1

MSM Sexual Health Summit August 20, 2012

HIV/STD Prevention and Care BranchTexas Department of State Health Services

80 82 84 86 88 90 92 94 96 98 00 02 04 06 08 100

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

0

1,000

2,000

3,000

4,000

5,000

6,000

Year

Nu

mb

er

Pe

op

le L

ivin

g w

ith

HIV

Nu

mb

er

of

Ne

w

Dia

gn

ose

s/D

ea

ths

Newly Diagnosed HIV Cases, Deaths, and People Living with HIV in Texas: 1980-2011

Newly diagnosed HIV infection includes all new HIV cases regardless of disease status. 2009-2010 death data are provisional.

Living with HIV

Deaths Among Cases

New HIV Cases

Public Awareness

Targeted Prevention

Full Diagnosis

Successful Linkage

Support Participation

in Care

Medical Adherence

Texas 2011 New Diagnosis Rate by Selected Characteristics

Tota

l Rat

e

Mal

e

Fem

ale

Whit

e

Black

Hispan

ic

Oth

er

MSM

^0

100

200

300

400

500

600

17 27 7 959

14 7

503

Cases p

er

10

0,0

00

^Denominator estimate based on: Lieb S, et al. Estimating Populations of Men Who Have Sex with Men in the Southern United States. Journal of Urban Health. 2009 Nov;86(6):887-901

2011 New Diagnosis Rate by Race Among MSM1

White Black Hispanic Other -

200 400 600 800

1,000 1,200 1,400 1,600 1,800

271

1,595

514

290

Cases p

er

10

0,0

00

1Denominator estimate based on: Lieb S, et al. Estimating Populations of Men Who Have Sex with Men in the Southern United States. Journal of Urban Health. 2009 Nov;86(6):887-901

6

Gonorrhea Cases:Texas, 1971-2011

0

1 0 ,0 0 0

2 0 ,0 0 0

3 0 ,0 0 0

4 0 ,0 0 0

5 0 ,0 0 0

6 0 ,0 0 0

7 0 ,0 0 0

8 0 ,0 0 0

9 0 ,0 0 0

1 0 0 ,0 0 0

7 1 7 3 7 5 7 7 7 9 8 1 8 3 8 5 8 7 8 9 9 1 9 3 9 5 9 7 9 9 0 1 0 3 0 5 0 7 0 9 1 1

Y e a r

Cases

7

STI/HIV ComorbidityProportion of HIV cases Co-Infected with STI 2005-2010

91.7%

8.3%

STDHIV/STD

8

GC/HIV ComorbidityBy Race/Ethnicity 2005-2010

GC Only HIV Only HIV/GC0%

10%

20%

30%

40%

50%

60%

16%

33%

28%

53%

39%

53%

22%

26%

17%

2% 1% 2%

WhiteBlackHispanicOther

9

GC/HIV ComorbidityBy Risk 2005-2010

HIV Only HIV/GC0%

10%

20%

30%

40%

50%

60%

70%

80%

54%

69%

15%

8%7% 6%

24%

17%

1% 1%0% 0%

MSMIDUMSM/IDUHeteroPediatricAdult Other

10

GC/HIV ComorbidityBy Age Group 2005-2010

GC Only HIV Only HIV/GC0%

10%

20%

30%

40%

50%

60%

70%

1% 1% 0%

63%

15%

22%24%

35% 36%

8%

32%

26%

4%

18%15%

0-1415-2425-3435-4445+

11

GC/HIV ComorbidityInterval Between Diagnoses 2005-2010

-7 to -12 -2 to -6 -1 to 1 2 to 6 7 to 120%

5%

10%

15%

20%

25%

30%

35%

40%

45%

17%15%

39%

14% 15%

Months From HIV Diagnosis to GC Diagnosis

12

12

Timing of Diagnoses2005-2010

-10.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%Chart Title

GCPSSTB

Axis Title

-12 -10 -8 -6 --4-2 0 2 4 6 8 10 12

Number of Months from HIV to Other DX

13

Interdependent Capacity Building

14

Interdependence, Unintended Consequences, Systems Adaptation

• Undetected and untreated disease driving GC and HIV– don’t ask don’t tell

• Not using all the laboratory weapons in our arsenal

• The unintended consequences of urine testing and how this may be fueling transmission of GC and also HIV in the MSM community

• Haven’t had a spotlight on the sexual transmission of HCV

15

CDC Recommendations from STD Treatment Guidelines, 2010

Screening tests should be performed at least annually for sexually active MSM:• HIV serology, if HIV negative or not tested in the

previous year• syphilis serology• GC/CT screening for:

– urethral infection (urine testing) for men who had insertive intercourse

– Rectal infection (rectal swab) for men who had receptive anal intercourse

– Pharyngeal infection (throat swab) for men who had receptive oral intercourse

16

CDC Recommendations

Sexual transmission of hepatitis C virus infection can occur, especially among HIV-infected MSM. Serologic screening for hepatitis C infection is recommended at initial evaluation of newly diagnosed HIV-infected persons. HIV-infected MSM can also acquire HCV after initial screening; therefore, men with new and unexplained increases in alanine aminotransferase (ALT) should be tested for acute HCV infection.

17

Overall Goals of Engagement

• Reduce undetected and untreated GC/CT in MSM

• Reduce transmission of HIV in MSM

• Increase identification of HIV-positive MSM co-infected with HCV

18

Summit Goals

• Increase awareness, urgency and action to implement consistent, appropriate and timely GC/CT detection for MSM and HCV screening for HIV-positive MSM

• Expand capacity to build protocols and provide education on this issue

19

Summit Outcomes

• Develop next steps for your organization to implement extra-genital screening for MSM

• Build coalitions with partners in your area to implement consistent, appropriate and timely extra-genital GC and HCV screening for MSM