HIV and Special Populations

HIV/AIDS and Special

Populations

Special Populations

• Pregnant Women • Children • Teenagers • Gay Men • Prisoners • Travelers • Seniors

Pregnant Women • An HIV positive woman can transmit the

virus to her baby during pregnancy, labor and delivery, and through breastfeeding.

• Modern drugs are highly effective at preventing HIV transmission during pregnancy, labor and delivery.

• When combined with other interventions, including formula feeding, a complete course of treatment can cut the risk of transmission to below 2%.

Pregnant Women (cont’d)

• Even a single dose of medicine given to mother and baby can cut the risk in half.

• If a pregnant woman takes no preventive drugs and later breastfeeds, the chance of her baby becoming infected is around 20-45%.

• AZT has been shown to be particularly useful for preventing HIV from being passed from a mother to child.

Pregnant Women (cont’d)

• The standard medical protocol is as follows: – AZT is prescribed at least 6 weeks before

delivery. – Medication continues through delivery, where

pregnant woman receives a strong dose of AZT. – An elective Caesarian section is recommended

to reduce transmission via the birth canal. – The newborn is also placed on AZT for 6 weeks

after birth. – Breast-feeding of the newborn is discouraged.

Testing Pregnant Women for HIV

• Testing for HIV is an important component of the treatment process.

• Some medical professionals argue that HIV testing should be mandatory for all pregnant women given the medical evidence to support the benefits of early intervention—which begins with testing.

• Newborns born to HIV positive mothers will need to be tested repeatedly for up to 18 months after birth.

Testing Pregnant Women for HIV (cont’d)

• This is because testing for HIV antibodies in the baby will in actuality reflect antibodies in the mother’s bloodstream.

• Babies inherit their mothers’ immune system and will not have developed an independent immune system until months after birth.

Testing Pregnant Women for HIV (cont’d)

• Currently, only New York and Connecticut require mandatory HIV testing of newborns.

• New Jersey requires two tests for pregnant women–at the beginning of the pregnancy and again in the third trimester–unless the mother objects.

• If the mother objects, the objection is noted in the medical record and the newborn is then tested for HIV (with the only exception being on religious grounds.)

• Newborns are also tested if the woman is HIV positive.

Testing Pregnant Women for HIV (cont’d)

• Arkansas, Michigan, Tennessee and Texas require testing of pregnant women unless the woman specifically says no.

• According to the CDC, 100 to 200 children a year are infected by their mothers.

• As of 2005, the last year for which figures are available, there were 6,051 people in the United States living with HIV/AIDS who had been infected in utero, during pregnancy or breast-feeding.

HIV/AIDS in Children • As of 2018, of the estimated nearly 38

million people worldwide living with HIV, approximately 1.7 million are children under 15 years of age.

• Almost all HIV-infected children acquire the virus from their mothers before or during birth, a process called perinatal transmission.

• In populations where breastfeeding is uncommon, most transmission occurs during the delivery.

HIV/AIDS in Children (cont’d) • According to the CDC, 9,112 children

in the United States under the age of 13 have been diagnosed with AIDS since the beginning of the epidemic.

• As of 2005, a total of 4,865 children have died of AIDS-related illnesses/complications.

• Most children under the age of 13 with HIV are born with it or contract it while breast-feeding from mothers who have HIV/AIDS.

HIV/AIDS in Children (cont’d)

• The number of newly diagnosed AIDS cases in children has declined dramatically since 1995.

• Twenty percent of children diagnosed with HIV develop AIDS and die within four years.

• The other eighty percent have a slower progression, not developing symptoms of AIDS until they are school-age or older.

HIV/AIDS in Teenagers • Each year in the United States, about

20,000 young people are newly infected with HIV.

• Teens are at high risk for infection with HIV, even though they account for only a small percentage of reported AIDS cases (4.7%).

• In the United States, half of all new HIV infections occur in people under age 25.

