Health
New D.C. HIV cases decline by widest margin in 5 years: report
City offering free home test kits to counter decline in clinic visits
The number of new HIV infections reported in D.C. in 2019 declined by 16 percent from 2018, the largest decline over the previous five years, indicating the city’s HIV prevention efforts are moving closer to achieving Mayor Muriel Bowser’s goal of ending the AIDS epidemic in the nation’s capital, according to a report released last week by the D.C. Department of Health.
The 2019 HIV data, which also show the city has met the mayor’s goal of ensuring that 90 percent of city residents with HIV know their HIV status by 2020, were released on Aug. 20 as part of the health department’s annual 2019 HIV, Sexually Transmitted Disease, Hepatitis, and Tuberculous Epidemiology and Surveillance Report.
The report shows the number of newly diagnosed HIV cases in D.C. decreased from 335 in 2018 to 282 in 2019, a 16 percent drop. The report notes that the 2019 figure of 282 new HIV cases represents a 79 percent decline from the 1,374 new cases reported in 2007.
DOH officials have said the decline in new cases appeared to have leveled off and reached a plateau between 2015 and 2018 when the number of new cases remained relatively stable. From 2015 to 2016, the new cases went from 399 to 379, a 5 percent decrease. The number of new cases from 2016 to 2017 dropped from 379 to 371, a decline of just 2 percent.
The new cases from 2017 to 2018 went from 371 to 335, a 9 percent decrease, the DOH report shows.
According to DOH officials, including DOH Director Dr. LaQuandra Nesbitt, the 16 percent decline from 2018 to 2019 is an indication that stepped up efforts are working to encourage people to seek out the HIV prevention drug known as PrEP and for people who are HIV positive to become virally suppressed through medication that’s 99 percent effective in preventing transmission of the virus to someone else.
The report released last week says that among the D.C. residents newly diagnosed with HIV in 2019, 59 percent were “virally suppressed” with medication within 90 days of their diagnosis. It says that was an improvement from the 45 percent that were virally suppressed within 90 days after diagnosis in 2018.
“However, this indicates that not enough people are getting on HIV treatment timely to attain viral suppression,” a DOH statement accompanying the release of the report says.
DOH Officials said HIV data for 2020 will not be released until August of 2021. But the officials nevertheless disclosed they observed a downward change in the number of people being tested for HIV from 2019 to the first half of 2020.
Michael Kharfen, senior deputy director for DOH’s HIV/AIDS, Hepatitis, STD, and TB Administration, told the Washington Blade that DOH has found that fewer people in D.C. in 2020 have been tested for HIV compared to this time last year.
Kharfen said restrictions and concerns related to the coronavirus pandemic are believed to be the main reason fewer D.C. residents are showing up this year at HIV testing sites offered by DOH, private community clinics, or doctors’ offices. He said DOH has responded to this development by offering free home HIV test kits to anyone who requests them by contacting DOH online or by phone.
Kharfen said the free test kits can be obtained through a special DOH website at: getcheckeddc.org.
“D.C. Health recognizes that the COVID-19 pandemic is changing the way D.C. residents obtain medical care and other services,” Nesbitt said in the DOH statement. “We are expanding telehealth options and home-based testing to give residents the opportunity to take charge of their health,” she said.
The 2019 DOH report includes these additional findings:
• There are 12,408 current D.C. residents, or 1.8 percent of the population, who are living with HIV. Black and Latino residents with HIV exceeded 1 percent of their respective populations, with Black residents disproportionately impacted at 2.8 percent.
• There were just two babies born with HIV in D.C. in 2019.
• “Men who have sex with men and heterosexual contact are the two leading modes of transmission reported among newly diagnosed and identified HIV cases.”
• More than half of people living with HIV in D.C. are 50 years old and older. Young people ages 13 to 24 represent nearly 20 percent of new HIV diagnoses between 2015 and 2019. The number of “new HIV cases among young people between the ages of 20-24 remained level for the past three years.”
• The number of “newly diagnosed HIV cases attributable to injection drug use decreased by 99 percent from 150 cases in 2007, prior to the scale up of D.C.’s needle exchange program, to 2 cases in 2019.
• In 2019, there were 9,337 cases of chlamydia, 4,374 cases of gonorrhea, and 297 cases of primary and secondary cases of syphilis reported in D.C.
• There were 1,099 people with newly reported hepatitis C in D.C. in 2019.
• There were 24 cases of newly reported tuberculosis in D.C. in 2019, a 33 percent decline from the 36 newly reported cases in 2018.
“Our partnerships with the community have continued to yield promising results to both stem and reduce new HIV cases, while also delivering better and more efficient treatment to residents living with HIV,” Mayor Bowser said in the DOH statement.
“Our goal of ending the HIV epidemic in D.C. is not yet done, and we will continue to work to ensure equity in services, reduce stigma as an access barrier, making testing easier, support needle exchange, and keep people HIV negative,” the mayor said.
Jewel Addy, a spokesperson for Whitman-Walker Health, one of D.C.’s largest private health centers that provides HIV and other medical services for the LGBTQ community, said Whitman-Walker saw a 63 percent decline in its HIV testing between January and July of this year compared to that same period in 2019.
Addy said Whitman-Walker has seen about a 62 percent decline during that same period in the number of sexually transmitted infections testing it has offered at its various offices. Whitman-Walker discontinued in-person office visits at most of its locations except for COVID-19 tests in the past several months, but Addy said in-person visits have been resumed for HIV and COVID testing in several of Whitman-Walker’s offices this summer.
Monkeypox
US contributes more than $90 million to fight mpox outbreak in Africa
WHO and Africa CDC has declared a public health emergency
The U.S. has contributed more than $90 million to the fight against the mpox outbreak in Africa.
The U.S. Agency for International Development on Tuesday in a press release announced “up to an additional” $35 million “in emergency health assistance to bolster response efforts for the clade I mpox outbreak in Central and Eastern Africa, pending congressional notification.” The press release notes the Biden-Harris administration previously pledged more than $55 million to fight the outbreak in Congo and other African countries.
“The additional assistance announced today will enable USAID to continue working closely with affected countries, as well as regional and global health partners, to expand support and reduce the impact of this outbreak as it continues to evolve,” it reads. “USAID support includes assistance with surveillance, diagnostics, risk communication and community engagement, infection prevention and control, case management, and vaccination planning and coordination.”
The World Health Organization and the Africa Centers for Disease Control and Prevention last week declared the outbreak a public health emergency.
The Washington Blade last week reported there are more than 17,000 suspected mpox cases across in Congo, Uganda, Kenya, Rwanda, and other African countries. The outbreak has claimed more than 500 lives, mostly in Congo.
Health
Mpox outbreak in Africa declared global health emergency
ONE: 10 million vaccine doses needed on the continent
Medical facilities that provide treatment to gay and bisexual men in some East African countries are already collaborating with them to prevent the spread of a new wave of mpox cases after the World Health Organization on Wednesday declared a global health emergency.
The collaboration, both in Uganda and Kenya, comes amid WHO’s latest report released on Aug. 12, which reveals that nine out of every 10 reported mpox cases are men with sex as the most common cause of infection.
The global mpox outbreak report — based on data that national authorities collected between January 2022 and June of this year — notes 87,189 of the 90,410 reported cases were men. Ninety-six percent of whom were infected through sex.
Sexual contact as the leading mode of transmission accounted for 19,102 of 22,802 cases, followed by non-sexual person-to-person contact. Genital rash was the most common symptom, followed by fever and systemic rash.
The WHO report states the pattern of mpox virus transmission has persisted over the last six months, with 97 percent of new cases reporting sexual contact through oral, vaginal, or anal sex with infected people.
“Sexual transmission has been recorded in the Democratic Republic of Congo among sex workers and men who have sex with men,” the report reads. “Among cases exposed through sexual contact in the Democratic Republic of the Congo, some individuals present only with genital lesions, rather than the more typical extensive rash associated with the virus.”
The growing mpox cases, which are now more than 2,800 reported cases in at least 13 African countries that include Kenya, Uganda, Rwanda, and prompted the Africa Centers for Disease Control and Prevention this week to declare the disease a public health emergency for resource mobilization on the continent to tackle it.
“Africa has long been on the frontlines in the fight against infectious diseases, often with limited resources,” said Africa CDC Director General Jean Kaseya. “The battle against Mpox demands a global response. We need your support, expertise, and solidarity. The world cannot afford to turn a blind eye to this crisis.”
The disease has so far claimed more than 500 lives, mostly in Congo, even as the Africa CDC notes suspected mpox cases across the continent have surged past 17,000, compared to 7,146 cases in 2022 and 14,957 cases last year.
“This is just the tip of the iceberg when we consider the many weaknesses in surveillance, laboratory testing, and contact tracing,” Kaseya said.
WHO, led by Director General Tedros Adhanom Ghebreyesus, also followed the Africa CDC’s move by declaring the mpox outbreak a public health emergency of international concern.
The latest WHO report reveals that men, including those who identify as gay and bisexual, constitute most mpox cases in Kenya and Uganda. The two countries have recorded their first cases, and has put queer rights organizations and health care centers that treat the LGBTQ community on high alert.
The Uganda Minority Shelters Consortium, for example, confirmed to the Washington Blade that the collaboration with health service providers to prevent the spread of mpox among gay and bisexual men is “nascent and uneven.”
