Why 3 in 10 People with Diabetes Don’t Know They Have It

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The surprising similarities between diabetes and HIV/AIDS

New research on diabetes suggests that nearly 30% of adults with diabetes remain undiagnosed—the same rate as people with HIV. And just like many HIV patients, only about 20% of diabetes patients are treated satisfactorily, finds the new study published in the Annals of Internal Medicine.

The study used the cascade of care method, which aggregates data on people’s treatment for a particular disease and has been used to guide treatment of HIV/AIDS. Study leaders say that the new diabetes research is the first time the method has been applied to another disease.

The research found a lot of similarities between the two diseases and how they’re managed. To start, the consequences can be grave for patients who don’t receive treatment for either disease. HIV/AIDS weakens the immune system and allows patients to develop other ailments, while diabetes can lead to problems with the kidney, heart and brain. Researchers showed where people with diabetes fall through the cracks on the path from the onset of a condition to the development of other serious illnesses. Millions aren’t diagnosed, more than a million people haven’t been to the doctor in years despite a diagnosis and millions of others don’t take the proper medication.

“As health care systems move from fee-for-service to fee-for-quality, something like the cascade can really aid in that shift and help both providers and patients be more motivated and spot the gaps and close the gaps in care,” said study co-author Mohammed Ali, an assistant professor at Emory University. Incentives could encourage both patients and health care providers to screen and then treat diabetes.

“They’re extremely similar because they both require patients to be extremely proactive in managing their own condition,” said Ali, specifically citing diet, exercise and taking medication. “If you’re a good patient, you’re actually going to prevent a lot of those diseases that come with diabetes and a lot of those bad outcomes that come with HIV.”

As electronic records make it easier for doctors to look at large sets of data, the cascade-of-care method has potential to aid in understanding where the health system has failed at treating diseases, Ali said.

“This should be easy to do for anything,” he said.

In the United States, the estimated number of persons aged ≥13 years living with HIV infection, including those whose infection had not been diagnosed, increased from 420,153 in 1985 to 1,178,250 in 2008 (Figure). HIV prevalence increased by an estimated 55.4% between 1996 (758,283), when highly active antiretroviral therapy became widely available in the United States, and 2008. Although the estimated percentage of undiagnosed HIV infections has decreased substantially, from 87.9% in 1985 to 20.1% in 2008, the percentage persisted at approximately 20% from 2004 to 2008.

The majority of the 1,178,250 persons aged ≥13 years living with HIV infection at the end of 2008 were male (75%), racial/ethnic minorities (66%), and aged 35–54 years (63%) (Table 1). MSM represented 66% of the 883,300 males estimated to be living with HIV infection, and black or African American females represented 64% of the 294,800 females. At the end of 2008, a total of 2,536.1 per 100,000 black or African American males and 897.3 per 100,000 Hispanic or Latino males were living with HIV infection, compared with 419.4 per 100,000 white males. Correspondingly, the rate of HIV prevalence among black or African American females (1,184.9 per 100,000) and Hispanic or Latino females (263.1 per 100,000) were 18 times and 4 times the rate among white females (66.4 per 100,000), respectively. Compared with the overall 20.1% undiagnosed HIV infection prevalence, greater percentages of undiagnosed HIV infection were observed among persons aged <35 years (13–24 years: 58.9%; 25–34 years: 31.5%), black or African American MSM (25.7%), men with high-risk heterosexual contact (24.9%), American Indians or Alaska Natives (25.0%), and Asians or Pacific Islanders (25.9%). The prevalence rate of undiagnosed HIV infection was highest among black or African American males (570.7 per 100,000), black or African American females (228.8 per 100,000), and Hispanic or Latino males (177.8 per 100,000) and lowest among Asian or Pacific Islander females (12.6 per 100,000) and white females (10.9 per 100,000).

