Just half of HIV positive Gay/Bi in Treatment, only 25 percent VL suppressed

[Ptrk3]

Dreary story from today's AIDSMEDS:

http://www.aidsmeds.com/articles/care_continuum_gay_1667_26248.shtml

[Ptrk3]

That should read 42 percent suppressed.  Sorry.

[leatherman]

I don't know what they quit calling this the "treatment cascade" and went with "continuum of care"

group	dx	linked	retained	art	ud
MSM	--	77	50	49	22
Everyone	82	66	37	33	25

really not too terrible when compared to all diagnosed. More are linked, retained, and on ART that average; while the UD is just slightly lower


http://aids.gov/federal-resources/policies/care-continuum/

[Miss Philicia]

You can add this to the mix as a contributing factor: More Than Half of Gay and Bisexual Men Say a Doctor Has Never Suggested H.I.V. Testing

excerpt:

Gay men and their doctors aren’t talking enough about sex, and that’s making it harder to control the spread of H.I.V.

That’s the conclusion of a new survey of gay and bisexual men by the Kaiser Family Foundation released on Thursday. It found that 47 percent of the men have never discussed their sexual orientation with their doctors, and 56 percent have never been advised by a doctor to be tested for H.I.V.


Q: How many of you (gay/bi) here on these forum were OUT SEXUALLY to your general practitioner before you were diagnosed with HIV?

[Ptrk3]

Very good point, Miss Philicia.  That was certainly the case in my situation.  After I was diagnosed with a CD4 of 9 and a VL of 111,000, in hospital, with PCP, my GP informed me that, "I knew you were homosexual," not in a mean way, just as an observation, though I never discussed anything with him (to answer your question, I was not "out" to him), so I guess he has "gaydar," since I was never married, etc.  Anyway, it would have been nice if he really did "know" that he had mentioned something like a test four years ago when I had shingles.  I could have found out years ago, but no matter now. 

But the point of the article posted is correct.  Doctors simply don't talk about it.  This is not to blame doctors (I was responsible for my own actions and, as mentioned, was not "out"), but when a doctor says nothing, a patient begins to think HIV may be only the remotest of possibilities.  Everyone needs to continue to work together to stop this pandemic.  Maybe it should be protocol that all doctors suggest an HIV test as part of a yearly physical.

[Miss Philicia]

Dunno... I've just never understood that even if a patient is not out to family/friends/work is it really that hard to discuss this with a doctor. The conversation is professional and completely confidential, like having it with a psychiatrist.

And if that's too difficult of course there are other ways to be tested outside of your family doctor. You know, anonymous clinic testing.

I don't think guys having sex with guys see HIV as "the remotest of possibilities" -- everyone thinks about it, even if they are simultaneously in denial about it. As far as yearly physicals, do most men have one? I didn't even have a personal general practitioner until I was 28, but I did make sure that when I got one he was also gay (word of mouth recommendation). If I got sick in college I went to the college clinic, and then when I got my first job I avoided my insurance deductible by going to a walk-in cheapo clinic until my salary was a bit higher.

But it's not even about medical access sucking in the US -- there are studies in the UK where medical services are free and easily available and the same situation is present. A large portion of MSM are in denial sexually and combine that with a reluctance to go to the doctor annually. It's a bad combination of fear and lack of personal responsibility.

[buginme2]

You can add this to the mix as a contributing factor: More Than Half of Gay and Bisexual Men Say a Doctor Has Never Suggested H.I.V. Testing

excerpt:

Gay men and their doctors aren’t talking enough about sex, and that’s making it harder to control the spread of H.I.V.

That’s the conclusion of a new survey of gay and bisexual men by the Kaiser Family Foundation released on Thursday. It found that 47 percent of the men have never discussed their sexual orientation with their doctors, and 56 percent have never been advised by a doctor to be tested for H.I.V.


Q: How many of you (gay/bi) here on these forum were OUT SEXUALLY to your general practitioner before you were diagnosed with HIV?

I was, and good thing too because he vaccinated me for hep a and b on our first visit when I just moved here.

