Category Archives: HIV

CDC Analysis: 4 out of 10 HIV-Diagnosed Not In Care

by D Gregory Smith

An analysis of epidemiological data by the Centers for Disease Control has arrived at a startling conclusion: as many as 4 out of 10 persons diagnosed with HIV do not remain in care.

Despite all the medical evidence which advocates early HIV treatment for a healthy life, people are still not accessing care. The specific reasons are unclear, but the National HIV Treatment Guidelines are very clear: Persons with HIV are to be tested for Viral Load and CD4 counts ever 3-4 months, unless they are considered “virus-suppressed” (usually with an undetectable viral load and normal CD4 count with no medication changes over a period of time), then it is every 6-12 months.

So, what’s happening?

In surveillance data from 13 regions, only 59% of people recently diagnosed with HIV had had a test for viral load or CD4-positive T-cell count within the previous year, according to Irene Hall, PhD, head of the CDC’s HIV incidence and case surveillance branch.

The finding implies that the remaining 41% are not under a physician’s continuing care, Hall said in a teleconference during the 2011 National HIV Prevention Conference in Atlanta.

The two tests are a “marker for being in care,” Hall told MedPage Today.

Maybe it’s time to start talking seriously about barriers to proper care, including discrimination, poverty, cultural issues and race.

At a time when we know treatment is prevention, it’s important that the members of our communities who are HIV infected receive the care they need.

I’m wondering if it’s about support. Many of the people in my HIV+ support groups help each other with their health care- talking honestly about issues, sharing resources- even giving each other rides to doc or lab visits. They stay on their meds, talk realistically about their health, exercise, pay closer attention to nutrition and reducing stress. They do it because they have people they can speak to honestly about their disease- people who know firsthand what it’s like. And, for the most part, they’re having incredible, fulfilling lives.

In my experience, it’s the people who are trying to deal with HIV on their own who don’t do so well.

Depression and fear can play an enormous part in healthcare apathy- and it’s a well-documented fact that fear and depression are alleviated by concern and compassion from family and friends- and involvement with others who share similar circumstances.

So, in the interest of trying to understand this better, I have a couple of questions:

Do you know anyone (maybe it’s you) with HIV who is not getting care for their disease? What can be done to get them into care?

I’d like to follow up with your responses- so feel free to contact me at Dgsma@hotmail.com if you are uncomfortable leaving a response in the thread.

Study: Simple Changes To Dating Sites Could Lower STD’s, HIV

by D Gregory Smith

Simple Changes to Dating Websites Could Decrease Spread of HIV and Sexually Transmitted Diseases

A study released today recommends eight ways to reduce transmission of HIV and other sexually transmitted diseases (STDs) among men who meet male sex partners online.

Owners of popular dating and “hook-up” websites and users of those websites, along with HIV and STD program directors, agreed that a few simple measures could have a major impact on the spread of sexually transmitted diseases.

Among the online measures supported by a majority of those surveyed:

• Including “safe sex” as a profile option and allowing users to search for partners by such characteristics
• Providing directories of STD testing locations
• Sending automatic reminders to get an HIV/STD test at regular intervals chosen by users
• Having chat-rooms and other areas for HIV+ men looking for other HIV+ men
• Providing e-cards to notify partners of a potential exposure to STDs
• Posting videos that show men discussing safe sex, HIV status, and related issues
• Providing access to sexual health experts

“Finding sex and love online is here to stay,” said Dan Wohlfeiler, one of the study’s authors working with the California HIV/STD Prevention Training Center for this project. “This shows how we can work with the website owners to turn the internet into a force for the health of their users.”

In California, gay and bisexual men who were diagnosed with syphilis or gonorrhea most frequently reported the Internet as where they met sex partners.

More than 3000 users, 82 state and local HIV and STD Program directors and 18 owners of dating and “hook-up “ websites completed the survey.

Jen Hecht, Education Director at STOP AIDS Project and co-author, said “Since all three groups agree these strategies are important, can be done, and would be used, we need to be getting them online now.”

The study also found a number of strategies with less support. Website owners expressed skepticism about health department staff going online to notify users that they might have been exposed to an STD. In contrast, a majority of HIV and STD prevention directors and users thought this strategy was important. The authors are planning follow-up meetings with owners to further understand their concerns.“We have rising rates of STDs among gay and bisexual men and turning that around means everyone needs to take responsibility for their sexual health,” said Bill Smith, Executive Director of the National Coalition of STD Directors (NCSD). “This study shows how public health professionals, as well the users and owners of sex seeking websites, can band together to make a real difference in securing the sexual health of gay men.”

The study, entitled “How Can We Improve HIV and STD Prevention Online for MSM” funded by amfAR, the Foundation for AIDS Research, was co-authored by H. Fisher Raymond and Willi McFarland at the San Francisco Department of Public Health. The results have been posted today at http://www.stopaids.org/online.

Seven Ways To Save On HIV Meds

by D Gregory Smith

Mark S King over at My Fabulous Disease has some excellent ways to save on medication costs for HIV+ persons. Excerpt:

With all the doctor appointments and wellness activities we engage in, living with HIV/AIDS can be a full-time job. And the truth is, it doesn’t pay very well. We’ve all been feeling the pinch of tough economic times. So I hope you’ll find some savings in this new video blog, “7 Ways to Save Money on Meds.”

