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CDC’s Response to HIV-Related Disparities among Gay Men in the U.S.

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Presentation on theme: "CDC’s Response to HIV-Related Disparities among Gay Men in the U.S."— Presentation transcript:

1 CDC’s Response to HIV-Related Disparities among Gay Men in the U.S.
The 4th Annual HIV Outreach & HEI Case Management Conference August 3, 2015 CDC’s Response to HIV-Related Disparities among Gay Men in the U.S. Lamont Scales, MA, NCC Public Health Analyst-MSM Coordinator, Office of Health Equity, Office of the Director, Division of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

2 Presentation Overview
Introduction & Icebreaker Epidemiology Causes of HIV Related Health Disparities Among MSM Health Equity and DHAP’s Office of Health Equity Prevention Activities in Texas Plans for Reaching our Goal Closing Remarks

3 Introduction & Icebreaker

4 Epidemiology

5 Estimated New HIV Infections by Route of Transmission, 2010
Two-thirds of new HIV infections occur among MSM

6 Diagnoses of HIV Infection among Adult and Adolescent Males, by Transmission Category, 2009–2013 United States and 6 Dependent Areas This slide presents the distribution of diagnoses of HIV infection among adult and adolescent males diagnosed from 2009 through 2013, by transmission category, for the United states and 6 dependent areas. The estimated number of diagnoses of HIV infection among adult and adolescent males attributed to male-to-male sexual contact increased by 12% from 27,668 in 2009 to 31,023 in During 2009 through 2013, among adult and adolescent males, the number of diagnoses of HIV infection attributed to heterosexual contact decreased by 14% (from 4,667 in 2009 to 4,021 in 2013); diagnoses of infections attributed to injection drug use decreased by 24% (from 2,687 in 2009 to 2,051 in 2013); and diagnoses of infections attributed to male-to-male sexual contact and injection drug use decreased by 22% (from 1,643 in 2009 to 1,284 in 2013). The remaining diagnoses of HIV infection among males were attributed to other transmission categories. Other transmission categories include hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.    Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing transmission category, but not for incomplete reporting. Heterosexual contact is with a person known to have, or to be at high risk for, HIV infection. Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. a Heterosexual contact with a person known to have, or to be at high risk for, HIV infection. b Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or identified.

7 Diagnoses of HIV Infection among Men Who Have Sex with Men, by Race/Ethnicity, 2009–2013—United States and 6 Dependent Areas The racial/ethnic distribution of diagnoses of HIV infection among adult and adolescent men who have sex with men (MSM) has changed over time in the United States and 6 dependent areas. From 2009 through 2013, the estimated percentage of MSM diagnosed with HIV infection that were white decreased from 34% to 32%, while the percentage of MSM diagnosed with HIV infection that were Hispanic/Latino increased from 23% to 24%, and the percentage among those that were black/African American increased from 38% to 39%. The percentages of MSM diagnosed with HIV infection that were American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander, and those reporting multiple races were small, but remained stable from Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing transmission category, but not for incomplete reporting. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use. Hispanics/Latinos can be of any race. Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use. a Hispanics/Latinos can be of any race.

8 Diagnoses of HIV Infection among Men Who Have Sex with Men, by Race/Ethnicity, 2013—United States and 6 Dependent Areas N = 31,023 This pie chart shows the percentage distribution of HIV infections diagnosed in 2013 among adult and adolescent men who have sex with men (MSM), by race/ethnicity, in the United States and 6 dependent areas. Black/African American MSM accounted for approximately 39% of adult and adolescent MSM who were diagnosed with HIV infection. White MSM accounted for an estimated 32% and Hispanic/Latino MSM accounted for 24%. Asians and persons of multiple races each accounted for approximately 2% of diagnoses of HIV infection. American Indians/Alaska Natives and Native Hawaiians/other Pacific Islanders each accounted for less than 1% of diagnoses. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing transmission category, but not for incomplete reporting. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use Hispanics/Latinos can be of any race. Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use. a Hispanics/Latinos can be of any race.

