This document discusses disparities in HIV among men who have sex with men (MSM) and the role of social determinants. It notes that addressing social conditions and drivers of HIV vulnerability through structural approaches is a key part of moving from an emergency response to a long-term response for AIDS. Several findings are highlighted: MSM have much higher HIV prevalence than general populations in many countries; criminalization of homosexuality and lack of funding targeting MSM undermine HIV prevention efforts; and experiences of discrimination, financial hardship and lack of social support are associated with higher risk sexual behaviors among MSM. Overall, the document emphasizes that effectively addressing the social drivers of the HIV epidemic among MSM through structural interventions is important for reducing disparities.
Burden of HIV and Research Gaps Among Key Populations in Sub-Saharan AfricaHopkinsCFAR
Key populations including sex workers, men who have sex with men, and people who inject drugs experience disproportionately high HIV burdens in sub-Saharan Africa due to various biological, behavioral, and structural factors. HIV prevalence among female sex workers ranges from 10.9% in Eastern Europe to 36.9% in sub-Saharan Africa, where sex workers are 12 times more likely to be infected than other women. Men who have sex with men also experience high HIV prevalence, though data remains limited in sub-Saharan Africa. Combination prevention approaches including behavioral, biomedical, and structural interventions are needed to address the outsized impact of HIV on key populations.
01 Setswe~Hiv Prevention Where Is The Evidence Of Interventions That WorkNicholas Jacobs
The document summarizes evidence for HIV prevention interventions that work. It discusses biomedical interventions like male circumcision, HAART, and PMTCT that have good evidence of effectiveness ranging from 60-98% based on randomized controlled trials. It also reviews behavioral interventions like HIV counseling and testing, the Stepping Stones program, and structural interventions like microfinance combined with gender training, finding some have promising evidence of effectiveness while evidence is limited or lacking for others.
This document summarizes data from the 2012 Global Men's Health and Rights Survey regarding young men who have sex with men (YMSM). Key findings include:
- YMSM reported higher rates of unstable housing, lack of income, lack of healthcare coverage compared to older MSM.
- YMSM also had lower access to HIV prevention services like condoms, lubricants, testing, and education programs compared to older MSM.
- Among YMSM living with HIV, fewer were on antiretroviral therapy and fewer had suppressed viral loads compared to older MSM living with HIV.
- YMSM reported experiencing more homophobia, violence, and less community engagement and comfort with providers than
This document provides an overview of Dr. James Frankish's background and research interests related to homelessness, health, and social determinants of health. It summarizes some of his key findings from research on homelessness in Canada and BC, including characteristics of the homeless population and factors contributing to homelessness. The document proposes several strategies to address homelessness, such as engaging the public in discussions, using housing to enable intersectoral collaboration, linking employment training to independent living, and creating local infrastructure to measure outcomes.
The document discusses homelessness and health in Canada. It provides an overview of Dr. James Frankish's research interests related to homelessness, poverty, and marginalized groups. It summarizes data on the characteristics of homeless populations in Vancouver and BC, including health issues, reasons for homelessness, and needed services. It also discusses strategies for addressing homelessness, including changing public discourse, using housing to facilitate intersectoral collaboration, and specific housing and support policies.
This document discusses issues related to advancing the sexual and reproductive health and human rights of men who have sex with men (MSM) living with HIV. It notes that MSM living with HIV face double stigma due to fear/ignorance around HIV transmission and negative attitudes towards MSM. Young MSM living with HIV face additional challenges accessing healthcare without parental consent. The document argues for a rights-based approach and inclusion of MSM in policymaking to address their disproportionately high rates of HIV infection worldwide due to criminalization, discrimination, and lack of access to appropriate healthcare services.
Getting to scale: How we can achieve the reach required of prevention service...HopkinsCFAR
This document discusses disparities in HIV/STI rates among Black and White MSM in Atlanta from 2009-2014. The study found significantly higher rates of new HIV infections, prevalent HIV infections, and STIs among Black MSM compared to White MSM. Factors contributing to the disparities included higher community-level HIV prevalence among Black MSM networks, increased likelihood of Black MSM encountering an HIV-positive partner, geographic clustering of Black MSM in high-poverty/high-stigma neighborhoods, and higher rates of condom failures or incomplete use among Black MSM. The document advocates for scaling up multiple prevention interventions like PrEP to achieve sufficient coverage levels to meaningfully reduce new HIV transmissions.
Burden of HIV and Research Gaps Among Key Populations in Sub-Saharan AfricaHopkinsCFAR
Key populations including sex workers, men who have sex with men, and people who inject drugs experience disproportionately high HIV burdens in sub-Saharan Africa due to various biological, behavioral, and structural factors. HIV prevalence among female sex workers ranges from 10.9% in Eastern Europe to 36.9% in sub-Saharan Africa, where sex workers are 12 times more likely to be infected than other women. Men who have sex with men also experience high HIV prevalence, though data remains limited in sub-Saharan Africa. Combination prevention approaches including behavioral, biomedical, and structural interventions are needed to address the outsized impact of HIV on key populations.
01 Setswe~Hiv Prevention Where Is The Evidence Of Interventions That WorkNicholas Jacobs
The document summarizes evidence for HIV prevention interventions that work. It discusses biomedical interventions like male circumcision, HAART, and PMTCT that have good evidence of effectiveness ranging from 60-98% based on randomized controlled trials. It also reviews behavioral interventions like HIV counseling and testing, the Stepping Stones program, and structural interventions like microfinance combined with gender training, finding some have promising evidence of effectiveness while evidence is limited or lacking for others.
This document summarizes data from the 2012 Global Men's Health and Rights Survey regarding young men who have sex with men (YMSM). Key findings include:
- YMSM reported higher rates of unstable housing, lack of income, lack of healthcare coverage compared to older MSM.
- YMSM also had lower access to HIV prevention services like condoms, lubricants, testing, and education programs compared to older MSM.
- Among YMSM living with HIV, fewer were on antiretroviral therapy and fewer had suppressed viral loads compared to older MSM living with HIV.
- YMSM reported experiencing more homophobia, violence, and less community engagement and comfort with providers than
This document provides an overview of Dr. James Frankish's background and research interests related to homelessness, health, and social determinants of health. It summarizes some of his key findings from research on homelessness in Canada and BC, including characteristics of the homeless population and factors contributing to homelessness. The document proposes several strategies to address homelessness, such as engaging the public in discussions, using housing to enable intersectoral collaboration, linking employment training to independent living, and creating local infrastructure to measure outcomes.
The document discusses homelessness and health in Canada. It provides an overview of Dr. James Frankish's research interests related to homelessness, poverty, and marginalized groups. It summarizes data on the characteristics of homeless populations in Vancouver and BC, including health issues, reasons for homelessness, and needed services. It also discusses strategies for addressing homelessness, including changing public discourse, using housing to facilitate intersectoral collaboration, and specific housing and support policies.
This document discusses issues related to advancing the sexual and reproductive health and human rights of men who have sex with men (MSM) living with HIV. It notes that MSM living with HIV face double stigma due to fear/ignorance around HIV transmission and negative attitudes towards MSM. Young MSM living with HIV face additional challenges accessing healthcare without parental consent. The document argues for a rights-based approach and inclusion of MSM in policymaking to address their disproportionately high rates of HIV infection worldwide due to criminalization, discrimination, and lack of access to appropriate healthcare services.