Jason King, a pharmacy specialist and patient advocate at AIDS Healthcare Foundation in Ft Lauderdale, was kind enough to give me a tour of their “Out of the Closet” thrift store and then sit down to discuss ways to save money that your pharmacist might not be telling you.

Really Helpful Stuff. Read the rest.

2011 GAY/BI HIV+ Men’s Health Retreat

by D Gregory Smith

 

To register, click here.

 

 

ADAP Waiting List Passes 9,000

by D Gregory Smith


As of August 4th – and for the first time ever – the number of people lingering on AIDS Drug Assistance Program wait lists passed 9,000. A total of 9,039 people in 13 states are now unable to access their medications via the programs, which provide drugs to under and un-insured individuals who are not eligible for other programs such as Medicaid. What’s more, Alabama, which already had a wait list, has reduced its program’s formulary, while Illinois, which already had expenditure caps, has lowered its program’s financial eligibility to 300% the Federal Poverty Level. This brings the total number of states that have enacted “cost-containment” measures to eighteen, plus Puerto Rico.

For more information on the nation’s ADAP crisis, visit www.ADAPaction.org.

Joint Statement Regarding HIV Prevalence, Urgency For Gay/Bi Men

by D Gregory Smith

NEW HIV INCIDENCE ESTIMATES CONFIRM URGENCY TO ADDRESS CRISIS AMONG GAY MEN OF ALL RACES AND ETHNICITIES

Washington, DC – New HIV surveillance data released today by the Centers for Disease Control and Prevention (CDC) indicates that while the overall number of new HIV infections has remained fairly stable from 2006–2009, there continues to be cause for great concern about increasing numbers of new infections among gay men.

While the new HIV incidence estimates, published in the Public Library of Science Medicine, show that prevention activities in the United States have successfully held the number of new infections steady, the National Alliance of State and Territorial AIDS Directors (NASTAD)i and National Coalition of STD Directors (NCSD)ii, remain alarmed about the continued disproportionate impact of HIV and sexually transmitted disease (STD) infections among gay and bisexual men of all races and ethnicities in this country. New estimates indicate that the top most impacted populations include white gay men, Black gay men and Latino gay men, followed closely by Black women.

“An unacceptable increase of HIV incidence among gay men, particularly young Black gay men ages 13-29, requires an honest and critical examination of our prior efforts and a sharpening of our prevention-focused activities among gay men,” remarked Julie Scofield, NASTAD’s Executive Director. “We need to strengthen our communities by breaking down the silos across program and sector and by investing in targeted and innovative programming that promotes the health equity of gay and bisexual men of all races and ethnicities,” she added.

“Increasing HIV rates, coupled with increasing incidence of syphilis and a frequent neglect of rectal STD infections, underscore that we are not doing enough to prevent all STD infections and reduce their role in HIV acquisition,” said William Smith, NCSD’s Executive Director. “NASTAD and NCSD will continue to work with state and local health departments and other partners to develop and implement effective tools and initiatives to address all STDs among all gay and bisexual men,” he continued.In this peer-reviewed article, the CDC estimates 48,100 new infections occurred in the U.S. in 2009, with gay and bisexual men remaining the population most severely impacted by HIV and the only population in which new HIV infections have been increasing steadily since the 1990s. New infections among gay men of all races and ethnicities continue to increase as a proportion of all new infections, with those among young Black gay men ages 13-29 increasing by 48 percent since 2006. This new HIV surveillance data closely follows data released by CDC last month that showed a growing resistance of gonorrhea to antimicrobials, particularly in men who have sex with men (MSM). Gonorrhea is an STD that can facilitate HIV transmission.

In June 2010, NASTAD and NCSD released a Statement of Urgency expressing concern regarding the HIV and STD crises among gay men and other MSM of all races and ethnicities in the United States. Pursuant to the recommendations made in the National HIV/AIDS Strategy (the Strategy), the joint statement calls for greater investment (financial and human) and leadership to address the epidemic among gay men. Given CDC’s decision to cut $20 million from core HIV prevention funding, our federal partners must continue to work with state and local health departments to ensure that all existing resources are leveraged to improve HIV prevention and care and treatment.

NASTAD and NCSD, with support from MAC AIDS Fund, will soon launch a series of targeted activities within HIV and STD programs that will examine and address stigma in public health practice. These efforts will aim to increase comprehensive and appropriate access to prevention, care and supportive services for young Black and Latino gay men, particularly those at-risk for STD transmission. Additionally, these efforts will target social and sexual networks to promote positive sexual health messages and reduce stigma. NASTAD and NCSD will work with their respective members to establish and promote evidence-based practices and tools to educate state and local health departments, service providers and other key community stakeholders about the sexual health of gay men.
______________________________________________________________

i- Founded in 1992, NASTAD is a nonprofit national association of state and territorial health department HIV/AIDS program directors who have programmatic responsibility for administering HIV/AIDS and viral hepatitis health care, prevention, education, and supportive services programs funded by state and federal governments. For more information, visit www.NASTAD.org.

ii- The National Coalition of STD Directors (NCSD) is a partnership of public health professionals dedicated to the prevention of STDs. NCSD provides dynamic leadership that strengthens STD Programs by advocating for effective policies, strategies, and sufficient resources and by increasing awareness of their medical and social impact. For more information, visit www.NCSDDC.org.

