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News From 2003 CDC Prevention Conference: new guidelines for health care providers to incorporate HIV prevention into ongoing care of persons living with HIV
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July 28, 2003, Atlanta
"Although we've made great progress in preventing HIV since the early days of the epidemic, new and significant challenges remain," Ronald O. Valdisseri, deputy director of the CDC's National Center for HIV, STD, and TB Prevention.
Those most at risk for infection: People of color, young teens, drug users, and gay men who meet sex partners online.
Between 850,000-900,000 persons are living with HIV in America, one-quarter of whom are unaware of their infection.
Twenty percent of African-American and Latinos are not aware that effective HIV treatments are available -- suggesting more needs be done to raise awareness, since the promise of effective treatment could encourage people to get tested.
HIV from injection drug use has increased by 15% in youth and young adults, with the greatest increase in the 13-15-year-olds. This increase follows years of steady declines, and points to the need for preventive education efforts aimed at young injection drug users.
Seventy-three percent of African-American women do not believe they are at risk for HIV, although more than half had a history of other STDs.
A CDC press release said: "CDC research with women of childbearing age shows that reducing mother-to-child HIV transmission, a major goal of the new initiative, in part depends on increasing awareness of the need to be tested and that treatment is available if results are positive".
In two separate CDC surveys of recently pregnant women, 20% or more pregnant women are still not being tested for HIV, despite the recommendation that testing be part of prenatal care. Another CDC study found that 40% of American women of childbearing age are not aware of methods to protect newborns from HIV. The CDC said that knowing that effective treatments are available could motivate more women to be tested during pregnancy.
Foreign-born women are more than twice as likely to refuse HIV testing as women born in the U.S.
"Thanks to the availability of treatment regimens to prevent transmission, the number of infants born with HIV has fallen dramatically," Valdissert said. "However, newborns still contract HIV from their mothers each year; each of these is preventable tragedy."
The number of women tested in New York State rose dramatically in 2002 from 64% to 94%. Rapid HIV testing can provide accurate results in just over an hour for women whose HIV status is unknown when they enter labor. This allows the doctor to introduce treatment to the newborn before transmission. CDC researchers presented study results at the conference showing that a brief training session for healthcare workers can enhance interpretation of results of the new OraQuick rapid test. Healthcare workers without previous laboratory experience more accurately interpreted results after a 20-minute training session than health care workers who had only the manufacturer's written instructions to follow.
Partners of HIV-infected persons need better counseling, Valdisseri said.
HIV-positive patients are often not counseled on ways to prevent transmission to their partners. Among those surveyed following a clinic visit, one-quarter said they had received general prevention information during the visit, and only 6% said specific sex activities had been discussed with them. Even a one-day training session could help HIV treatment providers talk with their patients about reducing risk behavior. Those who took part in the session said they felt more comfortable discussing high-risk behavior, including needle sharing and sexual behavior, with their patients.
New research indicates the Internet is a new environment for unsafe sex.
Among gay men, the numbers who met partners online are increasing.
More than three-quarters of gay men who meet partners online are likely to report high-risk sex with those partners. Thirty-nine percent reported having unprotected anal sex with those partners.
Also at the conference, CDC is announcing a new national system for measuring the rate of HIV infections in the United States. Using the Serologic Testing Algorithm for Recent HIV Seconversion (STARHS) technology, 35 US locations will be able to more accurately monitor the number of new HIV infections that occur each year and target prevention resources to the populations most in need.
HIV Diagnoses Climbing Among Gay and Bisexual Men
CDC Press release, July 28, 2003
New HIV diagnoses among gay and bisexual men in some states increased for the third consecutive year, the Centers for Disease Control and Prevention (CDC) announced today. CDC also released preliminary 2002 data showing a slight increase in AIDS incidence, although AIDS deaths continue to decline. Harold Jaffe, M.D., Director of CDC's National Center for HIV, STD, and TB Prevention (NCHSTP), presented the data at the 2003 National HIV Prevention Conference in Atlanta.
Data from 25 states (see list) with long standing HIV reporting show the number of new HIV diagnoses among gay and bisexual men increased by 7.1 percent, from 2001 to 2002, supporting recent findings that this population remains at high, and perhaps increasing, risk for HIV infection. HIV diagnoses for gay and bisexual men have increased by 17.7 percent since the lowest point in 1999. The data also show that HIV diagnoses in other vulnerable groups have remained stable since 2001. Dr. Jaffe cautioned that the new data reflect the number of people newly diagnosed, regardless of when they were infected, and increases may reflect increases in HIV testing as well as potential increases in new infections.
