On World AIDS Day, Saturday, December 1, I’m Positive, a new documentary produced by the Kaiser Family Foundation and MTV, will introduce three young adults living with HIV. The documentary is part of a project called GYT: Get Yourself Tested, a campaign to encourage testing for STDs, including HIV. GYT is a sexual health public information partnership between the Kaiser Family Foundation and MTV.

NewPublicHealth spoke with cast member Otis Harris, who is an HIV/AIDS peer advocate who lives in Chicago.

NewPublicHealth: How old are you and how old were you when you found out that you were HIV positive?

Otis Harris Jr.: I am 25 years old and I was 22 [when I found out I was HIV positive].

NPH: What do you wish you had known then that you know now?

Otis Harris Jr.: I wish that I could have been a little more educated about the virus and what to look for and how to protect myself. And if I would have known what I know now then I probably wouldn’t have been infected.

NPH: People have been working on HIV/AIDS education efforts for so many years now, but clearly they weren’t getting through. What are the ways in which they didn’t communicate well and how can they communicate better?

The choice of Washington, D.C. as the site of the 2012 International AIDS Conference is an important one – about 3 percent of the adult and teen residents of the city are HIV positive. That exceeds the definition of an AIDS epidemic by UNAIDS – 1 percent of a population.

A new report from the Kaiser Family Foundation says that, “In many ways, the D.C. epidemic is a microcosm for what is happening nationally”: D.C. is a small, densely populated community with overlapping sexual networks that can fuel transmission, and also faces significant health care access challenges, poverty, drug use, high rates of other sexually transmitted infections, stigma and lack of knowledge about HIV status.

Blacks in D.C. have the highest HIV prevalence rates per 100,000 adults and adolescents (4,264.6)—more than twice the rate among Latinos (1,836.4) and three times the rate among whites (1,226.3). One difference is that in D.C., there is a higher prevalence of HIV among Black women (2.6%) compared with white men (2.4%).

Importantly, though, the report finds gains in HIV awareness and testing in the city. Over 100,000 HIV tests were done in DC last year, triple the number in 2007. And, according to the Kaiser Family Foundation, D.C. was the first jurisdiction to adopt CDC recommendations for routine HIV testing in health care settings and actively works with providers to expand testing. More than four in 10 D.C. residents, ages 18-64, report being tested for HIV within the past year, the highest share of any state.

>>Bonus Link: The Washington Post has been live blogging the AIDS conference this week and the site also has some notable features including an important story on the stigma of AIDS in the South and obstacles in the U.S. to successful treatment for HIV/AIDS.

The International AIDS Conference is taking place in Washington, D.C., this week, and the Kaiser Family Foundation recently released a quiz to test your knowledge of the disease. Some answers may surprise you, and quiz creators hope that increasing awareness will help reduce the burden of the disease in the United States and around the world. Stats revealed include:

• Nearly 1 in 5 people with HIV don’t know they’re infected.
• Blacks account for the greatest number of new HIV infections in the U.S. (And although Blacks make up 12 percent of the U.S. population, they accounted for 44 percent of new HIV infections in 2009.)
• Since 2006, the CDC has recommended voluntary, routine HIV testing in health care settings for all people ages 13 to 64. In addition, CDC recommends more frequent testing for certain groups at higher risk for HIV infection or transmission.

>>Bonus Link: The AIDS Memorial Quilt will be on display in Washington, D.C., during the conference, but online viewers can see the quilt, and learn its history online.

The XIX International AIDS Conference is taking place in Washington, D.C., this week at a pivotal point in the prevention and treatment of the disease. The World Health Organization on Friday recommended using antiretroviral medicines to try to prevent the infection in people who do not have HIV but are at high risk of transmission. The recommendation is based on recent research that found the drugs effective for many people. And, the International Antiviral Society has recommended treating all patients diagnosed with HIV with antiretroviral drugs, rather than waiting for levels of the virus to reach a certain point. Earlier treatment may help prevent certain diseases associated with HIV, including cancer, heart and kidney disease.

