Ryan White HIV/AIDS Program anniversary

On August 18, 1990, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was signed into law, creating what is now the largest Federal program exclusively providing care and treatment services to people living with HIV – the Ryan White HIV/AIDS Program.

Twenty-five years later, the Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau commemorates this historic anniversary and honors the Ryan White HIV/AIDS Program, which has played a critical role in the United States’ public health response to the HIV/AIDS epidemic.   The theme:  Moving Forward with CARE: Building on 25 Years of Passion, Purpose, and Excellence”  reflects the passion that inspired the legislation, purpose that continues to drive the Ryan White HIV/AIDS Program and excellence in health outcomes for people living with HIV receiving Ryan White HIV/AIDS Program-funded care.  

HRSA has also produced a new video to highlight the work of the program: http://hab.hrsa.gov/ryanwhite25/

National HIV Testing Day

National HIV Testing Day is observed annually on June 27 to encourage everyone to Take the Test, Take Control, and know their HIV status.

More than 1.1 million people in the U.S. are living with HIV, but one in five does not know they are positive. Early diagnosis and treatment improves health, extends life, and helps prevent the spread of HIV.

Maine CDC’s HIV, STD, and Viral Hepatitis Program helps support HIV testing by providing more than 3,500 tests to high risk populations in the state every year, which are offered anonymously or confidentially through community and clinical HIV testing providers and family planning sites.

In 2012, 48 new cases of HIV were reported in Maine.  Most of these cases were diagnosed in private clinical settings.  Overall, 1,654 people in Maine are living with diagnosed HIV, with an estimated 300-400 additional people living in the state who are positive but don’t know their status.

In Maine and nationally, about 40% of people who are newly diagnosed with HIV develop AIDS within a year, which indicates that they have been infected for years prior to being diagnosed.  People with these late diagnoses have a shortened life expectancy and have missed opportunities for treatment as well as for preventing transmission to others.

Patients should have an HIV test during medical check-ups, just like they would have a blood test or a urine test to be sure they are healthy.  Certain people should be screened more regularly based on their risk factors.

You should get tested for HIV at least every year if you:

• Have had unprotected sex (vaginal, anal, or oral) with multiple or anonymous partners;
• Have had unprotected sex with a partner who did not know their own HIV status;
• Have a history of sexually transmitted diseases (STDs); or
• Share needles/syringes or other equipment (“works”) for injecting drugs.

Some health care providers may recommend testing every 3-6 months if you have certain risk factors, including injection drug use and/or unprotected sex with others who engage in high-risk behaviors.  Talk to your health care provider to see how often you should be tested. (Read the U.S. Preventive Services Task Force’s recommendations for screening.)

If you have any questions about HIV testing, please contact Emer Smith at (207) 287-5193 or emer.smith@maine.gov.

HIV updates

The XIX Annual International AIDS Conference is currently underway in Washington, D.C., and several recent developments have occurred in the fight against HIV/AIDS:


Home Testing

The US Food and Drug Administration (FDA) approved the first over-the-counter home-use rapid HIV test on July 3. The OraQuick In-Home HIV Test is designed to allow individuals to collect an oral fluid sample and obtain test results within 20 to 40 minutes.


A positive result with this test does not mean that an individual is definitely infected with HIV, but rather that additional testing should be done in a medical setting to confirm the test result. Similarly, a negative test result does not mean that an individual is definitely not infected with HIV, particularly when exposure may have been within the previous three months. The test has the potential to identify large numbers of previously undiagnosed HIV infections especially if used by those unlikely to use standard screening methods.


Pre-Exposure Prophylaxis

On July 16, FDA approved Truvada (a fixed dose combination of two antiretrovirals used to treat HIV) to reduce the risk of HIV infection in uninfected individuals who are at high risk of HIV infection and who may engage in sexual activity with HIV-infected partners. Truvada is to be used for pre-exposure prophylaxis (PrEP) in combination with safer sex practices to prevent sexually-acquired HIV infection in adults at high risk. Truvada is the first drug approved for this indication.

Truvada for PrEP is meant to be used as part of a comprehensive HIV prevention plan that includes risk reduction counseling consistent and correct condom use, regular HIV testing, and screening for and treatment of other sexually-transmitted infections. Truvada is not a substitute for safer sex practices. As part of PrEP, HIV-uninfected individuals who are at high risk will need to take Truvada daily to lower their chances of becoming infected with HIV should they be exposed to the virus.

For more information about PrEP, visit http://www.cdc.gov/hiv/prep/


Prevention with Positives

Earlier this week, US CDC launched the first ever Prevention with Positives website to help address the prevention needs of people living with HIV/AIDS.

Trends in HIV-related Risk Behaviors Among High School Students

An early release MMWR article “Trends in HIV-Related Risk Behaviors Among High School Students — United States, 1991–2011” describes the analysis of data from the biennial national Youth Risk Behavior Survey (YRBS) with results that suggest that progress in reducing some HIV-related risk behaviors among high school students overall and in certain populations stalled in the past decade. The article suggests that renewed educational efforts and other risk reduction interventions are warranted to reduce the number of young persons who become infected with HIV.


Maine Reports

Maine's May 2012 HIV/STD update and 2011 HIV/STD Surveillance Report are now both posted on the Maine CDC website.

HIV/STD Updates

 The US Department of Health and Human Services (HHS) has released updated HIV treatment recommendations: http://go.usa.gov/yTI

The updated recommendations have changed significantly regarding when to initiate antiretroviral therapy (ART).  Antiretroviral treatment is now recommended for all HIV infected individuals.  The strength of these recommendations depends on an individual’s CD4 count, but if an individual is at risk of transmitting HIV to HIV-negative sexual partner(s) the strength of the recommendations increases. 

Several HIV/STD surveillance documents have recently been added to Maine CDC’s website:

• March Monthly Update for HIV and STDs: http://go.usa.gov/yTR
• 2010 Annual HIV/STD Surveillance Report: http://go.usa.gov/yTQ
• A detailed report on HIV for 2011: http://go.usa.gov/yTE
• A detailed report on chlamydia and gonorrhea for 2011: http://go.usa.gov/yTV

US CDC Director Dr. Tom Frieden will host a live Twitter chat on STDs and young people at 1 p.m. April 23. Follow the conversation by using hashtag #CDCChat. Follow Dr. Frieden on Twitter:  http://twitter.com/DrFriedenCDC

Women and Girls HIV/AIDS Awareness Day

Every 35 minutes, a woman tests positive for HIV in the U.S. Women make up a quarter of all new HIV infections in Maine and account for about 16% of people living with HIV in Maine.

Women have unique issues and special challenges that make it harder for them to prevent HIV or take care of themselves if they have HIV:

• Women's bodies are different. A woman is twice as likely as a man to get HIV infection during vaginal sex (because the lining of the vagina provides a large area of potential exposure to HIV-infected semen). Some diseases or disorders unique to women make HIV more serious.
• Women can give HIV to their babies. Women who have HIV can give it to their babies during pregnancy, delivery, or breast-feeding.
• Women may lack control in relationships: they may be scared to refuse sex or insist that their partner use a condom, or can’t talk to their partner about abstinence, faithfulness, or using condoms.
• Women may not know if their partner is doing things that put him (and therefore her) at risk for HIV.
• Women may not earn much money, which makes it hard for them to pay doctors or even get a ride to their doctor appointments. In extreme instances, some women even end up trading sex for money or drugs.
• Women may be caregivers for others and not feel they have the time to take care of themselves or are unable to find someone to take care of their loved ones when they want to access services.

HIV testing should be a routine part of health care. For local testing resources and information, visit: http://askforthetest.org

For more information: http://www.cdc.gov/Features/WomenGirlsHIVAIDS/ or http://www.womenshealth.gov/nwghaad/

World AIDS Day

World AIDS Day will be recognized on Thursday, December 1. This observance marks the day when people from different countries, cities, and towns unite in the fight against HIV, show their support for people living with HIV, and observe the countless lives lost to AIDS. The day gives people the opportunity to commemorate the accomplishments and achievements that have been reached so far in the fight against HIV/AIDS. It also is a reminder to researchers, advocates, and affected and infected individuals the work that remains to be done.

The World Health Organization (WHO) reports that as of 2009 the number of people living with HIV reached 33.3 million globally. The numbers of people newly infected with HIV was 2.6 million. AIDS-related deaths reached 1.8 million people.

Maine is not immune to the epidemic; as the end of 2010, there were 1,563 people living with diagnosed HIV in Maine, with 59 cases diagnosed in 2010 alone.

National Women and Girls HIV/AIDS Awareness Day

Tomorrow is National Women and Girls HIV/AIDS Awareness Day, which is coordinated by the national Office on Women's Health. Women make up a quarter of all new HIV infections in Maine. Every 35 minutes, a woman tests positive for HIV in the US. In 2010, 20% of people accessing HIV medical case management in Maine were women.

Women have unique issues and special challenges that make it harder for them to prevent HIV or take care of themselves if they have HIV:

• Women's bodies are different. A woman is twice as likely as a man to get HIV infection during vaginal sex (because the lining of the vagina provides a large area of potential exposure to HIV-infected semen). Some diseases or disorders unique to women make HIV more serious.
• Women can give HIV to their babies. Women who have HIV can give it to their babies during pregnancy, delivery, or breast-feeding.
• Women may lack control in relationships: they may be scared to refuse sex or insist that their partner use a condom, or can’t talk to their partner about abstinence, faithfulness, or using condoms.
• Women may not know if their partner is doing things that put him (and therefore her) at risk for HIV.
• Women may not earn much money, which makes it hard for them to pay doctors or even get a ride to their doctor appointments. In extreme instances, some women even end up trading sex for money or drugs.
• Women may be caregivers for others and not feel they have the time to take care of themselves or are unable to find someone to take care of their loved ones when they want to access services. Women may not earn much money, which makes it hard for them to pay doctors or even get a ride to their doctor appointments. In extreme instances, some women even end up trading sex for money or drugs.

