Tag Archives: HIV

What Does Our Past Tell Us About Our Future? The Essential Role of Psychologists in Fighting HIV

aidsblogphoto

(L-R) Dr. Rich Wolitski (HHS/OHAIDP); Dr. Fayth Parks (Georgia Southern University) APA Ad Hoc Committee on Psychology & AIDS (COPA) chair and symposium co-chair; Dr. Sherry Wang (Santa Clara University) COPA symposium co-chair; Ms. Cherie Mitchell (APA); Dr. Karen Ingersoll (University of Virginia); Dr. Richard Jenkins (NIH/NIDA); and Dr. Ramani Durvasula (California State University, Los Angeles)

This article is cross-posted from the HIV.gov blog with their permission.

 

By Richard Wolitski, PhD (Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services)

 

Since the early days of the HIV/AIDS epidemic, psychologists have been essential in the response to HIV:

  • They offered mental health support for people living with, or at risk for, HIV—as well as for their families and communities, and those who provide HIV medical care and social services.
  • Psychologists developed programs to educate people about HIV and motivate behavior change to reduce risk.
  • They counseled and supported those who were diagnosed, and also played important roles in working to eliminate the stigma that attaches to HIV/AIDS, sexual minority status, gender identity, substance use, and other characteristics associated with HIV infection.
  • They conducted research that gave us an understanding of cognitive, behavioral, and social determinants of health that create health disparities.

 

They continue to do all of these things, and they play a vital role as the response to HIV/AIDS continues to evolve.

This year, the professional organization for psychologists, the American Psychological Association (APA), celebrated its 125th anniversary. The APA has been deeply involved in the response to HIV/AIDS in the United States:

  • From 1996-2014, the Centers for Disease Control and Prevention (CDC) funded APA’s Behavioral and Social Science Volunteer (BSSV) Program. The program established a national network of more than 300 psychologists, sociologists, anthropologists, and public health experts who provided capacity-building technical assistance to improve the delivery and effectiveness of HIV prevention services to more than 700 organizations.
  • And from 1991-2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) funded APA’s HIV Office for Psychology Education (HOPE) Program, which trained more than 36,500 psychologists and allied mental health providers about HIV, substance use, and mental health.

 

Today, the organization continues its mission to address the ongoing toll of HIV on the mental and physical health of people living with HIV. You can view information about activities, events, and resources on the APA’s HIV webpage.

 

Dr. Arthur C. Evans, Jr. , PhD, APA’s Chief Executive Officer, expressed his support for APA’s role in this work. He shared with me that he sees psychology’s role in this way:  

Psychology plays a critical role in HIV prevention and treatment by promoting behaviors aimed at helping to improve overall health, mental health and well-being and providing a better understanding of social and cultural factors, such as stigma and culturally appropriate counseling and treatment interventions. We know that access to quality behavioral health services facilitate better outcomes across the HIV care continuum, including viral suppression.

Dr. Arthur C. Evans, Jr., PhD

 

Given the organization’s commitment and long track record of service to the HIV community, I was honored when APA asked me to be a discussant as part of the 125th Anniversary Talk, Past, Present and Future of HIV/AIDS Science and Practice in Psychology. Under the skillful direction of co-chairs Dr. Fayth Parks and Dr. Sherry Wang, the panelists addressed a number of important topics:

  • Eugene Farber, PhD, ABPP, Emory University School of Medicine, The Future of Psychology as a Health Service Discipline: Clinical Lessons from the HIV Epidemic
  • Ramani Durvasula, PhD, California State University, Los Angeles: A History of HIV/AIDS in Women: Shifting Narrative and a Structural Call to Arms
  • Karen Ingersoll, PhD, Professor of Psychiatry and Neurobehavioral Sciences at the Center for Behavioral Health & Technology, University of Virginia: Internet Intervention for HIV+ Substance Users to Improve ART Adherence and Addictive Behaviors
  • Richard Jenkins, PhD, Health Scientist Administrator, Prevention Research Branch, National Institute on Drug Abuse: Roles for Psychologists in a World of Changing Epidemics and Policies

Each of the presentations drew attention to the ways that psychologists have contributed to the fight against HIV. A key point made by all the participants is that behavioral approaches to HIV prevention, care, and treatment optimize biomedical approaches—and that the two are inextricably linked.

Dr. Eugene Barber speaking
Dr. Eugene Farber, Emory University

Dr. Gene Farber set the frame for the session by reflecting on the essential role of behavioral health service providers in supporting a humanistic, culturally responsive, and patient-centered care experience for people living with HIV. He stressed that behavioral health services must encompass not only assessment and treatment of behavioral disorders but also interventions to prevent the onset of other health conditions and to optimize biopsychosocial well-being. He also noted that psychologists can make substantial contributions to patient care and evaluation in medical settings.

Dr. Karen Ingersoll took his points a step further to show how psychologists can help individuals even when in-person contact is impossible. She is working on finding better ways to support substance users who are living with HIV—particularly those in rural areas, where HIV and other types of care are not always available and may require time away from work. These individuals are at significantly higher risk for nonadherence to their HIV medications and disengaging from care—so Dr. Ingersoll and her colleagues have developed an interactive online video intervention  that features peer role models offering advice and support to viewers. (Much like our own Positive Spin series, which takes a similar approach to supporting people living with HIV to achieve viral suppression.) This behavioral intervention is currently being tested to see if it can support substance users to take full advantage of biomedical treatment for their HIV disease.

Dr. Ramani Durvasula spoke about the need for holistic approaches to psychological care for women living with HIV. Her presentation focused on “the story of HIV in women,” which includes the multiple challenges women have faced in attempting to:

  • Get information on HIV risk;
  • Obtain an HIV diagnosis, care and treatment; and
  • Participate in HIV clinical trials.

For many women, neither biomedical or behavioral interventions were available.

Dr. Durvasula then discussed the current need for psychologists to be aware of the multiple psychosocial stressors women with HIV face (e.g., economic and caregiving burdens, relational issues, stigma, intersectional discrimination) and how they affect women’s physical health. She also emphasized the need to focus on women’s resiliencies, strengths, and growth rather than just their HIV disease. She ended with the observation that, for the future, psychology training programs should be looking at social justice and advocacy training as key to producing psychologists with the skill sets necessary for the future.

