MAI/NEHEC Monthly Health Disparities Update: January 2013
This newsletter is developed by the AIDS Action Committee of Massachusetts in collaboration with the New England AIDS Education and Training Center Minority AIDS Initiative Project.
New U.S. HIV Infections Remain Stable Overall, But Rise Among MSM: In December, the Centers for Disease Control and Prevention issued their new HIV incidence estimates for the U.S. The data indicate that HIV incidence has remained stable for the country as a whole, with an estimated 47,500 new HIV infections in both 2008 and 2010 – the latest year for which official estimates are available. However, there have been substantial changes in HIV incidence in particular groups, including rising rates among men who have sex with men and falling rates among Black/African American females.
CDC Surveillance Data Yield New Estimates for HIV Rates and Racial/Ethnic Disparities Among MSM and IDUs: Rates of new HIV diagnoses among men who have sex with men (MSM) are about 67 and 58 times higher than those among other men and among women, respectively, according to recent surveillance data from CDC. In addition, syphilis rates are about 71 and 96 times higher for MSM than for other men and women, respectively. CDC researchers have calculated that, while the overall rate of new HIV diagnoses among injection drug users (IDUs) during 2009 was about 77 per 100,000, diagnosis rates were 15 times higher among Black IDUs and 9 times higher among Latino IDUs compared to Whites.
NRC/IOM study finds that Americans have worse health than people in other high-income countries: On average, Americans have higher rates of disease and injury and die sooner than people in other high-income countries, according to a new report from the National Research Council (NRC) and Institute of Medicine (IOM). Americans' health disadvantage compared to citizens of other high-income nations persists from birth to age 75 and even affects relatively advantaged Americans – persons with a college education, higher incomes, and health insurance. The report notes that the U.S. has the second highest prevalence of HIV infection the highest incidence of AIDS among 17 high-income countries studied.
NMAC 2013 Legislative Agenda Prioritizes Funding for HIV programs and Support for Bills Addressing Factors that Fuel the HIV/AIDS Epidemic: Earlier this month, the National Minority AIDS Council (NMAC) published its legislative agenda for 2013. According to the published agenda, "NMAC’s highest policy priority is to ensure robust funding for the wide array of discretionary HIV/AIDS prevention, care, treatment, and research programs authorized and funded by the federal government." In its advocacy efforts, NMAC plans to "focus on a number of specific bills that address many of the social determinants and inequities that drive the HIV/AIDS epidemic among minority populations as well as perpetuate poorer health outcomes for those living with HIV and AIDS."
HHS Reviews Programs for Reducing HIV Infection Among African Americans: During fiscal years 2009 through 2011, the Department of Health and Human Services (HHS) spent an average of nearly $300 million per year on 56 prevention programs and initiatives to reduce HIV infection among African Americans. According to the inventory, nearly three-quarters (72%) of the total HHS funding for these programs and initiatives was spent on HIV prevention and related services, about 12% on mental health and substance use services, 5% on outreach and education, 4% on family planning services, and 2% each on capacity building/technical assistance and evaluation activities.
New Sortable Stats 2.0 Health Resource Provides Quick Access to Risk Factor and Health Indicator Data: CDC has launched version 2.0 of its Sortable Stats health resource, which has data on population, death rates, risk factors, and other public health indicators by state and region, including information about diagnoses of HIV, hepatitis B, and hepatitis C.
Research Reports on HIV Health Disparities and Affected Populations: This new newsletter section includes the titles, authors, and links to the abstracts for recent research.
In December, the Centers for Disease Control and Prevention (CDC) issued a new report, Estimated HIV Incidence in the United States: 2007 - 2010. The report indicates that HIV incidence has remained stable in the country as a whole, with an estimated 47,500 new HIV infections in both 2008 and 2010 – the latest year for which official estimates are available. However, there have been substantial changes in HIV incidence in particular groups, including rising rates among men who have sex with men (MSM) and falling rates among Black/African American females.
