Determinants of HIV Incidence Disparities Among Young and Older Men Who Have Sex with Men in the United States.

This study sought to determine why young men who have sex with men (MSM) have higher HIV incidence rates than older MSM in the United States. We developed hypotheses that may explain this disparity. Data came from peer-reviewed studies published during 1996-2016. We compared young and older MSM with respect to behavioral, clinical, psychosocial, and structural factors that promote HIV vulnerability. Compared with older MSM, young MSM were more likely to have HIV-discordant condomless receptive intercourse. Young MSM also were more likely to have "any" sexually transmitted infection and gonorrhea. Among HIV-positive MSM, young MSM were less likely to be virally suppressed, use antiretroviral therapy, and be aware of their infection. Moreover, young MSM were more likely than older MSM to experience depression, polysubstance use, low income, decreased health care access, and early ages of sexual expression. These factors likely converge to exacerbate age-associated HIV incidence disparities among MSM.

A framework for elimination of perinatal transmission of HIV in the United States.

The availability of effective interventions to prevent mother-to-child HIV transmission and the significant reduction in the number of HIV-infected infants in the United States have led to the concept that elimination of mother-to-child HIV transmission (EMCT) is possible. Goals for elimination are presented. We also present a framework by which elimination efforts can be coordinated, beginning with comprehensive reproductive health care (including HIV testing) and real-time case-finding of pregnancies in HIV-infected women, and conducted through the following: facilitation of comprehensive clinical care and social services for women and infants; case review and community action; allowing continuous quality research in prevention and long-term follow-up of HIV-exposed infants; and thorough data reporting for HIV surveillance and EMCT evaluation. It is emphasized that EMCT will not be a one-time accomplishment but, rather, will require sustained effort as long as there are new HIV infections in women of childbearing age.

Correlates of mother-to-child transmission of HIV in the United States and Puerto Rico.

OBJECTIVE: The goal of this study was to examine associations between demographic, behavioral, and clinical variables and mother-to-child HIV transmission in 15 US jurisdictions for birth years 2005 through 2008. METHODS: The study used Enhanced Perinatal Surveillance system data for HIV-infected women who gave birth to live infants. Multivariable logistic regression was used to assess variables associated with mother-to-child transmission. RESULTS: Among 8054 births, 179 infants (2.2%) were diagnosed with HIV infection. Half of the births had at least 1 missed prevention opportunity: 74.3% of infected infants, 52.1% of uninfected infants. Among 7757 mother-infant pairs with sufficient data for analysis, the odds of having an HIV-infected infant were higher for women who received late testing or no prenatal antiretroviral medications (odds ratio: 2.5 [95% confidence interval (CI): 1.5-4.0] and 3.5 [95% CI: 2.0-6.4], respectively). The odds for mothers who breastfed were 4.6 times (95% CI: 2.2-9.8) the odds for those who did not breastfeed. The adjusted odds for women with CD4 counts <200 cells per microliter were 2.4 times (95% CI: 1.4-4.2) those for women with CD4 counts ≥500 cells per microliter. The odds for women who abused substances were twice (95% CI: 1.4-2.9) those for women who did not. CONCLUSIONS: The odds of having an HIV-infected infant were higher among HIV-infected women who were tested late, had no antiretroviral medications, abused substances, breastfed, or had lower CD4 cell counts. Increases in earlier HIV diagnosis, substance abuse treatment, avoidance of breastfeeding, and use of prenatal antiretroviral medications are critical in eliminating perinatal HIV infections in the United States.

Estimated number of infants born to HIV-infected women in the United States and five dependent areas, 2006.

OBJECTIVE: Although perinatal HIV infections are declining in the United States, there is no single source of nationally representative data available to estimate the number of infants born to HIV-infected women in the United States and its dependencies. This study determines the total number of births to HIV-positive women in the United States and 5 dependent areas in 2006. STUDY DESIGN: Diagnosed stage 1 or 2 HIV disease in the United States were based on reported data from 39 areas that conducted confidential name-based HIV case reporting and stage 3 HIV from all areas in the United States. A zero-inflated Poisson model was used to estimate the number of women aged 13-44 years living with diagnosed stage 1 or 2 HIV disease in the United States. The number of undiagnosed HIV-infected women (stage 1 or 2) of childbearing age was estimated from the number of reported Stage 3 HIV (ie, AIDS) cases using a back-calculation method. RESULTS: An estimated 115,200 women aged 13-44 years were living with stage 1 or 2 HIV disease in 2006. A total of 56,200 women were living with diagnosed stage 3 disease. The estimated number of births to all women living with HIV disease (diagnosed or undiagnosed) was 8700 [95% Confidence Interval (CI): 8400 to 8800] in 2006. CONCLUSIONS: The number of infants born to HIV-infected women in 2006 was approximately 30% greater than the number of such births (6075-6422) in 2000. This increase highlights the need to continue and strengthen efforts to prevent perinatal HIV transmission in the United States.

