1 MSM Sexual Health Summit August 20, 2012 HIV/STD Prevention and Care Branch Texas Department of State Health Services

Newly Diagnosed HIV Cases, Deaths, and People Living with HIV in Texas: Newly diagnosed HIV infection includes all new HIV cases regardless of disease status death data are provisional. Living with HIV Deaths Among Cases New HIV Cases

Public Awareness Targeted Prevention Full Diagnosis Successful Linkage Support Participation in Care Medical Adherence

Texas 2011 New Diagnosis Rate by Selected Characteristics ^Denominator estimate based on: Lieb S, et al. Estimating Populations of Men Who Have Sex with Men in the Southern United States. Journal of Urban Health Nov;86(6):

2011 New Diagnosis Rate by Race Among MSM 1 1 Denominator estimate based on: Lieb S, et al. Estimating Populations of Men Who Have Sex with Men in the Southern United States. Journal of Urban Health Nov;86(6):

6 Gonorrhea Cases: Texas,

7 STI/HIV Comorbidity Proportion of HIV cases Co-Infected with STI

8 GC/HIV Comorbidity By Race/Ethnicity

9 GC/HIV Comorbidity By Risk

10 GC/HIV Comorbidity By Age Group

11 GC/HIV Comorbidity Interval Between Diagnoses

12 Timing of Diagnoses Number of Months from HIV to Other DX

Interdependent Capacity Building 13

Interdependence, Unintended Consequences, Systems Adaptation Undetected and untreated disease driving GC and HIV– don’t ask don’t tell Not using all the laboratory weapons in our arsenal The unintended consequences of urine testing and how this may be fueling transmission of GC and also HIV in the MSM community Haven’t had a spotlight on the sexual transmission of HCV 14

CDC Recommendations from STD Treatment Guidelines, 2010 Screening tests should be performed at least annually for sexually active MSM: HIV serology, if HIV negative or not tested in the previous year syphilis serology GC/CT screening for: –urethral infection (urine testing) for men who had insertive intercourse –Rectal infection (rectal swab) for men who had receptive anal intercourse –Pharyngeal infection (throat swab) for men who had receptive oral intercourse 15

CDC Recommendations Sexual transmission of hepatitis C virus infection can occur, especially among HIV-infected MSM. Serologic screening for hepatitis C infection is recommended at initial evaluation of newly diagnosed HIV-infected persons. HIV-infected MSM can also acquire HCV after initial screening; therefore, men with new and unexplained increases in alanine aminotransferase (ALT) should be tested for acute HCV infection. 16

Overall Goals of Engagement Reduce undetected and untreated GC/CT in MSM Reduce transmission of HIV in MSM Increase identification of HIV-positive MSM co-infected with HCV 17

Summit Goals Increase awareness, urgency and action to implement consistent, appropriate and timely GC/CT detection for MSM and HCV screening for HIV-positive MSM Expand capacity to build protocols and provide education on this issue 18

Summit Outcomes Develop next steps for your organization to implement extra-genital screening for MSM Build coalitions with partners in your area to implement consistent, appropriate and timely extra-genital GC and HCV screening for MSM 19