Re: Misc. HIV/AIDS government pronouncements & stuff.
"New CDC Resources on HIV Among Women and Transgender People" blog.AIDS.gov 24 August 2011.
New CDC Resources on HIV Among Women and Transgender People
HIV Policy & Programs August 24, 2011
By Miguel Gomez, AIDS.gov Director
The Centers for Disease Control and Prevention (CDC) recently posted new resources on two important HIV prevention topics:
HIV among womenUpdated Fact Sheet: HIV among Women – According to 2009 HIV surveillance data, women represented 24% of all diagnoses of HIV infection among U.S. adults and adolescents in 40 states with long-established, confidential name-based reporting. In 2008, an estimated 25% of adults and adolescents living with HIV infection were female.
HIV among transgenderNew Topic: HIV among Transgender People – Transgender communities in the United States are among the groups at highest risk for HIV infection.
Both are available as web pages as well as formatted in PDF for download and printing.
Posted in: CDC, HIV Policy & Programs, LGBTQ Health
"HIV among Women"
According to 2009 HIV surveillance data, women1 represented 24% of all diagnoses of HIV infection among United States (US) adults and adolescents in 40 states with long-established, confidential name-based reporting. In 2008, an estimated 25% of adults and adolescents living with HIV infection were female. Black and Latina women are disproportionately affected at all stages of HIV infection compared with women of other races/ethnicities.
New HIV Infections2
In 2009, there were an estimated 11,200 new HIV infections among women in the United States. That year, women comprised 51% of the US population and 23% of those newly infected with HIV.
* Of the total number of new HIV infections in US women in 2009, 57% occurred in blacks, 21% were in whites, and 16% were in Hispanics/Latinas.
* In 2009, the rate of new HIV infections among black women was 15 times that of white women, and over 3 times the rate among Hispanic/Latina women.
HIV and AIDS Diagnoses3 and Deaths
* At some point in her lifetime, 1 in 139 women will be diagnosed with HIV infection. Black and Hispanic/Latina women are at increased risk of being diagnosed with HIV infection (1 in 32 black women and 1 in 106 Hispanic/Latina women will be diagnosed with HIV, compared with 1 in 182 Native Hawaiian/other Pacific Islander women; 1 in 217 American Indian/Alaska Native women; and 1 in 526 for both white and Asian women).
* From 2006 through 2009, estimated diagnoses of HIV infection among women decreased from 10,851 to 9,973. It is unknown whether this decrease is due to an actual decrease in new HIV infections (incidence) or whether the decrease reflects HIV testing trends.
* Women accounted for more than 25% of the estimated 34,247 AIDS diagnoses in 2009 and represent nearly 20% of cumulative AIDS diagnoses (including children) in the United States to date. There were 8,647 AIDS diagnoses among women in 2009 compared with 9,639 AIDS diagnoses among women in 2006.
* For women living with a diagnosis of HIV infection, the most common methods of transmission were high-risk heterosexual contact6 and injection drug use.
* In 2008, 4,796 (28%) of the estimated 17,374 persons with a diagnosis of HIV infection who died in the 40 states and 5 US dependent areas were women. Deaths attributed to HIV among women of color are disproportionately high: from 2000–2007, HIV infection was among the top 10 leading causes of death for black females aged 10–54 and Hispanic/Latina females aged 15–54.
Like other affected populations, women face a number of risk factors that may contribute to their risk for HIV infection.
* Most women are infected with HIV through heterosexual sex. Some women become infected because they may be unaware of a male partner’s risk factors for HIV infection or have a lack of HIV knowledge and lower perception of risk. Relationship dynamics also play a role. For example, some women may not insist on condom use because they fear that their partner will physically abuse or leave them.
* Both unprotected vaginal and anal sex pose a risk for HIV transmission. Unprotected anal sex presents an even greater risk for HIV transmission for women than unprotected vaginal sex.
* Women who have experienced sexual abuse may be more likely than women with no abuse history to use drugs as a coping mechanism, have difficulty refusing unwanted sex, exchange sex for drugs, or engage in high-risk sexual activities.
* Injection drug and other substance use increase HIV risk through sharing injection equipment contaminated with HIV or engaging in high-risk behaviors, such as unprotected sex, when under the influence of drugs or alcohol.
* The presence of some sexually transmitted diseases greatly increases the likelihood of acquiring or transmitting HIV. Rates of gonorrhea and syphilis are higher among women of color than among white women.
* Socioeconomic issues associated with poverty, including limited access to high-quality health care; the exchange of sex for drugs, money, or to meet other needs; and higher levels of substance use can directly or indirectly increase HIV risk factors.
