Progress towards ending HIV transmission in England by 2030

Background: England is committed to ending HIV transmission by 2030. The HIV Action Plan (2021) set an interim ambition to reduce HIV transmission by 80% to 600 new diagnoses first made in England by 2025. Here we present the progress between 2019 (baseline) and 2021, interpreted in the context of the COVID-19 pandemic. Method(s): People newly diagnosed with HIV were reported to the HIV and AIDS Reporting Section (HARS). The annual number of people having an HIV test in all sexual health services (SHS) including online testing were reported using GUMCAD. HIV diagnoses among people previously diagnosed abroad were excluded (25%). Result(s): New HIV diagnoses first made in England fell by 32% from 2,986 in 2019 to 1,987 in 2020, but plateaued in 2021 (2,023). Among gay/bisexual men, HIV diagnoses plateaued in 2021 (721) after a fall of 45% between 2019 and 2020, from 1,262 to 699. After a fall in HIV testing in 2020 (from 156,631 in 2019 to 144,800 in 2020), the number of people tested in 2021 (178,466) exceeded pre-COVID-19 levels. This suggests a decline in HIV incidence supported by a CD4 back calculation model (80% probability of a decline for the period 2019-2021), but at a slowing rate. Among heterosexual adults, new HIV diagnoses first made in England in 2021 also plateaued (798) following a 31% decrease (from 1,109 in 2019 to 761 in 2020). However, HIV testing coverage has not recovered to pre- COVID-19 levels (628,607 in 2019, 441,017 in 2020 and 489,727 in 2021). This provides no evidence of a fall in incidence in this population. Conclusion(s): A reduction by 360 new diagnoses first made in England year on year from 2022 onwards is required to meet the HIV Action Plan ambition. Despite an estimated 4,500 people with undiagnosed HIV and extremely high levels of antiretroviral therapy and viral suppression, PrEP access remains unequal. HIV testing numbers, which were affected by COVID-19 pandemic, have recovered in gay/bisexual men, but not among heterosexual adults. While the interim ambition is within reach for gay/bisexual men, PrEP and testing levels must be scaled up in heterosexual adults.

Joint Australasian Sexual Health and HIV and AIDS Conferences

The proceedings contain 22 papers. The topics discussed include: heard but not seen: experiences of telehealth by people living with HIV (PLHIV) in COVID times;clinical guidelines: their influence on HIV-related legal proceedings;examining HIV anxiety in gay men as an embodied response to the AIDS crisis;weight and lipid changes in phase 3 cabotegravir and rilpivirine long-acting trials;comparison of viral replication for the 2-drug regimen (2DR) of dolutegravir/lamivudine;lifetime cost of HIV management in Australia: a modelling study;Intentions for future use of PrEP following COVID-19 restrictions: results from the Flux Study of gay and bisexual men in Australia;associations between social capital and HIV risk-taking behaviors among men who have sex with men in Japan;HIV testing, treatment and viral suppression among men who have sex with men (MSM) in five countries: results of the Asia Pacific MSM Internet Survey;sustained higher levels of intracellular HIV-1 RNA transcript activity in viral blip patients;and lost in translation: preventing the meanings of sexual and reproductive health from being lost during the translation of national surveys.

Joint Australasian Sexual Health and HIV and AIDS Conferences

The proceedings contain 22 papers. The topics discussed include: heard but not seen: experiences of telehealth by people living with HIV (PLHIV) in COVID times;clinical guidelines: their influence on HIV-related legal proceedings;examining HIV anxiety in gay men as an embodied response to the AIDS crisis;weight and lipid changes in phase 3 cabotegravir and rilpivirine long-acting trials;comparison of viral replication for the 2-drug regimen (2DR) of dolutegravir/lamivudine;lifetime cost of HIV management in Australia: a modelling study;Intentions for future use of PrEP following COVID-19 restrictions: results from the Flux Study of gay and bisexual men in Australia;associations between social capital and HIV risk-taking behaviors among men who have sex with men in Japan;HIV testing, treatment and viral suppression among men who have sex with men (MSM) in five countries: results of the Asia Pacific MSM Internet Survey;sustained higher levels of intracellular HIV-1 RNA transcript activity in viral blip patients;and lost in translation: preventing the meanings of sexual and reproductive health from being lost during the translation of national surveys.