• One-fourth of new infections occur in people under the age of 21.

HIV/AIDS in Teenagers (cont’d)

• Rates of HIV infection are disproportionately high among young women of color, especially those who are members of the working poor and, therefore, lack health insurance and easy access to health care.

• Black women and Latinas account for 79% of all reported HIV infections among 13- to 19-year-old women.

• They represent 75% of HIV infections among 20- to 24-year-old women in the United States.

Risk Factors for Teens

• Early age at sexual initiation • Inconsistent condom use • Other sexually transmitted diseases • Drug and alcohol abuse • Life stressors

– Poverty – Unemployment – Violence

Gay Men • Gay men have been hit the hardest

with HIV and AIDS. • Men who had sex with men (MSM)

accounted for 81% of all HIV infections among male adults and adolescents in 2018.

• The number of HIV diagnoses for MSM decreased during the 1980s and 1990s.

Gay Men (cont’d) • Recent surveillance data, however, show

an increase in HIV diagnoses for this group due to: – Failure to practice safe sex – Optimistic attitudes about medications and

treatment – Substance abuse – Increased opportunity for finding new sexual

partners (i.e. via Internet). • HIV prevalence among Black MSM (46%)

was more than twice that among white MSM (21%).

• As of 2005, an estimated 207,810 gay men were living with HIV/AIDS.

Prisoners • The prevalence of HIV infection is

approximately 2% among inmates in correctional facilities.

• Incarcerated women are more likely to be HIV-infected than men, with a prevalence of 2.8% compared with 1.9% among males.

• Most incarcerated HIV-infected persons have acquired their HIV prior to entering prison.

• In-prison transmission of HIV has been associated with male to male sex and the acquisition of tattoos in prison.

HIV Testing for Prisoners

• Testing policies for incarcerated populations vary from state to state.

• Federal prisoners are required to undergo HIV testing. – HIV testing is mandatory upon release

from federal prisons. • Most state, city and county jail

systems, however, have no mandatory testing.

Travelers • All persons seeking entrance into the United

States are required to disclose their HIV status prior to entrance.

• In 1987 President Ronald Regan and Congress passed a law that added AIDS to the list of “dangerous and contagious diseases”. This made it illegal for AIDS patients to enter the United States for the purpose of immigration or establishing permanent residency.

• In 1993, the National Institutes of Health Revitalization Act added HIV to the list of

“ communicable disease with public health significance” that would exclude people from entering the United States.

• The ban remains in effect today despite legislation passed in 2008 that amended the law.

Travelers (cont’d)

• With waivers, HIV/AIDS patients may legally enter the United States for four general reasons: – To attend professional or academic

conferences – To receive medical treatment – To visit close family members – To conduct business

• Tourists, students and temporary workers with HIV/AIDS are barred under the law.

Travelers (cont’d) • Applicants seeking to enter the United

States for the purpose of establishing residency may also file for waivers if they are: – The spouse, unmarried child, or legally adopted

child of a United States citizen and (a) pose a minimal threat to public health (b) pose a minimal threat with regards to spreading the infection (c) will not cost any government agency any expense.

Travelers (cont’d)

• Persons who are identified as being HIV positive at ports of entry to the United States and have not declared their status can be legally detained indefinitely by the Department of Homeland Security.

• Such individuals would have to stand before an immigration judge and face possible deportation.

Seniors

• In the United States, approximately 78,000 people age 50+ have AIDS.

• This represents about 10% to 15% of all people with AIDS.

• In New York City, 31% of people with HIV are age 50 and over.

