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The article discusses the response to the Monkeypox outbreak in the U.S. Topics discussed include an overview of the first year of the response to the Monkeypox outbreak by Centers for Disease Control and Prevention (CDC), the measures taken by CDC in partnership with state and local health departments to identify cases, analyze trends, and implement public health measures.

Background. Men who have sex with men (MSM) accounted for two thirds of new HIV infections in the United States in 2019 despite representing approximately 2% of the adult population. Methods. CDC analyzed surveillance data to determine trends in estimated new HIV infections and to assess measures of undiagnosed infection and HIV prevention and treatment services including HIV testing, preexposure prophylaxis (PrEP) use, antiretroviral therapy (ART) adherence, and viral suppression, as well as HIV-related stigma. Results. The estimated number of new HIV infections among MSM was 25,100 in 2010 and 23,100 in 2019. New infections decreased significantly among White MSM but did not decrease among Black or African American (Black) MSM and Hispanic/Latino MSM. New infections increased among MSM aged 25-34 years. During 2019, approximately 83% of Black MSM and 80% of Hispanic/Latino MSM compared with 90% of White MSM with HIV had received an HIV diagnosis. The lowest percentage of diagnosed infection was among MSM aged 13-24 years (55%). Among MSM with a likely PrEP indication, discussions about PrEP with a provider and PrEP use were lower among Black MSM (47% and 27%, respectively) and Hispanic/Latino MSM (45% and 31%) than among White MSM (59% and 42%). Among MSM with an HIV diagnosis, adherence to ART and viral suppression were lower among Black MSM (48% and 62%, respectively) and Hispanic/Latino MSM (59% and 67%) compared with White MSM (64% and 74%). Experiences of HIV-related stigma among those with an HIV diagnosis were higher among Black MSM (median = 33; scale = 0-100) and Hispanic/Latino MSM (32) compared with White MSM (26). MSM aged 18-24 years had the lowest adherence to ART (45%) and the highest median stigma score (39). Conclusion. Improving access to and use of HIV services for MSM, especially Black MSM, Hispanic/Latino MSM, and younger MSM, and addressing social determinants of health, such as HIV-related stigma, that contribute to unequal outcomes will be essential to end the HIV epidemic in the United States. [ABSTRACT FROM AUTHOR]

The US Centers for Disease Control and Prevention has estimated human immunodeficiency virus (HIV) viral suppression (VS) using 2 data sources. The National HIV Surveillance System estimate (50% of HIV-diagnosed persons in 2012) is derived from viral load reporting from a subset of jurisdictions that vary yearly. The Medical Monitoring Project (MMP) estimate (42% of HIV-diagnosed persons in 2012) is based on a sample of persons receiving HIV care during the first 4 months of each year. We developed the cohort-adjustment method to reconstruct VS estimates, accounting for persons receiving care later in the year. Using the HIV Outpatient Study cohort, we assessed timing of care receipt, demographics, and VS at last test (<200 vs. ≥200 copies/mL), standardizing MMP to HIV Outpatient Study data using multivariable regression models and yielding adjusted VS estimates. We estimated that 52% (95% CI: 48, 56) of HIV-diagnosed persons achieved VS in 2012. Differences from previously published estimates were due to: 1) 23% underestimation of persons receiving HIV care, and 2) lower VS rates among persons receiving care outside versus inside the 4-month MMP sampling period (79% vs. 88%). This methodology yielded VS estimates closer to the National HIV Surveillance System estimate than previously published. Use of more, geographically diverse cohort data may enable assessment of temporal trends. [ABSTRACT FROM AUTHOR]

Since 2006, CDC has recommended routine screening of all persons aged 13-64 years for human immunodeficiency virus (HIV) and at least annual rescreening of persons at higher risk (1). However, national surveillance data indicate that many persons at higher risk for HIV infection are not screened annually, and delays in diagnosis persist (2). CDC analyzed 2006-2016 data from the General Social Survey (GSS)* and estimated that only 39.6% of noninstitutionalized U.S. adults had ever tested for HIV. Among persons ever tested, the estimated median interval since last test was 1,080 days or almost 3 years. Only 62.2% of persons who reported HIV-related risk behaviors in the past 12 months were ever tested for HIV, and the median interval since last test in this group was 512 days (1.4 years). The percentage of persons ever tested and the interval since last test remained largely unchanged during 2006-2016. More frequent screening of persons with ongoing HIV risk is needed to achieve full implementation of CDC's screening recommendations and to prevent new infections. Integration of routine screening as standard clinical practice through existing strategies, such as electronic medical record prompts (3), or through new, innovative strategies might be needed to increase repeat screening of persons with ongoing risk. [ABSTRACT FROM AUTHOR]

The Centers for Disease Control and Prevention (CDC) recommended in 2006 that sexually active gay, bisexual, and other men who have sex with men (MSM) be screened for human immunodeficiency virus (HIV) at least annually. A workgroup comprising CDC and external experts conducted a systematic review of the literature, including benefits, harms, acceptability, and feasibility of annual versus more frequent screening among MSM, to determine whether evidence was sufficient to change the current recommendation. Four consultations with managers of public and nonprofit HIV testing programs, clinics, and mathematical modeling experts were conducted to provide input on the programmatic and scientific evidence. Mathematical models predicted that more frequent than annual screening of MSM could prevent some new HIV infections and would be more cost-effective than annual screening, but this evidence was considered insufficient due to study design. Evidence supports CDC’s current recommendation that sexually active MSM be screened at least annually. However, some MSM might benefit from more frequent screening. Future research should evaluate which MSM subpopulations would benefit most from more frequent HIV screening. [ABSTRACT FROM AUTHOR]

Background: Persons unaware of their human immunodeficiency virus (HIV) infection account for approximately 40% of ongoing transmissions in the United States. Persons are unaware of their infection because of delayed HIV diagnoses that represent substantial missed opportunities to improve health outcomes and prevent HIV transmission.Methods: Data from CDC's National HIV Surveillance System were used to estimate, among persons with HIV infection diagnosed in 2015, the median interval (and range) from infection to diagnosis (diagnosis delay), based on the first CD4 test after HIV diagnosis and a CD4 depletion model indicating disease progression and, among persons living with HIV in 2015, the percentage with undiagnosed infection. Data from CDC's National HIV Behavioral Surveillance were analyzed to determine the percentage of persons at increased risk for HIV infection who had tested in the past 12 months and who had missed opportunities for testing.Results: An estimated 15% of persons living with HIV in 2015 were unaware of their infection. Among the 39,720 persons with HIV infection diagnosed in 2015, the estimated median diagnosis delay was 3.0 years (interquartile range = 0.7-7.8 years); diagnosis delay varied by race/ethnicity (from 2.2 years among whites to 4.2 years among Asians) and transmission category (from 2.0 years among females who inject drugs to 4.9 years among heterosexual males). Among persons interviewed through National HIV Behavioral Surveillance, 71% of men who have sex with men, 58% of persons who inject drugs, and 41% of heterosexual persons at increased risk for HIV infection reported testing in the past 12 months. In each risk group, at least two thirds of persons who did not have an HIV test had seen a health care provider in the past year.Conclusions: Delayed HIV diagnoses continue to be substantial for some population groups and prevent early entry to care to improve health outcomes and reduce HIV transmission to others.Implications For Public Health Practice: Health care providers and others providing HIV testing can reduce HIV-related adverse health outcomes and risk for HIV transmission by implementing routine and targeted HIV testing to decrease diagnosis delays. [ABSTRACT FROM AUTHOR]

