The Massachusetts HIV, hepatitis, addiction services integration (HHASI) experience: responding to the comprehensive needs of individuals with co-occurring risks and conditions

Categorical funding mechanisms traditionally used to fund public health programs are a challenge to providers serving individuals with complex needs that often span multiple service areas. Integration--a formalized, collaborative process among service systems--responds to the challenge by decreasing fragmentation of care and improving coordination. In 2000, the Massachusetts Department of Public Health (MDPH) received a one-year planning grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to evaluate opportunities for integrating HIV/AIDS programs and substance abuse treatment programs. The project was later expanded to include viral hepatitis programming. Outcomes include the development of a strategic plan, joint procurement initiatives, and an ongoing commitment to sustain inter-bureau integration efforts, even in the face of substantial budget reductions. Integrated approaches can promote greater efficiency, improving communication and coordination among clients, providers, and government funding agencies.     

Implementing a Routine, Voluntary HIV Testing Program in a Massachusetts County Prison

Although U.S. prison inmates have higher rates of HIV infection than the general population, most inmates are not routinely tested for HIV infection at prison entry. The study objective was to implement a routine, voluntary HIV testing program in a Massachusetts county prison. During admission, inmates were given group HIV pre-test counseling and were subsequently offered private HIV testing. This intervention was compared to a control period during which HIV testing was provided only upon inmate or physician request. Between November 2004 and April 2005, 1,004 inmates met inclusion criteria and were offered routine, voluntary HIV testing. Of these, 734 (73.1%) accepted, 2 (0.3%) were HIV-infected, and 457 (45.5%) had been tested for HIV in the previous year. The testing rate of 73.1% was significantly increased from the rate of 18.0% (318 of 1,723) during the control period (p<0.001). Among the inmates tested for HIV in the prior year, 78.2% had received their last HIV test in the prison setting. Careful attention should be paid to prevent redundancy of testing efforts in the prison population. Implementing a routine HIV testing program among prison inmates greatly increased testing rates compared to on-request testing. Liddicoat is with the Department of Medicine, Greater Los Angeles Veterans Administration, Mail 111G, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA; Zheng, Freedberg, and Walensky are with the Division of General Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Freedberg and Walensky are with the Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Zheng, Freedberg, and Walensky are with the Partners AIDS Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Internicola and Golan are with the Suffolk County House of Corrections, Boston, MA, USA; Golan is with the Department of Infectious Disease, Tufts University Medical School, Boston, MA, USA; Rubinstein is with the HIV/AIDS Bureau, Massachusetts Department of Public Health, Boston, MA, USA; Werner and Kazianis are with the Massachusetts State Laboratory Institute, Boston, MA, USA.     

HIV-related stigma and knowledge in the United States: prevalence and trends, 1991-1999

OBJECTIVES: This study assessed the prevalence of AIDS stigma and misinformation about HIV transmission in 1997 and 1999 and examined trends in stigma in the United States during the 1990s. METHODS: Telephone surveys with national probability samples of English-speaking adults were conducted in the period 1996 to 1997 (n = 1309) and in 1998 to 1999 (n = 669). Findings were compared with results from a similar 1991 survey. RESULTS: Overt expressions of stigma declined throughout the 1990s, with support for its most extreme and coercive forms (e.g., quarantine) at very low levels by 1999. However, inaccurate beliefs about the risks posed by casual social contact increased, as did the belief that people with AIDS (PWAs) deserve their illness. In 1999, approximately one third of respondents expressed discomfort and negative feelings toward PWAs. CONCLUSION: Although support for extremely punitive policies toward PWAs has declined, AIDS remains a stigmatized condition in the United States. The persistence of discomfort with PWAs, blame directed at PWAs for their condition, and misapprehensions about casual social contact are cause for continuing concern and should be addressed in HIV prevention and education programs.     