MSM: In the U.S., MSM remain the population most heavily affected by HIV infection. The number of new HIV infections among MSM overall increased 12% from an estimated 26,700 in 2008 to 29,800 in 2010. An even greater increase (22%) occurred among 13- to 24-year-old MSM, with estimated infections rising from 7,200 in 2008 to 8,800 in 2010. CDC noted that, although MSM comprise only about 4% of the male population in the U.S., they accounted for 78% of the new HIV infections among males in 2010.
The estimated number of new HIV infections was greatest among young Black/African American MSM 13 to 24 years old, with about 4,800. These young Black/African American MSM accounted for 45% of new HIV infections among all Black/African American MSM and 55% of new HIV infections among young MSM overall.
Race/Ethnicity: Comparing 2008 to 2010, the number of new HIV infections remained stable in all race/ethnicity groups. However, it is important to note that Blacks/African Americans and Hispanics/Latinos continue to be disproportionately affected by HIV infection. In 2010, Blacks/African Americans accounted for 44% of the new HIV infections, followed by Whites (31%) and Hispanics/Latinos (21%). The rates of new HIV infections per 100,000 population in Blacks/African Americans (68.9) and Hispanics/Latinos (27.5) were 7.9 times and 3.1 times, respectively, as high as the rate in Whites (8.7).
Age at the Time of HIV Infection: The estimated number of new HIV infections remained stable in all age groups between 2008 and 2010, according to CDC. Overall, in 2010, the estimated number of new HIV infections was highest among persons 25 to 34 years old (14,500), followed by persons 13 to 24 years old (12,200). In 2010, the highest HIV infection rates per 100,000 population occurred among persons 25 to 34 years old (34.9), followed by those 35 to 44 years old (27.3). Persons aged 55 years and older had the lowest rate of new HIV infections with 3.3 per 100,000 population.
Among Black/African American males, however, the largest percentage (38%) of new HIV infections in 2010 occurred in those 13 to 24 years old; this percentage was substantially higher than that for the same age group of either Hispanic/Latino males (25%) or White males (16%).
Gender: The estimated number of new HIV infections decreased among females, falling from about 12,000 in 2008 to 9,500 in 2010. During 2010, the overall rate of new HIV infections per 100,000 population among males (30.7) was 4.2 times that of females (7.3). That year, the rate of new HIV infections among Black/African American males was 6.6 times that for White males and 2.7 times that for Black/African American females.
The total number of new HIV infections among Black/African American females decreased 21% from 7,700 in 2008 to 6,100 in 2010. Nevertheless, the HIV infection rates for Black/African American and Hispanic/Latina females continued to be much higher – 20.1 and 4.2 times, respectively – than for White females. In 2010, the infection rates per 100,000 females were 38.1 for Blacks/African Americans, 8.0 for Hispanics/Latinas, and 1.9 for Whites.
Transmission Category: The estimated number of new HIV infections among males with infection attributed to male-to-male sexual contact increased, while the estimated number of new HIV infections among females with infection attributed to heterosexual contact decreased. As noted above, MSM continue to bear the heaviest burden of HIV in the U.S. The number of new HIV infections among females whose infection was attributed to heterosexual contact fell 18% from about 9,800 in 2008 to 8,000 in 2010. In 2010, the majority of new HIV infections was attributed to male-to-male sexual contact (63% overall and 78% among males). Among females, the largest percentage of new HIV infections was attributed to heterosexual contact (84%).
Last month, CDC notified its prevention partners about the availability of surveillance data with new estimates for HIV rates among MSM and injection drug users (IDUs). According to CDC, "It is critical to have accurate population estimates in order to better understand the HIV burden among risk groups as well as to make a substantial impact and save lives through better HIV prevention program planning. Without census estimates available for the IDU or MSM in the U.S., it has been difficult to quantify disease rates and disparities in disease rates among IDU and MSM compared to their population sizes in the same way we do for other factors such as sex, race/ethnicity, and age."
To address this difficulty, CDC researchers conducted two meta-analyses of multiple studies estimating the proportions of MSM and IDUs nationwide. They then combined these population estimates with other HIV surveillance data to calculate the rates of HIV among U.S. MSM and IDUs. The results of their calculations for MSM were published in The Open AIDS Journal, and those for IDUs were summarized in a recent poster presentation.
