Comparisons of New HIV Rapid Test Kit Performance.

The development of rapid point-of-care tests for HIV infection has greatly reduced the problem of failure to return for test results. Test manufacturers are now developing test kits that can test for two or even three diseases at the same time, multiple-disease test kits. This study reports on the sensitivity and specificity of HIV tests when included on multi-disease test kits. 1029 participants were recruited from 2011 to 2014. HIV test kit sensitivities ranged from 91.1 to 100%, and the HIV test kit specificities from 99.5 to 100%. The two HIV kits which used oral fluid instead of blood performed well.

HIV Viral Suppression, 37 States and the District of Columbia, 2014.

Achieving viral suppression among HIV-positive persons is a critical component of HIV treatment and prevention, because it leads to improved health outcomes for the individual and reduced risk of HIV transmission. There is wide variation in viral suppression across jurisdictions, races/ethnicities, age groups, and transmission risk groups. This analysis uses HIV surveillance data to examine rates of viral suppression among people living with diagnosed HIV (PLWDH) in 38 jurisdictions with complete lab reporting. Among people who received a diagnosis in 2014, the percentage with viral suppression within 12 months of diagnosis and the average time to viral suppression was assessed. Overall, among PLWDH in 2014, 57.9% were virally suppressed, and, among people with HIV diagnosed in 2014, 68.2% were suppressed within 12 months of diagnosis with an average time to suppression of 6.9 months. All outcomes varied by jurisdiction, but most had similar patterns of disparities with a few exceptions. These data highlight the need for tailored interventions at the local level. In addition, jurisdictions with relatively low viral suppression among particular groups could adapt effective interventions from jurisdictions who have higher rates of suppression.

Trends in Sexual Behavior Among Men Who have Sex with Men (MSM) in High-Income Countries, 1990-2013: A Systematic Review.

HIV diagnoses among men who have sex with men (MSM) have been increasing in several high-income countries. A better understanding of the sexual behavior trends among MSM can be useful for informing HIV prevention. We conducted a systematic review of studies that examined behavioral trends (1990-2013) in any condomless anal sex, condomless anal sex with an HIV-discordant partner, and number of partners. Studies included come from the United States, Europe, and Australia. We found increasing trends in condomless anal sex and condomless anal sex with an HIV-discordant partner, and a decreasing trend in number of partners. The increase in condomless anal sex may help to explain the increase in HIV infections. More explanatory research is needed to provide insight into factors that contribute to these behavior trends. Continuous monitoring of HIV, risk behaviors, and use of prevention and treatment is needed to evaluate prevention efforts and monitor HIV transmission risk.

Exchange Sex and HIV Infection Among Men Who Have Sex with Men: 20 US Cities, 2011.

This study assessed the prevalence of exchanging sex for money or drugs among men who have sex with men (MSM) in the 2011 US National HIV Behavioral Surveillance system. Prevalence of HIV, being HIV-positive but unaware (HIV-positive-unaware), risk behaviors and use of services were compared between MSM who did and did not receive money or drugs from one or more casual male partners in exchange for oral or anal sex in the past 12 months. Among 8411 MSM, 7.0 % exchanged sex. MSM who exchanged sex were more likely to be non-Hispanic black, live in poverty, have injected drugs, have multiple condomless anal sex partners, be HIV-positive and be HIV-positive-unaware. In multivariable analysis, exchange sex was associated with being HIV-positive-unaware (aPR 1.34, 95 % CI 1.05-1.69) after adjusting for race/ethnicity, age, education, poverty, and injecting drugs. MSM who exchange sex represent an important group to reach with HIV prevention, testing, and care services as they were more likely to report behavioral risk factors that put them at risk of HIV.

Association Between Enacted Stigma and HIV-Related Risk Behavior Among MSM, National HIV Behavioral Surveillance System, 2011.