9 Diagnoses of HIV Infection among Men Who Have Sex with Men, by Region of Residence and Race/Ethnicity 2013—United States and 6 Dependent Areas This bar graph shows the estimated number of diagnoses of HIV infection in 2013 among adult and adolescent men who have sex with men (MSM) by race/ethnicity and the region of the United States where they were living at the time of diagnosis. Diagnoses of HIV infection among adult and adolescent MSM in the 6 U.S. dependent areas are also shown by race/ethnicity. The South had more diagnoses of HIV infection among MSM — 15,267 diagnoses in 2013 — than any other region. The largest group of MSM diagnosed with HIV infection in the South were blacks/African Americans, followed by whites, Hispanics/Latinos, persons of multiple races, Asians, American Indians/Alaska Natives, and Native Hawaiians/other Pacific Islanders. In the West, the estimated number of diagnoses of HIV infection among MSM was 6,021. The racial/ethnic group with the largest number of diagnoses were Hispanics/Latinos, followed by whites, blacks/African Americans, Asians, persons of multiple races, American Indians/Alaska Natives, and Native Hawaiians/other Pacific Islanders. In the Northeast the estimated number of diagnoses of HIV infection among MSM was 5,144. The racial/ethnic group with the largest number of diagnoses were blacks/African Americans, followed by whites, Hispanics/Latinos, persons of multiple races, Asians, American Indians/Alaska Natives, and Native Hawaiians/other Pacific Islanders. In the Midwest, the estimated number of diagnoses of HIV infection among MSM was 4,256. The racial/ethnic group with the largest number of diagnoses were blacks/African Americans, followed by whites, Hispanics/Latinos, persons of multiple races, Asians, American Indians/Alaska Natives, and Native Hawaiians/other Pacific Islanders. In the dependent areas, 98% of diagnoses of HIV infection among MSM in 2013 were in Hispanics/Latinos. Inter-region comparisons of estimated numbers of diagnosed HIV infections should be made cautiously because the four regions and the dependent areas vary by number of jurisdictions and by population size. Regions of residence are defined as follows: Northeast—Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest—Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South—Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West—Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. The 6 U.S. dependent areas include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the U.S. Virgin Islands. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing transmission category, but not for incomplete reporting. Hispanics/Latinos can be of any race. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use. Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use. a Hispanics/Latinos can be of any race.

10 Diagnoses of HIV Infection among Men Who Have Sex with Men, by Age Group, 2009–2013—United States and 6 Dependent Areas From 2009 through 2013, in the United States and 6 dependent areas, the largest estimated numbers of diagnoses of HIV infection were seen among MSM aged years. The number of diagnoses among MSM aged 25–34 increased 25% from 2009 through MSM aged 55 years and older had the greatest percentage increase (29%) in diagnoses of HIV infection from 2009 through The number of diagnoses among those aged 35–44 decreased by 13% during this period. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing transmission category, but not for incomplete reporting. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use. Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use.

11 Diagnoses of HIV Infection among Men Who Have Sex with Men Aged 13–24 Years, by Race/Ethnicity, 2013—United States and 6 Dependent Areas N = 8,018 This pie chart displays the percentage distribution by race/ethnicity of young (aged 13–24 years at diagnosis) men who have sex with men (MSM) who were diagnosed with HIV infection during 2013 in the United States and 6 dependent areas. Of all MSM aged 13–24 years diagnosed with HIV infection in 2013, an estimated 58% were black/African American, followed by Hispanics/Latinos (21%) and whites (16%). This breakdown differs from the percentage breakdown in which all ages were considered: blacks/African Americans accounted for 39% of cases among all adult and adolescent MSM, whites accounted for 32%, and Hispanics/Latinos accounted for 24% (see slide 6 in series). Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing transmission category, but not for incomplete reporting.    Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use. Hispanics/Latinos can be of any race. Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use. a Hispanics/Latinos can be of any race.

12 Causes of HIV Related Health Disparities Among MSM

13 What are some of the causes of HIV/AIDS related disparities?
Increased prevalence of HIV and STDs among African Americans and Hispanic/Latinos HIV Positive AAYMSM & HLMSM are least likely to be aware of infection Stigma & homophobia prevent many from seeking testing and care services YAAMSM are more likely to have older partners and less access to ART YHLMSM may face language barriers or be reluctant to seek care Socioeconomic barriers play a key role Individ. risk behavior alone doesn’t acct for sig. HIV burden in these pops -- complex factors at play: o More HIV and STDs among AAs and Latinos increase risk for infection with every sexual encounter o Young, black HIV+ MSM least likely to be aware of infection; many young Latino MSM also unaware (NHBS) o Stigma, homophobia – prevents many from seeking testing & px o Socioeconomic barriers (e.g., lack of health care access) play a key role o YBMSM more likely to have older partners (who are more likely to be infected) and less access to ART YHLMSM may face language barriers or be reluctant to seek care due to concerns re: immigration status Joseph HA, Marks G, Belcher L, et al. Sex Transm Infect (2011) Mayer, Bekker, Stall, et al Lancet (Vol. 380: ) Millett, Peterson, Flores, et al Lancet (Vol. 380: ) Millett, Jeffries, Peterson, et al Lancet (Vol. 380: )

14 Factors Play a Role There are complex factors at play that can make HIV prevalence among Black gay men higher. Greater risk of being exposed to HIV Sexual relationships with older men, who are more likely to have HIV may increase risk Lack of awareness of HIV status Stigma, homophobia, and discrimination Socioeconomic /

15 definitions and dhap office of health equity

16 Comparison of Definitions
Health Disparities Health Inequities Health Equity SDOH Differences in the incidence and prevalence of health conditions and health status between groups based on: Race/ethnicity Socioeconomic status Sexual orientation Gender Disability status Geographic location Combination of these Systematic and unjust distribution of social, economic, and environmental conditions needed for health. Unequal access to quality education, healthcare, housing, transportation, other resources (e.g., grocery stores, car seats) Unequal employment opportunities and pay/income Discrimination based upon social status/other factors The opportunity for everyone to attain his or her full health potential. No one is disadvantaged from achieving this potential because of his or her social position or other socially determined circumstance. Equal access to quality education, healthcare, housing, transportation, other resources Equitable pay/income Equal opportunity for employment Absence of discrimination based upon social status/other factors Life-enhancing resources whose distribution across populations effectively determines length and quality of life. Food supply Housing Economic relationships Social relationships Transportation Education Health Care

17 DHAP Office of Health Equity MISSION STATEMENT
To coordinate and monitor the Division’s activities related to reducing health inequities among populations most disproportionately affected by HIV and AIDS These populations include, but are not limited to, African Americans; Latinos; gay, bisexual and other men who have sex with men; transgender persons; and injection-drug users.

18 Plans for Conducting Mission
Provide leadership in guiding the Division's efforts to document HIV and AIDS inequities. Provide leadership to the Division on understanding the determinants of HIV and AIDS inequities and strategies for increasing health equity. Serve as the Division liaison with key stakeholder groups including, but not limited to, state and local public health officials, community-based organizations, policy makers, and advocates on HIV and AIDS issues related to health inequities. Monitor the Division's performance on goals related to HIV and AIDS inequities.

19 Plans for Conducting Mission
Work with the Division to integrate methods for addressing health inequities into program activities. Develop partnerships with other federal and nongovernmental organizations focused on addressing HIV and AIDS issues related to health inequities. Sponsor and/or serve as the Division's key representative for health inequities on workgroups, meetings and conferences . Coordinate the DHAP/ORISE HIV Prevention in Communities of Color Post-doctoral Fellowship Program (COC). Coordinate the Minority AIDS Initiative Funding Opportunity.

20 Summary of Responsibilities
Science and Program - setting the Health Equity Science and Program Agenda for the Division. NHAS, NCHHSTP and DHAP Goals on Health Equity: reporting, monitoring and providing oversight on HIV prevention activities targeting populations that are disproportionately affected by HIV. Representation and Partnerships - representing the Division at Health Equity related activities and meetings and creating partnerships with organizations focused on addressing health equity across multiple diseases and disciplines.