Finally, Dr. Richard Jenkins took the audience through a history of the role of psychologists in the U.S. epidemic, including a look at the ways in which the advent of antiretroviral therapy (ART) and other biomedical approaches have pushed many behavioral interventions to the margins. However, he noted that many of issues that affected people living with HIV in the early days of the epidemic persist and have not been eliminated by effective biomedical treatment, including stigma, access to care, and racial/ethnic disparities. He ended his presentation with a series of questions about how to connect psychologists to opportunities in HIV work, and raise the value of psychology for workforce development related to HIV.

As I listened to these passionate, committed professionals, I thought about the long history of the HIV/AIDS epidemic in the United States. I thought about how our early efforts, which were based on the best information we had at the time, created systems and approaches that have sometimes hampered our efforts to respond to the realities of today’s epidemic.

For example, when the first HIV test became available, we created a standalone system for HIV testing that was supported with siloed funding (meaning the funds could only be used for HIV testing—not any follow-up care or treatment). This was necessary because of the large number of people who needed to be tested and the fact that many people were unwilling to be tested by their usual healthcare providers. They didn’t want their providers to know they were at risk for infection or did not want information about their risk and their HIV test results to be recorded.

So, we set up stand-alone systems for anonymous testing—meaning your name was never attached to your HIV test. You were given a number that matched the one on the vial of blood the worker at the testing site took from you, and you had to have that number to get your results. This approach was intended to alleviate the stigma of testing—but it also meant that we were not able to set up linkages to care and treatment for newly diagnosed people.

The lack of connection with health care was further reinforced—first, by the absence of effective treatment, and, then, for almost three decades, by guidelines indicating that ART was not needed until later in the course of the infection, when damage to the immune system became clear. This history—and the fact that funding streams were established for HIV testing separately from health care—have required substantial changes to facilitate immediate linkage to care, and establishing late in the epidemic coordinated prevention, care, and treatment plans.

Another way that our past response affects our future is in the way that surveillance systems were established. Initially we were focused on AIDS. We did not know what caused it, and we focused on documenting the cases when and where they were identified and when and where the person died. We did not need to gather data to support engagement in HIV care over a lifetime. We were focused on keeping people alive for the next year (or month) and preventing new cases. This changed as we learned what caused HIV, its effects on the body and how to treat it effectively. As changes occurred, we had to start playing catch-up on the surveillance front, and we continue to wrestle with how to collect data in ways that will help us end the epidemic.

We know now that being diagnosed and beginning HIV treatment as soon as possible are essential to the health of people living with HIV. We also know that good physical health and good mental health are closely connected, and that people who feel a sense of well-being are also more likely to feel motivated to care for their bodies. That’s particularly important for people living with HIV.

Our goal is to support every person to engage in care, remain on treatment, and achieve viral suppression—and that goal can only be reached if people feel empowered to take charge of their healthcare. That is where the contributions of my colleagues at APA come in.

Even though biomedical tools are clearly the way we will ultimately win this battle against the HIV epidemic, they will not work if people do not engage in the behaviors that are needed to use them effectively. Psychologists have the training and the skills to help them do just that.


Filed under: AIDS, Health Disparities, Human Rights and Social Justice Tagged: aids, AIDS research, behavioral health, discrimination, HIV, hiv prevention, HIV treatment, mental health, stigma

Latinxs: Take Action to Stop HIV

236981006_a7e4d452b2_z

By Karen Nieves-Lugo, PhD, MPH (Postdoctoral Fellow at George Washington University)

October 15th is National Latinx AIDS Awareness Day, and this year’s theme is “We’ll Defeat AIDS con Ganas!” But why is it important to talk about acquired immunodeficiency syndrome (AIDS) in the Latino community? Latinxs are disproportionally affected by the human immunodeficiency virus (HIV)—the virus that causes AIDS. Our community represents 17% of the total U.S. population, but accounts for 21% of all new HIV infections and 21% of people living with HIV.1 In addition, research shows that Latinxs are more likely to receive late diagnosis and HIV care compared to other races and ethnicities.2

Benita Ramírez3, a Honduran activist and poet living with HIV, wrote:

I dance

the sound of the wind

lifts my hair

of my old spirit

I learned to succeed.

Drawing inspiration from the title of Benita’s poem “Triumph,” the pathway to prevent new HIV infections is early detection and treatment of the disease in order to avert heath complications. By detecting HIV early and connecting to care, people living with HIV can have better quality of life and decrease the risk of transmission of HIV by adhering to treatment. While testing and treatment are steps an individual must decide to take on their own, we as a community should provide support wherever possible. Together we can make a difference.

What kind of action can we do?

Let’s start talking about HIV with our family, partner(s), friends, peers, and neighbors. Educating ourselves about HIV–how it is transmitted, how to practice safer sex, and how to use condoms–not only prevents new infections, but also empowers Latinxs to protect themselves. It’s also important to talk about HIV prevention with our youth because they are one of the most vulnerable groups in our community. Let’s talk to our teens about the ways to have safer sex to decrease their risk of getting HIV and other sexually transmitted infections.

Fight stigma and discrimination. Negative attitudes about HIV can discourage Latinxs from seeking testing and treatment services. Some people avoid getting tested for HIV out of fear of being rejected or discriminated against. As a Latina, I know that a central value in our community is to take care of our loved ones and that should not exclude those living with HIV. Supporting your loved ones to seek testing, prevention, and treatment services is a way of honoring them and our community. If you are a leader in your neighborhood, start a dialogue about HIV and encourage your community to get tested. The support from our family, friends, peers, and community can ease the potential physical and emotional difficulties of living with HIV. By destigmatizing HIV and encouraging community members to get tested, we can make a difference in early detection and treatment. These are the most effective strategies to stop HIV in our community.

Ask to be tested for HIV. Raising our voices to get tested for HIV is an important prevention measure, even when we do not recognize having any risk factor (e.g. multiple partners, drug use, having unprotected sex). Research shows that over a third of Latinxs (36%) were tested for HIV late compared to 31% of Black and 32% of White populations4. Although receiving an HIV diagnosis is frightening, an early detection brings the opportunity to take care of ourselves preventing health complications and transmitting HIV to others.

You can talk to your healthcare provider about getting tested or visit community organizations that offer free and anonymous HIV testing.  Many of these organizations have staffs who speak English and Spanish, understand our culture, and offer information about HIV prevention and access to care regardless of your immigration status.

Take action if you are HIV positive. When living with HIV, it is important to remain in regular care. As any other chronic disease (e.g. diabetes, hypertension) having regular treatment improves the quality of life, allowing people to live longer, healthier lives. Using medication as directed by your healthcare provider is beneficial for your health and reduces the risk of HIV transmission to others.

Together we can make a difference. In 2010, President Obama signed a National HIV/AIDS Strategy that outlines the principles, priorities, and actions needed to win the battle against HIV. The goals of this plan are: reducing HIV, incidence, increasing access to care and optimizing health outcomes and reducing HIV-related health disparities5. Some of the strategies to achieve these goals are: increase HIV testing, adhere to HIV treatment and remain in care. We need to take advantage of that strategy and advocate for our community in order to fight against HIV. History has shown that when we are united as a community we can be successful, overcome obstacles, and gain respect through our work and social actions. I am confident that in this occasion we can also win the battle against HIV, stopping new HIV infections and improving the health of those Latinxs living with HIV. We have the power to change our history and make a difference in our community.

We want to hear from you – Tell us in the comments:

  • What we can do as a community to fight against HIV?
  • What do you do to encourage other Latinxs seeking testing and treatment services for HIV?
  • What tools and strategies do you have to manage being HIV positive?

Acknowledgements: Thank you to Veronica Pinho and Maria Cecilia Zea for their encouragement in the development of this blog.

Biography:

Karen Nieves-Lugo, PHD, MPH, was born and raised in Mayaguez, Puerto Rico. She obtained her doctoral degree in Psychology at the University of Puerto Rico, Rio Piedras Campus and has a master’s degree in Public Health from the University of Puerto Rico, Medical Sciences Campus. She is a postdoctoral fellow at George Washington University, Department of Psychology. Dr. Nieves-Lugo’s research focuses on health disparities, aging, sexuality, and chronic diseases specifically examining the role of cultural, psychological and behavioral factors significant to HIV/AIDS. She has worked with Latino populations in research focused on: the experiences of sexual migration among Dominican gay men; the prevalence of eating disorders and body image among Puerto Rican college men; the relationship of gender roles and sexuality in the prevention of HIV infection among Puerto Rican heterosexual men; and the psychological and behavioral factors related to adherence to HIV medication among Puerto Rican men. She is a principal investigator in a Ruth L. Kirschstein National Research Service postdoctoral fellowship (F32) award funded by the National Institute of Mental Health, where she is examining the relationship of depression and substance use (alcohol, tobacco and drug use) with physical function over time in HIV-infected veterans compared to uninfected veterans in VACS. Dr. Nieves-Lugo is a member of the District of Columbia Center for AIDS Research (CFAR), the MSM and Sexual Minorities CFAR Scientific Interest Group, the Mid-Atlantic CFAR Consortium of Latinos and HIV, the Physical Function Working Group, Veterans Aging Cohort Study, and the American Psychological Association divisions 20 and 44.

 

References:

1 Center of Disease Control and Prevention. (2016). Today’s HIV/AIDS epidemic. Retrieved from http://www.cdc.gov/nchhstp/newsroom/docs/factsheets/TodaysEpidemic-508.pdf.

2 Dennis, A. M., Napravnik, S., Seña, A. C., & Eron, J. J. (2011). Late entry to HIV care among Latinos compared with non-Latinos in a southeastern US cohort. Clinical Infectious Diseases, 53(5), 480-487.

3 Evers, L. (2010) “I´m black, I´m a woman and I am HIV positive. But I am going to make a difference”. Retrieved from https://www.trocaire.org/blogs/make-a-difference.

4 “Latinos and HIV/AIDS”. (2014, April 15). Retrieved from http://kff.org/hivaids/fact-sheet/latinos-and-hivaids/

5 “HIV/AIDS National Strategies”. (2010, July). Retrieved from https://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf


Filed under: AIDS, Culture, Ethnicity and Race, Health Disparities Tagged: aids, health disparities, HIV, hiv prevention, HIV testing, HIV treatment, HIV/AIDS research, Latina, Latino, Latinx, National Latino HIV/AIDS Awareness Day

Why Did the FDA Prevent Gay and Bisexual Men from Donating Blood in the Aftermath of Orlando?

Blood donation bag syringe needle

By Leo Rennie (Senior Legislative and Federal Affairs Officer, APA Public Interest Government Relations Office) 

 

Understanding the Controversy

 

After the horrific shooting on June 12, 2016 at Pulse, a popular gay bar in Orlando, Florida, many of the victims were in extreme need of blood transfusions. Driven by empathy and solidarity with the victims, gay and bisexual men rushed to area hospitals and blood donation centers to help, along with scores of their Orlando neighbors. Sadly, hundreds identifying as men who have sex with men (MSM) were turned away because current FDA regulations prohibit gay and bisexual men from donating blood unless they abstain from sex with other men for a full year before donating blood.

 

HIV risk depends on several factors including condom use, number of sex partners and type of sexual activity, with unprotected anal sex being the most risky. While gay men and bisexual men make up more than half of the number of persons living with HIV/AIDS in Orlando, it is individual behavior, not sexual orientation, that puts someone at risk of acquiring or transmitting HIV.

The FDA 12-month MSM deferral policy prevents healthy gay and bisexual men from donating blood solely based on their sexual orientation rather than actual risk to the blood supply. The tragic Orlando shootings have brought attention to an outdated, discriminatory and stigmatizing policy and sparked renewed calls for the FDA to end it once and for all.

 

What is the FDA MSM deferral policy?

 

According to the FDA Blood Products Advisory Committee recommendations, blood centers must follow guidelines that inherently discriminate against and stigmatize gay and bisexual men. While the guidelines prior to 2015 included a lifetime ban on all donations from MSM, the 2015 guidelines are not much better. They require that blood donors must not be a man who has had sex with a man for the past 12 months, or a woman who has had sex with an MSM in the past 12 months.

 

What’s Wrong with Current FDA Regulations on Blood Donations?

 

Beyond being discriminatory and stigmatizing towards gay and bisexual men, they perpetuate stereotypes that HIV is a “gay disease” and that gay and bisexual men are the primary carriers of communicable diseases. This type of stigma and discrimination has no scientific basis and is particularly damaging to the psyche of gay and bisexual men.

 

The policy is also obsolete. The FDA implemented the MSM deferral policy in the early days of the HIV epidemic before blood donations could be screened for HIV. HIV tests weren’t developed before 1985, putting those receiving blood transfusions at risk of HIV infection. However, modern HIV and other sexually transmitted infection testing methods are incredibly rapid.

 

Compared with older testing methods, recent testing methods can detect positive results within days of exposure, or at most, a few weeks. Today, the nation’s blood supply is incredibly safe. The risk of HIV infection via blood transfusion is low. As of December 2015, the rate of HIV infection via blood transmission was miniscule at one out of 1.47 million donation cases.

 

What Can Policymakers Do?

 

We know that the current FDA deferral policy singles out gay and bisexual men based on criteria unlikely to put those receiving blood transfusions at risk of HIV infection. The FDA should change its 2015 blood donation guidelines to end the 12-month deferral policy for gay and bisexual men once and for all, replacing it with one based on assessment of individual risk behaviors.

 

One day after the shooting, Rep. Mike Quigley (D-IL), Vice President of the Congressional LGBT Equality Caucus, led a bipartisan group of more than 1,000 members of the House of Representatives in calling on the FDA to end its discriminatory blood ban. Senators Tammy Baldwin (D-MN) and Elizabeth Warren (D-MA) led a similar charge in their chamber. Lawmakers stopped short of taking legislative action, but they strongly urged the FDA commissioner to revise the 12-month MSM deferral policy to more closely align with current science and blood screening technologies.

 

FDA should promptly report back to congressional oversight committees and, in coordination with the Department of Health and Human Services Secretary’s Office, engage public health and LGBT stakeholders in devising a policy that may defer high-risk gay and bisexual men, while permitting low-risk gay and bisexual men to donate blood.

 

We urge federal agency heads and Members of Congress to consider the impact of stigmatizing and discriminatory laws and health policies on the LGBT community, and to take steps to correct them. For example, lawmakers can support the Equality Act of 2016, a bill to prohibit discrimination based on sex, sexual orientation and gender identity. APA supports policies that decrease stigmatization and marginalization of LGBT individuals. To learn more about APA’s advocacy efforts on this topic and others, please visit the Public Interest Government Relations Office website.

 

Resources

AIDS.gov – Blood Transfusions and Organ/Tissue Transplants

FDA – Revised Recommendations for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products – Questions and Answers

GMHC – MSM Blood Ban

WHO – Blood Safety and Availability


Filed under: AIDS, LGBT Issues Tagged: aids, discrimination, FDA MSM deferral policy, HIV, HIV testing, LGBT, MSM, MSM blood ban, Orlando shootings

Why HIV Providers Should Care About the Orlando Shooting

ORLANDO2

By David J. Martin, PhD, ABPP (Senior Director, APA Office on AIDS)

In the aftermath of the mass shooting of LGBT people in an Orlando nightclub on June 12, 2016, there was a great deal of discussion concerning the shooter’s motives. Was it a hate crime? An act of terrorism? Members and allies of the LGBT community have come together to express their support for the victims and to denounce violence against LGBT people.

Although the solid links between the LGBT community and the HIV prevention and treatment communities resulted in a strong show of solidarity, there is another reason HIV care providers and educators should be concerned about the shooting and its aftermath: It is an instance of the stigma that can increase the risk of HIV transmission and reduce the ability of people with HIV to fight their disease.

Although most LGBT community members demonstrate resilience in the face of these psychosocial factors, they do take a toll. These factors have been associated with poor mental health (increased depression, anxiety, loneliness, suicide ideation/attempt), diminished self-esteem, and drug and alcohol use/misuse.  

Just as important, they can increase the risk of HIV transmission in the LGBT community. And for those living with HIV, they may diminish the body’s ability to fight HIV beyond the damage done by the virus itself:

  • In an early study, Steve Cole and his colleagues reported that gay men with HIV who concealed their sexual orientation demonstrated faster disease progression than gay men with HIV who did not conceal their sexuality.
  • In a later study, Dr. Cole and his colleagues reported that gay men with high levels of autonomic nervous system activity (ANS: a measure of stress) experienced impaired response to anti-HIV medication—their viral loads prior to starting anti-HIV medication did not drop nearly as much as those with low ANS levels.
  • In 2003, Ron Stall and his colleagues reported on the impact of psychosocial health problems (polydrug use, depression, childhood sexual abuse) on high-risk sexual behavior among gay men; they found that the more of these health problems gay men had, the higher their sexual risk. Similarly, in 2007, Brian Mustanski and his colleagues demonstrated the role of psychosocial health problems (binge drinking, street drug use, regular marijuana use, psychological distress, sexual assault, partner violence) in increasing high-risk sex, and in 2012, Ann O’Leary and her colleagues also reported similar findings. They suggested that the overall constellation of findings suggests that “cumulative adverse psychosocial health conditions of any sort seem to exert their negative effects on HIV risk and infection.” Dr. O’Leary and her colleagues also found that optimism and education lessened (but did not eliminate) these effects.

The Orlando mass shooting is another manifestation of the multiple psychosocial insults that still confront the LGBT community. The recent findings cited here (and others) suggest that, in addition to their impact on the mental health of the LGBT community, these insults contribute to increased risk for HIV and diminished physical health among people with HIV.  For these reasons, HIV providers need to continue partnering with their LGBT allies in confronting anti-LGBT bias and discrimination.

You can visit the American Psychological Association’s Office on AIDS website for information on psychology and HIV.  While there, you can also read the Resolution Opposing HIV Criminalization recently passed by the APA Council of Representatives. The Psychology and AIDS Exchange is a topical newsletter on emerging HIV-related issues.

Image source: Flickr user Ashley Van Haeften via Creative Commons


Filed under: AIDS, LGBT Issues Tagged: aids, discrimination, HIV, hiv prevention, HIV risk, HIV/AIDS research, homophobia, LGBT, Orlando shootings, prejudice, stigma

PrEP: One Essential Tool in the HIV Prevention Toolkit

blog-nhtd2

June 27 is National HIV Testing Day. The Centers for Disease Control and Prevention recommend that all patients seen in healthcare settings be tested for HIV, and that people at highest risk should be screened for HIV at least annually.  These recommendations are intended to help people who don’t know they have HIV get treatment.  For those who are screened and test negative there are different things they can do to stay HIV negative.  Steven Shoptaw, PhD, describes one method that may be useful for those at highest risk.

By Steven Shoptaw, PhD (Center for HIV Identification, Prevention, and Treatment Services (CHIPTS), UCLA

For those who are at high risk for HIV infection, there’s a medical approach that reduces risks of contracting HIV dramatically. It’s called pre-exposure prophylaxis or PrEP.  PrEP uses antiretroviral medication (usually Truvada™, a two-drug combination of tenofovir and emtricitabine) to help HIV-negative people stay negative, even if they have sex without a condom with partners whose HIV status is either positive or unknown.

In this case, “high risk” is defined as having one or more sexual partners known to have HIV. It can also mean having sex where there is a high prevalence of HIV plus one or more of these risks:

  • Inconsistent or no condom use
  • Having sexual transmitted infections
  • Exchanging sex for money, food, shelter, drugs
  • Illicit drug use or alcohol dependence
  • Incarceration
  • Partners of unknown HIV status with any of the above risks.

PrEP using Truvada™ is approved for men who have sex with men, transgender individuals, for adult heterosexually active men and women and for injection drug users at substantial risk of HIV acquisition.

This is a significant advance in protecting the health of gay and bisexual men, men who have sex with men but don’t identify as gay, and transgender individuals. It brings sexual health for men into the domain of primary healthcare.

If you’re taking PrEP, it’s totally under your control—you don’t have to rely on someone else to put on a condom or to be truthful about his status. It echoes the ways that putting oral contraceptives into women’s hands brought women’s sexual health into primary healthcare.

For men who take PrEP as prescribed (daily or at least more than 4 doses per week), the risk for HIV infection decreases by more than 90%! But some people forget to take their medicine, raising the question, “What happens when a dose or two is missed?” One or two missed doses are not a big problem as long as you regularly take 4 or more doses each week. No infections have been reported for men who take 4 or more doses per week.

One possible exception was recently reported:  A gay man who was taking oral daily Truvada™ became HIV infected because one of his partners was HIV-positive and was inconsistent with his own HIV antiretroviral therapy.  Because the partner wasn’t following his PrEP regimen as instructed, the virus mutated and became resistant to several anti-HIV medications, including Truvada™. This happens very rarely, but it does confirm clinicians’ fears that not taking HIV medications as instructed can cause development of HIV that is resistant even to Truvada™. Consistency is key when it comes to PrEP.

Many, maybe even most, men at risk of HIV can take Truvada™ as recommended. But there are some important barriers that interfere with taking PrEP consistently.

  • Not having a regular place to live. Taking a pill every day requires consistent access to the essentials of good health, including a regular place to sleep and eating regular meals.
  • Lack of healthcare access. You have to go to a clinic or see a physician to get PrEP. Men—especially men of color—are not encouraged to seek healthcare, and in some parts of the United States, it is hard to get healthcare.
  • Stigma. Physicians may feel uncomfortable discussing sexual behavior, especially when it comes to men having sex with other men. Some may be unwilling to prescribe PrEP to men because they don’t approve of sex between men. Others may refuse to prescribe Truvada™ for HIV-negative men because its original use was to treat people with HIV. For some considering whether or not to take PrEP, concerns over embarrassment or harsh judgment from others can be a barrier.
  • Side effects. All medications have side effects; common ones for Truvada™ include mild gastrointestinal upset, nausea, and bloating. These usually go away once your body gets used to the drug. But there are also uncommon side effects that may be serious, including kidney damage. That’s why men starting PrEP with Truvada™ should have their kidney function tested before taking any pills. Truvada™ also causes bone mineral density loss, but this does not increase your risk for broken bones and it is reversed when you stop taking the drug. While risks for side effects are mild, it’s useful to discuss your own personal benefits relative to the risks with your medical provider.

Are you thinking about starting PrEP? Consult your physician and other people you trust. The decision to take PrEP should balance the risks of taking it against its benefits. For instance, most men don’t live their lives consistently having sex without a condom with multiple partners whose HIV status they don’t know.  Instead, many men experience “seasons of risk” in their sexual lives, when the potential for encountering HIV during sex is higher at some times and lower at others.

During periods of low or no risk, men might stop taking PrEP. One drawback to this common behavior is that you can’t always anticipate when sex without a condom will happen. If you do have unexpected condomless sex, you can start post exposure prophylaxis. This is a 28-day regimen of antiretroviral medications after possible HIV exposure. But for PrEP to work before you engage in sex, you have to take it for at least a week for the medication to start protecting you. PrEP is not for everyone at risk for HIV infection, but it does offer a lot of promise to men who are willing to use it to help them to stay HIV negative. Over time, as more men and transgender individuals at risk use it, PrEP could help turn the tide of growing HIV infections – improving the health and welfare of countless others.

The American Psychological Association recognizes the importance of PrEP, and supports combined biomedical and behavioral approaches to optimize HIV prevention. You can also find out more about taking PrEP at Whatisprep.org. For more information about APA’s work on HIV, please visit the APA Office on AIDS website.

Biography:

Steve Shoptaw, PhD, is a licensed psychologist and Professor in the UCLA Departments of Family Medicine and Psychiatry and Biobehavioral Sciences. Dr. Shoptaw joined the Department of Family Medicine as full professor in 2005. Prior to this, Dr. Shoptaw was a Research Psychologist with the Integrated Substance Abuse Program in the Dept. of Psychiatry & Behavioral Science since 2003. Dr. Shoptaw earned his BA (1982) in Psychology and MA (1985) and Ph.D. (1990) in Psychology at UCLA. His dissertation was nominated for the Gingerelli Award for Excellence in the Department of Psychology. Dr. Shoptaw completed his postdoctoral training in Psychophysiology at the UCLA NPI/VAMC in Sepulveda, CA in 1991.

Following that, Dr. Shoptaw worked for 10 years as a Principal Investigator with Friends Research Institute, Inc., during which time, his program of clinical research with substance abusers supported opening several treatment research clinics in Rancho Cucamonga, Hollywood, South Los Angeles, and West Hollywood. Dr. Shoptaw received the FRI Daniel Mendelsohn Young Investigator Award in 1996 and a mentoring award in 2000. In 1996, Dr. Shoptaw opened Safe House, a 24 bed facility that provides emergency, transitional and permanent housing to persons living with HIV/AIDS, chemical dependency, transitional and permanent housing to persons living with HIV/AIDS, chemical dependency, and mental illness who are homeless or at risk for homelessness. He continues with this program as a volunteer Executive Director. These linkages of clinical research and community collaboration have led Dr. Shoptaw’s work to influence practice guidelines in intervening with substance abusers, especially those at high risk for HIV transmission, locally, nationally and in emerging international epidemics.


Filed under: AIDS Tagged: aids, antiretrovirals, HIV, HIV testing, National HIV Testing Day, pre-exposure prophylaxis, PrEP, Truvada

Health and Healthcare Injustice: Why We Really Should Care About HIV Disparities

red aids ribbon in hand.

By Alyssa Arentoft, PhD (California State University, Northridge) & Monica Rivera Mindt, PhD (Fordham University & Icahn School of Medicine at Mount Sinai)

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” – Dr. Martin Luther King, Jr.

Perhaps nowhere are health and healthcare inequities so glaring as in HIV.

In the early years of the HIV epidemic, when we knew little about the virus and no viable treatment existed, HIV was viewed as a death sentence. During the 1990s and early 2000s, advances in medical and pharmacological treatment transformed HIV into a chronic, long-term condition. Concerns have now shifted from simply surviving HIV to living and hopefully thriving with the virus.

Much has changed since HIV first gripped the nation. Sadly, one thing remains constant—HIV continues to take its largest toll on our society’s most vulnerable, resulting in pervasive health and healthcare disparities.

So, what are health and healthcare disparities?

A health disparity exists when a particular group of people is more significantly affected by a condition than the general public.

“Affected” can mean:

  • Having higher rates of the condition, or
  • Having worse outcomes as a result of the condition, such as higher rates of medical complications, disability, or death.

A healthcare disparity refers to differences at the service level, such as access to healthcare coverage and medical treatment, as well as the quality of those services.

What health and healthcare disparities exist in HIV?

Prominent health disparities exist among:

  • African Americans
  • Hispanics/Latinos
  • Men who have sex with men (MSM)
  • Transgender people
  • People from low-income backgrounds

HIV+ individuals from these groups experience the following health and healthcare disparities:

  • Higher rates of HIV infection. For example, African Americans comprise 12% of the U.S. population, yet 41% of the HIV+ population. Latinos comprise 16% of the U.S. population, yet 21% of the HIV+ population.
  • Delayed HIV diagnosis
  • Less access to medical treatment for HIV
  • Lower quality healthcare
  • Lower likelihood of being prescribed HIV medication
  • Higher rates of death and disability
  • Worse cognitive or neurological outcomes

Why is this important?

By nature, health and healthcare disparities reflect injustices in our society, and those injustices can and should be remedied. As wage gaps widen and our population becomes increasingly diverse, these inequities will affect even more citizens.

From a social justice perspective, we must right these wrongs and protect the most vulnerable. From a health and economic perspective, the cost of not doing so is too great—if injustice is not ended, we all pay the price.

What do we need to do?

HIV has long been shrouded in stigma and HIV+ individuals often face discrimination. Therefore, we need to continue to:

  • Make efforts to de-stigmatize HIV and its treatment
  • Examine the complex relationship between these inequities and social, economic, environmental, cultural, and structural factors
  • Protect those at greater risk of contracting HIV
  • Identify and remove barriers to quality healthcare for those who become HIV+

We have a long way to go to eliminate these inequities in HIV, but we are making progress in reducing them.

Find out more about key initiatives such as the National HIV/AIDS Prevention Strategy (NHAS) and CDC’s Enhanced Comprehensive HIV Prevention Planning project (ECHPP).

Act Against AIDS is a CDC-sponsored website that lists different programs you can get involved in to help in the fight against AIDS.

To find out what APA is doing about HIV, visit the Office on AIDS webpage.

Humanity’s greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity” – Bill Gates

 

Biographies:

Alyssa Arentoft, PhD, is an Assistant Professor of Psychology at California State University, Northridge. Her research explores brain-behavior relationships in disease states using a biopsychosociocultural framework. She is particularly interested in health disparities and health-related outcomes among underrepresented and disenfranchised populations. Her current work is focused on individuals with HIV/AIDS. Ongoing projects in this area include an NIMH-funded study examining longitudinal changes in the brain among HIV+ individuals as a function of HIV antiretroviral medication. Differences in healthcare quality between non-Hispanic white and African American participants, as well as factors associated with these differences, are also being examined.

Monica Rivera Mindt, PhD, is a Professor and Director of Clinical Training in the Department of Psychology at Fordham University. She also serves as Professor in the Departments of Neurology and Psychiatry at the Icahn School of Medicine at Mount Sinai. She is a board certified clinical neuropsychologist. Her interests are in a variety of neurological disorders, particularly neurodegenerative disorders such as HIV/AIDS. Over the past few years, she has conducted numerous neuropsychological evaluations within her private practice with a variety of populations, including traumatic brain injury, dementia, Spanish-speakers, and others. Her primary projects at this time include a study of the neurocognitive and sociocultural aspects of antiretroviral adherence among HIV+ Latino/a adults, as well as a study examining the neurocognitive effects of opiate replacement therapies among HIV+ and HIV- opiate users. Dr. Rivera Mindt also serves as a co-investigator on a multi-site study of the CNS effects of HIV in the era of combined antiretroviral therapy. She is also investigating the sociocultural aspects of neurocognitive test performance.


Filed under: AIDS, Health Disparities, Human Rights and Social Justice Tagged: aids, health care, health disparities, health equity, HIV, poverty, public policy, social justice

Health and Healthcare Injustice: Why We Really Should Care About HIV Disparities

red aids ribbon in hand.

By Alyssa Arentoft, PhD (California State University, Northridge) & Monica Rivera Mindt, PhD (Fordham University & Icahn School of Medicine at Mount Sinai)

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” – Dr. Martin Luther King, Jr.

Perhaps nowhere are health and healthcare inequities so glaring as in HIV.

In the early years of the HIV epidemic, when we knew little about the virus and no viable treatment existed, HIV was viewed as a death sentence. During the 1990s and early 2000s, advances in medical and pharmacological treatment transformed HIV into a chronic, long-term condition. Concerns have now shifted from simply surviving HIV to living and hopefully thriving with the virus.

Much has changed since HIV first gripped the nation. Sadly, one thing remains constant—HIV continues to take its largest toll on our society’s most vulnerable, resulting in pervasive health and healthcare disparities.

So, what are health and healthcare disparities?

A health disparity exists when a particular group of people is more significantly affected by a condition than the general public.

“Affected” can mean:

  • Having higher rates of the condition, or
  • Having worse outcomes as a result of the condition, such as higher rates of medical complications, disability, or death.

A healthcare disparity refers to differences at the service level, such as access to healthcare coverage and medical treatment, as well as the quality of those services.

What health and healthcare disparities exist in HIV?

Prominent health disparities exist among:

  • African Americans
  • Hispanics/Latinos
  • Men who have sex with men (MSM)
  • Transgender people
  • People from low-income backgrounds

HIV+ individuals from these groups experience the following health and healthcare disparities:

  • Higher rates of HIV infection. For example, African Americans comprise 12% of the U.S. population, yet 41% of the HIV+ population. Latinos comprise 16% of the U.S. population, yet 21% of the HIV+ population.
  • Delayed HIV diagnosis
  • Less access to medical treatment for HIV
  • Lower quality healthcare
  • Lower likelihood of being prescribed HIV medication
  • Higher rates of death and disability
  • Worse cognitive or neurological outcomes

Why is this important?

By nature, health and healthcare disparities reflect injustices in our society, and those injustices can and should be remedied. As wage gaps widen and our population becomes increasingly diverse, these inequities will affect even more citizens.

From a social justice perspective, we must right these wrongs and protect the most vulnerable. From a health and economic perspective, the cost of not doing so is too great—if injustice is not ended, we all pay the price.

What do we need to do?

HIV has long been shrouded in stigma and HIV+ individuals often face discrimination. Therefore, we need to continue to:

  • Make efforts to de-stigmatize HIV and its treatment
  • Examine the complex relationship between these inequities and social, economic, environmental, cultural, and structural factors
  • Protect those at greater risk of contracting HIV
  • Identify and remove barriers to quality healthcare for those who become HIV+

We have a long way to go to eliminate these inequities in HIV, but we are making progress in reducing them.

Find out more about key initiatives such as the National HIV/AIDS Prevention Strategy (NHAS) and CDC’s Enhanced Comprehensive HIV Prevention Planning project (ECHPP).

Act Against AIDS is a CDC-sponsored website that lists different programs you can get involved in to help in the fight against AIDS.

To find out what APA is doing about HIV, visit the Office on AIDS webpage.

Humanity’s greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity” – Bill Gates

 

Biographies:

Alyssa Arentoft, PhD, is an Assistant Professor of Psychology at California State University, Northridge. Her research explores brain-behavior relationships in disease states using a biopsychosociocultural framework. She is particularly interested in health disparities and health-related outcomes among underrepresented and disenfranchised populations. Her current work is focused on individuals with HIV/AIDS. Ongoing projects in this area include an NIMH-funded study examining longitudinal changes in the brain among HIV+ individuals as a function of HIV antiretroviral medication. Differences in healthcare quality between non-Hispanic white and African American participants, as well as factors associated with these differences, are also being examined.

Monica Rivera Mindt, PhD, is a Professor and Director of Clinical Training in the Department of Psychology at Fordham University. She also serves as Professor in the Departments of Neurology and Psychiatry at the Icahn School of Medicine at Mount Sinai. She is a board certified clinical neuropsychologist. Her interests are in a variety of neurological disorders, particularly neurodegenerative disorders such as HIV/AIDS. Over the past few years, she has conducted numerous neuropsychological evaluations within her private practice with a variety of populations, including traumatic brain injury, dementia, Spanish-speakers, and others. Her primary projects at this time include a study of the neurocognitive and sociocultural aspects of antiretroviral adherence among HIV+ Latino/a adults, as well as a study examining the neurocognitive effects of opiate replacement therapies among HIV+ and HIV- opiate users. Dr. Rivera Mindt also serves as a co-investigator on a multi-site study of the CNS effects of HIV in the era of combined antiretroviral therapy. She is also investigating the sociocultural aspects of neurocognitive test performance.


Filed under: AIDS, Health Disparities, Human Rights and Social Justice Tagged: aids, health care, health disparities, health equity, HIV, poverty, public policy, social justice

Why Does HIV Impact African American Women Harder Than Everyone Else and What Can You Do to Help?

Professional black woman under cherry blossoms

By Leo Rennie, MPA (Senior Legislative & Federal Affairs Officer, APA Public Interest)

 

February 7th marked the annual observance of National Black HIV/AIDS Awareness Day. The day is an opportunity to raise awareness about HIV and AIDS and to promote HIV testing in the Black community.  Sadly, 35 years into the HIV epidemic the need for education and community mobilization remains significant.  Nearly half of the 50,000 people who become newly infected with HIV in the United States each year are Black. HIV-related disparities among Black women are even more striking. In 2014, the rate of HIV diagnosis of Black women was 18 times the rate of white women and 5 times that of Hispanic women.  

 

What puts Black women at higher risk for HIV infection? 

 

Black women make up the majority of women living with HIV in the United States. Most become infected through heterosexual sex. Sometimes they may be unaware of their male partner’s HIV-positive status and/or his risk factors for HIV infections (such as injection drug use or having sex with other men). Lack of access to preventive health screenings, quality mental and physical health care, including reproductive health and substance use services, and other health related factors such as untreated sexually transmitted infections play a role. Intimate partner violence (IPV) is another major risk factor for HIV transmission. It impedes women from seeking, accessing and staying in care or taking their medications. A White House interagency task force studied this problem and issued recommendations that resulted in new grant programs and federal initiatives to address the challenge of sexual violence.

 

What can be done about prevention and treatment?

