Linda Beer

To characterize U.S. adults with perinatally acquired HIV (lifetime survivors), a cross-sectional analysis of adults at least 18 years old and born with HIV or received an HIV diagnosis within 12 months of birth ( N = 292) using 2015–2022 cycle Medical Monitoring Project data was conducted. Weighted percentages and 95% confidence intervals for demographics, social determinants, and HIV outcomes were calculated. On average, lifetime survivors were 62% women, 58% Black, and 26% Hispanic/Latino; one third were more than 30 years old. Half lived in poverty, 21% had unstable housing, 93% received HIV care, but only 43% had sustained viral suppression over the past 12 months. Most rated their health good or better and were satisfied with HIV care. Lifetime survivors face major socioeconomic challenges and low rates of viral suppression. Expanding adherence support, responsive trauma-informed care, access to long-acting ART, and addressing housing could improve outcomes and quality of life and well-being.

Background: Long-acting injectable antiretroviral therapy (LA-ART) has enormous potential benefit for increasing viral suppression among persons with HIV (PWH). Setting: U.S. HIV care facilities. Methods: We analyzed data on past 12-month LA-ART prescriptions collected over 3 annual data collection cycles (2021–2023) from probability samples of U.S. adults with HIV (collected 6/1/2021–5/30/2024, N=11,524). We report weighted percentages of PWH prescribed LA-ART and use prevalence ratios (PRs) with predicted marginal means and 95% confidence intervals (CIs) to quantify differences in prescription of LA-ART over time and between groups. Results: The percentage of PWH prescribed LA-ART increased from 0.4% (CI 0.2–0.7) in the 2021 cycle to 3.4% (CI 2.8–3.9) in the 2023 cycle (PR 7.8 [CI 4.5–13.6]). During the 2022-2023 cycles, prescription of LA-ART was higher among those living in Northeastern Medical Monitoring Project (MMP) states versus Southern MMP states (3.4% [CI 2.4–4.3] vs. 1.9% [CI 1.3–2.5], PR 1.8 [1.2–2.8]) and those receiving care at Ryan White HIV/AIDS program (RWHAP)-funded versus non-funded facilities (2.9% [CI 2.4–3.4] vs. 1.8% [CI 1.3–2.4], PR 1.6 [CI 1.1–2.2]). Older age (>50 vs. <40 years) was also associated with lower ART prescription. Conclusion: Prescription of LA-ART is increasing among U.S. adults with HIV, though prevalence remains low. LA-ART uptake lagged in the South, where HIV infections and negative health outcomes are disproportionately high. Comprehensive HIV care delivery—such as found in RWHAP-facilities—may facilitate LA-ART adoption.

We present nationally representative estimates of cancer diagnoses among US persons with HIV (PWH) using data from the Medical Monitoring Project, a complex sample survey of US adults with diagnosed HIV. Data were collected June 2019–May 2023 from a probability sample of 14,798 PWH. Weighted frequencies and percentages of cancer diagnoses during the past 24 months were calculated, and differences between the groups were quantified using prevalence ratios. An estimated 66,641 PWH (6.7%) had a cancer diagnosis and 54,863 (5.5%) had a non–AIDS-defining cancer diagnosis. PWH with a cancer diagnosis had higher prevalence of formerly smoking cigarettes, being unable to work or retired, poor self-rated health, advanced HIV disease, retention in HIV care, and viral suppression compared with those without a cancer diagnosis. Providing recommended cancer screenings and cancer prevention and treatment strategies—in addition to HIV standard of care—may support overall well-being among PWH.

US young adults with HIV (YAWH) face service accessibility, social, and structural challenges and are less likely to be adherent to antiretroviral therapy (ART) and achieve sustained viral suppression (SVS) than older adults. We examined factors associated with ART adherence and SVS among US YAWH aged 18-24 years taking ART using data from the 2015–2022 cycles of Medical Monitoring Project. We reported weighted prevalences of 100% ART dose adherence over the past 30 days and SVS over the past 12 months with 95% confidence intervals (CIs). We estimated prevalence ratios (PRs) to assess associations (p < 0.05) between adherence and SVS with key social and structural factors and health-related needs. During 2015–2022, 36.1% of YAWH were adherent and 42.9% achieved SVS. Black/African American and Hispanic/Latino YAWH were less likely to be ART adherent than White YAWH. ART adherence was less likely among YAWH who experienced homelessness, food insecurity, >1 unmet subsistence service needs, and > 1 non-HIV medical care services unmet need. Compared to White YAWH, Black/African American YAWH were less likely to achieve SVS. Not achieving SVS was associated with unemployment and homelessness. Approximately one third of YAWH had 100% ART adherence and less than half achieved SVS. There is a need for a comprehensive approach that addresses social and structural barriers to improve health outcomes among YAWH.

