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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

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District of Columbia HIV, STD Hepatitis and TB report, gay news, Washington Blade
AIDS cases, District of Columbia HIV, STD Hepatitis and TB report, gay news, Washington Blade
‘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,’ said Mayor Muriel Bowser in a statement. (Washington Blade file photo by Michael Key)

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.

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Monkeypox

Monkeypox vaccination effort shifts towards maintaining demand

‘Thousands of shots’ administered at gay events across country

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White House National Monkeypox Response Deputy Coordinator Dr. Demetre Daskalakis (YouTube screenshot)

As ensuring adequate supply and distribution of the monkeypox virus vaccine becomes “less of an issue,” efforts have shifted toward maintaining demand, Dr. Demetre Daskalakis, White House national monkeypox response deputy coordinator, said on Sept. 7. 

This will mean, “making sure that people know that a effective and safe vaccine is available for those that could benefit,” he said, during a press briefing that also featured National Response Coordinator Dr. Bob Fenton and White House Press Secretary Karine Jean-Pierre. 

The officials said they were pleased with the impact of their targeted allocations of vaccine doses to events with large numbers of gay and bisexual men who have sex with men, populations considered high risk for MPV infection. 

“Thousands of shots were administered” at Southern Decadence in New Orleans, Black Pride in Atlanta and Oakland Pride in the San Francisco Bay Area, Fenton said. These efforts “were, frankly, wildly successful,” Daskalakis said. 

During a Q&A with reporters that followed the briefing, Daskalakis addressed questions about the racial disparities that have begun to emerge with respect to infection and vaccination rates. 

According to the Kaiser Family Foundation, “Black people have received 22 percent vaccines, while they account for 36 percent of cases. In contrast, White people have received 63 percent of vaccinations but account for 42 percent of cases.”

Daskalakis explained the events that were targeted this summer were a major part of addressing the disproportionately higher rates of infection and lower rates of vaccination among people of color. 

“It’s not about just the vaccine allocation,” he said. “It’s about that intense community engagement that happens on the ground because, ultimately, public health is a local event.”

From the beginning of the outbreak, those engaged in the federal response were in touch with community organizations, Daskalakis said: “Giving the tools that people need to be able to sort of reach health goals is what we’ve been doing. And the support of organizations that serve Black and brown people have been pivotal in really turning the tide in what I think you’re going to see, the new vaccine numbers emerging over the next few weeks.”

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Health

Percentage of gay D.C. monkeypox cases rises slightly

Latest data show category of ‘unknown’ sexual orientation at 41.9%

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The latest weekly release of monkeypox case numbers by the D.C. Department of Health shows there were a total cumulative number of 431 monkeypox cases in the District as of Wednesday, Aug. 31, an increase of 26 cases since 405 cases reported one week earlier.

This week’s DOH data for the category of cases based on an individual’s sexual orientation show there were a total of 14 cases (3.2%) listed as straight/heterosexual, up from 11 cases (2.7%) from the previous week;  212 (49%) gay, up from 172 (42.5%) from last week; 24 (5.6%) bisexual, up from 18 (4.4% last week; and 179 (41.5%) in a category listed as “unknown” for the person’s sexual orientation, which was up from 172 (42.5%) from the previous week.

Officials at DOH, which is also known as D.C. Health, have said since the start of the monkeypox outbreak earlier this year that the overwhelming majority of cases in D.C., similar to across the nation, have been among gay, bisexual, and other men who have sex with men.

One DOH official speaking at a monkeypox town hall event last month placed the number of D.C. cases among all men who have sex with men at more than 90 percent. Officials have said the lower percentage of “gay” cases and the rise in the “unknown” category reported over the past two weeks is most likely due to a change in the data gathering policy.

In an effort to lessen the stigma associated with monkeypox infections, officials have said they do not want to appear as if they are applying undue pressure on people to disclose their sexual orientation when they apply for a monkeypox vaccination or seek a monkeypox test or treatment.

For the category of “lesbian” and “other,” the DOH this week included an asterisk instead of a number and a percentage.

“To help protect confidentiality, small numbers (between 0 and 4 are shown by an asterisk,” DOH states as an explanation for not including a number for the “lesbian” and “other” categories.

In last week’s data release, DOH said there were 0 recorded monkeypox cases for lesbians and one case in the “other” category.