21 DHAP Office of Health Equity (OHE) STAFF
Associate Director Donna Hubbard McCree, PhD, MPH, RPh Behavioral Scientist Behavioral Scientist, Lead for Research and Program Evaluation Activities VACANT Senior Public Health Analyst, Coordinator for African American and Incarcerated Populations Activities Laurie Reid, RN, MS, Captain, U.S. Public Health Service Public Health Analyst, Coordinator, Hispanic/Latino Activities Emilio J. German, MS Public Health Analyst, Coordinator, Gay, Bisexual and Other MSM Activities Lamont Scales, MA, NCC

22 Prevention Activities in Texas

23 Prevention Activities in Texas
4/23/2017 Prevention Activities in Texas Community interventions Biomedical interventions Structural interventions HIV testing and linkage to care Individual and small group Interventions HIV prevention What’s working well? What are the challenges? Let’s develop collaborations and solutions. Adapted from : Coates TJ, Richter L, Caceres C. Lancet Aug 23;372(9639):669-84

24 Plans for Reaching our Goal

25 Interventions that are…
Scientifically proven Cost-effective Scalable … targeted to the right populations in the right geographic areas ... to achieve the greatest possible impact on the epidemic

26 CDC Partnerships & Activities
Supporting Prevention Programs Raising Awareness, Testing & Mobilizing Health Departments (CAPUS/PrEP/Data 2 Care/Comprehensive) social and structural factors continuum of care outcomes improvement awareness and access to PrEP Use of surveillance date to link and re-engage comprehensive models of prevention, care, behavioral health, and social services models state-of-the-art training culminating in a certificate of completion CBOs (Comprehensive HIP) ensure reach of programs Nat’l Capacity Building Assistance Program addressing gaps training and technical assistance AIDS United & the Center for Black Equity sexual health of Black gay men awareness, prevention communication, mobilization MSM Testing Initiative Event based testing, couples testing, social networking testing, episodic testing and linkage to care models. YMSM & Transgender Project testing Nat’l Communication Campaigns Act Against AIDS Testing Makes Us Stronger Start Talking. Stop HIV Young Black Gay Men’s Leadership Initiative Consultation & Community Sessions

27 A new era of prevention We can reduce the risk of infection by more than 90% through daily use of PrEP Daily HIV prevention pill recommended for those at risk Real-World PrEP Use Protects Against HIV

28 --“HIV testing is fast, easy and empowering.”
A new era of prevention We can diagnose people several weeks earlier than before with new HIV testing The Huffington Post Using a 21st Century Toolkit to Reverse the Epidemic CDC’s Dr. Jonathan Mermin, --“HIV testing is fast, easy and empowering.”

29 Early H.I.V. Therapy Sharply Curbs Transmission
A new era of prevention We can reduce the rate of transmission by 96% through early initiation of HIV treatment Early H.I.V. Therapy Sharply Curbs Transmission Treatment is prevention

30 Overall: In 2012, of the 1.2 million Americans living with HIV, only 30% are virally suppressed
This slide presents data on four HIV care continuum outcomes: HIV diagnosis (based on data from the National HIV Surveillance System) and receipt of HIV medical care, antiretroviral prescription, and viral suppression (based on data from the Medical Monitoring Project). The denominator is the estimated number of persons aged ≥13 years with diagnosed or undiagnosed HIV infection (prevalence, based on data from NHSS) in the United States. Of an estimated 1,218,400 persons living with (diagnosed or undiagnosed) HIV infection in the United States at the end of 2012, 87.2% had been diagnosed, 39.1% received medical care, 36.2% were prescribed antiretroviral therapy, and 30.2% achieved viral suppression. National HIV Surveillance System: Estimated number of persons aged ≥13 years with diagnosed or undiagnosed HIV infection (denominator) who were alive at the end of the specified year. Estimated number of persons aged ≥13 years with diagnosed HIV infection (numerator) who were alive at the end of the specified year; calculated as part of the overall prevalence estimate. Medical Monitoring Project: Estimated number of persons aged ≥18 years who received HIV medical care January to April of 2012, whose medical record contained documentation of antiretroviral therapy prescription, or whose most recent VL in the previous 12 months was undetectable or <200 copies/mL—United States and Puerto Rico. National HIV Surveillance System,: Estimated number of persons aged ≥13 years living with diagnosed or undiagnosed HIV infection (prevalence) in the United States at the end of The estimated number of persons with diagnosed HIV infection was calculated as part of the overall prevalence estimate. Medical Monitoring Project: Estimated number of persons aged ≥18 years who received HIV medical care during January to April of 2012, were prescribed ART, or whose most recent VL in the previous year was undetectable or <200 copies/mL—United States and Puerto Rico.

