Trends among MSM
HIV-related illness and death have had a devastating effect on
MSM. Despite dramatic decreases in AIDS incidence in this
population, MSM continue to account for the largest number of
people for whom AIDS is diagnosed each year. Research suggests
that some MSM are less concerned now than in the past about
becoming infected and may be inclined to take more risks. This
trend is backed up by reported increases in other STDs among MSM
in several large US cities and elsewhere.
AIDS
MSM accounted for nearly half (42%) of all estimated AIDS cases in
men and women (including adolescents) diagnosed in 2003. In that
year alone, 17,969 AIDS cases in MSM were diagnosed, compared
with 6,353 cases in men who acquired their infection through
injection drug use, 5,133 through sex with women, and 1,877
through having sex with men and injecting drugs.
HIV
Data from the 25 states with long-standing HIV reporting show
that estimated new HIV diagnoses in MSM declined from 1994
through 1999 and then began to rise. The increase since 1999 may
be the result of more people being tested, or it may represent new
infections. More data are needed to help explain this increase.
Data reported in 2003 from 41 areas with confidential HIV reporting
indicate that MSM still represent the largest proportion of new HIV
cases among men for which risk is known (46%), compared with
IDUs (11%), men who have sex with women (9%), and MSM who
inject drugs (3%).
Data from the 2004 National HIV behavioral Surveillance (NHBS)
system among young MSM surveyed in 5 US cities show that
- prevalence (number living with HIV at a given point in time) and
incidence (number of new infections over a period of time) of HIV
are high
- many HIV-infected MSM, especially younger and black MSM, are
unaware of their infection
- among MSM with unrecognized infection
- nearly half probably became infected during the past year
- many had not recently been tested because they feared
positive test results
These findings suggest that the HIV epidemic among MSM is
continuing well into the third decade and underscore the need to
increase testing and improve primary prevention practices for MSM.
Examples of CDC Programs and Research for MSM
Programs for MSM face the challenge of cultural barriers, including
stigma, especially in communities where black, Hispanic, and other
men of color live.
Interventions found to be effective for MSM include
- small-group lectures on HIV transmission
- training on negotiating condom use and communicating about
safer sex
- training popular MSM opinion leaders to promote safer sex
One of CDC’s HIV Prevention Strategic Plan objectives for
this population is to increase among MSM the proportion who
consistently engage in behaviors that reduce risk for HIV acquisition
or transmission.
CDC activities that address these objectives include
- Strategies to Address Sexually Transmitted Diseases and
HIV Transmission among MSM. In July 2005, CDC held a
meeting to consult with leaders of gay men’s organizations. The
key questions addressed related to how gay organizations and
CDC could increase awareness of and actions in response to
increasing rates of syphilis and HIV transmission.
- Joint Internal CDC Workgroup. This group developed a Nine-
Point MSM Plan, which focuses on prevention strategies for
reaching MSM.
- Behavioral Surveillance. National HIV Behavioral
Surveillance (NHBS) assesses HIV risk behaviors and trends in
behaviors among MSM in 25 metropolitan areas.
Programs
CDC provides 40 awards to directly funded CBOs that focus
primarily on MSM and provides indirect funding through state,
territorial, and local health departments to organizations serving
MSM. Of these 40 awards, 68% focus on blacks; 23%, Hispanics; 2%,
Asians and Pacific Islanders; and 7%, whites. In terms of age groups,
28% focus on adults; 65%, youth; 3%, elderly people; and 4% are not
reported.
Research
Brothers y Hermanos
This 4-year study will examine psychological, social, cultural, and
environmental factors associated with HIV risk behavior among
black and Hispanic MSM in 3 US cities. The results should shed
light on how these factors differ between men who become
infected with HIV and those who remain free of infection.
Development of prevention messages for MSM
Two research activities have focused on the design of
prevention messages for MSM. The first studies assessed
attitudes toward potential HIV risk-reduction practices,
knowledge of scientific developments, and potential
effectiveness of prevention measures focused on risk
perceptions and behavioral intentions. The second studies
evaluate message effectiveness and different methods
for communicating the relative risk of specific sexual
practices, appeals to protect oneself compared with
appeals to protect one’s partner, and variations in the
directness of visual materials and language.
Project Mix
Project Mix tests a behavioral intervention to reduce
sexual risk associated with substance use among MSM
who use alcohol and other noninjection drugs. The
activities and discussions aim to help the men reduce
sexual risk behavior and substance use. Participant groups are
diverse in terms of HIV status, race and ethnicity, sexual orientation
identification, socioeconomic status, substance use of choice, and
pattern of substance use. The intervention is being tested in 4 US
cities.