In advance of the meeting, Conference Co-Chair Diane Havlir, MD, chief of the HIV/AIDS division at San Francisco General Hospital and professor of medicine at the University of California, San Francisco, sat down with UCSF science writer Jason Bardi to talk about the pivotal research and global commitments being discussed in meeting sessions and hallway conversations in Washington, D.C., this week. Here are some key excerpts from that conversation, which originally ran on the UCSF News Center website.

Jason Bardi: What can we expect at the AIDS 2012 conference?

Dr. Havlir: Over the last couple of years, we’ve had breakthroughs in AIDS, mostly in the prevention area which include treatment as prevention, adult male circumcision having sustained benefits, pre-exposure prophylaxis, and data showing that early treatment benefits the individual. So, the big theme at AIDS 2012 is about how we begin to end the AIDS epidemic. The conference theme is “Turning the Tide Together,” and there is going to be emphasis on the how: how are we going to start to begin the end the AIDS epidemic? And there’s going to be emphasis on the together: who’s going to finance this, and what partners do we need to bring to the table? The way I like to explain it is that we need to think about the short- and medium-term strategies and the long-term strategies.

Jason Bardi: Your research group at UCSF is presenting quite a lot of research at the conference. Can you talk about some of the highlights?

Exercise May Increase Survival Rates for Some Cancer Patients

A review of 27 observational studies published between January 1950 and August 2011 finds that exercise may help improve survival for people with breast and colon cancer. The study was published in the Journal of the National Cancer Institute.

Read more on cancer.

OSHA Begins 2012 Campaign to Protect Outdoor Workers Summer Heat and Sun

The Occupational Safety and Health Administration (OSHA) has kicked off a national outreach initiative to educate workers and employers about the dangers of working outdoors in hot weather. The outreach effort builds on last year's campaign to raise awareness about the dangers of too much sun and heat.

Workers at risk include those on farms, construction workers, utility workers, baggage handlers, roofers, landscapers and anyone else who works outside. OSHA has developed heat illness educational materials in English and Spanish; a curriculum for workplace training; a dedicated website; and a free app that lets workers and supervisors monitor the heat index for a worksite. The app displays a risk level for workers based on the heat index, and worker safety information from National Oceanic and Atmospheric Administration heat alerts.

Read more on worker safety.

Johns Hopkins Establishes New Center for AIDS Research

Johns Hopkins University has been awarded $15 million over the next five years from the National Institutes of Health to establish a new Center for AIDS Research. A major priority for the new center will be to address Baltimore’s HIV epidemic. A report by the Baltimore City Health Department released last year found that despite national advances in HIV prevention and treatment, Baltimore continues to be among the top 10 urban areas in the country in HIV incidence rates.

At the end of 2009, there were 13,048 people in Baltimore living with HIV/AIDS and HIV infections were being diagnosed at a rate of almost one and a half per day. A 2006 study showed that the lifetime expense of treating each new case of HIV in Baltimore costs about $355,000. That expense, according to the Health Department’s report, “puts a significant strain on evolving health care systems, especially in a city like Baltimore with a high poverty rate.”

Read more on HIV/AIDS.

February 7, 2012 marks the 12th annual National Black HIV/AIDS Awareness Day, a national community mobilization initiative to boost HIV awareness and advance HIV prevention, testing, and treatment among blacks in the United States.

Among all racial and ethnic groups in the U.S., African Americans have the greatest burden of HIV. The Centers for Disease Control and Prevention (CDC) estimates that one in 16 black men and one in 32 black women will be diagnosed with HIV infection during their lifetimes. In 2009, blacks made up 14 percent of the U.S. population but accounted for nearly half (44 percent) of all new HIV infections. Recent CDC data shows an alarming 48 percent increase in new HIV infections from 2006 to 2009 among young, black men who have sex with men aged 13 to 29 years. Black women, according to the CDC, are far more affected by HIV than women of other races. The rate of new HIV infections for black women is more than 15 times as high as that of white women, and more than 3 times as high as that of Latino women.

The theme for 2012 is I Am My Brother's/Sister's Keeper: Fight HIV/AIDS! and is focused on making sure that all black men, women, and young adults, regardless of sexual orientation, economic class, or educational level, see themselves as part of the solution to the HIV epidemic in black communities.

Resources:

• To find a testing site call 1-800-CDC-INFO (232-4636), visit HIVtest.org, or, on your cell phone, text your zip code to KNOW IT (566948).
• Listen to a podcast from Dr. Kevin Fenton of CDC, talking about the HIV epidemic in the African American community and steps everyone can take to stop the spread of HIV.
• Get CDC information and resources on HIV and AIDS in African American and other black communities.
• Learn about HIV and AIDS, how it is and is not transmitted, the risk factors for HIV transmission, preventing transmission, and the symptoms of HIV infection.
• Join Testing Makes Us Stronger on Facebook.
• Follow TalkHIV on Twitter.
• Visit AIDS.gov for federal HIV and AIDS resources.

>>Read more about efforts to create health equity.

Kaiser Permanente, the largest nonprofit health care provider in the U.S., issued a challenge today to private health care providers and public and community health clinics to increase the number of HIV-positive people getting effective treatment by sharing Kaiser Permanente’s toolkit of clinical best practices, provider and patient education materials, mentoring, training and health IT expertise.

The HIV Challenge was announced at the Center for Medicare & Medicaid Innovation Care Innovations Summit in Washington, D.C.

Kaiser Permanente has treated more than 60,000 people with HIV in the last thirty years, and announced that it has reduced disparities among its current HIV population of more than 20,000 people by working to meet or exceed the objectives of the U.S. National HIV AIDS Strategy.

HIV clinical care outcomes announced by Kaiser Permanente include:

• HIV mortality rates that are half the national average
• More than 90 percent median treatment adherence among patients regularly in care and on antiretroviral therapy
• No disparities among its black and Latino HIV-positive patients for both mortality and medication rates, compared to a 15 percent higher rate in the United States for mortality and for medication
• Among Kaiser Permanente's HIV-positive patients, 89 percent are in HIV-specific care within 90 days—compared to 50 percent of HIV-positive patients in the U.S. getting this kind of care within one year
• Nearly 70 percent of all Kaiser Permanente's HIV-positive patients have maximal viral control, compared to 19 to 35 percent nationally

The tools being shared by Kaiser Permanente include:

• Quality improvement programs that measure gaps in care;
• Testing, prevention and treatment guidelines;
• Multi-disciplinary care team models that emphasize the medical home so HIV specialists, care managers, clinical pharmacists and providers work together; and
• Education for both the provider and patient.

Weigh In: Does your community have an HIV best practice that could improve detection and care in the U.S.? What about prevention

In a year with several milestone treatment breakthroughs, several federal agencies that provide information on HIV/AIDS are refining their sites and targeting messages for distinct audiences to increase the number of people infected with HIV who get tested and start treatment.

The numbers explain the effort. In observance of today's Worlds Aids Day, the Centers for Disease Control and Prevention released an early edition of their monthly health indicators report, Vital Signs, that shows that an estimated 1.2 million people are living with HIV in the United States. Of those, as many as 1 in 5 people don't know they have HIV. CDC recommends that all Americans between the ages of 13-64 be tested for HIV at least once as part of regular medical care. Others at greater risk (those with more than one sex partner, those who inject drugs or men who have sex with men) should get tested once a year or more, so that people who test positive for HIV can begin treatment quickly.

Toward that goal, the National Library of Medicine (NLM) has just redesigned its AIDSinfo page. Changes include:

• Two new categories: Education Materials and Mobile Resources & Tools. Users can also get one-click access to consumer resources such as the AIDSinfo HIV/AIDS Glossary and mobile applications.
• Links to key AIDSinfo fact sheets throughout the sites to improve access to critical information.
• Links to social media tools, such as Facebook and Twitter throughout the websites to make the resources accessible from any page.

NLM has also made changes to its InfoSida site, the agency’s Spanish language web page. Research by staff at NLM found that the primary audience for AIDSinfo is healthcare providers accessing medical practice guidelines, while the main users of infoSIDA are Spanish-speaking people with HIV; their family members and friends; and HIV case managers and outreach workers. Changes to infoSIDA include:

• Creating a distinct Web address for infoSIDA, which makes it easier to find through Google.
• Featuring Spanish-language Education Materials more prominently; research on the site showed that the fact sheets and the HIV/AIDS Glossary were accessed most often.

CDC has also just launched “Testing Makes Us Stronger,” a resource for black gay and bisexual men. Recent studies show that in major cities nearly one in three black gay and bisexual men is infected with HIV, and the majority (59 percent) don't know it. From 2006 to 2009, new infections in young black gay and bisexual men ages 13-29 increased by nearly 50 percent.

The campaign uses images of a diverse range of black men to get the attention of this population (see one example above). The campaign will be featured in targeted online and print media, as well as local outdoor, transit, and print media in cities experiencing high levels of HIV infection among black gay and bisexual men.

Some of the most interesting conversations overheard at the recent American Public Health Association annual meeting were among public health students discussing their plans to work in the developing world after graduation. Those plans often include a round trip ticket, says Jennifer Kates, Vice President and Director of Global Health and HIV policy at the Kaiser Family Foundation, who says overseas public health posts build skills that often come back home. CDC Director Thomas Frieden, MD, MPH, for example, worked in India for six years where he helped develop that country’s tuberculosis treatment program.

The inter-connectedness of U.S. and global health was underscored in a major address by Secretary of State Hillary Clinton last week at the National Institutes of Health. The Secretary pointed to recent, significant HIV and AIDS-related research findings and treatment advances largely spearheaded by U.S. funding and scientists. “[U.S.] efforts,” said Secretary Clinton, “have helped set the stage for a historic opportunity… to change the course of this pandemic and usher in an AIDS-free generation.”

“The Secretary’s speech was an important marker to think about in a world that has changed its response to HIV,” said Kates. “It’s a marker because of who it was, that it was a policy goal, and that has not been a goal before,” said Kates.

Among the recent advances:

• Research that shows the potential for voluntary medical male circumcision to reduce HIV incidence
• Earlier initiation of AIDS treatment to reduce the likelihood of one partner passing HIV to another, uninfected one
• Studies on the effectiveness of using vaginal microbicides to prevent infection in women
• Pre-exposure preventive treatment in heterosexual and homosexual populations

“These approaches, combined with behavioral interventions, condom access, prevention of mother-to-child transmission, syringe exchange programs, and other initiatives present the opportunity to make real progress against the epidemic, said Kevin Robert Frost, CEO of the American Foundation for AIDS Research, in response to Secretary Clinton’s address.

Secretary Clinton went on to explain exactly what she meant by an AIDS-free generation: “one where virtually no children are born with the virus; second, as these children become children and adults, they are at far lower risk of becoming infected than they would be today thanks to a wide range of prevention tools; and third, if they do acquire HIV, they have access to treatment that helps them from developing AIDS and passing the virus on to others.”

Additional advances are expected to be announced when the annual International AIDS Conference returns to the U.S. this July for the first time in 22 years. Conferences organizers decided decades ago not to allow the conference to be hosted by countries that banned entry to travelers who are HIV-positive. The U.S. ban was lifted in July 2010.

>>This continues a series of discussions around the impact of global health efforts here in the U.S. Read a related Q&A with Kaiser Family Foundation’s Jennifer Kates around the U.N. High-Level Meeting on Noncommunicable Diseases. In a Q&A with Public Health Newswire about the U.N. meeting and other topics, Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, who was a delegate at the meeting, said, “all nations need to apply what we can learn from other countries beyond our borders that are facing very similar public health challenges—and from leaders around the world who are on the vanguard of addressing the risk factors.” Read the full Public Health Newswire Q&A with Lavizzo-Mourey here.

>>Read more on global health.

A recent Centers for Disease Control and Prevention report found HIV cases stable in many populations, but, alarmingly, an almost fifty percent increase among young gay Black men between 2006 and 2009, the last year for which there is up-to-date information. Following the report, the New York Times published nine essays in its “Room for Debate” series on ways to stem the increase. One essayist, Emma DeVito, C.E.O. of Village Care, a non-profit agency in New York serving people with HIV, quotes a case worker, “Many of our guys get the message that they are not worth saving. In that context, how can we expect that they would wear a condom?”

Other contributors to the essay series include Gregorio A. Millett, a senior scientist at the CDC and previously a senior policy adviser in the White House Office of National AIDS Policy, and Chandra L. Ford, an assistant professor in the Department of Community Health Sciences at the University of California, Los Angeles.

Read the full set of essays here.