February 28 is HIV is Not a Crime Awareness Day, a day to emphasize the importance of HIV decriminalization, describe HIV criminalization from a legal and policy perspective, and explore paths towards a more equitable future. In honor of this day, CHIPTS Policy Impact Core Co-Director Ayako Miyashita Ochoa, JD, had a discussion with Nathan Cisneros, HIV Criminalization Analyst at the Williams Institute in the UCLA School of Law. Check out their discussion below.
Since 2015, when the first comprehensive report on state-level HIV criminalization data was published, the Williams Institute (WI) has engaged in continued efforts to analyze HIV criminalization trends across key states in the United States. Today, Nathan will share some of his reflections on this work.
Nathan, can you tell us about yourself and your current role at Williams Institute?
I came to the Williams Institute two years ago as our first full time HIV criminalization analyst. The Williams Institute has been studying the impact of HIV criminal laws for seven years now. We approach this issue in the same way we approach other policy areas that affect LGBTQ communities—we fight myths and stereotypes with deep dives into the data and facts. It’s a good fit for someone like me a background who knows how to analyze data and who wants to do social science for good.
For people who are unfamiliar with HIV criminalization, can you tell us why we should we care about the issue and its effects on people living with and at risk for HIV?
I like to remind people that we all have an HIV status. That status might be positive or negative, and we might know our status or we might not know our status. And that status might change over time. So what is HIV criminalization? HIV criminalization refers to criminal laws that make something a person does illegal because of their HIV status.
Let me give you an example. In Ohio if I don’t disclose my HIV status to a sex partner that’s perfectly legal—so long as my status is negative. If it’s positive, however, I’m suddenly liable for eight years in prison, and mandatory sex offender registration. Ohio’s law doesn’t require actual transmission, the intent to transmit, or even the possibility of transmission. In Tennessee, a sex worker who knows they’re positive can be put in prison for ten years for having a conversation about transactional sex.
HIV criminal laws also single out people living with HIV for harsher penalties. For example, spitting on someone might normally be a misdemeanor, but if you’re a person living with HIV, it might become a felony. The fact is, you cannot get HIV from someone spitting on you.
Today, over half of states across the U.S. criminalize people because of their HIV status. And HIV is pretty unique in the way a health condition is singled out in criminal law. Many of these laws were written at the height of the AIDS pandemic when there was a lot of fear and stigma and shame. Today we know so much more about how HIV is transmitted, and how to care for people living with HIV. It’s actually pretty hard to transmit HIV aside from sex and needle sharing, and we now have medications that can reduce risk of acquiring HIV through sex by about 99%.
Unfortunately, most HIV criminal laws haven’t been updated to reflect the latest science and medicine. Instead, they continue to single out people living with HIV for special punishment, and they perpetuate stigma and discrimination. That’s why the latest National HIV/AIDS Strategy calls on states to modernize or eliminate their HIV-specific criminal laws.
What’s something you have learned in the course of your research that you want to share with the world?
Many people are surprised that these HIV criminal laws are on the books and that they are still being enforced. Yet, through our research, the Williams Institute has uncovered incidents where thousands of people living with HIV were criminalized because of their HIV status. And it is still happening today—in red states and blue states, big states and small states—criminalizing things that hold zero HIV transmission risk.
For me, the biggest lesson has been to understand the real costs of these laws—not just to state governments, which can run into the tens of millions of dollars just on costs to incarcerate people—but to the people at risk of criminalization, and to their loved ones and the communities in which they live. There are people living with HIV in just about every community, in every county, in every one of the United States. So those costs, that real harm, isn’t just some abstract thing over there. It means it is a burden to members of all of our communities, and ultimately to us as well.
I’d also add that our research shows criminalization disproportionately affects the most vulnerable populations—including Black people, women, and sex workers. The burden of criminalization is simply not evenly distributed, and I think it is useful to ask why that might be so.
How can ending criminalization improve public health and health for all?
The public health rationale on this is pretty clear: HIV criminal laws can lower testing and treatment, which runs directly counter to both federal and state public health goals around ending the epidemic. HIV criminal laws also increase stigma and discrimination against people living with HIV, which itself can directly harm a person’s mental and physical health. Our recent experiences with other pandemics has shown some of the limits of trying to address public health needs through the criminal code. HIV is no different.
Thank you, Nathan, for this important information. Do you have any last thoughts?
Facts matter. Our work does a great job summarizing some of the science and medicine around HIV, and what we know about the who and how of HIV criminalization. I hope people will take a look themselves.
CROI 2023 provides a forum for scientists and clinical investigators to present, discuss, and critique their investigations into the epidemiology and biology of human retroviruses and associated diseases. CROI is the preeminent HIV research meeting in the world and includes up to 4,000 HIV research and care leaders internationally. CROI has facilitated the presentation of important discoveries in the field, thereby accelerating progress in HIV and AIDS research.
CHIPTS at CROI 2023
CHIPTS Co-Director and Combination Prevention Co-Director Dr. Raphael J. Landovitz was part of the team of experts selected to be part of this year’s CROI Scientific Program Committee (PC). The PC members are responsible for identifying topics and speakers that will ensure innovative programming; strategic planning; abstract review and program development; and organizing, conducting, or convening workshops, symposia, and special sessions.
During the conference, Dr. Landovitz presented during the pre-conference workshop on “Advances in Biomedical Prevention of HIV.”
