Shifting the Paradigm in HIV Prevention and Treatment Service Delivery Toward Differentiated Care for Youth

2019 ◽  
Author(s):  
Vincent Guilamo-Ramos ◽  
Marco Thimm-Kaiser ◽  
Adam Benzekri ◽  
Donna Futterman
Keyword(s):  
United States ◽  
Hiv Prevention ◽  
Service Delivery ◽  
The United States ◽  
Hiv Care ◽  
Health Concern ◽  
Service Needs ◽  
Minority Adolescents ◽  
Prevention And Treatment ◽  
Differentiated Care

Despite significant progress in the fight against HIV/AIDS in the United States, HIV prevention and treatment disparities among key populations remain a national public health concern. While new HIV diagnoses are increasing among people under age 30—in particular among racial, ethnic, and sexual minority adolescents and young adults (AYA)—dominant prevention and treatment paradigms too often inadequately consider the unique HIV service needs of AYA. To address this gap, we characterize persistent and largely overlooked AYA disparities across the HIV prevention and treatment continuum, identify AYA-specific limitations in extant resources for improving HIV service delivery in the United States, and propose a novel AYA-centered differentiated care framework adapted to the unique ecological and developmental factors shaping engagement, adherence, and retention in HIV services among AYA. Shifting the paradigm for AYA to differentiated HIV care is a promising approach that warrants implementation and evaluation as part of reinforced national efforts to end the HIV epidemic in the United States by 2030.

scholarly journals Mental health in 2020 for men who have sex with men in the United States

Sexual Health ◽  
2017 ◽  
Vol 14 (1) ◽  
pp. 59 ◽  
Author(s):  
Abigail W. Batchelder ◽  
Steven Safren ◽  
Avery D. Mitchell ◽  
Ivan Ivardic ◽  
Conall O'Cleirigh
Keyword(s):  
Mental Health ◽  
Hiv Prevention ◽  
The United States ◽  
Hiv Care ◽  
Hiv Care Cascade ◽  
Age Related ◽  
The Us ◽  
Prevention And Treatment ◽  
Sex With Men ◽  
Hiv Aids

Despite continued advances in HIV prevention and treatment, gay and bisexual men and other men who have sex with men (MSM) remain the population most impacted by HIV/AIDS in the US and many other Western countries. Additionally, MSM are disproportionately affected by various psychological problems, including depression, distress, trauma and substance use. These challenges frequently co-occur, and are associated with higher rates of behaviours related to HIV acquisition and transmission, HIV infection, and, for those living with HIV/AIDS, lower levels of treatment engagement. Moreover, racial disparities exist among MSM in the US; for example, young African American MSM bear a disproportionate burden of the continuing HIV epidemic, likely related to disparate HIV prevalence in partner pools as well as long-standing structural inequities. In this review, the mental health challenges facing MSM primarily in the US, related to HIV and STI prevention and across the HIV care cascade, including HIV diagnosis, engagement and retention in care, and antiretroviral adherence, are illustrated. Disparities among MSM including racial and ethnic, age-related and structural barriers associated with HIV prevention and treatment, as well as current interventions, are also described. Moving forward towards 2020, resources will be needed to assess and implement scalable intervention strategies to address psychological and social barriers to HIV and STI risk reduction and treatment for MSM, with a particular focus on the most vulnerable subpopulations. As access to prevention and treatment strategies expand, and new breakthroughs continue to emerge, behavioural strategies will continue to be needed to reduce risk and increase uptake and engagement among MSM most at risk through 2020 and beyond.

scholarly journals Ending the Human Immunodeficiency Virus Pandemic: Optimizing the Prevention and Treatment Toolkits

2019 ◽  
Vol 69 (12) ◽  
pp. 2212-2217 ◽  
Author(s):  
Robert W Eisinger ◽  
Gregory K Folkers ◽  
Anthony S Fauci
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Hiv Prevention ◽  
The United States ◽  
Risk Of Infection ◽  
The Past ◽  
Effective Interventions ◽  
Incidence And Mortality ◽  
Immunodeficiency Virus ◽  
Prevention And Treatment