Longitudinal factors associated with quality of life (EQ-5D-3L) in a U.S. cohort of people with HIV (PWH) in routine care in the current treatment era

Aims: To describe longitudinal associations between health-related quality of life (HR-QoL) scores and demographic, clinical, and health behavioral characteristics in a multisite U.S. cohort of adults in HIV care. Method(s): People with HIV (PWH) completed an electronic assessment of patient-reported outcomes (PROs) as part of routine clinical care between 2016 and 2021 including measures for HR-QoL (EQ-5D-3L), substance use (ASSIST, AUDIT/AUDIT-C), smoking, and HIV stigma, among others. We used generalized linear latent and mixed models with nonparametric random effects for the intercept term to accommodate repeated measures on individuals to examine longitudinal factors associated with HR-QoL overall and stratified by birth-sex. Result(s): PWH (n = 10,559, median age at first assessment = 49, 17.8% cis-gender women, 1.4% transgender women;68.3% non-White) completed 33,866 assessments. Lower HR-QoL scores were associated with increasing age (p <= 0.0001);identifying as female (cis or transgender) compared to cisgender male (p <= 0.0001, p = 0.005, respectively);living in the Southeast or Western US relative to Northeast (both p <= 0.0001);identifying as a sexual orientation other than gay (heterosexual p = 0.03, bisexual p = 0.009, other p <= 0.0001);higher internalized HIV stigma (p <= 0.0001);current or former smoking (both p <= 0.0001);past methamphetamine use (p = 0.015) and current cocaine/crack, methamphetamine, opioid and cannabis use (p <= 0.0001 for each except cannabis, which was p = 0.007). Higher HR-QoL scores were associated with race/ethnicities other than White (Black: p = 0.002, Hispanic: p = 0.002, other: p <= 0.0001);the COVID-19 pandemic period (March 2020-December 2021) (p <= 0.0001);and increased AUDIT/AUDIT-C score (p = 0.001). In sex stratified models men (n = 8666) had higher HR-QoL scores among non-white compared to white (Black p = 0.0006, Hispanic p = 0.007, Other p <= 0.0001);and during the COVID period (p <= 0.0001). Men had lower HR-QoL scores among heterosexual and bisexual men relative to gay (p = 0.004, p = 0.005), if they were a former smoker (p <= 0.0001), and among past or current methamphetamine users relative to nonusers (p = 0.002, p <= 0.0001). Women (n = 1893) had higher HR-QoL scores if in care longer (p = 0.005), and lower HR-QoL if in the South (p <= 0.0001), if previously used cocaine/crack (p <= 0.0001), or if currently uses marijuana (p = 0.001). Conclusion(s): Our findings describe HR-QoL and its associations among a large diverse cohort of PWH, identifying potentially modifiable factors to improve HR-QoL, such as substance use, smoking, and impact of HIV-related stigma.

Abuse of Marginalized Older Adults during COVID-19: Proxy Findings from the Canadian Longitudinal Study on Aging

