The Department of Health and Human Services announced that the Office for Civil Rights will interpret and enforce Section 1557 and Title IX’s prohibitions on discrimination based on sex to include: (1) discrimination on the basis of sexual orientation; and (2) discrimination on the basis of gender identity. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in covered health programs or activities. The update was made in light of the U.S. Supreme Court’s decision in Bostock v. Clayton County and subsequent court decisions.
“The Supreme Court has made clear that people have a right not to be discriminated against on the basis of sex and receive equal treatment under the law, no matter their gender identity or sexual orientation. That’s why today HHS announced it will act on related reports of discrimination,” said HHS Secretary Xavier Becerra. “Fear of discrimination can lead individuals to forgo care, which can have serious negative health consequences. It is the position of the Department of Health and Human Services that everyone – including LGBTQ people – should be able to access health care, free from discrimination or interference, period.”
Discrimination in health care impacts health outcomes. Research shows that one quarter of LGBTQ people who faced discrimination postponed or avoided receiving needed medical care for fear of further discrimination.
All youth deserve access to comprehensive sexual health education. National Youth HIV/AIDS Awareness Day (NYHAAD) is an opportunity to work together to make this a reality. By educating youth about the basics of HIV, how to protect themselves, find testing, treatment and care services, and confront HIV stigma in their communities, we are empowering them to take an active role in ending the HIV epidemic for future generations.
Today’s youth have many of the same hopes and dreams as previous generations. But we must also recognize they are distinct in many ways too. Their widespread passion for advocacy and social change sets them apart. They also face unique challenges and barriers when it comes to achieving those dreams.
In 2018, youth aged 13 to 24 made up 21% of the 37,832 new HIV diagnoses in the United States and dependent areas. Most new youth diagnoses were among gay, bisexual men, and men who have sex with men (MSM). Most of these new diagnoses occurred among young Black and Latinx MSM. Yet, in 2018, youth were the least likely age group to be aware they had HIV, remain in care, or achieve viral suppression. One of the most important things we can do to change this trend is to provide accurate, age-appropriate, and culturally sensitive information about HIV.
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.
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.”
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.”