Dr. Landovitz’s work was also featured in several other presentations and posters as the Protocol Chair of the HPTN 083 study:
Oral Abstract Session (#8): All Modes Lead to PrEP – Tuesday, February 21, 2023 from 10:00AM-12:00PM
The Levi Syndrome Characteristics of Early HIV Infection with Cabotegravir for PrEP
Cabotegravir for HIV PrEP in US Black and Transgender women who have sex with men
Poster Session-V4: PrEP use in Special Populations – Tuesday, February 21, 2023 from 2:30 PM-4:00 PM
Bone Density Changes with CAB-LA or TDF/FTC PrEP in MSM and TGW in HPTN 083
Poster Session (#6) PrEP Product Update and Effectiveness
PrEP Product Choice in US Participants in HPTN083
CHIPTS Combination Prevention Core Scientist Dr. Kara W. Chew also shared an engaging presentation at this year’s conference on “Future Directions in Outpatient Therapy for Mild to Moderate COVID-19″ during Symposium #5 – COVID-19: Where are we now? Additionally, Dr. Chew presented a poster focused on the “Reduction in HIV Reservoir Markers with GAG/POL/IL-12 DNA Therapeutic Vaccination.”
Dr. Chew’s work on multiple studies was featured as part of several other oral and poster presentations:
Symposium (#5) COVID-19: Where are we now?
Characterization of Single Versus Dual Active MAB Against SARS-Cov-2
Saftey and Efficacy of Inhaled Interferon-B1A (SNG001) in Outpatients with COVID-19
Symptoms and Viral Rebound in Untreated COVID-19 Infection
Poster Session-N1 PASC (LONG COVID)
Post-Acute COVID Outcomes: Amubarvimab/ Romlusevimab vs Placebo in the Activ-2 Trial
Poster Session-B7 LONG COVID
Plasma Antibody and N Antigen Status Predict Outcomes in Outpatients with COVID-19
This content originally appeared on HIV.Gov. View the full article here.
CDC’s Division of HIV Prevention recently released five notices of funding opportunity (NOFO) for research activities on several key issues in HIV prevention.
The funding opportunities are aligned with National HIV/AIDS Strategy (NHAS) priorities and support the implementation of the Ending the HIV Epidemic in the U.S. (EHE) initiative. Details on each opportunity with deadlines andlinks formore information are provided below.
Long-Acting Antiretroviral Therapy Preferences among Black Women
Exploring Preferences for Long-Acting Antiretroviral Therapies (LA-ART) in a Community-Based Sample of Priority Populations Living with HIV Who are Disproportionately Affected will support formative research on acceptance and perceived barriers and facilitators of using current and future LA-ART among cis-gender Black women with HIV (CgBWH). Creating equitable access to HIV treatment and care for people with HIV includes successful uptake of new and emerging treatments, such as LA-ART, which offer advantages such as convenience and reduced stigma compared to daily oral treatment. Inequities in HIV include the disproportionate rate of HIV among CgBWH. CgBWH account for nearly 60% of new HIV infections in U.S. women, despite making up less than 15% of the female population. Due to a host of social determinants of health (SDOH) like racism, poverty, stigma, unequal access to health care, and housing and educational inequities, CgBWH bear the highest burden of HIV infection among U.S. women. Given this disproportionate rate of infection and related SDOH, the focus population of this NOFO is CgBWH. This NOFO supports the EHE initiative “Treat” pillar. Specifically, the EHE plan lists CgBWH as a priority population to focus on for prevention, care, and treatment interventions and resources for the greatest impact in reaching the NHAS goals.
Expanding Rapid Initiation of Antiretroviral Therapy (ART) in Non-traditional Settings: Emergency Department will support implementation research on the rapid or immediate initiation of ART for persons newly diagnosed with HIV or for people with HIV returning to care in emergency department (ED) settings. Immediate initiation of ART is recommended for anyone newly diagnosed with HIV, regardless of CD4 count. The rapid ART model, defined as immediate diagnosis, linkage to care, and ART initiation on the same day as a new HIV diagnosis or return to care, should offer an accelerated entry into HIV medical care. Rapid ART confers a higher rate of engagement in care, reduces the time to viral suppression, and improves morbidity and mortality in people with HIV. The ED offers a unique setting to immediately engage with patients who are not accessing HIV care services. The implementation research supported by this funding will deploy rapid ART models in ED settings and evaluate acceptability, perceived barriers and facilitators, feasibility, sustainability, and HIV care continuum outcomes. Applied research resulting from this funding is expected to decrease HIV infections and quickly achieve viral suppression among people with HIV. This research is aligned with the NHAS and the EHE initiative’s “Treat” pillar.
Long-Acting Injectables (LAI) for the Treatment of HIV in Non-Clinic Community-Based Settings will support research on LAI-ART by implementing LAI-ART administration in non-clinic settings. LAI-ART offers many potential advantages over daily oral treatment such as improved convenience, adherence, and treatment satisfaction. Barriers and challenges exist with implementation of LAI-ART into current healthcare practice, both in logistics and in equity. Some of these barriers may be overcome by using non-clinic sites, such as community pharmacies, to administer LAI-ART. A multi-site effectiveness-implementation research study, designed to compare receiving LAI-ART in non-clinic community settings with the oral standard-of-care HIV clinical treatment, should offer a unique source of information for improving acceptability, availability, and uptake of LAI-ART. Implementation outcomes of interest include acceptability, perceived barriers and facilitators, feasibility, and sustainability. Health outcomes of interest include missed visits, on-time receipt of injections, and the HIV care continuum, including retention in care and viral load suppression. Applied qualitative and quantitative research resulting from this funding is expected to strengthen adherence to ART and is aligned with the NHAS and the EHE initiative’s “Treat” pillar.
