Inequalities in US Life Expectancy by Area Unemployment Level, 1990-2010

This study examined the association between unemployment and life expectancy in the United States during 1990-2010. 

Census-based unemployment rates were linked to US county-level mortality data. Life expectancies were calculated by age, sex, race, and unemployment level during 1990-2010. Differences in life expectancy were decomposed by age and cause of death. 

Life expectancy was consistently lower in areas with higher unemployment rates. In 2006-2010, those in areas with high unemployment rates (≥9%) had a life expectancy of 76.9 years, compared with 80.7 years for those in areas with low unemployment rates (<3%). The association between unemployment and life expectancy was stronger for men than for women. 

Life expectancy ranged from 69.9 years among black men in high unemployment areas to 90.0 years among Asian/Pacific Islander women in low unemployment areas. Disparities persisted over time. In 1990-1992, life expectancy was 4.7 years shorter in high unemployment than in low unemployment areas. In 2006-2010, the life expectancy difference between the lowest and highest unemployment areas decreased to 3.8 years. Heart disease, cancer, homicide, unintentional injuries, diabetes, HIV/AIDS, and liver cirrhosis contributed most to the lower life expectancy in high unemployment areas. High unemployment areas recorded larger gains in life expectancy than low unemployment areas, contributing to the narrowing gap during 1990-2010.

Below:  Life expectancy at birth by sex and area unemployment level, United States, 1990–2010

Below:  Survivorship by age, race, and unemployment level, United States, 1990–2010

Below:  Conditional probability of survival between ages of 25 and 64 years by unemployment level, United States, 1990–2010

Full article at:   http://goo.gl/FI27Gt

By:  Singh GK1, Siahpush M2.

• 1US Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857, USA.
• 2Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE 68198-4365, USA.
• Scientifica (Cairo). 2016;2016:8290435. doi: 10.1155/2016/8290435. Epub 2016 Mar 17. 

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A Successful Failure: Missing the MDG4 Target for Under-Five Mortality in South Africa

Summary Points

• Millennium Development Goal (MDG) “success” is based on relatively arbitrary targets, yet countries are coming under close scrutiny as the 2015 deadline approaches and the world’s focus moves on to new Sustainable Development Goals.
• Some countries may fail to meet MDG targets, for example, because of low baseline figures, despite making considerable advances in mortality reduction.
• In South Africa, under-five mortality was already low in 1990 as democracy advanced and the HIV epidemic emerged; thus, despite considerable mortality reduction in recent years, there was no appreciable net change from start to end of the MDG period.
• Understanding changes in childhood mortality depends on having detailed data over time, which can be interpreted in a more nuanced way than simply the achievement of arbitrary targets.

What Is “Success” in Terms of Reducing Under-Five Mortality?

When generic criteria to assess achievements are formulated long in advance of endpoints, unforeseen consequences may follow in particular instances. The Millennium Development Goals (MDGs) were fairly arbitrarily defined to be measured over the period from 1990 to the end of 2015, and now countries are being widely classified as meeting or failing those targets [1]. Achieving the MDG4 goal of reducing mortality in children under five years of age by two-thirds was always likely to be very difficult for some countries, particularly those with low mortality in 1990 [2]. The relevant, newly adopted third Sustainable Development Goal (SDG) now calls for under-five mortality to fall below 25 per 1,000 live births by 2030 [3], maintaining a global focus on achieving low childhood mortality.

Taking South Africa as an example, under-five mortality for the country in 1990 was the lowest in sub-Saharan Africa. But the intervening period has been pivotal, as the transition to democracy coincided with the start of the HIV pandemic. South Africa’s under-five mortality trajectory from 1980 to 1990 was effectively on track for the 2015 target, until a sharp rise in mortality was observed in the mid-1990s, as shown in Fig 1, using mortality estimates from UNICEF [4]. Nevertheless, South African child mortality levels remained substantially lower than in sub-Saharan Africa as a whole, despite neither the country nor the region being on track for their respective 2015 targets, and very rapid reductions in mortality were estimated for South Africa around 2010. Thus, South Africa apparently made progress before 1990, despite the iniquitous policies of the apartheid regime, and went on to record considerable reductions in child mortality during the latter part of the MDG period.

