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Thursday, December 01, 2016

Baltimore HIV incidence: reverse this infectious stigma

When I worked in Baltimore at Johns Hopkins Hospital, a few decades ago, the public health initiatives were in the area of sexually transmitted diseases, particularly how to diagnose and treat syphilis. Now, the urgency is to identify all the sexually transmitted diseases ie, STD's including reported HIV infections. HIV is a STD but also spreads through shared needle use by people addicted to illegal drugs.
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Baltimore is a city and metropolitan area with public health and community resources to treat and eliminate all sexually transmitted diseases- including HIV.

Although HIV is slowly declining, the trend in Baltimore remains in the highest among metropolitan areas. This stigma can be reversed!

Frankly, I don't understand how Baltimore finds itself the focus, again, of HIV and STD epidemics. Speaking from first hand nursing provider experience, Baltimore has the money and certainly the specialists with extraordinary expertise to reverse this reputation as a place where STD's "grow". 

In my opinion, given the resources at Baltimore City's disposal, the city should be a showcase of places where HIV is treated and eliminated.  

It's impossible for me to accept that the continued incidence of HIV in Baltimore is anything other than a lack of public policy and health care providers' willingness to treat and solve this problem.

Here's an article describing the problem:
Where Baltimore Region Ranks in New HIV Cases

Reported cases and rate of new HIV diagnosis
By Greg Hambrick (Patch National Staff) - December 1, 2016 2:52 pm ET

Baltimore metro area continues to have one of the highest rats of infection, according to figures released this week by the Centers for Disease Control (CDC).

Baltimore ranks 10th among metro areas when comparing new HIV cases, with a rate of 22.1 new diagnoses for every 100,000 residents. That's far higher than the national rate of 12.3. The Baltimore metro area includes cities and communities in and around Anne Arundel, Baltimore, Carroll, Harford, Howard and Queen Anne's counties.

There were 618 new HIV cases reported in the Baltimore metro area in 2015, down slightly from 678 a year earlier. Across Maryland, there were 1,348 new diagnoses of HIV in 2015 — a rate of 22.4 cases for every 100,000 residents. In total, 32,000 Marylanders are living with HIV.

The data comes from the federal "HIV Surveillance Report," with the number of new cases and overall infection rates collected nationwide. The CDC notes that the latest data compiled for 2015 is preliminary and may not include some delayed reports. Final 2015 numbers will be released next year.

Across the U.S., new HIV cases continues to decline, down to 39,513 in 2015, compared to more than 49,000 in 2008. Sixteen states saw an increase in the rate of new diagnoses in 2015. Louisiana saw a significant drop in new diagnoses but still had the highest rate — slightly ahead of Florida with 24.2 new cases for every 100,000 residents.

Dec. 1, 2016, is World Aids Day, an annual international effort to increases awareness about safe practices that prevent HIV infection and how to support those with the disease. provides a national locator for health centers that provide HIV testing.

The highest rate of HIV diagnosis among metropolitan areas is in Miami. The metro area — which includes Fort Lauderdale and West Palm Beach — had a rate of nearly 39 new HIV cases for every 100,000 residents. Along with Miami, other metro areas with a higher rate of infection include Louisiana's Baton Rouge and New Orleans, followed by Jackson, Mississippi, and Atlanta.

HIV and AIDS cases are generally concentrated in urban areas and, therefore, in states with large metropolitan regions. 

But in the South, larger percentages of diagnoses are in smaller metro areas and suburban and rural areas, according to the CDC.

Here are the 30 metro areas that had the highest rate of new HIV cases in 2015 (the rate is per 100,000 residents):

Miami–Fort Lauderdale–West Palm Beach, FL: 38.8
Baton Rouge, LA: 32.0
New Orleans–Metairie, LA: 31.9
Jackson, MS: 31.3
Atlanta–Sandy Springs–Roswell, GA: 25.8
Orlando–Kissimmee–Sanford, FL: 25.7
Louisville/Jefferson County, KY–IN: 24.5
Memphis, TN–MS–AR: 23.1
Jacksonville, FL: 22.7
Baltimore–Columbia–Towson, MD: 22.1
Houston–The Woodlands–Sugar Land, TX: 22.1
Washington–Arlington–Alexandria, DC–VA–MD–WV: 21.5
Columbia, SC: 21.1
Las Vegas–Henderson–Paradise, NV: 20.9
Tampa–St. Petersburg–Clearwater, FL: 20.1
Augusta–Richmond County, GA–SC: 18.6
Dallas–Fort Worth–Arlington, TX: 18.0 17
New York–Newark–Jersey City, NY–NJ–PA: 17.8
Richmond, VA: 17.7 19
Greensboro–High Point, NC: 17.3 20
San Juan–Carolina–Caguas, PR: 17.0 21
Austin–Round Rock, TX: 16.8 22
Virginia Beach–Norfolk–Newport News, VA–NC: 16.6 23
Lakeland–Winter Haven, FL: 16.6
Charlotte–Concord–Gastonia, NC–SC: 16.5
Los Angeles–Long Beach–Anaheim, CA: 16.5
San Antonio–New Braunfels, TX: 16.2
Little Rock–North Little Rock–Conway, AR: 16.0
Durham–Chapel Hill, NC: 15.7
Charleston–North Charleston, SC: 15.7

Drug Use and HIV Diagnosis

Also this week, federal officials expressed concern about infections among drug users who inject heroin and other narcotics. HIV cases among minorities injecting drugs dropped by 50 percent between 2008 and 2014, but new infections among white injected drug users dropped by only 28 percent.

One possible cause may be the continued use of shared needles among white drug users, according to the CDC report. It also notes that the rate of injected drug use has increased dramatically among whites — up 114 percent in recent years.

The new data was shared in an effort to support Syringe Services Programs that can provide clean needles, along with services that include substance abuse counseling, disease testing and overdose response training.

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