions typically associated with aging, such as cardiovascular disease, than persons who are not infected with HIV. Older PLWH also have very high rates of chronic lung diseases and sleep disorders, as well as blood disorders such as anemia that may occur as a complication of ART.
Adapting to the changing epidemiology of HIV infection, the National Heart, Lung, and Blood Institute (NHLBI) and National Institute of Allergy and Infectious Diseases (NIAID) “are working together to support a coordinated research agenda that will optimize the health of people with HIV and improve their quality of life by reducing HIV-related co-morbidities,” according to the U.S. Department of Health and Human Services (HHS).
As part of this collaboration, the primary stewardship for two major long-term HIV studies – the Multicenter AIDS Cohort Study (MACS) and the Women’s Interagency HIV Study (WIHS) – is shifting from NIAID to NHLBI. Current participants in these studies will now be followed in a combined study known as the MACS/WIHS Combined Cohort Study. “The combined cohort provides researchers from different disciplines with opportunities to focus on heart, lung, blood, and sleep co-morbidities as well as other conditions known to co-occur with HIV disease, including mental health and neurologic illnesses, diabetes, kidney failure, liver diseases, and certain cancers,” according to HHS.
The Opioid Epidemic
CDC Resources on Syringe Services Programs
“The opioid epidemic is one of the greatest public health crises of our time. Substantial increases in drug use across the country continue to result in tragic outcomes,” according to CDC. “These include overdose deaths and transmission of viral hepatitis, HIV, and other infections, negatively impacting families and communities across the nation.”
An extensive body of research during the past 30 years has demonstrated that comprehensive syringe services programs (SSPs) are safe, effective, and reduce overall health costs. SSPs can play an important role in reducing the transmission of HIV, viral hepatitis, and other infections, and they do not increase the illegal use of drugs by injection. Studies have also shown that SSPs protect the public and first responders by providing safe needle disposal.
CDC has recently produced several new and updated resources focusing on the critical role of SSPs in prevention and treatment. These materials include:
- A summary of information on the safety and effectiveness of SSPs in reducing viral hepatitis and HIV.
- A fact sheet outlining the various ways SSPs help prevent transmission of blood-borne infections and link people to care, reduce and treat substance use, and enhance public safety.
- An infographic for health departments and community partners that defines SSPs and summarizes their public health impacts.
- An SSP FAQ with frequently asked questions about SSPs and supporting evidence of their safety and effectiveness.
HIV.gov Posts Comprehensive Timeline of U.S. HIV/AIDS Epidemic
On June 5, 1981, CDC published a report describing the first cases of what would later be known as AIDS. On the 38th anniversary of that publication, HIV.gov announced the availability of a highly detailed, updated timeline of the HIV/AIDS epidemic, with particular emphasis on the United States. The interactive timeline presents extensive information on several hundred events over the course of the epidemic, including key research findings, advances in HIV testing and treatment, epidemiologic trends, policy and program developments, and cultural milestones. The updated timeline now includes events from June 1981 through May 2019.
AIDSinfo Updates Its Population-Specific HIV Fact Sheets
The AIDSinfo site has recently published updated fact sheets in both English and Spanish focusing on the impact of HIV infection on specific population groups. Each fact sheet is in a question-and-answer format, and includes a bulleted summary of key points, together with links to additional information and resources. The updated fact sheets are:
- HIV and Children and Adolescents (Spanish)
- HIV and Women (Spanish)
- HIV and Gay and Bisexual Men (Spanish)
- HIV and Older Adults (Spanish)
- HIV and Drug and Alcohol Users (Spanish)
Social Media and Digital Communication
Digital Tools and Tips from HIV.gov
During the past month, HHS’s HIV.gov blog site has published three new posts in its ongoing digital marketing and outreach series. The series is designed to help agencies and organizations become more knowledgeable about digital tools and use them effectively in health communications. The newest posts are:
How to Present Social Metrics to Leadership – This item describes ways to evaluate how social media activities support an organization’s mission and provides guidance on how to present that information in a meaningful way to the organization’s leaders.
How to Write Successful Subject Lines – In this post, HIV.gov staff share their knowledge about the elements of email subject lines that entice readers to open email communications. One key tip: Lead with the good stuff.
The Most Important Social Media Metrics to Track – In this item, social media expert George Weiner of Whole Whale answers questions about Integrating web and social media metrics, and checking media content to ensure that it is readily accessed by desktop, tablet, and mobile phone users.