Getting to scale: How we can achieve the reach required of prevention service...HopkinsCFAR
This document discusses disparities in HIV/STI rates among Black and White MSM in Atlanta from 2009-2014. The study found significantly higher rates of new HIV infections, prevalent HIV infections, and STIs among Black MSM compared to White MSM. Factors contributing to the disparities included higher community-level HIV prevalence among Black MSM networks, increased likelihood of Black MSM encountering an HIV-positive partner, geographic clustering of Black MSM in high-poverty/high-stigma neighborhoods, and higher rates of condom failures or incomplete use among Black MSM. The document advocates for scaling up multiple prevention interventions like PrEP to achieve sufficient coverage levels to meaningfully reduce new HIV transmissions.
The document discusses drug use patterns in India based on various surveys and studies. It provides data on the prevalence of alcohol, cannabis, and opioid use among males from a 2001 national household survey. Additional information is presented on new treatment seekers, drugs used, and demographic characteristics from the Drug Abuse Monitoring System. Regional data on drug use patterns among people who use drugs but are not in treatment is also presented. The summary highlights key findings on the prevalence of drug use in India and characteristics of drug using populations.
Rudolph Basson: Support or punish – reconsidered approaches to drug related h...SACAP
Harm Reduction acknowledges that drug use occurs and is potentially damaging, and attempts
to reduce and prevent these harms in ways, which are pragmatic and humanistic. Although the
harm reduction approach and specific harm reduction interventions (including needle and
syringe programmed and methadone programmed) have been implemented with resounding
success internationally (including in a number of African countries) for more than 20 years, the
South African approach to substance use and substance-related harms is still largely informed
by the doctrine and strategies of the "War on Drugs", and focuses almost exclusively on
prohibition and punishment. Because of the strong link between drug use and poverty, different
policy approaches to poverty and homelessness must also be considered. My talk will critically
examine these two approaches to drug use, poverty, and displacement (support or punish), as
they are being implemented in Cape Town. Opportunity for discussion will be provided.
The document summarizes HIV epidemiology among men who have sex with men (MSM) globally and in Asia Pacific. Some key points:
- HIV prevalence among MSM ranges from under 1% to over 25% depending on the country/region, with most of Asia and Africa over 5%.
- HIV is increasing among MSM in many countries as prevalence declines elsewhere, with urban areas often having much higher rates.
- Condom use and HIV testing is low among MSM in most areas. Criminalization and stigma also limit data collection and access to services.
- MSM population size estimates vary widely but are often in the hundreds of thousands to millions in Asia Pacific countries.
The document summarizes a report on a project conducted by the International HIV/AIDS Alliance to address the feminization of HIV/AIDS in India. The project worked with 16 partner organizations across 5 Indian states to empower vulnerable women through community-driven approaches. Activities included forming support groups, conducting trainings and workshops, and raising awareness of HIV/AIDS, sexual and reproductive health, and legal rights. An evaluation found that the project increased women's knowledge, access to services, and the capacity of partner organizations to address the issue in a sustainable manner through community participation.
The document discusses the role of statistics and mathematicians in public health practice and HIV/AIDS surveillance. It provides examples of how HIV/AIDS data is collected through disease reporting and used by statisticians to analyze trends, identify at-risk groups, and inform prevention strategies. Specific projects highlighted include using population attributable risk to quantify how social determinants influence racial disparities in HIV incidence among women and analyzing mediators of behavioral interventions.
This document discusses the role of public health in preventing violence. It argues that violence should be viewed as a public health problem and that the public health community has neglected this role. It makes three key points:
1) The public health community should be more interested in violence prevention and promote the evidence base for effective crime and violence prevention strategies.
2) Public health directors should provide leadership for local crime and violence prevention partnerships and agendas.
3) The police are interested in evidence-based approaches to crime prevention and public policy.
The document provides information on the magnitude of violence as a global public health issue, risk factors, and evidence for effective primary, secondary and tertiary prevention strategies. It emphasizes
Healthy Communities: Multnomah county is one of the 36 counties in the state of Oregon, located with Portland as its county seat. Portland is the second largest city in Oregon and the most populous metropolitan area in the state (U.S. Census Bureau [USCB], 2008, p. 1). As of 2007, Multnomah County's population is 681,454 people (Sperling, 2008). For the purpose of this study, the community focus will be primarily on the sector of Multnomah County in the 97212 area code, which will be called the Rose Sector.
This document discusses women and HIV globally and in Myanmar. It notes that HIV is still a leading cause of death for women aged 15-49 worldwide. In Asia, the proportion of people living with HIV who are women has increased from 19% in 2000 to 35% in 2008. Women are often vulnerable due to being partners of men in high-risk groups. The document recommends improving HIV testing and treatment services for women, developing targeted prevention for at-risk groups of women, and promoting socioeconomic support to reduce stigma faced by women living with HIV.
The new public health and std hiv preventionSpringer
This document discusses social determinants of sexually transmitted infections. It explores how social factors like education, occupation, neighborhoods, and media can influence sexual behaviors and networks, thereby affecting STI spread. Key determinants of STI transmission include likelihood of transmission during sex, number of sexual partners, and partnership patterns. Factors like consistent condom use, access to healthcare, sex education, sexual network patterns, and timing of partnerships all influence STI rates at a population level.
From 2004-2008, Nevada saw a shift in the HIV/AIDS epidemic toward blacks, youth, and heterosexual adults. To effectively plan prevention and care, it is important to identify at-risk populations. The document discusses Nevada's HIV epidemiology, including increases in infections among blacks, Hispanics, youth, MSM, and older age groups. It also summarizes community input that identified priority populations as MSM, HIV-positive individuals, youth/young adults, and minorities. Goals and strategies focused on increasing awareness, testing, interventions, condom access, and linkages to care for these at-risk groups.
1) Suicide rates are highest among males aged 75 and over, and methods like hanging and self-poisoning are common in older adults.
2) Risk factors for suicide in later life include depression, physical illness, social isolation, and bereavement. Only a small percentage of older adult suicide completers had recent contact with mental health services.
3) Community-based prevention programs that educate primary care physicians about depression and increase screening have been shown to reduce elderly suicide rates. Tele-monitoring services may also help prevent suicide in at-risk older adults.
America cares hiv-aids in black america#GOMOJO, INC.
Increase community awareness of HIV/AIDS and HIV prevention strategies.
Increase community understanding of the clinical research process.
Develop and strengthen relationships with community stakeholders, including (but not limited to) medical care providers, STD/HIV counseling and testing providers, faith leaders, Non Governmental Organizations and Community Based Organizations.
Increasingly, African Americans in general are recognizing that HIV is wreaking devastation across our communities. Those who have joined the fight against HIV and AIDS in Black communities are coming to understand that it is a difficult and multifaceted problem—but that it is also a winnable war. With this report, we aim to arm those people with the information they need to get there.
The Role of Government-Funded Assistance Programs on HIV Testing among Poor A...ICF
This study examined the impact of government assistance programs on HIV testing rates among poor adults in the United States. The study found that participation in public assistance programs, especially Medicaid and human services programs, was associated with higher rates of HIV testing compared to poor adults not enrolled in these programs. However, testing rates still did not meet the 90% target proposed in the Ending the HIV Epidemic plan. The results suggest that public assistance programs can help HIV prevention efforts but need to be strengthened, through continued funding and integration into national strategies, to improve testing among vulnerable groups.
