After surge in new HIV diagnoses, Nebraska doctor advises return to preventive care | Live well

Nebraska in 2021 saw its highest number of new HIV diagnoses since 2010, with the largest relative increases among white males and rural residents.






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While the 107 new diagnoses weren’t a record — it dates back to 2001, with 127 — the higher number and shifting demographics were enough for the Nebraska Department of Health and Human Services to issue an alert to healthcare providers. state health.

Nebraska state epidemiologist Dr. Matthew Donahue said at least part of the reason for the uptick, according to state data, appears to be a drop in HIV testing during the pandemic. Meanwhile, public health officials and healthcare providers have focused their resources on COVID-19. Additionally, some Nebraskans have avoided or missed routine screenings for various conditions.

Donahue said the recent increase in HIV diagnoses in the state and a recent increase in syphilis underscore the need for Nebraskanians to return to preventive testing and care — not only for sexually transmitted diseases, but also for diseases such as cancer and heart disease.

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Early diagnosis for many conditions can prevent bigger problems down the road. HIV, or human immunodeficiency virus, attacks the body’s immune system. If left untreated, it can lead to AIDS or acquired immunodeficiency syndrome. Treatment can reduce the virus to undetectable levels in the body. At this point, people can no longer transmit the virus.

“The overall goal, if I had a message, is to try to get people back for preventative health care, for sustained health care,” Donahue said. “If you don’t have a doc, you should get one.”

Donahue said his call for testing also applies to a new health problem: monkeypox. The state had five cases last week, with more likely to be reported.







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People who develop a suspicious rash, he said, should contact a health care provider, who can work with health officials to arrange testing and begin tracing close contacts. Monkeypox is spread through close contact with infected people. During the current outbreak, it appears to be spread largely through close sexual contact.

Identifying infections that already exist could also help the state get more vaccines that can prevent monkeypox, Donahue said. Like other states, Nebraska has greater demand than supply for the vaccine, known as Jynneos. The federal Centers for Disease Control and Prevention allocates shots to states based on the number of cases. Donahue said state health officials are in daily contact with federal authorities to get as many vaccines as possible for Nebraska.

The state, he said, is prioritizing the vaccine for healthcare professionals who might be exposed to monkeypox at work, including lab workers, and those who are most at risk of contracting the virus. . Those most at risk are primarily men who have sex with men, especially those with multiple sex partners and those who attend social events involving sex.

Donahue said health officials looked at HIV infection rates after seeing an increase in syphilis. Seventy cases were reported in the state in 2017. That number rose in 2021 to 255, a 264% increase. Syphilis, also on the rise worldwide, is easily treated if caught early.

The state has seen an increase in HIV diagnoses among all groups. But when it comes to race and ethnicity, the biggest increase was seen among white men. And while new diagnoses among urban residents rose from 51 in 2020 to 69 in 2021, the number of new cases among rural residents nearly doubled over the same period, from 20 in 2020 to 38 in 2021.







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Donahue said state health officials want to alert health care providers to these changes.

“We really wanted to say that and hammer home that we need to start talking about screening again,” Donahue said.

Although he said he could only guess why the numbers were rising, the data points to reduced testing during the pandemic. While the agency doesn’t see every HIV test in the state, it partners with 26 organizations for HIV education, counseling and testing. In 2019, these groups conducted 8,100 HIV tests. The number fell to around 5,100 in 2020 and 4,100 in 2021.

The CDC recommends that everyone between the ages of 13 and 64 be tested for HIV at least once and that those at high risk be tested annually.

Dr. Sara Hurtado Bares, an associate professor in the College of Medicine at the University of Nebraska Medical Center, said the CDC found that HIV testing fell 50% nationwide between 2019 and 2020 because so many health departments have diverted their efforts to COVID and many STI clinics have closed.

Locally, the Douglas County Health Department‘s STI Clinic was closed for much of the pandemic because staff were redeployed to assist with COVID vaccination efforts.







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Donahue said the increases among white men and rural residents may have occurred because reduced access to HIV testing and care has hit rural areas harder than urban areas.

Hurtado Bares said she was concerned that the increases in rural areas were actually higher than the data reflected. Historically, rural areas have not been counted well because many people travel to urban areas to get tested. They may not want to be tested where they live because of the stigma attached to the diagnosis.

Another concern: People newly diagnosed with HIV in rural counties had much lower initial immune cell counts, known as CD4+ T cells, than those newly diagnosed in urban counties, suggesting a delay in diagnosis. .

“We now know that ideally we start treatment long before the CD4 count drops, because we have data that it really does improve mortality,” said Hurtado Bares.

As for monkeypox, Donahue said, health officials believe it’s likely been in the United States longer than they initially thought.

He said he hopes barriers to testing will be lowered as more commercial labs come online. Health care providers are more used to ordering tests through these labs than through the Nebraska Public Health Lab.

“I suspect there are more cases there,” he said.

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