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Linkages for High-Risk, HIV-Negative Individuals Steven Shoptaw PhD May 20, 2014. Advancing the prevention and treatment of chronic illnesses . UCLA Department of Family Medicine .

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Linkages for High-Risk,

HIV-Negative Individuals

Steven Shoptaw PhD

May 20, 2014

Advancing the prevention and treatment of chronic illnesses

UCLADepartment of Family Medicine


Acknowledgements
Acknowledgements

  • U01 DA036267 – MASCULINE; Pamina Gorbach (MPI) and Peter Anton (Co-I)

  • 5P30 MH058107 – CHIPTS; Mary Jane Rotheram Borus (PI)

  • CFAR/AIDS Institute - 5P30 AI 028697

Advancing the prevention and treatment of chronic illnesses

UCLADepartment of Family Medicine


Overview

  • Epidemiology Concepts

  • Concepts on High Risk HIV-Negative Individuals in the HIV Prevention Strategy

  • Discussion/Future Directions

Advancing the prevention and treatment of chronic illnesses

UCLADepartment of Family Medicine


Aspirational goals 2015
Aspirational Goals: 2015

  • Sexual transmission reduced by 50%

    • Youth, MSM, Sex Workers

  • No vertical transmission

  • Transmissions via drug use eliminated

  • Universal access to ART

  • HIV-TB deaths < by 50%

  • Social justice; no stigma

Advancing the prevention and treatment of chronic illnesses

UCLADepartment of Family Medicine


Hiv epidemiology

U.S.

Global

HIV Epidemiology

Advancing the prevention and treatment of chronic illnesses

UCLADepartment of Family Medicine


Aids in america overlooked epidemic
AIDS in America: Overlooked Epidemic

Prevalence of HIV among MSM in Los Angeles County is about 19%

Substance use involved in 28% to 33% of incident cases among MSM

El-Sadr, Mayer, Hodder. (2010). NEJM. 362:967-970.


Risk groups by year los angeles county
Risk Groups by Year, Los Angeles County

LA County HIV Prevention Planning Report, 2013


Disproportionate racial burden in los angeles
Disproportionate Racial Burden in Los Angeles

LA County HIV Prevention Planning Report, 2013


President s strategy
President’s Strategy

  • Changes instituted by Executive Order to the 2010 National HIV/AIDS Strategy:

    • Prioritize continuum of HIV care, accelerating efforts and directing existing federal resources to increase HIV testing, services, and treatment, and improve patient access to all three

    • Expand capacity of community health centers, local health departments to better integrate HIV prevention and treatment across the continuum of care

  • Problem is that this ignores HIV-negatives

    • Based on medical model of controlling viremia

Advancing the prevention and treatment of chronic illnesses

UCLADepartment of Family Medicine


Hiv prevention cascade
HIV Prevention Cascade

www.treatmentactiongroup.org/tagline/2014/spring/forgotten-negatives-limits-treatment-prevention


Hierarchy of needs for high risk hiv negative msm
Hierarchy of Needs for High Risk HIV Negative MSM

Affiliations/engagement with Community

Relationship/disclosure;

Family Integrity

Medical Care; Needle Exchange; Condoms

Survival Needs

Advancing the prevention and treatment of chronic illnesses

UCLADepartment of Family Medicine


Linkages on physiological needs
Linkages on Physiological Needs

Advancing the prevention and treatment of chronic illnesses

UCLADepartment of Family Medicine


Linkages on safety needs
Linkages on Safety Needs

Advancing the prevention and treatment of chronic illnesses

UCLADepartment of Family Medicine


Sti rates among msm by race in sf
STI Rates Among MSM by Race in SF

Scott et al., BMC Public Health, 2010

Chlamydia

Gonorrhea

Advancing the prevention and treatment of chronic illnesses

UCLADepartment of Family Medicine


Drug use and black msm
Drug Use and Black MSM

  • Minority (Black, Latino) MSM surveyed on social media: those who used social networking sites to find sex partners were more likely to use meth; those who preferred social media to F2F were 4 and 6 times more likely to use meth and cocaine (Young et al., J Addict Disease, 2013)

Tobin et al., J Urban Health, 2011

Advancing the prevention and treatment of chronic illnesses

UCLADepartment of Family Medicine


Linkages on love belongingness
Linkages on Love/Belongingness

Advancing the prevention and treatment of chronic illnesses

UCLADepartment of Family Medicine


Summary
Summary

  • Among Black MSM, high incidence combined with HIV stigma, racism, homophobia, underuse of medical care and exaggerated by problems in linking to communities that provide love/belongingness (family, church, gay community) continue to present challenges to intervention and reducing new infections

  • For HIV-negative Black MSM, the resolution of this situation is not likely to involve more resources toward the seek, test, treat and retain strategy

Advancing the prevention and treatment of chronic illnesses

UCLADepartment of Family Medicine


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