Identifying and Addressing Historical and Structural Drivers of Medical Mistrust (MM) among Hispanic/Latino Gay, Bisexual and Other Men Who Have Sex with Men (HLMSM) for HIV Prevention targets EHE initiative jurisdictions with large Hispanic/Latino populations (30% or more based on 2020 US Census data) and will support research that captures variations in medical mistrust drivers among different Hispanic/Latino subgroups (e.g., Central Americans, Mexicans, Puerto Ricans, US-born, non-US-born, 1st generation, 2nd generation). The root causes for MM in Hispanic/Latino populations in the United States are understudied. MM is a social determinant of health associated with HIV disparities within HLMSM (e.g., low PrEP willingness and adherence) that prevents and delays access and engagement in HIV prevention and care services (such as PrEP, ART). The little research on MM among HLMSM has neither utilized a heterogeneous H/L population with different ethnic groups (e.g., Cuban, Mexican, Puerto Rican), nor addressed the historical roots and relevance of MM to healthcare access. Grounded in community-based participatory research (CBPR) principles, the objectives of this 2-phase NOFO are to: 1) identify MM drivers in HLMSM and existing interventions that build trust in health services via formative research (Phase 1); and (2) evaluate implementation of targeted multilevel interventions that build trust in health services (Phase 2).
Telehealth to Support Retention and Adherence to ART
Enhancing Telehealth Strategies to Support Retention and Adherence to Antiretroviral Therapy will support research on evidence of effectiveness of TeleART by implementing a hybrid effectiveness-implementation research study. Telehealth services such as TeleART are becoming more widely implemented; however, to date, there is a dearth of evidence of effectiveness of TeleART for ART adherence and retention in HIV care in the U.S. The study research supported by this NOFO should:
evaluate the effectiveness of an enhanced telehealth program for maintenance of HIV medication adherence among clinically stable people with HIV (PWH); identify potential implementation facilitators and challenges by evaluating the delivery of these strategies; and
evaluate the cost and cost-effectiveness of providing telehealth to patients on ART, and evaluate program enhancements that include, but may not be limited to, biospecimen sample self-collection and the use of specialized staff such as community health workers and patient navigators.
This enhanced telehealth program should focus on groups disproportionately affected by HIV and other persons for whom social determinants of health (e.g., stigma, discrimination, poverty, and low socioeconomic status) limit their engagement in HIV care and treatment. Specifically, African American cis-gender women, and/or Black or Hispanic/Latino gay, bisexual and other men who have sex with men, and/or transgender women, are groups of interest. The research supported by this NOFO should align with the NHAS and the EHE initiative’s “Treat” pillar.
This content originally appeared on The CDC National Center for HIV, Viral Hepatitis, STD, and TB Prevention. View the full article here.
Dear Colleague,
February 7 is National Black HIV/AIDS Awareness Day (NBHAAD), a day to highlight the progress of HIV testing, prevention, and treatment efforts and consider our ongoing challenges to reducing HIV among Black or African American people (hereafter referred to as African American people) in the United States. We have made strides in reducing the disproportionate impact of HIV on African American communities. Despite this progress, racism, poverty, and stigma continue to drive health disparities and make it more difficult for African American people to access HIV testing, prevention, and care services.
This NBHAAD, we invite our colleagues in HIV care and advocacy, health care, and public health to join us in challenging these systemic root causes of HIV disparities in African American communities in the United States. HIV surveillance data show us that African American people are disproportionately affected by HIV, making up 12% of the population, but accounting for 42% (12,827) of the 30,635 new HIV diagnoses in the United States and dependent areas in 2020. African American gay and bisexual men are the group most affected by HIV, making up 65% (8,294) of new HIV diagnoses among African American people in 2020.*
Research shows that a major source of these racial disparities is a lack of access to high-quality HIV prevention and treatment services. PrEP (pre-exposure prophylaxis) coverage, for example, is lower among African American people—only 8% of African American people who could benefit from PrEP were prescribed PrEP in 2019, compared to 23% of people overall. To help raise PrEP awareness and uptake, health care providers can follow CDC’s updated PrEP guideline(PDF, 1.57MB) to inform all sexually active people about PrEP.
Intersecting racial and economic factors create structural barriers to HIV prevention and treatment in African American communities. Our nation’s troubled history of medical racism and experiences with discrimination from health care providers have contributed to high levels of mistrust in the health care system among African American people. These same factors increase disparities for other illnesses, including mpox, other sexually transmitted diseases, and viral hepatitis. We can all work to address stigma and racism within our institutions and look for ways to connect African American people with HIV testing and prevention services, as well as compassionate, patient-centered, stigma-free HIV care.
This NBHAAD, help us raise awareness about HIV testing, prevention, and treatment for African American people by downloading and sharing resources from CDC’s Let’s Stop HIV Together campaign, the national campaign of both the Ending the HIV Epidemic in the U.S.(EHE)initiative and the National HIV/AIDS Strategy. Let’s Stop HIVTogether is an evidence-based campaign created in English and Spanish that aims to empower communities, partners, and health care providers to reduce HIV stigma and promote HIV testing, prevention, and treatment. You can also share social media content from CDC’s digital toolkit using the #NBHAAD and #StopHIVTogether hashtags. Together, we can work to address HIV disparities and enhance HIV prevention efforts among African American people in the United States.
Sincerely,
Robyn Neblett Fanfair, MD, MPH
Captain, USPHS
Acting Division Director
Division of HIV Prevention
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
As CHIPTS welcomes a new year and renews our commitment to ending the HIV epidemic, we reflect on the 2022 content that sparked the most engagement from our community. Through our website and social media accounts, we were able to share valuable information about the latest developments in HIV research, enriching learning opportunities, Center news, and more through our blog content, social media postings, video uploads, and new downloadable materials.