 

Few female-controlled HIV prevention options are available. That is why organizations dedicated to promoting Black women’s health are raising awareness about pre-exposure prophylaxis or PrEP. PrEP is the daily use of anti-retroviral HIV drugs to prevent HIV transmission. While PrEP can be up to 99 percent effective when taken as prescribed, in clinical research women have encountered challenges to taking the drug every day as required. Community perceptions about PrEP and stigma impacted women’s adherence to PrEP in studies.  As health care providers and advocates promote PrEP to women, messages must emphasize that adherence is critical.  Women must receive supports, if needed, once they make the decision to start PrEP. This may mean providing them with regular counseling or mental health treatment, or even day care and transportation services so that they can get to doctors’ appointments.

 

When people living with HIV reach viral suppression, they have very low levels of HIV in their bodies. They can live normal life spans and are less likely to transmit HIV to others. But only 28 percent of HIV-positive Black Americans are virally suppressed. Effective medical intervention to prevent and treat HIV depends on behavioral, social, economic, and political factors. Integrated mental and physical health care tailored for Black women, coupled with essential social services and support, not only are necessary for biomedical tools like PrEP to be effective, but are also required if women are to learn their HIV status through HIV testing, seek and stay in medical treatment, and adhere to antiretroviral treatment (ART).

 

What can you do to help?

 

  • Learn more by visiting the APA Office on AIDS . The office provides useful information you can share with friends, relatives, and loved ones.
  • Sign-up for our Federal Action Network to receive updates on APA’s important public policy advocacy efforts in Congress and with federal agencies to expand HIV prevention and care options for women.  Psychologists and other mental health professions are well suited to destigmatize  HIV infection at individual, community, and societal levels, thereby making prevention and treatment of HIV safe and  routine.
  • But most importantly get tested for HIV. Knowing your status is the first step to keeping you and your partner healthy. To find a testing site near you, visit Get Tested, text your ZIP code to KNOWIT (566948), or call 1-800-CDC-INFO (232-4636).

 

For  more information visit:

 

AIDS.gov

CDC – National Black HIV/AIDS Awareness Day

 

 


Filed under: AIDS, Health Disparities, Women and Girls Tagged: african american, african american women, aids, Black, Black women, HIV, intimate partner violence, National Black HIV/AIDS Awareness Day, NBHAAD, PrEP, public health, public policy

7 Ways in Which Charlie Sheen Is the Same as Everyone With HIV

step0001

iStock.com/Photo by Kevin Winter/Getty Images.

By David Martin, PhD, ABPP (Senior Director, APA Office on AIDS)

Charlie Sheen revealed in an interview with Matt Lauer on the TODAY show on November 17, 2015 that he has HIV.  Mr. Sheen is very well-known, and different from many, if not most, people with HIV in many ways—he’s rich, he’s famous, and he’s White, among others.  But I can think of at least seven ways in which he is just like most people with HIV.

1. Charlie Sheen didn’t know he had HIV. He only found out when he was sick and in the hospital and after a number of medical tests.

Today, almost one in eight of the people living with HIV in the United States don’t know they have HIV because they haven’t been tested.

You don’t have to wait until you’re sick to be tested for HIV.  The CDC recommends that all people seen in health care settings be tested for HIV routinely, and that people at high risk for HIV be tested at least every year:  If you have sex with partners you don’t know and you don’t use condoms, or if you inject drugs, you should be tested every year.  AIDS.gov has an HIV testing site locator you can use to find a place where you can get tested at no charge, in addition to other HIV-related services.

2. His emotional reaction to finding out he had HIV ranged from depression and anxiety to shame, anger, fear, and hopelessness: “It’s a hard three letters to absorb.”

Many, if not most, people who test positive for HIV have exactly these emotions, and they can last for months or even years.

3. He used drugs and alcohol to cope with his HIV infection, and they impaired his judgment.

Drug and alcohol use are common among people with HIV, frequently in response to the depression and anxiety that accompany an HIV positive status.Many people with HIV seek treatment for their depression, anxiety, and substance use. If you have HIV and you are depressed or anxious, seeking help is perfectly OK. Quitting or cutting down on alcohol or drug use is hard. You shouldn’t be ashamed to seek help if you want to stop or reduce your use of alcohol or drugs. The Substance Abuse and Mental Health Services Administration has a Behavioral Health Treatment Services Locator you can use to find local resources.

4. He was afraid of what would happen if other people found out he had HIV.

In fact, when he did tell people he thought he could trust, some demanded money to keep his secret—he faced betrayal when he needed compassion and acceptance. In many ways Mr. Sheen’s experience embodies the fear that prevents many people from telling others about their HIV status: They are ashamed of their HIV, and they may be afraid of rejection or that those they do tell will tell someone else. Hiding something you are ashamed of can be harmful.

5. He needed intimacy and sex.

Most people want emotional and sexual intimacy, and people with HIV are no different.

6. He’s taking his medication as prescribed.

As his doctor noted when asked, because he has been taking his medication faithfully, he can expect to live a long and productive life.  People who have HIV, who are in treatment, and who consistently take their medication as prescribed can be expected to live lives almost as long as they would if they didn’t have HIV.  They are also far less likely to give HIV to their sex partners.

7. He sees his HIV infection as a “turning point.”

Many people with HIV come to view their HIV disease as a “catalyst for growth,” a chance to rearrange priorities. For example some people leave jobs they see as meaningless to take jobs that give meaning to their lives, and many have devoted their lives to preventing HIV and to helping others with HIV.  You can read the personal stories of people living with HIV here.

It would be easy to condemn Mr. Sheen for behaviors that may have led to his HIV status (after all, he’s an easy person not to like). This is not the time for that—in fact I’m not sure there is a right time for that.  Most people with HIV are painfully aware of the behaviors that led to their HIV status. Reminding them doesn’t change their HIV, and if they’re trying to change it may actually get in the way.  This is a time to recognize his humanity.  I thank and commend Mr. Sheen for his courage in publicly disclosing his HIV status, and I wish him well in his continued recovery.  I hope we can all learn from his experience.

You can visit the American Psychological Association’s Office on AIDS website for information on psychology and HIV. You can also read an interview with Perry Halkitis, a respected HIV/AIDS researcher at New York University on Surviving the AIDS Epidemic conducted at the American Psychological Association.


Filed under: AIDS, Culture, Health and Wellness Tagged: HIV