Background: Measuring the capacity of HIV medical facilities to deliver quality treatment and prevention care to people with HIV is essential to the over 1 million Americans living with HIV and supports federal efforts to end the HIV epidemic. To fill this gap and complement the ongoing Medical Monitoring Project—which conducts annual surveys of people with HIV and periodic surveys of HIV care providers—the US Centers for Disease Control and Prevention (CDC) and RTI (Research Triangle Institute) International conducted the Medical Monitoring Project Facility Survey (MMPFS). Objective: We aimed to describe the survey methods designed to achieve a high response rate from the 1022 facilities providing care to people with HIV as part of the Medical Monitoring Project—including frame development, survey instrument development, facility recruitment, and postsurvey data processing. Methods: For the MMPFS, the CDC and RTI developed a sequential multimode data collection approach (paper, web, and phone), including an abbreviated nonresponse follow-up (NRFU) instrument and the collection of administrative data for all facilities. Data were then processed to produce raw, imputed, and weighted datasets. Analyses included comparisons of responses to the full survey and NRFU survey. Results: The full MMPFS survey yielded 455 complete survey respondents and the NRFU survey yielded 59 complete survey responses, a combined response rate of 50.3% (514/1022). A nonresponse bias analysis comparing the 2 surveys found a significant difference in the raw datasets for 4 (12%) of the 34 categorical variables that were identical between the 2 surveys (all P>.0014). Weighted and imputed datasets were then generated and compared. There was no significant difference between the 2 datasets for any variable (all P>.05). Conclusions: The CDC and RTI’s MMPFS methodology proved to be a valuable means of collecting data from HIV care providers and providing estimates for facility characteristics related to the provision of health care for people with HIV. The combined response rate allowed the CDC and RTI to generate facility-level estimates and an imputed dataset that can be linked to MMPFS patient data. The methods may be applied to other facility survey studies.

Objectives. To describe provision of HIV telehealth services during the COVID-19 pandemic using data from the Centers for Disease Control and Prevention (CDC) Medical Monitoring Project Facility Survey for the Ending the HIV Epidemic in the United States initiative, which aims to achieve an at least 90% reduction in new HIV infections by 2030 and highlights telehealth as an important strategy. Methods. During 2021, we surveyed 1023 facilities providing HIV care to a nationally representative sample of US adults with diagnosed HIV, of which 45% responded. We calculated weighted percentages with 95% confidence intervals comparing the characteristics of facilities providing telehealth services. Results. Overall, 83.4% of facilities provided HIV care telehealth services by the facility’s own providers (82.0%) or by outside providers through remote conferencing (27.0%). Gaps in coverage were identified in smaller facilities and in facilities in rural and primary care health professional shortage areas. Conclusions. Although most HIV care facilities provided telehealth services during the COVID-19 pandemic, gaps were identified, which must be addressed to meet Ending the HIV Epidemic in the United States goals and better prepare for future health emergencies. ( Am J Public Health. 2025;115(3):349–353. https://doi.org/10.2105/AJPH.2024.307908 )

This report found that as of 2022, none of the 2025 U.S. National HIV/AIDS Strategy goals for improving quality of life among people with diagnosed HIV were met.

People with human immunodeficiency virus (PWH) are disproportionately affected by depression, but the recent national estimates for US PWH encompassing both current symptoms and clinical diagnoses to assess missed diagnoses and lack of symptom remission are lacking. We used data from CDC's Medical Monitoring Project (MMP) to report nationally representative estimates of diagnosed and undiagnosed depression among US adult PWH. During June 2021 to May 2022, MMP collected interview data on symptoms consistent with major or other depression and depression diagnoses from medical records of 3928 PWH. We report weighted percentages and prevalence ratios (PRs) to quantify differences between groups on key social and health factors. Overall, 34% of PWH experienced any depression (diagnosis or Patient Health Questionnaire-8); of these, 26% had symptoms but no diagnosis (undiagnosed depression), 19% had both diagnosis and symptoms, and 55% had a diagnosis without symptoms. Among those with depression, persons with a disability (PR: 1.52) and food insecurity (PR: 1.67) were more likely to be undiagnosed. Unemployed persons (PR: 1.62), those experiencing a disability (PR: 2.78), food insecurity (PR: 1.46), or discrimination in human immunodeficiency virus (HIV) care (PR: 1.71) were more likely to have diagnosed depression with symptoms. Those with symptoms (undiagnosed or diagnosed) were less likely to be antiretroviral therapy (ART) dose adherent (PR: 0.88; PR: 0.73) or have sustained viral suppression (PR: 0.62; PR: 0.91) and were more likely to have unmet needs for mental health services (PR: 2.38, PR: 2.03). One-third of PWH experienced depression, of whom nearly half were undiagnosed or still experiencing clinically relevant symptoms. Expanding screening and effective treatment for depression could improve quality of life and HIV outcomes.

Background: Data are needed to assess the capacity of HIV care facilities to implement recommended Ending the HIV Epidemic activities. Setting: US HIV care facilities. Methods: We analyzed 2021 survey data from 514 facilities that were recruited from a census of facilities providing care to a national probability sample of US adults with HIV. We present weighted estimates of facility characteristics, services, and policies and estimates of the proportion of all US HIV patients attending these facilities. Results: Among HIV care facilities, 37% were private practices, 72% were in areas with population >1 million, and 21% had more than 1000 HIV patients. Most provided preexposure prophylaxis (83%) and postexposure prophylaxis (84%). More than 67% of facilities provided HIV-specific stigma or discrimination training for all staff (covering 70% of patients) and 66% provided training on cultural competency (covering 74% of patients). A majority of patients attended facilities that provided on-site access to HIV/sexually transmitted infection (STI) transmission risk reduction counseling (89%); fewer had on-site access to treatment for substance use disorders (35%). We found low provision of on-site assistance with food banks or meal delivery (14%) and housing (33%). Approximately 71% of facilities reported using data to systematically monitor patient retention in care. On-site access to adherence tools was available at 58% of facilities; 29% reported notifying patients of missed prescription pickups. Conclusion: Results indicate some strengths that support Ending the HIV Epidemic–recommended strategies among HIV care facilities, such as high availability of preexposure prophylaxis/postexposure prophylaxis, as well as areas for improvement, such as provision of staff antistigma trainings and adherence supports.

Objective(s): To examine associations between Index of Concentration at the Extremes (ICE) measures for economic and racial segregation and HIV outcomes in the United States (U.S.) and Puerto Rico. Methods: County-level HIV testing data from CDC’s National HIV Prevention Program Monitoring and Evaluation and census tract-level HIV diagnoses, linkage to HIV medical care, and viral suppression data from the National HIV Surveillance System were used. Three ICE measures of spatial polarization were obtained from the U.S. Census Bureau’s American Community Survey: ICEincome (income segregation), ICErace (Black-White racial segregation), and ICEincome+race (Black-White racialized economic segregation). Rate ratios (RRs) for HIV diagnoses and prevalence ratios (PRs) for HIV testing, linkage to care within 1 month of diagnosis, and viral suppression within 6 months of diagnosis were estimated with 95% confidence intervals (CIs) to examine changes across ICE quintiles using the most privileged communities (Quintile 5, Q5) as the reference group. Results: PRs and RRs showed a higher likelihood of testing and adverse HIV outcomes among persons residing in Q1 (least privileged) communities compared with Q5 (most privileged) across ICE measures. For HIV testing percentages and diagnosis rates, across quintiles, PRs and RRs were consistently greatest for ICErace. For linkage to care and viral suppression, PRs were consistently lower for ICEincome+race. Conclusions: We found that poor HIV outcomes and disparities were associated with income, racial, and economic segregation as measured by ICE. These ICE measures contribute to poor HIV outcomes and disparities by unfairly concentrating certain groups (i.e., Black persons) in highly segregated and deprived communities that experience a lack of access to quality, affordable health care. Expanded efforts are needed to address the social/economic barriers that impede access to HIV care among Black persons. Increased partnerships between government agencies and the private sector are needed to change policies that promote and sustain racial and income segregation.