Website
In 2022, the CHIPTS website featured nearly 40 blog posts on the latest Center news as well as local, state, and national news from our research and public health partners. In 2022, our most popular blog topics included:
FDA Permits Marketing of First Condom Specifically Indicated for Anal Intercourse (https://bit.ly/3XM1QWU)
UCLA’s HIV prevention and treatment center receives $7.5 million grant from NIH (https://bit.ly/3wGDBOc)
New Funding Awarded to CHIPTS and the UCLA-CDU CFAR to Support the Ending the HIV Epidemic Initiative (https://bit.ly/4083bsR)
The CHIPTS website also featured reflections from three of our CHIPTS scientists to commemorate HIV awareness days in 2022. These popular pieces highlighted current issues facing populations disproportionately impacted by HIV and innovative research to help address them:
Dr. Michael Li – National Gay Men’s HIV/AIDS Awareness Day 2022 (https://bit.ly/3JrD0r5)
Dr. Wei-Ti Chen – National Asian & Pacific Islander HIV/AIDS Awareness Day 2022 (https://bit.ly/3Dtev9g)
Dr. Dilara Uskup – National Women and Girls HIV/AIDS Awareness Day 2022 (https://bit.ly/3wE1N3J)
The resource library housed on the CHIPTS website includes a wide range of downloadable materials to support HIV researchers and community partners, from assessment tools to research project reports to policy briefs. Check out our most popular downloads of 2022 below:
CHIPTS had an active presence across our social media platforms in 2022, sharing relevant content with local, national, and global partners. Here is our most popular content posted on Twitter, Facebook, and YouTube in 2022:
Twitter:
NEW Infographic from @CHIPTS and @ca_hiv_policyrc: Single mothers in U.S. states with a more generous EITCs engaged in significantly less #HIV risk behaviors… (https://bit.ly/3Dqoo7x)
Join us for the next #HIVGrandRounds session on September 20, 2022 at 11am PST! Dr. Ifeoma C. Udoh, Senior Research Scientist at @ETRorg, will be speaking on ETR’s health equity framework and how it can be applied and integrated into HIV research… (https://bit.ly/3wGzjpO)
Check out this issue brief by @CDCgov that describes the role of HIV self-testing in #EndingtheHIVEpidemic… (https://bit.ly/3XOU8LM)
Join @Alisonh3, @annaslau, and @LBrookmanFrazee on Friday, May 6, at 11 AM PT for our upcoming #impsci beachside chat on “Developing Careers as Implementation Scientists through Partnerships”… (https://bit.ly/3RjRFGL)
Join our #impsci hub for an upcoming methods workshop on designing semi-structured interview guides for implementation research… (https://bit.ly/3XQqZzG)
Facebook:
It was great to see so many members of the CHIPTS community yesterday at our end-of-the-year social! We are so grateful for the dedication of our amazing scientists… (https://bit.ly/3HoVWnA)
CHIPTS very own Methods Core Director, Dr. Jae Lee, visited Chiang Mai University last week to meet with collaborators and trainees from the UCGHI GloCal training program… (https://bit.ly/3Yf7bGi)
Excited to be partnering with APLA Health, Pacific AIDS Education and Training Center, & San Francisco AIDS Foundation on a new California Statewide #HIV & #Aging Educational Initiative… (https://bit.ly/40cALxX)
Check out our “U=U for Women” infographic created by the CHIPTS Community Advisory Board! Maintaining an undetectable viral load helps prevent #HIV transmission to partners … (https://bit.ly/3HJLqZI)
Check out the latest publication in ScienceDirect’s International Journal of Drug Policy by CHIPTS Policy Core Director Dr. Nina Harawa! This article explores the psychosocial and structural barriers driving the disproportionate #HIV incidence among young Black MSM… (https://bit.ly/3YuO6Qz)
YouTube:
Beyond Research for Research Sake: Centering Equity and Community Engagement to Advance HIV Research (https://youtu.be/rciyhM88TpM)
Improving Access to Tuberculosis Care and HIV Prevention in South Africa presented by Andrew Marino (https://youtu.be/pV9omHCEYFw)
This content originally appeared on PEPFAR. View the full article here.
As the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) approaches its 20th anniversary in January, U.S. Global AIDS Coordinator and Special Representative for Health Diplomacy Ambassador at Large Dr. John Nkengasong has embarked on a journey of reimagining the HIV/AIDS response [3 MB] together with PEPFAR’s stakeholders and partners. Within days of starting in his new role last month, Nkengasong conducted inclusive consultative listening sessions with PEPFAR stakeholders including partner governments, members of Congress, former global AIDS coordinators, chiefs of mission, multilateral partners, public health experts, PEPFAR personnel based at headquarters and the field, public and private partners, civil society, and faith-based organizations to gain insights about how to ensure PEPFAR remains fit for purpose to achieve the goal of ending the HIV/AIDS pandemic by 2030.
PEPFAR’s successes are well documented, with some of the most recent milestones including: over 20 million lives saved; 5.5 million babies born HIV free; supporting over half a dozen high-burden countries to meet or surpass the 90-90-90 UNAIDS treatment target; and leveraging the PEPFAR platform to respond to other global health threats, including COVID-19, H1N1, and Ebola.
“While we celebrate these hard-earned achievements, we know that HIV/AIDS is not over, it’s still a pandemic and there are gaps in support for children, young people and key populations and geographic pockets that threaten our gains,” Nkengasong said. “Our fight is far from over and the future of PEPFAR will be guided by respect, humility, equity, accountability, transparency, impact and sustained engagement.”
Those are the guiding principles Nkengasong revealed today as he outlined the program’s strategic direction for positioning PEPFAR on the path to end the HIV/AIDS pandemic as a public health threat by 2030 and sustainably strengthening public health systems through the PEPFAR platform, in partnership with communities and countries.