Rapid HIV Testing at Minority Gay Pride Events
In 2004, CDC and collaborating state and local health departments
assessed the feasibility of rapid HIV testing at 5 minority gay
pride events in 4 US cities. Rapid HIV testing at these events was
determined to be feasible, accepted by clients and staff, and effective
at identifying persons with previously undiagnosed HIV infection.
During the summer and fall of 2005, CDC will provide funds to set
up rapid testing programs at approximately 4 minority gay pride or
similar events for minority populations.
Back to top
Trends among IDUs
Drug injection was identified as a risk factor for HIV/AIDS early in
the epidemic. HIV is transmitted among IDUs who share injection
drug equipment or have unprotected sex with an infected partner.
AIDS
Since the beginning of the epidemic, injection drug use has directly
or indirectly accounted for more than one third (38%) of estimated
AIDS cases diagnosed in the United States. This association appears
to be continuing. Of all new cases of AIDS diagnosed in 2003, nearly
one quarter (22%) were in IDUs.
Racial and ethnic minority populations are most heavily affected.
In 2003, injection drug use alone accounted for 25% of all AIDS
cases diagnosed in black men and women and 24% of all AIDS cases
diagnosed in Hispanic men and women, compared with only 16% in
white men and women.
Among women, injection drug use accounts for a larger proportion of
AIDS cases than it does among men. Since the epidemic began, 58%
of all AIDS cases in women have been attributed to injection drug
use or sex with partners who inject drugs, compared with 34% in
men.
HIV
The good news is that new HIV diagnoses seem to be declining
overall among IDUs, with a 53% decrease in estimated new HIV
diagnoses from 1994 through 2003 in the 25 states with longstanding
HIV reporting.
In 2003, data reported from 41 areas with confidential HIV infection
reporting showed that among IDUs, blacks accounted for 40% of HIV
infections, compared with Hispanics, 33%, and whites, 25%.
Examples of CDC Programs and Research for IDUs
Preventing the spread of HIV through injection drug use requires
several approaches, including programs to prevent initiation of drug
use, substance abuse treatment programs, education about HIV
prevention, and access to sterile needles and syringes for those who
are unwilling or unable to stop injecting.
Interventions found to be effective for IDUs include
- skills building for heterosexual women receiving methadone
treatment
- problem-solving therapy models for incarcerated male adolescent IDUs
- training to reduce sexual and drug-related HIV risk behaviors for
IDUs receiving treatment for substance abuse
One of CDC’s HIV Prevention Strategic Plan objectives for this
population is to increase among IDUs the proportion who abstain
from drug use or, for those who do not abstain, increase the
proportion who use a clean, sterile syringe for each injection to
reduce risk for HIV acquisition or transmission.
CDC activities that address these objectives include
- Behavioral Surveillance. National HIV Behavioral
Surveillance (NHBS) assesses HIV risk behaviors and trends in
behaviors among IDUs in 25 metropolitan areas.
- REP (Replicating Effective Programs). These “prevention in
a box” projects take interventions proven effective with specific
populations, including IDUs, and package them into kits for use
by local HIV prevention agencies. Examples of interventions
that have proven effective in reducing HIV risk behaviors among
IDUs include Holistic Health Recovery, Street Smart, and Safety
Counts.
Programs
CDC provides 4 awards to directly funded CBOs that focus primarily
on IDUs. Of these 4 awards, 25% focus on blacks; 25%, Hispanics;
25%, whites; and 25%, American Indians and Alaska Natives. In
terms of age groups, 100% focus on adults.
Research
INSPIRE (Interventions for HIV-Seropositive IDUS—Research and
Evaluation)
CDC and the Health Resources and Services Administration jointly
funded INSPIRE in late 1999 as a 5-year study to link prevention
and treatment in each of 4 cities (baltimore, Miami, New York, and
San Francisco). The intervention consists of 10 sessions that focus
on building cognitive-behavioral skills and encouraging participants
to mentor their peers. The results from this study are pending. A
description of the study design, methods, and baseline data was
published in the Journal of Acquired Immune Deficiency Syndromes
in 2004.
DUIT (Drug Users Intervention Trial)
CDC supports and collaborates on a behavioral intervention trial
that has been found effective for lowering the risk for HIV and
hepatitis C infections in IDUs in baltimore, Chicago, Los Angeles,
New York, and Seattle. Back to top
Trends among Heterosexual Adults
Historically, the HIV/AIDS epidemic has affected more men than
women, but women are being increasingly affected. Since 1985 the
proportion of estimated AIDS cases diagnosed among women has
more than tripled, from 8% in 1985 to 27% in 2003.
AIDS
The epidemic has increased most dramatically among women of
color. Although black and Hispanic women together represent
about one fourth of all US women, they account for more than
three fourths of estimated AIDS cases diagnosed to date among US
women. In 2003, black and Hispanic women represented an even
greater proportion (83%) of diagnosed cases in women.
