Inside This issue: HIV risk behaviors among youth, behavioral interventions to prevent STIs, Healthy People 2030 objectives, Ending the HIV Epidemic, HIV long-term survivors, and more.
2019 YRBS Reports Examine Risk Behaviors and Trends Among U.S. Youth
The newly released national Youth Risk Behavior Survey (YRBS) for 2019 indicates that, overall, there were no statistically significant changes in self-reported sexual risk behaviors among U.S. high school students between 2017 and 2019. However, a companion data sheet focusing on trends in sexual risk behaviors indicates that substantial improvements have occurred in some – but not all – sexual risk behaviors since the YRBS was launched in 1991.
Every 2 years, the YRBS monitors the following categories of health-related behaviors that contribute to the leading causes of death and disability among youth: 1) sexual behaviors related to unintended pregnancy and sexually transmitted infections (STIs), including HIV; 2) behaviors that contribute to unintentional injuries and violence; 3) tobacco use; 4) alcohol and other drug use; 5) unhealthy dietary behaviors; and 6) physical inactivity. In this brief feature, we focus on the YRBS report’s findings on HIV testing and sexual behavioral risks.
According to the 2019 YRBS report, for 9th through 12th grade students:
- about one in 11 (9.4%) had ever been tested for HIV, compared to 12.9% in 2013 and 11.9% in 2005 (the first year for which this information was compiled in the YRBS);
- about 38% had ever had sexual intercourse – decreasing from about 47% in 2013 and 54% in 1991;
- about one in 33 (3.0%) had sexual intercourse for the first time before age 13 – decreasing from 5.6% in 2013 and 10.2% in 1991;
- about one in 12 (8.6%) had had sexual intercourse with four or more people during their life – decreasing from about 15% in 2013 and 19% in 1991; and
- about one in four (27%) were currently sexually active – decreasing from about 34% in 2013 and 37.5% in 1991.
Among currently sexually active students:
- about 54% used a condom during their last sexual intercourse prior to taking the survey – a decline from 59% in 2013, but higher than the 46% reported in 1991;
- about 12% reported not using any method to prevent pregnancy during their last sexual intercourse – similar to the 14% reporting this behavior in 2013, but below the 16.5% reporting it in 1991;
- about 21% reported drinking alcohol or using drugs before their last sexual intercourse – very similar to the approximately 22% reporting the same behavior in 2013 and 1991.
Sexually Transmitted Infections
USPSTF Issues Guidance on Behavioral Interventions to Prevent STIs
The U.S. Preventive Services Task Force (Task Force) recently published guidance recommending behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs). The new recommendation is based on a literature review in which the Task Force evaluated 37 randomized and 2 nonrandomized controlled intervention studies of behavioral counseling interventions for adolescents and adults conducted in primary care settings. The study populations totaled nearly 66,000 persons and were composed predominantly of heterosexual adolescents and young adults (12 to 25 years), females, and racial and ethnic minorities at increased risk for STIs. The study evidence indicated that clinicians can help prevent STIs by providing behavioral counseling to all sexually active adolescents and to adults who are at increased risk for STIs.
“To determine which adolescents are sexually active, and which adults might engage in activities that may increase their risk for STIs, clinicians should routinely ask their patients for pertinent information about their sexual history,” according to the recommendation. “All sexually active adolescents are at increased risk for STIs because of the high rates of STIs in this age group and should receive behavioral counseling interventions. Adults at increased risk for STIs include those who currently have an STI or were diagnosed with one within the past year, do not consistently use condoms, have multiple sex partners, or have sex partners within populations with a high prevalence of STIs.”
The recommendation also notes that, “Most successful [behavioral counseling] approaches provide information on common STIs and STI transmission; assess the person’s risk for acquiring STIs; aim to increase motivation or commitment to safer sex practices; and provide training in condom use, communication about safer sex, problem solving, and other pertinent skills.” To implement the recommendations in their practice, “primary care clinicians can deliver in-person behavioral counseling interventions, refer patients to behavioral counseling interventions in other settings, or inform patients about media-based interventions.”
The Task Force designated this a Grade B recommendation, which indicates that, “There is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial.” Preventive services that have an “A” or “B” recommendation rating from the Task Force must, by law, be covered by most health plans at no cost to the patient. For further information, see the Evidence Summary, Final Evidence Review, or a plain-language summary for patients from the Journal of the American Medical Association.
Disease Prevention and Health Promotion
HHS Releases Report with National Health Objectives for the Next 10 Years
Every decade, the U.S. Department of Health and Human Services (HHS) Healthy People initiative develops a new set of science-based, 10-year national objectives with the goal of improving the health of all Americans. HHS’s Office of Disease Prevention and Health Promotion (ODPHP) recently released Healthy People 2030, which features 355 measurable health objectives with 10-year targets to improve the health and well-being of Americans during the next decade.
The 2030 health objectives are divided into five main categories – health conditions; health behaviors; populations; settings and systems; and social determinants of health – that are, in turn, divided into more than 60 sections focusing on particular health topics or themes. Many of the health objectives of greatest relevance to HIV and viral hepatitis are found in the infectious disease and sexually transmitted infections sections.
Healthy People 2030 includes the six HIV-specific objectives listed below (baseline figures are from 2017, unless otherwise noted):
- reduce the number of new HIV infections among adolescents and adults, from a baseline level of about 37,000/year to just 3,000/year by 2030;
- increase the proportion of persons 13 years and older who know their HIV status, from a baseline of about 86% to 95% by 2030;
- reduce the number of new HIV diagnoses by 90% among persons 13 years and older, from a baseline of about 38,350 diagnoses/year to 3,835 diagnoses/year by 2030;
- increase the percentage of persons 13 years and older with newly diagnosed HIV infection linked to HIV medical care within one month, from a baseline of about 78% to 95% by 2030;
- increase the percentage of persons 13 years and older with diagnosed HIV infection who are virally suppressed, from a baseline of about 63% to 95% by 2030; and
- reduce the rate of newly diagnosed perinatally acquired HIV infections, from a baseline of 1.3 perinatally acquired infections per 100,000 live births in 2015 to 0.9 perinatally acquired infections per 100,000 live births by 2030.
Ending the HIV Epidemic
2020 Ryan White Conference Video Series Focuses on EHE Initiative
The HIV.gov website recently posted a series of YouTube videos from last month’s 2020 Virtual National Ryan White Conference on HIV Care & Treatment. The videos focus on current and planned activities in support of the Ending the Epidemic (EHE) initiative, and feature conversations between EHE Chief Operating Officer Harold Phillips and key staff from the Health Resources and Services Administration (HRSA) and community leaders. The videos and their featured speakers are:
- Ending the HIV Epidemic, with Dr. Laura Cheever, Associate Administrator, HRSA’s HIV/AIDS Bureau;
- Implementing EHE: A Community Perspective, with Gabriel Maldonado, CEO and Founder of TruEvolution in Riverside, California;
- Innovating Care and Optimizing Public Health, with Heather Hauck, Deputy Associate Administrator, HRSA’s HIV/AIDS Bureau; and
- 30 Years of HIV Care and Treatment, with Dr. Cheever and Heather Hauck.
HIV.gov also published a recent blog item, Supporting Engagement & Re-Engagement in HIV Care to End the HIV Epidemic in Baltimore, which features a Ryan White Conference report on the Baltimore City Health Department’s Getting to Zero + Initiative.
