Good news for Mississippi in the battle against HIV: The proportion of residents unaware they are HIV infected has decreased from 21.6 percent to 13.6 percent, the national Centers for Disease Control and Prevention said this week.
It's a move in the right direction, largely due to increased awareness and testing, a University of Mississippi Medical Center sexually transmitted infections authority says.
“This is a great indicator and reassurance that what we are doing is having an impact, but we need to be more aggressive,” said Dr. Leandro Mena, professor and chair of Population Health Sciences in the John D. Bower School of Population Health and professor of medicine in infectious diseases at the University of Mississippi School of Medicine at UMMC.
A breakdown of figures released by the CDC for 2008-2014, the most recent years available, shows the number of Mississippians who didn't know they were HIV-infected was an estimated 2,000 in 2008. That has steadily dropped to an estimated 1,400 in 2014. That's largely due to the fact that more people are being tested - and perhaps infections are also being prevented by engaging in treatment those living with the virus, preventing people with HIV from passing the virus to others.
In 2008, Mena said, about one in five Mississippians who had HIV didn't know it. That improved to one in seven in 2014, Mena said. Testing is as simple as collection of a blood sample from a finger stick or mouth swab to be analyzed at a laboratory for detection of antibodies your body makes against HIV.
The CDC figures, supplemented by figures supplied by the Mississippi Department of Health, also show that Mississippi's HIV incidence - the number of new infections diagnosed during a time period - decreased from an estimated 440 in 2008 to 360 in 2014.
Nationally, HIV incidence has decreased by 18 percent, from an estimated 45,700 new infections in 2008 to 37,600 in 2014, the CDC says. That statistic reflects a dramatic decrease in new infections among heterosexuals and among people who inject drugs.
Gay and bisexual men didn't experience an overall decline in annual HIV infections. Reduced infections among white men who have sex with men (MSM) and young gay and bisexual men ages 13-24 were offset by increases in other groups, including a 35 percent increase among gay and bisexual men ages 25-34. Incidence rates were stable among black MSM, but increasing among Latino MSM.
The continuing bad news for Mississippi is that Jackson has the fourth-highest rate of HIV diagnosis per 100,000 population among the nation's metro areas. That's further tempered by statistics showing prevalence, which is the number of people who have a new or old condition in a time period. For 2014, an estimated 40 percent of MSM in the Jackson metro area are infected with HIV.
Overall, an estimated 10,050 Mississippians are living with HIV. The number is only the diagnosed cases, and not those undiagnosed and unaware of their condition, Mena said. Nationwide, about 1.2 million people are HIV positive, and one in eight of them don't know it, the CDC says.
“The declining trend in numbers of new HIV infections in our state may be indication that that prevention efforts may be having an impact in this epidemic, especially when considering the high prevalence estimates of infection found among men who have sex with men in the Jackson metro area,” Mena said.
“This is a top public health priority,” the CDC said in a statement Tuesday. “Studies have shown that, in addition to improving the health of people living with HIV, early treatment with antiretroviral medications dramatically reduces a person's risk of transmitting the virus to others.”
Rob Hill, Mississippi director of the Human Rights Campaign, agrees with Mena that there's plenty of room for improvement, especially in the Deep South, which has the highest HIV diagnosis rates and highest number of people living with HIV of any U.S. region, the latest data shows.
“Some of the numbers are good, and I attribute that to the work that's being done by people like Dr. Mena to create awareness among the MSM population,” Hill said. “But here in Mississippi, we're a conservative state where the funds for prevention can be used for abstinence education only. That stigmatizes and deprives young people of information on their sexual health. People are afraid to reveal their sexual orientation to medical professionals and get tested.”
Mena and those working with him in HIV prevention are championing the drug PrEP, or pre-exposure prophylaxis. It's a pill that people who don't have HIV take daily to reduce their risk of infection from sex. The Human Rights Campaign has endorsed the use of PrEP and education about the drug, both for physicians and those at risk.
Studies have shown that PrEP is “over 96 percent effective in preventing HIV infection,” said Joshua Agee, an infectious diseases researcher in the School of Medicine. “With the growing HIV rates in Mississippi, in particular the Jackson metropolitan area, we must regularly monitor our sexual health and have honest conversations with health care providers.
“One of the goals in the National HIV/AIDS strategy is to reduce new HIV infections,” said Agee, who takes PrEP. “Whether you're insured or uninsured, PrEP is a great tool available to us to prevent HIV.”
Testing for STDs including HIV and linkage of those infected to care is central to the mission of the Mississippi Department of Health's Crossroads Clinic in Jackson, which also offers medical referral services including PrEP referrals. Mena serves as medical director at Crossroads, the only publicly funded clinic of its kind in the state.
Facilities such Open Arms Healthcare Clinic in Jackson, where Mena also is medical director, prescribe PrEP, targeting those with an ongoing, substantial risk of HIV infection connected to their sexual behavior. Free testing for HIV and other sexually transmitted diseases also is available through county health department clinics.
Also key to education on wellness and sexually transmitted infections in minority populations is the nonprofit My Brother's Keeper in Jackson, which offers leadership in public and community health practices, collaborations and partnerships.
“The trend is definitely in the right direction, especially considering that Jackson has among the highest prevalence rates in the country,” said Mena, who last year was appointed to a four-year term on the CDC/HRSA Advisory Committee for HIV, Viral Hepatitis and STD Prevention and Treatment.
“Testing is an important entry point to both treatment and prevention.”