Background: In 2009, 6.7% of the estimated 1.1 million persons living with human immunodeficiency virus (HIV) infection in the United States were youths (defined in this report as persons aged 13-24 years); more than half of youths with HIV (59.5%) were unaware of their infection. Methods: CDC used National HIV Surveillance System data to estimate, among youths, prevalence rates of diagnosed HIV infection in 2009 and the number of new infections (incidence) in 2010. To assess the prevalence of risk factors and HIV testing among youths, CDC used the 2009 and 2011 Youth Risk Behavior Surveillance System for 9th-12th grade students and the 2010 National Health Interview Survey (NHIS) for persons 18-24 years. Results: Prevalence of diagnosed HIV was 69.5 per 100,000 youths at the end of 2009. Youths accounted for 12,200 (25.7%) new HIV infections in 2010. Of these, 7,000 (57.4%) were among blacks/African Americans, 2,390 (19.6%) among Hispanics/Latinos, and 2,380 (19.5%) among whites; 8,800 (72.1%) were attributed to male-to-male sexual contact. The percentage of youths tested for HIV overall was 12.9% among high school students and 34.5% among those aged 18-24 years; it was lower among males than females, and lower among whites and Hispanics/Latinos than blacks/African Americans. Conclusions: A disproportionate number of new HIV infections occurs among youths, especially blacks/African Americans, Hispanics/Latinos, and men who have sex with men (MSM). The percentage of youths tested for HIV, however, was low, particularly among males. Implications for Public Health: More effort is needed to provide effective school- and community-based interventions to ensure all youths, particularly MSM, have the knowledge, skills, resources, and support necessary to avoid HIV infection. Health-care providers and public health agencies should ensure that youths are tested for HIV and have access to sexual health services, and that HIV-positive youths receive ongoing health-care and prevention services. [ABSTRACT FROM AUTHOR]

The article focuses on increase in HIV infections in persons in the U.S. and Puerto Rico in 2010 which is attributed by the Centers for Disease Control and Prevention (CDC) to male-to-male sexual contact. The CDC in its National HIV Surveillance System used multiple imputation methods to assign transmission categories to those persons whose diagnoses are reported without risk factor. HIV infected persons are also assessed based on geographic difference.

Objectives. We examined racial/ethnic disparities in HIV diagnosis rates for persons aged 50 years and older. Methods. We analyzed surveillance data from the Centers for Disease Control and Prevention regarding HIV diagnoses during 2005 through 2008 in 37 states. Average annual rates of diagnoses were calculated for persons aged 50 years and older and compared with rates for persons aged 13 to 49 years. Results. The average annual rate of diagnosis (per 100 000 persons) for older persons was 9.8. Rates among older Blacks (49.2) and Hispanics/Latinos (19.5) were 12.6 and 5.0 times, respectively, the rate among older Whites (3.9); rates among younger Blacks (102.5) and Hispanics/Latinos (39.0) were 7.7 and 2.9 times, respectively, the rate among younger Whites (13.3). Older persons were more likely than younger persons to receive a late HIV diagnosis (prevalence ratio = 1.5, P < .001). Conclusions. Racial/ethnic disparities in HIV diagnosis rates are greater among persons aged 50 years and older than among younger persons. The greater HIV diagnosis rates in Blacks and later diagnosis among older persons of all races/ ethnicities indicate a need to increase their awareness of risk factors for HIV infection. [ABSTRACT FROM AUTHOR]

The article investigates previous human immunodeficiency virus (HIV) testing among adults and adolescents taking into account recently identified with HIV infection. The U.S. Centers for Disease Control and Prevention (CDC) has analyzed 2006-2009 data from 18 U.S. jurisdictions provided by CDC's National HIV Surveillance System. The findings reveal that more than 50 percent of the adults and adolescents diagnosed with HIV had a negative test before the diagnosis.

The article reports on research which was conducted in an effort to estimate the incidence of HIV infections in the United States. Researchers tested remnant diagnostic serum specimens from patients 13 years and older in 22 U.S. states that had been newly diagnosed with HIV during 2006, and determined the incidence of the disease in 22 states based on data from the U.S. Centers for Disease Control and Prevention. By using laboratory technologies previously implemented in clinic based settings, researchers determined that new HIV infections in the United States remain concentrated among men who have sex with men and among black individuals.