Despite continuing decreases in HIV/AIDS-related deaths in men
and women, HIV/AIDS remains the fifth leading cause of death in
the United States for men and women aged 35–44 years and one of
the top 10 leading causes of death for men and women aged 20–54.
For blacks in these age groups, HIV/AIDS ranks even higher as a
cause of death.
HIV
Although each year more men than women become infected with
HIV, this gap is slowly closing. Data from the 25 states with longstanding
HIV reporting show that new HIV diagnoses in men
declined 27% from 1994 through 2003.
Transmission routes differ by gender. Data from 2003 show that
- among men, HIV transmission is estimated to occur 63% through
sexual contact with men, 14% through injection drug use, and
17% through sexual contact with women.
- among women, HIV transmission is estimated to occur 79%
through sexual contact with men (many of whom are IDUs or also
have sexual contact with men) and 19% through injection drug
use.
Examples of CDC Programs and Research for
Heterosexual Adults
Research has shown that women, as well as men, benefit from
HIV prevention programs. Women benefit from programs aimed at
increasing their awareness of their own risk, assertiveness in sexual
situations, and coping skills.
In its funding of prevention programs for women, CDC emphasizes
- prevention and treatment services for young women and women
of color
- better integrated prevention and treatment services for all
women
- recognition of the intersection of drug use and sexual HIV
transmission, especially among women who trade sex for drugs or
money
- research on effective female-controlled prevention methods for
women who are unwilling or unable to negotiate condom use with
a male partner
- programs with a proven record of effectiveness for changing risky
behaviors and sustaining those changes over time
Interventions found to be effective include
- teaching young heterosexual black women about assertiveness,
negotiation, and condom use
- teaching male and female low-income, urban patients at high
risk about expectations of outcome, skills, and the belief that
one’s words and actions will be effective at preventing HIV
transmission
- showing videos on assertiveness, negotiation, and planning skills
to promote abstinence and safer behaviors among single, innercity
pregnant women
One of CDC’s HIV Prevention Strategic Plan objectives for this
population is to increase among at-risk sexually active women and
at-risk heterosexual men the proportions who consistently engage in
behaviors that reduce risk for HIV acquisition or transmission.
CDC activities and strategies that address these objectives include
- The Revised Recommendations for HIV Screening of
Pregnant Women
- Behavioral Surveillance. National HIV Behavioral
Surveillance (NHBS) will assess HIV risk behaviors and trends
in behaviors among high-risk heterosexuals in 25 metropolitan
areas. Currently, NHBS sites are conducting pilot studies to
determine the best definition of high-risk heterosexual and places
to recruit this population for the behavioral surveys.
Programs
CDC provides 22 awards to directly funded CBOs that focus
primarily on women. Of these 22 awards, 54% focus on blacks; 41%,
Hispanics; and 4%, whites. In terms of age groups, 45% focus on
adults; 45%, youth; and 10% are not reported.
Using Social Network Strategies for Reaching Persons at High Risk
for HIV Infection in Communities of Color
In October 2003, funding was awarded to 9 CBOs in 7 cities to
demonstrate the feasibility of using social network strategies to
reach persons at high risk for HIV infection and provide them HIV
counseling, testing, and referral services. As of September 2004, the
133 enlisted recruiters had referred 814 persons from their social,
sexual, or drug-using networks to get tested for HIV. For the 46
(6%) who received positive test results, this was the first time they
learned that they were HIV-infected.
Research
Safe City Project
The Safe City Project, which began in October 2001, was designed
to develop and evaluate a video-based prevention intervention for
patients in STD clinics. The primary goals are to assess whether
showing a brief 23-minute educational video to male and female
patients in the waiting room can reduce risky sexual behaviors
and new STDs for these patients. After 3 months, researchers will
compare levels of high-risk sexual behavior between the 900 patients
who saw the video and another 900 who did not. After 1 year, they
will compare number of new STDs diagnosed for each group. Back to top
Trends among People of Color
People of color are disproportionately affected by the HIV/AIDS
epidemic. In the early 1980s, most AIDS cases occurred in whites.
However, cases in blacks increased steadily, and by 1996 more cases
occurred in blacks than in any other racial or ethnic population.
AIDS cases have also increased in Hispanics, Asians, Pacific
Islanders, American Indians, and Alaska Natives.
AIDS
Although blacks represent a small proportion (13%) of the US
population, they accounted for a large proportion of the estimated
cumulative AIDS cases (40%) and AIDS deaths (37%) through 2003.
Likewise, Hispanics represent about 12% of the US population, but
they accounted for an estimated 19% of AIDS cases and 18% of AIDS
deaths through 2003.
