MAI/NEHEC Monthly Health Disparities Update: April 2013
This newsletter is developed by AIDS Action Committee of Massachusetts in collaboration with the New England AIDS Education and Training Center.
A Majority of Patients Who Receive Ryan White-Funded Medical Care Achieve Viral Suppression: About 70% of patients who received Ryan White-funded medical care and had viral load data available achieved viral suppression, according to a recent report by the Health Resources and Services Administration's HIV/AIDS Bureau. Viral load suppression was substantially higher in patients who were retained in care compared with patients who were not retained in care.
CDC Study Shows That, While More MSM Are Aware of Their HIV Status, Awareness Among Black MSM Lags: The level of awareness of HIV infection status has increased among men who have sex with men (MSM) testing positive for HIV in a 20-city study, according to a CDC analysis of data from the National HIV Behavioral Surveillance. Between 2008 and 2011, HIV awareness increased in all age categories and across all racial groups. However, the proportion of men aware of their infection remained lowest among Black MSM in 2011.
Viral Hepatitis Coinfection Increases Hospitalization Rates About 50% for HIV-Infected Persons: The hospitalization rates of persons coinfected with HIV and either hepatitis B, hepatitis C, or both is about 50% higher than the hospitalization rate for persons infected with HIV alone, according to a study by Johns Hopkins researchers. Coinfection with HIV and viral hepatitis was associated with higher hospitalization rates for non-AIDS-defining infections and gastrointestinal/liver disease.
NASTAD Issue Brief Focuses on HIV/AIDS, STDs, and Viral Hepatitis Among Native Gay Men and Two Spirit People: The National Association of State and Territorial AIDS Directors recently published an issue brief highlighting key issues that affect the risks for HIV/AIDS, sexually transmitted diseases, and viral hepatitis among Native gay men and Two Spirit people. The brief notes that American Indian and Alaska Native (AI/AN) MSM and AI/AN MSM with a history of injection drug use account for 58% and 15%, respectively, of all AI/AN people living with HIV through 2010.
U.S. Department of Labor's Benefits.gov Website Is Enhanced to Improve Access to HIV/AIDS Benefits Information: Benefits.gov staff have created an HIV/AIDS page that has links to program descriptions, requirements, and application and contact information for more than 30 programs that serve people living with, at risk for, or affected by HIV/AIDS.
Quick Take: Return on Investment of Public Health Programs and Services in the United States: To mark National Public Health Week in early April, Dr. Georges Benjamin, Executive Director of the American Public Health Association, wrote a blog item describing the favorable return on investment (ROI) of several public health programs and services, including HIV prevention programs.
Featured Health Resources: Materials for National Youth HIV and AIDS Awareness Day
About 70% of patients who received Ryan White-funded medical care and had viral load data available achieved viral suppression, according to a recent report by the Health Resources and Services Administration's (HRSA) HIV/AIDS Bureau. The HRSA report on the continuum of HIV care in the Ryan White HIV/AIDS Program (RW), was presented at the 20th Conference on Retroviruses and Opportunistic Infections (CROI) last month in Atlanta.
Successful engagement in HIV care has been shown to reduce rates of illness and death among people living with HIV. According to HRSA, "The continuum of HIV care focuses attention on health care services delivery at critical points in engagement in HIV care, with viral load suppression as a key goal to improve individual health outcomes and reduce HIV transmission. The continuum of engagement in HIV care is an important framework for understanding the status of HIV care and treatment in the United States."
Beginning in 2009, RW grantees began yearly reporting of demographic, service, and clinical data into their Ryan White Services Reports. Using this data, HRSA's HIV/AIDS Bureau calculated the total number of RW clients served, and the numbers of clients who were HIV-infected and received RW-funded medical care or case management, received medical care and had visit dates available, were retained in medical care, were prescribed antiretroviral therapy (ART), and had their viral load suppressed at the most recent test. For the purposes of this study, retention in medical care was defined as having at least two medical visits at least 90 days apart during the year; viral suppression was defined as having an HIV viral load below 200 copies/milliliter of blood.
The data analysis showed that there were an estimated 546,156 individual clients who received RW services in 2010. Of all RW clients, there were 68.5% males, 30.7% females, and 0.8% transgender (including both male-to-female and female-to-male). About 47% of the RW clients were Black, 28% were White, 22% were Hispanic/Latino, and the remaining racial/ethnic groups each accounted for 1% or less of the total. Of the total individual clients, 79% received any RW-funded outpatient ambulatory medical care or case management, and 56% of clients received RW-funded medical care.
Retention in Care
Of the persons who received RW-funded medical care and had visit dates available, a total of 76% were retained in medical care. However, the retention-in-care rates varied substantially in different subpopulation groups.
- Age: The age groups with the highest retention rates were children under 13 years old (83%), adults 65 years or older (82%), and adults 55 to 65 years old (81%). In contrast, adolescents and young adults had comparatively low retention-in-care rates: 67% for persons 13 to 24 years old, and 69% for those 25 to 34 years old.
- Race/ethnicity: The highest retention-in-care rates were among clients who are multiracial (79%), Hispanic/Latino (78%), or White (77%), with lower rates among Asian American (76%), Black (75%), American Indian/Alaska Native (74%), and Native Hawaiian/Pacific Islander (71%) clients.
- Gender: Retention-in-care rates were higher among females (77%) than either males (75%) or transgender persons (71%).
- Insurance: The highest retention-in-care rates were in persons with multiple insurance (83%) or Medicare (80%). The lowest retention-in-care rates were in persons with no insurance (73%) or Medicaid only (75%).
ART Prescriptions and Viral Suppression
Of the approximately 262,000 persons who received RW-funded medical care and had ART data and visit data available, 80% were prescribed ART. Of the approximately 250,000 persons who received RW-funded medical care and had viral load data available, 70% had viral load suppression. As might be expected, viral load suppression was substantially higher in patients who were retained in care (75%) compared with patients who were not retained in care (50%).
HRSA notes that, "These rates of retention, ART prescription, and viral load suppression among RW clients are high compared to CDC's nationwide estimates of the continuum of care for all people living with HIV; but they also demonstrate room for improvement. These improvements will help to achieve the goals of the National HIV/AIDS Strategy and improve individual and public health."
The level of awareness of HIV infection status has increased among men who have sex with men (MSM) testing positive for HIV in a 20-city study, according to a CDC analysis of data from the National HIV Behavioral Surveillance (NHBS). These findings were reported at last month's CROI in Atlanta. An edited version of the key findings of the CDC analysis follows:
Because awareness of HIV-positive status is a critical first step in obtaining care and treatment and preventing the spread of HIV, researchers examined trends in HIV prevalence and status of awareness among MSM. Using data from CDC's NHBS, which conducts surveys on HIV-related risk and protective behaviors and provides HIV testing in 20 U.S. cities with a high HIV/AIDS burden, researchers measured changes in the proportion of MSM testing positive for HIV from 2008 to 2011. In addition, among those testing positive, researchers assessed changes in the proportion who said that they were already aware of their infection due to a previous HIV test.
- HIV prevalence remained steady during the period – 19% of MSM tested positive in 2008, and 18% in 2011.
- As would be expected, HIV prevalence increased with age: In 2011, HIV prevalence rose from 12% among MSM 18 to 24 years old to 26% among MSM age 40 years or older.
- Overall HIV prevalence was about twice as high among Black MSM (30%) than among Hispanic/Latino MSM (15%), White MSM (14%), and MSM of other races (14%).
- The proportion of those testing positive that were already aware of their infection increased from 56% in 2008 to 66% in 2011. HIV awareness increased in all age categories and across all racial groups. However, the proportion of men aware of their infection remained lowest (54%) among Black MSM in 2011.