Below:  Under-five mortality estimates (with 90% uncertainty bounds) from UNICEF [4] for sub-Saharan Africa and South Africa from 1980 to 2013, together with respective MDG4 target levels for 2015 (two-thirds reduction from 1990).

Below:  Under-five mortality rates at the Agincourt site from 1992 to 2013, by age group and by cause of death category

Full article at:    http://goo.gl/3hNhmV

By:   Peter Byass, Chodziwadziwa W. Kabudula, Paul Mee, Sizzy Ngobeni, Bernard Silaule, F. Xavier Gómez-Olivé, Mark A. Collinson, Aviva Tugendhaft, Ryan G. Wagner, Rhian Twine, Karen Hofman, Stephen M. Tollman, Kathleen Kahn

MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Peter Byass, Paul Mee, Mark A. Collinson, Stephen M. Tollman, Kathleen Kahn

Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

Chodziwadziwa W. Kabudula, F. Xavier Gómez-Olivé, Mark A. Collinson, Stephen M. Tollman, Kathleen Kahn

INDEPTH Network, Accra, Ghana

Paul Mee

Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom

Aviva Tugendhaft, Karen Hofman

PRICELESS/PEECHi, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

  

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Stem Cell Sound Bites: HIV/AIDS

Via: http://goo.gl/ZrlNsO  By: https://twitter.com/uctelevision

HIV in Canada

New HIV cases are on the decline.

In 2014, there were an estimated 2,570 new HIV infections in Canada, down from 2,800 in 2011.

But the number of people living with HIV in Canada continues to rise.

In 2014 an estimated 75,500 people were living with HIV in Canada compared to the estimated 68,000 for 2011.

Why?

• people with HIV are living longer due to medical advances in treatment
• new HIV infections continue to occur

However, an estimated 1 in 5 people living with HIV in Canada are unaware of their HIV infection.

• 28% of people infected via heterosexual sex are unaware of their HIV positive status
• 20% of people infected via injection drug use are unaware of their HIV positive status
• 18% of men infected via sex with other men are unaware of their HIV positive status

Via:  http://goo.gl/OV7u6D

Elevated Sexual Risk Behaviors among Post-Incarcerated Young African American Males in the South

The dramatic racial disparities in the rates of HIV/STIs among African Americans make understanding broader structural factors that increase the risk for HIV/STIs crucial. The current study of young 564 African American men attending sexually transmitted infection (STI) clinics investigated whether those who had ever been incarcerated reported recent sexual behaviors relatively more risky than their counterparts who had never been incarcerated. 

Participants were recruited from clinics treating STIs in three southern U.S. cities. Males 15–23 years of age who identified as Black/African American and reported recent (past two months) sexual activity were eligible. Linear mixed-effects models and Generalized Estimating Equation (GEE) models were used to assess associations between baseline incarceration history and sexual risk behavior over a 6-month follow-up period. Mean age was 19.6 years (SD=1.87). 

At baseline, 240 (42.6%) men reported history of incarceration. Incarceration history predicted several risk behaviors over a 6-month follow-up period. Compared to those with no incarceration history, men previously incarcerated reported a desire to conceive a pregnancy, were less likely to have used a condom at last sex act and were more likely to have used drugs and alcohol before sex in the past two months. 

A history of incarceration may influence the sexual risk behavior of young African American males. Prevention programs and interventions should intensify support for post-incarceration African American males to help mitigate this behavior.