Toward understanding elders' health service utilization

Providing appropriate health services to the elderly is emerging as one of the major challenges of this decade. Using the theoretical framework developed by Andersen and Aday, this study attempts to improve our understanding of those factors which inhibit or facilitate elders' use of health services. The data come from a 1974 statewide random probability sample of 1,625 noninstitutionalized elders 65 years of age or older living in Massachusetts. Regression analysis is used to study the effects of predisposing, enabling, and need characteristics on the use of five health services: hospitals, physicians, dentists, home care, and ambulatory care. The model explains from 5% to 27% of the variance in health service utilization. Need characteristics, in general, account for most of the explained variance.Drs. Branch and Jette and Ms. Polansky are with the Department of Social Medicine and Health Policy, Division on Aging, Harvard Medical School, 643 Huntington Avenue, Boston, Massachusetts 02115; Dr. Jette is also with the Massachusetts General Hospital's Institute of Health Professions; Dr. Evashwick and Ms. Rowe are with the Department of Health Services and Long Term Care Gerontology Center, School of Public Health and Community Medicine, University of Washington; and Dr. Diehr is with the Department of Biostatistics, School of Public Health and Community Medicine, University of Washington. Work for this project was supported in part by a grant from the Massachusetts Department of Public Health while the first author was with the Center for Survey Research, a facility of the University of Massachusetts and the Joint Center for Urban Studies of M.I.T. and Harvard University; in part by Grant 90-A-1350/2 from the Administration on Aging of H.E.W. to the Harvard School of Public Health; and in part by Grant 90-AT-2159 from the Administration on Aging of H.E.W. to the Harvard Medical School.     

AIDS risk-reduction guidelines: A review and analysis

Until an effective treatment or vaccine for AIDS is developed, the principal strategy for controlling its spread will remain persuading at-risk and diseased populations to modify behaviors implicated in the transmission of the disease. In the case of homosexual and bisexual men the risk-reduction or safe-sex brochure has emerged as the most widely used public health intervention modality. While there has been a proliferation of such brochures, to date no systematic analysis of the content or potential efficacy of these materials has been undertaken.The authors carry out two kinds of analyses of a sample of risk-reduction brochures. First, these materials are characterized in terms of 13 characteristics related to their content, and style. Second, the extent to which they incorporate the elements of a standard model of health communication is assessed. Limitations of existing brochures are identified and the implications of the findings for the development of future materials are discussed.Karolynn Siegel, Ph.D. is Director of Research, in the Department of Social Work at Memorial Sloan-Kettering Cancer Center, and Assistant Professor of Sociology in Public Health, Cornell University Medical College. Phyllis B. Grodsky, Ph.D. is Research Projects Coordinator, Department of Social Work at Memorial Sloan-Kettering Cancer Center. Alan Herman, Ph.D. is Adjunct Assistant Professor of Health Education at Borough of Manhattan Community College of the City University of New York.The authors would like to gratefully acknowledge the cooperation of Mr. Bruce Schutte, AIDS Public Health Educator, New York City Department of Health.     

Developing a national HIV/AIDS Prevention Program through state health departments.

The Centers for Disease Control (CDC) shaped the basic development and direction of the HIV/AIDS Prevention Program through technical support and financial assistance for State and local health departments and other organizations. Through this provision of support, CDC has responded to the course of the human immunodeficiency virus (HIV)-acquired immunodeficiency syndrome (AIDS) epidemic by creating programs to preserve the safety of the blood supply, by developing counseling and testing centers, by promoting "safer sex," by promoting health education and risk reduction, by evaluating existing services, by disseminating new technology, and by targeting new at-risk behaviors as the infection spread. Funding has also been used to respond to congressional mandates, evaluations of program effectiveness, and the National Academy of Sciences report, "Confronting AIDS: Directions for Public Health, Health Care, and Research."     

Current approaches to prevention of HIV infections.

The HIV education and prevention strategy of the Centers for Disease Control has three principal components: (a) public information and education, (b) education for school-aged populations, and (c) risk reduction education and individual counseling and testing services for people at increased risk of HIV infection. The most visible components of the public information and education programs are the National Public Information Campaign ("America Responds to AIDS"), the National AIDS Hotline system, and the National AIDS Information Clearinghouse. Components of the youth education program consist of funding for national health and education organizations, funding for State and local education departments, training, surveillance of education efforts, and evaluation. Counseling and testing has entailed performance of approximately 2,500,000 HIV antibody tests with pre- and post-test counseling, notification and counseling of sexual and needle-sharing partners of those infected with HIV, and targeted risk reduction education through community-based organizations. Over time, these activities will continue to evolve and become more effective.     

