MMWR – Morbidity and Mortality Weekly Report

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1. Differences in Antiretroviral Therapy Outcomes among HIV-Infected Men Compared with Women — Six African Countries, 2004–2010

CDC Media Relations
404-639-3286

Further research on country-specific reasons for differences between HIV-infected men and women in antiretroviral therapy (ART) enrollment characteristics and attrition are needed. The results of such studies could potentially identify strategies to improve early diagnosis and treatment among men, which could improve overall ART program outcomes, and might contribute to prevention of new HIV-infections in female partners. In six countries from western, southern, and eastern Africa, retrospective cohort studies were conducted among samples of HIV-infected adult ART enrollees to describe enrollment characteristics and attrition (defined as death, loss to follow-up, or stopping ART). The study found lower median CD4 counts and more World Health Organization stage IV disease in men at enrollment in all six countries. In addition, the risk of attrition during ART was significantly higher in men in western and southern African countries, even after controlling for possible baseline predictors of ART outcomes. In eastern Africa, risk of attrition did not differ significantly between men and women. Further research on country-specific reasons for differences between HIV-infected men and women in ART enrollment characteristics and attrition are needed. The results of such studies could potentially identify strategies to improve early diagnosis and treatment among men, which could improve overall ART program outcomes, and might contribute to prevention of new HIV-infections in female partners.

2. Voluntary Medical Male Circumcision — Eastern and Southern Africa, 2010–2013

CDC Media Relations
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In nine countries where national ministries of health and the Centers for Disease Control and Prevention (CDC) are implementing Voluntary Medical Male Circumcision (VMMC) for HIV prevention, VMMC uptake has increased nearly fourfold from 2010-2012. In this period, 1,020,424 VMMCs were conducted in over 1,600 CDC-supported sites through funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) in Botswana, Kenya, Malawi, Mozambique, Namibia, South Africa, Tanzania, Uganda, and Zambia. This represents substantial increases in the annual number of VMMC: 137,096 in 2010, 347,724 in 2011, and 535,604 in 2012. Among countries reporting data on HIV testing and counseling (HTC), 86.5 percent (461,323) of VMMC clients accepted HTC, and among those, 2.4 percent (10,933) tested HIV-positive and were referred to care and treatment services. VMMCs were also conducted safely among clients returning to VMMC sites for postoperative assessment, as recommended. The overall moderate and severe postoperative adverse event rate was only 0.8 percent.

3.HIV Testing and Risk Behaviors Among Gay, Bisexual, and Other Men Who Have Sex with Men — United States

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
404-639-8895
NCHHSTPMediaTeam@cdc.gov

A new analysis of data from 20 major U.S. cities suggests concerning signs of sexual risk for HIV infection among gay and bisexual men, but indicates that accurate knowledge of HIV infection status can dramatically reduce risk. The authors found that the proportion of men who have sex with men (MSM) reporting unprotected anal sex at least once during the past 12 months increased from 48 percent in 2005 to 57 percent in 2011. While the analysis does not provide information on whether other prevention strategies were being employed, the trend is concerning given the high risk of HIV transmission during anal sex. Findings also highlight the importance of accurate knowledge of status. In 2011, 33 percent of HIV-positive MSM who were unaware of their infection had unprotected anal sex at last sex with a partner who they believed to be HIV-negative or whose status they did not know. Among HIV-positive MSM who knew they were infected, however, unprotected anal sex with partners of a different status was 60 percent lower. But far too many remain unaware of their status – in fact, in 2011, one-third of MSM reported not being tested for HIV within the past 12 months, as CDC recommends. To reduce the burden of HIV among gay and bisexual men, authors note the need for increased HIV testing and prevention efforts.

4.Tularemia — United States, 2001–2010

CDC Media Relations
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Hunting of rabbits and other small mammals is a leading source of tularemia in the winter months. With rabbit hunting season now in full swing in many states, hunters are reminded to wear gloves when handling animals and cook game meat thoroughly. Tularemia is an uncommon but potentially serious bacterial infection acquired through contact with infected animals (especially rabbits and other small mammals), bites from deer flies and ticks, and other sources. The causative organism, Francisella tularensis, is considered a possible bioterrorism agent. This report shows that children aged 5-9 years and men aged 65-69 years are at highest risk for naturally acquired tularemia. South Dakota, Arkansas, Wyoming, Missouri, and Nebraska have the highest rates. Preliminary findings suggest that the number of cases in some northeastern and Pacific states may have increased; however, more research is necessary to investigate these findings. Hunters, landscapers, and others who spend a lot of time outdoors should be aware of this disease so they can protect themselves and recognize the early symptoms.

5.Very High Blood Lead Levels Among Adults — United States, 2002–2011

CDC Media Relations
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Although there have been remarkable reductions in lead exposures in the United States, Lead exposures continue to occur at unacceptable levels. To prevent lead-related adverse health outcomes, increased efforts are needed to prevent lead exposures at workplaces and communities. Despite tremendous reductions in lead exposures over the past several decades in the United States, NIOSH reports that some individuals continue to be exposed to lead at unacceptable levels. During 2002–2011, 11,536 adults were identified with very high blood lead levels (BLLs greater than or equal to 40 µg/dL). More than 90 percent of these adults were exposed to lead at work. Even BLLs less than 10 µg/dL are known to cause adverse health effects. These findings underscore the need for increased efforts to prevent lead exposure. In particular, public health officials and practitioners need to increase lead exposure prevention activities directed at employers, workers, health-care providers, and the community.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES