The State of People Living with HIV/AIDS

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Presentation at HHS Consultation with People Living with HIV/AIDS in support fo the National HIV/AIDS Strategy. Washington, DC. July 25, 2011.

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  • 24% of people who have been diagnosed with HIV have not achieved an undetectable viral load, which means that 76% of people who have been diagnosed with HIV are at increased risk of HIV transmission and disease progression.
  • 24% of people who have been diagnosed with HIV have not achieved an undetectable viral load, which means that 76% of people who have been diagnosed with HIV are at increased risk of HIV transmission and disease progression.
  • The State of People Living with HIV/AIDS

    1. 1. The State of People Living with HIV/AIDS<br />Richard J. Wolitski, PhD<br />Deputy Director, Behavioral and Social Science<br />HHS Consultation with People Living with HIV/AIDS<br />July 25, 2011<br />National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention<br />Division of HIV/AIDS Prevention<br />
    2. 2. Overview<br /><ul><li>Who We Are
    3. 3. Some of Our Challenges
    4. 4. Some of Our Strengths</li></li></ul><li>WHO WE ARE<br />
    5. 5. HIV Incidence and Prevalence, United States, 1977-2006<br />Hall et al., JAMA, 2008. Campsmith et al., CROI, 2009.<br />
    6. 6. 1,178,350<br />People Living with HIV/AIDS<br />In the United States<br />At the end of 2008. CDC, MMWR, June 3, 2011.<br />
    7. 7. Gender<br />CDC, MMWR, June 3, 2011<br />
    8. 8. Transmission Risk<br />CDC, MMWR, June 3, 2011<br />
    9. 9. Race/Ethnicity<br />CDC, MMWR, June 3, 2011<br />
    10. 10. Age<br />CDC, MMWR, June 3, 2011<br />
    11. 11. Too Many PLWHA Don’t Know They Have HIV<br /><ul><li>236,400 people living with HIV/AIDS have not been diagnosed
    12. 12. 20% of people living with HIV/AIDS
    13. 13. Heterosexual men, MSM, youth, API and AI/AN at greatest risk of undiagnosed infection</li></ul>CDC, MMWR, June 3, 2011<br />
    14. 14. Undiagnosed HIV Infection is a Threatto Public Health and the Health of PLWHA<br /><ul><li>Not able to access HIV care and treatment
    15. 15. At greater risk for HIV transmission
    16. 16. At greater risk for disease progression and death</li></li></ul><li>Some of our Challenges<br />
    17. 17. Some Challenges: Acquiring HIV<br /><ul><li>Poverty
    18. 18. Homelessness
    19. 19. Depression and other mental health issues
    20. 20. Substance use and abuse
    21. 21. Physical and sexual abuse
    22. 22. Racism
    23. 23. Homophobia
    24. 24. Transphobia
    25. 25. Gender inequality</li></li></ul><li>Some Challenges: Coping with HIV<br /><ul><li>Depression and other mental health issues
    26. 26. Getting appropriate medical careand supportive services
    27. 27. Disclosure and nondisclosure of HIV status
    28. 28. HIV stigma and discrimination
    29. 29. Violence
    30. 30. Employment
    31. 31. Housing</li></li></ul><li>Bhaatia et al., AIDS and Behavior, 2011.<br />180 people diagnosed with HIV in past 90 days<br />Houston, Texas<br />Not already linked to care<br />67% screened positive for depression<br />56% of depressed and 68% of not depressed persons linked to care during study<br />
    32. 32. Many PLWHA Are Not Getting Appropriate Medical Care<br />4 out of 5 diagnosed<br />Gardner et al. CID. 2011.<br />
    33. 33. Many PLWHA Are Not Getting Appropriate Medical Care<br />75% linked to care<br />Gardner et al. CID. 2011.<br />
    34. 34. 67% retained in care<br />Gardner et al. CID. 2011.<br />Many PLWHA Are Not Getting Appropriate Medical Care<br />
    35. 35. 75% on ART<br />Gardner et al. CID. 2011.<br />Many PLWHA Are Not Getting Appropriate Medical Care<br />
    36. 36. 80% undetectable<br />Gardner et al. CID. 2011.<br />Many PLWHA Are Not Getting Appropriate Medical Care<br />
    37. 37. 24% of diagnosed undetectable<br />Gardner et al. CID. 2011.<br />Many PLWHA Are Not Getting Appropriate Medical Care<br />
    38. 38. 19% of all PLWHA<br />Gardner et al. CID. 2011.<br />Many PLWHA Are Not Getting Appropriate Medical Care<br />
    39. 39. Good HIV CareIs Good for Prevention<br />Higher viral load associated with HIV transmission (Fisher et al., AIDS, 2010; Das et al., PLOS One, 2010; Quinn et al., N Eng J Med, 2000)<br />Early ART led to 96% reduction in transmission in HPTN 052 (Cohen et al., NEJM 2011)<br />92% reduction in observational studies (Attia et al., AIDS, 2009)<br />
    40. 40. Good HIV CareIs Good for PLWHA<br />Inadequate or late health care increases morbidity and mortality<br />People living with HIV are at-risk for various health problems including:<br />Cardiovascular disease<br />Cervical and anal cancers<br />Bone loss<br />Dementia<br />Sexually transmitted infections<br />Hepatitis C<br />
