Abstract Purpose To estimate lifetime risk of receiving an HIV diagnosis in the United States if existing infection rates continue. Methods We used mortality, census, and HIV surveillance data for ...2010-2014 to calculate age-specific probabilities of an HIV diagnosis. The probabilities were applied to a hypothetical cohort of 10 million live births to estimate lifetime risk. Results Lifetime risk was 1 in 68 for males and 1 in 253 for females. Lifetime risk for men was 1 in 22 for blacks, 1 in 51 for Hispanic/Latinos, and 1 in 140 for whites; and for women was 1 in 54 for blacks, 1 in 256 for Hispanic/Latinas, and 1 in 941 for whites. By risk group, the highest risk was among men who have sex with men (1 in 6) and the lowest was among male heterosexuals (1 in 524). The majority of the states with the highest lifetime risk were in the south. Conclusions The estimates highlight different risks across populations and the need for continued improvements in prevention and treatment. They can also be used to communicate the risk of HIV infection and increase public awareness of HIV.
Background Exposure to ultraviolet radiation (from solar and nonsolar sources) is a risk factor for skin cancer. Objective We sought to summarize recent estimates on sunburns, sun-protection ...behaviors, and indoor tanning available from national and selected statewide behavioral surveys. Methods Estimates of the prevalence of sunburn, sun-protection behaviors, and indoor tanning by US adults, adolescents, and children collected in national surveys in 1992, 2004 to 2005, and 2007 to 2009 were identified and extracted from searches of computerized databases (ie, MEDLINE and PsychINFO), reference lists, and survey World Wide Web sites. Sunburn estimates from 3 state Behavioral Risk Factors Surveillance Systems were also analyzed. Results Latest published estimates (2005) showed that 34.4% of US adults were sunburned in the past year. Incidence of sunburns was highest among men, non-Hispanic whites, young adults, and high-income groups in national surveys. About 3 in 10 adults routinely practiced sun-protection behaviors, and women and older adults took the most precautions. Among adolescents, 69% were sunburned in the previous summer and less than 40% practiced sun protection. Approximately 60% of parents applied sunscreen and a quarter used shade to protect children. Indoor tanning was prevalent among younger adults and females. Limitations Limitations include potential recall errors and social desirability in self-report measures, and lack of current data on children. Conclusion Many Americans experienced sunburns and a minority engaged in protective behaviors. Females and older adults were most vigilant about sun protection. Substantial proportions of young women and adolescents recently used indoor tanning. Future efforts should promote protective hats, clothing, and shade; motivate males and younger populations to take precautions; and convince women and adolescents to reduce indoor tanning.
Abstract Purpose To assess the agreement between self-reported and medical record data on HIV status and dates of first positive and last negative HIV tests. Methods Participants were recruited from ...patients attending Houston health clinics during 2012–2013. Self-reported data were collected using a questionnaire and compared with medical record data. Agreement of HIV status was assessed using kappa statistics and of HIV test dates using concordance correlation coefficient. The extent of difference between self-reported and medical record test dates was determined. Results Agreement between self-reported and medical record data was good on HIV status and date of first positive HIV test, but poor on date of last negative HIV test. About half of participants that self-reported never tested had HIV test results in medical records. Agreement varied by sex, race and/or ethnicity, and medical care facility. For HIV-positive persons, more self-reported first positive HIV test dates preceded medical record dates, with a median difference of 6 months. For HIV-negative persons, more medical record dates of last negative HIV test preceded self-reported dates, with a median difference of 2 months. Conclusions Studies relying on self-reported HIV status other than HIV positive and self-reported date of last negative should consider including information from additional sources to validate the self-reported data.
Background Increased attention has been focused on health disparities among racial/ethnic groups in the U.S. Purpose To assess the extent of progress toward meeting the targets of Healthy People 2010 ...objectives and eliminating disparities. Methods All diagnoses of AIDS during 2000–2009 among people aged ≥13 years in the 50 states and District of Columbia, reported to national HIV surveillance through June 2010, together with census population data were used in this analysis (conducted in March 2011). This study assesses the trend in racial/ethnic disparities in rates of AIDS diagnoses both between particular groups using rate difference (RD) and rate ratio (RR) and across the entire range of racial/ethnic subgroups using three summary measures of disparity: between-group variance (BGV); Theil index (TI); and mean log deviation (MLD). Results The overall racial/ethnic disparity, black–white disparity, and Hispanic–white disparity in rates of AIDS diagnoses decreased for those aged 25–64 years from 2000 to 2009. The black–white and Hispanic–white disparity in rates of AIDS diagnoses also decreased among men aged ≥65 years; however, the black–white disparity increased among young men aged 13–24 years (BGV: p <0.001, black–white RD: p <0.01) from 2000 to 2009. Conclusions Findings indicate overall decreases in racial/ethnic disparities in AIDS diagnoses except in young men, particularly young black men aged 13–24 years where the burden of AIDS is increasing. HIV testing, prevention, treatment and policy-making should be a priority for this group.