Regardless if your doctor doesn't talk about it doesn't everyone fill out those patient questioners that ask you if you have sex with men or women and if your gay?? Are people lying?? That's weak

[Ptrk3]

You are correct, a bad combination of fear and lack of personal responsibility on my part (in my case, I simply did not think I was at risk since I thought I played safe the only time I engaged in the riskiest behavior, but condoms can break, etc., or oral is not completely risk free, just much, much less risky).  I don't dispute that I am the responsible party.

I don't recall ever being asked about MSM until I was ill, but I do get a physical every year since 45 or so. Nonetheless, the article does speak for itself and says what it says, for what it's worth and what can be learned from it by both patient and medical professional.

[mecch]

Dunno... I've just never understood that even if a patient is not out to family/friends/work is it really that hard to discuss this with a doctor. The conversation is professional and completely confidential, like having it with a psychiatrist.

And if that's too difficult of course there are other ways to be tested outside of your family doctor. You know, anonymous clinic testing.

I don't think guys having sex with guys see HIV as "the remotest of possibilities" -- everyone thinks about it, even if they are simultaneously in denial about it. As far as yearly physicals, do most men have one? I didn't even have a personal general practitioner until I was 28, but I did make sure that when I got one he was also gay (word of mouth recommendation). If I got sick in college I went to the college clinic, and then when I got my first job I avoided my insurance deductible by going to a walk-in cheapo clinic until my salary was a bit higher.

But it's not even about medical access sucking in the US -- there are studies in the UK where medical services are free and easily available and the same situation is present. A large portion of MSM are in denial sexually and combine that with a reluctance to go to the doctor annually. It's a bad combination of fear and lack of personal responsibility.

Duh, plenty of MSM are deeply closeted and/or in denial and surely they don't discuss their sex practices and risks with doctors either.

Heteros deny HIV concerns them.

I had a gay dumbass "blueblood" lover in the 80s who used to say HIV didn't happen to "his kind".   

duh duh duh duh duh

De Nile isn't just a river in Egypt.

This surprises anyone? Why is that?
________

Lets share around the blame and the responsibility here.

Since health professionals should know that its the human condition to deny and hide sexual practices AND that nobody wants to talk about STDS, all health professionals should take their god damned kid gloves off and press upon ALL their patients routine STD testing. 

[Ptrk3]

Mecch: you articulated my thoughts better than I did.  I agree with you.  Everyone has the opportunity to learn from the article to be more open and aware.

[mecch]

I guess some patients "who are not concerned" will be offended but if its done with a light touch, the doctor won't lose the patient - can just not do the "routine testing".  But I bet the majority of people will just follow doctors' recommendations -- and half the people in denial (but only partially) will be relieved that its "routine" and applies to "everyone" and go along with getting screened now and then.

[OneTampa]

Good thread here.

I was out to my GP shortly before being diagnosed.

[mecch]

HIV is a huge financial burden.

My experience of the epidemic in the USA before Affordable Care Act was that fear of the financial consequences - was indeed often in the mix of the fears that led people not to test.

But governments have dirty hands including those "rich" countries with universal health coverage.  Governments know if HIV screening is routine, then all the cases will be revealed and there will be a legal and moral imperative to treat.  MONEY, honey.  Budgets. Taxes.  Can the US or the UK afford to treat its HIV infected population at 1st world drug prices??   Do they have the SPINE to budget for that and shove fabulously expensive STD treatment cost down the un-infected tax payers' throats? 

cough

[mecch]

Truvada is one of the top expenses to Swiss insurers these days.
New Hep C treatment cost is giving accountants and managers the cold sweats.
Theres a moral and perhaps a legal requirement to treat but we all got to pay the bill.

So temping to either avoid the sticker shock by not testing....
Or worse, go back to the judging - "why should the cleans and righteous share/bear the costs for treating the dirties and immorals".

[mecch]

The post-industrial so called rich nations have high GDPs and immense wealth. Where the fuck are these resources going, that we can't scrape together the will, the way, and the means to test and treat everyone?  Its a pretty much easily managed STD but its terribly expensive and being an STD too many people get the vapours.

Dreary, indeed.