MSM bear a disproportionate burden of the HIV epidemic. Enacted stigma (overt negative actions) against sexual minorities may play an important role in increasing HIV risk among this population. Using data from the 2011 National HIV Behavioral Surveillance system, MSM cycle, we examined the independent associations between three measures of enacted stigma (verbal harassment, discrimination, physical assault) and engagement in each of four HIV-related risk behaviors as outcomes: condomless anal intercourse (CAI) at last sex with a male partner of HIV discordant or unknown status and, in the past 12 months, CAI with a male partner, ≥4 male sex partners, and exchange sex. Of 9819 MSM, 32% experienced verbal harassment in the past 12 months, 23% experienced discrimination, and 8% experienced physical assault. Discordant CAI at last sex with a male partner was associated with previous discrimination and physical assault. Past 12 month CAI with a male partner, ≥4 male sex partners, and exchange sex were each associated with verbal harassment, discrimination, and physical assault. These findings indicate that a sizable proportion of MSM report occurrences of past 12 month enacted stigma and suggest that these experiences may be associated with HIV-related risk behavior. Addressing stigma towards sexual minorities must involve an integrated, multi-faceted approach, including interventions at the individual, community, and societal level.

Age-Specific Race and Ethnicity Disparities in HIV Infection and Awareness Among Men Who Have Sex With Men--20 US Cities, 2008-2014.

BACKGROUND: Over half of human immunodeficiency virus (HIV) infections in the United States occur among men who have sex with men (MSM). Among MSM, 16% of estimated new infections in 2010 occurred among black MSM <25 years old. METHODOLOGY: We analyzed National HIV Behavioral Surveillance data on MSM from 20 cities. Poisson models were used to test racial disparities, by age, in HIV prevalence, HIV awareness, and sex behaviors among MSM in 2014. Data from 2008, 2011, and 2014 were used to examine how racial/ethnic disparities changed across time. RESULTS: While black MSM did not report greater sexual risk than other MSM, they were most likely to be infected with HIV and least likely to know it. Among black MSM aged 18-24 years tested in 2014, 26% were HIV positive. Among white MSM aged 18-24 years tested in 2014, 3% were HIV positive. The disparity in HIV prevalence between black and white MSM increased from 2008 to 2014, especially among young MSM. CONCLUSIONS: Disparities in HIV prevalence between black and white MSM continue to increase. Black MSM may be infected with HIV at younger ages than other MSM and may benefit from prevention efforts that address the needs of younger men.

Vital Signs: Trends in HIV Diagnoses, Risk Behaviors, and Prevention Among Persons Who Inject Drugs - United States.

BACKGROUND: Persons who inject drugs (PWID) are at increased risk for poor health outcomes and bloodborne infections, including human immunodeficiency virus (HIV), hepatitis C virus and hepatitis B virus infections. Although substantial progress has been made in reducing HIV infections among PWID, recent changes in drug use could challenge this success. METHODS: CDC used National HIV Surveillance System data to analyze trends in HIV diagnoses. Further, National HIV Behavioral Surveillance interviews of PWID in 22 cities were analyzed to describe risk behaviors and use of prevention services among all PWID and among PWID who first injected drugs during the 5 years before their interview (new PWID). RESULTS: During 2008-2014, HIV diagnoses among PWID declined in urban and nonurban areas, but have leveled off in recent years. Among PWID in 22 cities, during 2005-2015, syringe sharing decreased by 34% among blacks/African Americans (blacks) and by 12% among Hispanics/Latinos (Hispanics), but remained unchanged among whites. The racial composition of new PWID changed during 2005-2015: the percentage who were black decreased from 38% to 19%, the percentage who were white increased from 38% to 54%, and the percentage who were Hispanic remained stable. Among new PWID interviewed in 2015, whites engaged in riskier injection behaviors than blacks. CONCLUSIONS: Decreases in HIV diagnoses among PWID indicate success in HIV prevention. However, emerging behavioral and demographic trends could reverse this success. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Access to comprehensive prevention services is essential for all PWID. Syringe services programs reduce syringe sharing and can help PWID access prevention and treatment services for HIV and other bloodborne diseases, such as hepatitis C and hepatitis B.

Prevalence and Correlates of Heterosexual Anal Intercourse Among Men and Women, 20 U.S. Cities.

Heterosexual anal intercourse (HAI) is not an uncommon behavior and it confers a higher risk of HIV transmission than vaginal intercourse. We examined data from heterosexuals recruited in 20 US cities for the 2013 National HIV Behavioral Surveillance system. We assessed correlates of reporting HAI in the previous year. Then, among people reporting HAI in the past year, we assessed what event-level factors are associated with having HAI at last sex. Thirty percent of women and 35 % of men reported HAI in the past year. Among people who had HAI in the past year, those who had HAI at last sex were more likely to have a partner who was HIV-positive or of unknown status or to have exchanged money or drugs for sex at last sex. Information that highlights the risk of HIV transmission associated with HAI would complement existing HIV prevention messages focused on heterosexuals in the U.S.