In terms of risk groups for black men for whom AIDS was diagnosed
in 2003, MSM represent 46%; IDUs, 25%; and heterosexuals, 23%.
Of risk groups for Hispanic men with AIDS, MSM represent 53%;
IDUs, 23%; and heterosexuals, 17%.
Among black women for whom AIDS was diagnosed in 2003,
injection drug use accounted for an estimated 25% of all cases and
heterosexual contact for 72%. Among Hispanic women with AIDS,
heterosexual contact accounted for an estimated 71% of cases and
injection drug use for 27%.
HIV
The disparity between black and white people continues. Data from
the 25 states with long-standing HIV reporting from 1994 through
2003 indicate that an estimated 55% of people with a new diagnosis
of HIV were black (and not Hispanic), compared with 35% who were
white (and not Hispanic). New HIV diagnoses from 1994 through
2003 declined more sharply among whites (31%) than among blacks
(24%). Of the roughly 1 million people estimated to be living with
HIV at the end of 2003, 46/% were black.
Examples of CDC Programs and Research for
People of Color
CDC is committed to working with communities of color to ensure
that those who have been disproportionately affected by HIV/AIDS
have access to early testing, treatment, and prevention services and
programs that work.
Interventions found to be effective for people of color include
- using culturally appropriate videos to teach small groups of
sexually active black and Hispanic men and women about
condom use, negotiation skills, and safer sex
- teaching health care providers how to work with young black and
Hispanic MSM and heterosexuals in prevention activities
- providing risk-reduction activities; access to HIV counseling,
testing, and referral services; and prevention information to black
youth
- training black youth as peer educators in their communities
- offering HIV counseling and testing services and outreach
activities to black churches and offering outreach, discharge
planning, community case management, and education services
to correctional institutions
The CDC HIV Prevention Strategic Plan’s overarching national
goal focuses on eliminating racial and ethnic disparities in new HIV
infections.
CDC activities that address this goal include
- Supplemental Funding for Community-based Strategies
to Increase HIV Testing of Persons at High Risk in
Communities of Color. These funds support a social network
model to increase HIV counseling and testing among high-risk
minority communities.
- Research Fellowship on HIV Prevention in Communities
of Color. This program supports the training of scientists
researching sociocultural, structural, psychological, and
behavioral factors in minority health and HIV.
- MARI (Minority HIV/AIDS Research Initiative). This
capacity-building initiative funds investigators working on
HIV/AIDS research gaps in black and Hispanic communities.
Programs
CDC provides more than $300 million to help communities build and
sustain sound, innovative HIV prevention programs. In addition, the
Minority AIDS Initiative provides funding to state and local health
departments for HIV prevention resources for minority populations
at high risk. CDC provides 179 awards to directly funded CBOs that
focus primarily on people of color. Of these 179 awards, 59% focus
on blacks; 25%, Hispanics; 13%, Asians and Pacific Islanders; and
1% American Indians and Alaska Natives. In terms of age
groups, 69% focus on adults; 25%, youth; and 6%, elderly
people.
Using Social Network Strategies for Reaching Persons at
High Risk for HIV Infection in Communities of Color
In October 2003, funding was awarded to 9 CBOs in 7
cities to demonstrate the feasibility of using social network
strategies to reach persons at high risk for HIV infection
and provide them HIV counseling, testing, and referral
services. As of September 2004, the 133 enlisted recruiters
had referred 814 persons from their social, sexual, or drugusing
networks to get tested for HIV. For the 46 (6%) who
had positive HIV test results, this was the first time they
learned that they were HIV-infected.
Research
Project START
Conducted at 4 sites from 1998 through 2003, this HIV
and STD prevention project is for young men being released from
prison. At 24 weeks after release, men who received an enhanced
intervention (before and after release) were significantly less likely
to report having had unprotected sex during their most recent
sexual encounter (59%) than were men who received a 1-session
intervention (69%) before release.
Brothers y Hermanos
This 4-year study will examine psychological, social, cultural, and
environmental factors associated with HIV risk behavior among
black and Hispanic MSM in 3 US cities. The results should shed
light on how these factors differ between men who become infected
with HIV and those who remain free of infection. Back to top
Trends among Youth
The HIV/AIDS epidemic has taken a heavy toll on young people
in the United States. because it is presumed that young people
with HIV were infected fairly recently, scientists believe that HIV
infections among youth may indicate trends in the overall HIV/AIDS
epidemic. Trends in STDs other than HIV among young persons
serve as indicators of risk behaviors for HIV.
AIDS
From the beginning of the epidemic through 2003, an estimated
9,789 young people (aged 15–24 years) with AIDS have died.
