Special Conference Section

Update on the U.S.

by Enid Vázquez

The U.S. Centers for Disease Control and Prevention (CDC) reported the results of its new and on-going studies into epidemiological trends and the effects of disease.

Older people diagnosed later

For people born before 1950, 40% of men and 32% of women who received an HIV diagnosis did so in the same month as their AIDS diagnosis. Researchers said, “These late HIV diagnoses underscore the need for physicians to obtain a sexual and drug-use history from all adult patients, regardless of age, and for expanded access to HIV testing.” The report was based on HIV data from 25 states during 1994 to 2000.

High schools: less sex, fewer partners, more condoms

Based on seven surveys of 14,000 high schools conducted between 1991 and 2003, CDC researchers found a decrease in many HIV-related risk behaviors. The percent of students who had sexual intercourse dropped by 13% (from 54% in 1991 to 47% in 2001). The percent who used condoms during their last intercourse increased by 37% (from 46% in 1991 to 63% in 2001). The results were published in the May 21 issue of the CDC’s Morbidity and Mortality Weekly Report.

Racial and ethnic differences were presented at the international conference. The percent of students reporting four or more sex partners decreased 33% among black students and 27% among white students. Condom use increased by 54% among Latino students, 52% among black students and 37% among white students.

The CDC reports that “the authors attribute the changes in HIV-related risk behaviors to the broad efforts of families, schools, community-based organizations and government to reduce the impact of the AIDS epidemic among U.S. youth.”

Children’s treatment raises risk

As with adults, children on HIV therapy are at risk of increased cholesterol levels and therefore, perhaps cardiovascular complications. The CDC study of children infected during birth found the increased risk in those given therapy that included a protease inhibitor (Norvir is the one commonly given children, due to greater pediatric data with that drug).

Of 159 children followed over five years (1999–2003), the 99 children on a protease inhibitor (PI) were four times more likely to have high cholesterol levels than the other children.

The report stated that, “While cholesterol-associated health problems—including heart disease and heart attack—are extremely rare among children, researchers noted that cardiovascular complications might arise in these HIV-positive children as effective antiretroviral therapies allow them to live into adulthood. Researchers recommended that cholesterol levels be closely monitored among children taking PIs, and that the benefit of interventions such as diet, exercise, and lipid-lowering drug therapy be considered.”

The PACTS-HOPE study examines the medical and psychological impact of HIV on children infected at birth.

Optimistic risks

As previous studies have reported, feeling optimistic about the benefits of HIV treatment is associated with increased sexual risk-taking. The CDC researchers in this report interviewed 1,468 HIV-negative or untested men at gay bars in 13 cities between 2000 and 2002.

Of the 587 men who reported receptive anal intercourse in the previous six months, those who expressed “treatment optimism” were nearly twice as likely to not have used a condom during their latest intercourse. This was true even when the partner was HIV-positive or of unknown status. According to the CDC, “The researchers stressed the need for innovations in prevention that take into account the availability of effective AIDS treatments and the lessening concern about the consequences of infection.”

More risks

The CDC’s Young Men’s Survey reported that many of the MSM (men who have sex with men, who don’t necessarily identify as being gay) reported unprotected sex with both men and women.

In the first survey conducted, nearly one in five men (17%) reported having sex with both men and women in the previous six months. Of these, 22% reported that they had unprotected sex with both men and women.

In the second survey, 9% reported sex with both men and women in the previous six months, and 27% of this group reported unprotected sex with men and women in that period.

The level of HIV infections, other sexually transmitted diseases and risk behaviors for HIV (such as injection drug use or having sex under the influence of drugs or alcohol) did not differ between the MSM with female partners and the men who only had sex with men.

The Phase I survey was conducted with 3,592 MSM ages 15 to 22 in seven cities, between 1994 and 1998. Phase II was conducted with 2,949 MSM ages 23 to 29 in six cities, between 1998 and 2000.

High HIV rate

Also from the Young Men’s Survey, Dr. Linda Valleroy from the CDC presented data showing a high rate of HIV among men ages 23–29, based on Phase II results.

The incidence was 20% among African American MSM, 10% among those of mixed race; 5% among Latinos, 4% among whites and 3% among Asian Americans and Pacific Islanders.

The overall annual HIV incidence—the number of people newly diagnosed each year—among the 2,906 participants was 6%.

Anxiety and infection

The CDC reported that, “A study of 138 HIV-positive men at an Atlanta AIDS clinic found that MSM are significantly more likely than heterosexual men to have social anxiety that can lead to risk behavior.” Social anxiety was defined as “the fear of being perceived negatively in interpersonal situations.” The research team looked at three types of social anxiety:

• fear of being observed by others (in other words, a general self-consciousness),

• performance fear, and

• fear of social interaction.

Among the HIV-positive MSM, fear of being observed made men 15.4 times more likely to have had unprotected insertive anal intercourse with someone whose HIV status was negative or unknown. Fear of performance made this risk 7.4 times more likely, while fear of social interaction made it 4.7 times more likely.

The researchers found that social anxiety among the straight men did not “have a similar impact” on their risk behavior.

According to the report, “The authors conclude that social anxiety, like other mental health issues, affects sexual risk and may play a significant role in HIV transmission among MSM.”

In labor

Rapid HIV testing is being used to help prevent transmission during the time of labor. According to one CDC study, rapid testing of women in labor with unknown HIV status serves as “a timely, feasible and effective method to prevent mother-to-child HIV transmission and ensure that HIV-positive mothers receive life-prolonging treatment.”

The women received a finger-stick OraQuick Rapid HIV test. Of 4,849 women tested, 34 were found to be HIV-positive. They were given HIV treatment to prevent infection of the baby within an average of one hour. These moms represented a prevalence rate of 7.0 per 1,000 women.

The MIRIAD study (Mother-Infant Rapid Intervention At Delivery) took place at 16 hospitals in six cities during 2001–2003.

Baby doctors

Pediatricians told CDC researchers that they would like to talk to parents about the sexual risk-taking behavior of their teens. The majority, however—85%—said they would only talk with parents if the families raised the issue first. Based on this survey of 510 pediatricians across the country, the CDC plans to develop brochures with the American Academy of Pediatrics designed for parents that will discuss specific approaches they can take with their children along with a list of resources. Eighty-three percent of the docs said they would like to have such a brochure to give to parents.

There’s more to testing

…than just media messages. When talking to thousands of people about getting tested for HIV, researchers found that those who had seen media messages about getting tested did not get tested at a higher rate than the folks who didn’t see such information. “It takes more than a passing message to encourage testing among those most at risk for HIV,” the report stated. It said that “information-only prevention efforts alone may not be sufficient to encourage testing.” The researchers interviewed 2,491 persons in eight cities in 2000, including MSM at gay bars, injection drug users at needle exchange programs and heterosexuals at clinics for sexually transmitted diseases.

Released from prison

More counseling on safer sex is better than less counseling for newly released prisoners. Those who were given two counseling and training sessions before release, plus four follow-up, small group sessions after release, reported significantly lower rates of unprotected sex six months later. Another group of young men only received a single counseling session prior to release.

Nevertheless, unprotected sex remained high in both groups: 78% for the group receiving one counseling session vs. 68% for the group with more extensive counseling.

The 522 prisoners, all between the ages of 18 and 29, were counseled on reducing risks for acquiring hepatitis, HIV and other sexually transmitted diseases. The Project START study was conducted in eight state prisons in four states. Half received the extensive counseling.

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