In its category of “gender identity,” the DOH data released on Wednesday show that as of this week, out of the total cumulative cases of 431,423 (98.1%) were male. An asterisk is shown instead of a number for the categories of female; female-to-male transgender; male-to-female transgender; and gender nonconforming.

 A full breakdown of the latest monkeypox case number for all categories, including race/ethnicity, age group, and residential ward can be accessed at the D.C. Health website.

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Health

Biden health officials defend approach to monkeypox as cases grow

Contradictory information emerges on vaccine administration

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Biden officials defended their approach to monkeypox as contradictory emerges among health experts.

Top health officials in the Biden administration defended their approach Thursday to the monkeypox outbreak as cases continue to grow and contradictory information has emerged on appropriate vaccine administration.

Members of the White House monkeypox task force, in response to a question from the Washington Blade in a conference call with reporters, held fast to their new guidance on the JYNNEOS vaccine, which seeks to change the method of administration of the shot in an effort to expand use of the existing supply by fivefold — despite objections and even threats to cancel the supply from the vaccine manufacturer, according to a report this week in the Washington Post.

Meanwhile, cases of monkeypox in the United States are escalating — and beginning to extend outside the community of men who have sex with men — as the total number of confirmed cases has reached 13,517.

Bob Fenton, the White House monkeypox response coordinator, was first to respond to the Blade’s question on how the public can trust guidance from health officials amid the contradictory information by asserting “anytime that you have change, you’re going to have the need to update and educate the community on those changes.”

“The day…the FDA made that decision, we need signaled a week that this was being undertaken by FDA there already were a number of jurisdictions that started the training in anticipation of that decision,” Fenton said. “And that day, there were jurisdictions actually delivering intradermal shots that day [to] fivefold the number of shots and did that to areas of high risk and did that to areas that made equity a factor in those decisions where they vaccinated. So it is happening; it is being successful.”

The context of the Biden administration’s change in guidance last week — which shifts from injection through the subcutaneous route (delivery of the vaccine under the fat layer underneath the skin) to the intradermal route (delivery of the vaccine into the layer of skin just underneath the top layer) — is an announcement from localities, including the D.C. government, shifting from two doses to one dose to make up for limited supply. Biden officials discouraged the one-dose approach, pointing to data suggesting it was not effective in protecting against monkeypox.

In essence, contradictory information is coming from health experts on monkeypox on all levels localities offer on the vaccine, which in turn is criticized by the federal government as ineffective in favor of different approaches, which is in turn criticized by the vaccine manufacturer as untested and inappropriate.

Rochelle Walensky, director of the Centers of Disease Control & Prevention, responded to previously articulated concerns about the one-dose approach from localities by saying the Biden administration is working “really hand in glove in really fluid communication through this outbreak.”

“As I articulated we don’t yet know how well this vaccine will work in this outbreak,” Walensky said. “And as those data are evolving, as we had some resource constraints early on with the vaccine, we were working close with health departments so that they could maximize their coverage. We’ve met with them to talk about what data might be available for one dose, which are really limited [and] concerning in terms of how well it would work. And so when the strategy for intradermal dosing, which we anticipate will work just as well as subcutaneous dosing, we again met closely with the health departments…so that we could provide the data to them.”

Defense of changes in guidance in vaccine administration ended up overshadowing the announcements top officials were seeking to make, such as making an additional 1.8 million doses available for ordering starting Monday, a pilot program setting aside 50,000 doses for jurisdictions hosting large LGBTQ events, such as Black Pride in Atlanta and Southern Decadence in New Orleans; and making available next week 50,000 patient courses of TPOXX monkeypox treatment.

Dawn O’Connell, assistant secretary for preparedness and response at the Department of Health & Human Services, said when asked by CNN about expanding the supply the administration may look elsewhere aside from the JYNNEOS vaccine manufacturer, Bavarian Nordic in Denmark, calling the company a “small manufacturer.”

“They currently have one active line and in the Copenhagen area that we’re relying on for 2.5 million doses to be filled and finished, but when we ordered that second 2.5 million to be built and finished, we made it a requirement that they work with a domestic U.S. contract manufacturing organization and we continue to partner with Bavarian Nordic as they solidify that relationship,” O’Connell said. “We are also helping them in other ways consider manufacturing capacity increases, potentially working with a larger pharmaceutical company.”

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