Psychometric Properties of the Milestones of Recovery Scale-Older Adult Version.

The Milestones of Recovery Scale (MORS) is a tool that mental health professionals can use to track clients' recovery. It has been shown to have good reliability and validity in an adult population. It is important to demonstrate its psychometric properties among the elderly. This study assessed the reliability and validity of the MORS among a multi-ethnic (52 % White) sample of adults 54 and older (M = 67) at several mental health agencies in California. The clients, N = 432, were assessed by two raters each at two time points 2 weeks apart. Ratings were obtained on the MORS, the modified Global Assessment of Functioning scale (mGAF), and the Multnomah Community Ability Scale (MCAS). The MORS demonstrated acceptable reliability: inter-rater r = .65 and test-retest r = .71; the mGAF was .56 and .79; the MCAS was .66 and .85. The validity of the MORS was also supported: mGAF-MORS r = .68 and MCAS-MORS r = .74. This study lends support for the use of the MORS in older adult populations. In addition, this is the first report of the psychometric properties of the MCAS with an entirely older adult sample.

Intimate partner violence and sexually transmitted infections among young adult women.

BACKGROUND: Intimate partner violence (IPV) is common among young adult relationships, and is associated with significant morbidity, including sexually transmitted infections (STI). This study measured the association between IPV victimization and perpetration and prevalent STIs and STI-risk behaviors among a sample of young women. METHODS: This analysis uses wave 3 of the National Longitudinal Study of Adolescent Health and was restricted to the 3548 women who reported on a sexual relationship that occurred in the previous 3 months and agreed to STI testing. A multivariate random effects model was used to determine associations between STI and STI-risk behaviors and IPV. RESULTS: The IPV prevalence over the past year was 32%-3% victim-only, 12% perpetrator-only, and 17% reciprocal. The STI prevalence was 7.1%. Overall, 17% of participants reported partner concurrency and 32% reported condom use at last vaginal intercourse. In multivariate analysis, victim-only and reciprocal IPV were associated with not reporting condom use at last vaginal intercourse. Perpetrator-only, victim-only, and reciprocal IPV were associated with partner concurrency. Victim-only IPV was associated with a higher likelihood of having a prevalent STI (odds ratio: 2.1; 95% confidence interval: 1.0-4.2). CONCLUSIONS: This analysis adds to the growing body of literature that suggests that female IPV victims have a higher STI prevalence, as well as a higher prevalence of STI-risk behaviors, compared with women in nonviolent relationships. Women in violent relationships should be considered for STI screening in clinics, and IPV issues should be addressed in STI prevention messages, given its impact on risk for STI acquisition.

Use of the location-based social networking application GRINDR as a recruitment tool in rectal microbicide development research.

Mobile phone social networking applications such as GRINDR are potential tools for recruitment of men who have sex with men (MSM) for HIV prevention research. Demographics and sexual risk behaviors of men recruited through GRINDR and through traditional media were compared. GRINDR participants were younger (mean age 31 vs. 42, p < 0.0001), more White identified (44 vs. 30 %, p < 0.01), and had more sex partners in the previous 14 days (1.88 vs. 1.10, p < 0.05) than other recruits. Email responses were less successful for enrollment than phone calls (5 vs. 50 %). This approach resulted in successful recruitment of younger and more educated, White identified MSM.

Improving same-day antiretroviral therapy in Botswana: effects of a multifaceted national intervention.

