HIV a Southern Epidimic!: September 2014

Monday, September 29, 2014

HIV by the Numbers: Facts, Statistics, and You

The U.S. Centers for Disease Control (CDC) reported the first five known cases of HIV in Los Angeles in June of 1981. The previously healthy gay men had contracted pneumonia and two died. Today, more than a million Americans have the virus.
Being diagnosed with HIV was once a death sentence. Now, a 20-year-old man with HIV who begins treatment early can expect to live to 77 — the average lifespan of an average American man. The disease, which attacks the immune system, can be controlled by modern-day antiretroviral medications.

Prevalence, Incidence, and Death Rates: Then and Now

An estimated 1,155,792 Americans have HIV. About 180,900 people aged 13 and older don’t know they have it.
An estimated 49,273 Americans were newly diagnosed with HIV in 2011, but only 32,052 developed AIDS. This is in striking contrast to the early days of HIV/AIDS.
According to the American Federation of AIDS Research, of the 250,000 cases of reported AIDS cases, 200,000 already had died by 1992. By 2004, a million cases had been reported and 500,000 had died.
In 2010, 15,529 people accounted for 2 percent of total AIDS deaths in the U.S. So far, 636,000 people in the U.S. diagnosed with AIDS have died.

Demographics: Who Gets HIV and How?

According to the CDC, gay or bisexual men made up almost two-thirds of the 50,000 new infections in the U.S. in 2010. In 2011, 30,896 infections in the U.S. came as the result of male-to-male sexual contact. While gay men continue to represent most HIV infections in the U.S., anyone who practices unsafe sex or shares IVs can contract HIV. Among the 13,801 heterosexuals diagnosed in the U.S. in 2011, 4,775 men and 9,026 women contracted the virus.
When it comes to race, 23,042 of those diagnosed in the U.S. in 2011 were black, 13,817 were white, and 10,135 were Latino. Infection rates in the U.S. of black men and women have risen to eight times that of whites based on population size.
Of 49,273 diagnoses in the U.S. in 2011:

38,825 were adult and adolescent males
10,257 were adolescent females
192 were children under age 13

Americans in the 20 to 24 age range had the most diagnoses: 8,054. Next highest were those ages 25 to 29 (7,484) and 30 to 34 (6,209).

Location: A Big Problem Worldwide

Five states alone make up almost half of new diagnoses in the U.S. in 2011. These five states account for 23,923 of 49,273 new infections, according to the CDC:

California
Florida
Texas
New York
Georgia

According to AIDS.gov, 33.4 million people worldwide are living with HIV/AIDS, and 25 million have died since 1981. Additionally, 97 percent of people with HIV live in developing and moderate-income nations, such as those in sub-Saharan Africa.
Number of infections on other continents:

Asia: 4.7 million
Latin America: 2 million
Eastern Europe and Central Asia: 1.5 million

The World Health Organization reports that access to care has increased tenfold from 2002 to 2008 among poor countries hit hard by HIV. Still, people most at risk around the world do not have access to treatment or prevention. Just over one-third of the 28.6 million people in poor and moderate-income countries who should be on antiretroviral medication are getting it.

Prevention: Protect Yourself and Your Loved Ones

It’s important for people — especially high-risk groups — to be tested frequently. Starting HIV treatment early is important for best outcomes. Approximately 37 percent of people ages 18 to 64 in the U.S. have reported receiving an HIV test. HIV education is mandatory in 33 states and in Washington, D.C.
Preventing transmission of HIV is as important as treating those who have it, from a public health perspective. There has been remarkable progress in that regard. For example, modern-day antiretroviral therapy can reduce the chances of an HIV-positive person transmitting the virus by 96 percent.
There has been a sharp decline in transmission rates in the U.S. since the mid-1980s: from 130,000 per year to 50,000. However, transmission rates increased 12 percent from 2008 to 2010 among gay and bisexual men, who comprise the U.S. population most at risk. While gay and bisexual men represent only 4 percent of the male population in the U.S., they comprise 78 percent of new HIV infections.
Condom use remains an inexpensive, cost-effective first line of defense against HIV. A new pill known as Truvada, or pre-exposure prophylaxis (PrEP), also offers protection. An HIV-negative person can protect themselves from contracting HIV by taking a once-a-day pill. When taken properly, PrEP can reduce the risk of transmission by more than 90 percent.