Seniors (cont’d) • Issues relevant to this population:

– Health care providers often do not test older people for HIV

– Older people lack awareness of risk factors – Many older people are newly single, either

through widowhood or divorce. – Many have ignored HIV prevention while they

had a partner – Lack of HIV prevention education for this

population

Seniors (cont’d) – Belief that HIV only affects younger people – Lack of training in safe sex practices – Unsafe sex – Little is known about how medications for

high blood pressure, osteoporosis and other health problems interact with AIDS medications

– Most clinical trials exclude seniors because of their age and health problems

– Many of the symptoms related to HIV are similar to those that simulate the aging process

– For example, a weakened immune system, memory loss and fatigue are hallmarks of aging as well

October 2020

HIV and African American Gay and Bisexual Men

26% Of the 37,968 NEW HIV DIAGNOSES in the US and dependent areas* in 2018, 26% were among Black/African American† gay and bisexual men. ‡ **

Age, years

N um

be r

of N

ew H

IV D

ia gn

os es

Race/Ethnicity

Asian Black/African American* Hispanic/Latino† White Multiple Races

25–3413–24 35–44 45–54 >55

134

3,334

1,788

1,087

185 303

3,309

2,427

277 141

1,255

1,595

1,367

114 80

727 918

1,216

59 38

385

944

29

408

††

3,988

About 3 out of 4 Black/African American gay and bisexual men who received an HIV diagnosis were aged 13 to 34.

Subpopulations representing 2% or less of HIV diagnoses among gay and bisexual men are not reflected in this chart.

From 2014 to 2018, HIV diagnoses remained stable among Black/African American gay and bisexual men. ** But trends varied by age.

Trends by Age

0

3,500

13 to 24 25 to 34 35 to 44 45 to 54 55 and older

2014 2018

Stable

15%

12%

17%

8%

* American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands. † Black refers to people having origins in any of the Black racial groups of Africa. African American is a term often used for Americans of

African descent with ancestry in North America. This fact sheet uses African American, unless referencing surveillance data. ‡ This fact sheet uses the term gay and bisexual men to represent gay, bisexual, and other men who reported male-to-male sexual contact

aged 13 and older. ** Includes infections attributed to male-to-male sexual contact and injection drug use. †† Hispanics /Latinos can be of any race. ‡‡ In 50 states and the District of Columbia.

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

Black/African American gay and bisexual men who don’t know they have HIV cannot get the care and treatment they need to stay healthy.

At the end of 2018, an estimated 1.2 MILLION AMERICANS had HIV. ‡‡ Of those, 235,100 were Black/African American gay and bisexual men. 4 in 5

Black/African American gay and bisexual men knew they had the virus.***

It is important for Black/African American gay and bisexual men to know their HIV status so they can take medicine to treat HIV if they have the virus. Taking HIV medicine every day can make the viral load undetectable. People who get and keep an undetectable viral load (or stay virally suppressed) can live a long and healthy life. They also have effectively no risk of transmitting HIV to HIV-negative sex partners.

some HIV care, 58 were retained in care, and 65 were virally suppressed.‡‡‡

Compared to all people with diagnosed HIV, Black/African American gay and bisexual men have lower viral suppression rates. More work is needed to increase these rates. For every 100 Black/African American gay and bisexual men with diagnosed HIV in 2018:†††

received some HIV care

75

were retained in care

56 were virally suppressed

61 For comparison, for every 100 people overall with diagnosed HIV, 76 received

People With Diagnosed HIV

People With

Undiagnosed HIV

STIGMA

There are several challenges that place some African American gay and bisexual men at higher risk for HIV.

Delay in Linkage to HIV Medical Care Lower Viral Suppression Percentages

Not all African American gay and bisexual men with African American gay and bisexual men have diagnosed HIV are linked to care within 90 days of lower percentages of viral suppression than gay the diagnosis. and bisexual men of other races/ethnicities.

Socioeconomic Factors Racism, HIV Stigma, and Homophobia Higher poverty rates among some African American Racism, HIV stigma, and homophobia can gay and bisexual men can mean limited access to negatively impact risk-taking behaviors, knowledge quality health care, HIV prevention education, and of HIV status, HIV care, and other ne

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