Inside This Issue: HIV testing, care outcomes, transgender persons and HIV, traveling with HIV, guidelines, and health communication. 

HIV Testing

Despite Recommendations for Universal HIV Screening, Most Americans Have Never Been Tested

Since 2006, the U.S. Centers for Disease Control and Prevention (CDC) has recommended universal screening for HIV infection at least once in health care settings, and rescreening at least annually for persons at high risk for infection. However, according to a recent CDC study, less than 40% of people in the U.S. have ever had an HIV test and only about one-third (29%) of persons at high risk for HIV had been tested in the past year.

For the study, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) to assess the percentage of U.S. adults tested for HIV nationwide (38.9%), as well in the 50 local jurisdictions accounting for the majority of new HIV diagnoses (46.9%), and in the seven states with disproportionate occurrence of HIV in rural areas (35.5%). “Testing percentages varied widely by jurisdiction but were suboptimal and generally low in jurisdictions with low rates of diagnosis of HIV infection,” according to CDC. “To achieve national goals and end the HIV epidemic in the United States, strategies must be tailored to meet local needs. Novel screening approaches might be needed to reach segments of the population that have never been tested for HIV.”

“Examples of novel or promising approaches to increase access to HIV testing include: routinizing HIV screening in health care settings; integrating HIV screening with sexual health screenings; scaling up partner notification and other strategies (using social network strategy or mobile applications) that offer screening of the social and sexual networks of persons seeking HIV screening; promoting pharmacist-led screening as well as screening in other alternative clinical settings such as urgent care; and mass distribution of HIV self-tests,” the study authors note.

HIV Prevention and Care Outcomes

New Report and Slide Set on HIV Prevention and Care Outcomes in the U.S.

CDC has published a new report that analyzes data from the National HIV Surveillance System to measure progress toward achieving the U.S. national HIV prevention and care goals. An accompanying slide set presents key findings from the report. Selected highlights are summarized below:

Linkage-to-Care Rates: The report analyzed 2017 data on the percent of newly diagnosed persons aged 13 and older who were linked to care within one month after diagnosis. Data were available for 41 states and the District of Columbia.

• Nearly four out of five persons (78.3%) newly diagnosed with HIV were linked to care within one month after diagnosis – with nearly identical linkage-to-care rates for males and females.
• However, there were variations in linkage-to-care rates by age and race/ethnicity.  Linkage-to-care rates increased with age from 75.0% in adolescents and young adults between the ages of 13 and 24 to 81.6% in persons aged 55 or older.  For different racial/ethnic groups, linkage-to-care rates were lowest among Blacks/African Americans (75.8%) and Hispanics/Latinos (79.3%) and highest among American Indians/Alaska Natives (84.8%).
• There were also substantial differences in linkage-to-care rates in the 41 states with available data, ranging from just 60.2% in Tennessee and 67.9% in Oklahoma to 96.6% in Alaska and 93.5% in Maine.

Receipt and Retention in Care & Viral Suppression: The report also analyzed data on the percentage of adults and adolescents with HIV diagnosed infection who received medical care, were retained in care, and had viral suppression during 2016.  In particular:

• Overall rates of receipt of care, retention in care, and viral suppression were nearly 74.2%, 57.6%, and 61.5%, respectively. The rates of receipt of care and retention in care were essentially identical for males and females, but males had slightly higher viral suppression rates than females (62.2% versus 59.4%).
• Interestingly, adolescents and young adults 13 to 24 years old had the highest receipt of care rate (76.3%), but the lowest viral suppression rate (53.8%) of any age group. In contrast, adults 55 years and older were tied for the lowest receipt of care rate (73.2%), but had the highest viral suppression rate (64.2%).
• Persons with a multiracial heritage had the highest rates of receipt of care, retention in care, and viral suppression (85.9%, 67.5%, and 69.8%, respectively). The groups with the lowest rates were Native Hawaiians/Other Pacific Islanders for receipt of care (71.4%) and retention in care (51.0%), and Blacks/African Americans for viral suppression (56.1%).
• By transmission category, males who were infected through injection drug use had the lowest rates of receipt of care, retention in care, and viral suppression (63.6%, 51.0%, and 51.2%, respectively).
• By state, the lowest rates of receipt of care, retention in care, and viral suppression were in South Dakota (58.0%, 33.1%, and 45.1%, respectively), and the highest rates were in Montana (90.5%, 69.1%, and 79.7%).

Continuum of Care for All Infected Persons: The report also contains data on the HIV-prevalence-based continuum of care, for all persons aged 13 and older living with either diagnosed or undiagnosed HIV infection.

• Overall, 86% of all persons living with HIV were aware of their infection status, 64% were receiving care, 49% were retained in care, and 53% had viral suppression.
• HIV diagnosis rates varied widely by age.  Only 56% of adolescents and young adults aged 13 to 24 were aware of their status, compared to 94% for persons aged 55 and older.
• Because such a large percentage (44%) of young people are undiagnosed, the prevalence-based continuum of care rates are especially low for this age group, with only 43% receiving care, 31% retained in care, and 30% virally suppressed.

Transgender Persons and HIV

CDC Issue Brief Focuses on HIV in Transgender Communities

Nearly one million people in the U.S. identify as transgender. Transgender people, and particularly transgender women, are at very high risk for HIV infection. A recent meta-analysis of 88 studies published from 2006-2017 found that the laboratory-confirmed HIV prevalence rate was 14.1% for transgender women, 3.2% for transgender men, and 9.2% for transgender people overall. CDC recently published a 4-page issue brief that highlights the disproportional impact of HIV on transgender communities. The brief summarizes the best available data on HIV diagnoses and prevalence among transgender persons, identifies gaps in the data, and considers approaches to address these gaps. It also discusses the reasons why transgender persons are at such high risk of HIV infection, and describes the steps CDC and its collaborating partners are taking to intensify HIV prevention efforts for this population group. These include supporting high-impact prevention programs, advancing HIV prevention research, and raising awareness and engagement in transgender communities.

Traveling with HIV

UNAIDS and UNDP Urge Removal of All HIV-Related Travel Restrictions

UNAIDS and the United Nations Development Programme (UNDP) are urging countries to abide by the terms of the 2016 U.N. Political Declaration on Ending AIDS, which calls for an end to all forms of HIV-related travel restrictions. “Travel restrictions based on real or perceived HIV status are discriminatory, prevent people from accessing HIV services, and propagate stigma and discrimination,” according to a joint UNAIDS/UNDP statement issued late last month.

A total of 48 countries and territories currently maintain HIV-related travel restrictions. Of this total, at least 30 still impose bans on entry or stay and residence based on HIV status, and 19 deport non-nationals on the grounds of their HIV status. Although the majority of countries that retain travel restrictions are in the Middle East and North Africa, many countries in the Asia and Pacific region, Eastern Europe, and Central Asia also impose restrictions.  Since 2015, four countries have taken steps to lift their HIV-related travel restrictions – Belarus, Lithuania, the Republic of Korea, and Uzbekistan.

“HIV-related travel restrictions fuel exclusion and intolerance by fostering the dangerous and false idea that people on the move spread disease,” noted Mandeep Dhaliwal, director of UNDP’s HIV, Health, and Development Group. “These policies are counterproductive to effective AIDS responses.” 

Guidelines

Updates to HHS’s HIV Treatment and Opportunistic Infection Guidelines

HHS recently published updates to both its Adult and Adolescent Antiretroviral Treatment Guidelines (ART guidelines) and Guidelines for Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV (OI guidelines).

The updates to the ART guidelines include: 1) a new section focusing on gender-affirming care for transgender people living with HIV; 2) a rewritten section focusing on substance use and HIV; and 3) an updated section on HIV-2. Additional revisions to the ART guidelines are expected later this year.

The OI guidelines have updated information on the parasitic infection microsporidiosis, including new information about the responsible organisms and the latest recommendations about treating this condition.

Social Media and Digital Communication

More Digital Tools and Tips from HIV.gov

HHS’s HIV.gov blog site has recently published several new posts in its ongoing digital marketing and outreach series. The series is designed to help agencies and organizations become more knowledgeable about digital tools and use them effectively in health communications.  The newest posts are:

HIV Resource on Instagram @StartTalkingHIV – This post describes how CDC’s Start Talking. Stop HIV. campaign for gay and bisexual men of all races has been using Instagram to broaden its reach to key populations.

New Pew Data on Social Media Platforms – Facebook and YouTube continue to be the most widely used online platforms among U.S. adults, according to the most recent data from the Pew Research Center. Although much less widely used by adults overall, Instagram and Snapchat are very popular among young adults 18 to 29 years old – a key population group for HIV prevention messages.

Email: A Top HIV Communications Tool! – This blog item provides seven best practices tips for using email as a key element of your HIV communications strategy.

Global Smartphone Use: What New Data Tell Us – Approximately one in five American adults are “smartphone-only” internet users. According to HIV.gov, this fact is important for HIV communications because populations most at risk for, or living with, HIV are often most likely to be smartphone-dependent.

Level Up Your Email Marketing with List Hygiene – This post describes the importance of email “list hygiene,” which is the process of refining and cleaning your email lists to remove inactive subscribers.