Cost of HIV/AIDS

There is still no cure for HIV, and it can take a huge financial toll on those living with it. The U.S. is expected to spend almost $30 billion annually on HIV/AIDS programs, including:

research
housing
treatment
prevention

Of that amount, $6.5 billion is for aid abroad. This expenditure represents less than 1 percent of the federal budget. HIV/AIDS funding has increased almost $5 billion since 2009.
Not only are life-saving medications expensive, but massive numbers of people in hard-hit countries with limited resources have died or are unable to work due to HIV/AIDS. This has affected these nations’ development.
Unlike diseases that affect children or the elderly, HIV hits people during their working years. Countries end up with lost productivity and, in many cases, a significant reduction in the workforce. This all adds up to severe impacts on these national economies.
According to the U.S. Census Bureau, Zambia has “lost” more than 1.6 million people to HIV/AIDS — almost 12 percent of its population. Tanzania is “missing” more than 3.2 million people to HIV/AIDS — 7 percent of its population. Kenya, Uganda, and Mozambique have been similarly hard hit.
Some African countries such as Ethiopia, Kenya, and Zimbabwe spend between an estimated 30 and 60 percent of their total health ministry budget on HIV/AIDS.
The average cost of treating a person with HIV over the course of their lifetime is $379,668. The CDC reports that prevention interventions are deemed cost effective if they prevent an infection in one person for less than that.

Article Sources:

Cohen, M.S., Chen, Y.Q., McCauley, M., et al. (2011, August 11). Prevention of HIV-1 Infection with Early Antiretroviral Therapy. The New England Journal of Medicine, 365, 493-505. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMoa1105243#t=articleTop
Economic implications of HIV/AIDS: A crisis in development. (2011, June 25). The UC Atlas of Global Inequality. Retrieved from http://ucatlas.ucsc.edu/health/aids/econ_imp.php
Global statistics. (2012, June 6). AIDS.gov. Retrieved from http://www.aids.gov/hiv-aids-basics/hiv-aids-101/global-statistics/

- See more at: http://www.healthline.com/health/hiv-aids/facts-statistics-infographic#.dpuf

Friday, September 5, 2014

Why HIV patients develop dementia: Researchers track harmful immune reactions in the brain

Why HIV patients develop dementia: Researchers track harmful immune reactions in the brain:

'via Blog this'

Thursday, September 4, 2014

White House Meeting on HIV in the Southern United States - See more at: http://blog.aids.gov/2014/09/white-house-meeting-on-hiv-in-the-southern-united-states.html#sthash.x6yw326s.dpuf

HIV continues to take a heavy toll in states across the American South, a fact underscored at a meeting convened by the White House Office on National AIDS Policy (ONAP) earlier this summer. The June 18 meeting explored the response to HIV in the 17 southern states, a rapidly growing region where one-third of the U.S. population resides and the region of the country where the largest proportion of people living with HIV (PLWH) resides.
Echoing the President’s observation in the National HIV/AIDS Strategy (NHAS) that the federal government cannot achieve the Strategy’s goals alone, ONAP Director Douglas Brooks, MSW, observed that the diversity of voices participating in the meeting represented many vital partners, including PLWH, community-based organizations (CBOs), health centers, AIDS service organizations (ASOs), state and local health departments, academic medical centers, and funders. Mr. Brooks observed that only by working together can we refine and pursue strategies and policies that support communities in the southern U.S. to enhance prevention efforts and improve outcomes for thousands of Americans living with HIV in the region.

Characteristics of HIV in the South

The meeting opened with an overview of HIV/AIDS in the southern United States by Dr. Amy Lansky, Deputy Director for Surveillance, Epidemiology, and Laboratory Science in CDC’s Division of HIV/AIDS Prevention (DHAP). She noted that nearly half (49%) of all diagnoses of HIV infection in the U.S. in 2011 occurred in the South. Dr. Lansky observed that while the characteristics of the HIV epidemic in the South are similar to those in U.S. generally (e.g., mostly male; concentrated among gay, bisexual and other men who have sex with men (MSM) and in urban communities; and disproportionately affecting African Americans), there are some differences. These include the following: HIV in southern states affects a higher proportion of women than the national average; there is a slightly larger proportion of infections attributable to heterosexual contact; and the population affected by HIV is slightly less concentrated in urban settings. These characteristics, she observed, are important to consider when tailoring HIV prevention, care, and treatment to the needs of the region. She also pointed to another important factor: recent significant increases in the rate of HIV diagnoses among younger males in the South.
Across the several panel presentations that followed, we heard recurring accounts of a number of prevalent challenges to mounting effective responses to HIV in the southern states, including poverty; limited access to HIV prevention and care in rural areas and associated transportation concerns; and widespread homophobia, stigma, and discrimination against PLWH. While none of these factors are exclusive to the southern states, they seem to combine in unique ways in that region, requiring thoughtful regional, state, and community responses.
Another concern frequently cited by panelists was the challenge of poverty and the large number of vulnerable individuals who lack health insurance in states in the southern United States. In six southern states, Medicaid is being expanded under the Affordable Care Act and this will help overcome these challenges and improve health outcomes for many citizens, not just those at risk for or living with HIV. In the 11 southern states that have not chosen to expand Medicaid, the Ryan White HIV/AIDS Program must continue to provide a vital safety net for uninsured or marginally insured individuals.
But challenges notwithstanding, presenters also highlighted a number of innovative and successful approaches by federal and non federal stakeholders that are improving the response to HIV in communities across the South. Among these were:

