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Advancing the prevention and treatment of chronic illnesses

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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Advancing the prevention and treatment of chronic illnesses

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  1. 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

  2. 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

  3. 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

  4. 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

  5. U.S. Global HIV Epidemiology Advancing the prevention and treatment of chronic illnesses UCLADepartment of Family Medicine

  6. 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.

  7. Risk Groups by Year, Los Angeles County LA County HIV Prevention Planning Report, 2013

  8. Disproportionate Racial Burden in Los Angeles LA County HIV Prevention Planning Report, 2013

  9. 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

  10. HIV Prevention Cascade www.treatmentactiongroup.org/tagline/2014/spring/forgotten-negatives-limits-treatment-prevention

  11. 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

  12. Linkages on Physiological Needs Advancing the prevention and treatment of chronic illnesses UCLADepartment of Family Medicine

  13. Linkages on Safety Needs Advancing the prevention and treatment of chronic illnesses UCLADepartment of Family Medicine

  14. 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

  15. 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

  16. Linkages on Love/Belongingness Advancing the prevention and treatment of chronic illnesses UCLADepartment of Family Medicine

  17. 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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