The type of facility of initial diagnosis was known for 32,647 (78.1%) of the estimated 41,768 persons aged ≥13 years whose HIV infection was diagnosed in 2008 in the 40 states (Table 2). The majority (74.3%) of diagnoses occurred in a clinical setting, almost one fourth each in an acute care setting (24.8%) and at a private doctor’s office or health maintenance organization (HMO) (24.3%). The probability of initial diagnosis in an acute care setting was significantly higher among persons aged ≥55 years at diagnosis compared with persons aged 35–44 years (55–64 years: prevalence ratio [PR] =1.22, 95% CI = 1.15–1.29; ≥65 years: PR = 1.39, 95% CI = 1.28–1.51), blacks or African Americans (PR = 1.21, 95% CI = 1.15–1.26), and Hispanics or Latinos (PR = 1.17, 95% CI = 1.10–1.23) compared with whites, persons with a history of injection drug use compared with MSM (PR = 1.36, 95% CI = 1.29–1.44), and late testers compared with persons who were not late testers (PR = 2.53, 95% CI = 2.43–2.63).

 

Conclusion

HIV diminishes quality of life and productivity, increases the number of preventable deaths, and increases health-care expenditures. Based on the estimated incidence of HIV infection in 2009 (1) and the adjusted lifetime cost of HIV care in the United States to reflect 2010 U.S. dollars (18), CDC estimates that the total cost for treating HIV infection in the United States is $18.3 billion per year. To reduce the number of new HIV infections and thereby the ultimate cost of HIV, the National HIV/AIDS Strategy intends to increase 1) the percentage of persons living with HIV infection who know their serostatus to 90%; 2) the percentage of persons with a new HIV diagnosis who are linked into clinical care within 3 months of their diagnosis to 85%; 3) the percentage of Ryan White HIV/AIDS program (19) clients who are in continuous care to 80%; and 4) the percentage of HIV-diagnosed MSM, blacks or African Americans, and Hispanics or Latinos with undetectable viral load by 20% by 2015. These targets will not be met without the expansion of HIV prevention and intervention service delivery in health care. Only by combining expertise and efforts can public health professionals and health-care providers ensure greater public awareness of HIV infection and risk reduction, eliminate HIV-related stigma and discrimination, expand opportunities for HIV testing, increase the frequency of testing in high-risk populations, and establish a seamless prevention, intervention, care, and treatment infrastructure through which every HIV-infected person is able to receive the right care and support at the right time.

 

WORLD AIDS DAY 2014

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The effectiveness of microbicides that target HIV directly impaired by semen

In the fight against HIV, microbicides – chemical compounds that can be applied topically to the female genital tract to protect against sexually transmitted infections – have been touted as an effective alternative to condoms. However, while these compounds are successful at preventing transmission of the virus in a petri dish, clinical trials using microbicides have largely failed. A new study from the Gladstone Institutes and the University of Ulm now reveals that this discrepancy may be due to the primary mode of transportation of the virus during sexual transmission, semen.

“We think this may be one of the factors explaining why so many drugs that efficiently blocked HIV infection in laboratory experiments did not work in a real world setting,” explains co-first author Nadia Roan, PhD, a visiting scientist at Gladstone and an assistant professor-in-residence in the Department of Urology at the University of California, San Francisco. “We’ve shown previously that semen enhances HIV infection, but this is the first time we’ve shown that this activity markedly reduces the antiviral efficacy of microbicides.”

Semen markedly enhances the infectiousness of HIV through the presence of protein aggregates called amyloid fibrils. HIV binds to these fibrils, causing the virus to cluster together and increasing its ability to attach to and infect cells in the host – in this case the sexual partner of the infected individual. This effect is then sufficient to increase the infectiousness of the HIV virus, thereby diminishing the antiviral properties of the microbicides.

In the study, published in Science Translational Medicine, researchers tested the effectiveness of several different types of microbicides targeting the HIV virus on cells that had been exposed to HIV alone compared with cells that were treated with both HIV and semen. Across the board, they saw that not only did the cells with semen have rates of HIV infection approximately ten-fold higher than normal, these microbicides were up to twenty times less effective at blocking the virus in these cells than in those not exposed to semen.