    41. 41. Stigma Has Declined, But Still Widespread<br />Kaiser Family Foundation, June 2011.<br />45% of Americans would be uncomfortable having their food prepared by someone who is HIV‐positive<br />29% uncomfortable having their child in a classroom with an HIV‐positive teacher<br />18% uncomfortable working with someone with HIV<br />
    42. 42. Gielen, et al. Journal of Urban Health, 2000.<br />257 HIV-positive women, 92% African American<br />44% reported negative consequences of disclosure<br />24% lost friends <br />23% insulted or sworn at <br />21% rejected by family<br />10 women (4%) were physically or sexually assaulted<br />Women with a history of physical and sexual violence were significantly more likely to experience negative consequences <br />
    43. 43. Wolitski et al., AIDS and Behavior, 2009.<br />637 unstably housed/homeless PLWHA from 3 US cities<br />Higher levels of stigma associated with:<br />Poorer self-assessed physical and mental health<br />Poorer adherence to HIV treatment<br />Drug use<br />Decreased disclosure of HIV status to social network members and sex partners<br />
    44. 44. Galvan et al., AIDS Patient Care and STDs, 2008,<br />283 HIV-positive African Americans in Los Angeles<br />Less perceived stigma associated with fewer symptoms of major depression<br />Social support from friends associated with less perceived stigma<br />
    45. 45. Courtenay-Quirk et al., AIDS Education and Prevention, 2006.<br />206 HIV-positive MSM from New York City and San Francisco<br />Many perceived stigma and discrimination in gay community toward PLWHA<br />36% agreed that HIV-negative men judge you if they find out that you are positive<br />
    46. 46. Courtenay-Quirk et al., AIDS Education and Prevention, 2006.<br />Higher levels of stigma were associated with:<br />Anxiety, loneliness and depressive symptoms<br />Suicidal ideation<br />Avoidant coping<br />Seeking partners in sex clubs and private sex parties<br />
    47. 47. Some of our strengths<br />
    48. 48. Some Strengths<br />Individual and collective resilience<br />Strength, courage, knowledge and ability to bring about positive change:<br />Advocating for our needs and those of others<br />Helping others navigate complex medical care and service systems<br />Sharing our stories and experiences to:<br />Reduce stigma and discrimination<br />Educate others and prevent HIV transmission<br />Improve medical care and service delivery<br />Providing leadership at community and national levels<br />
    49. 49. Most PLWHA See Themselves as Responsible for Protecting Others<br />Wolitski et al., AIDS and Behavior, 1998.<br />
    50. 50. Perceived Responsibility is Associatedwith Transmission Risk<br />p < .001<br />p < .05<br />p < .001<br />Wolitski et al., AIDS and Behavior, 1998.<br />
    51. 51. A Growing Literature<br />Personal responsibility is associated with reduced risk in multiple studies<br />Injecting and other drug users in the US and Tanzania(Latka et al., 2007; Ross et al., 2007)<br />Ugandan men and women(King et al., 2008)<br />MSM in The Netherlands and US(Bogart et al., 2006; O’Dell et al., 2008; van Kesteren et al., 2005, 2007) <br />HIV+ clinic patients in US(Hong et al., 2006)<br />Psychological Bulletin.2009.<br />
    52. 52. Kimbrough et al., AJPH, 2009.<br />422 recruiters in 7 cities referred people they knew for HIV testing<br />60% living with HIV/AIDS<br />More undiagnosed HIV infections found by PLWHA<br />6.8% referred by PLWHA were newly diagnosed with HIV<br />4.4% referred by HIV-negative persons were newly diagnosed<br />
    53. 53. Women and Men Living with HIV/AIDSHelp Others Reduce Risk Behavior<br />Wingood et al., JAIDS, 2004; Kalichman et al. American Journal of Preventive Medicine, 2001.<br />More info available at: www.effectiveinterventions.org<br />
    54. 54. Women and Men Living with HIV/AIDSHelp Others Reduce Risk Behavior<br />
    55. 55. Conclusions<br />PLWHA are a large, growing and diverse population<br />Face multiple challenges<br />Countered by multiple strengths<br />The health care needs of PLWHA are not being adequately met and result in<br />Poorer health for PLWHA and increased health care costs<br />Missed opportunities to prevent HIV transmission<br />Stigma and discrimination continue to negatively affect the lives and health of PLWHA<br />PLWHA play important and effective roles in reducing stigma, improving HIV care and preventing HIV transmission<br />
    56. 56. Thank You!<br />For more information please contact Centers for Disease Control and Prevention<br />1600 Clifton Road NE, Atlanta, GA 30333<br />Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348<br />E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov<br />The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.<br />National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention<br />Division of HIV/AIDS Prevention<br />

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