The increasing prevalence of diabetes and obesity, growing health disparities, and shortage of bilingual and culturally trained health care professionals underscore the role of trained community health workers (CHWs) to provide economically sustainable and culturally relevant services. This prospective randomized design evaluated the relative effectiveness of a CHW intervention among Hispanic persons with newly diagnosed type 2 diabetes, as compared with usual clinic practice in three inner-city health centers. In sum, 189 Hispanic patients newly diagnosed with type 2 diabetes were randomly assigned to one of three 6-month diabetes management approaches--CHW, case management, and standard provider care--and assessed for diabetes-related health measures and clinical indicators at baseline and postintervention. Participants in the CHW group achieved greater improvements than did the controls in program measures: health status, emergency department utilization, dietary habits, physical activity, and medication adherence. They also had 2.9 times greater odds of decreasing body mass index.

Context: Antiretroviral therapy (ART) to treat and pre-exposure prophylaxis (PrEP) to prevent HIV infection are effective tools to help end the HIV epidemic. However, their use could affect HIV transfusion-transmission risk. Objectives: Three different ART/PrEP prevalence analyses in blood donors were conducted. Methods: First, blood samples from HIV-positive and a comparison group of infection-nonreactive donors were tested under blind using liquid chromatography-tandem mass spectrometry for ART. Second, blood donor samples from infection-nonreactive, 18-45 year-old, male, first-time blood donors in six US locations were tested for emtricitabine and tenofovir. Third, in men who have sex with men (MSM) participating in the 2017 CDC National HIV Behavioral Surveillance (NHBS) from five US cities self-reported PrEP use proximate to donation was assessed. Findings: In blind testing, no ART was detected in 300 infection-nonreactive donor samples, but in 299 HIV-confirmed infected donor samples, 46 (15.4%, 95% CI 11.5 - 20.0%) had evidence of ART. Of the 1,494 samples tested from first-time, male donors, 9 (0.6%, 95% CI 0.03 - 1.1%) had tenofovir and emtricitabine. In the NHBS MSM survey, 27 of 591 respondents (4.8%, 95% CI 3.2 - 6.9%) reported donating blood in 2016 or 2017 and PrEP use within the same time frame as blood donation. Conclusions: Persons who are HIV-positive and taking ART and persons taking PrEP to prevent HIV infection are donating blood. Both situations could lead to increased risk of HIV transfusion transmission if blood screening assays are unable to detect HIV in donations from infected donors.

Men who have sex with men (MSM) in the United States are stigmatized for their same-sex practices, which can lead to risky sexual behavior, potentiating risk for human immunodeficiency virus (HIV) infection. Improved measurement is necessary for accurately reporting and mitigating sexual behavior stigma. We added 13 sexual behavior stigma items to local surveys administered in 2017 at 9 sites in the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance system, which uses venue-based, time-sampling procedures to survey cisgender MSM in US Census Metropolitan Statistical Areas. We performed exploratory factor analytical procedures on site-specific (Baltimore, Maryland; Denver, Colorado; Detroit, Michigan; Houston, Texas; Nassau-Suffolk, New York; Portland, Oregon; Los Angeles, California; San Diego, California; and Virginia Beach-Norfolk, Virginia) and pooled responses to the survey items. A 3-factor solution—“stigma from family” (α = 0.70), “anticipated health-care stigma” (α = 0.75), and “general social stigma” (α = 0.66)—best fitted the pooled data and was the best-fitting solution across sites. Findings demonstrate that MSM across the United States experience sexual behavior stigma similarly. The results reflect the programmatic utility of enhanced stigma measurement, including tracking trends in stigma over time, making regional comparisons of stigma burden, and supporting evaluation of stigma-mitigation interventions among MSM across the United States.

The prevalence of transmitted HIV drug resistance (TDR) in Los Angeles County remains unknown, due in part to the absence of reliable genotypic data. The specific objectives of this study are to estimate the prevalence of TDR, to describe the demographic characteristics associated with TDR and to investigate the distribution of HIV-1 subtypes among persons newly diagnosed with HIV in Los Angeles County. From 2007 through 2009, 1,414 sequences were obtained from 7,100 persons newly diagnosed with HIV through HIV resistance surveillance. Overall, 257 (18%) sequences had some genetic evidence of drug resistance. Of these, 122 (9%) exhibited evidence of resistance to non-nucleoside reverse transcriptase inhibitors, 121 (9%) to nucleoside reverse transcriptase inhibitors and 76 (5%) to protease inhibitors. Subtype B was dominant (97%), followed by subtypes C (1.2%), CRF01_AE (0.8%), CRF02_AG (0.4%), A (0.3%), and F (0.1%). With a TDR prevalence of 18%, Los Angeles County ranks high compared with other jurisdictions across the nation. The prevalence of TDR in recent (19%) and long-standing (17%) HIV cases were similar, thus providing additional support for the notion that TDR-associated mutations may persist well beyond the period of recent infection. HIV-1 CRF01_AE, observed historically in central Africa and Asia, was observed to be circulating among men who have sex with men and heterosexuals in Los Angeles County. These findings underscore the need for continued and expanded HIV resistance surveillance to inform healthcare providers, policy makers and at-risk populations of emerging trends in HIV drug resistance.