Last data update: May 06, 2024. (Total: 46732 publications since 2009)
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Query Trace: Baugher A[original query] |
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Prevalence of discrimination and the association between employment discrimination and health care access and use - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020
Baugher AR , Olansky E , Sutter L , Cha S , Lewis R , Morris E , Agnew-Brune C , Trujillo L , Respress E , Lee K . MMWR Suppl 2024 73 (1) 51-60 Transgender women experience discrimination in many settings, including in employment. Because employment and health insurance are intertwined in the United States, employment discrimination might be related to lower health insurance coverage and health care use, including gender-affirming care. This analysis used data from transgender women (N = 1,608) in seven urban areas in the United States collected during 2019-2020 to present the prevalence of six discrimination types (employment, housing, bathroom, businesses, health care, and abuse) and to measure the association between employment discrimination (defined as trouble getting a job or fired due to being transgender) and sociodemographic characteristics, health care access, and health care use. Log-linked Poisson regression models were conducted to estimate adjusted prevalence ratios and 95% CIs. Seven in 10 transgender women experienced at least one type of discrimination during the past 12 months. During the same period, 9.9% of transgender women were fired and 32.4% had trouble getting a job because of being transgender. Employment discrimination was associated with younger age and lower socioeconomic status. Having trouble getting a job was associated with health care access and health care use factors, including having no health insurance or having Medicaid only, having an unmet medical need because of cost, never having transgender-specific care, and having an unmet need for gender-affirming procedures. These findings suggest that employment discrimination contributes to transgender women's economic marginalization and their ability to obtain adequate health insurance coverage and achieve their transition goals. These findings might help guide efforts that protect transgender women's right to pursue their work, health, and life goals without discrimination. |
Transgender Women Experiencing Homelessness - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020
Marcus R , Trujillo L , Olansky E , Cha S , Hershow RB , Baugher AR , Sionean C , Lee K . MMWR Suppl 2024 73 (1) 40-50 Transgender women experience high prevalence of homelessness, which can affect their likelihood of acquiring HIV infection and can lead to poor medical outcomes. CDC analyzed data from the National HIV Behavioral Surveillance Among Transgender Women to identify whether personal characteristics and social factors affecting transgender women were associated with duration of homelessness during the past 12 months. Longer duration and chronic homelessness might indicate greater unmet needs, which increases their likelihood for acquiring HIV infection. Ordinal logistic regression was conducted to calculate adjusted prevalence odds ratios and 95% CIs for transgender women from seven urban areas in the United States experiencing homelessness 30-365 nights, 1-29 nights, and zero nights during the past 12 months. Among 1,566 transgender women, 9% reported 1-29 nights homeless and 31% reported 30-365 nights homeless during the past 12 months. Among participants who reported physical intimate partner violence or forced sex, 50% and 47%, respectively, reported experiencing 30-365 nights homeless. Furthermore, 55% who had been evicted or denied housing because of their gender identity and 58% who had been incarcerated during the past year experienced 30-365 nights homeless. The odds of transgender women experiencing longer duration of homelessness was associated with being younger and having a disability; higher psychological distress scores were associated with longer duration of homelessness. Analysis of social determinants of health found transgender women experiencing longer homelessness to be less educated, living below the Federal poverty level, and having lower social support. Therefore, focusing on HIV prevention and interventions addressing housing instability to reduce the duration of homelessness among transgender women is important. Further, integrating housing services with behavioral health services and clinical care, specifically designed for transgender women, could reduce HIV acquisition risk and improve HIV infection outcomes. |
Intersectional discrimination in HIV healthcare settings among persons with diagnosed HIV in the United States, Medical Monitoring Project, 2018-2019
McCree DH , Beer L , Crim SM , Kota KK , Baugher A , Jeffries WLth , Patel D , Marcus R , Yuan XA , Luke Shouse R . AIDS Behav 2023 27 (11) 3623-3631 Experiences with stigma and discrimination in healthcare settings are associated with negative health outcome for persons with HIV (PWH). PWH may experience discrimination due to the intersection of multiple marginalized social identities. Describing these experiences is important for informing interventions and strategies to reduce stigma and discrimination. We report experiences with discrimination in HIV healthcare settings attributed to multiple characteristics, e.g., sexual orientation, race/ethnicity, income, or social class, and/or injection drug use, among a nationally representative sample of persons with diagnosed HIV in the United States using data from the Medical Monitoring Project (MMP). We calculated weighted prevalences and associated 95% confidence intervals for any discrimination and discrimination attributed to multiple characteristics (intersectional discrimination). Among those experiencing discrimination, nearly 1 in 4 persons reported intersectional discrimination, with a higher burden among key populations of focus for HIV prevention and treatment. Discrimination was attributed to HIV status (62.5%), sexual orientation (60.4%), and race/ethnicity (54.3%). Persons who experienced intersectional discrimination were less likely to have a regular HIV care provider, have trust in HIV care or treatment information from healthcare providers, and be antiretroviral treatment or HIV care visit adherent. Future studies should explore methods to operationalize and assess experiences with intersectional stigma and discrimination and use the outcomes to inform qualitative research that provides more context and a deeper understanding of experiences with intersectional discrimination among PWH. |
HIV self-testing and risk behaviors among men who have sex with men in 23 US cities, 2017
Bien-Gund CH , Shaw PA , Agnew-Brune C , Baugher A , Brady KA , Gross R . JAMA Netw Open 2022 5 (12) e2247540 IMPORTANCE: HIV self-testing (HIVST) is a promising strategy to expand the HIV care continuum, particularly among priority populations at high risk of HIV infection. However, little is known about HIVST uptake among men who have sex with men (MSM) outside of clinical trial settings. OBJECTIVE: To evaluate HIVST use among urban MSM in the US who reported testing within the past 12 months. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study of adult MSM in the 2017 National HIV Behavioral Surveillance system, which used venue-based sampling methods to collect data related to HIV testing, receipt of prevention services, and risk factors for HIV, was conducted at 588 venues in 23 urban areas in the contiguous US and Puerto Rico. All participants were offered HIV testing. Adult cisgender MSM who reported HIV-negative or unknown HIV status and obtained HIV testing in the past 12 months were included. Data for this study were collected between June 4, 2017, and December 22, 2017, and analyzed between October 23, 2020, and August 20, 2021. MAIN OUTCOMES AND MEASURES: Self-reported HIVST in the past year. Adjusted prevalence ratios (aPRs) using survey weights were calculated to assess factors associated with HIVST. RESULTS: A total of 6563 MSM in 23 urban areas met inclusion criteria, of whom 506 (7.7%) individuals reported HIVST in the past year. The median age of self-testers was 29 (IQR, 25-35) years, 52.8% had completed college, and 37.9% reported non-Hispanic White race. One self-tester reported seroconverting in the prior 12 months, and an additional 10 self-testers were diagnosed with HIV during the survey. HIVST was associated with sexual orientation disclosure (aPR, 10.27; 95% CI, 3.45-30.60; P < .001), perceived discrimination against people with HIV (aPR, 1.53; 95% CI, 1.09-2.03; P = .01), younger age (aPR, 0.74; 95% CI, 0.66-0.84; P < .001), higher educational level (aPR, 1.20; 95% CI, 1.04-1.37; P = .01), and higher income levels (aPR, 1.18; 95% CI, 1.04-1.32; P = .009). No association was noted with condomless anal sex (aPR, 0.96; 95% CI, 0.88-1.06, P = .88), sexually transmitted infections (aPR, 0.96; 95% CI, 0.70-1.30; P = .77), or preexposure prophylaxis use (aPR, 0.99; 95% CI, 0.75-1.30; P = .92). CONCLUSIONS AND RELEVANCE: In this study, HIVST was relatively uncommon in this sample of urban MSM. HIVST may not be reaching those with lower socioeconomic status or who have not disclosed their sexual identity. The findings of this study suggest that efforts to increase HIVST should focus on engaging underserved and vulnerable subgroups of MSM. |
Physical and sexual violence and sexual behaviors among men who have sex with men in 22 U.S. Cities-national HIV behavioral surveillance, 2017
Freeman JQ , Cha S , Wejnert C , Baugher A . J Interpers Violence 2022 38 8862605221078821 National prevalence of physical and sexual violence and its relationship to sexual behaviors are unknown among men who have sex with men (MSM). We estimated 12-month prevalence of physical and sexual violence and assessed relationships between violence and sexual behaviors among MSM. Data were obtained from National HIV Behavioral Surveillance 2017 that used time-space sampling methods to recruit and interview MSM in 22 U.S. cities. Weighted percentages with 95% confidence intervals (CI) were reported. Adjusted prevalence ratios (aPR) and 95% CIs were calculated using logistic regression with predicted marginal means. Overall, 10.2% (95% CI: 9.3%-11.2%) of MSM experienced physical violence only, 3.2% (95% CI: 2.7%-3.7%) experienced sexual violence only, and 2.3% (95% CI: 1.9%-2.7%) experienced both types of violence, in the past 12 months. Compared to MSM who did not experience violence, those who did reported higher percentages of unemployment, poverty, homelessness, same-sex discrimination, non-injection drug use, and binge drinking. Violence was not independently associated with condomless anal sex among MSM. MSM who experienced both types of violence were more likely than those who did not experience violence to have had four or more male sex partners (aPR=1.18, 95% CI: 1.02-1.37). MSM who experienced both types of violence (aPR=2.49, 95% CI: 1.52-4.09), sexual violence (aPR=2.27, 95% CI: 1.47-3.52), or physical violence (aPR=1.76, 95% CI: 1.27-2.44) were more likely than those who did not experience violence to have had exchange sex. Recent physical violence and sexual violence are common among MSM. Findings highlight the importance of violence screening and suggest the need for tailored interventions that improve the safety and economic security of MSM who experience violence, including those who exchange sex. |
Multistate Outbreak Investigation of Salmonella Infections Linked to Kratom: A Focus on Traceback, Laboratory, and Regulatory Activities.
