The recently released STI National Strategic Plan (STI Plan) and HIV National Strategic Plan were developed concurrently with the Viral Hepatitis National Strategic Plan and each calls for a more integrated approach to addressing the syndemic of HIV, STIs, viral hepatitis, and substance use and mental health disorders. Together, these three plans aim to enhance coordination of the activities of federal agencies and diverse community stakeholders to reduce morbidity and mortality, stigma, discrimination, health inequities, and disparities; improve outcomes; and fortify the public health and health care infrastructure to support prevention, diagnosis, care, and treatment across these infectious diseases. As federal agencies begin work to develop implementation plans for each of these five-year plans, we will explore opportunities to enhance integration of prevention, care, and treatment of STIs, HIV, viral hepatitis, and behavioral health issues by leveraging capacity and infrastructure across the domains and breaking down operational and funding silos.
Such silos result in missed opportunities every day to test people for multiple infections and to scale up services in settings where people at risk receive other services. These missed opportunities translate directly into lost time and resources and may result in harm to people who remain undiagnosed, untreated, and at risk of severe outcomes or of transmitting HIV, an STI, or viral hepatitis to others. A reciprocal, integrated approach in our responses to infectious diseases and substance use and mental health disorders that puts patients first through a status-neutral and no-wrong-door approach will maximize their ability to access services that meet their health needs.
For example, HIV testing, prevention, and care programs can identify opportunities to screen for other STIs, viral hepatitis, and behavioral health issues and provide treatment and/or linkage to appropriate services. Current CDC PrEP guidelines recommend STI screening as part of PrEP care and the HHS HIV Treatment Guidelines provide information on screening, treatment, and prevention of herpes and syphilis.
Similarly, STD clinic patients represent a population at increased risk for HIV; so STD specialty clinics play a vital role in reaching people at risk for HIV who are not engaged in HIV prevention programs or other health care services, including those who are uninsured and those who seek confidential services. In addition, STD specialty clinics serve a high proportion of racial and ethnic minorities, gay and bisexual men, and transgender people so are ideally positioned to reach these populations disproportionately affected by HIV who could benefit from PrEP or PEP or reach people with HIV who are either unaware of their status or are not virally suppressed and could benefit from linkage to or reengagement in care.
Injectable long-acting cabotegravir (CAB LA) has been proven safe and highly effective in preventing HIV infection among cisgender women, according to interim results from a major study announced in late January. The findings complement previously established strong results for cabotegravir-based injectable pre-exposure prophylaxis (PrEP) in cisgender men who have sex with men (MSM) and transgender women who have sex men, adding to evidence that injectable PrEP could ultimately have greater real-world efficacy than daily oral PrEP in many populations, thanks to better adherence.
The new data come from HIV Prevention Trials Network (HPTN) Study 084, interim results of which were presented at the biennial HIV Research for Prevention (HIVR4P) conference, which took place virtually this year in late January and early February. “These results complement data from HPTN 083, and confirm cabotegravir as the first safe and effective injectable PrEP agent for cisgender women,” said Sinead Delany-Moretlwe, MBBCh, Ph.D., the protocol chair and director of research at the Wits Reproductive Health and HIV Institute within the University of the Witwatersrand in Johannesburg, who presented the study. “We hope that these results will lead to the expansion of HIV prevention options for at-risk cisgender women globally, and ultimately reductions or elimination of HIV acquisition.”
The U.S. Department of Health and Human Services (HHS) recently enhanced mail-order delivery options for participants to receive PrEP HIV prevention medication at no cost to eligible individuals without prescription drug coverage. Ready, Set, PrEP participants can choose to have their PrEP medication sent directly to their home or healthcare providers (in participating states) when they enroll or continue to use the more than 32,000 participating co-sponsoring pharmacies.
The option of having PrEP delivered to a preferred location is not only convenient for participants, but it also allows Federally Qualified Health Centers (FQHCs) and Indian Health Service (IHS) facilities, Tribal Health Programs, and Urban Indian Organizations to provide “one stop shopping” for potential enrollees. They can now get tested, receive their PrEP prescription and get the prescription sent via mail in one visit by enrolling with a healthcare provider’s assistance through GetYourPrEP.com or the call center by calling 855-447-8410.
“This option allows our IHS, Tribal and Urban facilities the ability to provide a wholly integrated service inclusive of HIV testing, PrEP prescriptions and now the ability for our healthcare providers to offer mail-order for Ready, Set, PrEP enrollees,” said Darrell LaRoche, director of the Office of Clinical and Preventive Services at IHS. “The convenience of getting tested, enrolled and prescriptions mailed in one visit, sent to their home or a healthcare provider, is particularly important in Indian Country where a health center or pharmacy may be hours away.”
As one of several Indian Health Service activities supported by the Minority HIV/AIDS Fund (MHAF) in Fiscal Year 2020, the Urban Indian Health Institute (UIHI) is currently leading a project focused on creating culturally attuned HIV education materials—including print, digital, and video formats—for both American Indian and Alaska Native patients and the healthcare providers who serve them.
UIHI , located in Seattle, Washington, works to provide information to and assist urban Indian-serving organizations to better the urban Indian community’s health nationwide. Seven out of 10 American Indians and Alaska Natives currently live in urban settings away from federally defined tribal lands. Since 2016, UIHI has led several projects that promote culturally attuned HIV prevention and treatment.