Child and spousal abuse rates tend to increase during various disasters. This study sought to determine the prevalence and determinants of older adults' experiences of increased verbal or physical conflict (+VPC) as a proxy for elder abuse during the COVID-19 pandemic. Data stem from the Canadian Longitudinal Study on Aging (CLSA), a prospective cohort study of 51,338 Canadians aged 45-85 at baseline. We analyzed the data of participants aged 55 or older at core follow-up 1 who also participated in a CLSA COVID-19 substudy (n = 24,306). Experiencing +VPC was the main outcome variable;explanatory variables included gender identity, sexual orientation, age group, race/ethnicity, educational attainment, marital status, household income, working status, living arrangement (alone vs. with others), social support availability, cohesion in the community, self-rated health, anxiety, depression, and previous history of elder abuse. The overall weighted prevalence of +VPC was 7.4%. Gay/bisexual men, 55-64 age group, living with others, low social support, poor social cohesion, low self-rated health, poor mental health, and history of psychological or physical abuse were each significantly associated with +VPC. Weighted multivariable logistic regression revealed that male gender, living with others, higher depression and anxiety scores, and a history of psychological abuse were independent predictors of +VPC. Implications for postpandemic recovery and prevention strategies during future disasters include targeted outreach programs for the most vulnerable group, which included males and younger older adults between 55 and 64 years as well as those with mental health issues and/or history of elder psychological abuse.

Sexual Minority Mental Health and Care Access during the COVID-19 Pandemic

Background: The current scarcity of research surrounding sexual minorities has yielded an incomplete picture of their health needs, especially during the COVID-19 pandemic. The Household Pulse Survey (HPS) was launched in April of 2020 to efficiently understand the impact of the coronavirus pandemic on households and was recently expanded to include questions related to sexual orientation and gender identity (SOGI). Aim: In this study, we examined the mental health of sexual minorities (gay/lesbian and bisexual) in the United States compared with heterosexual peers during the COVID-19 pandemic. Methods: This study used data from 357,939 heterosexual adults, 13,293 gay/lesbian adults, and 12,856 bisexual adults aged 18 years and older surveyed in waves 34-39 from the HPS. We compared anxiety and depression (calculated using the PHQ-2 and GAD-2), as well as access to and utilization of mental health treatment between sexual minority and heterosexual adults using multivariable logistic regression models controlling for sociodemographic characteristics. Results: After adjusting for sociodemographic characteristics, gay men had higher odds of experiencing both anxiety (OR=1.798, p<0.001) and depression (OR=1.603, p<0.001) than heterosexual men. Bisexual men experienced similar disparities of a greater magnitude for anxiety (OR=2.453, p<0.001) and depression (OR=2.309, p<0.001). Lesbian women also had higher odds of experiencing anxiety (OR=1.762, p<0.001) and depression (OR=1.740, p<0.001) than heterosexual women. Bisexual women experienced similar disparities of a greater magnitude for both anxiety (OR=2.084, p<0.001) and depression (OR=2.386, p<0.001). These disparities are not restricted to the prevalence of anxiety and depression but are instead also reflected in health access measures. Unmet mental health care needs displayed similar disparities: gay (OR=2.482, p<0.001) and bisexual (OR=2.644, p<0.001) men had higher odds of reporting this outcome than heterosexual men. Similarly, lesbian (OR=2.009, p<0.001) and bisexual (OR=2.092, p<0.001) women had higher odds of reporting unmet mental health care needs than heterosexual women. Discussion and Limitations: Although we used weighting to generate nationally representative estimate, important limitations include possible selection bias (owing to low survey response rate). Causal associations cannot be assumed given the repeated cross-section design and because sexual minority respondents may be different from heterosexual respondents in ways not accounted for. Implications for Health Care Provision and Use: Practitioners and public health leaders should be mindful of sexual minority vulnerabilities when developing targeted treatment plans, public health campaigns, and interventions to combat the mental health effects of the COVID-19 pandemic. Implications for Health Policies: These results establish that sexual minorities are extremely vulnerable in the area of mental health during the COVID-19 pandemic and that they are experiencing disproportionate gaps in access to care. Policymakers must consider the access gaps faced by this population when designing policies to combat the mental health effects of the COVID-19. Implications for Further Research: The health of gender minorities during the COVID-19 pandemic is a crucial and understudied topic. Additionally, further research can explore what this novel data source can tell us about other factors that may be contributing to sexual minority mental health disparities during the COVID-19 pandemic, including employment differences, housing disparities, and food insecurity.