Senior author Jan Munch, PhD, from the University of Ulm says, “Our findings suggest that targeting amyloids in semen is an alternative strategy to improve drug efficacy. The next step is to create a compound or cocktail of drugs that targets both the HIV virus and these amyloid fragments and to test its effectiveness. Also, given that semen is the main means of transmission of HIV, future testing of microbicides in the lab should be performed in the presence of semen to better predict antiretroviral efficacy in real life.”

To test that it was the HIV-enhancing ability of semen that was having this effect on the microbicides and not some other substance, the researchers repeated the experiments using semen from men whose semen does not enhance HIV infection due to a disorder called ejaculatory duct obstruction. In the presence of these samples, there was no decrease in effectiveness of the anti-viral microbicides, confirming the importance of the HIV-promoting effects of semen in counteracting the effectiveness of these drugs.

Most microbicides work by targeting the virus itself, attempting to break it down or blocking its ability to infect a cell. However, the heightened infectiousness of HIV in the presence of semen appears to over-power any anti-viral effects the microbicides possess. The one exception to this finding is a different type of microbicide that acts on the host cells’ receptors, stopping the virus from latching on from within. In the current study, this microbicide, called Maraviroc, was equally effective in preventing infection both with and without the presence of semen.

“There are important potential clinical implications for this study,” says Warner Greene, MD, PhD, director of the Gladstone Institute of Virology and Immunology and a senior author on the paper. “Microbicides were originally developed as a way to empower and protect women in sub-Saharan Africa who often don’t have a way to negotiate safe sex or condom use. However, the first generation of microbicides were largely ineffective or worse, some even leading to increased transmission of the virus. This study sheds light on why these microbicides did not work, and it provides us with a way to fix this problem by creating a new compound drug combining antivirals and amyloid inhibitors.”

2013 Was the Deadliest Year of LGBT Intimate Partner Violence On Record

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For 17 years, the National Coalition of Anti-Violence Programs (NCAVP) has been collecting data on domestic violence in LGBT communities. They started in 1997 with a report that was the first-ever look at intimate partner violence among LGBT couples. It was an important intervention in the domestic violence movement largely defined by the ways that cisgender men physically or emotionally abused their wives.

 

When NCAVP released what ultimately became its annual report, it helped expand the movement within the federal government and departments of public health. Like most statistics on domestic violence, the reported cases were generally thought to be an underestimate because many victims don’t actually report their assaults. But the problem was especially hard for LGBT folks because, in 1997, 21 states had enforceable sodomy laws on the books that could put a queer person behind bars.

Since then, the language has changed, but the problem has not. Domestic violence, which in this report is also called intimate partner violence, is a catchall phrase that refers to “a pattern of behavior where one partner coerces, dominates, or isolates another intimate partner to maintain power and control over the partner and the relationship,” according to researchers.

In 2013, the Centers for Disease Control and Prevention released data on intimate partner violence that included sexual orientation, but left out gender identity. Still, the results showed that LGBT partnerships were not immune to violence: 44 percent of lesbian women and 61 percent of bisexual women have experienced physical violence, stalking or rape in their intimate partnerships.

In this year’s report on intimate partner violence, NCAVP reports that 2013 was an especially deadly year for LGBT victims of domestic violence. By their researchers’ estimates, there were 21 homicides due to intimate partner violence, the highest number ever recorded. More than 28 percent of those victims were people of color. Of the 21 victims in 2012, 10 were identified as cisgender men, eight as cisgender women and three as transgender women.

What’s more:

• LGBTQ people of color were more likely to report experiencing physical violence, discrimination, threats or intimidation, and harassment as a result of intimate partner violence.

• LGBTQ and HIV-affected people of color were more likely to experience incidents of intimate partner violence in streets or public spaces.

• Bisexual survivors were 1.6 times more likely to experience sexual violence and 2.2 times more likely to experience physical violence as a result of intimate partner violence.

• Transgender people of color were 2.6 times more likely to experience discrimination within intimate partner violence.

• Transgender survivors were 2.5 times more likely to experience incidents of intimate partner violence in public spaces.