CDC notes that, "Since half of all new infections are transmitted by people who are unaware of their HIV-positive status, these increases in awareness are encouraging, but continuing racial/ethnic disparities are concerning. [The] authors conclude that outreach and testing programs should be sustained and that efforts to reduce disparities remain critical in the fight against HIV."
The audio and slides for this CROI presentation are available at this link on the CROI website; the presentation and follow-up questions and answers comprise the first 18-minutes of the session.
The hospitalization rates of persons coinfected with HIV and either hepatitis B (HBV), hepatitis C (HCV), or both is about 50% higher than the hospitalization rate for persons infected with HIV alone, according to a study presented last month at the 2013 CROI in Atlanta. For their study, Johns Hopkins University researcher Dr. Trevor Crowell and his colleagues reviewed lab test, hospitalization, and demographic data for all patients receiving longitudinal HIV care at 11 sites in the U.S. HIV Research Network during 2010.
Of the more than 14,000 patients with complete data on their viral hepatitis status, nearly three-quarters (72%) were infected with HIV alone, about 6% were coinfected with HBV, 20% with HCV, and about 3% were coinfected with both HBV and HCV. When the researchers compared different subgroups of HIV-infected patients, they found that viral hepatitis coinfection significantly increased the hospitalization rates. Compared to patients infected with HIV alone, those with:
- HIV/HBV coinfection had hospitalization rates about 52% greater;
- HIV/HCV coinfection had hospitalization rates about 45% greater; and
- HIV/HBV/HCV coinfection had hospitalization rates about 46% greater.
Overall, coinfection with viral hepatitis was associated with higher hospitalization rates for non-AIDS-defining infections and gastrointestinal/liver disease. In addition, HIV/HCV coinfection was associated with a higher risk of hospitalization for psychiatric illness, kidney disease, and cardiovascular disease, while HIV/HBV coinfection was associated with a higher risk of hospitalization for non-AIDS-defining cancers.
The researchers also found a strong correlation between the patients' CD4 counts and their hospitalization rates. Patients with the lowest CD4 counts (at or below 50) had hospitalization rates about 7 times greater than those with the highest CD4 counts (over 500). In addition, the researchers found significant differences in hospitalization rates by race, age, and gender:
- Blacks had a hospitalization rate 21% higher than Whites, while the hospitalization rates of persons of Hispanic ethnicity was about the same as that of Whites;
- Females had a hospitalization rate 38% higher than males;
- Persons age 65 or older had hospitalization rates more than twice as high as persons age 18 to 34.
According to the researchers, "Providers and policy-makers should be aware of the high risk of both GI-related and non-GI-related morbidity in patients with hepatitis and HIV co-infection." The researchers recommended that further research be conducted to determine why persons coinfected with HIV and viral hepatitis have higher risks for non-AIDS-defining infections. They also noted that providing appropriate mental health care might reduce the hospitalization rate of patients coinfected with HIV and HCV.
In conjunction with last month's National Native HIV/AIDS Awareness Day, the National Association of State and Territorial AIDS Directors (NASTAD) published a new 7-page issue brief highlighting key issues that affect the risks for HIV/AIDS, sexually transmitted diseases (STDs), and viral hepatitis among Native gay men and Two Spirit people. The issue brief, Native Gay Men and Two Spirit People and HIV/AIDS and Viral Hepatitis Programs and Services, is the result of a collaborative effort involving NASTAD's Native American Networking Group and Gay Men's Health Equity Work Group.
American Indian and Alaska Native (AI/AN) MSM and AI/AN MSM with a history of injection drug use (MSM/IDU) account for 58% and 15%, respectively, of all AI/AN people living with HIV through 2010, according to the NASTAD brief. "AI/AN people experience elevated rates of risk behaviors that contribute to HIV/AIDS and other STDs. In 2005, AI/AN people had the second highest rates of gonorrhea and chlamydia and third highest rates of primary and secondary syphilis." In addition, "according to the 2011 National Survey on Drug Use and Health, AI/AN people have a higher rate of lifetime illicit drug use than persons of other races/ethnicities (58% versus 47%)."
The NASTAD issue brief also notes that AI/AN communities are negatively affected by a range of socioeconomic factors, including low educational attainment, underemployment and unemployment, and higher rates of poverty, violence, and trauma. To help state and local health departments address these issues, NASTAD worked with Native gay men, Two Spirit people, and health department representatives to develop a series of recommendations to tailor HIV, STD, and viral hepatitis services for Native gay men and Two Spirit people. The recommendations include:
- Letting improved data about Native gay men and Two Spirit people drive funding decisions;
- Including Native gay men and Two Spirit people in HIV/AIDS planning groups and councils;
- Supporting Native gay and Two Spirit people's organizations and communities;
- Offer culturally appropriate services;
- Breaking down bureaucratic silos;
- Building public health capacity to work effectively with Native gay men and Two Spirit people and connect with tribal leaders;
- Implementing strategies to capitalize on social networks; and
- Using new tools to effectively communicate the impact of HIV/AIDS, viral hepatitis, and STDs on Native gay men and Two Spirit people.
The NASTAD brief also provides a series of short case studies to illustrate how different state health departments, Native organizations, and members of Native gay and Two Spirit communities have worked together to address the social determinants that affect the risks for HIV/AIDS and STDs in Native gay men and Two Spirit communities. According to NASTAD, such efforts "require education and coalition building within the health department to create cultural awareness and collaboration, as well as to help educate mainstream Native communities on the issues impacting Native gay men and Two Spirit people in their communities."
U.S. federal agencies recently reviewed and expanded the HIV/AIDS information available on the Department of Labor's Benefits.gov website. A key feature of the website is an eligibility prescreening questionnaire or "Benefit Finder." The user's answers to this questionnaire are compared to the eligibility criteria for of more than 1,000 federally funded benefits and assistance programs. The user can search for all available benefits and assistance programs that they qualify for, or specify any combination of more than 20 benefits/assistance categories, which include HIV/AIDS, healthcare, housing, insurance, living assistance, Medicaid/Medicare, and Social Security.
Benefits.gov staff have created an HIV/AIDS page that has links to program descriptions, requirements, and application and contact information for more than 30 programs that serve people living with, at risk for, or affected by HIV/AIDS. The information is available in English and Spanish.
The revised Benefits.gov prescreening questionnaire now includes several HIV-specific questions to assess individual eligibility and more effectively direct users to appropriate programs. The site administrators have also added the AIDS.gov HIV Testing and Care Services locator widget to several Benefits.gov pages, which will help visitors identify services available in their local area.
"By ensuring that Benefits.gov features the full range of Federal benefits and services for people living with HIV/AIDS, we hope to facilitate improved access to this information and the available benefits and services to a broader population," according to Dr. Ronald Valdiserri, Deputy Assistant Secretary for Health, Infectious Diseases. He also noted that these efforts will be bolstered by the outreach Benefits.gov concentrates on several key population groups, including low-income individuals and families, case workers serving at-risk populations, Veterans, students, and educators.
To mark National Public Health Week during the first week of April, Dr. Georges Benjamin, Executive Director of the American Public Health Association, wrote a blog item in which he described the return on investment (ROI) of public health programs and services. Of particular interest, Dr. Benjamin noted that, from 1991 to 2006, investments in HIV prevention in the U.S. averted more than 350,000 infections and averted more than $125 billion in medical costs. He also noted that:
- Investing $10 per person each year in community-based public health activities could save more than $16 billion within 5 years – a ROI of $5.60 for every $1 invested;
- Routine childhood immunizations save $9.9 million in direct health care costs, save 33,000 lives, and prevent 14 million cases of disease;
- Every $1 invested in the U.S. poison center system saves more than $13 in medical costs and lost productivity, with U.S. savings totaling more than $1.8 billion every year;
- The benefits of tobacco cessation programs nearly always outweigh the costs, with a benefits-to-cost ratio reaching more than $2.50 for every $1 invested; and
- Substance abuse treatment has a ROI of $4 to $7 for every $1 invested."
The first National Youth HIV and AIDS Awareness Day (NYHAAD) is being observed this year on Wednesday, April 10. Although NYHAAD has not yet been officially designated as one of the federal government's HIV/AIDS awareness days, it has been embraced by numerous national and state organizations, including Advocates for Youth, AIDS United, National Alliance of State and Territorial AIDS Directors, National Coalition for LGBT Health, National Minority AIDS Council, and Sexuality Information and Information Council of the United States.
According to Advocates for Youth, "The creation of NYHAAD is a step toward acknowledging and addressing the needs of young people in the HIV and AIDS response. Each year, young activists in high schools and at colleges and universities across the country will use this day to organize and educate about HIV and AIDS. They will promote HIV testing, fight stigma, and start the necessary conversation we need to deal honestly and effectively with the challenges we face. NYHAAD will also provide a yearly date for all of us to hold our leaders responsible to their commitments and invest in realizing an AIDS-free generation."
To support activities commemorating NYHAAD, we've compiled an annotated list of online resources focusing on HIV/AIDS among adolescents and young adults.
National Youth HIV and AIDS Awareness Day: This is the web page for NYHAAD. It provides background information about the day, together with links to a list of the day's founding partners, a petition calling for federal recognition of the NYHAAD, and information resources focusing on HIV/AIDS among young persons.
Vital Signs: HIV Infection, Testing, and Risk Behaviors Among Youths - United States. Article dated November 27, 2012 in MMWR.
Vital Signs: HIV Among Youth in the U.S. Online fact sheet/infographic from the Centers for Disease Control and Prevention (CDC).
HIV Surveillance in Adolescents and Young Adults. CDC slide set.
HIV/AIDS Among Youth. CDC fact sheet.
Trends in HIV-Related Risk Behaviors Among High School Students - United States, 1991–2011. Article dated July 27, 2012 in MMWR.
Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9–12 in Selected Sites - Youth Risk Behavior Surveillance, United States, 2001–2009. Article dated 2011 in MMWR.
Youth Risk Behavior Surveillance - United States, 2011. Report dated June 12, 2012 in MMWR.
About HIV/AIDS for Young People. On-line fact sheet on avert.org web site.
Reclaiming Our Future: The State of AIDS Among Black Youth in America. A report from the Black AIDS Institute.
HIV Transmission and Prevention in Adolescents. Chapter from the HIV InSite Knowledge Base.
Primary Care of Adolescents with HIV: Related Resources. Section from the HIV InSite Knowledge Base.
United States of America HIV & AIDS Statistics. Fact sheet from avert.org with a section focusing particularly on age.
Fact Sheets from Advocates for Youth:
- Young People and HIV in the United States
- Young People Living with HIV Around the World
- How Social and Cultural Forces Lead to Unequal Risk for African Americans/Blacks (focus on youth)
- Young Women of Color and the HIV Epidemic
- Young African American Women and HIV
- Young Women of Color and Their Risk for HIV and Other STIs
- HIV and Young American Indian/Alaska Native Women
- HIV/STD Prevention and Young Men Who Have Sex with Men. Also available in Spanish.
- Young Men Who Have Sex with Men: At Risk for HIV and STIs. Also available in Spanish.
Fact Sheets from UCSF's Center for AIDS Prevention Studies:
- What are adolescents' HIV prevention needs? Also available in Spanish.
- What are the HIV prevention needs of young men who have sex with men? Also available in Spanish.
- What are young women's HIV prevention needs? Also available in Spanish.
- What is the role of the family in HIV prevention? Also available in Spanish.
- How do parents and children talk About HIV? Also available in Spanish.
- What works best in sex/HIV education? Also available in Spanish.
- How does childhood sexual abuse affect HIV prevention? Also available in Spanish.
This newsletter section includes the titles, authors, and links to abstracts for recent research. Papers are listed alphabetically according to the lead author's last name.
Exploring Barriers and Facilitators to Participation of Male-to-Female Transgender Persons in Preventive HIV Vaccine Clinical Trials. By M.P. Andrasik, R. Yoon, J. Mooney, G. Broder, M. Bolton, T. Votto, A. Davis-Vogel; HVTN 505 study team; and NIAID HIV Vaccine Trials Network, in Prevention Science.
Influence of Geographical Origin and Ethnicity on Mortality in Patients on Antiretroviral Therapy in Canada, Europe, and the United States. By the Antiretroviral Therapy Cohort Collaboration, in Clinical Infectious Diseases.
Use of Antiretrovirals for HIV Prevention: What Do We Know and What Don't We Know? By J.M. Baeten and R. Grant, in Current HIV/AIDS Reports.
"The Black Man's Country Club": Assessing the Feasibility of an HIV Risk-Reduction Program for Young Heterosexual African American Men in Barbershops. By B.M. Brawner, J.L. Baker, J. Stewart, Z.M. Davis, J. Cederbaum, and L.S. Jemmott, in Family and Community Health.
Racial/Ethnic Differences in the Rates and Correlates of HIV Risk Behaviors Among Drug Abusers. By A.J. Brooks, Y. Lokhnygina, C.S. Meade, J.S. Potter, D.A. Calsyn, and S.E. Greenfield, in American Journal on Addictions.
Why the Treatment of Mental Disorders Is an Important Component of HIV Prevention Among People Who Inject Drugs. By E. Buckingham, E. Schrage, and F. Cournos in Advances in Preventive Medicine.
An HIV Prevention Intervention for Ethnically Diverse Men in Substance Abuse Treatment: Pilot Study Findings. By D.A. Calsyn, A.K. Burlew, M.A. Hatch-Maillette, B. Beadnell, L. Wright, and J. Wilson, in American Journal of Public Health.
Differences between Men and Women in Condom Use, Attitudes, and Skills in Substance Abuse Treatment Seekers. By D.A. Calsyn, M. Peavy, E.A. Wells, A.N. Campbell, M.A. Hatch-Maillette, S.F. Greenfield, and S. Tross, in American Journal on Addictions.
HIV Infection Among Heterosexuals at Increased Risk - United States, 2010. By Centers for Disease Control and Prevention, in MMWR.
Experiences of Discrimination and Their Impact on the Mental Health Among African American, Asian and Pacific Islander, and Latino Men Who Have Sex With Men. By K.H. Choi, J. Paul, G. Ayala, R. Boylan, and S.E. Gregorich, in American Journal of Public Health.
Sexual Orientation and Gender Identity/Expression Related Peer Victimization in Adolescence: A Systematic Review of Associated Psychosocial and Health Outcomes. By K.L. Collier, G. van Beusekom, H.M. Bos, and T.G. Sandfort, in Journal of Sexual Research.
Trajectories of Risk for Early Sexual Activity and Early Substance Use in the Fast Track Prevention Program. By Conduct Problems Prevention Research Group, in Prevention Science.
At the Intersection of Marginalised Identities: Lesbian, Gay, Bisexual, and Transgender People's Experiences of Injecting Drug Use and Hepatitis C Seroconversion. By R.M. Deacon, J. Mooney-Somers, C. Treloar, and L. Maher, in Health and Social Care in the Community.
The Concept of "Silencing the Self" in Low-Income, Aging, HIV-Infected African American Women: A 10-Year Community-Based Participatory Program of Research with Results. By R.F. Demarco and L.R. Lanier, in Journal of the Association of Nurses in AIDS Care.
Mental and Physical Health and Intimate Partner Violence Against Women: A Review of the Literature. By G. Dillon, R. Hussain, D. Loxton, and S. Rahman, in International Journal of Family Medicine.
HIV/AIDS and Minority Men Who Have Sex with Men: A Meta-Ethnographic Synthesis of Qualitative Research. By P.J. Dillon and A. Basu, in Health Communication.
Sexual Risk Behavior and Viremia Among Men Who Have Sex with Men in the HIV Outpatient Study (HOPS), USA, 2007 – 2010. By M.D. Durham, K. Buchacz, J. Richardson, D. Yang, K. Wood, B. Yangco, J.T. Brooks; and the HOPS Investigators, in Journal of Acquired Immune Deficiency Syndromes.
Association of Discrimination-Related Trauma with Sexual Risk Among HIV-Positive African American Men Who Have Sex With Men. By E.L. Fields, L.M. Bogard, F.H. Galvan, G.J. Wagner, D.J. Klein, and M.A. Schuster, in American Journal of Public Health.
Metropolitan Social Environments and Pre-HAART/HAART Era Changes in Mortality Rates (per 10,000 Adult Residents) Among Injection Drug Users Living with AIDS. By S.R. Friedman, B.S. West, E.R. Pouget, H.I. Hall, J. Cantrell, B. Tempalski, S. Chatterjee, X. Hu, H.L. Cooper, S. Galea, D.C. Des Jarlais, in PLoS One.
Sociodemographic Characteristics Explain Differences in Unprotected Sexual Behavior Among Young HIV-Negative Gay, Bisexual, and Other YMSM in New York City. By P.N. Halkitis, and R.P. Figueroa, in AIDS Patient Care and STDs.
Individual, Psychosocial, and Social Correlates of Unprotected Anal Intercourse in a New Generation of Young Men Who Have Sex With Men in New York City. By P.N. Halkitis, F. Kapadia, D.E. Siconolfi, R.W. Moeller, R.P. Figueroa, S.C. Barton, and J. Blachman-Forshay, in American Journal of Public Health.
HIV Transmission in the United States: Considerations of Viral Load, Risk Behavior, and Health Disparities. By H.I. Hall, D.R. Holtgrave, T. Tang, and P. Rhodes, in AIDS and Behavior.
Parental Influences of Sexual Risk Among Urban African American Adolescent Males. By A.L. Harris, M.A. Sutherland, and M.K. Hutchinson, in Journal of Nursing Scholarship.
Women Hold Up Half the Sky - and Half the Burden of the HIV Epidemic. By S. Heidari, S. Kippax, P.S. Sow, and M.A. Wainberg, in Journal of the International AIDS Society.
Hepatitis B Testing and Access to Care Among Racial and Ethnic Minorities in Selected Communities Across the United States, 2009-2010. By D.J. Hu, J. Xing, R.A. Tohme, Y. Liao, H. Pollack, J.W. Ward, and S.D. Holmberg, in Hepatology.
Lessons Learned from Field-Testing a Brief Behavioral Intervention Package for African American Women at Risk for HIV/STDs. By P.L. Jones, J.L. Baker, D. Gelaude, W. King, and L. Jemmott, in Health Promotion Practice.
Knowledge, Attitudes, and Practices Regarding Syphilis Screening Among Men Who Have Sex with Men in San Francisco. By K.A. Katz, H.F. Raymond, K.T. Bernstein, and J.D. Klausner, in Sexually Transmitted Diseases.
Temporal Trends in Sexual Behavior Among Men Who Have Sex with Men in the United States, 2002 to 2006-10. By J.S. Leichliter, L.T. Haderxhanaj, H.W. Chesson, and S.O. Aral, in Journal of Acquired Immune Deficiency Syndromes.
Sexual Risk Behavior Among HIV-Uninfected Men Who Have Sex with Men (MSM) Participating in a Tenofovir Pre-exposure Prophylaxis (PrEP) Randomized Trial in the United States. By A.Y. Liu, E. Vittinghoff, K. Chillag, K. Mayer, M. Thompson, L. Grohskopf, G. Colfax, S. Pathak, R. Gvetadze, B. O'Hara, B. Collins, M. Ackers, L. Paxton, and S.P. Buchbinder, in Journal of Acquired Immune Deficiency Syndromes.
Factors Contributing to Dropping Out from and Returning to HIV Treatment in an Inner City Primary Care HIV Clinic in the United States. By A. Pecoraro, C. Royer-Malvestuto, B. Rosenwasser, K. Moore, A. Howell, M. Ma, and G.E. Woody, in AIDS Care.
Knowledge and Use of Pre-Exposure Prophylaxis Among an Online Sample of Young Men Who Have Sex with Men in New York City. By K.B. Rucinski, N.P. Mensah, K.A., B.H.Cutler, M.M. Sweeney, and J.E. Myers, in AIDS and Behavior.
Psychosocial and Demographic Correlates of Drug Use in a Sample of HIV-Positive Adults Ages 50 and Older. By D.E. Siconolfi, P.N. Halkitis, S.C. Barton, M.J. Kingdon, R.E. Perez-Figueroa, V. Arias-Martinez, S. Karpiak, and M. Brennan-Ing, in Prevention Science.
Costs of a Public Health Model to Increase Receipt of Hepatitis-Related Services for Persons with Mental Illness. By E.P. Slade, S. Rosenberg, L.B. Dixon, R.W. Goldberg, G.L. Wolford, S. Himelhoch, and S. Tapscott, in Psychiatric Services.
The Psychological Cost of Anticipating HIV Stigma for HIV-Negative Gay and Bisexual Men. By T.J. Starks, H.J. Rendina, A.S. Breslow, J.T. Parsons, and S.A. Golub in AIDS and Behavior.
'Where Sex Ends and Emotions Begin': Love and HIV Risk Among Female Sex Workers and Their Intimate, Non-Commercial Partners Along the Mexico-U.S. Border. By J.L. Syvertsen, A.M. Robertson, L.A. Palinkas, M.G. Rangel, G. Martinez, and S.A. Strathdee, in Culture, Health, and Sexuality.
African American Children's Perceptions of HIV-Focused Community-Based Participatory Research. By D.E. Traube, J.A. Cederbaum, D. Kerkorian, C. Bhupali, and M.M. McKay, in Journal of Empirical Research on Human Research Ethics.
Community Poverty and Trends in Racial/Ethnic Survival Disparities Among People Diagnosed with AIDS in Florida, 1993-2004. By M.J. Trepka, T. Niyonsenga, L. Maddox, S. Lieb, K. Lutfi, and E. Pavlova-McCalla, in American Journal of Public Health.
Differences in HIV Risk Behavior of Injection Drug Users in New York City by Health Care Setting. By A.K. Turner, K. Harripersaud, N.D. Crawford, A.V. Rivera, and C.M. Fuller, in AIDS Care.
Paying for Prevention: Challenges to Health Insurance Coverage for Biomedical HIV Prevention in the United States. By K. Underhill, in American Journal of Law and Medicine.
Changes in Seroadaptive Practices from Before to After Diagnosis of Recent HIV Infection Among Men Who Have Sex with Men. By S. Vallabhaneni, J.J. McConnell, L. Loeb, W. Hartogensis, F.M. Hecht , R.M. Grant, and C.D. Pilcher, in PLoS One.
Is the HCV-HIV Co-infection Prevalence Amongst Injecting Drug Users a Marker for the Level of Sexual and Injection Related HIV Transmission? By P. Vickerman, N.K. Martin, A. Roy, T. Beattie T, EMCDDA Collaborative Group, D.D. Jarlais, S. Strathdee, L. Wiessing, and M. Hickman, in Drug and Alcohol Dependence.
In Their Own Words: Racial/Ethnic and Gender Differences in Sources and Preferences for HIV Prevention Information Among Young Adults. By D. Voisin, C.S. Shiu, A. Chan Tack, C. Krieger, D. Sekulska, and L. Johnson, in AIDS Care.
Minority Stress Experiences and Psychological Well-Being: The Impact of Support from and Connection to Social Networks Within the Los Angeles House and Ball Communities. By C.F. Wong, S.M. Schrager, I.W. Holloway, I.H. Meyer, and M.D. Kipke, in Prevention Science.