He shared five strategic pillars and three enablers for reimagining PEPFAR at 20 to achieve the 2030 goals. The 5×3 Strategic Approach includes:
Five Pillars:
Health Equity for Priority Populations – Knowing and closing the prevention and treatment gaps for adolescent girls and young women, children and key populations.
Sustaining the Response – Strengthening national and local political, programmatic, and financial leadership.
Public Health Systems and Security – Utilizing the PEPFAR platform to protect HIV gains and leverage it for broader disease surveillance and public health programming.
Transformative Partnerships – Designing new partnerships with key private, public and multi-sector entities that can complement existing programs and expand reach.
Following the Science – Investing in the scale-up of cutting edge behavioral and implementation science to bend the curve on new infections.
Three Enablers:
Community Leadership – Sustained leadership (including women and key populations) will be promoted in all elements of PEPFAR priority setting, funding allocations, program design and monitoring.
Innovation – The status quo is not enough to get us through the last mile; we need to deploy creative and innovative solutions at scale for the remarkable challenges ahead.
Lead with Data – Data will continue to drive decision making, and we will support strong country-led data systems.
“Respectful, action-oriented partnerships are front and center in PEPFAR’s way forward, which will continue to include partner governments, communities, bilateral and multilateral donors, philanthropies, the private sector, and others,” Nkengasong noted. Nkengasong is also looking to expand support for community-led solutions with an eye toward sustainability and accountability. In addition, the program will expand collaboration and build new partnerships in regional manufacturing and supply chains, digital health, health workforce, patient-centered care, and health equity.
Nkengasong’s announcements also included leveraging the PEPFAR platform for pandemic preparedness and global health security in support of overall objectives of the program. “We need to look at how the incredible platform established for the HIV/AIDS response can be further used to prepare the world to fight other pandemic diseases, while protecting and advancing HIV/AIDS response gains. We don’t need to build new systems to fight a pandemic – we should use existing platforms more broadly [to ensure the health of individuals and communities],” he said.
The way forward for PEPFAR will include continuing to lead with data, as the program continues to innovate and collaborate with its vast array of partners to reach and sustain HIV impact now and into the future.
This content originally appeared on NIH Office of AIDS Research. View the full article here.
Over the past 40 years, substantial progress has been made in preventing and treating HIV and AIDS; however, the pandemic is far from over.
Approximately 38 million people globally have HIV, and in 2020 approximately 1.5 million people became newly infected.1 In the United States, an estimated 1.2 million people have HIV, and in 2019 approximately 34,800 people became newly infected.2
Moreover, HIV prevalence and incidence are not distributed equally around the world and within the United States. Disparities in transmission risk, health outcomes, and death exist by race, ethnicity, sex, gender, age, and region and reflect ongoing structural inequalities in access to HIV research and its outputs.
To reach the goals of the Ending the HIV Epidemic in the U.S. (EHE) initiative, the science community must remedy disparities and further advance scientific discovery and its application in equitable and effective ways, that include focused efforts to enhance the pipeline, diversity, and sustainability of the HIV research workforce. OAR is committed to these efforts, as stated in Goal 4 of the NIH Strategic Plan for HIV and HIV-Related Research: to “build human resource and infrastructure capacity to enhance sustainability of HIV research discovery and the implementation of findings by a diverse and multidisciplinary workforce.” As a key element of this commitment, OAR is developing and implementing a multipronged initiative to increase the cadre of early career, next-generation HIV investigators—including NIH-defined Early Stage Investigators (ESIs) and Early Established Investigators—across disciplines and institutions.
As a first step, OAR conducted a portfolio analysis for fiscal years (FYs) 2015–2020 which found that, although the number of ESIs receiving their first grants at the NIH overall has increased since the inception of the NIH Next Generation Researchers Initiative policy in 2017, the number of HIV-focused ESIs receiving grants remained flat or decreased over this time frame. These data prompted OAR to take immediate action to identify the variables and determinants that contribute to a decline even in the presence of policies aimed to support early career investigators.
In early 2021, OAR convened a series of four virtual listening sessions with HIV research early career investigators to hear directly from them about the challenges and opportunities they face. Three sessions involved investigators who had received R01-equivalent funding in FYs 2018, 2019, or 2020, respectively; and one involved investigators who had not successfully competed for R01-equivalent NIH funding despite submitting multiple applications in FYs 2017, 2018, or 2019. Each session included between 10 and 21 early career investigators from diverse institutions and a small number of staff from OAR and NIH.
Key themes that arose during these sessions included—
A need for greater diversity in mentors and for mentoring specifically about grant writing and peer review processes.
Interest inmore exposure to and earlier involvement in NIH study section and grant review processes.
The need for greater flexibility (e.g., protected time and budget) in NIH funding mechanisms and research career pathways.
The desire to have an NIH-supported network of peers from different institutions who could compare notes, share information, and support each other.
The need for leaders in the field of HIV research and academia to acknowledge and address the wide range of adverse effects of the COVID-19 pandemic on research careers.
Following these listening sessions, OAR convened an Expert Panel consultation involving 19 senior HIV investigators and experienced mentors from a variety of academic institutions. The framework for the Expert Panel discussion was based on a set of questions derived from the feedback received during the early career investigator sessions. The questions addressed obstacles to ensuring a robust pool of early career investigators in HIV research; examples of existing efforts and successful programs; and opportunities to enhance support for and engagement of diverse early career investigators in HIV research careers.
The Expert Panel made a number of suggestions that are similar to the comments from the early career investigators, such as—
Modify policies related to specific funding mechanisms—such as the R- and K-series—to allow greater flexibility in mentoring and time allocation.
Update NIH practices related to peer review of applications from early career investigators, such as dedicated study sections.
Develop funding strategies to engage early career investigators from underrepresented minority populations and under-resourced institutions.
Enhance support for and replication of successful training programs for early career investigators.