"These findings add to the growing concern that we are facing a potential resurgence of HIV among gay and bisexual men," Dr. Jaffe said.
Dr. Jaffe also presented preliminary 2002 data on AIDS diagnoses and deaths in the United States. These data show a 2.2 percent increase in new AIDS diagnoses (42,136 diagnoses) and a 5.9 percent decline in deaths (16,371 deaths). The findings suggest a continuing plateau in the dramatic progress against AIDS following the introduction of highly active anti-retroviral treatment (HAART) in the mid-1990s. The lack of continued progress in reducing AIDS diagnoses is likely due to several factors, Dr. Jaffe said, including treatment failure, difficulty adhering to complex regimens, and late HIV diagnoses delaying initiation of treatment.
"The AIDS epidemic in the United States is far from over," Dr. Jaffe said. "While effective treatments are crucial in our fight against HIV, preventing infection in the first place is still the only true protection against the serious and fatal consequences of this disease." Dr. Jaffe also emphasized that CDC's Advancing HIV Prevention Initiative, focusing on HIV testing as a routine part of care, greater access to HIV testing, increased attention to prevention among people living with HIV, and reduced mother-to-child transmission, will help address these continued challenges.
Alabama, Arkansas, Arizona, Colorado, Idaho, Indiana, Louisiana, Michigan, Minnesota, Mississippi, Missouri, New Jersey, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Virginia, West Virginia, Wisconsin, Wyoming
New Guidelines Aim to Help Health Care Providers Incorporate HIV Prevention into Ongoing Care of Persons Living with HIV
CDC Press Release, July 17, 2003
The Centers for Disease Control and Prevention (CDC) today released new guidelines aimed at helping healthcare professionals communicate with their HIV infected patients about what they can do to prevent transmitting the virus to others. The guidelines, the first of their kind, were published in the July 18, 2003, issue of Morbidity and Mortality Weekly Report.
"It's time we merge prevention services for HIV-infected persons into the mainstream of medical care," said Julie L. Gerberding, MD, MPH, CDC director. "These guidelines provide a much-needed roadmap for medical professionals that allows them to work more closely with their HIV-infected patients to reduce HIV transmission."
The guidelines resulted from a collaboration of three Department of Health and Human Services agencies: CDC, the National Institutes of Health (NIH), and the Health Resources and Services Administration (HRSA), and the HIV Medicine Association of the Infectious Diseases Society of America.
The audience for the new guidelines includes physicians and physician assistants, nurses, social workers and others who work in medical settings and provide care to persons living with HIV. The guidelines call for:
- Screening patients for risk of HIV transmission. Recommended screening practices include using questionnaires and interviews to assess risk behaviors as well as testing for sexually transmitted diseases (STDs) when appropriate. The guidelines recommend talking to female patients about the possibility of pregnancy to help prevent mother-to-child HIV transmission.
- Delivering prevention interventions. Health care providers can help reduce their patients' risk of transmitting HIV through such strategies as delivering prevention messages, providing condoms and printed information, and, when appropriate, referring patients to outside prevention services.
- Partner counseling and referral services. The guidelines encourage health care professionals to determine whether patients have notified partners of their infections and to help patients contact local health departments to arrange for partners who have not already been informed to be notified. The guidelines emphasize the importance of reaching partners with counseling and testing services.
"With an estimated 900,000 people in our country living with HIV, prevention strategies for HIV-infected individuals are essential," said Harold Jaffe, MD, director of CDC's National Center for HIV, STD and TB Prevention. "Health care professionals provide a critical link to HIV prevention information and services. They can help equip HIV-infected individuals with the best tools to protect their health and the health of their partners."
While research has shown that some people who are aware of their HIV infections tend to reduce risky behavior, recent reports suggest that many have difficulty sustaining those behavior changes. At the same time, medical professionals who care for HIV-infected patients have not had clear guidance on how to help patients maintain safe behaviors and protect their partners.
The guidelines further the objectives outlined in the new, national HIV prevention initiative that CDC introduced in April 2003.
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