Fortunately, since the late 1980s (from 1989 through 2003), deaths
from AIDS have declined 71% for people in this age group. However,
the challenges of addressing disparities in care, preventing
secondary transmission of HIV, and meeting the social and medical
needs of persons living with HIV or AIDS are especially critical for
youth, considering their long-term needs.
HIV
Data from the 25 states with long-standing HIV reporting show
that among people aged 25–34 years, the estimated number of new
diagnoses from 1994 through 2003 declined by a remarkable 49%.
However, in youth aged 13–24, new HIV diagnoses remained stable
during this time period.
Young women and young black men and women are being
increasingly affected by HIV. In 2003, data reported from 41 areas
with confidential HIV reporting showed that young women account
for nearly half (40%) of HIV infections in those aged 13–24 years.
black youth have been most heavily affected, accounting for 55% of
all HIV infections reported among those aged 13–24 in areas with
confidential HIV reporting.
Young MSM, especially those of color, are also at high risk for HIV
infection. The CDC Young Men’s Survey showed that from 1994
through 1998, 14% of black MSM and 7% of Hispanic MSM aged
15–22 years were HIV-infected.
Examples of CDC Programs and Research for Youth
Prevention research has identified many interventions that help
young people adopt healthier behaviors. Parents have been shown
to be powerful resources. CDC’s primary message for youth is
abstinence.
Interventions CDC has found effective with youth include
- holding small-group discussions among young MSM about
reducing unsafe sexual behaviors, training others to conduct
informal outreach, and conducting a publicity campaign
- teaching runaway youth safer behaviors through role-playing
and problem-solving exercises to help them identify triggers and
decrease harmful behavior
- teaching students to postpone sex and reduce unsafe sexual and
drug-using behaviors
One of CDC’s HIV Prevention Strategic Plan objectives for this
population is to increase among adolescents the proportion who
consistently engage in behaviors that reduce risk for HIV acquisition
or transmission.
CDC activities that address this goal include
- HIV Prevention Projects for Community-based
Organizations Targeting Young Men of Color Who Have
Sex with Men. These programs create, put into place, and
sustain services to help prevent HIV in young MSM of color, their
sex partners, and transgendered youth.
- Pregnancy in Perinatally Infected Youth. This study looks at
teenagers who had acquired HIV from their mothers and are now
pregnant and having their own children.
- REP (Replicating Effective Programs). This “prevention in
a box” project takes interventions proven effective with specific
populations and packages them into kits for use by local HIV
prevention agencies. Of 10 interventions, 3 serve youth only and
2 others include youth in their populations served.
- School-based HIV Prevention. These programs support
48 state education agencies, 18 large city education agencies,
7 territorial agencies, and 37 national nongovernment
organizations to help set up school health programs that provide young people with skills and information to avoid or reduce
behaviors that put them at risk for HIV infection. In 2003, 88%
of all high school students reported receiving HIV prevention
education.
Programs
CDC provides 36 awards to directly funded CBOS that focus
primarily on youth and provides indirect funding through state,
territorial, and local health departments to organizations serving
youth. Of these 36 awards, 75% focus on blacks; 19%, Hispanics; 3%,
Asians and Pacific Islanders; and 3%, whites.
Parents Matter!
This community-based intervention promotes effective parenting
and parent-child communication to reduce sexual risk. Although
parents are in a unique position to provide early and continuous HIV
prevention messages, many lack the information, skills, comfort, or
confidence to do so.
Partnership for Adolescent Wellness Study (PAWS)
PAWS is a formative research study of black youth (aged 12–17
years) whose mothers use crack cocaine. Conducted in 2 cities in
North Carolina, the study explores what influences HIV-related risk
behaviors of these young people.
Research
CITY (Community Intervention Trials for Youth)
CITY evaluated approaches for encouraging young men who engage
in HIV-risk behaviors, especially racial and ethnic minorities aged
15–25, to change these behaviors.
YMS (Young Men’s Survey)
This study, conducted in 2 phases (1994–1998 and 1998–2000),
measured HIV infection (and hepatitis and syphilis) and related risk
behaviors of young MSM.
YWS (Young Women’s Survey)
This survey, conducted in 1999, examined sexual behaviors and HIV
risk behaviors of young black women at clinics in New York City and
Dallas. Back to top
Trends among Pregnant Women and their Infants
HIV transmission from mother to child (also called perinatal
transmission) can occur during pregnancy, labor, delivery, or breastfeeding.
Mother-to-child HIV transmission accounts for over 90% of
all AIDS cases in US children.