• More than eight percent of reported victims were undocumented (of the more than 83 percent who disclosed their immigration status).

Osman Ahmed, one of the report’s authors, told me by phone that “how you identify is an important factor in terms of how abuse can happen [because] your identity can be used against you within intimate partner violence.”

by Jamilah King

HIV and smoking

 

The CDC’s Tips From Former Smokers campaign tells the stories of real people who experienced the challenges and rewards of quitting smoking. One of those stories is about Brian, a former smoker who has HIV. His story shows how smoking cigarettes can intensify the health risks of HIV, even for people who have their condition well controlled.

Brian’s story begins nearly 20 years ago with a hospital stay and an HIV diagnosis. Brian had contracted — with no explanation —a crippling case of pneumonia that left him with no energy and forced him to quit his job.

Once Brian was diagnosed, his health was transformed. He began receiving medications to control his HIV, which allowed him to regain his strength and return to work. Brian knew that HIV would forever be part of his identity, but it alone wouldn’t prevent him from living a long and productive life. The knowledge that he survived HIV and pneumonia, made Brian feel invincible, and two months after leaving the hospital Brian started smoking cigarettes again.

Brian had first started smoking as a teenager. It seemed daring to him—a symbol of freedom and independence. But he quickly learned that cigarettes had nothing to do with freedom. Smoking had become an addiction that controlled him and he wanted to quit.

When Brian picked up cigarettes again, he didn’t understand that mixing HIV with smoking is a perilous combination. Smoking is dangerous for everyone—it is the leading cause of preventable death in the U.S., killing 480,000 Americans every year. But the risks of serious health consequences are much higher for smokers who are living with HIV. Smoking increases the chances of heart disease, cancer, serious lung diseases and infections, which are all conditions that those with HIV are more vulnerable to developing.

Despite this, people who are HIV-positive are more likely to smoke. The smoking rate is two to three times higher among adults with HIV than those without. Despite many attempts to quit, Brian continued smoking until New Year’s Day in 2013. After taking a cigarette break from this job as a master teacher at a pottery studio, he returned to find that his right hand had stopped working. He couldn’t hold a pen, a glass, or a piece of clay. He struggled to speak. At just 43 years old, Brian was having a stroke.

Fortunately, Brian was rushed to the hospital and surgeons cleaned out a clogged artery in his neck. His doctors told him that HIV, both the virus and some of the treatments, can increase your risk for a stroke and that his continued smoking had substantially increased that risk and causeda stroke. After three decades of being addicted to cigarettes, this was the news that finally led Brian to quit smoking. The day of the stroke was the last time he picked up a cigarette.

Brian went through a long process to regain use of his body and mind, and the effects of the stroke still linger. At first, he couldn’t dress himself, brush his teeth, or cook. Speaking and reading were difficult. Today, Brian can manage buttons and shoelaces, as long as he goes slowly, but numbness in his right hand affects his ability to work.

Despite the struggle of relearning basic tasks after the stroke and recovering from a near fatal case of pneumonia that left him sprawled on his apartment floor, Brian still counts quitting smoking as one of the hardest things he has ever done. He also sees it as one of the best things he’s ever done for his health and his future.

It took a stroke for Brian to decide that he would stop smoking for good. Now, he hopes his story will inspire others—especially people living with HIV—to quit before they experience a serious health consequence.

Read more about Brian’s story, watch his video, and download his tip to post or share with others. Learn more about smoking and living with HIV on this page from AIDS.gov.

ACA – Open Enrollement Begins November 15th, 2014

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5 easy ways to get ready

This weekend, you’ll be able to sign up for 2015 health coverage through the Marketplace.

Open Enrollment begins on November 15th this year.

Here are 5 ways you can get ready right now:

Millions of Americans are already benefiting from Marketplace coverage. We want to make sure you join them.

The HealthCare.gov Team


Enroll by December 15th and coverage can begin on January 1st, 2015.

Don’t let your friends or loved ones miss important dates & deadlines!