Synopsis for August 11, 2006

The MMWR is embargoed until Thursday, 12 PM EST.

1. The Global HIV/AIDS Pandemic, 2006
2. HIV Prevalence among Populations of Men Who Have Sex with Men – Thailand
3. HIV-Related Practices at Chest Clinics – Guyana
4. Trends in HIV-Related Risk Behaviors among High School Students – United States
5. Vibrio parahaemolyticus Infections Associated with Consumption of Raw Shellfish – Three States, 2006

The Global HIV/AIDS Pandemic, 2006

Effective prevention and treatment of HIV infection with antiretroviral therapy (ART) is now available, even in countries with limited resources. A more than 200 percent increase in the number of persons receiving ART was seen between 2003 and 2005 in resource-limited countries. Despite the gains in ART, only 20 percent of persons in need of treatment worldwide received it in 2005. In addition, despite a five-year scale-up of interventions to prevent mother-to-child HIV transmission (PMTCT) of HIV, only 8 percent of pregnant women globally have access to PMTCT services.  As more HIV-infected persons receive ART, the number of persons living with HIV infection will increase, requiring scaling up of programs to prevent HIV transmission.  

Despite gains in global HIV treatment and prevention efforts, 4.1 million persons were newly infected with HIV and 38.6 million were living with HIV and AIDS in 2005. The epidemic still disproportionately affects certain geographical regions including sub-Saharan Africa and subpopulations (e.g., men who have sex with men, injection drug users, and sex workers). From 2003 to 2005, adult HIV infection prevalence estimates were lowered in many countries. In some countries, reductions might be the result of new surveillance sites and population-based surveys that provided increased coverage of rural populations with lower prevalence of HIV infection. Changes in sexual behavior (e.g., delayed onset of sexual intercourse, decreased number of partners, or increased condom use) appear partly responsible for declines in HIV infection prevalence in Kenya, Uganda, Zimbabwe, and Haiti. 

HIV Prevalence among Populations of Men Who Have Sex with Men –Thailand

To address an important gap in knowledge about the HIV/AIDS epidemic in Thailand, the Thailand Ministry of Public Health – U.S. CDC Collaboration conducted the first surveillance of HIV prevalence and risk behaviors among men who have sex with men (MSM) in Thailand. 

The study examined prevalence among community-based MSM in Bangkok in 2003, and expanded in 2005 to include community-based MSM, male sex workers, and trans-gendered persons in Bangkok, Chiangmai and Phuket.  The study found high HIV prevalence among all groups of MSM in 2005, an alarming 64 percent increase in prevalence among community-based MSM in Bangkok between 2003 and 2005 (from 17.3 percent to 28.3 percent), and low awareness of HIV status among all men in the study.  Researchers also found a relatively high prevalence among young men, suggesting a high underlying HIV incidence. The study provides the clearest picture to date of HIV prevalence and risk among diverse MSM communities in Thailand and underscores the need to reach MSM with more effective behavioral and biomedical interventions, more frequent and increased access to HIV counseling and testing, improved STD diagnosis and treatment, and community awareness and support. 

HIV-Related Practices at Chest Clinics – Guyana

Worldwide, tuberculosis (TB) is a leading cause of death among people living with HIV.  A new study from Guyana, where 20 percent of all TB patients are reported to be infected with HIV, finds that targeting TB treatment facilities for HIV testing and treatment referrals can help expand the reach of HIV services in developing country settings. 

In 2000, the Guyana Ministry of Health began providing HIV testing and care referrals for patients at Guyana’s six public TB clinics (“Chest” clinics), where 90 percent of the country’s TB patients are treated.  An analysis of the program, conducted in 2006 by researchers from CDC and other institutions, found that the clinics offered HIV tests to nearly three-quarters (73 percent) of patients with unknown HIV status at the time of TB diagnosis; 91 percent of these patients were ultimately tested, of whom 10 percent were found to be HIV infected.  Overall, more than one third of Chest clinic patients were found to be HIV-infected, including a significant number who already knew their HIV status prior to TB diagnosis.  Most HIV-infected TB patients (79 percent) were successfully linked to HIV care, often at nearby government-run HIV clinics.  The authors conclude that targeting TB clinics is feasible and effective, and that additional measures such as routine, opt-out HIV testing in TB patients should be considered to further improve HIV diagnosis and links to care at Chest clinics. 

Trends in HIV-Related Risk Behaviors among High School Students – United States

Progress has been made during the past 15 years in decreasing overall the prevalence of lifetime sexual intercourse, multiple sex partners, and current sexual activity and in increasing the prevalence of condom use among currently sexually active high school students.  However, efforts need to be intensified among black students, who are more likely than white and Hispanic students to report HIV-related sexual risk behaviors and who have experienced a leveling in lifetime sexual intercourse since 2001 and a leveling in condom use since 1999.  Additional measures also are needed among Hispanic students, who have not experienced decreases in the prevalence of sexual experience, having had multiple sex partners, or current sexual activity.  Improved health outcomes for all groups likely resulted from the combined efforts of parents and families, schools, youth-serving community organizations, health-care providers, mass media campaigns, government agencies, and the youths themselves and improved availability of effective interventions that address HIV-related knowledge, skills, and behaviors and their determinants. 

Overall, HIV-related sexual risk behaviors have decreased during the past 15 years among high school students in the United States, according to data from the CDC’s National Youth Risk Behavior Survey.  During 1991-2005, the prevalence of sexual experience decreased 13 percent, the prevalence of multiple sex partners decreased 24 percent, the prevalence of current sexual activity decreased 9 percent, and the prevalence of condom use among currently sexually active students increased 36 percemt.  Despite these positive changes, many students still engage in HIV-related risk behaviors.  In addition, some subgroups of students have not experienced these decreases.  Efforts to decrease these risk behaviors should be increased so that the incidence and prevalence of HIV/AIDS among young persons can be lowered.

Vibrio parahaemolyticus Infections Associated with Consumption of Raw Shellfish – Three States, 2006 

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