HIV and syphilis estimates for MSM: The CDC meta-analysis of MSM studies found that about 3.9% of the U.S. adult male population had engaged in same-sex behavior in the previous five years, and about 6.9% of males reported ever engaging in same-sex behavior. Using the 5-year estimate for the size of the MSM population, the CDC researchers calculated that the 2008 HIV diagnosis rate among MSM was about 67 times higher than that of other men and about 58 times higher than that of women. The calculated HIV prevalence among MSM was also about 42 times higher than that of other men and about 46 times higher than that of women.
The analysis also found racial and ethnic disparities in new HIV diagnoses and prevalence rates among MSM. The 2008 HIV diagnosis rates among Black/African American and Hispanic MSM were 6.0 and 2.7 times higher, respectively, compared to White MSM. HIV prevalence rates were also higher: 3.8 times and 1.9 times higher, respectively, among Black/African American and Hispanic MSM compared to White MSM.
The 2008 syphilis diagnosis rate among MSM was also about 71 times higher than that of other men and about 96 times higher than that of women. As with HIV diagnoses, there were significant racial and ethnic disparities in syphilis rates among MSM. The syphilis diagnosis rates among Black/African American and Hispanic MSM were 4.5 and 1.8 times higher, respectively, compared to White MSM.
HIV estimates for IDUs: According to the CDC meta-analysis, about 2.6% of the U.S. population age 13 years or older had ever used injection drugs and about 0.3% had used injection drugs in the previous year. The CDC researchers calculated that the overall HIV diagnosis rate for IDUs was 77 per 100,000 in 2009; the poster presentation did not provide a comparable HIV diagnosis rate for non-IDUs. Black/African American and Hispanic IDUs had HIV diagnosis rates 15 and 9 times higher, respectively, than White IDUs. The overall prevalence rate of HIV infection among IDUs was 2,429 per 100,000. And again, HIV prevalence rates were much greater among Black/African American IDUs (16 times) and Hispanic IDUs (11 times), compared to White IDUs.
On average, Americans have higher rates of disease and injury and die sooner than people in other high-income countries, according to a new report from the National Research Council (NRC) and Institute of Medicine (IOM). Americans' health disadvantage compared to citizens of other high-income nations persists from birth to age 75 and even affects relatively advantaged Americans – persons with a college education, higher incomes, and health insurance.
The report presents a series of sobering facts about the state of American health. For example:
- The U.S. has the second highest prevalence of HIV infection the highest incidence of AIDS among 17 peer [high-income] countries.
- Since the 1990s, U.S. adolescents have had the highest rate of pregnancies and have had higher rates of sexually transmitted infections than other high-income countries.
- Americans also lose more years of life to alcohol and other drugs than people in other high-income countries, even when deaths from drunk driving are excluded.
- For decades, the U.S. has experienced the highest infant mortality rate of high-income countries and also ranks poorly on other birth outcomes, such as low birth weight. American children are less likely to live to age 5 than children in other high-income countries.
- Deaths from motor vehicle crashes, nontransportation-related injuries, and violence occur at much higher rates in the U.S. than in other countries and are a leading cause of death in children, adolescents, and young adults.
- For decades, the United States has had the highest obesity rate among high-income countries.
- The U.S. death rate from ischemic heart disease is the second highest among high-income countries.
The NRC/IOM expert panel that wrote the report identified several factors that they believe contribute to the U.S. health disadvantage: health systems, health behaviors, social and economic conditions, and physical environments. Quoting directly from the 4-page report brief:
- "Health systems: Unlike its peer countries, the U.S. has a relatively large uninsured population and more limited access to primary care. Americans are more likely to find their health care inaccessible or unaffordable and to report lapses in the quality and safety of care outside of hospitals.
- Health behaviors: Although Americans are currently less likely to smoke and may drink alcohol less heavily than people in peer countries, they consume the most calories per person, have higher rates of drug abuse, are less likely to use seat belts, are involved in more traffic accidents that involve alcohol, and are more likely to use firearms in acts of violence.
- Social and economic conditions: Although the income of Americans is higher on average than in other countries, the U.S. also has higher levels of poverty (especially child poverty) and income inequality and lower rates of social mobility. Other countries are outpacing the U.S. in the education of young people, which also affects health. And Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages.
- Physical environments: U.S. communities and the built environment are more likely than those in peer countries to be designed around automobiles, and this may discourage physical activity and contribute to obesity."
The expert panel concluded that, "With lives and dollars at stake, the U.S. cannot afford to ignore this problem. One obvious solution is to intensify efforts to improve public health by addressing the specific conditions responsible for the U.S. health disadvantage, from infant mortality and heart disease to obesity and violence. Public health leaders have already identified many promising strategies to address these problems, and the nation has adopted detailed health objectives aimed at their implementation. Although these are positive steps, addressing the U.S. health disadvantage will require not only a list of goals, but also a societal commitment of effort and resources to meet them."
Earlier this month, the National Minority AIDS Council (NMAC) published its legislative agenda for 2013. In the introduction to its 5-page agenda, NMAC notes that it "is redoubling its commitment to addressing and mitigating structural contributors, and socioeconomic determinants, to health. To this end, NMAC is prioritizing the enactment of new legislation, as well as appropriations to existing federal programs, that remedy barriers to care disproportionately affecting minority individuals disadvantaged in their ability to access quality health care."
According to the agenda, "NMAC’s highest policy priority is to ensure robust funding for the wide array of discretionary HIV/AIDS prevention, care, treatment, and research programs authorized and funded by the federal government." These programs include:
- Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which is subject to reauthorization on October 30, 2013;
- Housing for People Living with HIV/AIDS (HOPWA) Program; and
- The Minority AIDS Initiative (MAI)
In addition, NMAC is calling for the removal of the ban on the use of Federal funds for syringe services programs (SSPs). Although the U.S. Congress had lifted a two-decade ban on Federal support for SSPs in December 2009, Congress reinstated the ban two years later. "Syringe Services Programs have been proven effective and cost-efficient interventions that prevent the spread of HIV and hepatitis infections among drug users, particularly in Black and Latino communities," according to NMAC. "NMAC is committed to working with the 113th Congress to once again lift restrictions on the use of federal funds for SSPs in state and local governments permitting such operations."
Regarding its legislative priorities, NMAC plans to focus on several specific bills "that address many of the social determinants and inequities that drive the HIV/AIDS epidemic among minority populations as well as perpetuate poorer health outcomes for those living with HIV and AIDS." These include:
- Repeal Existing Policies that Encourage and Allow Legal HIV Discrimination (REPEAL) Act: The REPEAL Act, introduced by Representative Barbara Lee (D-CA) in 2011 is designed to remedy state and federal laws that criminalize the exposure or transmission of HIV.
- The Comprehensive Immigration Reform (CIR) Act: CIR was introduced in 2011 to create a Lawful Prospective Immigrant status for non-criminal undocumented immigrants living in the U.S. According to NMAC, "citizenship and residency status play a critical role in access to healthcare in this country. Immigrants, including those living with HIV/AIDS, must have access to high quality care and treatment services both for individual health, as well as broader public health."
- Employment Non-Disclosure Act (ENDA): NMAC is working to extend federal employment discrimination protections to include sexual orientation and gender identity.
- Health Equity and Accountability Act (HEAA): Introduced in 2012, this bill is designed to reduce ethnic and racial disparities by focusing on barriers to care that disproportionately affect minority individuals. Provisions in HEAA would increase the ability of minority individuals to access appropriate and competent care, and encourage research for diseases and conditions that disproportionately impact minority individuals.
- Violence Against Women Act (VAWA): VAWA, which was passed in 1994, is coming up for reauthorization. NMAC supports a reauthorized version of VAWA that would include "comprehensive protections for Native women, LGBT individuals, and all immigrants."
- Housing Opportunities Made Equal (HOME) Act: The HOME Act would prohibit housing discrimination on the basis of sexual orientation, gender identity, marital status, or source of income.
In addition, NMAC is supporting legislative efforts to: protect LGBT youth from discrimination in schools; repeal the Defense of Marriage Act so that same-sex married couples will enjoy all the rights and legal protections of other married couples; and allow HIV-infected persons to donate organs to other HIV-infected persons in need of transplants.
The Department of Health and Human Services (HHS) spent an average of about $293 million annually between fiscal years 2009 and 2011 on 56 prevention programs and initiatives designed to reduce HIV infection among African Americans, according to a recently published HHS program inventory. It is important to note that these figures do not capture all HHS HIV activities and funding that benefit African Americans, since this HHS inventory did not include its programs that provide HIV prevention, treatment, or care but do not specifically target African Americans or other subgroups of the population.
Under the National HIV/AIDS Strategy, HHS is required to acknowledge the heavy burden of HIV among African Americans and to target prevention resources accordingly. CDC data indicate that, while African Americans represent 14% of the total U.S. population, they account for 44% of all HIV-infected persons in the U.S. HHS conducted this inventory to determine how its HIV prevention funds are being used to addess the disproportionate burden of HIV on African Americans.
The inventory indicates that nearly three-quarters (72%) of the total HHS funding for the 56 programs and initiatives studied was spent on HIV prevention and related services, about 12% on mental health and substance use services, 5% on outreach and education, 4% on family planning services, and 2% each on capacity building/technical assistance and evaluation activities.
According to HHS, "While these investments [in HIV prevention programs and initiatives serving African Americans] generally follow the distribution of the African American HIV epidemic, this review found preliminary evidence suggesting that more focused prevention program development and targeting of services may be warranted, particularly in disproportionately affected subpopulations (e.g., young MSM and women) and U.S. regions (i.e., South and Northeast). Given the inequities in HIV rates among African Americans, a more systematic review may be needed to inform the optimal distribution of these federal investments if we are to fully achieve the National HIV/AIDS Strategy goals of reducing the number of people who become infected with HIV, increasing access to care and optimizing health outcomes for people living with HIV, and reducing HIV-related health disparities."
CDC recently launched version 2.0 of its Sortable Stats health resource – an interactive database with data on 31 behavioral risk factors and health indicators by state and region, as well as current data on U.S. state populations by race/ethnicity and health insurance coverage. The site's Health Indicators section has national and state-by-state data on HIV diagnosis rates and cases of hepatitis B and C that can be sorted into ranked lists with a mouse click. In addition to data about these infectious diseases, Sortable Stats has race/ethnicity, gender, and geographic breakdowns, as well as time trends for infant mortality, heart disease, hypertension, stroke, diabetes, smoking, obesity, physical activity levels, binge drinking, and many other risk factors and health indicators.
Thursday, February 7, is the 13th annual National Black HIV/AIDS Awareness Day (NBHAAD). As was the case in 2012, the theme for NBHAAD in 2013 is: "I am My Brother's/Sister's Keeper: FIGHT HIV/AIDS!" According to NBHAAD organizers, the purpose of the event is four-fold: 1) to educate Blacks about the basics of HIV/AIDS in their local communities; 2) to encourage Blacks to get tested for HIV infection; 3) to encourage involvement among Blacks from all walks of life in the fight against HIV/AIDS in their communities; and 4) to get HIV-positive Blacks connected to treatment and care services.
To help you and your clients or patients prepare for and mark the day, we've compiled an annotated list of online resources focusing on HIV/AIDS in the Black/African American community.
Fact Sheets and Reports
HIV/AIDS among African Americans. This two-page CDC fact sheet presents recent statistics, information on prevention challenges, and steps CDC is taking to address the HIV/AIDS epidemic in African Americans.
Diagnoses of HIV Infection Among Adults and Adolescents by Sex and Transmission Category, 2010: 46 States and 5 U.S. Dependent Areas. This 79-page CDC report includes detailed information about HIV and AIDS cases and deaths among Blacks/African Americans and five other racial/ethnic groups. Breakdowns are also provided by age, gender, HIV transmission category, and geographic region.
Black Americans and HIV/AIDS. This two-page fact sheet from the Kaiser Family Foundation was just updated in December. It provides detailed information on HIV/AIDS among Black Americans in the following topic areas: snapshot of the epidemic, key trends and current cases, women and young people, HIV transmission, geographic distribution of cases, access to and use of health care, health insurance, HIV testing, and opinions about HIV/AIDS.