Nsubuga J , Baugher J , Dahl E , Schwensohn C , Blessington T , Aguillon R , Whitney B , Goldman S , Brewster M , Humbert J , Crosby A , Gieraltowski L , Shade Singleton L , Hilgendorf J . J Food Prot 2022 85 (5) 747-754 During the spring of 2018, the U.S. Food and Drug Administration (FDA), U.S. Centers for Disease Control and Prevention (CDC), states and local public health agencies responded to a multistate outbreak of gastrointestinal illnesses caused by multiple Salmonella serovars and associated with consumption of kratom, a product harvested from a tropical tree native to Southeast Asia. The outbreak included 199 case-patients reported by 41 U.S. states, with illness onset dates ranging from January 11, 2017 to May 8, 2018, leading to 54 hospitalizations, and no deaths. Case-patients reported purchasing kratom products from physical and online retail points of service (POS). Products distributed to 16 POS where 24 case-patients from 17 states purchased kratom were selected for traceback investigation. Traceback revealed that the kratom was imported from several countries, the most common being Indonesia. Local and state officials collected product samples from case-patients and retail POS. The FDA collected 76 product samples from POS and distributors, of which 42 (55%) tested positive for Salmonella . The positive samples exhibited a wide range of pulsed field gel electrophoresis (PFGE) patterns and whole genome sequence (WGS) genetic heterogeneity, and a total 25 of 42 (60%) yielded at least one isolate indistinguishable from one or more outbreak-related clinical isolates. While it does not exclude a possibility of a single contamination source, the extent of genetic diversity exhibited by the Salmonella isolates recovered from product samples and a lack of traceback convergence, suggested that kratom was widely contaminated across multiple sites from which it was grown, harvested, and packaged. As a result of the contamination, kratom products were recalled by numerous firms (both voluntarily and mandatory). Epidemiologic, traceback, and laboratory evidence supported the conclusion that kratom products were associated with illnesses. |
Prevalence of and racial/ethnic differences in sexuality disclosure among men who have sex with men in 23 U.S. citiesNational HIV Behavioral Surveillance, 2017
Freeman JQ , Trujillo L , Baugher AR . J HIV AIDS Soc Serv 2021 21 (1) 76-89 Sexuality disclosure among men who have sex with men (MSM) is key in access to HIV prevention services. We used weighted 2017 data from National HIV Behavioral Surveillance to investigate prevalence of, and racial/ethnic differences in, sexuality disclosure among MSM. Of 10,753 MSM, 89.4% (95% CI: 88.590.3%) had disclosed their sexuality to any non-lesbian, gay, or bisexual (LGB) friends, 85.9% (95% CI: 84.887.0%) had disclosed their sexuality to any family members, and 82.8% (95% CI: 81.683.9%) had disclosed their sexuality to any health care providers. Although most MSM had disclosed, 23.8% (95% CI: 22.425.1%) had not disclosed to at least one of the three groups. Black, Hispanic/Latino, or Asian MSM were less likely than White MSM to have disclosed their sexuality to any non-LGB friends, any family members, or any health care providers, after adjusting for age and region. We found high prevalence of sexuality disclosure among MSM, but racial/ethnic differences persist. Strategies and interventions to promote sexuality disclosure among MSM are needed. 2021 Taylor & Francis Group, LLC. |
Prevalence of and racial/ethnic differences in sexuality disclosure among men who have sex with men in 23 U.S. cities—National HIV Behavioral Surveillance, 2017
Freeman JQ , Trujillo L , Baugher AR . J HIV AIDS Soc Serv 2021 21 (1) 76-89 Sexuality disclosure among men who have sex with men (MSM) is key in access to HIV prevention services. We used weighted 2017 data from National HIV Behavioral Surveillance to investigate prevalence of, and racial/ethnic differences in, sexuality disclosure among MSM. Of 10,753 MSM, 89.4% (95% CI: 88.5–90.3%) had disclosed their sexuality to any non-lesbian, gay, or bisexual (LGB) friends, 85.9% (95% CI: 84.8–87.0%) had disclosed their sexuality to any family members, and 82.8% (95% CI: 81.6–83.9%) had disclosed their sexuality to any health care providers. Although most MSM had disclosed, 23.8% (95% CI: 22.4–25.1%) had not disclosed to at least one of the three groups. Black, Hispanic/Latino, or Asian MSM were less likely than White MSM to have disclosed their sexuality to any non-LGB friends, any family members, or any health care providers, after adjusting for age and region. We found high prevalence of sexuality disclosure among MSM, but racial/ethnic differences persist. Strategies and interventions to promote sexuality disclosure among MSM are needed. © 2021 Taylor & Francis Group, LLC. |
Racial, ethnic, and gender disparities in awareness of preexposure prophylaxis among HIV-negative heterosexually active adults at increased risk for HIV infection - 23 urban areas, United States, 2019
Baugher AR , Trujillo L , Kanny D , Freeman JQ , Hickey T , Sionean C , Respress E , Bardales JC , Marcus R , Finlayson T , Wejnert C . MMWR Morb Mortal Wkly Rep 2021 70 (47) 1635-1639 In 2019, heterosexual sex accounted for 23% of new HIV diagnoses in the United States and six dependent areas (1). Although preexposure prophylaxis (PrEP) can safely reduce the risk for HIV infection among heterosexual persons, this group is underrepresented in PrEP research (2). CDC analyzed National HIV Behavioral Surveillance (NHBS) data to describe PrEP awareness among heterosexually active adults in cities with high HIV prevalence. Overall, although 32.3% of heterosexually active adults who were eligible were aware of PrEP, <1% used PrEP. Racial, ethnic, and gender disparities were identified, with the lowest awareness of PrEP among residents of Puerto Rico (5.8%) and Hispanic or Latino (Hispanic) men (19.5%) and women (17.6%). Previous studies have found that heterosexual adults are interested in taking PrEP when they are aware of it (3); tailoring PrEP messaging, including Spanish-language messaging, to heterosexual adults, might increase PrEP awareness and mitigate disparities in use. |
Black men who have sex with men living in states with HIV criminalization laws report high stigma, 23 U.S. cities, 2017
Baugher AR , Whiteman A , Jeffries WL4th , Finlayson T , Lewis R , Wejnert C . AIDS 2021 35 (10) 1637-1645 OBJECTIVES: To examine the association between HIV laws, perceived community stigma, and behaviors and to compare differences between and within Black and White men who have sex with men (MSM). DESIGN/METHODS: National HIV Behavioral Surveillance conducted interviews and HIV testing with MSM in 23 U.S. cities in 2017 using venue-based sampling methods. We used weighted cross-sectional data to compare MSM living in states with versus without HIV laws using Rao-Scott chi-square tests. We modeled the association between stigma and state HIV laws within racial groups to obtain adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs). RESULTS: Among 7392 MSM, 56% lived in a state with HIV laws. In law states, Black MSM were more likely than White MSM to report their community would discriminate against persons with HIV (PWH) (59 versus 34%), not support the rights of PWH (20 versus 9%), not be friends with PWH (19 versus 10%), believe PWH 'got what they deserved' (27 versus 16%), and be intolerant of MSM (14 versus 5%). Adjusted for confounders, Black MSM in HIV law states were more likely to think their community would discriminate against PWH (aPR, 1.14; 95% CI, 1.02-1.29; P = 0.02) and be intolerant toward MSM (aPR, 2.02; 95% CI, 1.43-2.86; P < 0.001) than Black MSM in states without such laws. CONCLUSIONS: HIV laws were related to higher stigma, but only for Black MSM. Future research regarding HIV-related laws should account for racial/ethnic disparities. Modernizing laws can delegitimize stigma and promote focusing on effective HIV prevention strategies. |