Applying the criteria for the development of health promotion and education programs to AIDS risk reduction programs for gay men

As a result of the AIDS (Acquired Immune Deficiency Syndrome) epidemic, many community health agencies are faced with the task of planning and implementing programs to prevent or reduce the risks of HIV (Human Immunodeficiency Virus) infection. Furthermore, the urgency of AIDS will force community groups to develop prevention programs prior to an analysis of substantial data relating to intervention efficacy. By using the five criteria for the development of health promotion and education programs enumerated by the American Public Health Association, planners can benefit from the experience of past health promotion initiatives, and insure a comprehensive approach to planning. The authors describe, using specific examples, how these criteria were used to develop and implement an AIDS risk reduction program for gay and bisexual men.Dr. Ronald Valdiserri is Associate Professor of Pathology and Assistant Professor of Infectious Diseases, University of Pittsburgh School of Medicine and Graduate School of Public Health. Dr. Lyter is a Research Associate, University of Pittsburgh Department of Medicine. Dr. Leviton is Assistant Professor in the Department of Health Services Administration, University of Pittsburgh Graduate School of Public Health. Mr. Kerry Stoner is Manager of the AIDS Prevention Project, and Mr. Anthony Silvestre is the Director of Community Relations for the Pitt Men's Study.The authors wish to thank the following individuals for their assistance: Mr. James Huggins; Mr. James Fauzio and Ms. Jill Hall.This research was supported by a grant from the Centers for Disease Control, DHHS, grant number U62/CCU3001060-01.     

Improving HIV/AIDS services through palliative care: An HRSA perspective

There has been a dramatic shift of the human immunodeficiency virus/acquired immunodeficiency syndrom (HIV/AIDS) epidemic into poor, marginalized, and minority communities in the US. At the same time, the availability of new highly active antiretroviral treatments has made it possible for a large number of individuals to live for a much longer time with their disease. A net result is that the US is faced with an increasing number of people who are living with HIV/AIDS and are dependent on publicly supported health care services. In this paper, we review the palliative care efforts of the federal agency, the Health Resources and Services Administration (HRSA), responsible for providing Ryan White CARE Act HIV/AIDS care to medically underserved populations. In addition to supporting traditional hospice care, HRSA's HIV/AIDS Bureau has begun a series of initiatives that apply a broader concept of palliative care to its HIV programs in hospital-and community-based settings. Our interest is not to substitute palliation for access to new HIV therapies, such as highly active antiretroviral treatments, but to ensure that our health delivery systems attend to the alleviation of symptoms and suffering along with the provision of antiretroviral and other necessary treatments. HRSA's HIV/AIDS Bureau is organizing a broader provision of palliative care for its clients and actively contributing to improving care for the disenfrachised internationally. The authors are from the HIV/AIDS Bureau, Health Resources and Services Administration, HRSA.     

The effects of an HIV project on HIV and non-HIV services at local government clinics in urban Kampala

Background

HIV/AIDS is a major public health concern in Uganda. There is widespread consensus that weak health systems hamper the effective provision of HIV/AIDS services. In recent years, the ways in which HIV/AIDS-focused programs interact with the delivery of other health services is often discussed, but the evidence as to whether HIV/AIDS programs strengthen or distort overall health services is limited. The aim of this study was to examine the effect of a PEPFAR-funded HIV/AIDS program on six government-run general clinics in Kampala.

Methods

Longitudinal information on the delivery of health services was collected at each clinic. Monthly changes in the volume of HIV and non-HIV services were analyzed by using multilevel models to examine the effect of an HIV/AIDS program on health service delivery. We also conducted a cross-sectional survey utilizing patient exit interviews to compare perceptions of the experiences of patients receiving HIV care and those receiving non-HIV care.

Results

All HIV service indicators showed a positive change after the HIV program began. In particular, the number of HIV lab tests (10.58, 95% Confidence Interval (C.I.): 5.92, 15.23) and the number of pregnant women diagnosed with HIV tests (0.52, 95%C.I.: 0.15, 0.90) increased significantly after the introduction of the project. For non-HIV/AIDS health services, TB lab tests (1.19, 95%C.I.: 0.25, 2.14) and diagnoses (0.34, 95%C.I.: 0.05, 0.64) increased significantly. Noticeable increases in trends were identified in pediatric care, including immunization (52.43, 95%C.I.: 32.42, 74.43), malaria lab tests (1.21, 95%C.I.: 0.67, 1.75), malaria diagnoses (7.10, 95%C.I.: 0.73, 13.46), and skin disease diagnoses (4.92, 95%C.I.: 2.19, 7.65). Patients’ overall impressions were positive in both the HIV and non-HIV groups, with more than 90% responding favorably about their experiences.