BACKGROUND: In 2019, the Botswana Ministry of Health and Wellness (MOHW) implemented an HIV national Reboot program, which was needed for refocusing and intensifying efforts for achieving epidemic control. The strategies deployed as part of Reboot were reviewed and evaluated for their effect on same-day and within-seven-days (fast-track initiation) antiretroviral therapy (ART) initiation among adults newly identified with HIV. METHODS: We conducted a retrospective cohort analysis of patients aged 18 years or older who were newly diagnosed with HIV from October 2018 to September 2019 across 41 health facilities. We used generalized linear mixed models, adjusting for clustering by facility, to assess the association of the Reboot with same-day or within-seven-days ART initiation (fast-track initiation). RESULTS: From October 2018 to January 2019, 28% (636/2269) of newly diagnosed HIV patients were initiated the same day of diagnosis, and 56% (1260/2269) were initiated within seven days. Following the launch of Reboot (February to September 2019), 59% (2092/3553) were initiated the same day of diagnosis, and 77% (2752/3553) were initiated within seven days. Clients were 2.08 (adjusted risk ratio 95% confidence interval 1.79-2.43) times more likely to be initiated the same day of diagnosis and 1.39 (adjusted risk ratio 95% confidence interval 1.28-1.52) times more likely to be initiated within seven days than before Reboot after adjusting for sex and age. CONCLUSION: In Botswana, a multifaceted national intervention improved timely ART initiation. Identifying and implementing different client-centered strategies to facilitate ART initiation is critical to preventing AIDS-related complications and prevent ongoing transmission.

Brief Report: Racial and Ethnic Disparities in Sustained Viral Suppression and Transmission Risk Potential Among Persons Aged 13-29 Years Living With Diagnosed HIV Infection, United States, 2016.

BACKGROUND: In 2016, persons aged 13-29 years represented 23.1% of the US population, yet accounted for 41.7% of HIV diagnoses. Racial/ethnic minorities are disproportionally affected by HIV. Sustaining viral suppression helps persons living with diagnosed HIV infection (PLWDH) stay healthy and reduces the risk of transmitting HIV. We examined racial/ethnic disparities in sustained viral suppression and transmission risk potential among PLWDH aged 13-29 years. METHODS: We analyzed data from the National HIV Surveillance System reported through December 2018 from 42 jurisdictions with complete laboratory reporting. We included persons aged 13-29 years who received an HIV diagnosis by December 31, 2015, most recently resided in one of the 42 jurisdictions, and were alive at the end of 2016. Sustained viral suppression was defined as viral load <200 copies/mL for all tests in 2016. Transmission risk potential was estimated using the number of days with viral loads >1500 copies/mL. RESULTS: Of the 90,812 PLWDH aged 13-29 years included in the analysis, 41.5% had sustained viral suppression in 2016. Across age, sex, and most transmission categories, blacks had the lowest prevalence of sustained viral suppression. Among the 28,154 who were in care but without sustained viral suppression, the average number of days with viral load >1500 copies/mL was 206 days (56.4% of the 12-month period). CONCLUSIONS: Sustained viral suppression was suboptimal and transmission risk potential was high for PLWDH aged 13-29 years. Racial/ethnic disparities were apparent, calling for strengthening tailored interventions to improve care outcomes.

Receptive anal sex contributes substantially to heterosexually acquired HIV infections among at-risk women in twenty US cities: Results from a modelling analysis.

PROBLEM: Receptive anal intercourse (RAI) is more efficient than receptive vaginal intercourse (RVI) at transmitting HIV, but its contribution to heterosexually acquired HIV infections among at-risk women in the USA is unclear. METHOD OF STUDY: We analysed sexual behaviour data from surveys of 9152 low-income heterosexual women living in 20 cities with high rates of HIV conducted in 2010 and 2013 as part of US National HIV Behavioral Surveillance. We estimated RAI prevalence (past-year RAI) and RAI fraction (fraction of all sex acts (RVI and RAI) at the last sexual episode that were RAI among those reporting past-year RAI) overall and by key demographic characteristics. These results and HIV incidence were used to calibrate a risk equation model to estimate the population attributable fraction of new HIV infections due to RAI (PAFRAI ) accounting for uncertainty in parameter assumptions. RESULTS: Receptive anal intercourse prevalence (overall: 32%, city range: 19%-60%) and RAI fraction (overall: 27%, city range: 18%-34%) were high overall and across cities, and positively associated with exchange sex. RAI accounted for an estimated 41% (uncertainty range: 18%-55%) of new infections overall (city range: 21%-57%). Variability in PAFRAI estimates was most influenced by uncertainty in the estimate of the per-act increased risk of RAI relative to RVI and the number of sex acts. CONCLUSION: Receptive anal intercourse may contribute disproportionately to new heterosexually acquired HIV infections among at-risk low-income women in the USA, meaning that tools to prevent HIV transmission during RAI are warranted. The number of RVI and RAI acts should also be collected to monitor heterosexually acquired HIV infections.