During the early to mid 1990s, 6,000 to 7,000 HIV-infected women
gave birth each year. An estimated 1 in 4 of these newborns acquired
the mother’s HIV infection. Had this transmission rate continued,
an estimated 1,750 HIV-infected infants would have been born in
the United States each year, and lifetime medical costs for these
infants may have reached $282 million. Fortunately, this trend was
successfully interrupted. With current estimates being 280 to 370 perinatal infections each year and costs per individual $185,000,
lifetime costs are closer to $60 million.
This decline in the number of HIV-infected infants occurred after
the 1994 and 1995 US Public Health Service recommendations for
preventing mother-to-child HIV transmission.
The recommendations include
- routinely offering counseling and voluntary HIV testing to
pregnant women
- offering zidovudine (also called ZDV or AZT) treatment to HIV infected
women during pregnancy and delivery
- treating the infant with zidovudine after birth
Most pregnant women voluntarily accept HIV testing if it is offered by their
health care provider. Testing rates are higher in areas
with voluntary opt-out policies (in which testing is routine unless a
woman chooses to not be tested) and mandatory testing of newborns.
Between 1992 and 2003, estimated cases of perinatally acquired
AIDS declined 94% in the United States, from 912 cases to 58 cases.
However, children of color—especially black children—continue
to be disproportionately affected by AIDS. Although only 16%
of US children are black, 67% of US children with a diagnosis of
perinatally acquired AIDS in 2003 were black.
HIV exposure risks for mothers of children with AIDS have changed over time. In
the early 1980s, most women were exposed to HIV through injection drug use and a
smaller proportion through sex with men. However, during the 1990s, these
proportions reversed; the mother’s exposure through sex with men now plays a
larger role than the mother’s injection drug use.
Examples of CDC Programs and Research for
Pregnant Women and their Infants
Efforts to prevent mother-to-child HIV transmission must focus on
preventing new HIV infections in women; providing timely prenatal
care and HIV testing during pregnancy (including rapid HIV testing
during labor); and making sure all HIV-infected pregnant women
receive care, prevention case management, and treatment.
One of CDC’s HIV Prevention Strategic Plan objectives is to increase
the proportion of pregnant women who are tested for HIV and, if
infected, choose to take medication to interrupt mother-to-child
transmission of HIV. One of the goals of CDC’s recently launched
initiative, Advancing HIV Prevention, is to further decrease mother-to-child transmission of HIV.
Program
Perinatal Elimination Efforts
Since 1999, Congress has provided $10 million a year to reduce
mother-to-child transmission of HIV in the United States. CDC
distributes these funds to
- 10 state and city jurisdictions for enhanced perinatal surveillance
16 state prevention programs serving pregnant women at high
risk for HIV
5 national health care provider organizations to develop training
materials for health care providers and educational materials for
pregnant women
Research
EPS (Enhanced Perinatal Surveillance)
EPS is one of CDC’s activities to further reduce mother-to-child
transmission of HIV in areas with high levels of HIV. EPS is an
extension of routine surveillance activities. Its goals are to
- monitor
-
adherence to US Public Health Service recommendations for
HIV counseling and voluntary testing of pregnant women
- use of medication regimens recommended by the US Public
Health Service to prevent mother-to-child transmission of
HIV
- effect of the recommendations on trends of HIV disease in
children
- establish a surveillance system that collects data to help states
respond to certain requirements of the Ryan White CARE Act
- assist in timely evaluation of efforts to prevent mother-to-child
transmission of HIV
EPS data from 24 sites from 1999 through 2001 show that 1 in 8
(12%) HIV-infected women did not receive prenatal care, and 1 in 10
(10%) did not get tested for HIV before giving birth.
MIRIAD (Mother Infant Rapid Intervention at Delivery)
The MIRIAD project has shown that rapid HIV testing during labor
for women whose HIV status is unknown is acceptable,
effective, and feasible. CDC has a national plan for rapid HIV
testing of pregnant women. CDC published a model protocol
for hospitals, updates the protocol as new rapid HIV tests
become licensed, and funds regional trainings for several US
hospitals.
LEGACY (Longitudinal Epidemiologic Study to Gain Insight
into HIV and AIDS in Children and Youth)
LEGACY is a new study of HIV-infected children and
adolescents, from birth through 24 years, who are receiving
care from a pediatrician or specialist in adolescent medicine.
The study is being conducted at approximately 20 sites
throughout the United States. The study will monitor trends
in
- illness and death in HIV-infected children and adolescents,
including how their disease is progressing, how well their
immune system is working, any long-term complications from the
disease or its treatment, and how long they are living
- use of antiretroviral drugs and any side effects or viral resistance
from long-term treatment with these drugs
- factors that may be related to the risk for secondary transmission
of HIV from young people
Back to top
Trends among Correctional Facility Inmates
Rates of HIV and AIDS are high among correctional facility inmates;
similarly, rates of incarceration are high among HIV-infected
people. Many inmates (12% according to a 2002 Supplement to
HIV/AIDS Surveillance study) receive their diagnosis of HIV while
incarcerated.