Conclusions

This study shows that when a collaboration is established to strengthen existing health systems, in addition to providing HIV/AIDS services in a setting in which other primary health care is being delivered, there are positive effects not only on HIV/AIDS services, but also on many other essential services. There was no evidence that the HIV program had any deleterious effects on health services offered at the clinics studied.

     

HIV counselling and testing in Nova Scotia: the provincial strategy in the context of an international debate

Nova Scotia, as a small province in Atlantic Canada, provides health care professionals and policy analysts with unique challenges for developing and implementing a strategy for accessible and acceptable HIV counselling and testing. Despite universal health care in Canada, barriers and challenges persist in relation to HIV counselling and testing programs and services in Nova Scotia. It is therefore necessary to examine the unique circumstances in the provision of programs and services in Nova Scotia prior to the possibility of adopting international HIV counselling and testing standards and guidelines being implemented in other jurisdictions. Nova Scotia's provincial strategy on HIV/AIDS promotes a harm-reduction approach for different populations in various service settings, recognizing the diverse circumstances and experiences of people living in Nova Scotia. By contrast, the Centers for Disease Control (CDC) recommended strategy promotes opt-out testing and in some instances alters the requirement of informed consent. As the Public Health Agency of Canada (PHAC) revises the national HIV counselling and testing policies, it is imperative to address the unique characteristics of Nova Scotia's provision of services, and how divergent strategies have the potential to address or compound the barriers to access that exist in this province's communities.     

Oregon eyes a hybrid reporting plan using names, codes

The Oregon Department of Human Services has decided to try tracking HIV cases with a hybrid use of names and coded identifiers. Public health workers will convert each name to a code and then the names will be purged from their databases once all necessary data are collected and the cases are connected to medical and prevention services. Since the epidemic began, the state Health Division has tracked 4,500 cases of AIDS by names without a breach of confidentiality. The next step is for the Public Health Advisory Board to review the new system. If the proposal is accepted, it will be many months before the system is up and running.     

AIDS Service Organizations and Their Presence on the Internet

Summary

AIDS service organizations have been the driving forces behind providing HIV/AIDS-positive individuals and the public with up-to-date information about the disease, treatment regimens, and prevention measures. It is critical that these organizations develop and maintain Internet sites for the rapid dissemination of information. The Internet offers the capability of providing a communication and publication means to reach a wider audience, reach greater numbers of HIV/AIDS-positive individuals, and reach even those in the most remote areas. This article discusses six major AIDS service organizations (Gay Men's Health Crisis, San Francisco AIDS Foundation, AIDS Project Los Angeles, AIDS Action Committee of Massachusetts, AID Atlanta, and the Howard Brown Clinic) and their presence on the Internet. All six organizations have made a national impact on the provision of HIV/AIDS services, programs, information, and advocacy efforts.     

Community-wide HIV counselling and testing in central Massachusetts: Who is retested and does their behavior change?

HIV counselling and testing was provided to 4267 individuals between September 1987 and June 1992 at a multi-site program, including community clinics, drug treatment programs, and a men's prison in central Massachusetts. Half of those tested reported the risk behaviors targeted by the programs: injection drug use (38.1%) and sexual contact with a drug injector (12.6%). The objectives of this study were to examine 1) factors associated with repeat HIV testing among these initially seronegative, and 2) behavior change following counselling and testing. Initially 7.4% were HIV positive, and 12.4% of those testing negative were retested within one year. Risk behavior was the only strong independent predictor of retesting (odds ratios of 3.8 and 4.2 for men reporting sex with men and recent drug injectors, respectively). Changes in risk behaviors between the time of the initial test and the second test were assessed (n = 207). Among those who continued to inject drugs at follow-up there was a reduction in the percent visiting shooting galleries (p = 0.05); no other significant behavior changes were reported. While selection bias may be responsible in part for the minimal behavior change observed, continued monitoring of risk behavior and counselling are warranted.This work was supported by the National Institute on Drug Abuse, R01-DA05615 and by grants from the Commonwealth of Massachusetts, Division of Public Health.This work was presented in part at the IX International Conference on AIDS/IV STD World Congress, Berlin, Germany, June 6–11, 1993.     

