This Week in HIV Research: A Yawning Racial Gap in U.S. Testing

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In this week's journey through the untamed wilderness of HIV-related journal research, your intrepid This Week in HIV Research scouts have spotted the following newly published discoveries:

  • A massive disparity between HIV testing rates and HIV burden among black men who have sex with men in the Southern U.S.

  • A nuanced glimpse into the reasons behind reported adherence shortfalls in the ASPIRE vaginal HIV prevention ring trial.

  • An affirmation of the importance of pre-exposure prophylaxis (PrEP) even amidst growing successes in improving the HIV care continuum.

  • A warning sign in one African nation that reported rates of antiretroviral usage may not be what they seem.

Join us as we travel further down each of these paths. To beat HIV, you have to follow the science!

Barbara Jungwirth is a freelance writer and translator based in New York. Follow Barbara on Twitter: @reliabletran.

Myles Helfand is the executive editor and general manager of TheBody.com and TheBodyPRO.com. Follow Myles on Twitter: @MylesatTheBody.


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In U.S. South, Low HIV Testing but High Diagnosis Rates Among Black MSM

In 2016, of the 374,871 HIV tests that were funded by the Centers for Disease Control and Prevention and administered in the U.S. South outside of health care facilities, just 6% were given to African-American men who have sex with men (MSM), even though 36% of the 2,304 new HIV diagnoses in non-health care facilities were among that population, a study published in Morbidity and Mortality Weekly Report showed.

In addition to the new diagnoses, 44% of the African-American MSM who tested positive in the study were identified as people who had previously been diagnosed with HIV. Re-testing may indicate that people are willing to return to HIV care, study authors hypothesized. However, only 58% of black MSM who were re-diagnosed with HIV were then linked to care within 90 days. Linkage to care was slightly better among newly diagnosed black MSM, at 67%, but both rates fell far short of the 85% goal specified within the National HIV/AIDS Strategy. Racism, stigma, lower incomes and educational levels, and lack of health care access are all barriers to treatment, as is the considerable distance some people in rural areas must travel to get HIV care.

To reduce the HIV burden on this population, study authors recommended targeted risk-based testing in non-health care settings or routine screening in health care agencies, as well as better linkage to care for those diagnosed.


Adherence Report Disparities Seen in Vaginal HIV Prevention Ring Study

Women in the ASPIRE trial of a vaginal ring for HIV prevention reported consistent use of the device, even when drug-level data showed only intermittent use, a study published in AIDS found.

The discrepancy between perceived and actual adherence to the ring may be interpreted as complementary, rather than contradictory, study authors said: "participants generally felt they used the ring consistently once they got used to it, and they may have removed it regularly." Reasons given for removing the ring included fear that a sexual partner would notice the device, hygiene during menstruation, and concerns about negative health implications or side effects. Conversely, women with high levels of the study drug (dapivirine) in their blood did not report fear of their partner discovering the device.

To overcome some of these obstacles, future studies should include preemptive counseling to counteract rumors about health implications and target messaging about the ring also to men, researchers recommended.


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PrEP Remains Key Even if HIV Treatment Goals Are Reached in U.S.

Pre-exposure prophylaxis (PrEP) will remain an important tool for preventing HIV transmission in the U.S. even if the country reaches its HIV treatment and care goals, a modeling study published in the Journal of Acquired Immune Deficiency Syndromes found.

At 2016 levels of engagement in the continuum of HIV care, implementing PrEP for people at high risk of seroconversion would reduce new HIV acquisitions by 18% between 2016 and 2020, researchers estimated. If current national goals -- 90% of people living with HIV diagnosed, 85% of these linked to care, and 80% of those in care virally suppressed -- were achieved, PrEP would still avert another 11% of seroconversions.

The greatest benefit would be seen among men who have sex with men, among whom PrEP could prevent 15% of HIV acquisitions, followed by heterosexual people and people who inject drugs (each with about a 4% drop in HIV acquisitions). Thus, even if HIV treatment were scaled up to reach the national goals, a strong PrEP implementation would still prevent additional seroconversions, study authors concluded.


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High Levels of Undisclosed Antiretroviral Use in Botswana May Impact Country-Level HIV Statistics

Antiretrovirals were found in blood samples of a significant proportion of study participants who reported never having taken these medications, a Botswana study published in AIDS showed.

Researchers surveyed 12,610 adults, 29% of whom were living with HIV. Twenty-seven percent of those living with HIV said they were antiretroviral-naive. However, blood samples showed that 39% of those virologically suppressed had indeed taken HIV medications, most commonly the country's standard first-line regimen.

Study authors speculated that people may have shared medications prescribed for someone else, may have misrepresented their use of antiretrovirals for fear of stigma, or may not have disclosed that they are not adherent to their drug regimen. It is also possible that the 69% of those with antiretrovirals in the blood who said that they did not know their HIV status wanted a confirmatory HIV test.

The relatively large number of people taking antiretrovirals but not disclosing this fact has implications for country-level HIV statistics -- specifically, increasing estimates of viral suppression -- study authors concluded.