Disease and Dad

by D Gregory Smith

From my friend Mark S King over at My Fabulous Disease comes this gem:

The descriptions of his decline, in whispered calls from back home, had a dreadfully familiar feel to them. Weight loss at a frightful pace. Losing interest in the world. Suddenly looking very old indeed. Most gay men of a certain age have heard those words, have seen the patient, have buried the friend. This case was different, though. It wasn’t AIDS, it was cancer.

And the patient was Dad.

Dad and Mark

The disease had swept rapidly through my father since his initial diagnosis. The inevitable was approaching, but the territory was completely unfamiliar to my family, who hadn’t seen a death in more than 30 years. They were about to get a tour through hell. I have traveled it many times.

Amazing take- especially since losing my own mom in April….
Read the full story here.

Survey Time!

by D Gregory Smith

I am always interested in helping researchers understand HIV+ persons, our treatment and the ways we live with our disease. So when I run across them, I like to bring them to your attention.

You are invited to participate in a research project entitled: “Impact of physician communication on HIV/AIDS patients.”
You will be asked about your experiences communicating with your doctor.
This questionnaire will also ask you about your demographic information as well as your HIV/AIDS treatment.

Take the survey here.

Thought You Didn’t Have To Worry About Hepatitis C?

by D Gregory Smith

Hot on the heels of Godzilla Gonorrhea, comes further buzzkill from Science Daily:

Sexual transmission of hepatitis C virus (HCV) is considered rare. But a new study by researchers at Mount Sinai School of Medicine, working with the Centers for Disease Control and Prevention (CDC), provides substantial evidence that men with HIV who have sex with other men (MSM) are at increased risk for contracting HCV through sex.

Yeah. I know- what next? And while it bears further watching, it’s still not the end of the world:

“While hepatitis C is rarely transmitted among stable heterosexual couples, this is clearly not the case among HIV-infected MSM in New York City,” said Dr. Daniel Fierer, Assistant Professor of Medicine and Infectious Diseases at Mount Sinai School of Medicine. “MSM, and to some extent their health care providers are generally not aware that having unprotected receptive sex can result in HCV infection. The good news is that the cure rate for new HCV infections is very high with early treatment, but without regular testing of the men at risk, these largely asymptomatic infections may be missed and this opportunity lost.”
“Our study suggests that HIV-infected MSM should take steps to protect themselves and others by using condoms. Also, health care providers should be screening these men for hepatitis C, and public education and outreach programs should include information about these risks,” Dr. Fierer concluded.

And if you think you’re at risk, (for more info, click this link) you should talk to your healthcare provider and/or ask to be tested.

Your health is YOUR health. Advocate for it.

HIV: Treatment is Prevention

by D Gregory Smith

Today’s New England Journal of Medicine has an excellent research study on HIV, entitled Preventing HIV-1 Infection with Antiretroviral Therapy.

Scott Hammer,MD, in an editorial for the journal, gives a brief overview of the study:

In this issue of the Journal, Cohen et al. describe the results of the HIV Prevention Trials Network (HPTN) 052 study, which has now provided definitive proof that (as suggested by the findings of previous cohort studies) antiretroviral treatment reduces the rate of sexual transmission of HIV-1.

Did you hear that? Definitive proof.

Early antiretroviral treatment not only significantly lowers the risk of transmitting the virus, it also shows increased health benefits for the HIV infected. The conclusions by the research team in the article:

In conclusion, the biologic plausibility of the use of antiretroviral therapy for the prevention of HIV-1 infection has been carefully examined during the past two decades. The idea of HIV-1 treatment as prevention has garnered tremendous interest and hope and inspired a series of population-level HIV-1 treatment-as-prevention studies that are now in the pilot or planning stages. Such interventions are based on the hypothesis that the use of antiretroviral therapy reliably prevents HIV-1 transmission over an extended period of time. In this trial, we found that early antiretroviral therapy had a clinical benefit for both HIV-1–infected persons and their uninfected sexual partners. These results support the use of antiretroviral treatment as a part of a public health strategy to reduce the spread of HIV-1 infection. (emphasis mine)

This is science at work. Get tested. If you’re HIV-positive, get into care and take your meds. We can slow this thing down.

Money quote from Dr Hammer:

Antiretroviral therapy is by no means perfect and is not the ultimate answer to controlling and ending the HIV epidemic. Adverse events, emergence of drug-resistant viral strains, maintenance of adherence, sustainability, and cost are just some of the concerns. However, this is precisely the wrong time to limit access to antiretroviral therapy in resource-limited settings, since we have the tools in hand to maintain or restore health in infected persons and reduce transmission to their sexual partners.

Yep.
So now that we know, will anything happen?

(PS- the picture above is of my morning pills)