HIV and AIDS Among African Americans. This online document from Avert.org provides an extensive overview of the HIV/AIDS epidemic in Black America, complete with citations to more than 70 source research papers and reports. Topics covered include: main risk factors among African Americans; how African Americans view the epidemic; and steps being taken to combat HIV/AIDS in the African American community.
Selected Organizations and Web Sites
NBHAAD website: This site provides background information about the awareness day, links to resources, a facility to register for NBHAAD events, and information about the Historically Black Colleges and Universities HIV/AIDS awareness initiative. You can also order posters and postcards to raise awareness of HIV/AIDS in the Black community.
Black AIDS Institute: The Black AIDS Institute is a leading organization addressing HIV/AIDS among Black Americans. Their website provides detailed information on a range of programs and reports focusing on the impact of the epidemic on the Black community. Recent reports include:
- Back of the Line: The State of AIDS Among Black Gay Men in America, 2012
- Exit Strategy: Ending the AIDS Epidemic in Black America
- AIDS: 30 Years Is Enuf
- Deciding Moment: The State of AIDS in Black America, 2011
- Passing the Test: The Challenges and Opportunities of HIV Testing in Black America
- Rights Here, Right Now
National Minority AIDS Council (NMAC): The NMAC website has extensive resources in support of its mission to develop leadership in communities of color to end the HIV/AIDS epidemic. These resources include information on legislation and advocacy, conferences, training programs, and educational materials.
HIV/AIDS Resource Center for African Americans: This special section on thebody.com website has links to numerous resources about HIV/AIDS in the Black community, as well as links to recent news articles, opinion pieces, and personal stories.
Center for AIDS Prevention Studies (CAPS): The University of California-San Francisco's CAPS has compiled many fact sheets in English and Spanish on HIV prevention in different communities. CAPS fact sheets include:
- What are African Americans' HIV prevention needs? Also available in Spanish.
- What are Black Men's HIV prevention needs? Also available in Spanish.
- What are Black Women's HIV prevention needs? Also available in Spanish.
Selected Recent Articles about HIV/AIDS Among Blacks/African Americans
High Viral Loads Linked to HIV Risk Among Black MSM. (aidsmeds.com)
More Black Teenagers Practicing Safe Sex. (CDC/TheBodyPRO.com)
Persistent Racial/Ethnic Disparities in AIDS Diagnoses Among People Who Inject Drugs in the Largest U.S. Metropolitan Areas, 1993-2008. (Second news brief from CDC/TheBodyPRO.com)
New Study Finds Greatly Elevated HIV Infection Rates Among Young Black Gay and Bisexual Men in the U.S. (HIV Prevention Trials Network)
HIV Still a Chief Cause in Smaller Racial Life Expectancy Gap. (aidsmeds.com)
As NBHAAD approaches, be on the lookout for additional reports, fact sheets, and articles about HIV/AIDS in the Black community. CDC and many of the organizations cited above often time the release of important new studies to NBHAAD. We plan to summarize these studies in an upcoming issue of the MAI/NEHEC Monthly Health Disparities Update.
This new newsletter section includes the titles, authors, and links to abstracts for recent research.
Mortality Among Homeless Adults in Boston: Shifts in Causes of Death Over a 15-Year Period. By Travis Baggett, Stephen Hwang, and others, in JAMA Internal Medicine.
All Black People Are Not Alike: Differences in HIV Testing Patterns, Knowledge, and Experience of Stigma Between U.S.-Born and Non-U.S.-Born Blacks in Massachusetts. By Bisola Ojikutu, Chioma Nnaji, and others, in AIDS Patient Care and STDs.
Is There a Legacy of the U.S. Public Health Syphilis Study at Tuskegee in HIV/AIDS-Related Beliefs Among Heterosexual African-Americans and Latinos? By Vickie Mays, Courtney Coles, and Susan Cochran, in Ethics and Behavior.
Primary Care Provider Cultural Competence and Racial Disparities in HIV Care and Outcomes. By Somnath Saha, P. Todd Korthuis, and others, in Journal of General Internal Medicine.
Hispanics, Incarceration, and TB/HIV Screening: A Missed Opportunity for Prevention. By Dora Dumont, Annie Gjelsvik, and others, in Journal of Immigrant and Minority Health.
