March 14, 2019 at 12:37 pm PDT | by Staff reports
HIV prevention efforts stall

Jennifer Millar lives in a tent with her two dogs under a Hollywood freeway ramp. Millar says she keeps trash bags and hand sanitizer near her tent, and she regularly pours water mixed with hydrogen peroxide on the sidewalk. ‘I worry about all those diseases,’ says Millar. (Photo by Heidi de Marco for Kaiser Health News)

A report issued Feb. 27 by the Centers for Disease Control & Prevention disclosed that a decline in annual HIV infections has stopped and new infections have stabilized in recent years. However, the CDC report details that the rate of new infections coupled with decline in HIV infections in minority communities, especially among LGBTQ Black and Latino people, has plateaued negatively because effective HIV prevention and treatment are not adequately reaching those who could most benefit from them.

These gaps remain particularly troublesome in rural areas and in the South and some urban areas among those disproportionately affected populations. Homeless populations, specifically LGBTQ youth remain at the greatest risk.

Some urban areas are addressing the problem with intensified local efforts to prevent HIV.  Metroplexes such as New York and Washington, D.C., have developed and enacted plans to eliminate their local HIV epidemics — and they are seeing the results of those commitments. New HIV infections decreased about 23 percent in New York and about 40 percent in Washington, D.C., in a six-year period from 2010 to 2016. Los Angeles however, remains a different story.

The CDC estimates that from 2010 to 2016, annual HIV infections:

• Remained stable among gay and bisexual men, who continue to account for the largest portion (about 70 percent) of new infections. However, trends varied by race/ethnicity and age:

• By race/ethnicity, infections remained stable among black gay and bisexual men; increased 30 percent among Latino gay and bisexual men; and decreased 16 percent among white gay and bisexual men.

• By race/ethnicity and age, infections decreased more than 30 percent among black gay and bisexual males ages 13 to 24; remained stable among Latino gay and bisexual males ages 13 to 24; and increased about 65 percent among both black and Latino gay and bisexual males ages 25 to 34.

• Decreased about 17 percent among heterosexual men and women combined, including a 15 percent decrease among heterosexual African American women.

• Decreased 30 percent among people who inject drugs, but appear to have stabilized in more recent years.

Coupled with the stall in the HIV prevention and treatment is the growing population of homeless people in the United States and especially in California. A report issued in December 2018 by the U.S. Department of Housing and Urban Development in its annual report to Congress, found that nearly 553,000 Americans were homeless at the end of 2018, with nearly one-quarter residing in California.

The issues and challenges of homelessness, especially in Los Angeles, which impacts HIV prevention and treatment has been further exacerbated by an outbreak of diseases that were common during Medieval times and had been reduced in modern times.

This rise in those statistics garnered that attention of California’s Chief Executive. “Our homeless crisis is increasingly becoming a public-health crisis,” Governor Gavin Newsom said in his State of the State speech last month. “Typhus,” he said. “A medieval disease. In California. In 2019.”

The Governor also referenced recent outbreaks of hepatitis A in the greater San Diego metroplex as well as a surge in reported cases of syphilis in Sonoma County in Northern California.

At highest risk according to public health and policy experts are LGBTQ youth who are homeless.

A 2012 study by the Williams Institute at the University of California Los Angeles found that 94% of respondents from agencies who actively are working with LGBTQ youth, discovered that 30% of their clients identified as gay or lesbian, 9% identified as bisexual, and 1% as transgender (for a total LGBTQ population served of 40%). Additionally, more than 75% of responding agencies worked with transgender youth in the past year. Survey findings suggest that 30% of clients in housing programs targeting youth are LGBTQ.

There has not been a significant reduction in that overall population of 40% at risk LGBTQ youth since the study was commissioned and released seven years ago.

“The hygiene situation is just horrendous” for people living on the streets, says Glenn Lopez, a physician with St. John’s Well Child & Family Center, who treats homeless patients in Los Angeles County, told The Atlantic Magazine in a March 11 article.  “It becomes just like a Third World environment, where their human feces contaminate the areas where they are eating and sleeping.”

Those infectious diseases are not limited to homeless populations, Lopez warns: “Even someone who believes they are protected from these infections [is] not.”

A Los Angeles based social worker, who asked to remain unidentified, told the Blade that while St. John’s Well Child & Family Center as well as outreach efforts from other non-profits to include the LA LGBT Center and its satellite facilities are crucial, there is still not enough awareness of critical healthcare issues being fostered among the LGBTQ Homeless youth population. Adding to that issue the worker added, was that many of those youth are often involved in survival sex via escort/sex work. Many simply do not know of the healthcare options available unless they learn of those options via word of mouth or search out the clinical resources themselves.

This is especially true of Trans youth of colour who are at greater risk for not only sexually transmitted diseases to include HIV, but more often than not are ‘sleeping rough’ in one of the hundreds of encampments spread throughout the LA metroplex.

(Reporting by The Sacramento Bee, The Atlantic, and the staff of the Los Angeles Blade.)

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