106 research outputs found
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Socio-ecological Barriers to Viral Suppression Among Transgender Women Living with HIV in San Francisco and Los Angeles, California
Troubling disparities in viral suppression persist among transgender (trans) women living with HIV in the US. We utilized baseline data from a randomized controlled trial of a behavioral intervention among trans women living with HIV in San Francisco and Los Angeles, to identify the socio-ecological correlates of biologically confirmed viral suppression (< 200 HIV-1 RNA copies/mL). Among 253 participants, the mean age was 43 (SD = 11), 46% identified as Black or African American and 35% were virally non-suppressed. In adjusted Poisson regression models, the following barriers to viral suppression were identified: injection drug use [adjusted risk ratio (aRR) 0.78, 95% CI 0.65-0.93, Z = - 2.64, p = 0.008], methamphetamine use (aRR 0.65, 95% CI 0.51-0.83, Z = - 3.45, p = 0.001), amphetamine use (aRR 0.62, 95% CI 0.44-0.87, Z = - 2.75, p = 0.006), homelessness (aRR 0.79, 95% CI 0.63-0.98, Z = - 2.06, p = 0.039), and sex work (aRR 0.60, 95% CI 0.41-0.86, Z = - 2.77, p = 0.009). These findings underscore the importance of interventions that address the socio-ecological barriers to viral suppression among trans women in urban settings
Decreases in Community Viral Load Are Accompanied by Reductions in New HIV Infections in San Francisco
BACKGROUND: At the individual level, higher HIV viral load predicts sexual transmission risk. We evaluated San Francisco's community viral load (CVL) as a population level marker of HIV transmission risk. We hypothesized that the decrease in CVL in San Francisco from 2004-2008, corresponding with increased rates of HIV testing, antiretroviral therapy (ART) coverage and effectiveness, and population-level virologic suppression, would be associated with a reduction in new HIV infections. METHODOLOGY/PRINCIPAL FINDINGS: We used San Francisco's HIV/AIDS surveillance system to examine the trends in CVL. Mean CVL was calculated as the mean of the most recent viral load of all reported HIV-positive individuals in a particular community. Total CVL was defined as the sum of the most recent viral loads of all HIV-positive individuals in a particular community. We used Poisson models with robust standard errors to assess the relationships between the mean and total CVL and the primary outcome: annual numbers of newly diagnosed HIV cases. Both mean and total CVL decreased from 2004-2008 and were accompanied by decreases in new HIV diagnoses from 798 (2004) to 434 (2008). The mean (p = 0.003) and total CVL (p = 0.002) were significantly associated with new HIV cases from 2004-2008. CONCLUSIONS/SIGNIFICANCE: Reductions in CVL are associated with decreased HIV infections. Results suggest that wide-scale ART could reduce HIV transmission at the population level. Because CVL is temporally upstream of new HIV infections, jurisdictions should consider adding CVL to routine HIV surveillance to track the epidemic, allocate resources, and to evaluate the effectiveness of HIV prevention and treatment efforts
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Substance Use and Alcohol among Key Populations at risk for HIV: Novel Approaches in Intervention Development and Evaluation.
Substance use and alcohol can have negative health consequences among both HIV-positive and -negative individuals, and are associated with behaviors that facilitate HIV transmission and acquisition, particularly among key affected populations disproportionately impacted by HIV, including transgender women, men who have sex with men (MSM) and adults from sub-Saharan Africa. Although there is a large body of literature documenting the overlap between substance use, alcohol and HIV, many gaps remain in our understanding of these intertwined conditions. For example, the relationship between HIV infection and different classes and patterns of substance use and alcohol consumption remain understudied among transgender women. On the other hand, those relationships are well-characterized for non-dependent substance-using and alcohol-drinking MSM, yet there are no evidence-based behavioral interventions efficaciously shown to reduce substance use, alcohol and associated harm exclusively for this population. Furthermore, among treatment-naïve HIV-positive individuals, there is limited longitudinal data characterizing the impact of anti-retroviral treatment (ART) initiation on alcohol consumption. The objective of this dissertation was to address these gaps in the literature and help elucidate the complex interplay between substance use, alcohol consumption and HIV with a special emphasis on key affected populations. The study populations and study designs in this dissertation include: 1) transgender women from San Francisco (n=314) from a Respondent Drive Sampling (RDS) study conducted in 2010; 2) HIV-negative, sexually-active, substance-using and alcohol-drinking MSM from San Francisco (n=326) from a randomized controlled trial (RCT) on the efficacy of a behavioral intervention, Personalized Cognitive Counseling (PCC), compared to rapid HIV testing to reduce HIV-related sexual risk behaviors conducted from 2009-2012; and 3) HIV-positive individuals from rural Uganda initiating ART (n=502) from a prospective cohort study followed from 2005-2011. The key findings of these studies are summarized below
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