Missed opportunities to prevent perinatal human immunodeficiency virus transmission in 15 jurisdictions in the United States during 2005-2008.

The objective of this study was to identify factors related to failure to receive recommended interventions for the prevention of mother-to-child HIV transmission among HIV-infected pregnant women in the United States. Using Enhanced Perinatal Surveillance data from 2005 through 2008, we identified characteristics of HIV-infected women (n = 5,391) that increased their odds of missing an opportunity to prevent perinatal HIV transmission. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were calculated by using backward step-wise logistic regression analyses to determine the relationship between demographic variables and missed opportunities. Of 4,220 HIV-infected pregnant women with complete data, 2,545 (60%) did not receive all of the recommended interventions. Missed opportunities for prevention occurred more often among HIV-infected women aged 25-34 years (aOR = 1.9, 95% CI = 1.4-2.5), and greater than 34 years (aOR = 2.0, 95% CI = 1.5-2.7) compared to those 13-19 years and among injection drug users (aOR = 1.3, CI = 1.0-1.5) compared to women infected with HIV through heterosexual contact. Clinicians can decrease missed opportunities by routinely providing recommended interventions, especially among HIV-infected women who are injection drug users or aged 25 years or older.

Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years--United States, 2008.

For adults and adolescents (i.e., persons aged >/=13 years), the human immunodeficiency virus (HIV) infection classification system and the surveillance case definitions for HIV infection and acquired immunodeficiency syndrome (AIDS) have been revised and combined into a single case definition for HIV infection. In addition, the HIV infection case definition for children aged <13 years and the AIDS case definition for children aged 18 months to <13 years have been revised. No changes have been made to the HIV infection classification system, the 24 AIDS-defining conditions for children aged <13 years, or the AIDS case definition for children aged <18 months. These case definitions are intended for public health surveillance only and not as a guide for clinical diagnosis. Public health surveillance data are used primarily for monitoring the HIV epidemic and for planning on a population level, not for making clinical decisions for individual patients. CDC and the Council of State and Territorial Epidemiologists recommend that all states and territories conduct case surveillance of HIV infection and AIDS using the 2008 surveillance case definitions, effective immediately.

Epidemiology of HIV/AIDS among non-Hispanic black women in the United States.

BACKGROUND: HIV/AIDS has emerged as a persistent health threat to black women in the United States. For the past decade, HIV disease has been among the top 10 leading causes of death for this population. METHODS: We analyzed national HIV surveillance data from 29 states with confidential name-based HIV infection reporting that have conducted integrated HIV/AIDS surveillance since at least 1998. We also analyzed AIDS surveillance data from all 50 states and the District of Columbia. RESULTS: In 2002, black women represented 14% of all women in the 29 states whose HIV data were analyzed but 72.3% of annual HIV infection diagnoses among women. In that same year, black women were diagnosed with HIV infection at a rate of 68.7 per 100,000, approximately 23 times the rate for white women (three per 100,000) and four times that for Hispanic women (17.2 per 100,000). Likewise, in 2002, black women represented 13% of all women in the 50 states and the District of Columbia but an estimated 67.8% of new AIDS diagnoses among women. In that same year, black women were diagnosed with AIDS at a rate of 48 per 100,000, approximately 23 times the rate for white women (2.1 per 100,000) and more than four times that for Hispanic women (10.6 per 100,000), CONCLUSIONS: Because black women are disproportionately affected by HIV/AIDS, effective strategies are needed to prevent new HIV infections, to detect HIV infections early and to assure adequate treatment for black women who are infected with HIV.

The integrated epidemiologic profile: using multiple data sources in developing profiles to inform HIV prevention and care planning.

HIV/AIDS epidemiologic profiles describe the HIV/AIDS epidemic among state and local populations. The Centers for Disease Control and Prevention and the Health Resources Services Administration collaborated to develop one set of guidelines for developing epidemiologic profiles that would serve as the basis for both prevention and care planning. The Integrated Guidelines for Developing Epidemiologic Profiles was published in 2003. Profiles based on these guidelines describe the epidemic in terms of sociodemographic, geographic, behavioral, and clinical characteristics and should include enough data sources (e.g., sexually transmitted disease, tuberculosis, behavioral, and care-related data) to allow users to make informed, evidenced-based decisions. Development and use of these epidemiologic profiles should lead to more effective prevention and care planning and contribute to objective measures of the impact and outcomes of programs, supported by both federal agencies.