What can providers do?

• Emphasize and make HIV testing a routine part of health care. Integrate HIV testing into reproductive health care and other key services.
• Reach out and educate, especially among young women and women of color. Many women want more information and are most likely to get it from doctors, other women with HIV/AIDS, the Internet, television, and radio.
• Decrease mother-to-child transmission by testing, educating, and treating.
• Prevent new infections by working with HIV-infected partners.
• Improve access to care and support services for women, as well as support women’s roles as caregivers and mothers.

HIV test sites in Maine

Update on HIV, STDs, and Viral Hepatitis

The Maine HIV, STD, and Viral Hepatitis program has updated its web site. For easy access to information and resources, check out www.mainepublichealth.gov/hivstdhep

The Sixth Annual Comprehensive Sexuality Education Conference will be held from 8:30 a.m. to 3:30 p.m. April 7 at the Augusta Civic Center.

Keynote speaker is Pamela Wilson, M.S.W., author of Our Whole lives: Sexuality Education for Grades 7-9. Workshops focus on foundational knowledge and skills, networking opportunities, and innovative ideas to put into practice.

The cost is $40 before March 18 and $50 after March 18.

The conference is co-sponsored by: Family Planning Association of Maine; Maine Department of Education; Maine Center for Disease Control & Prevention, an Office of the Department of Health & Human Services; New Beginnings; University of Maine Farmington; and the Maine Association for Health, Physical Education, Recreation, and Dance.

For more information and to register: https://www.mainefamilyplanning.org/forms/conference_form.php

HIV

The Institute of Medicine (IOM) has released the report HIV Screening and Access to Care: Exploring the Impact of Policies on Access to and Provision of HIV Care. The report examines how Federal and State laws and policies and private health insurance policies affect entry into clinical care and the provision of continuous and sustained care for people with HIV.

US CDC has published an article on disparities in HIV diagnoses among African Americans and other racial and ethnic minorities.

STDs

US CDC published the article “Discordant Results from Reverse Sequence Syphilis Screening” in the MMWR.

Viral Hepatitis

US CDC has made new patient education materials related to hepatitis available on its website.

The following articles have been published in the MMWR:

• Potential Transmission of Viral Hepatitis Through Use of Stored Blood Vessels as Conduits in Organ Transplantation
• Deaths from Acute Hepatitis B Virus Infection Associated with Assisted Blood Glucose Monitoring in an Assisted-Living Facility

HIV/STD Update

World AIDS Day

December 1 is World AIDS Day. There are approximately 1,462 people estimated to be living in Maine with diagnosed HIV infection. In addition, Maine CDC estimates that about 388 people in Maine may be infected but unaware of their HIV status. Worldwide, more than 33 million people are estimated to be living with HIV. For more information on World AIDS Day: http://www.aids.gov/world-aids-day/ For more information on HIV/AIDS in Maine: www.mainepublichealth.gov/hivstdhep

Syphilis

Since mid-July, health care providers in Maine have diagnosed 19 cases of early syphilis, ages 19-56, in Cumberland, Penobscot, Waldo and York Counties. Eleven cases were primary syphilis, 5 cases were secondary syphilis, and 3 cases were early latent syphilis. All 19 cases were among men who have sex with men (MSM). Eight of the 19 individuals (42%) are known to be HIV positive. A total of 33 cases of early syphilis have been reported since the beginning of the calendar year. For more information, see this Health Alert: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=152027&v=alert

PrEP

The National Institutes of Health (NIH) has announced the results of an international clinical trial, co-sponsored by the Bill and Melinda Gates Foundation, that examined whether a pill containing two drugs used to treat HIV can also help prevent HIV infection – an approach called pre-exposure prophylaxis, or PrEP. The trial found that daily oral use of Truvada ® provided an average of 44 percent additional protection to trial participants that included gay, bisexual, and other men who have sex with men (MSM), as well as transgendered women who have sex with men. These participants also received a comprehensive package of prevention services that included monthly HIV testing, condom provision, counseling, and management of other sexually transmitted infections.

US CDC will fully review the trial data and publish interim guidance in the coming weeks in the Morbidity and Mortality Weekly Report, to be followed in several months by formal U.S. Public Health Service guidelines. The agency urges individuals and their doctors to await those guidelines before use. For more information, please refer to the PrEP fact sheet: http://www.cdc.gov/nchhstp/newsroom/PrEPforHIVFactSheet.html

This blog has additional information from the White House.

Sixth Annual Comprehensive Sexuality Education Conference

Save the date for the sixth annual Comprehensive Sexuality Education Conference, which will be held April 7 at the Augusta Civic Center. It is sponsored by: Family Planning Association of Maine; Maine Department of Education, Maine CDC; New Beginnings; University of Maine at Farmington; and the Maine Association for Health, Physical Education, Recreation, and Dance.