HIV Surveillance Of Racial, Ethnic, And Sexual Minority Youth

1. HIV Surveillance Of Racial, Ethnic, And Sexual Minority Youth Alicia Mezu Maryland State Department Of Education

2. Objectives • Define Health Disparities. • Identify Surveillance Data for HIV/AIDS related to race/ethnicity; geographic region; gender; and age. • Defining Sexual Minority Youth. • Understand Social Networks.

3. Defining Health Disparities • Health Disparity/Health Inequality/Health Inequity • Differences that occur in • Gender, race, ethnicity, education/income, disability, geographic location, or sexual orientation • Epidemiology (incidence, prevalence, mortality, etc.) • Health status of general population Reference: www.cdc.gov/nchhstp/healthdisparities/docs/NCHHSTPHealthDisparitiesReport1107.pdf

4. HIV/AIDS Rates By Race/Ethnicity "Health Disparities in HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis in the US: Issues, Burden and Response" CDC, November 2007

5. HIV/AIDS Rates By U.S. Geographic Region "Health Disparities in HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis in the US: Issues, Burden and Response" CDC, November 2007

6. HIV/AIDS Rates By Gender "Health Disparities in HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis in the US: Issues, Burden and Response" CDC, November 2007

7. HIV/AIDS Rates By Age Group "Health Disparities in HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis in the US: Issues, Burden and Response" CDC, November 2007

8. New Jersey HIV Data Sarah Kleinman New Jersey Department of Education

9. Persons Living With HIV/AIDS In New Jersey, Current Age As Of December 12, 2006 By Race/Ethnicity White, Non- Hispanic Black, Non- Hispanic Hispanic

10. Newly Diagnosed HIV/AIDS in New Jersey during Period 2001-2005 by Age at Diagnosis and Race/Ethnicity

11. Newly Diagnosed HIV/AIDS Cases In New Jersey During Period 2001-2005 By Age At Diagnosis And Exposure Category

12. Delaware Data

13. Delaware Data

14. Delaware Data

15. Maryland Data

16. Maryland Data

17. Maryland Data

18. Maryland Data

19. Maryland Data

20. Maryland Data Vs. National Data

25. Philadelphia Data

26. Philadelphia Data

27. DC Data • Department of Health DC Youth and HIV Prevention InitiativeFall 2007 Calendar of Trainings http://doh.dc.gov/doh/cwp/view,a,1371,q,603102.asp

28. D.C. Data

29. Part II: Sexual Minority Youth And Social Networks The following information was provided by Kalima Young, STAR TRACK/Connect To Protect: Baltimore, University of Maryland, Baltimore.

30. Defining Sexual Minority Youth Sexual orientation refers to: Person is attracted to people of the same sex (homosexual), Opposite sex (heterosexual), Both sexes (bisexual).. Gender identity refers to: Identifies as a male or female regardless of that persons biological gender. Transgender refers to those whose psychological self (gender identity) differs from social expectations for the biological gender they were born with.. Sexual minority youth are gay, lesbian, bisexual, transgender, inter-sex and queer/questioning young people.. SMY cut across the spectrum of ethnic, racial, religious and class diversity.

31. A Few Facts Neither school or home is necessarily a safe place for lesbian and gay youth.. They are met with harassment and violence in school. More than 90% of lesbians and gay youth reported that they frequently or sometimes hear homophobic remarks in their school (ex. Faggot, dyke, queer). More than a quarter (27% ) reported that experiences of physical harassment (being shoved or pushed). More than 13 percent reported being physically assaulted (being beaten or kicked). GLSEN network blackboard online (2000). Youth suicide.

32. SMY Risk Behaviors In comparison to their heterosexual peers, SMY are: Over five times more likely to attempt suicide in the past year. Over three times more likely to miss school in the past month because of feeling unsafe. Over three times more likely to have been injured or threatened with a weapon at school. In 2005, the youth risk behavior survey  reported: -SMY suicide rates nearly double those of their peers. -Are more likely to purposefully hurt themselves (44% vs. 17 %). -SMY have seriously considered suicide (34% vs. 11%), -Have made a suicide attempt in the past year (21% vs. 5%).

33. SMY Risk Behaviors In a study that tracked youth substance use over a three month span, 68 percent of the gay male adolescents reported alcohol use with 26 % using one or more times weekly.. 44 % reported drug use in addition to alcohol, and 8% considered themselves drug dependent.. 83% of lesbian adolescents reported alcohol use, 56% reported drug use, and 11% specifically reported crack/cocaine use.

34. Factors Contributing To HIV Risk Family Social Networks

35. SMY And Family Upon ‘coming out’ many youth face: stigma. rejection from their family. leading to homelessness. In religious families, often SMY are forced to. hide their sexuality and/or. encounter feelings of internalized homophobia due to church doctrine. Survivor sex can become common for youth without families, especially transgender youth.

36. A Few concepts of Networks to Consider for SMY Partner Concurrency Number of partners Randomness of partner selection Travel: away from closet/family, towards high-prevalence areas Length of time in networks over lifetime

37. STD Transmission Dynamics R0=ßDc R0 Reproductive rate of infection ß Transmission efficiency D Duration of infection c Number of sexual partners per unit time (variance!)

38. Intervening on networks www.cbc.ca/stories/ 2003/08/16/outage_ohio030816

39. Networks compound individual risk Barbells Serial monogamy Clusters (which may include bar-bells and serial monogamists) Potterat, “Phase Specific Strategies for the Prevention, Control and Elimination of Sexually Transmitted Diseases,” Rome, October 2000.

40. Serial Monogamy Exposure Flow Infected Partner After A is exposed to infected partner D, three are potentially infected

41. Concurrency Flow Infected Partner After A is exposed to infected partner D, five are potentially infected. Concurrency facilitates more transmission than serial monogamy.

42. Even though individual level risk may look the same, network architecture dramatically alters risk. For outreach to succeed in reducing transmission, you need to reach the most important people and cut the most important links. Klovdahl AS, Potterat J, Woodhouse D, et al. HIV infection in a social network: a progress report. Bulletin de Methodologie Sociologique. 1992;36:24-33

43. Young Gay Men’s Biggest Risk Of Infection Is From Having Sex With Older Men Having more than 10 partners: OR = 4 IDU: OR = 3.3 All partners 30 or older: OR = 5.4 Blower, Service, Osmond: Calculating the Odds of HIV Infection due to Sexual Partner Selection; AIDS and Behavior, v. 1, no. 4, 1997, p. 273

44. References • http://www.dhmh.state.md.us/AIDS/Data&Statistics/statistics.htm • http://doh.dc.gov/doh • http://www.dhss.delaware.gov/dhss/dph/dpc/files/hivepi2006.pdf • http://www.phila.gov/health • http://www.dsf.health.state.pa.us

45. The End Thank You!! Questions/Comments