Correlates of HIV Infection Among Transfemales,San Francisco, 2010: Results From a Respondent-Driven Sampling Study

Objectives. We evaluated the use of respondent-driven sampling (RDS) among a high-risk population of transfemales. We also obtained up-to-date epidemiological data on HIV infection and related correlates among this population.Methods. We evaluated the utility of RDS in recruiting a sample of 314 transfemales in San Francisco, California, from August to December 2010 by examining patterns of recruitment and assessing network sizes and equilibrium. We used RDS weights to conduct bivariate and multivariate analyses of correlates of HIV infection.Results. The sample had moderate homophily and reached equilibrium at the eighth wave of recruitment. Weighted HIV prevalence among transfemales was 39.5%. Being a transfemale of color, using injection drugs, and having low educational attainment were independently associated with HIV infection and having a high number of sexual partners and identifying as female were not.Conclusions. RDS performed well and allowed for analyses that are generalizable to the population from which the sample was drawn. Transfemales in San Francisco are disproportionately affected by HIV compared with all other groups except men who have sex with men who also inject drugs.Over the years, many words have been coined to describe individuals born male who identify as female whether they engage in gender transition or enhancement procedures. These words have included “male-to-female transgender,” “transgender women,” and “transwomen.” In some cases, these individuals no longer label themselves as “trans” but rather label themselves solely as “female” or “women.” Furthermore, words such as “women” and “woman,” with their adult association, may alienate adolescent individuals who feel their gender is something other than the one they had at birth. A community process was undertaken in San Francisco, California, to agree on the most inclusive terms. “Transfemales” was thought to capture the spectrum of male-to-female transgender identities while also respecting trans people along the age spectrum. In this article, we have used the word “transfemales” throughout, but we should note that participants identified both as transfemales and as females.Available data on transfemales have suggested extremely high prevalence and incidence of HIV.1 A study carried out by the San Francisco Department of Public Health in 1997 found HIV prevalence among transfemales who inject drugs to be 51.4%—the highest prevalence of any population ever studied in San Francisco—and 26.4% among transfemales who were not injection drug users (IDUs).2 Analysis of voluntary counseling and testing data published in 2001 found HIV incidence to be the highest of any population measured in San Francisco at 13.2% per year among transfemale IDUs and 6.2% per year among transfemale non-IDUs.3 Studies have also shown high rates of sexually transmitted infections among transfemales, particularly gonorrhea and syphilis.4As of December 2010, 194 living AIDS cases and 123 HIV/non-AIDS cases among transfemales had been reported in San Francisco.5 Case reporting conducted by the San Francisco Department of Public Health illustrates the racial/ethnic diversity among transfemales affected by HIV/AIDS. In cumulative reported cases, 29% were White, 31% were Black, 30% were Latino, and 10% were of some other race.5 However, limitations exist to our understanding of HIV prevalence among transfemales on the basis of AIDS and HIV/non-AIDS case reporting alone. Private physicians may not always correctly record transfemales’ gender identity in medical charts, and how many transfemales are misclassified as men who have sex with men or as women is unclear. Underreporting and misclassifications may be common, thus inhibiting accurate reporting of HIV/AIDS diagnoses among transfemales.6On the basis of the available information, San Francisco’s Centers for Disease Control and Prevention–funded HIV Prevention Community Planning Group ranked the transfemale population as the highest priority for HIV prevention funding for 2004–2008.7 Despite the high priority for HIV prevention among transfemales in San Francisco, the population has not become a part of the Centers for Disease Control and Prevention’s national HIV behavioral surveillance system. Yet updated, basic epidemiological data on the prevalence and incidence of HIV among transfemales are needed to determine whether prevention strategies have worked and to plan future efforts at the local level. Unfortunately, studies among transfemales to date have limited external validity because they have primarily been based on convenience samples.1 To our knowledge, few studies have been conducted that could reliably represent the transfemale population. This omission has been understandable—obtaining representative data in hard-to-reach and often hidden populations, especially transfemales, is challenging. Although the 1997 San Francisco Department of Public Health study was rigorous in obtaining a sample size of more than 300, it did not use population-based sampling methods.2 Thus, our secondary aim was to assess the suitability of using a respondent-driving sampling (RDS) study among transfemales. In an effort to fill this gap in data and assess the use of RDS among transfemales, the San Francisco Department of Public Health conducted the Transfemales Empowered to Advance Community Health (TEACH) study to gather up-to-date and representative data on HIV prevalence, HIV incidence, and related risk behaviors among transfemales.     

