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The coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios-anchoring comparisons to non-Hispanic Whites-in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of 30 December 2020. Using a novel Monte Carlo simulation procedure to perform estimation, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, estimated disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.

Low blood levels of beta carotene and vitamin A may increase a woman's risk of HIV infection. This could occur because vitamin A deficiency produces changes in the vagina or because it affects the immune system.

Testing blood samples for the HIV p24 antigen may help detect HIV infection earlier. This viral protein is produced when the virus is actively reproducing and may occur sooner than the antibodies that most HIV tests rely on. Researchers tested blood samples from 3,874 people who tested negative for HIV antibodies for the p24 antigen. Fifty-eight tested positive. Unprotected sex with prostitutes and genital ulcers were risk factors for HIV infection. Fever, joint pain and night sweats were more common in p24-positive persons, occurring in almost half. These could be signs of early HIV infection., Context.--Most previous studies of clinical presentation and risk factors in early human immunodeficiency virus (HIV) infection have relied on retrospective analyses and referred seroconverters, and thus were subject to possible bias. Objectives.--To apply a method based on measurement of prevalent HIV-1 p24 antigenemia for identification of risk factors for newly acquired HiV infection and to describe the signs and symptoms of acute HIV infection. Design and Setting.--Nested case-control study in Pune, India. Participants.--HIV antibody-negative persons attending 2 sexually transmitted disease (STD) clinics between May 1993 and June 1996. Outcome Measures.--Prevalent p24 antigenemia, risk factors for HIV infection, and clinical symptoms of acute primary HIV infection. Results.--Of 3874 HIV antibody-negative persons tested, 58 (1.5%) were p24 antigen positive at initial presentation to the clinics. Unprotected sexual contact with a commercial sex worker (CSW) was reported by 39 (77%) of the 51 p24 antigenemic men, compared with 131 (51%) of 255 control men (adjusted odds ratio [AOR], 3.4; 95% confidence interval [CI], 1.2-9.6; P=.02). The presence of an active genital ulcer at the time of screening was found in 46 (79%) of the 58 p24 antigenemic men and women, compared with 137 (47%) of the 290 control subjects (AOR, 4.2; 95% CI, 2.0-9.0; P[is less than] .001). Signs and symptoms independently associated with p24 antigenemia in HIV antibody-seronegative persons included fever, which was reported by 28 (48%) of the 58 p24 antigenemic subjects, but only 52 (18%) of the 290 control subjects (AOR, 4.7; 95% CI, 2.4-9.0; P [is less than] .001). Joint pain was reported by 10% of subjects recently HIV infected, compared with 2% of the control subjects (AOR, 6.5; 95% CI, 1.7-24.8; P=.006). Night sweats were reported by 9% of the p24 antigenemic, but only 1% of the control subjects (AOR, 9.1; 95% CI, 1.7-47.6; P = .009). Overall, fever, joint pain, and/or night sweats were reported in 27 (47%) of the 58 subjects with recent HIV infection. Conclusions.--This systematic case-control study of p24 antigen screening in HIV-seronegative patients attending STD clinics in India identified unprotected sex with a CSW and a genital ulcer as independent. risk factors associated with newly acquired HIV infection. In addition, p24 antigen positivity identified recent fever, night sweats, and arthralgias as symptoms that may be predictive of recent HIV infection. In a study of patients attending STD clinics in India, screening for p24 antigen in HIV antibody-negative persons was found to be a reliable and effective research method for determining recent risk behavior and identifying clinical signs of acute primary HIV infection. JAMA. 1997;278:2085-2089

Research on the effectiveness of needle exchange programs should analyze information on individual injection drug users, information on risk behaviors and the HIV status of participants in the program. HIV infection is high among injection drug users and is linked to the sharing of contaminated needles and syringes while injecting drugs. Innovative approaches to prevent HIV infection include the provision of safe and sterile needles by needle exchange programs. A mathematical model, based on circulation theory, has been used to overcome the difficulties of evaluating the effectiveness of needle exchange programs. A reduction in circulation time lowers the probability that a needle is used by different drug users and thus markedly decreases HIV infection rates. However, the Office of National Drug Control Policy questioned these findings and prompted additional analysis. Further analysis of the data indicated there was a significant association between shorter needle circulation time and a lower incidence of HIV infection. Analyzing additional information on racial/ethnic groups and individual users would provide a clearer indication of the effectiveness of needle exchange programs.

Objectives. We implemented an intervention to reduce drug use in an urban commune in northern Vietnam. Methods. We encouraged the intervention commune to accept responsibility for developing their own intervention strategies based on a community mobilization model used in southern, rural China. We selected a comparison commune, which had demographic characteristics and a drug history similar to the intervention commune. The 2-year incidence of new drug users was estimated retrospectively in the intervention and comparison communes between baseline (2003) and follow-up (2009). Results. Increased incidence of new (noninjecting) drug users between 2003 and 2009 in the intervention commune was lower than that in the comparison commune, and these participants expressed more positive attitudes toward local authority and people with drug use and HIV/AIDS. Increased condom use during last intercourse with female sex workers and with female casual partners was observed in the intervention commune. HIV prevalence and positive opioid tests decreased more in the intervention commune. Conclusions. Our results suggested that the community mobilization had a positive influence in the intervention commune. [ABSTRACT FROM AUTHOR]

Males are at higher risk relative to females of severe outcomes following COVID-19 infection. Focusing on COVID-19-attributable mortality in the United States (U.S.), we quantify and contrast years of potential life lost (YPLL) attributable to COVID-19 by sex based on data from the U.S. National Center for Health Statistics as of 31 March 2021, specifically by contrasting male and female percentages of total YPLL with their respective percent population shares and calculating age-adjusted male-to-female YPLL rate ratios both nationally and for each of the 50 states and the District of Columbia. Using YPLL before age 75 to anchor comparisons between males and females and a novel Monte Carlo simulation procedure to perform estimation and uncertainty quantification, our results reveal a near-universal pattern across states of higher COVID-19-attributable YPLL among males compared to females. Furthermore, the disproportionately high COVID-19 mortality burden among males is generally more pronounced when measuring mortality in terms of YPLL compared to age-irrespective death counts, reflecting dual phenomena of males dying from COVID-19 at higher rates and at systematically younger ages relative to females. The U.S. COVID-19 epidemic also offers lessons underscoring the importance of a public health environment that recognizes sex-specific needs as well as different patterns in risk factors, health behaviors, and responses to interventions between men and women. Public health strategies incorporating focused efforts to increase COVID-19 vaccinations among men are particularly urged.