Read more at:  http://ht.ly/S6DN5

Via: JaNelle M. Ricks, DrPH,1 Richard A. Crosby, PhD,2,3 and Ivy Terrell, MPH4

1Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, 1518 Clifton Rd. NE, Atlanta, GA 30322, USA

2Department of Health Behavior, College of Public Health at the University of Kentucky, 111 Washington Ave, Lexington, KY 40506, USA

3The Kinsey Institute for Research in Sex, Gender, and Reproduction, Morrison Hall 302, 1165 E Third Street, Bloomington, IN 47405, USA

4Department of Pediatrics at Louisiana State University Health Sciences Center-New Orleans, 433 Bolivar Street, New Orleans, LA 70112, USA

Correspondence: JaNelle M. Ricks, DrPH, Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, 1518 Clifton Road, Room 426, Atlanta, GA 30322

Community Cleavages: Gay and Bisexual Men’s Perceptions of Gay and Mainstream Community Acceptance in the Post-AIDS, Post-Rights Era

Below: Regression results of gay and bisexual men’s mean perceived levels of broader community acceptance of different subgroups, by respondent age

Below: Regression results of gay and bisexual men’s mean perceived levels of gay community acceptance of different subgroups, by respondent age

Changes in gay and bisexual men’s connectedness to the gay community are related to the declining public visibility of HIV/AIDS and greater acceptance for homosexuality and bisexuality in mainstream society. Little work, however, has focused on perceived acceptance for subgroups within the gay community or broader society. Using interviews (n = 20) and a survey (n = 202) of gay and bisexual men in a mid-sized Canadian city, we find perceived hierarchies of acceptance for the various subgroups as well as an age effect wherein middle-aged men perceive the least acceptance for all groups. These differences are linked with the uneven impact of social, political, and institutional changes relevant to gay and bisexual men in Canada.

Read more at: http://ht.ly/ROqWJ HT https://twitter.com/unisouthampton

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High HIV Burden in Men Who Have Sex with Men across Colombia’s Largest Cities: Findings from an Integrated Biological and Behavioral Surveillance Study

Below:  Cities included in the study

Across cities, HIV prevalence averaged 15%, varied from 6% to 24% and was highest in Cali, Bogota, and Barranquilla. In the past 12 months, 65% of MSM had ≥ 5 casual male partners and 23% had a female partner. Across partnerships (i.e., casual, stable, and commercial), the proportion of MSM engaging in unprotected sex was ≥ 52% with male partners and ≥ 66% with female partners. Self-reported history of STI (24%) and past-year illicit drug use (38%) were also common. In multivariate analysis, age ≥ 35 (adjusted odds ratio [AOR], 19.2) and 25–39 (AOR, 5.6) relative to ≤ 18–24 years, identifying as homosexual relative to heterosexual (AOR 0.1), meeting casual partners on the Internet (adjusted odds ratio [AOR], 3.1) and age of sexual debut of ≤ 13 years (AOR, 3.1) predicted HIV infection. HIV testing and prevention messaging reached just 24% of MSM in the past year.

Findings support consistently elevated HIV burden among MSM throughout Colombia’s largest cities and a need for enhanced behavioral prevention and HIV testing, emphasizing men who use the Internet as well as physical venues to meet sex partners.


Via:   http://goo.gl/KGSAFB HT @UNFPA 

Identifying a Sample of HIV-Positive Beneficiaries From Medicaid Claims Data and Estimating Their Treatment Costs

Abstract
We sought to identify people living with HIV/AIDS from Medicare and Medicaid claims data to estimate Medicaid costs for treating HIV/AIDS in California. We also examined how alternate methods of identifying the relevant sample affect estimates of per capita costs. Methods. We analyzed data on Californians enrolled in Medicaid with an HIV/AIDS diagnosis reported in 2007 Medicare or Medicaid claims data. We compared alternative selection criteria by examining use of antiretroviral drugs, HIV-specific monitoring tests, and medical costs. We compared the final sample and average costs with other estimates of the size of California's HIV/AIDS population covered by Medicaid in 2007 and their average treatment costs. Results. Eighty-seven percent (18 290) of potentially identifiable HIV-positive individuals satisfied at least 1 confirmation criterion. Nearly 80% of confirmed observations had claims for HIV-specific tests, compared with only 3% of excluded cases. Female Medicaid recipients were particularly likely to be miscoded as having HIV. Medicaid treatment spending for Californians with HIV averaged $33 720 in 2007. Conclusions. The proposed algorithm displays good internal and external validity. Accurately identifying HIV cases in claims data is important to avoid drawing biased conclusions and is necessary in setting appropriate HIV managed-care capitation rates. 