HIV Prevalence Among Women Who Exchange Sex for Money or Drugs-4 U.S. Cities.

BACKGROUND: Limited data exist in the United States on the prevalence of HIV among women who exchange sex. SETTING: We estimate HIV prevalence of women who exchange sex from a 2016 survey in Chicago, Detroit, Houston, and Seattle and compare it with the prevalence of HIV among women of low socioeconomic status (SES), who did not exchange sex, and women in the general population. METHODS: Women who exchange sex were recruited via respondent-driven sampling among some cities participating in National HIV Behavioral Surveillance, interviewed, and offered HIV testing. We estimate HIV prevalence and, using prevalence ratios, compare it with the prevalence among women of low SES who did not exchange sex in the 2013 National HIV Behavioral Surveillance cycle, and to women in the general population estimated using 2015 National HIV Surveillance data. RESULTS: One thousand four hundred forty women reported exchange sex in 2016. Aggregated HIV prevalence was 4.9% [95% confidence interval (CI): 2.7 to 7.1] among women who exchanged sex, 1.6% (95% CI: 0.3 to 2.8) among women of low SES who did not exchange sex, and 0.6% (95% CI: 0.5% to 0.6%) among women in the general population. HIV prevalence among women who exchanged sex was 3.1 times (95% CI: 1.6 to 5.9) as high as among women of low SES who did not exchange sex, and 8.8 times (95% CI: 7.0 to 11.1) as high as among women in the general population. CONCLUSION: HIV prevalence was significantly higher among women who exchanged sex compared with women in the general population and women of low SES who did not exchange sex.

Anal intercourse among young heterosexuals in three sexually transmitted disease clinics in the United States.

OBJECTIVE: To examine factors associated with heterosexual anal intercourse (AI). METHODS: Between 2001 and 2004, 1084 heterosexual adults aged 18 to 26 attending public sexually transmitted disease clinics in Seattle, New Orleans, and St Louis were interviewed using computer-assisted self interview and tested for STIs; Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, and genital herpes (HSV-2). Characteristics associated with AI were identified using logistic regression. RESULTS: Overall 400 (37%) reported ever having had AI, 266 (28.9%) reported AI with at least 1 of their last 3 partners, and 19% reported AI with their last partner. Fewer women than men reported condom use at last AI (26% vs. 45%, P <0.001). Ever having AI was associated with sex on the same day as meeting a partner [AOR 3.9 (95% CI, 2.46-6.21)], receiving money for sex [AOR 2.8 (1.40-5.45)], and >3 lifetime sex partners [AOR 2.8 (1.56-5.07)] among women, and sex on the same day as meeting a partner [AOR 2.0 (1.33-3.06]) among men. AI with the last partner was associated with sex toy use [AOR 5.6 (2.63-12.0)] and having concurrent partners [AOR 2.2 (1.21-4.11)] among men, and with sex within a week of meeting [AOR 2.4 (1.28-4.37)], believing the partner was concurrent (AOR 1.9 [1.12-3.22]), and sex toy use [AOR 5.7 (2.31-14.0)] among women. Prevalent vaginal and urethral sexually transmitted infections were not associated with AI. CONCLUSIONS: Many young heterosexuals attending sexually transmitted disease clinics reported AI, which was associated with other sexual risk behaviors, suggesting a confluence of risks for HIV infection.

Estimating national rates of HIV infection among MSM, persons who inject drugs, and heterosexuals in the United States.

