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Part of Left Behind: Black America -- A Neglected Priority in the Global AIDS Epidemic

August 2008

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  81. The U.S. incarcerates more people than any other country in the world -- 2.3 million in 2006. (Bureau of Justice Statistics, Corrections Statistics, Accessed 18 May 2008.) Black men in America are most likely to be incarcerated, experiencing an imprisonment rate that is 6.6 times higher than among white males. (Sabol WJ et al., Prison and Jail Inmates at Midyear 2006, Bureau of Justice Statistics, 2007.) Accounting for only 13% of the U.S. population, Blacks comprise 44% of all correctional inmates in the U.S. (Sabol, 2007.) Estimates suggest that more than one in four Black men (28.5%) in the US will be imprisoned sometime during their lives. (Bonczor JP, Beck AJ, Lifetime Likelihood of Going to State or Federal Prison, Bureau of Justice Statistics, Accessed 18 May 2008.)

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  99. CDC, Trends in HIV/AIDS Diagnoses Among Men Who Have Sex with Men -- 33 States, 2001-2006, MMWR 2008;57:681-686.

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  118. Monitoring the AIDS Pandemic Network, Male-Male Sex and HIV/AIDS in Asia, 2005.

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  123. See Kegeles SM et al., The intersection of stigma and HIV in young African American men who have sex with men's (YAAMSM) lives, International Conference on AIDS, abstract no. WePeD6400, 2004.

  124., Discrimination, Stigma Against MSM Hindering HIV/AIDS Programs in Senegal, Globe and Mail Reports, 4 June 2008.

  125. Human Rights Watch, Hated to Death: Homophobia, Violence and Jamaica's HIV/AIDS Epidemic, 2004, accessed 29 June 2008.

  126. Nyakairu F, Uganda Shuns Gays in Anti-HIV Drive, Reuters, 2 June 2008 (summarized in Kaiser Daily HIV/AIDS Report, Henry J. Kaiser Family Foundation, 3 June 2008).

  127. See Pisani E et al., HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia, Sex Transm Infect 2004;80:536-540.

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  135. Human Rights Watch, Thai AIDS Treatment Action Group, Barriers to HIV/AIDS Treatment for People Who Use Drugs in Thailand, 2007; International Treatment Preparedness Coalition, Missing the Target #5: Improving AIDS Drug Access and Advancing Health Care for All, 2007.

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  140. The frequency of HIV transmission in correctional settings in the U.S. remains a topic of some debate. Because few prison systems in the U.S. test inmates for HIV upon discharge, a definitive estimate of HIV incidence in correctional populations has not proven feasible. A retrospective study by the CDC of the Georgia state prison system suggests that HIV transmission among inmates may be rarer than some believe. (CDC, HIV Transmission Among Male Inmates in a State Prison System -- Georgia, 1992-2005, MMWR 2006;55:421-426.) The Georgia study, though, found that Black inmates were at highest risk of having HIV infection.

  141. UNAIDS reports that comprehensive HIV prevention and treatment services for imprisoned drug users are available in only three countries. UNAIDS, Report on the global AIDS epidemic, 2008.

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  162. Sexually transmitted infections facilitate HIV transmission and acquisition by causing genital ulcers that expose blood or membranes to HIV and by activating immune cells that are especially receptive to the virus. In the 1990s, studies on the potential of STI control to reduce HIV incidence reached seemingly contrary conclusions in Tanzania and Uganda. Subsequent analysis of these findings led to agreement that STI control may be a more potent tool for HIV prevention at an earlier stage of an epidemic, before infection is widely generalized. (For a discussion of these trial results, see UNAIDS, WHO, Consultation on STD interventions for preventing HIV: What is the evidence? 2000.) At the International AIDS Conference in Toronto in 2006, WHO sponsored an international expert consultation to review evidence on STI control for HIV prevention, resulting in agreement that focused STI interventions can help slow the spread of HIV. (WHO, Treatment for sexually transmitted infections has a role in HIV prevention, News release, 16 August 2006.

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  165. Millett G et al., 2007; Torian LV et al., HIV infection in men who have sex with men, New York City Department of Health sexually transmitted disease clinics, 1990-1999: A decade of serosurveillance finds that racial disparities and associations between HIV and gonorrhea persist, Sex Transm Dis 2002;29:73-78. See CDC, STDs in Men Who Have Sex with Men: Sexually Transmitted Disease Surveillance, 2005, accessed 18 May 2008.

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  168. Hogrefe W et al., Detection of herpes simplex virus type 2-specific immunoglobulin G antibodies in African sera by using recombinant gG2, Western Blotting, and gG2 inhibition, J Clin Microbiol 2002;40:3635-3640.

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  171. New York City Department of Health and Mental Hygiene, HIV Epidemiology Program -- 1st Semiannual Report, April 2006.

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  174. UNAIDS, 2008.

  175. Antiretroviral Therapy in Lower Income Countries Collaboration, ART Cohort Collaboration Groups, Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries, Lancet 2006;367:817-824.

  176. Beck E, Walensky RP, The Outcome and Impact of Ten Years of HAART, in A Decade of HAART (Zuniga JM et al., eds.), Oxford University Press, Oxford, UK, 2008.

  177. Bergier EM et al., New York City's HIV-Related Health Disparities: Surveillance Data Guides Public Health Action, New York City Department of Health and Mental Hygiene, XVI International AIDS Conference, Toronto, 2006, accessed 16 June 2008.

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  180. For a history of the Minority AIDS Initiative, see Aragón R, Kates J, The Minority AIDS Initiative, Henry J. Kaiser Family Foundation, 2004, accessed 9 June 2008.

  181. See Henry J. Kaiser Family Foundation, U.S. Federal Funding for HIV/AIDS: The FY2009 Budget Request, April 2008 (Kaiser 2008 Funding Report); Summers T, Kates J, Trends in U.S. Government Funding for HIV/AIDS: Fiscal Years 1981 to 2004, March 2004.

  182. Kaiser 2008 Funding Report; Summers T, Kates J, March 2004; Henry J. Kaiser Family Foundation, Federal Funding for HIV/AIDS: The FY2005 Budget Request, February 2004.

  183. Summers T, Kates J, March 2004.

  184. Kaiser 2008 Funding Report.

  185. Since national goals were established for Health People 2010, the federal government added an indicator tracking the number of HIV/AIDS cases in adolescents and adults, relying on surveillance data from 33 states with mature reporting systems. Trends in new diagnoses, however, do not necessarily reflect actual HIV incidence and do not constitute an estimate of the number of HIV infections prevented as a result of federally-financed prevention programs. As of August 2007, no national target had been established for the indicator on HIV/AIDS diagnoses. (U.S. Department of Health and Human Services, Public Health Service, Progress Review -- HIV -- Healthy People 2010, 30 August 2007, accessed 9 June 2008.

  186. See UNAIDS, HIV Prevention Needs and Successes: A Tale of Three Countries, 2001.

  187. Piot, 2008.

  188. See Henry J. Kaiser Family Foundation, U.S. Federal Funding for HIV/AIDS: The FY2009 Budget Request, 2008 (Kaiser Funding Report).

  189. Kaiser Funding Report, 2008.

  190. Schackman B, Lifetime Cost of Current HIV Care in the United States, Medical Care 2006;44:990-997.

  191. Funders Concerned About AIDS, U.S. Philanthropic Commitments for HIV/AIDS 2005 & 2006, 2007.

  192. See UNAIDS, 2008.

  193. United Nations Development Program, Thailand's Response to HIV/AIDS: Progress and Challenges, 2004, accessed 10 June 2008.

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