Intimate Partner Violence Experienced by Adults With Diagnosed HIV in the U.S
Lemons-Lyn AB , Baugher AR , Dasgupta S , Fagan JL , Smith SG , Shouse RL . Am J Prev Med 2021 60 (6) 747-756 INTRODUCTION: Intimate partner violence is associated with adverse health consequences among people with diagnosed HIV, which could have implications for disease progression and transmission. However, nationally representative estimates of intimate partner violence among people with diagnosed HIV are lacking. Investigators used nationally representative data to estimate the prevalence of physical violence by an intimate partner among adults with diagnosed HIV and examine the differences by selected characteristics. METHODS: This analysis included interview and medical record data from the 2015-2017 cycles of the Medical Monitoring Project, analyzed in 2019. Weighted percentages and 95% CIs were used to report the prevalence of intimate partner violence among people with diagnosed HIV (N=11,768). Bivariate and multivariate differences in intimate partner violence by sociodemographic, behavioral, and clinical characteristics were examined using Rao-Scott chi-square tests (p<0.05). RESULTS: Among people with diagnosed HIV, 26.3% reported having ever experienced intimate partner violence, and 4.4% reported having experienced intimate partner violence in the past 12 months. The prevalence of intimate partner violence differed by gender and gender/sexual identity. People who experienced intimate partner violence in the past 12 months were more likely to engage in behaviors associated with elevated HIV transmission risk and have unmet needs for supportive services. People who recently experienced intimate partner violence were less likely to be engaged in routine HIV care but were more likely to seek emergency care services and have poor HIV clinical outcomes. CONCLUSIONS: This study's findings support the need for screening people with diagnosed HIV for intimate partner violence and offering linkage to supportive services. Screening for intimate partner violence among people with diagnosed HIV, coupled with supportive services and counseling, may lead to improved safety and HIV clinical outcomes and decreased need for emergency and inpatient medical services. |
Health care coverage and preexposure prophylaxis (PrEP) use among men who have sex with men living in 22 US cities with Medicaid expansion, 2017
Baugher AR , Finlayson T , Lewis R , Sionean C , Whiteman A , Wejnert C . Am J Public Health 2021 111 (4) e1-e9 Objectives. To compare health care coverage and utilization between men who have sex with men (MSM) in Medicaid expansion versus nonexpansion states.Methods. We used cross-sectional weighted data from the National HIV Behavioral Surveillance system, which used venue-based methods to interview and test MSM in 22 US cities from June through December, 2017 (n = 8857). We compared MSM in Medicaid expansion versus nonexpansion states by using the Rao-Scott χ(2) test stratified by HIV status. We used multivariable logistic regression to model the relationship between Medicaid expansion, coverage, and preexposure prophylaxis (PrEP) use.Results. MSM in expansion states were more likely to have insurance (87.9% vs 71.6%), have Medicaid (21.3% vs 3.8%), discuss PrEP with a provider (58.8% vs 44.3%), or use PrEP (31.1% vs 17.5%).Conclusions. Medicaid expansion is associated with higher coverage and care, including PrEP.Public Health Implications. States may consider expanding Medicaid to help end the HIV epidemic. (Am J Public Health. Published online ahead of print January 21, 2021: e1-e9. https://doi.org/10.2105/AJPH.2020.306035). |
Gen-FS coordinated proficiency test data for genomic foodborne pathogen surveillance, 2017 and 2018 exercises.
Timme RE , Lafon PC , Balkey M , Adams JK , Wagner D , Carleton H , Strain E , Hoffmann M , Sabol A , Rand H , Lindsey R , Sheehan D , Baugher JD , Trees E . Sci Data 2020 7 (1) 402 The US PulseNet and GenomeTrakr laboratory networks work together within the Genomics for Food Safety (Gen-FS) consortium to collect and analyze genomic data for foodborne pathogen surveillance (species include Salmonella enterica, Listeria monocytogenes, Escherichia coli (STECs), and Campylobactor). In 2017 these two laboratory networks started harmonizing their respective proficiency test exercises, agreeing on distributing a single strain-set and following the same standard operating procedure (SOP) for genomic data collection, running a jointly coordinated annual proficiency test exercise. In this data release we are publishing the reference genomes and raw data submissions for the 2017 and 2018 proficiency test exercises. |
Assessing self-reported discrimination among men who have sex with men
Whiteman A , Baugher A , Sionean C . AIDS 2020 35 (1) 141-146 OBJECTIVES: To determine the prevalence of 4 forms of sexual identity discrimination among men who have sex with men (MSM) in 23 US metropolitan statistical areas, examine racial/ethnic and socioeconomic disparities in each form of discrimination, and assess the association of MSM discrimination with sexual behavior. METHODS: We examined interview data collected during 2017 for National HIV Behavioral Surveillance (n = 10 029 respondents) and used generalized linear models to assess the association between the prevalence of reported discrimination during the previous 12 months and selected sociodemographic groups. RESULTS: Overall, 34% of participants reported experiencing verbal discrimination; 16%, discrimination in a workplace, school, or a health care setting; and 8%, physical assault. MSM who had reported experiencing discrimination were most likely to be young, had achieved lower education, and had lower incomes. High prevalence of reported discrimination was associated with young age, lower education, lower household income, sexual identity disclosure, and lower perceived community tolerance of gay or bisexual persons. CONCLUSIONS: MSM discrimination affects different groups and occurs in multiple settings. Addressing discrimination should be an integral aspect of multifaceted efforts to improve MSM health. |
Healthcare access and utilization among persons who inject drugs in Medicaid expansion and nonexpansion states: 22 United States cities, 2018
Lewis R , Baugher AR , Finlayson T , Wejnert C , Sionean C . J Infect Dis 2020 222 S420-s428 BACKGROUND: Medicaid expansion under the Affordable Care Act increased insurance coverage, access to healthcare, and substance use disorder treatment, for many Americans. We assessed differences in healthcare access and utilization among persons who inject drugs (PWID) by state Medicaid expansion status. METHODS: In 2018, PWID were interviewed in 22 US cities for National HIV Behavioral Surveillance. We analyzed data from PWID aged 18-64 years who reported illicit use of opioids (n = 9957) in the past 12 months. Poisson regression models with robust standard errors were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were used to examine differences by Medicaid expansion status in indicators of healthcare access and utilization. RESULTS: Persons who inject drugs in Medicaid expansion states were more likely to have insurance (87% vs 36%; aPR, 2.3; 95% CI, 2.0-2.6), a usual source of healthcare (53% vs 34%; aPR, 1.5; 95% CI, 1.3-1.9), and have used medication-assisted treatment (61% vs 36%; aPR, 1.4; 95% CI, 1.1-1.7), and they were less likely to have an unmet need for care (21% vs 39%; aPR, 0.6; 95% CI, 0.4-0.7) than those in nonexpansion states. CONCLUSIONS: Low insurance coverage, healthcare access, and medication-assisted treatment utilization among PWID in some areas could hinder efforts to end the intertwined human immunodeficiency virus and opioid overdose epidemics. |
COVID-19 Among American Indian and Alaska Native Persons - 23 States, January 31-July 3, 2020.
Hatcher SM , Agnew-Brune C , Anderson M , Zambrano LD , Rose CE , Jim MA , Baugher A , Liu GS , Patel SV , Evans ME , Pindyck T , Dubray CL , Rainey JJ , Chen J , Sadowski C , Winglee K , Penman-Aguilar A , Dixit A , Claw E , Parshall C , Provost E , Ayala A , Gonzalez G , Ritchey J , Davis J , Warren-Mears V , Joshi S , Weiser T , Echo-Hawk A , Dominguez A , Poel A , Duke C , Ransby I , Apostolou A , McCollum J . MMWR Morb Mortal Wkly Rep 2020 69 (34) 1166-1169 Although non-Hispanic American Indian and Alaska Native (AI/AN) persons account for 0.7% of the U.S. population,* a recent analysis reported that 1.3% of coronavirus disease 2019 (COVID-19) cases reported to CDC with known race and ethnicity were among AI/AN persons (1). To assess the impact of COVID-19 among the AI/AN population, reports of laboratory-confirmed COVID-19 cases during January 22(†)-July 3, 2020 were analyzed. The analysis was limited to 23 states(§) with >70% complete race/ethnicity information and five or more laboratory-confirmed COVID-19 cases among both AI/AN persons (alone or in combination with other races and ethnicities) and non-Hispanic white (white) persons. Among 424,899 COVID-19 cases reported by these states, 340,059 (80%) had complete race/ethnicity information; among these 340,059 cases, 9,072 (2.7%) occurred among AI/AN persons, and 138,960 (40.9%) among white persons. Among 340,059 cases with complete patient race/ethnicity data, the cumulative incidence among AI/AN persons in these 23 states was 594 per 100,000 AI/AN population (95% confidence interval [CI] = 203-1,740), compared with 169 per 100,000 white population (95% CI = 137-209) (rate ratio [RR] = 3.5; 95% CI = 1.2-10.1). AI/AN persons with COVID-19 were younger (median age = 40 years; interquartile range [IQR] = 26-56 years) than were white persons (median age = 51 years; IQR = 32-67 years). More complete case report data and timely, culturally responsive, and evidence-based public health efforts that leverage the strengths of AI/AN communities are needed to decrease COVID-19 transmission and improve patient outcomes. |
An open challenge to advance probabilistic forecasting for dengue epidemics.