“While some community-led health service providers such as Ark Wellness Clinic, Children of the Sun Clinic, Ice Breakers Uganda Clinic, and Happy Family Youth Clinic, have demonstrated commendable efforts, widespread collaboration on mpox prevention remains a significant gap,” UMSC Coordinator John Grace stated. “This is particularly evident when compared to the response to the previous Red Eyes outbreak within the LGBT community.”
Grace noted that as of Wednesday, there were no known queer-friendly health service providers to offer mpox vaccinations to men who have sex with men. He called for health care centers to provide inclusive services and a more coordinated approach.
Although Grace pointed out the fear of discrimination — and particularly Uganda’s Anti-Homosexuality Act — remains a big barrier to mpox prevention through testing, vaccination, and treatment among queer people, he confirmed no mpox cases have been reported among the LGBTQ community.
Uganda so far has reported two mpox cases — refugees who had travelled from Congo.
“We are for the most part encouraging safer sex practices even after potential future vaccinations are conducted as it can also be spread through bodily fluids like saliva and sweat,” Grace said.
Grace also noted that raising awareness about mpox among the queer community and seeking treatment when infected remains a challenge due to the historical and ongoing homophobic stigma and that more comprehensive and reliable advocacy is needed. He said Grindr and other digital platforms have been crucial in raising awareness.
The declarations of mpox as a global health emergency have already attracted demand for global leaders to support African countries to swiftly obtain the necessary vaccines and diagnostics.
“History shows we must act quickly and decisively when a public health emergency strikes. The current Mpox outbreak in Africa is one such emergency,” said ONE Global Health Senior Policy Director Jenny Ottenhoff.
ONE is a global, nonpartisan organization that advocates for the investments needed to create economic opportunities and healthier lives in Africa.
Ottenhoff warned failure to support the African countries with medical supplies needed to tackle mpox would leave the continent defenseless against the virus.
To ensure that African countries are adequately supported, ONE wants governments and pharmaceutical companies to urgently increase the provision of mpox vaccines so that the most affected African countries have affordable access to them. It also notes 10 million vaccine doses are currently needed to control the mpox outbreak in Africa, yet the continent has only 200,000 doses.
The Blade has reached out to Ishtar MSM, a community-based healthcare center in Nairobi, Kenya, that offers to service to gay and bisexual men, about their response to the mpox outbreak.
Health
White House urged to expand PrEP coverage for injectable form
HIV/AIDS service organizations made call on Wednesday
A coalition of 63 organizations dedicated to ending HIV called on the Biden-Harris administration on Wednesday to require insurers to cover long-acting pre-exposure prophylaxis (PrEP) without cost-sharing.
In a letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, the groups emphasized the need for broad and equitable access to PrEP free of insurance barriers.
Long-acting PrEP is an injectable form of PrEP that’s effective over a long period of time. The FDA approved Apretude (cabotegravir extended-release injectable suspension) as the first and only long-acting injectable PrEP in late 2021. It’s intended for adults and adolescents weighing at least 77 lbs. who are at risk for HIV through sex.
The U.S. Preventive Services Task Force updated its recommendation for PrEP on Aug. 22, 2023, to include new medications such as the first long-acting PrEP drug. The coalition wants CMS to issue guidance requiring insurers to cover all forms of PrEP, including current and future FDA-approved drugs.
“Long-acting PrEP can be the answer to low PrEP uptake, particularly in communities not using PrEP today,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “The Biden administration has an opportunity to ensure that people with private insurance can access PrEP now and into the future, free of any cost-sharing, with properly worded guidance to insurers.”
Currently, only 36 percent of those who could benefit from PrEP are using it. Significant disparities exist among racial and ethnic groups. Black people constitute 39 percent of new HIV diagnoses but only 14 percent of PrEP users, while Latinos represent 31 percent of new diagnoses but only 18 percent of PrEP users. In contrast, white people represent 24 percent of HIV diagnoses but 64 percent of PrEP users.
The groups also want CMS to prohibit insurers from employing prior authorization for PrEP, citing it as a significant barrier to access. Several states, including New York and California, already prohibit prior authorization for PrEP.
Modeling conducted for HIV+Hep, based on clinical trials of a once every 2-month injection, suggests that 87 percent more HIV cases would be averted compared to daily oral PrEP, with $4.25 billion in averted healthcare costs over 10 years.
Despite guidance issued to insurers in July 2021, PrEP users continue to report being charged cost-sharing for both the drug and ancillary services. A recent review of claims data found that 36 percent of PrEP users were charged for their drugs, and even 31 percent of those using generic PrEP faced cost-sharing.
The coalition’s letter follows a more detailed communication sent by HIV+Hepatitis Policy Institute to the Biden administration on July 2.
Signatories to the community letter include Advocates for Youth, AIDS United, Equality California, Fenway Health, Human Rights Campaign, and the National Coalition of STD Directors, among others.
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