Proportion Of HIV Diagnoses Research Articles

Combining traditional and molecular epidemiology methods to quantify local HIV transmission among foreign-born residents.

Objectives:We evaluated the ability for molecular epidemiology to augment traditional HIV surveillance beyond the detection of clusters for outbreak investigation. To do this, we address a question of interest to Public Health – Seattle and King County: what proportion of HIV diagnoses among people born outside of the United States are acquired locally?Design:King County residents diagnosed with HIV, 2010–2018.Methods:We linked HIV-1 pol gene sequences to demographic information obtained from the National HIV Surveillance System, Public Health – Seattle and King County case investigation and partner services interviews. We determined the likely location of HIV acquisition based on HIV testing, travel histories and cluster-based molecular analyses.Results:Among 2409 people diagnosed with HIV, 798 (33%) were born outside of the United States. We inferred the location of acquisition for 77% of people born outside of the United States: 26% likely acquired HIV locally in King County (of whom 69% were MSM, 16% heterosexual), and 51% likely acquired HIV outside of King County (primarily outside of the United States). Of this 77% of people for whom we inferred the location of HIV acquisition, 45% were determined using traditional epidemiology methods and an additional 32% were inferred using molecular epidemiology methods.Conclusion:We found that the National HIV Surveillance System misclassified the majority of HIV-infected foreign-born residents as ‘new’ local infections, and that these cases contribute to an overestimate of local incidence. Our findings highlight how molecular epidemiology can augment traditional HIV surveillance activities and provide useful information to local health jurisdictions beyond molecular cluster detection.

1254. Association of Structural Stigma Due to Sexual Orientation and HIV Diagnosis/PrEP Use in the United States: An Ecological Analysis

BackgroundStructural stigma has the potential to reduce engagement in HIV prevention and care, particularly for sexual and gender minorities (SGM) who account for the highest proportion of new HIV diagnosis in the United States. We considered if structural stigma related to sexual orientation, that is the social/cultural norms and institutional policies/practices that constrain the lives of the stigmatized, is associated with state-level HIV diagnosis and use of pre-exposure prophylaxis (PrEP).MethodsWe used a composite measure of structural stigma that was previously developed; components included proportion of same-sex couples, gay-straight alliances in public schools, policies related to discrimination of sexual orientation, and public perception toward homosexuality. Proportion of HIV diagnosis from 2008 to 2017 and PrEP use from 2012 to 2017 per 100,000 population were extracted from AIDSVu. To account for overdispersion and the hierarchical structure of our data, we used a Poisson model with robust standard errors using generalized estimating equations.ResultsStates with higher (vs. lower) levels of structural stigma related to sexual orientation had lower rates of HIV diagnosis (β = −0.550; 95% CI: −0.628, −0.472) and PrEP use (β = −0.165; 95% CI: −0.203, −0.119), after adjusting for state-level covariates such as median age, percentage black race, and legislative majority party in 2013.ConclusionState-level stigma has been shown to reduce SGM visibility, therefore, restricting access to prevention services. These findings suggest that states with higher levels of structural stigma toward same-sex sexuality may also have lower rates of engagement in HIV prevention services.Disclosures All authors: No reported disclosures.

Refugees and family-reunified immigrants have a high incidence of HIV diagnosis and late presentation compared with Danish born: a nationwide register-based cohort study.

Migrants represent a considerable proportion of HIV diagnoses in Europe and are considered a group at risk of late presentation. This study examined the incidence of HIV diagnoses and the risk of late presentation according to migrant status, ethnic origin and duration of residence. We conducted a historically prospective cohort study comprising all adult migrants to Denmark between 1.1.1993 and 31.12.2010 (n = 114.282), matched 1:6 to Danish born by age and sex. HIV diagnoses were retrieved from the National Surveillance Register and differences in incidence were assessed by Cox regression model. Differences in late presentation were assessed by logistic regression. Both refugees (HR = 5.61; 95% CI 4.45-7.07) and family-reunified immigrants (HR = 10.48; 95% CI 8.88-12.36) had higher incidence of HIV diagnoses compared with Danish born and the incidence remained high over time of residence for both groups. Migrants from all regions, except Western Asia and North Africa, had higher incidence than Danish born. Late presentation was more common among refugees (OR = 1.87; 95% CI 1.07-3.26) and family-reunified immigrants (OR = 2.30; 95% CI 1.49-3.55) compared with Danish born. Southeast Asia and Sub-Saharan Africa were the only regions with a higher risk of late presentation. Late presentation was only higher for refugees within 1 year of residence, whereas it remained higher within 10years of residence for family-reunified immigrants. This register-based study revealed a higher incidence of HIV diagnoses and late presentation among migrants compared with Danish born and the incidence remained surprisingly high over time.

