By: Eric Brus*—
Last month, the U.S. Prevention Services Task Force (USPSTF) issued new recommendations that healthcare providers should offer routine HIV testing to all adolescents and adults between 15 and 65 years old. IF you don’t already know your status, you should get tested, particularly if you are at increased risk of HIV infection, such as a man who has sex with other men; an active injection drug user; if you engage in unprotected vaginal or anal intercourse; if you have sexual partners who are HIV-infected, bisexual, or injection drug users; and if you exchange sex for drugs or money.
What About Hepatitis?
May is Hepatitis Awareness Month and May 19 is Hepatitis Testing Day. Last year, the CDC, issued new guidelines recommending that everyone born between 1945 and 1965 be tested for hepatitis C. Hepatitis Testing Day was established in the U.S. Department of Health and Human Services (DHHS) Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis, which was published in 2011. Its purpose is to raise awareness about chronic viral hepatitis and educate health care providers and the public about who should be tested for hepatitis infection. [pullquote]“Unfortunately, many communities and populations remain uninformed about various facets of viral hepatitis, including associated adverse health effects, the need for testing and care, and the availability of vaccines (for hepatitis A and hepatitis B) and treatment – especially priority populations at high risk for viral hepatitis, such as injection drug users; people living with HIV; gay, bisexual, and other men who have sex with men; baby boomers (people born between 1945-1965); African Americans; and Asians and Pacific Islanders.”[/pullquote]
In the U.S., viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation. Dr. Ronald Valdiserri, Director of the Office of HIV/AIDS and Infectious Disease Policy notes that, “Unfortunately, many communities and populations remain uninformed about various facets of viral hepatitis, including associated adverse health effects, the need for testing and care, and the availability of vaccines (for hepatitis A and hepatitis B) and treatment – especially priority populations at high risk for viral hepatitis, such as injection drug users; people living with HIV; gay, bisexual, and other men who have sex with men; baby boomers (people born between 1945-1965); African Americans; and Asians and Pacific Islanders.”
Who Is Most Impacted by HIV?
HIV has a disproportionate impact on people of color and on people who live in areas characterized by high levels of poverty, unemployment, lower household income, and lower levels of educational attainment, according to a supplemental HIV surveillance report recently issued by the CDC. The 28-page report, “Social Determinants of Health Among Adults with Diagnosed HIV Infection in 18 Areas, 2005 – 2009,” analyzed data at the census tract level on selected social determinants of health among adults diagnosed with HIV infection. [pullquote]The CDC surveillance report includes data collected from 18 U.S. areas for persons 18 years and older who were diagnosed with HIV infection during the five-year period from 2005 through 2009.[/pullquote]
The CDC surveillance report includes data collected from 18 U.S. areas for persons 18 years and older who were diagnosed with HIV infection during the five-year period from 2005 through 2009. These areas include the following states, counties, and cities: Colorado, the District of Columbia, Illinois (excluding Chicago), Iowa, Los Angeles County, Louisiana, Michigan, Minnesota, Mississippi, New York City, New York state, North Carolina, Puerto Rico, San Francisco, South Carolina, Virginia, Washington, and Wisconsin.
Race/Ethnicity: The highest average annual rate of HIV diagnosis was among Blacks/African Americans (44.4 per 100,000 population), which was about eight times the rate for Whites (5.4 per 100,000), and twice the rate for Hispanics/Latinos (20.5 per 100,000). Among males, the largest percentage of diagnoses was among Blacks/African Americans (39.6%), followed by Whites, (30.7%), and Hispanics/Latinos (25.6%). Among females, Blacks/African Americans accounted for a majority of HIV diagnoses (61.8%), followed by Hispanics/Latinos (21.7%), and Whites (13.0%).
Household Income and Poverty Level: HIV diagnosis rates were highest in areas where the median annual household income was relatively low and the percentage of families living below the poverty level was relatively high. For example, the HIV diagnosis rates in areas with household income under $36,000 were 48.5 per 100,000 for men and 19.9 per 100,000 for women. These diagnosis rates were nearly 3 times greater for men and 6 times greater for women than the HIV rates seen in areas with relatively high household incomes ($66,000 or higher).
Similarly, for areas in which 20% or more of the population was living below the U.S. federal poverty level, the HIV diagnosis rates were 50.1 per 100,000 for men and 19.9 per 100,000 for women. These HIV diagnosis rates were nearly 4 times greater for men and over 7 times greater for women than the rates seen in areas with less than 6% of the population living below the poverty level.
Education Level: HIV diagnosis rates were inversely related to the level of educational attainment. Rates were highest in areas where 8% or more of adults had less than a high school education: 44.2 per 100,000 for men and 16.5 per 100,000 for women. The lowest HIV diagnosis rates were seen in areas where fewer than 2% of adults had less than a high school education: 17.9 per 100,000 for men and 3.1 per 100,000 for women.