AIDS
The rate of confirmed AIDS cases for state and federal inmates
(48/10,000) is more than 3 times the rate for the general US
population (14/10,000). In 2002, the prevalence of AIDS was 0.5%
for inmates in state prisons and 0.4% for inmates in federal prisons.
About 20% of inmates known to be HIV-infected also had a diagnosis
of AIDS.
Fortunately, effective therapies have led to marked increases in the
survival of inmates with AIDS. The number of AIDS-related deaths
of inmates has been decreasing dramatically since it peaked in 1995;
by 2002, the number of AIDS-related deaths in state prisons had
declined 72%. In 2002, the reported number of AIDS-related deaths
was 215 for state inmates and 17 for federal inmates. AIDS-related
deaths accounted for 5% of all deaths in federal prisons.
HIV
At the end of 2002, 2.0% of state prison inmates and 1.1% of federal
prison inmates were known to be HIV-infected. The total number of
inmates known to be HIV-infected was 23,864. In 2002, the highest
rates of HIV infection for inmates occurred in the Northeast, where
4.6% of the prison population was HIV-infected, followed by 2.2%
in the South, 1.0% in the Midwest, and 0.7% in the West. In state
prisons, a higher percentage of female (3.0%) than male (1.9%)
inmates were HIV-infected.
Examples of CDC Programs and Research for
Correctional Facility Inmates
Trends in HIV and AIDS in correctional facilities affect not
only inmates but the general public because many inmates
(approximately 7.5 million per year) are released back into the
community. However, most correctional facilities have inadequate
or no discharge planning (plans for linking released inmates with
community-based health care, substance abuse treatment, and other
services). CDC uses a community approach to improve the health of
inmates by collaborating with correctional facilities, public health
agencies, and community health care and social service providers.
because approximately 80% of prisoners have a history of substance
use, some HIV prevention programs for inmates focus on IDUs.
Program
CDC/HRSA Corrections Demonstration Project
CDC and the Health Resources and Services Administration ( funded 7 states for this project. The project’s purpose was
to develop, set up, and evaluate models for innovative programs
to provide continuity of care (follow-up care after release). Using
outreach, HIV education, and HIV/AIDS counseling and testing,
the project served inmates, especially racial and ethnic minorities,
who were HIV-infected or at risk for HIV infection. The project
encouraged collaborations between correctional facilities, public
health agencies, CBOs, and health care providers. Evaluations
will focus on whether health outcomes were improved by linking
discharged inmates to services and keeping them in services.
Routine Rapid HIV Testing of Inmates in Short-stay Correctional
Facilities
State health departments in Florida, Louisiana, New York,
and Wisconsin have been funded to offer HIV rapid testing and
prevention counseling as a standalone procedure to male and female
inmates. All inmates are confidentially notified of their test results
at the time of rapid testing. Inmates with preliminary positive HIV
rapid test results are offered confirmatory HIV testing. Inmates
with a positive confirmatory result are referred to appropriate care,
treatment, and prevention services. From January 2004 through March 2005, a total of 16,676 rapid tests have been conducted. Of
these, 256 (1.5%) were reactive. Of the 236 persons who consented to
confirmatory HIV testing, 200 had confirmed positive test results; of
these, 121 (61%) were newly identified infections. Routinely offering
voluntary rapid HIV testing with other STD screening as
a component of the medical evaluation may increase use.
Provision of consistent, high-quality counseling and testing
services could potentially build trust between inmates
and staff and improve program acceptance and success. A
comprehensive guidance document on implementing HIV
rapid testing in jails will be developed after project activities
have been completed.
Research
CDC Corrections Discharge Planning Study
CDC funded this study of discharge planning and continuity of care
for HIV-infected releases in 10 states. Questionnaires and follow up
phone interviews identified state-of-the-art practices and factors
that help or hinder discharge planning and continuity of care. The
findings indicated that
- discharge planning should be holistic and tailored to the
individual
- continuity of medical care is most likely when releases receive
- medication at the time of release
- a printed summary of their prison medical records
- a medical appointment in the community
- help applying for medical and cash benefits (eg, Medicaid,
AIDS Drug Assistance Program)
Project START
Conducted at 4 sites from 1998 through 2003, this HIV/STD
prevention project is for young men being released from prison. It
compared sexual risk after a 1-session intervention (before release)
to that after an enhanced intervention (before and after release). At
24 weeks after release, men who received the enhanced intervention
were significantly less likely to report having had unprotected sex
during their most recent sexual encounter (59%) than were men who
received the 1-session intervention (69%). Back to top
Trends among People Worldwide
HIV and AIDS pose one of the greatest challenges to global public
health. Worldwide in 2004, more than 3 million people died from
AIDS. During that same year, an estimated 5 million people
acquired HIV, bringing the number of people living with HIV to 39
million. Especially vulnerable are disadvantaged, marginalized, and unempowered populations such as commercial sex workers, IDUs,
MSM, women and girls, and people living in poverty. Many people
do not know that they carry the virus. Millions more know nothing
or too little about HIV to protect themselves against it. Even those
who do know about HIV prevention may not have the power to act
on it, especially women and girls, who are often unable to say no to
unprotected sex or to negotiate safer behaviors.