Johansson MA , Apfeldorf KM , Dobson S , Devita J , Buczak AL , Baugher B , Moniz LJ , Bagley T , Babin SM , Guven E , Yamana TK , Shaman J , Moschou T , Lothian N , Lane A , Osborne G , Jiang G , Brooks LC , Farrow DC , Hyun S , Tibshirani RJ , Rosenfeld R , Lessler J , Reich NG , Cummings DAT , Lauer SA , Moore SM , Clapham HE , Lowe R , Bailey TC , Garcia-Diez M , Carvalho MS , Rodo X , Sardar T , Paul R , Ray EL , Sakrejda K , Brown AC , Meng X , Osoba O , Vardavas R , Manheim D , Moore M , Rao DM , Porco TC , Ackley S , Liu F , Worden L , Convertino M , Liu Y , Reddy A , Ortiz E , Rivero J , Brito H , Juarrero A , Johnson LR , Gramacy RB , Cohen JM , Mordecai EA , Murdock CC , Rohr JR , Ryan SJ , Stewart-Ibarra AM , Weikel DP , Jutla A , Khan R , Poultney M , Colwell RR , Rivera-Garcia B , Barker CM , Bell JE , Biggerstaff M , Swerdlow D , Mier YTeran-Romero L , Forshey BM , Trtanj J , Asher J , Clay M , Margolis HS , Hebbeler AM , George D , Chretien JP . Proc Natl Acad Sci U S A 2019 116 (48) 24268-24274 A wide range of research has promised new tools for forecasting infectious disease dynamics, but little of that research is currently being applied in practice, because tools do not address key public health needs, do not produce probabilistic forecasts, have not been evaluated on external data, or do not provide sufficient forecast skill to be useful. We developed an open collaborative forecasting challenge to assess probabilistic forecasts for seasonal epidemics of dengue, a major global public health problem. Sixteen teams used a variety of methods and data to generate forecasts for 3 epidemiological targets (peak incidence, the week of the peak, and total incidence) over 8 dengue seasons in Iquitos, Peru and San Juan, Puerto Rico. Forecast skill was highly variable across teams and targets. While numerous forecasts showed high skill for midseason situational awareness, early season skill was low, and skill was generally lowest for high incidence seasons, those for which forecasts would be most valuable. A comparison of modeling approaches revealed that average forecast skill was lower for models including biologically meaningful data and mechanisms and that both multimodel and multiteam ensemble forecasts consistently outperformed individual model forecasts. Leveraging these insights, data, and the forecasting framework will be critical to improve forecast skill and the application of forecasts in real time for epidemic preparedness and response. Moreover, key components of this project-integration with public health needs, a common forecasting framework, shared and standardized data, and open participation-can help advance infectious disease forecasting beyond dengue. |
Behavioral and clinical characteristics of American Indian/Alaska Native adults in HIV care - Medical Monitoring Project, United States, 2011-2015
Baugher AR , Beer L , Bradley HM , Evans ME , Luo Q , Shouse RL . MMWR Morb Mortal Wkly Rep 2019 67 (5152) 1405-1409 The rate of diagnosis of human immunodeficiency virus (HIV) infection among American Indians and Alaska Natives (AI/ANs) in 2016 (10.2 per 100,000 population) was the fourth highest among seven racial/ethnic groups in the United States (1); the number of diagnoses of HIV infection among AI/AN persons increased by 70%, from 143 in 2011 to 243 in 2016 (1). However, little has been published about the sociodemographic, behavioral, and clinical characteristics of AI/AN patients with HIV infection in care because small sample sizes have led to infrequent analysis of AI/AN-specific estimates (2) and because of underestimation of AI/AN race/ethnicity in surveillance and other data sources (3). CDC analyzed data from the Medical Monitoring Project (MMP), a surveillance system that collects information about the experiences and needs of persons with diagnosed HIV infection, collected during 2011-2015 among AI/AN adults receiving HIV medical care. The results indicated that 64% of AI/AN patients with HIV infection in care achieved sustained viral suppression, and 76% achieved viral suppression at their most recent viral load test within the past 12 months, which is below the national HIV prevention goal of 80%, but comparable to or better than some other racial/ethnic groups (4). Based on self-report, 51% of AI/AN patients with HIV infection had incomes at or below the U.S. Department of Health and Human Services' (HHS) annual poverty limit, 27% had symptoms of depression, 78% reported internalized HIV-related stigma, and 20% reported binge drinking in the past 30 days. To improve the health of AI/AN patients with HIV infection, it is important that health care providers, tribal organizations, and state and local health departments consider the sociodemographic and behavioral barriers to AI/AN patients with HIV infection achieving viral suppression and design care plans that seek to eliminate those barriers. |