What CDC Is Doing
CDC recognizes the importance of incorporating culture- and gender-relevant material into current HIV interventions. CDC has increased the availability of effective behavioral interventions for populations at increased risk for HIV infection, including women living with HIV infection or AIDS and those who are at risk for infection, by supporting research studies to develop new interventions and to adapt existing interventions. CDC also supports the national dissemination of effective HIV behavioral interventions for women. For example:
* SIHLE (Sistering, Informing, Healing, Living, and Empowering) is a group-level intervention aimed at reducing risk behaviors among sexually active black teenagers aged 14–18.
* Sister to Sister is a brief, one-on-one, skills-based behavioral intervention for sexually active African American women aged 18 to 45 years to reduce sexual risk behaviors and prevent HIV and other sexually transmitted infections.
* WILLOW (Women Involved in Life Learning from Other Women) is a social-skills building and educational intervention for adult heterosexual women, aged 18 to 50 years, living with HIV infection.
CDC also developed Take Charge. Take the Test. (TCTT), a phase of the Act Against AIDS campaign designed to increase HIV testing among African American women aged 18–34.
CDC also continues to
* Partner with organizations such as the Black Women’s Health Imperative, Congressional Black Caucus Foundation, and others to address HIV among African American women through the Act Against AIDS Leadership Initiative;
* Fund HIV testing and prevention programs in state and local health departments and community-based organizations;
* Be actively involved in the research of microbicides—creams or gels that can be applied vaginally or anally before sexual contact to prevent HIV transmission;
* Support clinical trials of pre-exposure prophylaxis (PrEP), including a recent CDC trial in Botswana which found that PrEP reduced the risk of heterosexual transmission of HIV by roughly 63% in the study group overall; and
* Work to further reduce mother-to-child HIV transmission in the US by supporting perinatal HIV prevention campaigns, enhanced surveillance for HIV-infected mothers and babies, education programs, and capacity building among health care providers and public health practitioners.
1Unless otherwise noted, this fact sheet defines women as adult and adolescent females aged 13 and older.
2New HIV infections refers to HIV incidence, or the number of people that are newly infected with HIV.
3HIV and AIDS diagnoses indicates when a person is diagnosed with HIV infection or AIDS but does not indicate when the person was infected.
4The term men who have sex with men (MSM) is used in CDC surveillance systems. It indicates the behaviors that transmit HIV infection, rather than how individuals self-identify in terms of their sexuality
5IDU is an acronym for injection drug user.
6Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
Last Modified: August 10, 2011
Last Reviewed: August 10, 2011
Divisions of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
"HIV among Transgender People"
Transgender communities in the United States (US) are among the groups at highest risk for HIV infection. The term gender identity refers to a person’s basic sense of self, of identifying as male, female, or some other gender (e.g., transgender, bigender, intersex). Transgender refers to people whose gender identity does not conform to norms and expectations traditionally associated with a binary classification of gender based on external genitalia, or, more simply, their sex assigned at birth. It includes people who self-identify as gender variant; male-to-female (MtF) or transgender women; female-to-male (FtM) or transgender men; many other gender nonconforming people with identities beyond the gender binary; and people who self-identify simply as female or male. Gender identity, gender expression, and sexual orientation are separate, distinct concepts, none of which is necessarily linked to one’s genital anatomy.
Because surveillance data for this population are not uniformly collected, information is lacking on how many transgender people in the US are infected with HIV. However, data collected by local health departments and scientists studying transgender people show high HIV positivity.
* Data from CDC-funded HIV testing programs show high percentages of newly identified HIV infections among transgender people. In 2009, about 4,100 of 2.6 million HIV testing events were conducted with someone who identified as transgender. Newly identified HIV infection was 2.6% among transgender persons compared with 0.9% for males and 0.3% for females. Among transgender persons, the highest percentage of newly identified HIV infection was among blacks (4.4%) and Hispanics (2.5%). More than half (52%) of testing events with transgender persons occurred in non-clinical settings.
* In New York City, from 2005–2009, there were 206 new diagnoses of HIV infection among transgender people, 95% of which were among transgender women. Approximately 90% of MtF and FtM people newly diagnosed with HIV infection were black or Hispanic. Newly diagnosed transgender people were more likely to have been in their teens or twenties than their non-transgender counterparts. Also, among newly diagnosed people, 50% of transgender women had documentation in their medical records of substance use, commercial sex work, homelessness, incarceration, and/or sexual abuse as compared with 31% of other people who were not transgender.
