MSM Sexual Health Summit August 20, 2012

1. MSM Sexual Health Summit August 20, 2012 HIV/STD Prevention and Care Branch Texas Department of State Health Services

2. Newly Diagnosed HIV Cases, Deaths, and People Living with HIV in Texas: 1980-2011 Living with HIV New HIV Cases Deaths Among Cases Newly diagnosed HIV infection includes all new HIV cases regardless of disease status. 2009-2010 death data are provisional.

3. Full Diagnosis Public Awareness Support Participation in Care Targeted Prevention Successful Linkage Medical Adherence

4. Texas 2011 New Diagnosis Rate by Selected Characteristics ^Denominator estimate based on: LiebS, et al. Estimating Populations of Men Who Have Sex with Men in the Southern United States. Journal of Urban Health. 2009 Nov;86(6):887-901

5. 2011 New Diagnosis Rate by Race Among MSM1 1Denominator estimate based on: LiebS, et al. Estimating Populations of Men Who Have Sex with Men in the Southern United States. Journal of Urban Health. 2009 Nov;86(6):887-901

6. Gonorrhea Cases:Texas, 1971-2011

7. STI/HIV ComorbidityProportion of HIV cases Co-Infected with STI 2005-2010

8. GC/HIV ComorbidityBy Race/Ethnicity 2005-2010

9. GC/HIV ComorbidityBy Risk 2005-2010

10. GC/HIV ComorbidityBy Age Group 2005-2010

11. GC/HIV ComorbidityInterval Between Diagnoses 2005-2010

12. Timing of Diagnoses2005-2010 -8 4 0 2 6 8 -12 -10 -6 --4 -2 10 12 Number of Months from HIV to Other DX 12

13. Interdependent Capacity Building

14. Interdependence, Unintended Consequences, Systems Adaptation • Undetected and untreated disease driving GC and HIV– don’t ask don’t tell • Not using all the laboratory weapons in our arsenal • The unintended consequences of urine testing and how this may be fueling transmission of GC and also HIV in the MSM community • Haven’t had a spotlight on the sexual transmission of HCV

15. CDC Recommendations from STD Treatment Guidelines, 2010 Screening tests should be performed at least annually for sexually active MSM: • HIV serology, if HIV negative or not tested in the previous year • syphilis serology • GC/CT screening for: • urethral infection (urine testing) for men who had insertive intercourse • Rectal infection (rectal swab) for men who had receptive anal intercourse • Pharyngeal infection (throat swab) for men who had receptive oral intercourse

16. CDC Recommendations Sexual transmission of hepatitis C virus infection can occur, especially among HIV-infected MSM. Serologic screening for hepatitis C infection is recommended at initial evaluation of newly diagnosed HIV-infected persons. HIV-infected MSM can also acquire HCV after initial screening; therefore, men with new and unexplained increases in alanine aminotransferase (ALT) should be tested for acute HCV infection.

17. Overall Goals of Engagement • Reduce undetected and untreated GC/CT in MSM • Reduce transmission of HIV in MSM • Increase identification of HIV-positive MSM co-infected with HCV

18. Summit Goals • Increase awareness, urgency and action to implement consistent, appropriate and timely GC/CT detection for MSM and HCV screening for HIV-positive MSM • Expand capacity to build protocols and provide education on this issue

19. Summit Outcomes • Develop next steps for your organization to implement extra-genital screening for MSM • Build coalitions with partners in your area to implement consistent, appropriate and timely extra-genital GC and HCV screening for MSM