Good News And Bad News In Michigan's 2013 HIV Report

By Todd Heywood

The final 2013 report from the Michigan Department of Community Health on the HIV epidemic in Michigan is out. And while there are glimmers of hope in the report, there are also concerning trends appearing.

First, the good news. The state reported the lowest number of AIDS-related deaths since 1985. In 2013, the report says 53 people died of AIDS-related diseases. In 1985, the state reported 63 deaths. The state is also reporting the lowest number of new HIV-positives - 789 cases - since 2010, when the state reported 784 new cases. The last time the new case reports dropped below this level was over a decade ago, in 2002, when the state reported 765 new cases.

Now the bad news. Twenty-nine percent of the state's newly identified cases were in the age group of 13-24; 17 percent were 25-30. Of those 13-24 who were newly diagnosed in 2013, 66 percent were men who have sex with men.

"This, in Michigan and nationally, is a very at-risk demographic for HIV infection," says Angela Minicuci, spokesperson for MDCH.

A troubling number revealed in the reports: 26 percent of identified cases were co-diagnosed as HIV-positive as well as stage 3 of the disease, commonly referred to as AIDS. Co-diagnosis points to a late diagnosis, which means the person had been living with HIV for some time -- usually years. Studies show that those people who are infected, but don't know it, are more likely to transmit the infection.

Overall, 49 percent of new cases reported in 2013 were attributed to men who have sex with men, two percent to men who inject drugs and have sex with men, four percent to people who inject drugs and 14 percent to heterosexual activity. Thirty-one percent of new cases had no identified risk.

State gay organizations are worried about the new numbers.

"Equality Michigan is pleased to see that AIDS-related deaths have continued to decline, but the ongoing trend in high HIV infection rates among young trans* women and gay and bisexual men remains of great concern to us," said Bryan Victor of Equality Michigan. Victor works specifically on HIV issues for the organization. "We must continue to expand the range of prevention options available to our youth and remove all barriers to testing and treatment. Equality Michigan continues to work for expanded access to PrEP and the modernization of Michigan's criminal HIV laws because we know that these are important tools in promoting the physical and sexual health of youth in LGBT communities."

With 64 percent of all new cases in the state reported among African American men, coupled with the high percentage of MSM being infected, Curtis Lipscombe, executive director of KICK - the African American LGBT Agency - says he is concerned.

"The increased percentage of HIV infections for any type of persons is alarming, but incredibly distressing for gay men," said Lipscombe in a Facebook interview. "Unfortunately, since the 1980s, gay men carry the burden of stigma and are still the face of HIV/AIDS in Michigan. This newly released report is evidence of a failure to decrease infections. My home state of Michigan does not effectively lead in educating at-risk populations for risk reductions. I continue to lose loved ones - straight, gay, black and white. Continuous and effective education, funded by the state in common and targeted populations, must become a priority. Michigan must lead as a state reducing the stigma and reduction of HIV. Can we create another type of social media challenge to combat the increase of HIV infections in Michigan? I challenge Gov. Snyder and MDCH's Dir. Haveman to soak themselves in a bucket of cold ice and act now!"

In Ingham county, which has the second highest HIV prevalence rate outside of Wayne county, officials say a commitment to prevention is necessary.

In Ingham county, Linda Vail, the county health officer, says 20 people were diagnosed with HIV in 2013. Among those, eight were men who have sex with men, one more was a man who has sex with men and injects drugs and the remainder were among the other risk groups. Also, Ingham's identified cases skew slightly older than the state. Two of the cases were in 20-24 year-olds, six of the cases were in the 25-29 age group and three were between 30 and 34. The remaining nine cases are spread out through the 35 and older age groups.

Todd Tennis, an Ingham County Commissioner and a member of the health policy committee of that body, notes Ingham has been at or near the top of prevalence numbers for years, and the health department has been working to raise awareness on the disease. He said, however, the advent of PrEP (pre-exposure prophylaxis) is a game changer.

PrEP is a once-a-day dose of the anti-HIV drug, Truvada, taken to prevent infection. Studies have placed the real world efficacy of the drug - when taken daily - at 92 percent. A mathematical model of daily use of the drug places efficacy at 99 percent.

"With the new PrEP drug, this is the biggest breakthrough this disease has seen since the new drugs were released which made HIV a manageable chronic disease instead of a death sentence," Tennis said.


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