Realigning HIV Prevention Funding to Match Disease Burden

Ms. Janet Cleveland, MS, DHAP’s Deputy Director for Prevention Programs, highlighted CDC’s four-year effort to re-align its programs and funding to match the burden of disease geographically and concentrate on cost-effective prevention interventions that have been shown to work at a scale that will achieve significant reductions in HIV incidence. As an example, she pointed to the fact that CDC has re-aligned its HIV prevention grants to health departments to be more reflective of the current epidemic, which significantly increased funding to many southern states. Additionally, she noted that one-third of the CBOs whose HIV prevention activities DHAP supports with grant funds are located in the southern region.

Implementing “Red Carpet” Service to Accelerate Linkage to HIV Care

Mr. Don Blanchon, Executive Director of Whitman-Walker Health, a former ASO turned health center in Washington, DC, shared that the center recognized the need to improve linkage to care for newly diagnosed individuals in the city. In response, the center piloted an on-demand protocol in which the clinic “rolls out the red carpet,” making it possible for a newly diagnosed individual to get into care the same day they are diagnosed. A similar approach has now been adopted city-wide, according to Mr. Michael Kharfen, Director of the DC Department of Health’s HIV/AIDS administration. Under this protocol, the health department guarantees an appointment for a newly diagnosed person with an HIV medical provider within 72 hours of diagnosis. Over the past year, more than 70% of DC’s newly diagnosed individuals have been engaged via that protocol and the city has achieved a linkage to care rate of 87% among those newly diagnosed.

Utilizing Telemedicine to Extending the Reach of HIV Services

Dr. DeAnn Gruber, Director of the Louisiana Department of Health and Hospitals’ STD/HIV Program, discussed a promising use of technology to enhance care transitions for people living with HIV who are leaving incarceration and returning to the community. With support from a Ryan White HIV/AIDS Program grant, Louisiana is enabling virtual case management sessions between incarcerated individuals preparing to leave the corrections system and CBOs or Ryan White clinics offering case management services. These sessions are designed to keep individuals in care by establishing relationships virtually, before their return to the community.To date, of the individuals who have participated in such virtual sessions and have been released, 75% have been linked to HIV care within 90 days of release.

Tailoring HIV Services

Ms. Tonya King of the Tennessee Department of Health shared that the state has established specialized “one-stop shops” for PLWH. These clinics offer not just medical care, but also other needed support services, including assistance with housing and utility payments. Dr. Gruber of Louisiana also pointed to the creation of the state’s six wellness centers for gay men as another example of tailoring HIV services to meet the needs of specific populations.

Harnessing the Promise of PrEP

Several participants indicated that they were supportive of the addition of pre-exposure prophylaxis (PrEP) to the HIV prevention toolbox, but likewise observed that there are barriers to its uptake in the southern states, including low provider awareness as well as stigma, shame, and homophobia. To increase PrEP uptake, Dr. Vignetta Charles of AIDS United

highlighted the work of two of her organization’s grantees. One of them, Georgia Equality

, is using social media to educate individuals about PrEP. Another, My Brother’s Keeper

in Jackson, Mississippi, is supporting PrEP education and outreach for community health centers. Dr. Michael Kolber of the University of Miami noted the importance of work underway to enhance healthcare providers’ understanding of both PrEP and post-exposure prophylaxis (PEP) and educate providers about their merits.
This ONAP meeting was important for a number of reasons, not the least of which was bringing together some 200 diverse stakeholders to share their experiences and perspectives. The day’s dialogue also underscored the importance of using data to drill deeper and examine what is happening not just in the region or even in particular states, but at the county and community levels. As Mr. Brooks noted at the opening of the meeting, improving HIV outcomes across the southern U.S. will require concerted and focused efforts by all stakeholders—the federal government as well as state and local governments, medical academia, the faith community, the business community, the media, and affected communities. Working together, we can make a difference.
- See more at: http://blog.aids.gov/2014/09/white-house-meeting-on-hiv-in-the-southern-united-states.html#sthash.x6yw326s.dpuf