Employment: Likewise, HIV diagnosis rates were highest in areas where the unemployment rate was 7% or more: 48.5 per 100,000 for men and 19.2 per 100,000 for women. Diagnosis rates were lowest in areas where the unemployment rate was less than 3%: 17.4 per 100,000 for men and 4.1 per 100,000 for women.
Paying for HIV/AIDS Services and Prevention
Total US spending on domestic and international HIV/AIDS programs would increase about 7% from $27.8 billion in Fiscal Year (FY) 2012 to $29.7 billion in FY14, according to the Obama Administration’s budget proposal issued in April. The U.S. Office of Management and Budget (OMB) has issued a summary focusing on the HIV/AIDS-related portions of the budget. Selected highlights of this summary are extracted below:
Support for the National HIV/AIDS Strategy (NHAS) and Investments in Prevention, Care, and Research: Compared to FY12, the FY14 proposed budget would increase the Department of Health and Human Services discretionary HIV/AIDS funding by $73 million and Veterans Affairs HIV/AIDS funding by $155 million.
Ryan White HIV/AIDS Program: The FY14 budget proposal includes an increase of $20 million for care and treatment through the Ryan White HIV/AIDS Program. FY14 funding for AIDS drug assistance programs would rise to $943 million – $10 million above the FY12 level. Ryan White Part C funding would also be increased by $10 million to a total of $225 million. This funding would support efforts to expand access to HIV care and retain HIV-infected patients in care.
HIV/AIDS Prevention and Service Integration: The budget proposal includes $833 million (an increase of $10 million) to support CDC’s efforts to prevent HIV/AIDS in high-risk communities through the use of evidence-based interventions. The budget would also redirect $40 million from less effective activities to support a new $40 million Community High-Impact Prevention initiative that is designed to improve the systems that link persons recently diagnosed with HIV to appropriate care. The budget would also increase funding for data collection by $10 million and invest $10 million to build the infrastructure and capacity that state public health departments and community-based organizations will need to bill private insurers for infectious disease testing.
National Institutes of Health (NIH) Research: The FY14 budget request for AIDS research at NIH is $3.12 billion, an increase of $48 million above the FY12 level. Some NIH research will include studies focusing on the causes and progression of HIV-related illness, vaccine and microbicide development, and innovative approaches to develop an HIV/AIDS cure.
Housing Assistance for People Living with HIV/AIDS: The FY14 budget request includes $332 million for the Department of Housing and Urban Development’s Housing Opportunities for Persons with AIDS (HOPWA) program, to address housing needs among people living with HIV/AIDS and their families. To modernize the HOPWA program and focus on regions of greatest need, the Obama Administration is proposing an updated formula for distributing HOPWA based on the number of cases of people living with HIV and adjusted for an area’s fair market rent and poverty rates, focusing HOPWA on the areas with the most need.
Support for Veterans Living with HIV/AIDS: The budget request also includes $1.1 billion within the Department of Veterans Affairs to ensure that HIV-infected veterans have access to testing and are linked to comprehensive clinical care.
HIV/AIDS-Related Stigma and Discrimination: To strengthen enforcement against discrimination based on race, ethnicity, sexual orientation, religion, and gender, the Administration’s budget proposal includes a 7% increase in funding to the Department of Justice’s Civil Rights Division.
Global AIDS Initiatives: The FY14 budget request includes $6.0 billion for global AIDS initiatives through the President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR initiatives include expanding antiretroviral treatment to 6 million patients globally and investing in prevention programs that include voluntary medical male circumcision, preventing mother-to-child transmission, and expanding access to condoms. In addition, the budget proposal includes funding to meet the nation’s 3-year, $4 billion pledge to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. According to the OMB, “Better program coordination, decreased costs, and greater efficiencies between Global Fund and U.S. investments are helping to increase coverage of essential HIV services and save more lives.”
New and Worth Reading
The President’s Advisory Council on HIV/AIDS (PACHA) issued a Resolution on Effectively Addressing the HIV/AIDS Epidemic in Transgender Populations
New Issue of HIV Counselor Perspectives Focuses on Young Black and Latino Men Who Have Sex with Men
Blackmail, Violence, and Stigma Restrict Access to Sexual Health Services for Gay Men, Global Health and Rights Study Reports (Article from AIDSmap)
International Networks of Gay Men Unite to Fight HIV (Press release from the Global Forum on MSM & HIV)
*Eric Brus is the Director of HIV Health Promotion of AIDS Action Committee. This report is produced by the Health Library of the AIDS Action Committee in collaboration with the New England AIDS Education and Training Center Minority AIDS Initiative Project. The full version is available online.
[From a News Release]