High Rates of Late HIV Diagnosis Among People Who Inject Drugs Compared to Men Who Have Sex with Men and Heterosexual Men and Women in Australia

We aimed to estimate temporal trends in the proportion of HIV diagnoses which could be characterized as recent infections in Australia for men who have sex with men (MSM), people who inject drugs (PWID), and heterosexual men and women using modified back-projection methodology based on data sources from HIV/AIDS Surveillance database. The proportion of HIV diagnoses among MSM that can be classified as recent infections increased in MSM, heterosexual men and women consistently. However, after initial increases during 1996-2000, the proportion of overall recent infections estimated among PWID declined by 50% in 2007 compared to 2000 (from 23 to 11%). These data suggest that late HIV diagnoses were more common among PWID compared to other groups. Ongoing prevention efforts need to be coupled with targeted testing and treatment efforts to increase the diagnosis of recent infection in PWID and reduce apparent inequities in access to screening.

Riesgo elevado de infección por el virus de la inmunodeficiencia humana en varones homosexuales incluso después del contacto con el sistema sanitario

Objective To determine the incidence of HIV seroconversion and to evaluate the characteristics associated with a greater risk of seroconversion in homosexual men in the period 2000-2003. Methods We performed a dynamic cohort study of all homosexual men tested for HIV in 20 ambulatory care centers specialized in diagnosing HIV, located in 19 cities in Spain. The characteristics of the men were analyzed and the seroconversion incidence rate was calculated among those who were followed up. Results In the period 2000-2003, a total of 10,189 persons-year of follow-up were accumulated and 167 seroconversions were diagnosed with a seroconversion incidence rate of 16.4 per 1,000 persons-year. Most of the seroconversions (63%) occurred in men younger than 30 years old. The seroconversion rate was higher among homosexual men from Latin America and sub-Saharan Africa than among Spanish men. Conclusions In Spain, the risk of HIV transmission among men who have sex with men is still high. Therefore, this population continues to be a high priority group in HIV prevention. A proportion of HIV diagnoses among immigrants concern infections acquired after their arrival to Spain, probably due to conditions of greater social vulnerability. Reinforcing and renewing prevention strategies directed at this population would be timely.

Men who have sex with men who are born abroad and diagnosed with HIV in England and Wales: an epidemiological perspective

Relatively little is known about the sexual health needs of men who have sex with men (MSM) born abroad who reside in the UK. We describe here the epidemiology of HIV among MSM born outside the UK and diagnosed with HIV in England and Wales. Reports of HIV diagnoses in England and Wales received at the Health Protection Agency Centre for Infections were analysed. Between 2000 and 2003, 6386 MSM were diagnosed with HIV in England and Wales. Country of birth was recorded for 3571 (56%). Of those with country of birth reported, 2598 (73%) were born in the UK and 973 (27%) abroad. Of those born abroad (973), 424 (44%) were born in Europe, 141 (15%) in Africa, 104 (11%) in South/Central America and the remainder in other regions. Where reported (949), 69% of MSM born abroad were White, 12% other/mixed, 9% Black Caribbean and 7% Black African. Probable country of infection was reported for 612 MSM born abroad: 52% were infected in the UK, 43% in their region of birth and 5% in another region. Men born abroad represent a significant proportion of HIV diagnoses among MSM in England and Wales. More than half probably acquired their HIV infection in the UK, strengthening the call for targeted HIV prevention and sexual health promotion among MSM who are not born in England and Wales.