HIV in persons born outside the United States, 2007-2010.

CONTEXT: Persons born outside the United States comprise about 13% of the US population, and the challenges these persons face in accessing health care may lead to poorer human immunodeficiency virus (HIV) disease outcomes. OBJECTIVE: To describe the epidemiology of HIV among persons born outside the United States and among US-born persons diagnosed in the United States. DESIGN, SETTING, AND PARTICIPANTS: Analysis of the estimated number of US-born persons and persons born outside the United States diagnosed with HIV from 2007 through 2010 in 46 states and 5 US territories, the demographic characteristics, and the HIV transmission risk factors reported to the National HIV Surveillance System. Foreign-born persons were defined as persons born outside the United States and its territories, inclusive of naturalized citizens. MAIN OUTCOME MEASURE: Diagnosis of HIV infection. RESULTS: From 2007 through 2010, HIV was diagnosed in 191,697 persons in the US population; of these, 16.2% (95% CI, 16.0%-16.3%) (n = 30,995) were born outside the United States. Of the 25,255 persons with a specified country or region of birth outside the United States, 14.5% (n = 3656) were from Africa, 41.0% (n = 10,343) were from Central America (including Mexico), and 21.5% (n = 5418) were from the Caribbean. The 4 states (California, Florida, New York, and Texas) reporting the highest numbers of persons born outside the United States and diagnosed with HIV were also the top 4 reporters of HIV cases overall. Among persons born outside the United States with HIV, 73.5% (n = 22,773) were male. Among whites, 1841 of 55,574 (3.3%) of HIV diagnoses were in persons born outside the United States; in blacks, 8614 of 86,547 diagnoses (10.0%); in Hispanics, 17,913 of 42,431 diagnoses (42.2%); and in Asians, 1987 of 3088 diagnoses (64.3%). The percentage infected through heterosexual contact was 39.4% among persons born outside the United States vs 27.2% for US-born persons. CONCLUSIONS: Among persons in 46 US states and 5 US territories who received a diagnosis of HIV from 2007 through 2010, 16.2% were born outside the United States. Compared with US-born persons diagnosed with HIV, persons born outside the United States had different epidemiologic characteristics.

The impact of ecological conditions on the prevalence of malaria among orangutans.

Contemporary human land use patterns have led to changes in orangutan ecology, such as the loss of habitat. One management response to orangutan habitat loss is to relocate orangutans into regions of intact, protected habitat. Young orangutans are also kept as pets and have at times been a valuable commodity in the illegal pet trade. In response to this situation, government authorities have taken law enforcement action by removing these animals from private hands and attempted to rehabilitate and release these orangutans. In relocating free-ranging orangutans, the animals are typically held isolated or with family members for <48 h and released, but during the course of rehabilitation, orangutans often spend some time in captive and semicaptive group settings. Captive/semicaptive groups have a higher density of orangutans than wild populations, and differ in other ways that may influence susceptibility to infectious disease. In order to determine the impact of these ecological settings on malaria, the prevalence of malaria was compared between 31 captive and semicaptive orangutans in a rehabilitation program at the Sepilok Orangutan Rehabilitation Centre and 43 wild orangutans being moved in a translocation project. The prevalence of malaria parasites, as determined by blood smear and Plasmodium genus-specific nested-polymerase chain reaction, was greater in the captive/semicaptive population (29 of 31) than in the wild population (5 of 43) even when accounting for age bias. This discrepancy is discussed in the context of population changes associated with the management of orangutans in captive/semicaptive setting, in particular a 50-fold increase in orangutan population density. The results provide an example of how an ecological change can influence pathogen prevalence.