* Findings from a meta-analysis of 29 published studies showed that 27.7% of transgender women tested positive for HIV infection (4 studies), but when testing was not part of the study, only 11.8% of transgender women self-reported having HIV (18 studies). In one study, 73% of the transgender women who tested HIV-positive were unaware of their status. Studies also indicate that black transgender women are more likely to become newly infected with HIV.
Many cultural, socioeconomic, and healthrelated factors contribute to the HIV epidemic and prevention challenges in US transgender communities.
* Identifying transgender people can be challenging. Using gender alone is not enough because some people in this community do not self-identify as transgender. Using the 2-step data collection method of asking for sex assigned at birth and current gender identity increases the likelihood that all transgender people will be accurately identified. It is important to avoid making assumptions about sexual orientation and sexual behavior based on gender identity as there is great diversity in orientation and behavior among this population, and some identify as both transgender and gay, bisexual, or lesbian. The Institute of Medicine has recommended that behavioral and surveillance data for transgender men and women should be collected and analyzed separately and not grouped with data for men who have sex with men (MSM).
* High levels of HIV risk behaviors have been reported among transgender people. HIV infection among transgender women is associated with having multiple sex partners and unprotected receptive or insertive anal intercourse.
* Additionally, many transgender women reported high levels of alcohol and substance use. These substances can affect judgment and lead to unsafe sexual practices, which can increase HIV risk.
* The few studies examining HIV risk behaviors among transgender men suggest some have multiple male sex partners and engage in unprotected receptive anal or vaginal intercourse with men; however, no studies have reported links between these behaviors and HIV infection among transgender men. Nonetheless, these are established HIV risk behaviors in other populations.
* Discrimination and social stigma can hinder access to education, employment, and housing opportunities. In a study conducted in San Francisco, transgender people were more likely than MSM or heterosexual women to live in transient housing and have completed fewer years of education. Discrimination may help explain why transgender people who experience significant economic difficulties often pursue high-risk activities, including commercial sex work, to meet their basic survival needs. Social stigma also may explain why some transgender people engage in unprotected receptive intercourse with their sex partners. Qualitative data suggest that some transgender people who fear sex partner rejection or need their gender affirmed through sex may engage in unprotected receptive intercourse. High rates of depression, emotional distress, loneliness, and social isolation have been linked to suicidal thoughts and suicide attempts by transgender people. Therefore, interventions that address multiple cooccurring, syndemic public health problems— including substance use, poor mental health, violence and victimization, discrimination, and economic hardship—should be developed and evaluated for transgender people.
* Health care provider insensitivity to transgender identity or sexuality can be a barrier for HIV-infected transgender people seeking health care. Although research shows a similar proportion of HIV-positive transgender women have health insurance coverage as compared with other infected people who are not transgender, HIV-positive transgender women were less likely to be on antiretroviral therapy.
* Additional research is needed to identify factors that prevent HIV in this population. Several behavioral HIV prevention interventions developed for transgender people have been reported, generally involving relatively small samples comprised entirely or primarily of transgender women. Most have shown at least modest reductions in HIV risk behaviors, such as fewer sex partners and/or reducing unprotected anal sex acts, although none have involved a control group.
What CDC Is Doing
CDC recognizes that accurate information is key to understanding the HIV epidemic, public health needs, and gaps in services among all people at risk for HIV infection.
* In response to recommendations for collecting data from transgender people, CDC is currently revising the national system for reporting HIV cases to capture sex assigned at birth and current gender identity. This will improve the likelihood of accurately identifying diagnoses of HIV infection among transgender people.
* CDC is developing an HIV-related behavioral survey to monitor current HIV-related risk behaviors and prevention experiences among transgender women.
* CDC is currently collecting information on gender identity in its HIV testing programs.
* To respond to a shortage of proven behavioral HIV prevention interventions for the transgender community, CDC funded researchers to develop ground-breaking interventions for transgender people. Data from this research will be available later in 2011.
* CDC has funded organizations to adapt proven behavioral HIV prevention interventions for use with transgender people. Adapted curricula and supporting materials and technical assistance for implementing agencies are available.
* CDC-funded capacity building assistance (CBA) providers help community-based organizations (CBOs) serving transgender people to enhance structural interventions such as condom distribution, community mobilization, HIV testing, and coordinated referral networks and service integration.
* YMSM and YTransgender CBO Project — CDC currently funds prevention programs for transgender youth of color through the Prevention Program Branch.
Last Modified: August 12, 2011
Last Reviewed: August 12, 2011
Divisions of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention