Showing posts with label AIDS. Show all posts
Showing posts with label AIDS. Show all posts

Tuesday, February 3, 2015

Financial Tips for Living with HIV

Originally Published by Healthy Black Men

Most of us don’t think about insurance until we need it and don’t have it.
Malcolm “MJ”  Harris is Managing Director of The Hurston Group, a national full services financial brokerage firm and he wants you covered.
“My role as a financial services professional is to help my clients plan for their future in a way that addresses their goals and budget. This includes helping them select life insurance, health insurance, and disability income insurance. Another major part of my work is helping clients make sure that they have enough money to retire.”
According to Mr. Harris, most people are under-insured for death and disability because people don’t think they can afford it or their health status disqualifies them. But life insurance can be as low as $30 a month, and can help cover final expenses and debt so that your loved ones won’t be burdened upon your death.
Disability insurance can replace up to 100% of your income for 90 days or until you are age 65 in most cases. Some life insurance plans also allow for income pay out if you become disabled.
Medical advances now allow many of us living with HIV positive to expect a longer life span. Now insurance and other financial companies are beginning to provide financial products to people living with HIV so that we can have the same financial protections as everyone else. Here are two financial products I recommend to most people living with HIV:
  1. Get Life Insurance:When we pass away, we don’t want to leave our loved ones in a difficult financial position because we didn’t properly plan for our future. I recommend that every black gay man have life insurance if they:
  • Have any joint debt (such as being a co-signer on a loan).
  • Plan to leave their assets (such as their home) to someone when they die. For a $200,000 home, it can be as much as $6,000 to transfer the property to another person.
  • Have at least $10,000 in life insurance to cover the cost of your funeral and final expenses.
  1. Open a Guaranteed Income Retirement Account:The most common two concerns that I hear from my clients living with HIV are: “will I have enough money to retire and continue to meet my health care costs?”  and “how can I make sure that I don’t run out of money after I retire?” We offer guaranteed income retire accounts, which address both of these concerns. These accounts:
  • Provide a guaranteed monthly or yearly payment to the client from the day that you retire until death.
  • Can continue paying out money to a spouse or loved one even after death.
These account options can be important for people living with HIV because they provide an income source and help cover healthcare costs.

Malcolm “MJ”  Harris is Managing Director of The Hurston Group, a national full services financial brokerage firm that specializes in providing estate planning, life insurance, health insurance, and retirement planning. His team is a national leader in providing Chronic and Positive Financial Planning, a no-cost service designed to help chronically ill clients (including those who are HIV-positive) secure life and health insurance and plan for retirement.  
Click here to go to original article.

Tuesday, January 27, 2015

Get Tested

WHERE TO GET AN HIV TEST

You can ask your healthcare provider for an HIV test. In addition, you can get an HIV test in many other places such as at many medical clinics, substance abuse treatment programs, community health centers, hospitals, Title X Family Planning Clinics, and even some pharmacies, as well as at many community-based organizations, AIDS services organizations, and even mobile testing vans.
One of the easiest ways to find a convenient HIV testing site is to use the HIV Testing and Care Services Locator. Just type in your ZIP code and, within seconds, you will get a list of HIV testing sites near you—including those that offer freeHIV testing!

Services
Enter your location, such as: "Washington, DC", or "20002".
For more information on this widget, please visit AIDS.gov.
Please contact contact@aids.gov with any comments, suggestions, or concerns.
You can also:
  • Text your ZIP code to KNOWIT (566948), and you will receive a text back with a testing site near you.
  • Call 800-CDC-INFO (800-232-4636) to ask for free testing sites in your area.
  • Contact your local health department.
  • Get a home testing kit (the Home Access HIV-1 Test System or the OraQuick In-Home HIV Test) from a drugstore.
Check out our National HIV Testing Day page for information and resources you can use to help promote HIV testing in your community.

Tuesday, December 30, 2014

HIV In the United States

CDC estimates that 1,201,100 persons aged 13 years and older are living with HIV infection, including 168,300 (14%) who are unaware of their infection1. Over the past decade, the number of people living with HIV has increased, while the annual number of new HIV infections has remained relatively stable. Still, the pace of new infections continues at far too high a level— particularly among certain groups.
HIV Incidence (new infections): The estimated incidence of HIV has remained stable overall in recent years, at about 50,000 new HIV infections per year2. Within the overall estimates, however, some groups are affected more than others. MSM continue to bear the greatest burden of HIV infection, and among races/ethnicities, African Americans continue to be disproportionately affected.
HIV Diagnoses (new diagnoses, regardless of when infection occurred or stage of disease at diagnosis): In 2012, an estimated 47,989 people were diagnosed with HIV infection in the United States. In that same year, an estimated 27,928 people were diagnosed with AIDS. Overall, an estimated 1,170,989 people in the United States have been diagnosed with AIDS3.
Deaths: An estimated 13,834 people with an AIDS diagnosis died in 2011, and approximately 648,459 people in the United States with an AIDS diagnosis have overall3. The deaths of persons with an AIDS diagnosis can be due to any cause—that is, the death may or may not be related to AIDS.

Tuesday, December 23, 2014

Reduce Your Risk


In the United States, HIV is mainly spread by having sex with someone who has HIV. There are several steps you can take to reduce your risk of getting HIV through sexual contact, and the more of these actions you take, the safer you can be. These actions include:
  • Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex. Anal sex is the highest-risk sexual activity for HIV transmission. If you are HIV-negative, insertive anal sex (“topping”) is less risky for getting HIV than receptive anal sex (“bottoming”). Remember: HIV can be sexually transmitted via blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluid, and vaginal fluid. Sexual activities that do not involve the potential exchange of these bodily fluids (e.g. touching) carry no risk for getting HIV. For more details, see Sexual Practices and HIV Risk, below.
  • Use condoms consistently and correctly. When used consistently and correctly, condoms are highly effective in preventing HIV. For more details, see Using Condoms, below.
  • Reduce the number of people you have sex with. The number of sex partners you have affects your HIV risk. The more partners you have, the more likely you are to have a partner with HIV whose viral load is not suppressed or to have a sex partner with a sexually transmitted disease. Both of these factors can increase the risk of HIV transmission. Remember: one in six people living with HIV in the U.S. are unaware of their infection.
  • Talk to your doctor about pre-exposure prophylaxis (PrEP). PrEP is taking HIV medicine daily to prevent HIV infection. PrEP should be considered if you are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner. PrEP also should be considered if you are HIV-negative and have had a sexually transmitted disease (STD) or any anal sex (receptive or insertive) with a male partner without condoms in the past six months and are not in an exclusive relationship with a recently tested, HIV-negative partner. For more information, see our page on PrEP.
  • Talk to your doctor right away (within 3 days) about post-exposure prophylaxis (PEP) if you have a possible exposure to HIV. An example of a possible exposure is if you have anal or vaginal sex without a condom with someone who is or may be HIV-positive, and you are HIV-negative and not taking PrEP. Your chance of exposure to HIV is lower if your HIV-positive partner is taking antiretroviral therapy (ART) consistently and correctly, especially if his/her viral load is undetectable. Starting PEP immediately and taking it daily for 4 weeks reduces your chance of getting HIV. For more information, see our page on PEP.
  • Get tested and treated for other sexually transmitted diseases (STDs) and encourage your partners to do the same. If you are sexually active, get tested at least once a year. STDs can have long-term health consequences. They can also increase your chance of getting HIV or transmitting it to others. Find an STD testing site.
  • If your partner is HIV-positive, encourage your partner to get and stay on treatment. ART reduces the amount of HIV virus (viral load) in blood and body fluids. If taken consistently and correctly, ART can keep people with HIV healthy for many years, and greatly reduce their chance of transmitting HIV to sex partners.
Of course, you can also reduce your risk of getting HIV by not having sex. If you aren't having sexual contact, you are 100% protected from getting HIV in that way. Alternatively, if you are having sex, you can reduce your risk if you and your partner have both been tested and know that you are both HIV-negative and you practice monogamy. Being monogamous means: 1) You are in a sexual relationship with only one person and 2) Both of you are having sex only with each other. However, monogamy won't protect you completely unless you know for sure that both you and your partner are not infected with HIV.

Wednesday, December 17, 2014

Immune System 101

HOW DOES YOUR IMMUNE SYSTEM WORK?

Your immune system works because your body is able to recognize "self" and "non-self." This means that your body is able to tell if an invader (virus, bacteria, parasite, or other another person's tissues) has entered it—even if you aren't consciously aware that anything has happened. Your body recognizes this invader and uses a number of different tactics to destroy it.

THE IMMUNE SYSTEM IN ACTION

Your immune system has many different ways of fighting off foreign invaders. When confronted with a virus, your body responds by activating specific processes of the immune system. First your body recognizes a foreign antigen and delivers it to the lymph system, where it is ingested by a macrophage.
Then the macrophage processes the virus and displays the antigens for that particular virus on its own exterior. This antigen then signals a helper T- cell.
Next the T-cell reads this signal and sounds the alarm for other parts of your immune system to respond.
The B-cell responds to this call and comes to read the antigen from the surface of the macrophage.

Tuesday, December 9, 2014

America's AIDS Miracle

By Michael Elliott

Originally published by Time on November 20, 2014

How the U.S. fought the disease by thinking big and staying smart

At my home in Washington, D.C., placed so that I see it every morning, is a photograph of Princess Adeyeo, a young Liberian woman I met in 2012. Princess had been a refugee during Liberia's civil war; when she returned there, she found that she was HIV-positive. But in Monrovia's John F. Kennedy Hospital she was put on a course of antiretroviral drugs (ARVs), which prevent mother-to-child transmission of the virus, and a few months before our visit she gave birth to a beautiful baby boy. He was HIV-negative, healthy.

Right now, of course, people associate Liberia with Ebola. It's right that we get mad about Ebola-mad that the world waited so long to tackle the outbreak; mad that poor, vulnerable societies don't have the resources needed to tackle infectious diseases. But we should remember too that in the past few years, Liberia-in fact, every country, rich or poor-has seen small miracles like the story of Princess and her son, and sees more of them each year.

In 2003, across all of sub-Saharan Africa, just 50,000 people were on ARVs, now more than 9 million are. There is no reason, in the next few years, that we cannot virtually end mother-to-child transmission of HIV in even the most challenging environments. Unheralded, we just passed a tipping point: in 2013, more people were added to the rolls of those on lifesaving treatment for HIV/AIDS than the number who were newly infected. That crossover of trend lines should mark the beginning of the end of AIDS.

Monday, December 1, 2014

World AIDS Day

What is World AIDS Day?

World AIDS Day is held on 1 December each year and is an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV and to commemorate people who have died. World AIDS Day was the first ever global health day and the first one was held in 1988.

Why is World AIDS Day important?

Around 100,000 are currently living with HIV in the UK and globally an estimated 34 million people have HIV. More than 35 million people have died from the virus, making it one of the most destructive pandemics in history.
Today, many scientific advances have been made in HIV treatment, there are laws to protect people living with HIV and we understand so much more about the condition. But despite this, people do not know the facts about how to protect themselves and others from HIV, and stigma and discrimination remain a reality for many people living with HIV. World AIDS Day is important as it reminds the public and Government that HIV has not gone away – there is still a vital need to raise money, increase awareness, fight prejudice and improve education.

What should I do on World AIDS Day?

World AIDS Day is an opportunity for you to learn the facts about HIV and put your knowledge into action. Find out how much you know by taking our online quiz: Are you HIV aware? Test your knowledge and awareness by taking the quiz and act aware by passing the quiz on and sharing it with your friends on Twitter and Facebook.

If you understand how HIV is transmitted, how it can be prevented, and the reality of living with HIV today - you can use this knowledge to take care of your own health and the health of others, and ensure you treat everyone living with HIV fairly, and with respect and understanding. Click here to find out the facts.
You can also show your support for people living with HIV on World AIDS Day by wearing a red ribbon, the international symbol of HIV awareness and support.
World AIDS Day is also a great opportunity to raise money for NAT (National AIDS Trust) and show your support for people living with HIV. If you feel inspired to hold an event, bake sale or simply sell red ribbons, click here to get started. If you'd like to see what other events are taking place — click here and find out more.

But what about after World AIDS Day?

Although World AIDS Day is a great opportunity to get the public talking about HIV and fundraise, we need to remember the importance of raising awareness of HIV all year round. That's why NAT has launched HIVaware — a fun, interactive website which provides all the information everyone should know about HIV. Why not use what you have learnt on World AIDS Day to Act Aware throughout the year and remember, you can fundraise at any time of year too — NAT is always here to give you suggestions and ideas.

Wednesday, November 19, 2014

The Red Ribbon


Where did the idea come from?

In 1991 – a decade after the emergence of HIV – a group of 12 artists gathered to discuss a new project for Visual Aids; a New York arts organisation that raises awareness of HIV. They were photographers, painters, film makers and costume designers, and they sat around in the shared gallery space in New York's East Village.
After a short brainstorm they had come up with a simple idea that later became one of the most recognised symbols of the decade - the red ribbon, worn to signify awareness and support for people living with HIV.

Why did we need a symbol?

When the artists sat down to work on this project, their aim was to get people talking about HIV. This was during a time where HIV was highly stigmatised and people living with HIV were suffering behind closed doors, some too scared to even tell their loved ones they were living with the virus. The artists wanted to create a visual expression of compassion for people living with, and affected by, HIV.
The artists were inspired by the yellow ribbons tied on trees to denote support for the US military fighting in the Gulf War. Pink and the rainbow colours were rejected because they were too closely associated with the gay community, and they wanted to convey that HIV went beyond the gay community and was relevant to everyone.
Red was chosen as it is bold and visible – symbolising passion, a heart and love. The shape was chosen simply because it was easy to make and replicate – anyone can make one by just cutting out a piece of ribbon, looping it around your finger and pinning it on.

How did the red ribbon become so well known?

Red Ribbons
In the early days, the artists made the ribbons themselves and distributing them around the New York art scene and dropped them off at theatres. Initially there was a text that went with it, to explain why they were being worn, but eventually this was dropped as its symbolism no longer needed an explanation.
Within weeks of the red ribbon idea being born, world-famous actors starting wearing the red ribbon to high-profile award ceremonies such as the Oscars and talking about why it was important. The media also cottoned on, and within a short space of time the red ribbon symbol became universally recognised.
At the Freddie Mercury Tribute Concert held at London's Wembley Stadium on Easter Sunday 1992, more than 100,000 red ribbons were distributed among the audience, with performers such as George Michael wearing one. The Red Ribbon continues to be a powerful force in the efforts to increase public awareness of HIV.

Wednesday, October 8, 2014

25 Young Gay Men. 25 Inspiring Stories.

Powerful Personal Videos Reveal the Impact of HIV And Urge Others to #SpeakOutHIV 
MENLO PARK, CA – Twenty-five young gay men get real about HIV as part of #SpeakOutHIV, a  campaign from Greater Than AIDS. The group is encouraging people to break the silence around HIV on social media in the two weeks between National Gay Men’s HIV/AIDS Awareness Day (September 27) and National Coming Out Day (October 11).
Anchored by a series of powerful personal videos recorded by men who are 25 or younger, #SpeakOutHIV challenges people to post their own stories about HIV on YouTube and share through Twitter, Facebook and other social media platforms as part of a collective effort to promote more open discussion about the issue.
The campaign comes at a critical time. New HIV infections are rising among young gay men. The U.S. Centers for Disease Control and Prevention (CDC) reported a 22 percent increase in new infections among gay men ages 13-24 between 2008 and 2010. Overall, young gay men account for one in five new infections in the United States, a share far greater than their representation in the population.
“Despite the continued impact of HIV, gay and bisexual men are not talking about HIV even with those closest to them,” noted Tina Hoff, Senior Vice President and Director of Health Communication and Media Partnerships, Kaiser Family Foundation – a co-founding partner in Greater Than AIDS.  “#SpeakOutHIV is about promoting a more open dialogue about HIV in all aspects of life, in relationships, with health care providers and within the community generally.”
The young men featured in #SpeakOutHIV offer unfiltered, intimate accounts about how HIV has affected them and what they want others to know about the disease. They come from regions with high rates of HIV, including the South. The majority are men of color. About one third are HIV positive.
They created their videos with cellphones and other personal devices this month at a Speak Out digital storytelling workshop organized by Greater Than AIDS in Washington, DC.  “Once the courageous stories about coming out, HIV-diagnosis, isolation, self-esteem, and the like were shared, I learned from these young men that my story is not so uncommon,” said Jai, an HIV/AIDS educator from Dallas who helped facilitate the workshop and serves as a Greater Than AIDS Speak Out ambassador. “The stories and our shared experience linked us.”
#SpeakOutHIV is part of a broader Speak Out campaign, launched last fall by Greater Than AIDS, to engage the lesbian, gay, bisexual and transgender (LGBT) community in response to the silence and stigma surrounding HIV. The cross-platform campaign, which features HIV-positive and HIV-negative gay men, encourages more open communication about the disease in personal relationships, as well as with healthcare providers and within the community.
AIDS United, Black AIDS Institute and the National Alliance of State and Territorial AIDS Directors helped organize the workshop, along with the Kaiser Family Foundation. Funding was provided by the Ford Foundation and Elton John AIDS Foundation.
To view the #SpeakOutHIV videos, go to: www.youtube.com/greaterthanaids.
For more information about Greater Than AIDS and all the Speak Out elements, including #SpeakOutHIV, visit: www.greaterthan.org/speak-out.
About Greater Than AIDS
Greater Than AIDS is a leading national public information response focused on the U.S. domestic epidemic. Launched in 2009, it is supported by a broad coalition of public and private sector partners, including: major media and other business leaders; federal, state and local health agencies and departments; national leadership groups; AIDS service and other community organizations; and foundations, among others. Through targeted media messages and community outreach, Greater Than AIDS works to increase knowledge, reduce stigma and promote actions to stem the spread of the disease. While national in scope, Greater Than AIDS focuses on communities most affected.
The Kaiser Family Foundation provides strategic direction and day-to-day management, in addition to overseeing the production of the campaigns. The Black AIDS Institute – a think tank exclusively focused on AIDS in Black America – provides leadership and expert guidance and supports community engagement. Additional financial and substantive support is provided by the Elton John AIDS Foundation and Ford Foundation, among others.
Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.

Sunday, September 28, 2014

An AIDS Free Generation

The (RED) Manifesto:


Every Generation is known for something.

Let's be the one to deliver an AIDS FREE GENERATION.

We all have tremendous power. What we choose to do or even buy, can affectsomeone’s life on the other side of the world. In 2002, more than 1,500 babieswere born every day with HIV. Today that number is just over 650. We must actnow to get that close to zero.
 


We’re at a tipping point in the fight against AIDS - with urgency and action, it’s possible for the world to end the transmission of HIV from moms to their babies.We can deliver the first AIDS FREE GENERATION in over thirty years.
(RED) can’t accomplish this alone. It will take all of us to get there –governments, health organizations, companies, and you. When you DO THE (RED) THING, a (RED) partner will give up some of its profits to fight AIDS.


It’s as simple as that.
BE (RED). Start the end of AIDS now.

Wednesday, August 27, 2014

Frequently Asked Questions


AID Atlanta offers the answers to these frequently asked questions on their website:



Can I tell by symptoms if I am HIV positive or not?

You cannot tell your HIV status by symptoms. Symptoms for HIV may not occur for years after you become infected, so many people who are infected do not know it. Initial symptoms of HIV are very common and may be associated with a variety of illnesses.
If you are feeling sick or having symptoms you should see your doctor. However, if you think you might have been at risk of getting HIV, you must get an HIV test to know if you did become infected or not.

Are HIV and AIDS the same thing?

No. HIV and AIDS are not interchangeable terms, although the media often uses them that way. HIV is a tiny microscopic organism. AIDS is a specific collection of illnesses or diseases caused by having the HIV virus in your body.
A person can have HIV for many years without showing any symptoms of AIDS. Some people have been infected with HIV for 15 years or more without having symptoms. They are considered to be HIV positive. When an HIV positive person develops minor symptoms it may be a sign that the disease is progressing. A doctor would determine, based on the symptoms and certain blood test if the person has AIDS or not.

Which body fluids do not transmit HIV and which ones do?

Saliva, Sweat, Tears, and Urine do not transmit HIV -- But, semen, blood, and vaginal fluids do. Any activity that includes no direct contact with your partner's semen, blood or vaginal fluids is safe. Activities that do involve direct contact with semen, blood, or vaginal fluids are risky. Any precautions that reduce the chance of direct contact with those fluids will make sex safer.

Isn't abstinence the only real "safe" sex?

