The document discusses the state of people living with HIV/AIDS in the United States. Over 1 million people were living with HIV/AIDS in the US in 2008. Many face challenges such as poverty, mental health issues, and stigma. However, people living with HIV/AIDS also demonstrate strengths like resilience and leadership in advocacy and prevention efforts. While antiretroviral treatment has improved health outcomes, many people living with HIV/AIDS still do not receive adequate medical care or achieve viral suppression.

1. The State of People Living with HIV/AIDS Richard J. Wolitski, PhD Deputy Director, Behavioral and Social Science HHS Consultation with People Living with HIV/AIDS July 25, 2011 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

3. Some of Our Challenges

5. HIV Incidence and Prevalence, United States, 1977-2006 Hall et al., JAMA, 2008. Campsmith et al., CROI, 2009.

6. 1,178,350 People Living with HIV/AIDS In the United States At the end of 2008. CDC, MMWR, June 3, 2011.

7. Gender CDC, MMWR, June 3, 2011

8. Transmission Risk CDC, MMWR, June 3, 2011

9. Race/Ethnicity CDC, MMWR, June 3, 2011

10. Age CDC, MMWR, June 3, 2011

12. 20% of people living with HIV/AIDS

13. Heterosexual men, MSM, youth, API and AI/AN at greatest risk of undiagnosed infectionCDC, MMWR, June 3, 2011

15. At greater risk for HIV transmission

18. Homelessness

19. Depression and other mental health issues

20. Substance use and abuse

21. Physical and sexual abuse

22. Racism

23. Homophobia

24. Transphobia

26. Getting appropriate medical careand supportive services

27. Disclosure and nondisclosure of HIV status

28. HIV stigma and discrimination

29. Violence

30. Employment

32. Many PLWHA Are Not Getting Appropriate Medical Care 4 out of 5 diagnosed Gardner et al. CID. 2011.

33. Many PLWHA Are Not Getting Appropriate Medical Care 75% linked to care Gardner et al. CID. 2011.

34. 67% retained in care Gardner et al. CID. 2011. Many PLWHA Are Not Getting Appropriate Medical Care

35. 75% on ART Gardner et al. CID. 2011. Many PLWHA Are Not Getting Appropriate Medical Care

36. 80% undetectable Gardner et al. CID. 2011. Many PLWHA Are Not Getting Appropriate Medical Care

37. 24% of diagnosed undetectable Gardner et al. CID. 2011. Many PLWHA Are Not Getting Appropriate Medical Care

38. 19% of all PLWHA Gardner et al. CID. 2011. Many PLWHA Are Not Getting Appropriate Medical Care

39. Good HIV CareIs Good for Prevention Higher viral load associated with HIV transmission (Fisher et al., AIDS, 2010; Das et al., PLOS One, 2010; Quinn et al., N Eng J Med, 2000) Early ART led to 96% reduction in transmission in HPTN 052 (Cohen et al., NEJM 2011) 92% reduction in observational studies (Attia et al., AIDS, 2009)

40. Good HIV CareIs Good for PLWHA Inadequate or late health care increases morbidity and mortality People living with HIV are at-risk for various health problems including: Cardiovascular disease Cervical and anal cancers Bone loss Dementia Sexually transmitted infections Hepatitis C

41. Stigma Has Declined, But Still Widespread Kaiser Family Foundation, June 2011. 45% of Americans would be uncomfortable having their food prepared by someone who is HIV‐positive 29% uncomfortable having their child in a classroom with an HIV‐positive teacher 18% uncomfortable working with someone with HIV

42. Gielen, et al. Journal of Urban Health, 2000. 257 HIV-positive women, 92% African American 44% reported negative consequences of disclosure 24% lost friends 23% insulted or sworn at 21% rejected by family 10 women (4%) were physically or sexually assaulted Women with a history of physical and sexual violence were significantly more likely to experience negative consequences

43. Wolitski et al., AIDS and Behavior, 2009. 637 unstably housed/homeless PLWHA from 3 US cities Higher levels of stigma associated with: Poorer self-assessed physical and mental health Poorer adherence to HIV treatment Drug use Decreased disclosure of HIV status to social network members and sex partners

44. Galvan et al., AIDS Patient Care and STDs, 2008, 283 HIV-positive African Americans in Los Angeles Less perceived stigma associated with fewer symptoms of major depression Social support from friends associated with less perceived stigma

45. Courtenay-Quirk et al., AIDS Education and Prevention, 2006. 206 HIV-positive MSM from New York City and San Francisco Many perceived stigma and discrimination in gay community toward PLWHA 36% agreed that HIV-negative men judge you if they find out that you are positive

46. Courtenay-Quirk et al., AIDS Education and Prevention, 2006. Higher levels of stigma were associated with: Anxiety, loneliness and depressive symptoms Suicidal ideation Avoidant coping Seeking partners in sex clubs and private sex parties

47. Some of our strengths

48. Some Strengths Individual and collective resilience Strength, courage, knowledge and ability to bring about positive change: Advocating for our needs and those of others Helping others navigate complex medical care and service systems Sharing our stories and experiences to: Reduce stigma and discrimination Educate others and prevent HIV transmission Improve medical care and service delivery Providing leadership at community and national levels

49. Most PLWHA See Themselves as Responsible for Protecting Others Wolitski et al., AIDS and Behavior, 1998.

50. Perceived Responsibility is Associatedwith Transmission Risk p < .001 p < .05 p < .001 Wolitski et al., AIDS and Behavior, 1998.

51. A Growing Literature Personal responsibility is associated with reduced risk in multiple studies Injecting and other drug users in the US and Tanzania(Latka et al., 2007; Ross et al., 2007) Ugandan men and women(King et al., 2008) MSM in The Netherlands and US(Bogart et al., 2006; O’Dell et al., 2008; van Kesteren et al., 2005, 2007) HIV+ clinic patients in US(Hong et al., 2006) Psychological Bulletin.2009.

52. Kimbrough et al., AJPH, 2009. 422 recruiters in 7 cities referred people they knew for HIV testing 60% living with HIV/AIDS More undiagnosed HIV infections found by PLWHA 6.8% referred by PLWHA were newly diagnosed with HIV 4.4% referred by HIV-negative persons were newly diagnosed

53. Women and Men Living with HIV/AIDSHelp Others Reduce Risk Behavior Wingood et al., JAIDS, 2004; Kalichman et al. American Journal of Preventive Medicine, 2001. More info available at: www.effectiveinterventions.org

54. Women and Men Living with HIV/AIDSHelp Others Reduce Risk Behavior

55. Conclusions PLWHA are a large, growing and diverse population Face multiple challenges Countered by multiple strengths The health care needs of PLWHA are not being adequately met and result in Poorer health for PLWHA and increased health care costs Missed opportunities to prevent HIV transmission Stigma and discrimination continue to negatively affect the lives and health of PLWHA PLWHA play important and effective roles in reducing stigma, improving HIV care and preventing HIV transmission

56. Thank You! For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention