Publications by authors named "Wade Ivy"

10 Publications

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HIV Prevalence Among Women Who Exchange Sex for Money or Drugs-4 U.S. Cities.

J Acquir Immune Defic Syndr 2020 08;84(4):345-354

Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA.

Background: Limited data exist in the United States on the prevalence of HIV among women who exchange sex.

Setting: We estimate HIV prevalence of women who exchange sex from a 2016 survey in Chicago, Detroit, Houston, and Seattle and compare it with the prevalence of HIV among women of low socioeconomic status (SES), who did not exchange sex, and women in the general population.

Methods: Women who exchange sex were recruited via respondent-driven sampling among some cities participating in National HIV Behavioral Surveillance, interviewed, and offered HIV testing. We estimate HIV prevalence and, using prevalence ratios, compare it with the prevalence among women of low SES who did not exchange sex in the 2013 National HIV Behavioral Surveillance cycle, and to women in the general population estimated using 2015 National HIV Surveillance data.

Results: One thousand four hundred forty women reported exchange sex in 2016. Aggregated HIV prevalence was 4.9% [95% confidence interval (CI): 2.7 to 7.1] among women who exchanged sex, 1.6% (95% CI: 0.3 to 2.8) among women of low SES who did not exchange sex, and 0.6% (95% CI: 0.5% to 0.6%) among women in the general population. HIV prevalence among women who exchanged sex was 3.1 times (95% CI: 1.6 to 5.9) as high as among women of low SES who did not exchange sex, and 8.8 times (95% CI: 7.0 to 11.1) as high as among women in the general population.

Conclusion: HIV prevalence was significantly higher among women who exchanged sex compared with women in the general population and women of low SES who did not exchange sex.
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http://dx.doi.org/10.1097/QAI.0000000000002362DOI Listing
August 2020

Changes in Characteristics and Behavior Among African American Men Who Have Sex with Men and Women in the Context of Reductions in HIV Diagnoses Among Women.

AIDS Behav 2020 Mar;24(3):960-966

Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS-E04, Atlanta, GA, 30333, USA.

Men who have sex with men and women (MSMW) connect lower prevalence populations of women to higher prevalence populations of men who have sex with men only. We hypothesize that HIV testing and treatment among MSMW have increased in recent years, and this increase can help explain the declining rates of new HIV diagnoses among African American women. We analyzed data from 2008, 2011, and 2014 of the National HIV Behavioral Surveillance system. African American men who have sex with men (MSM) were surveyed from 19 United States cities using venue-based sampling and tested for HIV infection. We used generalized estimating equations, using year of survey as an independent variable, adjusting for age, to determine differences for selected outcomes regarding healthcare and risk behaviors over time. Among the 1299 African American MSMW interviewed, significant increases were observed in the percent of men who had an HIV test in the previous 12 months (2008: 54%, 2011: 69%, and 2014: 68%, p-value < 0.001). Among HIV-positive men, the percentage of men who were aware of their infection at the time of the interview increased significantly over time (26, 35, and 48%, p-value = 0.002). Among those men, the percentage who reported currently being on antiretroviral therapy also increased significantly over time (46, 69, and 72%, p-value = 0.050). The percentage of men reporting high-risk sexual risk behaviors increased or remained stable. Our findings support the hypothesis that HIV testing and treatment has increased among African American MSM from 2008 to 2014. Additional research is needed to fully explore the population-level impact it has on HIV transmission among women.
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http://dx.doi.org/10.1007/s10461-019-02528-2DOI Listing
March 2020

Jeffries et al. respond to "Men who have sex with men and women (MSMW), biphobia and the CDC: A bridge ignored!?"

Prev Med 2017 Dec;105:370-371

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.

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http://dx.doi.org/10.1016/j.ypmed.2017.07.007DOI Listing
December 2017

Reductions in HIV Diagnoses Among African American Women: A Search for Explanations.

J Acquir Immune Defic Syndr 2017 07;75 Suppl 3:S253-S260

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.

Background: African American women experienced a 46% reduction in the rate of HIV diagnoses from 56.0 in 2008, to 30.0 in 2014 (per 100,000). The reasons for this decrease are unknown; however, we hypothesize that improvements in socioeconomic status, health care access, and risk behaviors may have contributed to this reduction.

Methods: We analyzed data from 2006, 2010, and 2013 of the National HIV Behavioral Surveillance system. African American women living at or below poverty were surveyed from 19 United States cities using respondent-driven and venue-based sampling, and tested for HIV infection. We used generalized estimating equations to determine differences for selected outcomes regarding health care and risk behaviors over time.

Results: Among 11,065 women, we found increases in the percentage of women who reported having a recent HIV test (P value = 0.0002); having health insurance (P < 0.0001); and recently visiting a health care provider (P < 0.0001). Being unemployed declined significantly (P = 0.0057), as did reporting recent injection drug use (P < 0.0001). Crack use declined among women aged 25-44 years (P < 0.0001). However, reporting condomless vaginal sex at last sex (P = 0.0268), condomless anal sex at last sex (P = 0.6462), or 3 or more sex partners in the past 12 months (P = 0.5449) remained stable.

Discussion: Enhanced health care access and socioeconomic status and reductions in drug use may have contributed to the declines in HIV diagnoses among African American women in the United States.
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http://dx.doi.org/10.1097/QAI.0000000000001400DOI Listing
July 2017

HIV acquisition and transmission among men who have sex with men and women: What we know and how to prevent it.

Prev Med 2017 Jul 24;100:132-134. Epub 2017 Apr 24.

Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address:

Men who have sex with men and women (MSMW) compose a subset of men who have sex with men (MSM) and represent an estimated 35% of MSM. Research on the HIV risk behaviors of MSMW has largely focused on their behaviors in comparison to men who have sex with men only (MSMO). Results suggest that compared to MSMO, MSMW are less likely to have ever had an HIV test, are at greater risk of being unaware of their HIV infection and are less likely to have encountered HIV prevention activities or materials. Additional research is needed to provide a more comprehensive understanding of the unique sexual behaviors and lived experience of MSMW as a group in order to better inform HIV prevention efforts. The purpose of this paper is to summarize existing data and discuss strategies to reduce HIV acquisition and transmission among MSMW.
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http://dx.doi.org/10.1016/j.ypmed.2017.04.024DOI Listing
July 2017

Notes from the Field: Ebola Virus Disease Response Activities During a Mass Displacement Event After Flooding--Freetown, Sierra Leone, September-November, 2015.

MMWR Morb Mortal Wkly Rep 2016 Feb 26;65(7):188-9. Epub 2016 Feb 26.

Since the start of the Ebola virus disease (Ebola) outbreak in West Africa, Sierra Leone has reported 8,706 confirmed Ebola cases and 3,956 deaths. During September 15-16, 2015, heavy rains flooded the capital, Freetown, resulting in eight deaths, home and property destruction, and thousands of persons in need of assistance. By September 27, approximately 13,000 flood-affected persons registered for flood relief services from the government. On September 17, two stadiums in Freetown were opened to provide shelter and assistance to flood-affected residents; a total of approximately 3,000 persons stayed overnight in both stadiums (Sierra Leone Ministry of Health and Sanitation, personal communication, September 2015). On the same day the stadiums were opened to flood-affected persons, the Ministry of Health and Sanitation (MoHS) and Western Area Ebola Response Center (WAERC) staff members from CDC, the World Health Organization (WHO), and the African Union evaluated the layout, logistics, and services at both stadiums and identified an immediate need to establish Ebola response activities. The patient in the last Ebola case in the Western Area, which includes Freetown, had died 37 days earlier, on August 11; however, transmission elsewhere in Sierra Leone was ongoing, and movement of persons throughout the country was common.
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http://dx.doi.org/10.15585/mmwr.mm6507a4DOI Listing
February 2016

Notes from the Field: Ebola Virus Disease Response Activities During a Mass Displacement Event After Flooding--Freetown, Sierra Leone, September-November, 2015.

MMWR Morb Mortal Wkly Rep 2016 Feb 26;65(7):188-9. Epub 2016 Feb 26.

Since the start of the Ebola virus disease (Ebola) outbreak in West Africa, Sierra Leone has reported 8,706 confirmed Ebola cases and 3,956 deaths. During September 15-16, 2015, heavy rains flooded the capital, Freetown, resulting in eight deaths, home and property destruction, and thousands of persons in need of assistance. By September 27, approximately 13,000 flood-affected persons registered for flood relief services from the government. On September 17, two stadiums in Freetown were opened to provide shelter and assistance to flood-affected residents; a total of approximately 3,000 persons stayed overnight in both stadiums (Sierra Leone Ministry of Health and Sanitation, personal communication, September 2015). On the same day the stadiums were opened to flood-affected persons, the Ministry of Health and Sanitation (MoHS) and Western Area Ebola Response Center (WAERC) staff members from CDC, the World Health Organization (WHO), and the African Union evaluated the layout, logistics, and services at both stadiums and identified an immediate need to establish Ebola response activities. The patient in the last Ebola case in the Western Area, which includes Freetown, had died 37 days earlier, on August 11; however, transmission elsewhere in Sierra Leone was ongoing, and movement of persons throughout the country was common.
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http://dx.doi.org/10.15585/mmwr.mm6507a4DOI Listing
February 2016

Cancer Among Children With Perinatal Exposure to HIV and Antiretroviral Medications--New Jersey, 1995-2010.