[Ptrk3]

Good points.  Perhaps this is a remaining vestige of the silence=death days of early years.  It is ultimately a public-policy call, probably best left up to the States, since the Feds getting involved would bring the discussion into a larger and more heated arena.  It probably is a State call, anyway, outside of military service (for which I believe HIV testing is required for entry and, perhaps, periodically after entry).

I know that many States require HIV testing prior to getting a marriage license and I know that many, if not all, require HIV testing of pregnant women.  A good start, to be sure, and it may be interesting to see what develops now in those States that have mandatory testing to get a marriage license and now allow gay marriage. 

Anyway, mandatory testing of this sort will pose a sticky wicket for a while, but if there is a way to apply the testing to all in a general or neutral way, as you point out, it may pass muster and become part of a routine (like TB testing once was, or may still be in some quarters).

[leatherman]

It is ultimately a public-policy call, probably best left up to the States, since the Feds getting involved would bring the discussion into a larger and more heated arena.  It probably is a State call, anyway, outside of military service

ugh to that stupid states' rights crap. The confederacy lost a war because of that.

One state's problems are always bleeding over into another. Heck even the funding often bleeds out of one state going to another which actually has the problem. don't get me wrong, I believe the costs should be spread around though, but this illustrates that a state by state approach is a fool's errand to solve major issues. Matters of public health deserve a uniform national policy.

[Ptrk3]

You misunderstand me or I am not explaining myself well enough.

For the Feds to take over would likely take years, since there are all sorts of potential Constitutional issues, etc., not to mention all of the regional pushback and compromises necessary to pass legislation.  It's not a matter of State's rights, really, but a matter of expediency and efficacy.  The States may simply be better equipped and have existing infrastructure and well established legal authorities to do certain things quickly.  For instance, with marriage licenses, the Feds don't issue them, States do, so to get the Feds to require testing for marriage licenses, the Fed would have to first establish a (de novo) jurisdiction to establish marriage licenses.

On the other hand, in terms of the military, the Feds have the authority to require military recruits to be HIV tested--and the Feds do.  Perhaps, the solution would be for a strategy to create authorities for HIV testing pursuant to the respective Federal and/or State jurisdictions in place, since it takes so much time and energy to create these authorities de novo.

[tednlou2]

Good points.  Perhaps this is a remaining vestige of the silence=death days of early years.  It is ultimately a public-policy call, probably best left up to the States, since the Feds getting involved would bring the discussion into a larger and more heated arena.  It probably is a State call, anyway, outside of military service (for which I believe HIV testing is required for entry and, perhaps, periodically after entry).

I know that many States require HIV testing prior to getting a marriage license and I know that many, if not all, require HIV testing of pregnant women.  A good start, to be sure, and it may be interesting to see what develops now in those States that have mandatory testing to get a marriage license and now allow gay marriage. 

Anyway, mandatory testing of this sort will pose a sticky wicket for a while, but if there is a way to apply the testing to all in a general or neutral way, as you point out, it may pass muster and become part of a routine (like TB testing once was, or may still be in some quarters).

From what I'm finding, no states require HIV testing.  I read Mississippi requires a test for syphilliis and NY does for sickle-cell in blacks, but not HIV.  Are these sites not accurate? 

http://www.nolo.com/legal-encyclopedia/chart-state-marriage-license-blood-29019.html

http://www.poz.com/articles/hiv_mandatory_test_marriage_1_14681.shtml

[Ptrk3]

Good catch, tednlou2.  I'm from Illinois, which at one time did have such a statute (I remember when a friend of mine got married in the 80's, he had to get such a test:  he was moaning because it cost 90 bucks or so for both bride and groom to get tested).  The only other state to have such a test was LA, but that no longer exists either.  Here's a link that I just found references the matter and articulates the barriers to required testing:

https://www.law.uh.edu/healthlaw/perspectives/HIVAIDS/990226Premarital.html

So, unfortunately, nothings going to happen fast on this front, unless there's a national emergency, but not sure we'd want to go back to those early days when people were talking about testing and tattooing.  When will reason prevail?

[Ptrk3]

And with pregnant women, some states recommend HIV testing but don't require it.
The CDC, though, recommends on "opt out" clause, so that may be a way to encourage HIV testing in many different arenas.  That could work, if people were serious about testing and worried about various Constitutional issues.  There's where the Feds could step in and encourage testing:

http://www.cdc.gov/hiv/risk/gender/pregnantwomen/opt-out.html

[buginme2]

This isn't all bad news.  If you look at the numbers it appears that most everyone that is retained in care is on treatment. 

It doesn't appear that dr's are waiting to treat anymore. 

[mecch]

I don't follow your logic
100% estimated people with HIV, 82% have been diagnosed (that's good) and only 33% have been prescribed drugs.
Thats not even HALF of those known to have HIV.  Well more than 1/2 diagnosed HIV+ people not in treatment.

How is this "not bad news"?

[buginme2]

I don't follow your logic
100% estimated people with HIV, 82% have been diagnosed (that's good) and only 33% have been prescribed drugs.
Thats not even HALF of those known to have HIV.  Well more than 1/2 diagnosed HIV+ people not in treatment.

How is this "not bad news"?

We are looking at different numbers.  From the aidsmeds article that the original op posted it says


The CDC found that, among the MSM diagnosed with HIV in the United States, an estimated 77.5 percent were linked to care within three months, with 50.9 percent of the total retained in care, 49.5 percent prescribed antiretrovirals (ARVs) and just 42 percent virally suppressed.

If the percentages are all from the same population then almost everyone retained in care is on treatment.  Am I reading that right? 

[Ptrk3]

In regard to the OP linked story from AIDSMEDS:

"The CDC found that, among the MSM diagnosed with HIV in the United States, an estimated 77.5 percent were linked to care within three months, with 50.9 percent of the total retained in care, 49.5 percent prescribed antiretrovirals (ARVs) and just 42 percent virally suppressed."

I guess one's interpretation is a glass half-full, half-empty type thing, or how you slice the pie, but the copy editor who wrote the headline clearly does not think it's a good thing, nor does the writer of the story who consistently uses the modifier "just."  Sure, if you just look at those prescribed ARV's, you could boast that more than 80 percent (42 percent of the 49.5 percent) are virally suppressed, but the reality is that only 42 percent of the 100 percent of positives are virally suppressed, a much bleaker picture, if you are looking at all the positives (which would mean that 58 percent of positives are still capable of transmitting HIV, right?). 

[buginme2]

That's the point of saying "it's not all bad news." 

The disappointing statistics don't disqualify the positive ones.  99% of people retained in care receive treatment.  That's a positive statement and it didn't always be that way, even just a few years ago.

[mecch]

Ok I see what you mean.

[Giancarlo]

group	dx	linked	retained	art	ud
MSM	--	77	50	49	42
Everyone	82	66	37	33	25

really not too terrible when compared to all diagnosed.

You might want to compare with the treatment cascade in France:

group	dx	in care	art	ud
Everyone	81	74	65	56

And also a comparison between the cascades of France and US:


(Sorry for the labels in French)

[mecch]

But les français must live under an insufferable socialist regime that constrains both personal freedom and the economy. Un vrai couchemar!
http://www.youtube.com/watch?v=6UwQ2fyEgzo


And then there's hell on earth Norway
http://www.youtube.com/watch?v=k4L6-0WRfSA

[buginme2]

But les français must live under an insufferable socialist regime that constrains both personal freedom and the economy. Un vrai couchemar!
http://www.youtube.com/watch?v=6UwQ2fyEgzo


And then there's hell on earth Norway
http://www.youtube.com/watch?v=k4L6-0WRfSA

Th French are so sensible with their socialism and universal healthcare, they must hate freedom.

[leatherman]

You might want to compare with the treatment cascade in France:

yikes! I live in SC, under a Republican administration that hasn't accepted Medicaid Expansion. The advocacy work we do here often starts at the very basic level of simply getting access to healthcare and getting transportation to get to the health care. Because of our troubled health care system, comparing American numbers to French numbers is definitely apples to oranges. So while Yea! for the good French numbers, those numbers certainly illustrate how the disparities in the American health care system hurt individuals and our society as a whole.

[zach]

Vive la France!