Based on the input from these sessions, OAR is working with the NIH Institutes, Centers, and Offices to implement a number of actions to develop and support HIV-focused early career investigator initiatives; identify meritorious but unfunded HIV research applications from early career investigators; continue engagement with early career investigators and mentor stakeholders; focus on inclusion of underrepresented minority groups and under-resourced institutions; and host a symposium to bring together HIV-focused early career and senior investigators and OAR and NIH program officials.
This content originally appeared on FDA News Release. View the full article here.
[On December 22, 2022], the U.S. Food and Drug Administration approved Sunlenca (lenacapavir), a new type of antiretroviral medication for adult patients living with human immunodeficiency virus type 1 (HIV-1), whose HIV infections cannot be successfully treated with other available treatments due to resistance, intolerance, or safety considerations. After the starting dose is completed, Sunlenca is administered as subcutaneous (under the skin) injections once every six months, allowing convenient dosing for patients.
“Today’s approval ushers in a new class of antiretroviral drugs that may help patients with HIV who have run out of treatment options,” said Debra Birnkrant, M.D., director of the Division of Antivirals in the FDA’s Center for Drug Evaluation and Research. “The availability of new classes of antiretroviral medications may possibly help these patients live longer, healthier lives.”
Sunlenca is the first of a new class of drugs called capsid inhibitors to be FDA-approved for treating HIV-1. Sunlenca works by blocking the HIV-1 virus’ protein shell (the capsid), thereby interfering with multiple essential steps of the viral lifecycle. Sunlenca’s starting dose is given as oral tablets and subcutaneous injections, followed by maintenance injections every six months; Sunlenca is given in combination with other antiretroviral(s).
The safety and efficacy of Sunlenca were established through a multicenter clinical trial with 72 patients whose HIV infections were resistant to multiple classes of HIV medications. These patients had to have high levels of virus in their blood despite being on antiretroviral drugs. Patients were enrolled into one of two study groups. One group was randomized to receive either Sunlenca or placebo in a double-blind fashion, and the other group received open-label Sunlenca. The primary measure of efficacy was the proportion of patients in the randomized study group who achieved a certain level of reduction in virus during the initial 14 days compared to baseline. In this group, 87.5% of patients who received Sunlenca achieved such a decrease in virus compared to 16.7% of patients who received a placebo. After 26 weeks of Sunlenca plus other antiretrovial drugs, 81% of participants in the first group achieved HIV RNA suppression, where levels of HIV were low enough to be considered undetectable. After 52 weeks, 83% of participants continued to have HIV RNA suppression.
The most common adverse reactions with Sunlenca were injection site reactions and nausea. Most injection site reactions were described as swelling, pain or redness. Sunlenca comes with certain warnings and precautions. Injection site reactions described as nodules or indurations may be persistent in some patients. Additional warnings and precautions include the risk of developing immune reconstitution syndrome, which is when the immune system overreacts after starting HIV treatment. Also, small (residual) amounts of Sunlenca can remain in the body for up to a year or longer; low levels of drug caused by missing doses of Sunlenca or failing to maintain a fully suppressive HIV treatment regimen after stopping Sunlenca could lead to an increased risk of developing viral resistance. Residual amounts of Sunlenca could also lead to potential drug interactions.
Patients should not receive Sunlenca if they also take certain drugs that cause reduced levels of Sunlenca. This may result in losing virologic response and developing viral resistance.
CHIPTS Combination Prevention Core Director Dr. Cathy Reback was recently recognized for her work developing an impactful text messaging intervention – Text Me, Girl! – that improves antiretroviral therapy (ART) uptake and adherence and self-reported viral suppression among transgender women ages 18–34 years. As of November 2022, Text Me, Girl! is live on TargetHIV.org as part of the Ryan White HIV/AIDS Program (RWHAP) Best Practices Compilation. As described on TargetHIV.org:
Text Me, Girl! is a text messaging intervention that aims to improve linkage to and retention in HIV care, increase adherence to HIV medications, and improve viral suppression and other health outcomes among transgender women ages 18–34 years. Text Me, Girl! delivers automated text messages grounded in behavioral change theory and associated with all stages of the HIV care continuum. The intervention supports young transgender women with HIV, particularly those experiencing barriers to care such as periods of homelessness and/or incarceration, substance misuse, or engaging in sex work.
Text Me, Girl! was developed and evaluated as part of Use of Social Media to Improve Engagement, Retention, and Health Outcomes along the HIV Care Continuum, an initiative funded by the Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance (SPNS) program. Text Me, Girl! participation was associated with statistically significant improvements in ART uptake and adherence, and self-reported viral suppression.
Check out these resources to learn more about the Text Me, Girl! Intervention and evidence-base:
The 2022 HIV Next Generation Conference hosted by CHIPTS welcomed 130 attendees for a day of presentations, discussions, and networking. The conference facilitated by Dallas Swendeman, CHIPTS Development Core Co-Director, welcomed attendees and participants from academic institutions, community-based organizations, health care institutions, and other organizations working to end the HIV epidemic. The day also provided a unique opportunity for cross-collaboration and mentorship.
The conference theme, “Implementation Science for HIV Prevention and Treatment to End the Epidemics” was emphasized throughout the day’s program. Steve Shoptaw, CHIPTS Director and Norweeta Milburn, CHIPTS Development Core Director gave opening remarks to lay the groundwork for the conference. Amaya Perez-Brumer, Assistant Professor at the University of Toronto offered an engaging and informative opening plenary.
The program proceeded with the first set of sessions featuring presentations and panel discussion that occurred concurrently. One set of sessions, moderated by Laura Bogart, CHIPTS Combination Prevention Core Scientist centered on mental health and HIV prevention. The first session featured Jasmine Lucero Lopez, she discussed the impact of a virtual platform to mitigate the effects of isolation among older people living with HIV using Discord.Katherine Lewis highlighted mental health strengths among youth at-risk for and living with HIV. Curtis Wong & Alice Ma shared sexual health promotion methods and decision-making strategies among youth at-risk for HIV in Los Angeles and New Orleans.
The second session running concurrently, facilitated by Dilara K. Üsküp, CHIPTS Policy Impact Core Scientistcentered on HIV prevention. The second set featured David Mosqueda & Dino Selders who addressed PrEP/ PEP use disparities amongst marginalized communities by way of a peer-led collaborative initiatives. Lori Zomback described medical student-ran telehealth for HIV testing and counseling among sexual minority men. Pablo Zapata discussed factors associated with HIV testing among Spanish and English speaking Latinx youth.
A second set of two concurrent sessions followed, this set included a session focused on substance use and HIV that was facilitated by Pamina M. Gorbach, CHIPTS Global HIV Director. Boram Kim & Cheng-Shi Shiu began the first session, discussing factors influencing betel nut chewing behavior in people living with HIV in Myanmar. Amanda P. Miller presentation examined substance use and associated intimate partner violence risk among MSM In Los Angeles, California.
A concurrent session facilitated by Jesse Clark, CHIPTS Combination Prevention Scientist Core was the first of the EHE Implementation Science panels. Alison Hamilton discussed the UCLA Rapid, Rigorous, Relevant (3R) implementation science hub and its supporting EHE Initiatives. Wei-Ti Chen addressed intersectional oppression in Asian Pacific Americans with HIV in Southern CA through a implementation science framework. Laura Hoyt D’Anna, Everardo Alvizo & Jaelen Owens collaborated to present on implementing a community-engaged equity approach to identify barriers and facilitators to the PrEP care continuum in Long Beach, CA.
The first panel in the final set focused on policy impact and was facilitated by Ayako Miyashita Ochoa, CHIPTS Policy Impact Core Co-Director. Felipe Findley & Vanessa Warri led an engaging discussion focused on HIV and the carceral state describing the effects of research on health outcomes. The second panel led by Dallas Swendeman, CHIPTS Development Core Co-Director closed the second part of the EHE Implementation Science panels. Ronald A. Brookspresented on implementation strategies that promoted equitable dissemination of LAI and PrEP to Black/Latino MSM and Transgender women in Los Angeles. Raiza M. Beltran & Tam Phan discussed pharmacist delivered PrEP and PEP in three high priority EHE counties in CA. Carl Highshaw & Sung-Jae Lee provided an overview of Haus of C.H.O.P (Choosing Healthy Options for Prevention/PrEP). Corrina Moucheraud & Raphael Landovitz described their project focused on financially incentivizing strategies for HIV prevention in high-incidence populations in LA County.
Finally, CHIPTS Co-Director Raphael J. Landovitzgave the closing remarks, reminding attendees of the conference’s purpose and highlighting the need for innovative interventions to end the HIV Epidemic.
See below for oral presentation PDFs and available recorded presentations.
WELCOME AND OPENING REMARKS
Opening Remarks by:
Norweeta Milburn, PhD, Director, CHIPTS Development Core
Steve Shoptaw, PhD, Director, CHIPTS
Conference Facilitator and Announcements by:
Dallas Swendeman,PHD, Co-Director, CHIPTS Development Core
OPENING PLENARY
Amaya Perez-Brumer, PhD, MSC, Assistant Professor, Dalla Lana School of Public Health, Division of Social and Behavioural Health Science
Presentation Title: Who Benefits from Global HIV Prevention Science? A Call for Researcher Accountability
Presentation Summary: To imagine and reimagine a more just praxis for HIV research globally, we, as scholars and practitioners, must grapple with the extreme privilege at the center of who gets to do global HIV health research, who are its beneficiaries, and who are its subjects. To begin to think through these provocations, this talk will discuss three ongoing paradoxes rooted in data politics and the extractive logics at the center of global HIV prevention science.
Presentation Summary: This presentation will discuss the perspectives of a Community Advisory Board (CAB) on the usability of Discord as a virtual village. We will explore the benefits and drawbacks of this platform for the purpose of this study, based on the opinions expressed by the CAB. Lessons learned from this experience and how to improve future studies will be shared.
Presentation Summary: Youth enrolled in several linked HIV prevention and treatment continua studies who participated in a telehealth coaching intervention completed a strengths assessment, and qualitative data on mental health strengths was analyzed using thematic analysis and a resilience lens. Youth self-described mental health strengths included intrapersonal resilience assets (protective traits, stress management activities, feeling positive despite current mental health challenges, and no current mental health challenges) and external resilience resources (social/emotional support, therapy/counseling, and use of mental health medication). These results highlight the utility of strengths-based intervention methods and resilience for youth at-risk for and living with HIV.
Presentation Summary:A strengths-based telehealth coaching intervention was delivered to youth at-risk for or living with HIV in Los Angeles and New Orleans within the context of several linked HIV prevention and treatment continua studies. We used a choice-based framework and qualitative methods to analyize strengths assessment data, which revealed intrapersonal, interpersonal, and structural factors that influenced participants’ sexual health decision-making, including decisions regarding PrEP use, condom use, and other strategies. These results demonstrate the utility of self-determination and choice-based frameworks in sexual health promotion efforts for youth.
Presentation Summary: PrEP Furnishing shows promise of assisting marginalized peoples living in primary care healthcare shortage areas. Altamed fast tracks furnishing initiatives by placing PrEP navigators in the lead when it comes to Patient initial care and retention.