Kaiser Family Foundation Launches EHE Funding Tracker
The Kaiser Family Foundation (KFF) has posted an online Ending the HIV Epidemic Funding Tracker, “which provides up-to-date data on federal EHE funding, including an overview of funding mechanisms by year, agency, grant mechanism, and jurisdiction,” according to KFF. At present, the tracker includes the following six tables:
- Federal Ending the HIV Epidemic Funding to Date, with breakdowns by federal department/agency and year;
- EHE Funding – Federal Funding Streams and Grants Awarded, with breakdowns by department/agency, year, grant names, number of grantees, and total grant awards;
- EHE Fiscal Year (FY) 2019 Funding for Phase 1 Counties, D.C., and San Juan, Puerto Rico, with breakdowns by jurisdictions and types of funding;
- EHE FY 2019 Funding for Phase 1 States, with breakdowns by state and types of funding;
- EHE FY 2020 Funding for Phase 1 Counties, D.C., and San Juan, Puerto Rico, with breakdowns by jurisdictions and types of funding; and
- EHE FY 2020 Funding for Phase 1 States, with breakdowns by state and types of funding.
KFF plans to update its EHE Funding Tracker as new funding data become available.
Living with HIV
Early Results of REPRIEVE Study Shed Light on Long-Term Health Effects of HIV
The Journal of Infectious Disease (JID) has published a supplemental issue focusing on early results from the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) – the largest study of cardiovascular disease among persons with HIV. The ongoing study, which enrolled 7,770 participants at sites across 5 continents,
is evaluating whether the statin medication pitavastatin can reduce the risk of heart disease among people with HIV. On average, REPRIEVE study participants are about 50 years old, have longstanding HIV, have been receiving antiretroviral therapy for nearly a decade, and have relatively well-preserved immune function. More than 60% of the study participants are non-white, and nearly a third are female.
“By leveraging data collected from this diverse group of study participants, researchers also are learning more about the long-term health effects of HIV,” according to the National Institutes of Health (NIH), which sponsored the study. Early REPRIEVE study findings described in the JID supplement include:
- a substantial number of study participants show signs of reduced kidney function;
- many participants have excess fat around the heart, a condition that increases the risk of developing heart problems;
- impaired muscle strength and function are also common; and
- some women in the study showed signs of accelerated reproductive aging – a process that eventually leads to menopause and may heighten risk for heart disease and stroke.
REPRIEVE study researchers are also examining the relationship between HIV and heart disease among transgender people. “Transgender people are disproportionately affected by HIV, and studies have suggested that hormone use as part of gender-affirming therapy may increase cardiovascular disease risk,” according to NIH. “By collecting data on gender identity and use of gender-affirming therapy, the REPRIEVE investigators aim to address this knowledge gap.”
AVAC Webinar and “Cheat Sheet” on COVID-19 Vaccine R&D
On August 25, AVAC held a webinar presentation and discussion with Dr. Barney Graham, the Deputy Director of NIH’s Vaccine Research Center. Dr. Graham reviewed the rapid development timeline for COVID-19 vaccines and discussed recent and past vaccine research experiences that are now being applied to the challenge of developing a safe and effective COVID-19 vaccine. He also provided an update on the mRNA-1273 vaccine – developed by Moderna and NIH – which is undergoing testing in a Phase III clinical trial launched last month. AVAC has made available a YouTube recording of the webinar, plus Dr. Graham’s presentation slide set.
Another recent AVAC resource – Cheat Sheet: COVID-19 Vaccine Pipeline – is a two-page fact sheet that provides an “at-a-glance view of the funders, platforms, research phase, and considerations for some of the front-runner candidates,” according to AVAC. For each of the 12 vaccine candidates included, the cheat sheet lists the primary sponsor(s), a brief description of the vaccine, its platform, funders, current phase of research, and other considerations, such as information on immunogenicity, vaccine manufacturing/delivery, and platform history.
New Patient Education Videos for Women of Color with HIV
AIDS United and the Boston University School of Social Work (BUSW) have developed a series of six animated, short videos that provide HIV-specific patient education especially for women of color with HIV. The videos follow a structured patient education curriculum that is a core element of BUSW’s Enhanced Patient Navigation for Women of Color with HIV intervention. The videos linked to below are available in English and Spanish: