Inside This Issue: New supplement to HIV Prevention Strategic Plan; stigma and discrimination among Hispanic/Latino persons with HIV; updated COVID-19 vaccines in children; Monkeypox vaccines administration; and more.
The U.S. HIV Epidemic
CDC Issues New Supplement to Its HIV Prevention Strategic Plan
The U.S. Centers for Disease Control and Prevention (CDC) recently published the Division of HIV Prevention Strategic Plan Supplement: An Overview of Refreshed Priorities for 2022–2025. Late last year, the Division of HIV Prevention (DHP) implemented “a more fit-for-purpose organizational structure that fosters enhanced collaboration between scientific and programmatic activities to drive meaningful, lasting change in communities affected by HIV,” according to Dr. Demetre Daskalakis, director of DHP. “The new structure helps to modernize and better position DHP to address the Division’s key priorities with renewed energy, direction, and focus. In line with the new organizational structure was a need to refresh the existing plan to better fit the new operating model.”
The supplement emphasizes four focus areas for HIV prevention:
- health equity, which involves engaging with CDC’s HIV funding recipients, people with lived experience, and other partners to identify appropriate strategies for overcoming systemic barriers to the equitable distribution of beneficial HIV tools and services;
- community engagement, which involves expanding how DHP engages with people with lived experiences and communities and to increase the number and diversity of partnerships in HIV prevention;
- a syndemic approach, which involves collectively addressing intersecting conditions – such as HIV, viral hepatitis, sexually transmitted infections, substance use, and behavioral health – to prioritize “whole person” care that leads to better HIV prevention and care options; and
- a status neutral approach, which serves both persons with HIV and those in need of HIV prevention, since these persons often have similar medical and social service needs, including the reduction of HIV-related stigma.
The supplement also outlines six areas of investment in both time and resources to effect change:
- strengthening DHP’s workforce and organizational capacity;
- expanding access to and use of DHP funding;
- enhancing implementation guidance and technical assistance;
- integrating data and data systems;
- advancing partnerships and increasing collaboration; and
- supporting partner and recipient communication efforts
Stigma and Discrimination Are Common Among Hispanic/Latino Persons with HIV
Hispanic/Latino persons with HIV experience disparities in health outcomes – including disproportionally high rates of HIV infection, and lower rates of receipt of HIV care, retention in care, and viral suppression of HIV – compared with non-Hispanic White persons with HIV. Since HIV stigma and health care discrimination are associated with adverse HIV outcomes, CDC researchers used data from the Medical Monitoring Project (MMP) to assess the levels of self-reported stigma and discrimination scores among Hispanic/Latino adults with HIV. Their analysis of 2018-2020 MMP data for nearly 2,700 Hispanic/Latino persons indicated that the median HIV stigma score on a scale of 0 to 100 was 31.7, with women (35.6) and American Indian or Alaska Native persons (38.9) reporting the highest scores among Hispanic/Latino persons with HIV.
The researchers found that HIV stigma was primarily attributed to persons’ disclosure concerns, such as fearing that others would disclose their HIV status and feeling cautious about who to share their HIV status with. Nearly one-quarter (23%) of all the Hispanic/Latino persons in the data analysis reported experiencing health care discrimination. Health care discrimination was experienced more frequently by Hispanic/Latino men (23%) than by Hispanic/Latino women (18%) and by Black or African American Hispanic/Latino persons (28%) than by White Hispanic/Latino persons (21%).
“HIV stigma and discrimination experiences in an HIV health care setting were commonly reported among Hispanic persons with HIV and varied by characteristics such as race, gender, and English proficiency,”according to the researchers. “Hispanic persons with HIV are highly diverse. Efforts to reduce HIV stigma and discrimination should consider the varied and unique experiences of this population . . . Training for providers should focus on actively listening to patient concerns, including stigma experiences, using culturally and linguistically appropriate methods.”
Vaccines for COVID-19 and Monkeypox
CDC Expands Use of Updated COVID-19 Vaccines to Include Children 5 to 11 Years Old
On October 12, CDC Director Dr. Rochelle Walensky signed a decision memo expanding the use of updated (bivalent) COVID-19 vaccines to children 5 to 11 years old. This action follows the Food and Drug Administration (FDA) authorization of updated COVID-19 vaccines from Pfizer-BioNTech for children aged 5 to 11 years, and from Moderna for children and adolescents aged 6 to 17 years. These updated COVID-19 vaccines add Omicron BA.4 and BA.5 spike protein components to the original vaccines’ composition, in an effort to restore protection that has waned since previous vaccination and to target recent Omicron variants that are more transmissible and immune-evading than the original strains of the virus.
“Since children have gone back to school in person and people are resuming pre-pandemic behaviors and activities, there is the potential for increased risk of exposure to the virus that causes COVID-19,” noted Dr. Peter Marks, director of FDA’s Center for Biologics Evaluation and Research. “While it has largely been the case that COVID-19 tends to be less severe in children than adults, as the various waves of COVID-19 have occurred, more children have gotten sick with the disease and have been hospitalized. Children may also experience long-term effects, even following initially mild disease. We encourage parents to consider primary vaccination for children and follow-up with an updated booster dose when eligible.”
HHS Expands Categories of Providers Authorized to Administer Monkeypox Vaccines
Earlier this month, HHS Secretary Xavier Becerra amended the Public Readiness and Emergency Preparedness Act (PREP Act) to expand the categories of providers authorized to administer vaccines and therapeutics against smallpox, monkeypox virus, and other orthopoxviruses in a declared emergency. In addition to healthcare professionals already licensed or authorized under their state laws to administer these vaccines and therapeutics, the amended list of authorized providers now includes:
- advanced or intermediate emergency medical technicians;
- licensed or certified professional midwives;
- nurses, advanced practice registered nurses, registered nurses, licensed practical nurses;
- pharmacy interns, pharmacy technicians;
- physician assistants;
- respiratory therapists;
- veterinarians; and
- recently retired healthcare professionals and students of the listed professions.
“As our supply of JYNNEOS vaccine steadily increases, we are exceeding demand in all 50 states,” noted HHS assistant secretary for Preparedness and Response Dawn O’Connell. “By expanding the pool of providers who can administer monkeypox vaccines, we can increase equitable access for people at high risk for monkeypox infections who have not yet had an opportunity to get vaccinated.”
HIV Treatment Guidelines
Expert Panel Updates ART Guidelines for Children
The HHS Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV recently updated several sections of the Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. These updates address FDA’s recent approvals of the dispersible tablet formulation of the fixed-dose combination abacavir/dolutegravir/lamivudine (trade name Triumeq PD) and long-acting injectable cabotegravir and rilpivirine (trade name Cabenuva) in children and adolescents in particular age and weight ranges.
Updated information and recommendations have been incorporated into the following guidelines sections:
- What to Start: Regimens Recommended for Initial Therapy of Antiretroviral-Naive Children
- What Not to Start: Regimens Not Recommended for Use in Antiretroviral-Naive Children
- Management of Children Receiving Antiretroviral Therapy: Modifying Antiretroviral Regimens in Children with Sustained Virologic Suppression on Antiretroviral Therapy
- Drug Sections: Abacavir, Lamivudine, Dolutegravir, Cabotegravir, and Rilpivirine
Highlights from the 2022 U.S. Conference on HIV/AIDS
This year’s U.S. Conference on HIV/AIDS (USCHA) was held in San Juan, Puerto Rico from October 8 through 11. This was the first time the event was held in person since 2019. Thousands of people from more than 120 organizations participated, including representatives from clinics, AIDS service organizations, advocacy groups, pharmaceutical companies, and government agencies at the federal, state, and local level.
The USCHA website includes a conference agenda and program in both English and Spanish listing the many workshops, poster sessions, and plenary sessions offered during the conference. In addition, the HIV.gov website has published a series of blog items recapping the event. These include:
- Watch Highlights from the Opening Day at USCHA 2022
- “Celebro mi salud” Launched – Day 2 USCHA
- A Focus on Community – Day 3 at USCHA
- National Monkeypox Response – Closing Day at USCHA
CDC Letter and New AIDSVu Resources Focus on HIV Among Hispanic/Latino Persons
In the run-up to National Latinx AIDS Awareness Day, the acting director of CDC’s Division of HIV Prevention, Dr. Robyn Fanfair distributed a Dear Colleagues letter highlighting HIV diagnoses and trends among Hispanic/Latino persons. Dr. Fanfair noted that the annual number of HIV infections has recently decreased among young Hispanic/Latino men aged 13 to 24, which may indicate the partial success of focused HIV prevention, testing, and treatment efforts. “However, there is still much work to do to reduce HIV incidence and disparities,” she wrote.
The AIDSVu website also recently posted two new blog items focusing on the HIV in marginalized populations and health inequities among Hispanic/Latinx populations. A third AIDSVu blog item takes a deeper look at the impacts of HIV on Hispanic/Latinx persons, and includes a new set of infographics about HIV in this population group. These infographics include:
- HIV Care Continuum Among Hispanic/Latinx People
- Late HIV Diagnoses Among Hispanic/Latinx People
- Deaths Among Hispanic/Latinx People with HIV
- HIV Diagnoses Among Hispanic/Latinx Gay and Bisexual Men
- Recent Decreases in HIV Diagnoses Among Hispanic/Latinx Females and Males
- Disproportionate HIV Diagnoses Among Hispanic/Latinx People
- HIV Testing Rates Among Hispanic/Latinx People
In the same blog item, AIDSVu has also published downloadable, Spanish-language versions of selected infographics.
Updates to CDC’s HIV Infographics Library
CDC has added many new and updated resources to its extensive HIV infographics library. These include infographics specifically about:
- the HIV care continuum, HIV prevalence, and deaths among people with diagnosed HIV;
- HIV treatment, depression and anxiety, sexual behaviors, HIV stigma, and needed ancillary services among different population groups affected by HIV; and
- basic educational graphics about a range of topics, including HIV post-exposure prophylaxis and pre-exposure prophylaxis, CDC’s recommendations for HIV testing, finding an HIV test, HIV self-testing, knowing your HIV status, the HIV window period, what to do if recently diagnosed with HIV, ending HIV stigma, and staying healthy with HIV.