Community capacity proposal gomojo for WORLD CHANGE FROM DTLV #GOMOJO, INC.
The document discusses strategies to combat the HIV/AIDS epidemic in the United States and Nevada. It provides background on HIV/AIDS rates nationally and in Nevada, highlighting disproportionate impacts among certain groups. Key strategies discussed include increasing availability of media campaigns, online interventions, substance use interventions, and HIV testing. Specific tactics proposed under each strategy, such as developing culturally appropriate media campaigns targeting various communities, increasing online outreach and education, and requiring acknowledgement of safe sex practices on dating websites. The document emphasizes the need for a coordinated response using evidence-based approaches to reduce transmission rates and improve health outcomes.
The Madison County AIDS Program (MadCAP) is seeking funding to implement an HIV/AIDS risk reduction program for adolescents in Madison County high schools. The program will use the evidence-based BART (Becoming a Responsible Teen) curriculum over the 2016-2017 school year. The goal is to reduce HIV rates among teens and young adults by increasing HIV knowledge, perceived risk of infection, and safe sex practices. Freshmen students will participate in sessions on causes, transmission, testing and prevention. The program aims to have 75% of participants increase essential HIV knowledge and perceive themselves at higher risk of infection after. It will also teach proper condom use through demonstrations to further prevent spread of HIV. Evaluation will compare pre-
A bridge too near injecting drug users' sexual behaviourMd. Nakebul Kausar
This document summarizes a study on the personal profiles and health seeking behaviors of injecting drug users (IDUs) in Dhaka, Bangladesh. The study involved interviews with 120 IDUs attending a drug treatment center between March and September 2005. Key findings included: 1) Most respondents (60%) had little knowledge about diseases spread by injecting drugs or needle sharing, with only 17.5% mentioning HIV/AIDS. 2) Regarding protection, 29.2% mentioned not injecting drugs anymore while 34.2% mentioned using sterile needles/syringes. 3) The majority (60%) had never participated in a needle exchange program, with lack of awareness being a key barrier.
This document discusses male circumcision as an HIV prevention strategy in South Africa. It provides evidence from clinical trials showing circumcision reduces HIV risk in men by 50-60%. Models estimate circumcision could prevent millions of new HIV infections in Africa. Circumcision may also reduce other STIs and penile cancers. While acceptability studies show over 50% of South Africans support circumcision, some sectors raise concerns about risks and commercialization. South Africa is now implementing male medical circumcision guidelines and integrating circumcision into its prevention strategy based on evidence and consultations, to help address the HIV prevention gap.
Harm reduction aims to reduce the negative consequences of drug use without requiring abstinence. It focuses on keeping people safe and healthy. Examples include needle exchange programs to prevent disease transmission and medication-assisted treatment to help stabilize drug use. The goals are to save lives, improve health, support relationships, and reduce stigma and isolation for drug users. Harm reduction takes a non-judgmental approach and recognizes that abstinence may not always be immediately achievable, so the priority is harm minimization through accessible services regardless of how drugs were used.
Despite many barriers that exist, physicians and nurses become the most important players in the space where MSM navigate their health and HIV needs. MSM face significant stigma and discrimination, which increases their vulnerability to poor health outcomes like HIV and mental health issues. Providers have an important role and responsibility to deliver compassionate and non-judgmental care to MSM. Overcoming biases, ensuring privacy and confidentiality, and addressing the specific health needs of MSM are crucial for encouraging MSM to seek the care they need.
LAC 2010 - Keynote Presentation: Innovation in GamingiGB Affiliate
In this light hearted look at the gaming industry, Jez will take a peek at the existing online gaming offerings and comment on their attempts to innovate, and will also demonstrate some examples of what PKR has been doing recently. Jez will give his views on why gaming companies should strive to improve the end-user experience and how that can improve their sales.
Speaker: Jez San OBE, PKR
Opportunities for Expanding HIV Testing through Health ReformCDC NPIN
The document discusses opportunities to expand HIV testing through recent US health reform efforts. It notes that Medicaid expansion, Medicare improvements, and private health insurance reforms will require coverage of preventive services rated A or B by the US Preventive Services Task Force. This includes HIV testing for those at increased risk. While routine HIV testing is not currently covered, many people could now receive testing through these revised policies. Advocates may still need to work on regulations and state-level decisions to maximize expanded HIV testing opportunities through health reform implementation.
The document discusses drug use patterns in India based on various surveys and studies. It provides data on the prevalence of alcohol, cannabis, and opioid use among males from a 2001 national household survey. Additional information is presented on new treatment seekers, drugs used, and demographic characteristics from the Drug Abuse Monitoring System. Regional data on drug use patterns among people who use drugs but are not in treatment is also presented. The summary highlights key findings on the prevalence of drug use in India and characteristics of drug using populations.
Rudolph Basson: Support or punish – reconsidered approaches to drug related h...SACAP
Harm Reduction acknowledges that drug use occurs and is potentially damaging, and attempts
to reduce and prevent these harms in ways, which are pragmatic and humanistic. Although the
harm reduction approach and specific harm reduction interventions (including needle and
syringe programmed and methadone programmed) have been implemented with resounding
success internationally (including in a number of African countries) for more than 20 years, the
South African approach to substance use and substance-related harms is still largely informed
by the doctrine and strategies of the "War on Drugs", and focuses almost exclusively on
prohibition and punishment. Because of the strong link between drug use and poverty, different
policy approaches to poverty and homelessness must also be considered. My talk will critically
examine these two approaches to drug use, poverty, and displacement (support or punish), as
they are being implemented in Cape Town. Opportunity for discussion will be provided.
The document summarizes HIV epidemiology among men who have sex with men (MSM) globally and in Asia Pacific. Some key points:
- HIV prevalence among MSM ranges from under 1% to over 25% depending on the country/region, with most of Asia and Africa over 5%.
- HIV is increasing among MSM in many countries as prevalence declines elsewhere, with urban areas often having much higher rates.
- Condom use and HIV testing is low among MSM in most areas. Criminalization and stigma also limit data collection and access to services.
- MSM population size estimates vary widely but are often in the hundreds of thousands to millions in Asia Pacific countries.
The document summarizes a report on a project conducted by the International HIV/AIDS Alliance to address the feminization of HIV/AIDS in India. The project worked with 16 partner organizations across 5 Indian states to empower vulnerable women through community-driven approaches. Activities included forming support groups, conducting trainings and workshops, and raising awareness of HIV/AIDS, sexual and reproductive health, and legal rights. An evaluation found that the project increased women's knowledge, access to services, and the capacity of partner organizations to address the issue in a sustainable manner through community participation.
The document discusses the role of statistics and mathematicians in public health practice and HIV/AIDS surveillance. It provides examples of how HIV/AIDS data is collected through disease reporting and used by statisticians to analyze trends, identify at-risk groups, and inform prevention strategies. Specific projects highlighted include using population attributable risk to quantify how social determinants influence racial disparities in HIV incidence among women and analyzing mediators of behavioral interventions.
This document discusses the role of public health in preventing violence. It argues that violence should be viewed as a public health problem and that the public health community has neglected this role. It makes three key points:
1) The public health community should be more interested in violence prevention and promote the evidence base for effective crime and violence prevention strategies.