Via:  http://ht.ly/HZAHX HT @UCLALuskin

What's new in sexually transmitted infections in the HIV care setting: Focus on syphilis and gonorrhea

Below: Varied presentations of primary and secondary syphilis infection

Abstract
Sexually transmitted infections are a resurgent problem in HIV disease. The number of new cases of syphilis among men who have sex with men has continued to increase, requiring renewed vigilance in screening, diagnosis, and treatment. Drug-resistant gonorrhea has prompted changes in treatment regimens and warrants continued monitoring. This article summarizes an IAS-USA continuing education webinar presented by Jeanne M. Marrazzo, MD, MPH, in January 2014

Via:  [PDF] http://ht.ly/I7dcg HT @UWMedicine

Partner Characteristics Associated with HIV Acquisition among Youth in Rakai, Uganda

RESULTS:
In regression analyses controlling for marital status, young women's risk of HIV acquisition increased if their partner was a truck driver, drank alcohol before sex, and used condoms inconsistently. In young men, the risk of HIV acquisition increased with partners who were not enrolled in school, in partnerships with higher coital frequency, and in partnerships where respondents were unable to assess the HIV risk of their partner. Mixed-model regressions adjusting for respondent's individual-level risk factors, showed that young women's risk of HIV acquisition increased with each non-marital sexual partner (IRR: 1.54 [1.20-1.98]), each partner who drank alcohol before sex (IRR: 1.60 [1.11-2.32]), and each partner who used condoms inconsistently (IRR: 1.99 [1.33-2.98]). Among young men, having non-marital partnerships increased HIV acquisition (IRR for each partner: 1.54[1.20, 1.98]).

IMPLICATIONS:
Partner characteristics predicted HIV acquisition among youth. HIV prevention programs should emphasize awareness of partner's risk characteristics to avoid high risk relationships.

Via: http://ht.ly/I7njx HT @ColumbiaMSPH 

Positive Coping Strategies & HIV-Related Stigma in South India

Abstract
Whether perceived or enacted, HIV-related stigma is widespread in India, and has had a crippling effect on People Living with HIV/AIDS (PLHA). Research has shown that a positive attitude towards the illness sets a proactive framework for the individual to cope with his or her infection; therefore, healthy coping mechanisms are essential to combat HIV-related stigma. This qualitative study involving in-depth interviews and focus group discussions with PLHA affiliated with HIV support groups in South India explored positive coping strategies employed by PLHA to deal with HIV-related stigma. Interviews and focus group discussions were translated, transcribed, and analyzed for consistent themes. Taboos surrounding modes of transmission, perceiving sex workers as responsible for the spread of HIV, and avoiding associating with PLHA provided the context of HIV-related stigma. Despite these challenges, PLHA used several positive strategies, classified as Clear Knowledge and Understanding of HIV, Social Support and Family Well-Being, Selective Disclosure, Employment Building Confidence, and Participation in Positive Networks. Poor understanding of HIV and fears of being labeled immoral undermined healthy coping behavior, while improved understanding, affiliation with support groups, family support, presence of children, and financial independence enhanced PLHA confidence. Such positive coping behaviours could inform culturally relevant interventions.

