While the eyes of the nation are on the coronavirus pandemic, another threat to public health has been steadily growing in the United States. We’ve been battling rising rates of sexually transmitted infections (STI) for the last several years. In fact, 2020 marks the fifth consecutive year of increasing rates of gonorrhea, chlamydia and syphilis in the U.S., due in part to significant funding cuts to more than 50% of the nation’s public health STI programs. And now the COVID-19 pandemic has placed an even greater burden on our strained public health system and supply chains, shifting focus from one major public health issue to another.
We can’t risk losing one critical resource that will be essential to ending the STI epidemic — the availability of free and confidential STI testing for adolescents. Prior to the pandemic, national public health efforts were scaling up to improve STI and HIV testing, and quickly link youth to prevention services. Rapid identification and treatment of STIs not only has public health benefits in terms of lowering transmission, but when left untreated, STIs increase the risk of infertility, severe pelvic infection, chronic pelvic pain, ectopic pregnancy and HIV transmission.
While accounting for 25% of the population, adolescents and young adults comprise over 50% of STIs in the U.S. each year. Black, Latinx, and LGBT youth face the greatest burden of infections and risk of complications. Fortunately, significant advances have been made over the last several decades to improve rates of STI and HIV testing among adolescents and young adults. The American Academy of Pediatrics now recommends HIV screening by the age of 16-18 years for all youth regardless of their sexual activity.
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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.”
Vaginal swab samples collected by patients performed similarly to lab-based molecular diagnostics for chlamydia and gonorrhea testing, therefore supporting the use of a new 30-minute point-of-case assay, according to findings published in JAMA Network Open.
“The new binx io CT/NG assay can facilitate a complete paradigm shift in how we offer testing for the two most commonly reported notifiable diseases in the United States — chlamydia and gonorrhea,” Barbara Van Der Pol, PhD, MPH, professor of medicine and public health at the University of Alabama at Birmingham and president of the American STD Association, told Healio. “Rates of infection with chlamydia and gonorrhea continue to rise, suggesting the need for additional tools in order to effectively reduce the burden of disease. Providers can now identify and treat infections (that are predominately asymptomatic) during a single office visit to prevent transmission and development of sequelea.”
[…] “Sample-first collection by clients seeking sexual health care (or who are eligible for routine screening according to the CDC guidelines) immediately upon arrival at the clinic can enable rapid, accurate results that allow the provider to offer both accurate treatment and appropriate counseling,” Van Der Pol said. “This is the first truly rapid molecular assay for chlamydia and gonorrhea. It is a breakthrough development.”
Among young people living with HIV, having a detectable viral load is associated with a slight increase in the risk of cardiovascular disease.
Sitaji Gurung, MD, PhD, MPH, of Hunter College at the City University of New York, presented findings from a study of HIV-positive youth 14 to 26 years old at the 2020 Conference on Retroviruses and Opportunistic Infections in Boston last month.
The study relied on electronic health records from the Adolescent Medicine Trials Network 154 Cascade Monitoring, which derives its data from clinics across the United States that care for adolescents with HIV.
Communication between pediatricians and adolescent boys who engage in same-sex sexual intercourse may be a potential avenue to increase HIV testing in this population, according to a study published in Pediatrics.
Although it is estimated that 14.5% of HIV infections are undiagnosed in the United States, this estimation is 51.4% (>3.5-times higher) in individuals aged 13 to 24 years because of poor testing rates among those who are aged <18 years.
There have been few studies that have described HIV testing rates among minors; these data are needed to reveal opportunities for pediatrician-adolescent communication about HIV and sexual orientation, which could increase the odds of testing. This study described HIV testing rates and identified salient individual, family, school, and healthcare influences among adolescent boys who engage in same-sex sexual intercourse (ClinicalTrials.gov identifier: NCT03511131).\
Despite similar rates of enrollment into medical care, youth with HIV have much lower rates of viral suppression — reducing HIV to undetectable levels — compared to adults, according to an analysis funded by the National Institutes of Health. Among more than 1,000 youth, most of whom were newly enrolled in care at treatment centers throughout the United States, 12% had attained viral suppression, far lower than the 32% to 63% observed in studies of adults over age 24. The findings suggest that after they enroll in an HIV treatment program, a low proportion of youth adhere to care regimens. The study appears in the Journal of Acquired Immune Deficiency Syndromes.
“Our findings indicate an urgency for research on how best to tailor HIV intervention services to the needs of youth,” said the study’s first author, Bill G. Kapogiannis, M.D., of the Maternal and Pediatric Infectious Diseases Branch at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The analysis was funded by NICHD, the National Institute on Drug Abuse and the National Institute of Mental Health.
HIV prevalence is as high as 12% in young people experiencing homelessness. This population is also 6 to 12 times more likely to become infected with HIV than housed youth. Obstacles to HIV prevention and care among youth experiencing homelessness are compounded by substance use, housing instability, and mental illness. These obstacles present a need to develop targeted interventions for this population.
Few HIV prevention programs prioritize the prevention needs of youth experiencing homelessness, but an oral abstract session at the Association of Nurses in AIDS Care Conference (ANAC 2019) discussed the development of a protocol for nurse care management for HIV prevention called NCM4HIV.
NCM4HIV integrates a theoretical framework, methodology for behavioral change, and practical strategies designed to engage youth experiencing homelessness, with an outcome evaluation plan. The program builds on past nurse care management using the Comprehensive Health Seeking and Coping Framework. NCM4HIV also incorporates the psychological modality known as motivational interviewing. Results of behavioral interventions will then be accounted for through behavioral feedback technology, allowing case management specialists to further tailor the intervention through goal setting and patient response.
There is a dearth of scientifically investigated, evidence-based interventions to address substance use, mental health conditions and violence victimization in sexual and gender minority youth, according to a research review led by the University of Pittsburgh Graduate School of Public Health and published today in the journal Pediatrics.
After poring over thousands of research publications spanning nearly two decades, the scientists identified only nine studies that evaluated such interventions, and most of these used suboptimal study designs, thereby limiting the validity of the findings. None of the programs would be sufficient to mitigate the substantial inequities faced by lesbian, gay, bisexual, transgender and queer (LGBTQ) youth, the scientists concluded.
“While this knowledge gap is distressing, I think we can look at it as an opportunity,” said lead author Robert W.S. Coulter, Ph.D., M.P.H., assistant professor in Pitt Public Health’s Department of Behavioral and Community Health Sciences. “Promising programs are being created by community-based organizations that are ripe for rigorous evaluation by scientists to determine if they are successfully improving health among LGBTQ youth and, if so, whether they can be replicated in other communities.”