Sub-Saharan Africa
Approximately 25.4 million people are living with HIV/AIDS; an
estimated 3.1 million were newly infected with HIV in 2004.
HIV/AIDS is the leading cause of death in sub-Saharan Africa.
In 2004 alone, AIDS killed 2.3 million African people. Without
adequate treatment and care, most of those living with HIV will not
survive the next decade.
Asia and the Pacific
Approximately 8.2 million people are living with HIV/AIDS; an
estimated 1.2 million were newly infected in 2004. New infections
increased 8% since 2002. The epidemic claimed over 540,000 lives
in 2004. High HIV infection rates in the region are being discovered
among IDUs, MSM, and sex workers.
Latin America and the Caribbean
Approximately 2.1 million people are living with HIV/AIDS; an
estimated 293,000 were newly infected in 2004. Driving the spread
of HIV are unequal socioeconomic development and a highly mobile
population. The region, however, has made admirable progress in
providing treatment and care.
Western Europe, North America, Australia, and New Zealand
Approximately 1.6 million people are living with HIV/AIDS; an
estimated 70,000 were newly infected in 2004. A larger epidemic
threatens to develop in high-income countries. Unsafe sex and
widespread injection drug use are propelling these epidemics, which
are shifting more toward underprivileged communities.
Eastern Europe and Central Asia
Approximately 1.4 million people are living with HIV/AIDS; an
estimated 210,000 were newly infected in 2004. Eastern Europe—
especially the Russian Federation—continues to experience the
fastest growing epidemic in the world. because of high levels
of other STDs and injection drug use among young people, the
epidemic may grow considerably.
The Middle East and North Africa
Approximately 540,000 people are living with HIV/AIDS; an
estimated 92,000 were newly infected in 2004. Poor surveillance
systems in several countries hinder accurate assessment of and
response to the epidemic.
Examples of CDC Programs and Research for
People Worldwide
For many years, CDC has been working with others to fight
HIV/AIDS around the world. The international goal of CDC’s HIV
Prevention Strategic Plan is to assist in reducing HIV transmission
and improving HIV/AIDS care and support in partnership with
resource-constrained countries.
Program
CDC’s Global AIDS Program (GAP)
CDC’S Divisions of HIV/AIDS Prevention provide support and
technical assistance for GAP. Under the direction of the US Global
AIDS Coordinator’s Office, CDC’s Global AIDS Program (GAP) is a
major partner in the effort to address the Emergency Plan for AIDS
Relief, announced by President bush in his 2003 State of the Union
address. The goals of the Plan are to
- treat 2 million HIV-infected people
- prevent 7 million new HIV infections
- care for 10 million people (people living with HIV and children
orphaned because of HIV) in 15 of the world’s most affected
countries
As of 2004, GAP has programs in 25 countries and 4 regional
programs in Africa, Asia, Latin America, and the Caribbean. GAP
provides assistance directly through its own staff and through
partnerships with governments, communities, and other national
and international groups.
GAP’s mission is to
- prevent HIV infection
- improve care, support, and treatment for people living with
HIV/AIDS
- strengthen the capacity of countries to address the global
HIV/AIDS epidemic
GAP’s priority areas include
- providing support for HIV/AIDS surveillance systems
- enhancing voluntary counseling and testing programs and
services
- strengthening laboratory capacities and systems
- providing care, support, and treatment for people living with
HIV/AIDS
- reducing mother-to-child transmission of HIV
- training program staff
Research
The focus of CDC’s international HIV research is developing and
testing potential HIV vaccines and microbicides as well as looking
for new ways to reduce mother-to-child HIV transmission. CDC is
also involved in providing technical support for programs working
with drugs for HIV treatment; these programs aim to improve care
for people with HIV and to prevent HIV transmission from mother to
child. CDC’s international HIV/AIDS research is mostly conducted
in GAP field stations with staff assigned to Botswana, Kenya, and
Thailand. In addition, CDC is involved in collaborative research
projects in Cameroon, Malawi, Russia, South Africa, Uganda, and
Zimbabwe.
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