BACKGROUND: Calculating national rates of HIV diagnosis, incidence, and prevalence can quantify disease burden, and is important for planning and evaluating programs. We calculated HIV rates among MSM, persons who inject drugs (PWID), and heterosexuals in 2010 and 2015. METHODS: We used proportion estimates of the US population classified as MSM, PWID, and heterosexuals along with census data to calculate the population sizes which were used as the denominators for calculating HIV rates. The numerators (HIV diagnosis, incidence, and prevalence) were based on data submitted to the National HIV Surveillance System through June 2017. RESULTS: The estimated HIV diagnosis and incidence rates in 2015 were 574.7 and 583.6 per 100 000 MSM; 34.3 and 32.7 per 100 000 PWID; and 4.1 and 3.8 per 100 000 heterosexuals. The estimated HIV prevalence in 2015 was 12 372.9 per 100 000 MSM; 1937.2 per 100 000 PWID; and 126.7 per 100 000 heterosexuals. The HIV diagnosis rates decreased from 2010 to 2015 in all three transmission categories. Black individuals had the highest HIV diagnosis rates at both time points. The HIV incidence rates decreased among white MSM, MSM aged 13-24 years, PWID overall, and male and female heterosexual individuals; however, it increased among MSM aged 25-34 years. CONCLUSIONS: The estimated HIV diagnosis and HIV infection rates decreased for several transmission categories, and also race/ethnicity and age subgroups. MSM continue to be disproportionately affected. Disparities remain and have widened for some groups. Efforts are needed to strengthen prevention, care, and supportive services for all persons with HIV infection.

Improving HIV Surveillance Data by Using the ATra Black Box System to Assist Regional Deduplication Activities.

BACKGROUND: Focused attention on Data to Care underlines the importance of high-quality HIV surveillance data. This study identified the number of total duplicate and exact duplicate HIV case records in 9 separate Enhanced HIV/AIDS Reporting System (eHARS) databases reported by 8 jurisdictions and compared this approach to traditional Routine Interstate Duplicate Review resolution. METHODS: This study used the ATra Black Box System and 6 eHARS variables for matching case records across jurisdictions: last name, first name, date of birth, sex assigned at birth (birth sex), social security number, and race/ethnicity, plus 4 system-calculated values (first name Soundex, last name Soundex, partial date of birth, and partial social security number). RESULTS: In approximately 11 hours, this study matched 290,482 cases from 799,326 uploaded records, including 55,460 exact case pairs. Top case pair overlaps were between NYC and NYS (51%), DC and MD (10%), and FL and NYC (6%), followed closely by FL and NYS (4%), FL and NC (3%), DC and VA (3%), and MD and VA (3%). Jurisdictions estimated that they realized a combined 135 labor hours in time efficiency by using this approach compared with manual methods previously used for interstate duplication resolution. DISCUSSION: This approach discovered exact matches that were not previously identified. It also decreased time spent resolving duplicated case records across jurisdictions while improving accuracy and completeness of HIV surveillance data in support of public health program policies. Future uses of this approach should consider standardized protocols for postprocessing eHARS data.

Autism treatment survey: services received by children with autism spectrum disorders in public school classrooms.

The Autism Treatment Survey was developed to identify strategies used in education of children with autism spectrum disorders (ASD) in Georgia. Respondents of the web-based survey included a representative sample of 185 teachers across the state, reporting on 226 children with ASD in grades preschool-12th. The top five strategies being used in Georgia (Gentle Teaching, sensory integration, cognitive behavioral modification, assistive technology, and Social Stories) are recognized as lacking a scientific basis for implementation. Analysis revealed the choice of strategies varied by grade level and classroom type (e.g., general education, special education). Results highlight clear implications for preservice and inservice educator training, and the need for continued research to document evidence-based strategy use in public schools for students with ASD.

Lifetime risk of a diagnosis of HIV infection in the United States.

PURPOSE: To estimate lifetime risk of receiving an HIV diagnosis in the United States if existing infection rates continue. METHODS: We used mortality, census, and HIV surveillance data for 2010 to 2014 to calculate age-specific probabilities of an HIV diagnosis. The probabilities were applied to a hypothetical cohort of 10 million live births to estimate lifetime risk. RESULTS: Lifetime risk was 1 in 68 for males and 1 in 253 for females. Lifetime risk for men was 1 in 22 for blacks, 1 in 51 for Hispanic/Latinos, and 1 in 140 for whites; and for women was 1 in 54 for blacks, 1 in 256 for Hispanic/Latinas, and 1 in 941 for whites. By risk group, the highest risk was among men who have sex with men (1 in 6) and the lowest was among male heterosexuals (1 in 524). Most of the states with the highest lifetime risk were in the South. CONCLUSIONS: The estimates highlight different risks across populations and the need for continued improvements in prevention and treatment. They can also be used to communicate the risk of HIV infection and increase public awareness of HIV.