Abstract Unprecedented basic and clinical biomedical research advances over the past 4 decades have led to the development of “toolkits” of highly effective interventions for preventing and treating human immunodeficiency virus (HIV). Despite many successes in decreasing the incidence and mortality of HIV, major challenges remain in the goal of ending the HIV pandemic in the United States and globally. Overcoming these challenges will require optimization of the implementation of existing interventions for HIV prevention and treatment together with the continued development of new and innovative approaches that can be readily utilized by individuals with HIV and those at risk of infection.

scholarly journals Optimal Allocation of Societal HIV Prevention Resources to Reduce HIV Incidence in the United States

2021 ◽  
Vol 111 (1) ◽  
pp. 150-158
Author(s):  
Stephanie L. Sansom ◽  
Katherine A. Hicks ◽  
Justin Carrico ◽  
Evin U. Jacobson ◽  
Ram K. Shrestha ◽  
...  
Keyword(s):  
United States ◽  
Hiv Prevention ◽  
Optimal Allocation ◽  
The United States ◽  
Hiv Care ◽  
Public And Private ◽  
Hiv Model ◽  
Sustained Viral Suppression ◽  
Adherence Support ◽  
Optimal Allocations

Objectives. To optimize combined public and private spending on HIV prevention to achieve maximum reductions in incidence. Methods. We used a national HIV model to estimate new infections from 2018 to 2027 in the United States. We estimated current spending on HIV screening, interventions that move persons with diagnosed HIV along the HIV care continuum, pre-exposure prophylaxis, and syringe services programs. We compared the current funding allocation with 2 optimal scenarios: (1) a limited-reach scenario with expanded efforts to serve eligible persons and (2) an ideal, unlimited-reach scenario in which all eligible persons could be served. Results. A continuation of the current allocation projects 331 000 new HIV cases over the next 10 years. The limited-reach scenario reduces that number by 69%, and the unlimited reach scenario by 94%. The most efficient funding allocations resulted in prompt diagnosis and sustained viral suppression through improved screening of high-risk persons and treatment adherence support for those infected. Conclusions. Optimal allocations of public and private funds for HIV prevention can achieve substantial reductions in new infections. Achieving reductions of more than 90% under current funding will require that virtually all infected receive sustained treatment.

scholarly journals Pre-Exposure Prophylaxis Training among Medical Schools in the United States

2021 ◽  
Vol 12 ◽  
pp. 215013272110287
Author(s):  
Robert L. Cooper ◽  
Mohammad Tabatabai ◽  
Paul D. Juarez ◽  
Aramandla Ramesh ◽  
Matthew C. Morris ◽  
...  
Keyword(s):  
United States ◽  
Hiv Prevention ◽  
Injection Drug Users ◽  
Drug Users ◽  
Healthcare Providers ◽  
Medical Schools ◽  
The United States ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Exposure Prophylaxis

Pre-Exposure Prophylaxis (PrEP) has been shown to be an effective method of HIV prevention for men who have sex with-men (MSM) and -transgender women (MSTGWs), serodiscordant couples, and injection drug users; however fewer than 50 000 individuals currently take this regimen. Knowledge of PrEP is low among healthcare providers and much of this lack of knowledge stems from the lack or exposure to PrEP in medical school. We conducted a cross sectional survey of medical schools in the United States to assess the degree to which PrEP for HIV prevention is taught. The survey consisted Likert scale questions assessing how well the students were prepared to perform each skill associated with PrEP delivery, as well as how PrEP education was delivered to students. We contacted 141 medical schools and 71 responded to the survey (50.4%). PrEP education was only reported to be offered at 38% of schools, and only 15.4% reported specific training for Lesbian, Gay, Bisexual, and Transgender (LGBT) patients. The most common delivery methods of PrEP content were didactic sessions with 11 schools reporting this method followed by problem-based learning, direct patient contact, workshops, and small group discussions. Students were more prepared to provide PrEP to MSM compared to other high-risk patients. Few medical schools are preparing their students to prescribe PrEP upon graduation. Further, there is a need to increase the number of direct patient contacts or simulations for students to be better prepared.

“In the Bible Belt:” The role of religion in HIV care and prevention for transgender people in the United States South

2021 ◽  
Vol 70 ◽  
pp. 102613
Author(s):  
Darius Scott ◽  
Nastacia M. Pereira ◽  
Sayward E. Harrison ◽  
Meagan Zarwell ◽  
Kamla Sanasi-Bhola ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Hiv Care ◽  
Bible Belt ◽  
Transgender People ◽  
United States South ◽  
The Bible ◽  
Role Of Religion
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