Measuring Population Transmission Risk for HIV: An Alternative Metric of Exposure Risk in Men Who Have Sex with Men in the US. By Colleen Kelley, Eli Rosenberg, and others, in PLoS One.
It Gets Better: Resolution of Internalized Homophobia Over Time and Associations with Positive Health Outcomes Among MSM. By Amy Herrick, Ronald Stall, and others, in AIDS and Behavior.
Latino Adolescent Reproductive and Sexual Health Behaviors and Outcomes: Research Informed Guidance for Agency-based Practitioners. By Vincent Guilamo-Ramos, V. Goldberg, and others, in
Clinical Social Work Journal.
Patterns and Correlates of Linkage to Appropriate HIV Care After HIV Diagnosis in the US Medicaid Population. By Stephen Johnston, Timothy Juday, and others, in Sexually Transmitted Diseases.
Reframing the Context of Preventive Health Care Services and Prevention of HIV and Other Sexually Transmitted Infections for Young Men: New Opportunities to Reduce Racial/Ethnic Sexual Health Disparities. By Yzette Lanier and Madeline Sutton, in American Journal of Public Health.
Disparities in the Burden of HIV/AIDS in Canada. By Robert Hogg, Katherine Heath, and others, in PLoS One.
The Hispanic HIV Epidemic. By Andrés Henao-Martíne and Jose Castillo-Mancilla, in Current Infectious Disease Reports.
Community Member Perspectives from Transgender Women and Men Who Have Sex with Men on Pre-Exposure Prophylaxis as an HIV Prevention Strategy: Implications for Implementation. By Gabriel Galindo, Ja'Nina Walker, and others, in Implementation Science.
The Influence of Social Determinants on Evidence-Based Behavioral Interventions: Considerations for Implementation in Community Settings. By Alice Gandelman and M. Margaret Dolcini, in Translational Behavioral Medicine.
Vital Signs: HIV Infection, Testing, and Risk Behaviors Among Youths - United States. By the Centers for Disease Control and Prevention, in the Morbidity and Mortality Weekly Report.
HIV Prevention for Adolescents: Where Do We Go from Here? By Marguerita Lightfoot, in the American Psychologist.
Health Disparities Experienced by People with Disabilities in the United States: A Behavioral Risk Factor Surveillance System Study. By Jennifer Pharr and Tim Bungum, in Global Journal of Health Science.
HIV-Positive and in Jail: Race, Risk Factors, and Prior Access to Care. By Mathew Stein, Anne Spaulding, and others, in AIDS and Behavior.
Racial Disparity in U.S. Diagnoses of Acquired Immune Deficiency Syndrome, 2000-2009. By Qian An, Joseph Prejean, and H. Irene Hall, in American Journal of Preventive Medicine.
Improvement in the Health of HIV-Infected Persons in Care: Reducing Disparities. By Richard Moore, Jeanne Keruly, and John Bartlett, in Clinical Infectious Diseases.
Straight talk: HIV prevention for African-American heterosexual men: theoretical bases and intervention design. By Victoria Frye, Sebastian Bonner, and others, in AIDS Education and Prevention.
The Impact of African Americans' Beliefs About HIV Medical Care on Treatment Adherence: A Systematic Review and Recommendations for Interventions. By Gina Gaston and Binta Alleyne-Green, in AIDS and Behavior.
HIV Diagnoses and Prevalence in the Southern Region of the United States, 2007-2010. By Joseph Prejean, T. Tang, and H. Irene Hall, in Journal of Community Health.
Association Between Community Socioeconomic Position and HIV Diagnosis Rate Among Adults and Adolescents in the United States, 2005 to 2009. By Qian An, Joseph Prejean, and others, in the American Journal of Public Health.
High HIV Incidence and Prevalence and Associated Factors Among Young MSM, 2008. By Alexandra Balaji, Kristina Bowles, and others, in AIDS.
The Relationship of Self-Esteem and Risky Sexual Behaviors in Young African-American Women. By Laura Pittiglio, Frances Jackson, and Ann Florio, in Journal of the National Black Nurses' Association.