A public health approach to "prevention with positives": the New York State HIV/AIDS Service Delivery System.

Prevention of new HIV infections through meeting the prevention needs of HIV-infected persons, known as "prevention with positives," is a national priority. State health departments administer complex HIV/AIDS prevention, health care, and supportive service programs and shape the context for prevention services in their states. This larger context provides opportunities for development and enhancement of HIV prevention interventions. This article presents results of an assessment conducted by the New York State Department of Health of the extent to which the New York State HIV service delivery system, conceptualized as a continuum of services, supports prevention with positives and identifies opportunities for new initiatives. The New York State service continuum offers a comprehensive yet flexible framework into which effective HIV prevention interventions and services are embedded. It is mobilized in support of meeting individuals' HIV prevention needs. The service continuum continues to evolve and requires constant attention on the part of New York State Department of Health to keep pace with the ever-changing HIV epidemic. Additional features of New York State's comprehensive approach to prevention with positives are also discussed. This simple assessment, which can be adapted for use elsewhere, was effective in pinpointing how the current service delivery system supports prevention with positives. Approaches used by state health departments to advance prevention with positives warrant support and recognition.     

What if the HIV/AIDS pandemic were an opportunity to improve the relevance of breastfeeding promotion programs in Africa?

In the 1990s, many programs and actions were set up for promoting breastfeeding in Africa, more or less successfully in different countries. The main achievements of these programs were the training of health professionals and the apparent ending of the distribution of formula in Health services. The impact of these programs on breastfeeding practices in countries with prevalent prolonged mixed feeding is less obvious, as many programs did not emphasize "best practices". Health messages delivered on this topic have been poor, because they were often conceived at the international level rather than adapted to African contexts, and because the consensus about the promotion of breastfeeding is so strong that the programs have rarely undergone a critical evaluation. The HIV/AIDS pandemic could be an opportunity to rethink these programs. "Baby friendly" Health services are now considered as the most knowledgeable to deal with breastfeeding in the context of HIV, through the reinforcement of the promotion of "best feeding practices" and through the follow-up of formula-feeding for some HIV-positive mothers. To prevent HIV transmission, health messages will have to promote some practices that are useful for HIV-negative, as well as HIV-positive, mothers, such as exclusive breastfeeding, the prevention, early diagnosis and treatment of abscesses and mastitis, and the management of weaning - all strategies that were undervalued until now. For children of HIV-positive mothers and for orphans, Health services will have to set up a medical follow-up of artificial feeding. These new goals mean that breastfeeding promotion programs will have to develop complementary strategies with an emphasis on care, coordinated with other vertical programs such as AIDS and malnutrition programs.     

HIV/AIDS among racial/ethnic minority men who have sex with men--United States, 1989-1998

In the United States, racial/ethnic minority populations account for an increasing proportion of acquired immunodeficiency syndrome (AIDS) cases, including cases among men who have sex with men (MSM) (1). This report presents recent trends in AIDS incidence and deaths among MSM who belong to racial/ethnic minority populations, and compares data on human immunodeficiency virus (HIV) diagnoses with AIDS diagnoses during 1996-1998 among racial/ethnic minority MSM in the 25 states that have conducted confidential HIV surveillance and AIDS case surveillance since 1994. The findings indicate that among MSM, non-Hispanic black and Hispanic men accounted for an increasing proportion of AIDS cases and had smaller proportionate declines in AIDS incidence and deaths from 1996 to 1998. Of HIV and AIDS diagnoses among racial/ethnic minority MSM, the proportion who are young (aged 13-24 years) is higher than among white MSM.     

Heterosexual transmission of HIV--29 states, 1999-2002

Worldwide, the majority of human immunodeficiency virus (HIV) infections result from heterosexual transmission. To characterize heterosexual transmission of HIV infections in the United States, CDC analyzed data for 1999-2002 from the 29 states that have met CDC standards for name-based HIV/acquired immunodeficiency syndrome (AIDS) reporting for > or =4 years. This report summarizes the results of that analysis, which indicated that heterosexually acquired HIV infections represented 35% of all new HIV cases; 64% of heterosexually acquired HIV infections occurred in females, and 74% occurred in non-Hispanic blacks. To decrease the number of new heterosexually acquired HIV infections, especially among certain minority populations, culturally targeted education and prevention programs should be provided, and barriers to HIV care and prevention services should be removed.