Presentation Summary: A group of medical students conducted tele-health HIV testing using OraQuick and provided education and risk-reduction counseling during the turnaround time. There was high participant satisfaction and educational benefit for the students, demonstrating benefits to both public health and medical education.
Presentation Summary: Data for the current project were collected as part of SMART, an ongoing pragmatic trial of an online HIV prevention intervention for adolescent sexual minority youth. Despite higher risk, few Latino youth reported ever having received an HIV test. Results suggest sexual health education and pediatricians are an important, but largely untapped, source of testing and could be further supported with familial support to end the epidemic
Presentation Summary: Despite the WHO classifying betel nuts as a carcinogen with a high risk of oral and laryngeal cancer, Myanmar is one of the world’s largest consumers of betel nuts because chewing betel nuts is socially and culturally influenced in Myanmar. The study aimed to examine factors that influence betel nut chewing in people living with HIV (PLWH) in Myanmar. From a secondary analysis of 2020 Myanmar PLWH data, physiological hyperarousal symptoms and loneliness were associated with increased betel nut chewing among PLWH in Myanmar.
Presentation Summary: Prior work suggests substance use is a risk factor for intimate partner violence but limited research exploring this association among MSM exists. We explored associations between substance use and experiences of IPV among MSM participating in the mSTUDY cohort in Los Angeles. Stimulant use was associated with increased odds of experiencing IPV relative to those reporting no stimulant use and the magnitude of this association was greater among MSM living with HIV.
Set 2 – Panel 2: EHE Implementation Science (PT. 1)
Presentation Summary: The UCLA 3R Hub, a supplement to CHIPTS, is one of eight hubs funded by the NIMH to support EHE pilot Implementation studies. Tis presentation will briefly address the critical role of Implementation science in ending the HIV Epidemic and will describe services and supports that are available to the Southern California community and beyond.
Presentation Summary: The purpose of this study is to collaborate with the local Asian Pacific American With HIV (APAWH) community to adapt and evaluate the appropriateness, acceptability, and feasibility of a 4-session, 4-week Social-justice Oriented, Family Informed self-management intervention to promote health among APAWH in Southern California, particularly Orange counties (SOFIAA). The scientific premise is that APAWH experience systematic barriers in healthcare delivery and policies, resulting in poor health outcomes. Additionally, regardless of ethnicity, APAs often prioritize their responsibilities to their families over their own individual needs. Our hypothesis is that APAWH will perceive SOFIAA as acceptable, feasible, and appropriate and a future study will demonstrate SOFIAA may be used to promote family support, decrease the effects of structural racism and HIV-related stigma, and achieve better outcomes in APAWH. This study addresses the critical need to optimize an intervention to promote self-management skills among APAWH by simultaneously addressing the reality and effects of structural racism and discrimination against APAWH from both the mainstream U.S. society and the APA communities.
3. Laura Hoyt D’Anna, MPA, DrPH & Everardo Alvizo, LCSW & Jaelen Owens, BA
Presentation Summary: The study aims to address the HIV epidemic by improving PrEP linkage, uptake, and retention among Black and Latinx same-gender loving men, transgender women, and other gender-diverse persons in Long Beach, CA. This is a mixed methods study designed to explore barriers and facilitators to engagement along the PrEP care continuum from the viewpoints of community members and current and potential PrEP providers. Findings will inform the following: 1) the Long Beach HIV/STI Strategic Plan, 2) a culturally appropriate PrEP readiness and facilitation tool, and 3) intervention opportunities to be studied in future research.
Set 3 – Panel 1: Policy Impact
1. Felipe Findley, PA-C, MAPS, AAHIVS & Vanessa Warri, MSW
Presentation Summary: This panel will share broad perspectives of CHIPTS Community Advisory Board member and community partners engaged in CHIPTS PIC work to address disproportionate health outcomes across communities engaged by carceral systems. Panelists will elucidate pathways for researchers to better capture the effects of criminalization on health outcomes.
Set 3 – Panel 2: EHE Implementation Science (PT. 2)
Presentation Summary: The project will host 7 informational/educational community workshops to provide up-to-date and relevant information on LAI-PrEP to providers (medical and non-medical) that serve Black/Latino/a MSM and transgender women and potential consumers. Additionally, the project will develop a community-derived and culturally appropriate strategic messaging guide to facilitate ongoing dissemination of LAI PrEP information to our focused populations of providers and consumers.
2. Raiza M. Beltran, PhD, MPH & Tam Phan, PharmD, AAHIVP
Presentation Summary: For this presentation, we will provide a short overview of our proposed project that builds community capacity to better examine the facilitators and barriers to pharmacists-furnished HIV services in select priority areas of Southern California.
Presentation Summary: For this study, we provide a plan on the equity-focused approaches aimed at optimizing engagement of young Black LGBTQ+ individuals across the PrEP care continuum by partnering with House & Ball Community (H&BC) members using social work guiding principles.
Presentation Summary: TIPS is a recently-funded project (an Ending the HIV Epidemic supplement to CHIPTS) that is using a mixed methods approach to understand how best to design an investigational financial incentives program for PrEP use and HIV prevention among young, Latino, Black and African American, cisgender men who have sex with men in South Los Angeles. This represents a collaborative research endeavor between investigators at UCLA, APLA Health & Wellness, and DHSP; and aims to generate policy- and program-relevant insights.
February 28 is HIV is Not a Crime Awareness Day, a day to emphasize the importance of HIV decriminalization, describe HIV criminalization from a legal and policy perspective, and explore paths towards a more equitable future. In honor of this day, CHIPTS Policy Impact Core Co-Director Ayako Miyashita Ochoa, JD, had a discussion with Nathan Cisneros, HIV Criminalization Analyst at the Williams Institute in the UCLA School of Law. Check out their discussion below.