2) Public health directors should provide leadership for local crime and violence prevention partnerships and agendas.
3) The police are interested in evidence-based approaches to crime prevention and public policy.
The document provides information on the magnitude of violence as a global public health issue, risk factors, and evidence for effective primary, secondary and tertiary prevention strategies. It emphasizes
Healthy Communities: Multnomah county is one of the 36 counties in the state of Oregon, located with Portland as its county seat. Portland is the second largest city in Oregon and the most populous metropolitan area in the state (U.S. Census Bureau [USCB], 2008, p. 1). As of 2007, Multnomah County's population is 681,454 people (Sperling, 2008). For the purpose of this study, the community focus will be primarily on the sector of Multnomah County in the 97212 area code, which will be called the Rose Sector.
This document discusses women and HIV globally and in Myanmar. It notes that HIV is still a leading cause of death for women aged 15-49 worldwide. In Asia, the proportion of people living with HIV who are women has increased from 19% in 2000 to 35% in 2008. Women are often vulnerable due to being partners of men in high-risk groups. The document recommends improving HIV testing and treatment services for women, developing targeted prevention for at-risk groups of women, and promoting socioeconomic support to reduce stigma faced by women living with HIV.
The new public health and std hiv preventionSpringer
This document discusses social determinants of sexually transmitted infections. It explores how social factors like education, occupation, neighborhoods, and media can influence sexual behaviors and networks, thereby affecting STI spread. Key determinants of STI transmission include likelihood of transmission during sex, number of sexual partners, and partnership patterns. Factors like consistent condom use, access to healthcare, sex education, sexual network patterns, and timing of partnerships all influence STI rates at a population level.
From 2004-2008, Nevada saw a shift in the HIV/AIDS epidemic toward blacks, youth, and heterosexual adults. To effectively plan prevention and care, it is important to identify at-risk populations. The document discusses Nevada's HIV epidemiology, including increases in infections among blacks, Hispanics, youth, MSM, and older age groups. It also summarizes community input that identified priority populations as MSM, HIV-positive individuals, youth/young adults, and minorities. Goals and strategies focused on increasing awareness, testing, interventions, condom access, and linkages to care for these at-risk groups.
1) Suicide rates are highest among males aged 75 and over, and methods like hanging and self-poisoning are common in older adults.
2) Risk factors for suicide in later life include depression, physical illness, social isolation, and bereavement. Only a small percentage of older adult suicide completers had recent contact with mental health services.
3) Community-based prevention programs that educate primary care physicians about depression and increase screening have been shown to reduce elderly suicide rates. Tele-monitoring services may also help prevent suicide in at-risk older adults.
America cares hiv-aids in black america#GOMOJO, INC.
Increase community awareness of HIV/AIDS and HIV prevention strategies.
Increase community understanding of the clinical research process.
Develop and strengthen relationships with community stakeholders, including (but not limited to) medical care providers, STD/HIV counseling and testing providers, faith leaders, Non Governmental Organizations and Community Based Organizations.
Increasingly, African Americans in general are recognizing that HIV is wreaking devastation across our communities. Those who have joined the fight against HIV and AIDS in Black communities are coming to understand that it is a difficult and multifaceted problem—but that it is also a winnable war. With this report, we aim to arm those people with the information they need to get there.
The Role of Government-Funded Assistance Programs on HIV Testing among Poor A...ICF
This study examined the impact of government assistance programs on HIV testing rates among poor adults in the United States. The study found that participation in public assistance programs, especially Medicaid and human services programs, was associated with higher rates of HIV testing compared to poor adults not enrolled in these programs. However, testing rates still did not meet the 90% target proposed in the Ending the HIV Epidemic plan. The results suggest that public assistance programs can help HIV prevention efforts but need to be strengthened, through continued funding and integration into national strategies, to improve testing among vulnerable groups.
Community capacity proposal gomojo for WORLD CHANGE FROM DTLV #GOMOJO, INC.
The document discusses strategies to combat the HIV/AIDS epidemic in the United States and Nevada. It provides background on HIV/AIDS rates nationally and in Nevada, highlighting disproportionate impacts among certain groups. Key strategies discussed include increasing availability of media campaigns, online interventions, substance use interventions, and HIV testing. Specific tactics proposed under each strategy, such as developing culturally appropriate media campaigns targeting various communities, increasing online outreach and education, and requiring acknowledgement of safe sex practices on dating websites. The document emphasizes the need for a coordinated response using evidence-based approaches to reduce transmission rates and improve health outcomes.
The Madison County AIDS Program (MadCAP) is seeking funding to implement an HIV/AIDS risk reduction program for adolescents in Madison County high schools. The program will use the evidence-based BART (Becoming a Responsible Teen) curriculum over the 2016-2017 school year. The goal is to reduce HIV rates among teens and young adults by increasing HIV knowledge, perceived risk of infection, and safe sex practices. Freshmen students will participate in sessions on causes, transmission, testing and prevention. The program aims to have 75% of participants increase essential HIV knowledge and perceive themselves at higher risk of infection after. It will also teach proper condom use through demonstrations to further prevent spread of HIV. Evaluation will compare pre-
A bridge too near injecting drug users' sexual behaviourMd. Nakebul Kausar
This document summarizes a study on the personal profiles and health seeking behaviors of injecting drug users (IDUs) in Dhaka, Bangladesh. The study involved interviews with 120 IDUs attending a drug treatment center between March and September 2005. Key findings included: 1) Most respondents (60%) had little knowledge about diseases spread by injecting drugs or needle sharing, with only 17.5% mentioning HIV/AIDS. 2) Regarding protection, 29.2% mentioned not injecting drugs anymore while 34.2% mentioned using sterile needles/syringes. 3) The majority (60%) had never participated in a needle exchange program, with lack of awareness being a key barrier.
This document discusses male circumcision as an HIV prevention strategy in South Africa. It provides evidence from clinical trials showing circumcision reduces HIV risk in men by 50-60%. Models estimate circumcision could prevent millions of new HIV infections in Africa. Circumcision may also reduce other STIs and penile cancers. While acceptability studies show over 50% of South Africans support circumcision, some sectors raise concerns about risks and commercialization. South Africa is now implementing male medical circumcision guidelines and integrating circumcision into its prevention strategy based on evidence and consultations, to help address the HIV prevention gap.
Harm reduction aims to reduce the negative consequences of drug use without requiring abstinence. It focuses on keeping people safe and healthy. Examples include needle exchange programs to prevent disease transmission and medication-assisted treatment to help stabilize drug use. The goals are to save lives, improve health, support relationships, and reduce stigma and isolation for drug users. Harm reduction takes a non-judgmental approach and recognizes that abstinence may not always be immediately achievable, so the priority is harm minimization through accessible services regardless of how drugs were used.
Despite many barriers that exist, physicians and nurses become the most important players in the space where MSM navigate their health and HIV needs. MSM face significant stigma and discrimination, which increases their vulnerability to poor health outcomes like HIV and mental health issues. Providers have an important role and responsibility to deliver compassionate and non-judgmental care to MSM. Overcoming biases, ensuring privacy and confidentiality, and addressing the specific health needs of MSM are crucial for encouraging MSM to seek the care they need.
LAC 2010 - Keynote Presentation: Innovation in GamingiGB Affiliate
In this light hearted look at the gaming industry, Jez will take a peek at the existing online gaming offerings and comment on their attempts to innovate, and will also demonstrate some examples of what PKR has been doing recently. Jez will give his views on why gaming companies should strive to improve the end-user experience and how that can improve their sales.
Speaker: Jez San OBE, PKR
Opportunities for Expanding HIV Testing through Health ReformCDC NPIN
The document discusses opportunities to expand HIV testing through recent US health reform efforts. It notes that Medicaid expansion, Medicare improvements, and private health insurance reforms will require coverage of preventive services rated A or B by the US Preventive Services Task Force. This includes HIV testing for those at increased risk. While routine HIV testing is not currently covered, many people could now receive testing through these revised policies. Advocates may still need to work on regulations and state-level decisions to maximize expanded HIV testing opportunities through health reform implementation.
Program Collaboration & Service Integration Michigan NhpcCDC NPIN
The document summarizes the organizational structure of disease prevention and control efforts within the Michigan Department of Community Health. It describes the Division of Health, Wellness and Disease Control which oversees HIV/AIDS, sexually transmitted diseases, and minority health. It provides details on collaboration between units to integrate information on related issues into training. Challenges and opportunities for further integration across the department are also discussed.
Adapting Community PROMISE with Older MSM &Transgender Individuals of ColorCDC NPIN
This document discusses implementing an HIV prevention intervention called Community PROMISE among older MSM and transgender individuals of color in New York City. It provides background on HIV rates in NYC, noting high rates among people of color, MSM, and transgender individuals. It then describes Community PROMISE, a peer-based intervention, and efforts to implement it with fidelity among older adults through community assessment, role model stories, peer advocates, and evaluation. Challenges and lessons learned are discussed, emphasizing stigma reduction and culturally appropriate messaging. Next steps focus on continued evidence-based prevention targeting this population.
Barriers and Facilitators Associated with HIV Testing among Latino MSMCDC NPIN
This project aims to identify barriers and facilitators to HIV testing among Latino men who have sex with men (MSM) and develop a culturally-specific intervention. The researcher will conduct qualitative interviews with 60 Latino MSM to understand individual, health system, and testing factors that influence decisions around HIV testing. Findings will inform the development of a DVD using a peer model, storytelling, and marketing strategies to promote HIV testing. Ten focus groups will provide feedback to refine the DVD's script. The goal is to increase acceptance and intentions to seek HIV testing among the target population.
Advancing a Sexual Health FrameworkFor Gay, Bisexual and Other MSMIn the Unit...CDC NPIN
Richard J. Wolitski presented on advancing a sexual health framework for gay, bisexual, and other men who have sex with men (MSM) in the United States. He noted that over 30,000 new HIV infections occurred among MSM in 2009, showing that current efforts are not effective. A sexual health approach considers broader health issues, relationships, discrimination and stigma. It emphasizes wellness, prevention, and respectful relationships. Structural changes are needed to address homophobia and improve health care and education to reduce HIV transmission and promote sexual health for all.
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
This document summarizes a presentation given to youth leaders on HIV risks and vulnerabilities. It discusses definitions of key terms, facts about HIV and AIDS, how HIV is transmitted, risks faced by out-of-school youth, impacts of HIV/AIDS, epidemiology of HIV in the Philippines, and examples of interventions youth can support like peer education and promoting condom use. The overall goal is to inform youth leaders so they can help prevent the spread of HIV in their communities.
Global Medical Cures™ | HIV Among Women
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
The Role of Men and Boys in Challenging Gender in the Context of HIV and othe...UNDP Eurasia
This document discusses the role of men and boys in challenging gender norms in the context of HIV and gender-based violence. It finds that gender norms that promote inequitable power dynamics between men and women increase vulnerability to HIV/STIs. Changing these norms through gender-transformative programming with men and boys is an important part of prevention. Effective approaches include group education to promote reflection on gender socialization, as well as community mobilization campaigns combining multiple intervention levels. Evidence demonstrates that such interventions can positively impact gender attitudes and behaviors.
This document summarizes key information about HIV in the United States:
- Over 1.1 million people are living with HIV in the US, with about 56,000 new infections each year. Rates are highest among men who have sex with men, African Americans, Latinos, and intravenous drug users.
- Effective prevention strategies include promoting abstinence, fewer partners, condom use, not sharing needles, antiretroviral treatment, male circumcision, and pre-exposure prophylaxis. Widespread testing is also an important prevention approach.
- Combining multiple prevention approaches and targeting high-risk groups can maximize the impact of HIV prevention and reduce transmission rates in the US.
Adolescent and Young Adult Scientific Working GroupHopkinsCFAR
This document summarizes the objectives and proceedings of the Adolescent & Young Adult Scientific Working Group (AYA SWG) annual meeting at the CFAR. It provides epidemiological data on HIV among adolescents and young adults globally and in the US/Baltimore. It introduces an ecological framework for understanding HIV in this group and highlights the mission and initiatives of the AYA SWG. Examples of funded CFAR projects focusing on adolescents/young adults are also presented that address topics like ART adherence, economic empowerment, use of geosocial networking apps, and needs of transgender women of color. Next steps discussed for the AYA SWG include developing a position paper, panel discussions, and expanding collaborations.
1. Combination prevention approaches that integrate biomedical, behavioral, and structural interventions may provide the most effective strategy for HIV prevention.
2. While biomedical interventions like PrEP and treatment as prevention have shown promise, their effectiveness relies on optimal adherence which is influenced by behavioral and social factors.
3. Behavioral interventions alone have had questionable effectiveness, so combining them with biomedical approaches could help ensure medication adherence and uptake.
4. Structural interventions are also needed to address social determinants like poverty, discrimination, and gender inequality that fuel the HIV epidemic.
The document summarizes the key findings of a consultation on the issues and barriers facing transgender people in accessing HIV and other services in Yangon, Myanmar. The consultation identified low levels of condom use and HIV awareness within the transgender community. It also found that transgender people face discrimination in healthcare settings, preventing access to prevention, treatment, and support services. Common issues included stigma, unfriendly services, and a lack of tailored HIV prevention interventions. The document recommends improving health services, reducing risk behaviors, and addressing discrimination in order to improve transgender health outcomes in Yangon.
This document discusses sexually transmitted infections (STIs) in the Eastern Mediterranean Region (EMR). It provides estimates of STI incidence and prevalence in the EMR, showing that 34 million new STI cases were reported in 2016. It also discusses challenges related to awareness, knowledge, beliefs and attitudes towards STIs in the region. Some countries have national STI policies, but implementation is slow due to lack of resources and infrastructure. The document highlights regional best practices like Marsa in Lebanon and opportunities to expand integrated STI services, prevention interventions, and advocacy. Overall, it analyzes the regional situation of STIs and identifies socio-cultural barriers to effective prevention and management in the EMR.
This document summarizes research on the transgender population in Ho Chi Minh City, Vietnam and the challenges they face related to HIV, health, and human rights. It notes that transgender people suffer discrimination worldwide and lack legal protections in most of Asia. In Vietnam, they are often conflated with MSM and lack recognition of their gender identity. The document reviews limited available data on health issues like HIV prevalence and access to transition-related care. It estimates the transgender population in Ho Chi Minh City to be 2,000-3,000 and notes a lack of targeted programs and legal protections for this at-risk group.
