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Asian American Pacific Islander Data Consultation Workshop July 15-17, 2002 Washington, DC

Asian American Pacific Islander Data Consultation Workshop July 15-17, 2002 Washington, DC. Mona Saraiya, M.D., M.P.H. Division of HIV/AIDS Prevention CDC. HIV/AIDS surveillance: issues and concerns voiced by Asian/ Pacific Islander communities.

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Asian American Pacific Islander Data Consultation Workshop July 15-17, 2002 Washington, DC

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  1. Asian American Pacific IslanderData Consultation Workshop July 15-17, 2002 Washington, DC Mona Saraiya, M.D., M.P.H. Division of HIV/AIDS Prevention CDC

  2. HIV/AIDS surveillance: issues and concerns voiced by Asian/ Pacific Islander communities • Stigma, denial, discrimination: delayed testing and test avoidance • Cultural, social, language barriers: lack of access to prevention, testing and treatment • Providers may not ask patient’s race/ethnicity: misclassification and lack of needed information for prevention planning

  3. Community concerns cont’d • Data presentation: need to highlight Asian Pacific Islanders • Behavioral data: need info. on co-morbidities (e.g STD, TB, hepatitis) and other behavioral and lab markers of high risk for HIV • Resources allocated based on AIDS cases may miss emerging epidemics: need data on HIV-infected and at-risk groups to improve HIV prevention

  4. Local Health Dept Sources of Reports HIV/AIDS -Hospital Practitioners 9,999 Reports -Private Practitioners -Public Clinics -Laboratories Passive Reporting Active Case Finding CDC Dissemination State Health Dept -Local Bulletins -HIV/AIDS Surveillance Reports HIV/AIDS -Supplemental Reports -CDC HIV/AIDS Web Sites -Public Information Data Set -Surveillance Slide Sets HIV/AIDS Surveillance How HIV/AIDS Surveillance Works People with HIV/AIDS

  5. HIV/AIDS Reporting System (HARS)-Core Surveillance What Data are Collected? • Demographic characteristics • Sex, race/ethnicity, age, residence • Risk information • Potential modes of exposure to HIV • Laboratory and clinical information • Virologic and immunologic status • Opportunistic illnesses diagnosed • Other Information • Prescription of antiretroviral and prophylactic therapies • Use of medical and substance abuse treatment services • Health insurance coverage

  6. Supplementary Surveys • Record reviews • ASD (Adult/Adolescent Spectrum of Disease) • SHDC (Survey of HIV Disease and Care) • Interview studies • SHAS (Supplement to HIV/AIDS Surveillance) • Persons with HIV/AIDS • HITS (HIV Testing Survey) • Persons at risk • BRFSS (Behavioral Risk Factor Surveillance System) • Telephone-based • General population

  7. Surveillance Branch Behavioral Surveillance Activities

  8. Current status of the epidemic in Asians and Pacific Islanders

  9. Estimated Incidence of AIDS* for Adults/Adolescents, by Race/Ethnicity, 1985-1999, United States 12,000 1993 definition White, not Hispanic Black, not Hispanic implementation Hispanic 10,000 Asian/Pacific Islander American Indian/ 8,000 Alaska Native Number of Cases 6,000 4,000 2,000 0 1985 1987 1988 1989 1990 1991 1992 1993 1994 1995 1997 1998 1999 1986 1996 Quarter-Year of Diagnosis *Adjusted for reporting delays

  10. Estimated Incidence of AIDS* for Adults/ Adolescents by Race/Ethnicity, 1985 -1999, United States 200 1993 definition Asian/Pacific Islander implementation 180 American Indian/Alaska Native 160 140 120 Number of Cases 100 80 60 40 20 0 1985 1986 1987 1988 1989 1990 1991 1993 1994 1995 1996 1997 1998 1999 Quarter-Year of Diagnosis *Adjusted for reporting delays

  11. Estimated AIDS Deaths* of Adults/Adolescents, by Race/Ethnicity,1985 -1999, United States 120 Asian/Pacific Islander American Indian/Alaska Native 100 80 Number of Deaths 60 40 20 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Quarter-Year of Death *Adjusted for reporting delays

  12. AIDS Cases in Adults and Adolescents by Exposure Category and Race/Ethnicity Reported through 2000, United States *Includes patients with hemophilia or transfusion-related exposures and those whose medical record review is pending; patients who died, were lost to follow-up, or declined interview; and those with other or undetermined modes of exposure

  13. HIV Data

  14. Number and percentages of persons diagnosed with HIV, by race/ethnicity - 25 states* with HIV reporting;1994 - 2000 *Alabama, Arizona, Arkansas, Colorado, Idaho, Indiana, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Virginia, West Virginia, Wisconsin, and Wyoming ** AIDS diagnosis within 1 month of HIV diagnosis Source: MMWR July 12, 2002

  15. Supplemental Studies

  16. Proportion of HIV-infected MSM reporting ever having STDs, SHAS 1991-2000

  17. Examples Special Studies • HIV Testing Survey in Asians and Pacific Islanders (HITS-API) • Young Asian Men’s Study Oversampling Persons of Color • Survey of HIV Disease and Care (SHDC) Asian/Pacific Islander- 3% of cohort • Adult spectrum of Disease (ASD) Asian//Pacific Islander- 2% of cohort

  18. Panel Discussion Points • Number and Percentage of Asian Americans and Pacific Islanders (API) in each survey • Statistical reliability of current API data • Strategies and resource needs to increase data reliability • Status of implementation of 1997 OMB standards • and barriers • Methods for improved presentation and reporting of Asian and Pacific Islander data • Supplementary data collection strategies to increase AAPI data • Data analysis methods to increase API data availability

  19. HIV/AIDS Surveillance Branch Response • Participate in forums to hear community concerns • Improve presentation of data; recommend states use multiple scales, insets • Increasing number of states conducting interview surveys; patient self-report of race, ethnicity, sexual identity • Increased dissemination of data; supplemental report series; AJPM article on AIDS trends • New software in 2002; comply with OMB directive

  20. Response cont’d • Promote collection of expanded race/ethnicity data where feasible (e.g. CA had data on 28 categories of Asian Pacific Islanders/Hawaii) • Promote improved disease reporting through cooperation of communities, health departments, providers • Promote use of behavioral and co-morbidity data in epi profiles and prevention planning

  21. HIV/AIDS Information • AIDS Public Information Data Set (PIDS) • http://wonder.cdc.gov • http://www.cdc.gov/hiv/software/apids.htm • State Health Department • Slides/Publications/General Information • http://www.cdc.gov/hiv

  22. Thank you

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