Abstract Purpose We focus on a little-researched issue—how human immunodeficiency virus (HIV) epidemics and programs in key populations in metropolitan areas affect epidemics in other key ...populations. We consider (1) How are earlier epidemics among people who inject drugs (PWID) and men who have sex with men (MSM) related to later AIDS incidence and mortality among heterosexuals?; (2) Were prevention programs targeting PWID or MSM associated with lower AIDS incidence and mortality among heterosexuals?; and (3) Was the size of the potential bridge population of noninjecting drug users (NIDUs) in a metropolitan area associated with later AIDS incidence and mortality among heterosexuals? Methods Using data for 96 large U.S. metropolitan areas, Poisson regression assessed associations of population prevalences of HIV-infected PWID and MSM (1992); NIDU population prevalence (1992–1994); drug use treatment coverage for PWID (1993); HIV counseling and testing coverage for MSM and for PWID (1992); and syringe exchange presence (2000) with CDC data on AIDS incidence and mortality among heterosexuals in 2006–2008, with appropriate socioeconomic controls. Results Population density of HIV+ PWID and of NIDUs were positively related, and prevention programs for PWID negatively related to later AIDS incidence among heterosexuals and later mortality among heterosexuals living with AIDS. HIV+ MSM population density and prevention programs for MSM were not associated with these outcomes. Conclusions Efforts to reduce HIV transmission among PWID and NIDUs may reduce AIDS and AIDS-related mortality among heterosexuals. More research is needed at metropolitan area, network, and individual levels into HIV bridging across key populations and how interventions in one key population affect HIV epidemics in other key populations.
Abstract Purpose We estimated female and male incident AIDS diagnosis rates (IARs) among people who inject drugs (PWID) in U.S. metropolitan statistical areas (MSAs) over time to assess whether ...declines in IARs varied by sex after combination antiretroviral therapy (cART) dissemination. Methods We compared IARs and 95% confidence intervals for female and male PWID in 95 of the most populous MSAs. To stabilize estimates, we aggregated data across three-year periods, selecting a period immediately preceding cART (1993–1995) and the most recent after the introduction of cART for which data were available (2005–2007). We assessed disparities by comparing IAR 95% confidence intervals for overlap, female-to-male risk ratios, and disparity change scores. Results IARs declined an average of 58% for female PWID and 67% for male PWID between the pre-cART and cART periods. Among female PWID, IARs were significantly lower in the later period relative to the pre-cART period in 48% of MSAs. Among male PWID, IARs were significantly lower over time in 86% of MSAs. Conclusions IARs among female PWID in large U.S. MSAs have declined more slowly than among male PWID. This suggests a need for increased targeting of prevention and treatment programs and for research on MSA level conditions that may drive differences in declining AIDS rates among female and male PWID.
Purpose To estimate relative survival (RS) after human immunodeficiency virus (HIV) diagnosis, by race/ethnicity and county-level socioeconomic status (SES). Methods We estimated 5-year RS by age, ...race/ethnicity, transmission category, sex, diagnosis year, CD4 count, and by county-level SES variables from the U.S. Census. Data, from the national HIV/AIDS Reporting System, were for HIV-infected persons ages ≥13 years (diagnosis during 1996–2003 and follow-up through 2005). We calculated RS proportions by using a maximum likelihood algorithm and modeled the relative risk of excess death (RR) using generalized linear models, with poverty as a random effect. Results For men, RS was worse in counties with larger proportions of people living below the 2000 U.S. poverty level (87.7% for poverty of ≥20% vs. 90.1% for poverty of <5.0%) and where unemployment was greater (87.8% where unemployment > 7.1% vs. 90.5% where unemployment < 4.0%). The effects of county-level SES on RS of women were similar. In multilevel multivariate models, RR for men and women within 5 years after an HIV diagnosis was significantly worse in counties where 10.0–19.9% (compared with <5.0%) lived below the poverty level (RR = 1.3 95% CI 1.2–1.5 and RR = 1.8 95% CI 1.4–2.2, respectively). Conclusions RS was worse in lower SES areas. To help address the impact of county-level SES, resources for HIV testing, care, and proven economic interventions should be directed to areas with concentrations of economically disadvantaged people.