Discrimination in healthcare settings among adults with recent HIV diagnoses
Baugher AR , Beer L , Fagan JL , Mattson CL , Luke Shouse R . AIDS Care 2018 31 (9) 1-6 The prevalence of discrimination in healthcare settings among HIV patients in the United States is unknown. The Medical Monitoring Project (MMP) is a complex sample survey of adults receiving HIV medical care in the United States. We analyzed nationally representative MMP data collected 2011-2015. We assessed the prevalence of self-reported healthcare discrimination, perceived reasons for discrimination, and factors associated with discrimination among persons with HIV diagnoses </=5 years before interview (n = 3,770). Overall, 14.1% of patients living with HIV (PLWH) experienced discrimination, of whom 82.2% attributed the discrimination to HIV. PLWH reporting poverty, homelessness, or attending a non-Ryan White HIV/AIDS Program (RWHAP) facility were more likely to report discrimination compared with other groups. Of patients attending non-RWHAP facilities, discrimination was higher among those in poverty (27.5%) vs. not in poverty (15.1%). Discrimination was associated with homelessness regardless of facility type, and was highest among homeless persons attending non-RWHAP facilities. Healthcare discrimination was commonly reported among PLWH, and was most often attributed to HIV status. Discrimination was higher among those reporting poverty or homelessness, particularly those attending non-RWHAP facilities. Incorporating practices, such as anti-discrimination training, in facilities may reduce healthcare discrimination. |
Changes in perceived discrimination in healthcare settings reported by HIV patients in the United States from 1996 to 2011-2013
Valverde EE , Beer L , Johnson CH , Baugher A . AIDS 2018 32 (14) 2075-2076 Discrimination in healthcare settings is a barrier to healthcare engagement. We analyzed two nationally representative datasets to assess change in discrimination in healthcare settings reported by HIV patients from 1996 to 2011-2013. Perceived discrimination in healthcare settings significantly decreased over time, from 24% in 1996 to 15% in 2011-2013. Improvements over time in HIV clinicians' engagement in prevention discussions with patients following federal agencies' recommendations may have been a contributing factor. |
Prevalence of internalized HIV-related stigma among HIV-infected adults in care, United States, 2011-2013
Baugher AR , Beer L , Fagan JL , Mattson CL , Freedman M , Skarbinski J , Shouse RL . AIDS Behav 2017 21 (9) 2600-2608 HIV-infected U.S. adults have reported internalized HIV-related stigma; however, the national prevalence of stigma is unknown. We sought to determine HIV-related stigma prevalence among adults in care, describe which socio-demographic groups bear the greatest stigma burden, and assess the association between stigma and sustained HIV viral suppression. The Medical Monitoring Project measures characteristics of U.S. HIV-infected adults receiving care using a national probability sample. We used weighted data collected from June 2011 to May 2014 and assessed self-reported internalized stigma based on agreement with six statements. Overall, 79.1% endorsed ≥1 HIV-related stigma statements (n = 13,841). The average stigma score was 2.4 (out of a possible high score of six). White males had the lowest stigma scores while Hispanic/Latina females and transgender persons who were multiracial or other race had the highest. Although stigma was associated with viral suppression, it was no longer associated after adjusting for age. Stigma was common among HIV-infected adults in care. Results suggest individual and community stigma interventions may be needed, particularly among those who are <50 years old or Hispanic/Latino. Stigma was not independently associated with viral suppression; however, this sample was limited to adults in care. Examining HIV-infected persons not in care may elucidate stigma's association with viral suppression. |
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