HIV Commission Resources

Intersecting Public Health Issues in the City of Pittsburgh

Meeting the Growing Challenges: HIV STIs Hepatitis C and Substance Misuse

Presentation by the Commission to City Council, March 6, 2018

Public Health Issue: Mental Health and HIV

Mental illness in persons living with HIV/AIDS have social and health consequences at individual and societal levels. Mental illness may predispose individuals to behaviors which put them at risk for HIV or may be co-occuring in persons living with HIV/AIDS (PLWHA). People with mental illness and HIV have challenges related to their treatment of both conditions, including stigma. Mental illness may be unrecognized by PLWHA undiagnosed by providers and this may result in missed medical appointments and poor adherence to antiretroviral

therapy (ART). Lack of HIV testing in mental health settings and inadequate screening and diagnosis of mental illness during HIV treatment may impact disease progression and worsen clinical outcomes for PLWHA.

Policy Brief: Mental Health and HIV

Public Health Issue: HIV and Substance Use Disorders

Substance use disorder (SUD) and human immunodeficiency virus (HIV) are pervasive overlapping epidemics with a vast array of social and health consequences at individual and societal levels. Injection drug use with contaminated needles puts the individual at high risk for acquiring and transmitting HIV. Substance use lowers individuals’ guard and predisposes to behaviors which put them at risk for HIV. Persons with HIV have high prevalence of alcohol and other drug problems and are at increased risk for accidental overdose, have psychiatric disorders, family and social problems. HIV positive individuals struggle with coping with challenges related to their recovery and treatment of their HIV illness. Substance use often delays HIV treatment, generates serious drug/drug interactions, and contributes to poor adherence to antiretroviral therapy (ART) and HIV treatment. Lack of HIV testing during substance use treatment and inadequate screening and diagnosis of SUDs during HIV treatment could lead to serious medical and psychological problems.

Policy Brief: HIV and Substance Use Disorders.

Public Health Issue: Sexually Transmitted Diseases / Infections and Hepatitis C

The relationship between HIV and other STDs/STIs (sexually transmitted diseases/sexually transmitted infections) is well documented. There are three well-known bi-directional associations between HIV and STDs including: 1) being infected with an STD greatly increases the risk of acquiring HIV, 2) being infected with an STD accelerates the progression of HIV disease, and 3) being infected with HIV can alter the natural progression of other STDs including response to treatment. Among people living with HIV in the United States, men who have sex with other men (MSM) are disproportionately impacted by co-infections of HIV and other STDs. While rates of STDs among persons living with HIV are disproportionately high, the greatest co-infection among persons living with HIV is Hepatitis C. Persons with Hepatitis C are at greater risk for HIV infection due to compromised immune systems. Persons who inject drugs have the greatest risk for acquiring Hepatitis C and are at high risk for HIV infection due to reused injection equipment. In order to reduce HIV transmission and mortality from HIV, public health policy must focus on HIV prevention inclusive of STDs and Hepatitis C prevention.

Policy Brief: Sexually Transmitted Diseases / Infections and Hepatitis C.

Ending the HIV Epidemic: A Plan for America

Information on the federal government`s plan is available from the United States Department of Health and Human Services at this link.

Overview of Federal Plan
Ending the HIV Epidemic in Pittsburgh