Abstract Objective We sought to determine epidemiological patterns in diagnoses of human immunodeficiency virus (HIV) infection and prevalence among females by age, race/ethnicity and transmission ...category, and essential steps in the continuum of HIV care. Methods Using data from the National HIV Surveillance System, we estimated the number of females aged 13 years or older diagnosed with HIV infection in 2008 through 2012 and living with HIV at the end of 2011 in the United States. We determined percentages of females linked to care, retained in care, and virally suppressed in 18 jurisdictions with complete reporting of CD4 and viral load test results. Results From 2008 to 2012, the estimated rate of HIV diagnoses among females decreased from 9.3 to 6.9 per 100,000 (−7.1% per year; 95% confidence interval CI, −7.9, −6.3). In 2012, the diagnosis rate was highest among Blacks/African Americans (35.7), followed by Hispanics or Latinos (6.4), and Native Hawaiian Other Pacific Islander (5.1), and lowest among Whites (1.8). Most females diagnosed in 2012 were linked to care within 3 months of diagnosis (82.5%). About one-half (52.4%) of females living with HIV in 2011 received ongoing care in 2011 and 44.3% had a suppressed viral load. Viral suppression was lower among American Indian/Alaska Native (29.7%) and Black/African American (41.6%) compared with White females (46.5%). The percentage in care and with viral suppression was lower among younger compared with older females. Conclusion HIV diagnoses continue to decrease among females; however, disparities exist in HIV burden and viral suppression. Improvements in care and treatment outcomes are needed for all women with particular emphasis on younger women.
Abstract Context There is little evidence on the symptoms experienced by those with advanced (Stage 5) chronic kidney disease (CKD), managed without dialysis, as they approach death. As palliative ...care extends to noncancer illnesses, understanding symptom prevalence and severity close to death will clarify which symptom interventions are most needed and which elements of (largely cancer-driven) models of palliative care best translate into end-of-life care for this population. Objectives To determine symptom prevalence and severity in the last month of life for patients with Stage 5 CKD, managed without dialysis. Methods Longitudinal symptom survey in three U.K. renal units, using the patient-completed Memorial Symptom Assessment Scale-Short Form (MSAS-SF). We calculated the prevalence of individual symptoms (with 95% confidence intervals CI to reflect sample size), plus MSAS-SF subscales, in the month before death. Comparison is made with previously published data on symptoms in the last month of life in advanced cancer, also measured using the MSAS-SF. Results Seventy-four patients (mean age: 81 years; standard deviation SD: 6.8) were recruited (response rate: 73%); 49 (66%) died during follow-up (mean age: 81 years; SD: 5.7). “Month before death” symptom data were available for 43 (88%) of the 49 participants who died. Median time of data collection was 18 days from death (interquartile range: 12–26 days). More than half had lack of energy (86%; 95% CI: 73%–94%), itch (84%; 70%–93%), drowsiness (82%; 68%–91%), dyspnea (80%; 66%–90%), poor concentration (76%; 61%–87%), pain (73%; 59%–85%), poor appetite (71%; 57%–83%), swelling arms/legs (71%; 57%–83%), dry mouth (69%; 55%–82%), constipation (65%; 50%–78%), and nausea (59%; 44%–73%). Levels of distress correspond to prevalence, with the exception of dyspnea, which was disproportionately more distressing. The median number of symptoms reported was 16.6 (range: 6–27), rising to 20.4 (range: 7–34) if additional renal symptoms were included. On average, psychological distress was moderate (mean MSAS-PSYCH: 1.55) but with wide variation (SD: 0.50; range: 0.17–2.40), suggesting diverse levels of individual distress. The prevalence of both physical and psychological symptoms and the number reported were higher than those in advanced cancer patients in the month before death. Conclusion Stage 5 CKD patients have clinically important physical and psychological symptom burdens in the last month of life, similar or greater than those in advanced cancer patients. Symptoms must be addressed through routine symptom assessment, appropriate interventions, and with pertinent models of end-of-life care.
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