Dr. Vincent Guilamo-Ramos Gives Plenary Talk on Adolescents at Risk and Living With HIV at National Latino HIV & Hepatitis C Conference
Dr. Vincent Guilamo-Ramos, Professor and Director of NYU Silver’s Center for Latino Adolescent and Family Health (CLAFH), gave a plenary lecture at the 2018 National Latino HIV and Hepatitis C Conference in San Antonio, TX on May 20, 2018.
The three-day conference highlighted innovative concepts, best practices, and new information on how to best serve Latino communities, which are disproportionately affected by HIV and Hepatitis C. It drew more than 450 medical professionals and social service providers from across the U.S. who are committed to fulfilling the goals of the 2020 National HIV/AIDS Strategy and bringing the needs of Latinos to the forefront in the fight against HIV and HCV.
Dr. Guilamo-Ramos’ presentation, entitled “Left Behind: Adolescents at Risk and Living with HIV,” laid out the imperative for sound adolescent sexual health and social welfare interventions; summarized current data on adolescent sexual activity, sexually transmitted infections, and HIV infections; and presented the latest findings on engaging adolescents in comprehensive biomedical HIV prevention or, for those living with HIV, retention in care resulting in sustained viral suppression.
Of particular concern, Dr. Guilamo-Ramos said, are the most recent data showing an increase in estimated HIV incidence among Latino Men who have sex with men (MSM) in the U.S., with particularly high rates among youth. According to the U.S. Centers for Disease Control and Prevention (CDC), from 2011 to 2015, new HIV diagnoses increased 19% among young Latino gay and bisexual men ages 13 to 24.
Dr. Guilamo-Ramos also pointed to a recent CDC analysis of molecular surveillance data that identified 60 rapidly growing HIV transmission clusters of 5-42 people in which transmission rates were up to 33 times the national average. “Dr. Anne Marie France and colleagues found that the people in those high transmission clusters are disproportionately Latino, under 30 years, and MSM,” said Dr. Guilamo-Ramos. “While these data underscore the high risk of contracting HIV faced by young gay and bisexual Latinos, they also provide critical information that will enable us to target our prevention interventions in order to reduce future infections within high-risk social and sexual networks.”
A licensed nurse practitioner (NP) and HIV/AIDS certified registered nurse (ACRN) as well as a licensed clinical social worker (LCSW), Dr. Guilamo-Ramos said that the U.S. Food and Drug Administration’s recent approval of Truvada® as pre-exposure prophylaxis (PrEP) for adolescents at risk of acquiring HIV has expanded this powerful tool, previously only FDA approved for adults, for youth HIV prevention. However, he explained, “Young people need to combine PrEP with consistent, correct condom use, and to receive comprehensive, individualized wrap-around services to cover all facets of their HIV prevention and adherence needs. Those supports include assistance with youth friendly and LGBT supportive physical, mental, and behavioral health services; HIV stigma reduction; sexual and reproductive health services; and substance use and harm reduction services.”
In his presentation, Dr. Guilamo-Ramos reviewed both the HIV/AIDS prevention continuum and the HIV/AIDS care continuum and noted the challenges and opportunities for maintaining youth engagement at each stage. One common challenge on both continuums, he said, is engaging youth in HIV testing. According to the CDC, only 10% of high school aged youth nationwide have ever been tested for HIV; however, the American Academy of Pediatrics guidelines indicate that HIV testing should be offered at least once to those between 15-18 years of age and annually for those adolescents who are sexually active or otherwise at high risk for HIV. Dr. Guilamo-Ramos explained that routine HIV testing for youth can prolong life, reduce HIV transmission, and lower overall HIV care costs by connecting those who are positive to treatment and those who are at high-risk of contracting HIV to PrEP and prevention supports.
Dr. Guilamo-Ramos also discussed recently published findings from an Adolescent Medicine Trials Network for HIV/AIDS (ATN) study evaluating the effectiveness of primary and ongoing treatment for HIV infected young people at ATN sites across the U.S., which are known for their specialty care to HIV-positive adolescents. Dr. Michelle Lally and colleagues found that with the optimum HIV adolescent care the ATN sites provide, 89% of study participants prescribed antiretroviral therapy achieved viral load suppression at least once during the study period, with 81% achieving viral load suppression at least 50% of the time, and 59% sustaining viral load suppression at all measured time points. Dr. Guilamo-Ramos applauded the exemplary work of adolescent HIV health and social welfare providers across the United States. However, he cautioned conference attendees on the importance of HIV+ youth achieving sustained viral suppression throughout their lifetimes, which remains a gap in current national adolescent and young adult HIV treatment cascade efforts.
Dr. Guilamo-Ramos concluded his presentation by addressing the specific challenges faced by LGBT youth, who, he said, “must develop an integrated, positive identity amidst homophobia, racism, transphobia, discrimination often without family support.” Transgender youth in particular, he said, not only face social rejection, stigma, violence, and discrimination, but also face an increased risk of HIV transmission from sharing needles for hormone treatment or body modification, and a lack of health and social service providers able to adequately address their needs.
Oscar Lopez, Director of Education at the South Texas-based Valley AIDS Council and one of the conference co-organizares, praised Dr. Guilamo-Ramos’s presentation. “Our audience of medical providers, HIV specialized counselors, health advocates and others who all work with Latino communities needed to understand the vulnerability of our Latino adolescents and the greater impact it will have on our country as they become the adults. Dr. Guilamo-Ramos did not sugarcoat the challenges of engaging adolescents at risk of and living with HIV in testing and comprehensive prevention or treatment, but he provided concrete direction for doing so based on the latest research findings and he provided us with facts and tools needed to be able to advocate with abstinence-only school districts and our more conservative elected officials.”
Valley AIDS Council CEO Wally Cantu said, “Dr. Guilamo-Ramos presented the latest medical and social science findings highlighting historical and growing structural and systemic barriers. Conference attendees left armed with new knowledge and perspective to better attack the growing HIV epidemic among Latino youth.”