J Acquir Immune Defic Syndr 2015 Sep;70(1):62-6

*Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †New Jersey Department of Health, Division of HIV/AIDS Services, Trenton, NJ; ‡New Jersey Department of Health, Communicable Disease Service, Trenton, NJ; and §New Jersey Department of Health, Cancer Epidemiology Services, Trenton, NJ.

Background: Concerns remain regarding the cancer risk associated with perinatal antiretroviral (ARV) exposure among infants. No excessive cancer risk has been found in short-term studies.

Methods: Children born to HIV-infected women (HIV-exposed) in New Jersey from 1995 to 2008 were identified through the Enhanced HIV/AIDS Reporting System and cross-referenced with data from the New Jersey State Cancer Registry to identify new cases of cancer among children who were perinatally exposed to ARV. Matching of individuals in the Enhanced HIV/AIDS Reporting System to the New Jersey State Cancer Registry was conducted based on name, birth date, Social Security number, residential address, and sex using AutoMatch. Age- and sex-standardized incidence ratio (SIR) and exact 95% confidence intervals (CIs) were calculated using New Jersey (1979-2005) and US (1999-2009) cancer rates.

Results: Among 3087 children (29,099 person-years; median follow-up: 9.8 years), 4 were diagnosed with cancer. Cancer incidence among HIV-exposed children who were not exposed to ARV prophylaxis (22.5 per 100,000 person-years) did not differ significantly from the incidence among children who were exposed to any perinatal ARV prophylaxis (14.3 per 100,000 person-years). Furthermore, the number of cases observed among individuals exposed to ARV did not differ significantly from cases expected based on state (SIR = 1.21; 95% CI: 0.25 to 3.54) and national (SIR = 1.27; 95% CI: 0.26 to 3.70) reference rates.

Conclusions: Our findings are reassuring that current use of ARV for perinatal HIV prophylaxis does not increase cancer risk. We found no evidence to alter the current federal guidelines of 2014 that recommend ARV prophylaxis of HIV-exposed infants.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5057387PMC
http://dx.doi.org/10.1097/QAI.0000000000000695DOI Listing
September 2015

Correlates of HIV infection among African American women from 20 cities in the United States.

AIDS Behav 2014 Apr;18 Suppl 3:266-75

Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS-E46, Atlanta, GA, 30333, USA,

Little research has been conducted to investigate multiple levels of HIV risk-individual risk factors, sex partner characteristics, and socioeconomic factors-among African American women, who, in 2010, comprised 64 % of the estimated 9,500 new infections in women. Respondent-driven sampling was used to recruit and interview women in 20 cities with high AIDS prevalence in the United States through the National HIV Behavioral Surveillance System. We assessed individual risk factors, sex partner characteristics, and socioeconomic characteristics associated with being HIV-positive but unaware of the infection among African American women. Among 3,868 women with no previous diagnosis of HIV, 68 % had high school education or more and 84 % lived at or below the poverty line. In multivariable analysis, women who were 35 years or older, homeless, received Medicaid, whose last sex partner ever used crack cocaine or was an exchange sex partner were more likely to be HIV-positive-unaware. Developing and implementing strategies that address socioeconomic factors, such as homelessness and living in poverty, as well as individual risk factors, can help to maximize the effectiveness of the public health response to the HIV epidemic.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5057389PMC
http://dx.doi.org/10.1007/s10461-013-0614-xDOI Listing
April 2014

Premastication as a route of pediatric HIV transmission: case-control and cross-sectional investigations.

J Acquir Immune Defic Syndr 2012 Feb;59(2):207-12

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

Background: Three cases of pediatric HIV transmission attributed to the feeding practice of premasticating food for children have been reported. The degree of risk that premastication poses for pediatric HIV transmission and the prevalence of this behavior among HIV-infected caregivers is unknown.

Methods: During December 2009 to February 2010, we conducted a case-control investigation of late-diagnosed HIV infection in children at 6 HIV clinics using in-person and telephone interviews. A cross-sectional investigation of premastication was conducted in concert with this case-control investigation.

Results: We compared 11 case-patients to 35 HIV-exposed controls of similar age. Sixteen (35%) of 46 children were fed premasticated food, 10 (22%) by an HIV-infected caregiver. Twenty-seven percent of case-patients received premasticated food from an HIV-infected caregiver compared with 20% of controls (odds ratio = 1.5; 95% confidence interval = 0.3 to 7.1). In the cross-sectional investigation, 48 (31%) of 154 primary caregivers of children aged ≥6 months reported the children received premasticated food from themselves or someone else. The prevalence of premastication decreased with increasing caregiver age and had been used to feed children aged 1-36 months.

Conclusions: Premastication, a potential route of HIV transmission to children, was a common practice of caregivers. Public health officials and health care providers should educate the public about the potential risk of disease transmission via premastication.
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http://dx.doi.org/10.1097/QAI.0b013e31823b4554DOI Listing
February 2012
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