This study aims to investigate factors that influence male partner involvement in eliminating mother-to-child HIV transmission in Makueni County, Kenya. Male involvement is currently low, at 0.2% testing rate in antenatal clinics. The study will employ a mixed-methods design using questionnaires, focus groups, and key informant interviews to assess male involvement levels, how involvement influences elimination of transmission, and barriers/opportunities. Data will be collected from October 2022 to December 2022, analyzed from January 2023 to March 2023, and the thesis submitted by July 2023. Ethics approval will be obtained and informed consent, confidentiality, and participants' right to withdraw will be ensured. The budget is KSh 410
This document provides an overview of integrating gender into monitoring and evaluation (M&E) of HIV programs. It begins with definitions of key gender-related terms like sex, gender, gender equality, and gender identity. It then discusses why gender is important to consider for HIV outcomes and programming, noting how gender inequality can increase HIV risk. The document reviews approaches to collecting gender-sensitive monitoring and evaluation data, including sex-disaggregated indicators and indicators that directly measure gender attitudes, norms, and inequalities. It emphasizes integrating gender into all aspects of M&E systems and processes to help improve programs and demonstrate their impact on gender equality and HIV outcomes.
The document summarizes 18 studies on preventing HIV among older adults. It finds that while HIV rates are rising in older populations, few prevention programs have targeted this group. The studies examined universal prevention programs for the general older population (3 studies), indicated prevention for older adults already infected (5 studies), and strategies/recommendations (10 studies). Most interventions showed improved HIV knowledge, though more research is needed due to the growing numbers of older adults at risk of infection.
Invisible Men who have Sex with Men and Survival: From Practice to Research a...Jim Pickett
John Schneider's, University of Chicago, presentation at the Sex in the City II: Men, Sex, Love and HIV conference, held in Chicago on September 25, 2014. Sponsored by AIDS Foundation of Chicago and other partners.
Jill Blumenthal MD of UC San Diego presents "Free to Be You and Me: Providing Culturally-Sensitive Patient Care to Transgender Individuals" at AIDS Clinical Rounds
1) About 33% of people living with HIV/AIDS in the US are over 50 years old, and by 2015 over 50% are projected to be over 50. Older African Americans and gay men are disproportionately affected.
2) In New York City, 75% of people with HIV/AIDS are over 40, and 38% are over 50. There are three groups of older adults with HIV - newly infected, newly diagnosed, and longtime survivors.
3) Older adults experience stigma around both HIV status and aging, which can lead to isolation, depression, and challenges accessing care. Health providers must address the long-term effects of HIV and aging.
This presentation provides an overview of stigma and discrimination against people living with HIV/AIDS (PLHIV) in Ghana. The objectives are to understand the forms of stigma, appreciate its impact, and find ways to end it. HIV prevalence in Ghana is consistently over 1% and it is a generalized epidemic. Stigma negatively impacts PLHIV's quality of life and ability to access healthcare. It takes many forms including self-stigma, governmental stigma through discriminatory policies, healthcare stigma like denial of care, and stigma in employment and communities through social isolation and rejection. Ending stigma is critical to effectively respond to the HIV epidemic in Ghana.
This report summarizes findings on HIV/AIDS among gay, bisexual, and other men who have sex with men (MSM) in Canada. Key findings include: rates of HIV are highest among MSM, who represent over 40% of new HIV infections; factors like homophobia, lack of social support, and barriers to healthcare contribute to higher vulnerability; and more research is needed on resilience, subpopulations of MSM, and culturally-competent healthcare services. The report aims to inform future research, policy, and programming to address HIV/AIDS in these communities.
A youth-focused case management intervention to engage and ret.docxransayo
A youth-focused case management intervention to engage and retain young gay men of color
in HIV care
Amy Rock Wohl
a
*, Wendy H. Garland
a
, Juhua Wu
b
, Chi-Wai Au
b
, Angela Boger
b
, Rhodri Dierst-Davies
a
,
Judy Carter
b
, Felix Carpio
c
and Wilbert Jordan
d
a
Los Angeles County Department of Public Health, HIV Epidemiology Program, Los Angeles, CA, USA;
b
Los Angeles County
Department of Public Health, Office of AIDS Programs and Policy, Los Angeles, CA, USA;
c
AltaMed Health Services
Corporation, Daniel V. Lara Clinic, Los Angeles, CA, USA;
d
Los Angeles County MLK-MACC, OASIS Clinic, Los Angeles,
CA, USA
(Received 5 April 2010; final version received 18 November 2010)
HIV-positive Latino and African-American young men who have sex with men (YMSM) have low rates of
engagement and retention in HIV care. An evaluation of a youth-focused case management intervention (YCM)
designed to improve retention in HIV care is presented. HIV-positive Latino and African-American YMSM, ages
18�24, who were newly diagnosed with HIV or in intermittent HIV care, were enrolled into a psychosocial case
management intervention administered by Bachelor-level peer case managers at two HIV clinics in Los Angeles
County, California. Participants met weekly with a case manager for the first two months and monthly for the
next 22 months. Retention in HIV primary care at three and six months of follow-up was evaluated as were
factors associated with retention in care. From April 2006 to April 2009, 61 HIV-positive participants were
enrolled into the intervention (54% African-American, 46% Latino; mean age 21 years). At the time of
enrollment into the intervention, 78% of the YMSM had a critical or immediate need for stable housing,
nutrition support, substance abuse treatment, or mental health services. Among intervention participants
(n �61), 90% were retained in primary HIV care at three months and 70% at six months. Among those who had
previously been in intermittent care (n �33), the proportion attending all HIV primary care visits in the previous
six months increased from 7% to 73% following participation in the intervention (pB0.0001). Retention in HIV
care at six months was associated with increased number of intervention visits (p �0.05), more hours in the
intervention (p �0.02), and prescription of HAART. These data highlight the critical needs of HIV-positive
African-American and Latino YMSM and demonstrate that a clinic-based YCM can be effective in stabilizing
hard-to-reach clients and retaining them in consistent HIV care.
Keywords: adolescents; MSM; HIV/AIDS; Latinos; African-Americans; interventions
Introduction
National HIV and AIDS rates are elevated for
African-American and Latino youth which is consis-
tent with 2008 behavioral surveillance data in Los
Angeles County in which HIV prevalence rates were
17% for African-American and 13% for Latino
18�24-year-old young men who have sex with men
(YMSM) (Bingham & Sey, 2009;.
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The National Prevention Information Network (NPIN) is a service of the Centers for Disease Control and Prevention (CDC) that provides substance use and HIV prevention resources and information. NPIN offers access to materials on topics like alcohol, tobacco, other drugs, and HIV/AIDS in both English and Spanish. Their website contains thousands of publications, videos, and other materials to support prevention professionals and the general public.
CDC's new social networking site will allow two-way communication between CDC and partners, peer knowledge sharing through conversations and resources, and collaborative workspaces. A new testing site will provide recommendations for HIV, STD, and hepatitis testing based on a user's responses and show nearby testing locations. The STD microsite was redesigned with a modern look and new navigation. A new "widget wizard" will allow partners to access and display information from CDC's testing and treatment organization database on their own websites.
In the Know II: What's New In Image & Video Sharing?CDC NPIN
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Using What You Know about Social Media: How to Conduct a Twitter ChatCDC NPIN
This is the 1st in our newest online training opportunity for public health professionals: Using What You Know about Social Media - How to Conduct a Successful Twitter Chat!
In the Know II: Creating Your Social Media PlanCDC NPIN
This presentation was used in a webcast that offered public health professionals the methods to successfully create a social media plan. How do you truly connect with your target audience? Developing a plan is one of the first and most important aspects of an engagement strategy. The right plan has many facets that work together to increase the likelihood of success.
In honor of World AIDS Day 2013 and to ensure we always remember those no longer with us, CDC NPIN is proud to host 15 sections of the Names Project AIDS Memorial Quilts. Each panel underscores commitment and effort to end this pandemic.
The NPIN by the Numbers document provides statistics about the National Prevention Information Network and its websites from April 2012. It summarizes that the cdcnpin.org and hivtest.org websites had millions of visitors and page views. The NPIN databases contained information for over 10,000 organizations providing HIV, STD, TB, and viral hepatitis testing and services. Social media engagement saw increases in members, followers, and impressions discussing HIV prevention.
NPIN's In the Know: Social Media for Public Health Webcast Series PosterCDC NPIN
In the Know is a live, interactive webcast series designed to provide the latest in social media to support public health success. The first series of webcasts wrapped up in June, 2013.
CDC NPIN In the Know: Social Media Measurement and Evaluation for Public Heal...CDC NPIN
This document discusses evaluation and measurement tactics for social media use in public health. It explores various social media metrics and tools that can measure exposure, engagement, influence, and results across platforms like Facebook, Twitter, LinkedIn, and YouTube. Case studies are presented that demonstrate how organizations have used metrics and tools to evaluate success, inform improvements, and show contributions to goals. Cross-channel evaluation tools are also highlighted that can aggregate data from multiple social media channels.
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This is the fifth of six interactive webcasts in the series, In the Know: Social Media for Public Health. Each webcast focuses on a different social media channel and provides basic information, tips, success stories, and discussion on how best to use social media to promote public health and expand outreach initiatives.
CDC NPIN In the Know: Facebook & Visual Social Media for Public HealthCDC NPIN
This document provides an overview of using visual social media, especially Facebook, for public health purposes. It discusses making the case for social media use, relevant demographics and behaviors, best practices for creating and posting engaging content, tracking success, and examples of how other public health organizations are leveraging social media. Specific platforms covered include Facebook, Pinterest, Instagram, Tumblr, Vine, and their potential uses for public health messaging and promotion. Case studies highlight campaigns by organizations like Boston Public Health Commission, Philadelphia Department of Public Health, and the University of Colorado Health.
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
4 wed ayala nhpc atlanta august 2011
1. Disparities in HIV among MSM:
Role of Social Determinants
George Ayala, Executive Officer
The Global Forum on MSM & HIV
2. A key component of the shift from an emergency to a long-term
response to AIDS is a change in focus from HIV prevention
interventions focused on individuals to a comprehensive strategy
in which social/structural approaches are core elements. Such
approaches aim to modify social conditions by addressing key
drivers of HIV vulnerability that affect the ability of individuals to
protect themselves and others from HIV.
Source: Auerbach, JD, Parkhurst, JO, and Caceres, CF. 2011. Addressing the social drivers of HIV/AIDS for the long-term response:
Conceptual and methodological considerations. Global Public Health.
3. HIV Prevalence Among MSM Compared with HIV
Prevalence in the General Population (Aged 15 and over) in
36 Low- and Middle-Income Countries
35
30
25
20
15
10
5
0
HIV Prevalence Among MSM Population Prevalence of HIV (Ages >/= 15 years)
Source: Beyrer C, Baral SD, Walker D, Wirtz AL, Johns B, Sifakis F. The Expanding Epidemics of HIV Type 1 Among Men Who Have
Sex With Men in Low- and Middle-Income Countries: Diversity and Consistency. Epidemiol Review. 2010;32(1):137-51. Epub 2010 Jun
23.
4. Nearly80 countries around the world criminalize
homosexuality, five with the death penalty.
2% of global spending on HIV prevention programs is
specifically targeted to men who have sex with men in low and
middle-income countries.
In Latin America, 60% of people living with HIV are MSM, but only 0.5% of
total HIV prevention spending is targeted at them (2004)
Available resources led to between 7 – 17% coverage of basic HIV
prevention services in the Asia-Pacific region among MSM (2006)
Only 0.6% of total HIV prevention spending was targeted toward MSM in 55
low- and middle-income countries (2006)
6. MSM and HIV in the U.S.:
An Overview
• MSM accounted for more than half (61%) of all new HIV infections in
2009.
• The rate of new HIV diagnoses among MSM is more than 44 times
that of other men and more than 40 times that of women (522-989
cases per 100,000 vs. 12 per 100,000 other men and 13 per 100,000
women).
• Among people aged 13-29, only MSM experienced increases in HIV
incidence between 2006-2009 . There was a 48% increase among
Black MSM during the same period.
• Unrecognized HIV infection is of particular concern especially among
young Black and Latino MSM.
Sources: Prejean, J., et al. Estimated Incidence in the U.S., 2006-2009. PloS ONE; 6(8): 1-13.
Centers for Disease Control and Prevention. Subpopulation estimates from the HIV incidence surveillance system – United States,
2006. MMWR. 2008; 57(36): 985-989.
Centers for Disease Control and Prevention. Trends in HIV/AIDS diagnoses among men who have sex with men – 33 states, 2001 –
6
2006. MMWR. 2008; 57(25): 681-686.
7.
8.
9.
10. In 2009, there were 6,604 reported incidents of hate crimes in
the U.S.
50% were due to racial bias
19% were due to a person’s sexual orientation
Source: Federal Bureau of Investigations - 2010
11. Average FY2009 Funding
100%
90%
80%
70%
60% $4,992,473
$5,099,351 $1,579,356 $10,106,396
50%
Total
40%
MSM
30%
20%
10% $1,146,330
$680,172 $199,441 $1,375,983
0%
CDC HD Core CDC HD HIV State Funds All Sources
Funding Testing
Source: National Alliance of State and Territorial AIDS Directors. 2010. Black Gay Men and HIV/AIDS: Evaluating Our Progress to
Reverse the Epidemic.
12. In 2009, the Division of HIV/AIDS Prevention (DHAP) targeted
43% of its funding to HIV prevention among MSM.
The smallest category of the U.S. President’s FY2012 budget
request for domestic HIV/AIDS spending was HIV prevention at
just under 4%.
Sources: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD,
and TB Prevention. 2011. Strategic Plan DHAP 2011 through 2015.
Kaiser Family Foundation. 2012.