31 In 2012, of the gay men diagnosed with HIV, 30% are virally suppressed
This slide presents data on four HIV care continuum outcomes: HIV diagnosis (based on data from the National HIV Surveillance System) and receipt of HIV medical care, antiretroviral prescription, and viral suppression (based on data from the Medical Monitoring Project). The denominator is the estimated number of males aged ≥13 years with diagnosed or undiagnosed HIV infection attributed to male-to-males sexual contact (prevalence, based on data from NHSS) in the United States. Of an estimated 666,900 men with HIV infection attributed to male-to-male sexual contact living with HIV infection in the United States at the end of 2012, 85.2% had been diagnosed, 38.5% received medical care, 35.6% were prescribed antiretroviral therapy, and 30.9% achieved viral suppression. National HIV Surveillance System: Estimated number of persons aged ≥13 years with diagnosed or undiagnosed HIV infection (denominator) who were alive at the end of the specified year. Estimated number of persons aged ≥13 years with diagnosed HIV infection (numerator) who were alive at the end of the specified year; calculated as part of the overall prevalence estimate. Data were statistically adjusted to account for missing transmission category. Medical Monitoring Project: Estimated number of persons aged ≥18 years who received HIV medical care January to April of 2012, whose medical record contained documentation of antiretroviral therapy prescription, or whose most recent VL in the previous 12 months was undetectable or <200 copies/mL—United States and Puerto Rico. National HIV Surveillance System,: Estimated number of persons aged ≥13 years living with diagnosed or undiagnosed HIV infection (prevalence) in the United States at the end of The estimated number of persons with diagnosed HIV infection was calculated as part of the overall prevalence estimate. Medical Monitoring Project: Estimated number of persons aged ≥18 years who received HIV medical care during January to April of 2012, were prescribed ART, or whose most recent VL in the previous year was undetectable or <200 copies/mL—United States and Puerto Rico.

32 Moving Gay Men Along the Continuum of Care

33 Resources – Continuum of Care
Effective Interventions Guidelines

34 Behavioral Interventions Selected for Support by DHAP
People Living with HIV (PLWH) CLEAR Healthy Relationships Partnerships for Health WILLOW Interventions Adapted for PLWH CONNECT for HIV discordant couples START for newly released HIV positive prisoners IDU PROMISE Women Sister to Sister MSM d-up! Mpowerment 3MV POL PCC PROMISE VOICES/VOCES General Safe in the City High-Risk Youth Transgender populations Any of the interventions

35 Resources – PrEP for High Risk Negatives
Guidelines for PrEP and provider supplement PrEPline (in partnership with UCSF)

36 To End HIV/AIDS, let’s take action together.

37 DHAP Publications and Resources
Available by visiting the DHAP website: Or by calling: 1-800-CDC-INFO Division of HIV Prevention Centers for Disease Control and Prevention Corporate Square, Atlanta GA MS D-21 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

38 Thank You Lamont Scales, MA, NCC
Coordinator for Gay, Bisexual, and Other MSM Activities CDC/NCHHSTP/DHAP/OD/OHE or The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, TB Prevention Centers for Disease Control and Prevention


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