Yes. That is why we have the term "Safer" Sex. Safer sex is any means of enjoying sex to the fullest without transmitting, or acquiring, any sexually related infections. Safer sex does not mean eliminating sexual passion and intimacy from your life. It just means that you have to be aware of the risk and use the tools available to reduce the risk to a level that both you and your partner feel comfortable with.

Can I get HIV by just masturbating with my partner?

Masturbation is one of the safest sexual activities you can engage in. It is safe for semen or vaginal fluids to contact healthy, unbroken skin in mutual masturbation. Healthy skin (no open cuts or fresh sores) provides very good protection against HIV.

Is HIV spread by kissing?

There is no evidence that saliva transmits HIV. Deep kissing may transmit other sexually transmitted disease but not HIV. Kissing or licking your partner's body will not spread HIV. The only time kissing could be a possible mode of transmission for HIV would be if there was a significant presence of blood in the mouth of the infected person.

Can it be risky to perform oral sex on a woman?

The risk of getting HIV by performing oral sex on a woman is lower than the risk of getting it through vaginal and anal sex. Using a latex square, dental dam, condom cut open or plastic wrap may reduce the risk further. During menstruation the risk may increase because of the presence of blood.
The risk of a woman acquiring HIV by receiving oral sex is extremely low. Some other diseases, such as gonorrhea and herpes may be transmitted during oral sex on a woman.

Would performing oral sex on a man be as risky as anal sex, vaginal sex, or sharing injection drugs?

No. Performing oral sex on a man is lower risk than vaginal and anal sex or sharing injection drugs. However, low risk does not mean no risk. In a man with HIV, both semen and pre-ejaculatory fluid (pre-cum) which contain the virus could be introduced into the mouth, so merely stopping before he ejaculates may not eliminate the risk.
Using a condom for oral sex on a man reduces the risk of getting HIV. The risk of a man getting HIV by receiving oral sex is very low. Some other diseases, such as gonorrhea and herpes may be transmitted by giving oral sex to a man.

Are all condoms the same?

No. There are many options available in brands, styles, colors, flavors, and lubrication. Latex condoms are most effective at preventing HIV transmission, when used properly. Natural skin or animal membrane condoms do not prevent HIV transmission.
Be aware that many condoms, french ticklers, glow in the dark, etc. are sold as novelty items and are not intended to prevent infection of any disease. Condoms do not provide 100 percent protection against HIV, but they are highly effective if they are used properly each time you have sex.

How long after a possible exposure should I wait to be tested to know for sure that I am not HIV infected?

The tests used to determine HIV infection look for antibodies produced by the body to fight HIV. According to the CDC, most people will develop detectable antibodies within 3 months after infection. In rare cases, it can take up to six months. A test at least 3 months after the last possible exposure should be highly accurate. However, the CDC recommends testing again at 6 months, just to be sure.

How do you use a condom?

Always leave a space at the tip to receive the semen. Put a drop of water-based lubricant inside the tip of the condom to increase pleasure. Do not use oil-based lubricants as they can cause the latex to break. Put the condom on the erect penis before any contact with the other person.
If the penis is uncircumcised (uncut), pull back the foreskin before rolling the condom down. Unroll the condom slowly all the way down the shaft of the penis, making sure to remove any air bubbles and inspect for holes. Have a spare condom handy, just in case. Use only water-based lubricants. Also apply water-based lubricant to the vagina or anus in addition to the lubrication applied to the outside of the condom to further reduce the chance of breakage.
After ejaculation, carefully pull the penis out while it is still erect, hold onto the base of the condom to prevent slipping. Be careful not to spill the semen. Dispose of the used condom. Never re-use condoms!

Is the blood supply safe?

The United States blood supply is among the safest in the world. In 1985, technology made it possible to test donated blood for HIV. Virtually all people infected with HIV through blood transfusion or blood products received them before 1985. Potential blood donors must undergo strict screening test prior to being accepted as donors.
Anyone that is determined to be at high risk for HIV is rejected. Blood and blood products are carefully tested and are safely disposed of if they prove to contain the HIV virus. At the present time, the risk of HIV transmission through receiving a blood transfusion or blood products in the United States is very rare and continues to become more infrequent even in areas with high prevalence of HIV.