Via: http://ht.ly/I7sJ5 

Drug Use, Sexual Risk Behaviour & Sexually Transmitted Infections among Swingers: A Cross-Sectional Study In The Netherlands

Via:  http://ht.ly/IvoaG HT @MaastrichtU

Mortality among Drug Users in Europe: New & Old Challenges for Public Health

Below:  Main causes of death among the pooled cohort, where the cause of death is reported

Via:  http://ht.ly/IE8J9 RT @EMCDDA 

'Disproportionate HIV incidence in young women in South Africa'

Below:  Disproportionate HIV incidence in young women in South Africa

Below:  Age–Sex disparity in HIV acquisition - South Africa

Adolescent girls and young women: Key populations for HIV epidemic control

Adolescent girls and young women in southern Africa are uniquely vulnerable to HIV and have up to eight times more infection than their male peers. While the cause of this vulnerability has not been fully elucidated, it is compounded by structural, social and biological factors. These factors include but are not limited to: engagement in age-disparate and/or transactional relationships, few years of schooling, experience of food insecurity, experience of gender-based violence, increased genital inflammation, and amplification of effects of transmission co-factors. Despite the large and immediate HIV prevention need of adolescent girls and young women, there is a dearth of evidence-based interventions to reduce their risk. The exclusion of adolescents in biomedical research is a huge barrier. School and community-based education programmes are commonplace in many settings, yet few have been evaluated and none have demonstrated efficacy in preventing HIV infection. Promising data are emerging on prophylactic use of anti-retrovirals and conditional cash transfers for HIV prevention in these populations.

There is an urgent need to meet the HIV prevention needs of adolescent girls and young women, particularly those who are unable to negotiate monogamy, condom use and/or male circumcision. Concerted efforts to expand the prevention options available to these young women in terms of the development of novel HIV-specific biomedical, structural and behavioural interventions are urgently needed for epidemic control. In the interim, a pragmatic approach of integrating existing HIV prevention efforts into broader sexual reproductive health services is a public health imperative

Via:  http://ht.ly/JQICq HT @CAPRISAOfficial

Long-Term Trends in Esophageal Candidiasis Prevalence and Associated Risk Factors with or without HIV Infection: Lessons from an Endoscopic Study of 80,219 Patients

Below:  Endoscopic findings (A, B) and pathological findings (C) of candida esophagitis.

(A) Confluent, linear, and nodular elevated plaques. (B) Thick white plaque cover on esophageal mucosa circumferential narrowing the lumen. (C). Numerous Candida pseudohyphae and spores in the exfoliated esophageal epithelium and detached superficial squamous epithelium (×400).

Candida esophagitis (CE) prevalence was 1.7% (1,375/80,219) in all patients, 9.8% (156/1,595) in HIV-infected patients, and 1.6% (1,219/78,624) in non-HIV-infected patients. CE prevalence from 2002-2003 to 2012-2014 tended to increase in non-HIV-infected patients (0.6% to 2.5%; P<0.01) and decrease in HIV-infected patients (13.6% to 9.0%; P=0.097). Multivariate analysis revealed increasing age (odds ratio [OR], 1.02; p=0.007), HIV infection (OR, 4.92; p<0.001), and corticosteroid use (OR, 5.90; p<0.001) were significantly associated with CE, and smoking (OR, 1.32; p=0.085) and acetaminophen use (OR, 1.70; p=0.097) were marginally associated. No significant association was found with alcohol consumption, hepatitis B or C virus, syphilis, diabetes mellitus, cardiovascular disease, cerebrovascular disease, chronic kidney disease, liver cirrhosis, anticancer, or PPIs use. In HIV-infected patients, CD4 cell count <100/μL (OR, 4.83; p<0.001) and prior HAART (OR, 0.35; p=0.006) were independently associated with CE, but sexual behavior was not. Among corticosteroid users, CE was significantly associated with higher prednisone-equivalent dose (p=0.043 for trend test).

This large, endoscopy-based study demonstrated that CE prevalence increased in non-HIV-infected patients but decreased in HIV-infected patients over 13 years. Risk analysis revealed that increasing age, HIV infection, and corticosteroids use, particularly at higher doses, were independently associated with CE, but alcohol, other infections, diabetes, anticancer drugs, and PPIs use were not.