14. Study Aims
The goals of the survey were to:
– provide a platform for MSM voices from around the globe
– highlight key gaps in basic HIV prevention services
– assess predictors of access and participation for those
services
– assess knowledge about emerging prevention strategies
– identify potential challenges in implementation of prevention
strategies
15. Methods
• Online survey for MSM and service providers
– Administered from June to August of 2010
• MSMGF networks, list serves, e-mail blasts, website
• Chinese, English, French, Russian, Spanish
• Measures adapted from validated scales
• Assessments included items from recommendations by
governmental agencies, and advocacy organizations
• Data Analysis
– Identify disparities - Analysis of Variance (Anova)
– Identify predictors - Regression models
16. Constructs Measured
• Perceived stigma/external homophobia
• Internalized homophobia
• Self-esteem
• Access to basic HIV prevention services
• Access to emerging HIV prevention technologies
• Knowledge of emerging technologies
• Desire to learn about emerging technologies
• PrEP knowledge
• Attitudes about PrEP
• Participation in HIV prevention activities
• Exposure to HIV prevention messages
• Venues in which HIV prevention materials were obtained
17. Sample Characteristics
• Total sample = 5,066
– English (46%)
– Chinese (40%)
• Geographic Distribution
– 56% from Asia-Pacific
– 14% from North America
– 11% from Central/South America and the Caribbean
– 7% from Australia/New Zealand
– 6% from Europe
– 4% from Africa
– 1% from the Middle East
• Mean age was 34.3 years (range: 14-86 years)
• 21% of the sample were health providers
18. Access to Basic HIV Prevention
Services
“this is easily accessible in my
Prevention components community”
Free HIV Testing 48%
HIV Counseling 51%
HIV Treatment 36%
Sexual Transmitted Diseases STD)Testing 53%
STD Treatment 47%
Free Condoms 44%
Condom-compatible lubricants 29%
Sex Education Programs 25%
19. Key Findings
• Basic HIV prevention interventions—including free condoms,
condom-compatible lubricants, HIV testing—are not widespread and
easily accessible globally for MSM
– Rates lowest in Asia-Pacific, Middle East, Africa and Central/South
America or the Caribbean
• Youth lack access to basic HIV prevention interventions, have low
knowledge of emerging interventions
• Alarming levels of external homophobia
– Rates highest in Africa, followed by Caribbean and Central/South
America, Asia-Pacific, and the Middle East
• External homophobia and younger age independently predict lower
access to basic HIV prevention interventions
• Overall knowledge of emerging HIV prevention strategies low across
all regions
– Strong desire to learn more about emerging ARV-based primary
prevention interventions overall
20. Modeling the impact of social discrimination
and financial hardship on the sexual risk for
HIV among Latino and Black MSM
George Ayala, Trista Bingham, Junyeop Kim, Darrell Wheeler,
and Greg Millet
21. Stigma: A dynamic process of devaluation that
significantly discredits an individual in the eyes of others.
Social Discrimination: Mean, unfair, or
unequal treatment (including acts of verbal or physical
violence) intended to marginalize or subordinate
individuals or communities based on their real or
perceived affiliation with socially constructed stigmatized
attributes.
22. Hypotheses
• Experiences of social discrimination and lack of social support
would each be positively associated with UAI with casual male
partners
• Experiences of social discrimination and financial hardship would be
positively associated with lack of social support
• Experiences of social discrimination, financial hardship, and lack of
social support would each be associated with reports of being in
situations that make safer sex more difficult
• Participation in difficult sexual situations would mediate the
associations between social discrimination, financial hardship, and
lack of social support on UAI with casual male partners
23. Methods
• Respondent driven sampling (RDS)
• Traditional mediation analysis and path analysis
• Chi-square and t-test stats to examine bi-variate
associations
• Linear and logistic regression analyses to examine
associations between variables
25. Sample
• Recruited 1,081 Latinos and 1,154 Black MSM from May 2005 through
April 2006 in New York City, Philadelphia, and Los Angeles
• Reported sex with another man in the past 12 months, irrespective of
HIV serostatus
• 57% of Latinos and 9% Blacks were born outside the U.S.
• Latinos were younger than Blacks (median ages 32 and 43 respectively)
• 58% Latinos and 33% Blacks reported being employed full or part time
• 39% of Latinos and 53% of Blacks were HIV-positive based on HIV
testing conducted during study, of which 2/3 reported receiving ARV
therapy in the past 3 months
26. Associations between Social Discrimination, Lack of
Social Support, Difficult Sexual Situations & HIV Risk
UAI w/ Casual
Male Partner (past 3
months)
Yes No p-value
Homophobia
Full Scale (Cronbach’s alpha=.83) 9.11 8.15 <.0001
Racism
Full Scale (Cronbach’s alpha=.73) 8.18 7.30 <.0001
Financial Hardship (single item)
Ran out of money for basic needs 72% 60% <.0001
Lack of Social Support: Dichotomized item
Full scale (Cronbach’s alpha=.81) 46% 38% .0005
Difficult Sexual Situations: Dichotomized and Scale Items
Had anal sex for drugs/money/place to stay 30% 6% <.0001
Used illicit drugs in past 3 months 46% 29% <.0001
Sex in someone else’s home 39% 17% <.0001
Had a partner who was more masculine 38% 15% <.0001
Used alcohol or drugs before or during sex 54% 17% <.0001
Sum of potentially risky sexual situations (Sum of 5 items) 2.1 .8 <.0001
27. Modeling the Impact of Social Discrimination on the
Risk for HIV Among Latino and Black MSM
Predictor B p-value
Hypothesis 2: Social discrimination predicts lack of social support
Homophobia .50 <.0001
Racism .51 <.0001
Poverty .75 <.0001
R2 = .15, F = 128.57, p < .0001
Hypothesis 3: Social discrimination and lack of social support predict
difficult sexual situations
Homophobia .12 .0001
Racism .11 .006
Poverty .14 <.0001
Lack of social support .03 <.0001
R2 = .08, F = 47.5, p < .0001
28. Social Discrimination’s Impact on HIV Risk is
Mediated by Lack of Social Support and Difficult
Sexual Situations
Predictor OR 95% CI p-value
Homophobia 1.0 .88 -1.1 .94
Racism 1.2 1.0 -1.4 .03
Financial Hardship 1.1 .91 -1.4 .25
Lack of social support 1.0 .99 -1.0 .07
Difficult sexual situations (ref=none)* 1.0 -- --
One 2.6 2.0 -3.4 <.0001
Two 7.3 5.5 -9.7 <.0001
Three to Five 13 10 -18 <.0001
29. Associations between Social Discrimination and
UAI among Latino and Black MSM
Racism Among black
MSM
Among Latino
MSM
Lack of Social
Support
Sexual Risk
Homophobia for HIV (UAI)
Difficult Sexual
Situations
Financial
Hardship Among
Latino MSM
30. Sources and types of discrimination matter ----
are cumulative ---- and may have differential
salience for different men of color.
31.
32. A surprising amount of research remains to be done to understand
how sexual behavior among MSM is shaped by developmental
influences (e.g., early sexual experiences, coming out,
acceptance/rejection by family and friends, school
environment and policies), self concept, and mental health
aspects of sexuality (e.g., internalized homo-negativity,
body image, sexual compulsivity,
erotophobia/erotophilia, social anxiety), formation and
maintenance of primary relationships, sexual relationships
within and outside of primary relationships and sexual
satisfaction and physical function.
Source: Wolitski, RJ and Fenton KA. 2011. Sexual health, HIV, and sexually transmitted infections among gay , bisexual, and other men
who have sex with men in the United States. AIDS Behavior.
34. Sexual health is a state of physical, emotional, mental
and social well-being in relation to sexuality; it is not
merely the absence of disease, dysfunction or infirmity.
Sexual health requires a positive and respectful
approach to sexuality and sexual relationships, as well
as the possibility of having pleasurable and safe sexual
experiences, free of coercion, discrimination and
violence. For sexual health to be attained and
maintained, the sexual rights of all persons must be
respected, protected and fulfilled.
Source: World Health Organization. Defining sexual health: report of a technical consultation on sexual health 28-31 January 2002,
Geneva. Geneva: World Health Organization; 2006.