Among the new materials being developed under this project, in March 2020, UIHI released a short film, Positively Native , in which long-time HIV survivors Bill Hall (Tlingit), Shana Cozad (Kiowa), and Hamen Ides (Lummi) discuss their lived experiences with HIV stigma, discrimination, and advocacy. Along with the film, UIHI released an accompanying toolkit that includes a facilitator’s guide, discussion questions, and a presentation on the basics of HIV. The organization presented Positively Native to an audience of 38 people at the International Indigenous Pre-Conference on HIV/AIDS in July 2020.
Levels of sexual health screening among gay men taking PrEP fall well below recommended levels, investigators from the United States report in the online edition of Clinical Infectious Diseases. Rates of testing for sexually transmitted infections (STIs) in the rectum and throat – which can be asymptomatic – were especially low, so too testing coverage in south-eastern US states which have an especially high burden of HIV and STI infections among gay and other men who have sex with men.
“Consistency of STI screening at PrEP care visits was lower than recommended, especially for rectal and pharyngeal infections that are mostly asymptomatic,” write the authors. “Our findings also highlight the regional variation in gaps between recommendations and PrEP clinical practice overall, and raise concerns about whether comprehensive PrEP care as currently practiced would be effective for STI control.”
Tenofovir-based PrEP is highly effective at preventing infection with HIV but the treatment provides no protection against STIs. Pre-existing research shows elevated STI rates among PrEP-using gay men, probably the result of increased surveillance and sexual risk behaviour. The Centers for Disease Control and Prevention (CDC) therefore recommends that gay men taking PrEP should have comprehensive check-ups for bacterial STIs every three to six months. These sexual health screens should include tests for chlamydia, gonorrhoea and syphilis, with swabs or samples taken from the urethra, throat and rectum.
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From Medical Express…
A new study has found that HIV screening every three months compared to annually will improve clinical outcomes and be cost-effective among high-risk young men who have sex with men (YMSM) in the United States. The report, led by researchers at the Massachusetts General Hospital (MGH), is being published online in Clinical Infectious Diseases.
“Young men who have sex with men account for one in five new HIV infections in the United States. Yet, more than half of young men who have sex with men and who are living with HIV don’t even know that they have it,” says Anne Neilan, MD, MPH, investigator in the MGH Division of Infectious Diseases and the Medical Practice Evaluation Center, who led the study.
“With so many youth with HIV being unaware of their status, this is an area where there are opportunities not only to improve care for individual youth but also to curb the HIV epidemic in the U.S. Despite these numbers, the Centers for Disease Control and Prevention previously determined that there was insufficient youth-specific evidence to warrant changing their 2006 recommendation of an annual HIV screening among men who have sex with men.”
It may seem obvious that if a person is infected with COVID-19, they risk infecting others during sex. But people still have a lot of questions. Here’s an excerpt on the topic form the Mayo Clinic Website:
The virus spreads by respiratory droplets released when someone with the virus coughs, sneezes or talks. These droplets can be inhaled or land in the mouth or nose of a person nearby. Coming into contact with a person’s spit through kissing or other sexual activities could expose you to the virus. People who have COVID-19 could also spread respiratory droplets onto their skin and personal belongings. A sexual partner could get the virus by touching these surfaces and then touching his or her mouth, nose or eyes. In addition, the COVID-19 virus can spread through contact with feces. It’s possible that you could get the COVID-19 virus from sexual activities that expose you to fecal matter.
There is currently no evidence that the COVID-19 virus is transmitted through semen or vaginal fluids, but the virus has been detected in the semen of people who have or are recovering from the virus. Further research is needed to determine if the COVID-19 virus could be transmitted sexually.
Since some people who have COVID-19 show no symptoms, it’s important to keep distance between yourself and others if the COVID-19 virus is spreading in your community. This includes avoiding sexual contact with anybody who doesn’t live with you. If you or your partner isn’t feeling well or think you might have COVID-19, don’t kiss or have sex with each other until you’re both feeling better. Also, if you or your partner is at higher risk of serious illness with COVID-19 due to an existing chronic condition, you might want to avoid sex.
In case that wasn’t clear, The National Coalition of STD Directors (NCSD), in partnership with National Alliance of State and Territorial AIDS Directors (NASTAD), released a frequently asked questions resource regarding sex and COVID-19. In short, if you’re in the same room with someone who has the virus, you can get infected–sex or no sex.
If you have questions about getting tested, talk to your doctor or health care provider. You can also find testing in your area via a Google search. In Pennsylvania, call the Health Department at 1-877-PA-HEALTH (1-877-724-3258).
Bruce W. Furness, M.D., M.P.H., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues developed and evaluated a quality improvement initiative (Transforming Primary Care for LGBT People) to enhance the capacity of 10 federally qualified health centers (FQHCs; 123 clinical sites in nine states) to provide culturally affirming care.
The researchers found that FQHCs reported increases in culturally affirming practices, including collecting patient pronoun information (42.9 percent increase) and identifying LGBT patient liaisons (300.0 percent increase). Based on sexual orientation and gender identity (SOGI) from electronic health records among nine FQHCs, SOGI documentation increased from 13.5 to 50.8 percent of patients. Screening of LGBT patients increased from 22.3 to 34.6 percent for syphilis, from 25.3 to 44.1 percent for chlamydia and gonorrhea, and from 14.8 to 30.5 percent for HIV among the eight FQHCs reporting the number of LGBT patients.
“FQHCs participating in this initiative reported improved capacity to provide culturally affirming care and targeted screening for LGBT patients,” the authors write.
Read the full article on Medicalxpress.com.