Read more at:   goo.gl/S6zYcb .@PLOSONE

Predictors of HIV-Related Stigmas among African American and Latino Religious Congregants

Of the survey participants, 63.8% were women, mean age was 40.2 years, and 34.4% were African American, 16.8% were U.S.-born Latinos, 16.0% were foreign-born, English-speaking Latinos, and 32.9% were foreign-born, Spanish-speaking Latinos. Exploratory and confirmatory factor analyses identified 4 dimensions of HIV stigma: discomfort interacting with people with HIV (4 items, α = .86), feelings of shame "if you had HIV" (3 items, α = .78), fears of rejection "if you had HIV" (3 items, α = .71), and feelings of blame toward people with HIV (2 items, α = .65). Across all dimensions, after controlling for sociodemographic characteristics and previous communication about HIV, knowing someone with HIV was associated with lower HIV stigma, and greater stigma concerning drug addiction and homosexuality were associated with higher HIV stigma.

Via:  http://ht.ly/Qfibc  HT @APAPsycNET 

Project Inform's Consumer Flow Chart for Accessing PrEP

Via:  [PDF] http://ht.ly/QaC2h HT @PAETC1 & .@ProjectInform

WHO Transgender People and HIV Policy Brief

Read at:  [PDF] http://ht.ly/QaAne HT @PAETC1 MT @WHO 

Perception of sexuality and fertility in women living with HIV: a questionnaire study from two Nordic countries

Below:  Desire for pregnancy and influence of HIV diagnosis and treatment on desire for children. Participants were asked the following questions: (a) Do you wish to become pregnant? (b) Has your HIV diagnosis changed your view on having children? (c) Have the improved treatment possibilities influenced your desire to have children?

In total, 560 women were included in the study. The median age was 44 years. The majority were of white European origin, with fully suppressed HIV viral load, CD4 cell count >350 µL and mild or no symptoms of their HIV infection. A total of 62% were sexually active, stating condom use as their sole form of contraception. Of the sexually inactive women, one-third were in steady relationships. Eighty percent reported prior pregnancies, of which the majority had one or more children. Most children were born prior to the women's HIV diagnosis and the mode of conception was predominantly natural. One-quarter of the participating women desired pregnancy, while more than half did not. The remaining quarter either stated that they already had the desired number of children or chose not to answer the question. Fourteen percent stated that their HIV diagnosis ended their wish for children; of these women, the median time of diagnosis was between 1995 and 1996. Pregnancy had been attempted unsuccessfully in one-quarter of study participants. The final question inquired what the risk of mother-to-child transmission was, with all precautions taken. Fifteen percent estimated the risk to be above two percent.

In conclusion, the majority of WLWH in industrialized settings in Denmark and Finland have few HIV-related symptoms, are sexually active and have a strong desire for children.

Via: http://ht.ly/O11hm  HT @uni_copenhagen

Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006 - 2010

Below: Crude mortality rates by cause of death according to in-treatment and out-of-treatment periods

The primary outcome was mortality, indicated by time to death, crude mortality rates (CMR), and standardized mortality ratios (SMR).

Individuals being treated for opioid dependence had a more than four-fold increase of mortality risk compared with the general population (SMR 4.5 95% CI: 4.2, 4.8). Mortality risk was higher (1) when individuals were out-of-treatment (SMR 6.1, 95% CI: 5.7, 6.5) than in-treatment (SMR 1.8, 95% CI: 1.6, 2.1) and (2) during detoxification (SMR 2.4, 95% CI 1.5, 3.8) than during MMT (SMR 1.8, 95% CI 1.5, 2.1), especially in the two weeks post-treatment entry (SMR 5.5, 95% CI 2.7, 9.8 versus SMR 2.5, 95% CI 1.7, 4.9). Detoxification and MMT both independently reduced the instantaneous hazard of all-cause and drug-related mortality. MMT preceded by detoxification was associated with lower all-cause and other-cause-specific mortality than MMT alone.

In people with opiate dependence, detoxification and methadone maintenance treatment both independently reduce the instantaneous hazard of all-cause and drug-related mortality.

Via:   http://ht.ly/O46n0  HT @UCLAHealth