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Are public health efforts to beat HIV in the U.S. coming to fruition? Not quite, but the HIV rate among US adults is stable.  National survey data show that between 2007 and 2012, the rate dipped slightly but not significantly. This is despite the fact that just over half of respondents were in one or more high-risk behavior groups.

This information comes from the most recent  National Health Statistics Report and uses data from over 10,000 Americans ages 18-59 who completed the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2012. The slight decrease in overall HIV prevalence is likely the result of multiple factors including but not limited to:

  • Approval of PrEP and the subsequent health promotion campaigns surrounding it
  • Improved ability via technology and other tools to reach the individuals most at-risk for HIV

Age, race, and gender matter.

Besides the overall HIV rate, the report also looks at key risk factors and prevalence of antiretroviral drug (ART) use among adults with HIV. They found that age, gender, race, STI status, and sexual risk-taking all impact who gets HIV. Specifically, someone is more likely to be HIV-positive if they are older, male, or non-Hispanic black. These correlations aren’t particularly surprising given the lack of condom use among older Americans and the distrust of the healthcare system reported by many blacks.

Other factors associated with HIV infection included being in one of the following high-risk groups:

  • having herpes simplex virus type 2 or a history of another STI
  • sleeping with 10 or more people in their lifetime
  • same sex sexual contact among men

Here again, the report doesn’t offer any new information but rather supports the idea that so-called risky sexual behavior puts individuals more at risk for all STIs, including HIV.

The researchers also found a few things that did not affect the HIV rate. These include education, poverty index ratio, or current health insurance status. This provides an interesting counterpoint to the social-political narrative of the poor, uneducated, uninsured, and “living off the system” person who has HIV. Even more interesting is the lack of news coverage about this result.

ART use remains low.

While the steady rate of HIV is promising, the news around treatment is less so. Only about half of adults with HIV report using ART in the past month.  And the exact numbers were extremely small, making this data highly unreliable. ART use was higher among non-Hispanic whites, men, and those with health insurance. ART use also increased with age and was more common among those in one or more high risk groups.

2007-2012 was the first year adults over age 49 were included in the NHANES.

Some people are getting tested, though.

Most of those with HIV have a history of being tested for it outside of blood donations but less than half of adults without HIV can say the same. Testing rates were higher in men, MSM, those with a history of an STI, and those with five or more lifetime sexual partners.

This last correlation is particularly exciting because it shows improvement in sexual health care by providers and/or patients. It’s impossible to know whether these individuals are self-selecting for more routine testing or if their healthcare providers are encouraging testing based on taking a full sexual history. Either way, this is good news because it shows that health care providers and patients are taking more responsibility for sexual health.

Though this is likely outside the abilities of the NHANES it would be fascinating to perform some qualitative studies looking at the conversations the different subgroups have with their sexual partners. Are the risk takers who get tested having the talk more? Who’s initiating the conversation? Is this more or less than individuals who report less sexual risk taking? Answers to these questions could help public health professionals better address concerns people express about having such conversations.

Education, not shame

As public discourse around STIs becomes more nuanced, the question is how can we as a field make a significant dent in the HIV rate without shaming those already diagnosed and/or who are sexual risk takers. It’s a tricky balance. Those who didn’t grow up during the AIDS crisis, and who don’t study it as most of us do, lack a certain fear of HIV that can push them to make less risky sexual decisions. On the other hand, fear-based campaigns don’t work and ultimately add to the sexual shame that prevents people from being honest about their sexual histories (check out the story below) and getting the testing and treatment they need.

Obviously getting rid of HIV isn’t so simple as answering this question There are clear connections to socioeconomic status, race, and other forms of oppression that make it more difficult for certain people to access the information, tools, and treatment that could help them more fully assess what risks they’re willing to take and then live with the potential outcomes of those risks. And of course, there’s a lack of funding for comprehensive sex education and a lack of states that require even medically accurate HIV education.

Figuring out how to navigate this more nuanced, balanced approach to HIV education and messaging is just one piece of the larger puzzle. However, it’s something we should begin studying sooner rather than later, along with novel ways of getting our messages to the highest risk groups, so that in the next Report (or maybe the one after that), the news will be significantly more positive.

Other Sexual Health News This Week

Millions More Need H.I.V. Treatment, W.H.O Says (New York Times)

Billboards Linking Tinder to STDs are Latest Battleground in Online Dating Wars (Washington Post)

Men May Underreport Male Sex Partners at Time of HIV Testing (Medscape)

Beauty or Beast? Why Perceptions of Attractiveness Vary (Live Science)

California Mandates New High School Lessons to Prevent Sexual Assaults  (LA Times) This is part of their new mandated sex education for grades 7-12 (EdSource).

Lawmaker Works to Add Gender Identity to [Wisconsin] State Law (Channel 3000)

What the Updated National HIV/AIDS Strategy Means for Black America (Indianapolis Recorder)