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Healthy People 2010 Focus Area 13: HIV Progress Review August 30, 2007

This report provides an overview of the HIV/AIDS epidemic in the United States, including new cases, deaths, prevalence, and treatment progress. It highlights the importance of improving prevention strategies and access to care.

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Healthy People 2010 Focus Area 13: HIV Progress Review August 30, 2007

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  1. Healthy People 2010 Focus Area 13: HIV Progress ReviewAugust 30, 2007

  2. HIV/AIDS in the United States • HIV/AIDS • More than 1 million persons estimated to be living with HIV in 2003: • Of those, approximately one quarter did not know that they were infected • Federal spending on HIV related medical care in 2005: $11.6 billion • Lifetime cost of care: $385,200* Note: * From the time entering HIV care, projected life expectancy for a person with an initial CD4+ cell count less than 350 cells/µL is 24.2 years, and the lifetime cost of care for such a person’s treatment is $385,200 when rebates and other discounts on HIV medications are taken into consideration. Sources: Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003, National HIV Prevention Conference, June 2005, Atlanta., Abstract 595;Schackman, BR, Gebo KA, Walensky, RP et. al., The Lifetime Cost of Current Human Immunodeficiency Virus Care in the United States. Medical Care, Volume 44, Number 11, November 2006.

  3. HIV/AIDS in the United States • AIDS • Estimated new cases diagnosed in 2005: 40,608 • Cumulative cases diagnosed (as of 12/2005): 952,629 • Number of deaths in 2005: 16,316 • Cumulative deaths (as of 12/2005): 530,756 Source: HIV/AIDS Surveillance Report, CDC/NCHHSTP.

  4. Highlighted Objectives HIV/AIDS Incidence & Deaths 13-01. New AIDS cases 13-02. New AIDS cases among men who have sex with men 13-03. New AIDS cases among persons who inject drugs 13-04. New AIDS cases among men who have sex with men & inject drugs 13-05. New HIV cases 13-14. Deaths due to HIV infection 13-17b. Perinatally-acquired AIDS HIV/AIDS Treatment 13-13c. Treatment according to guidelines – Any antiretroviral therapy 13-13d. Treatment according to guidelines – Highly active antiretroviral therapy Developmental Target met Improving Little or no change * Getting worse * Percent of targeted change achieved is between -10% and 10%.

  5. Estimated AIDS Incidence, Prevalence, and Deaths 450 90 80 400 Incidence P 70 r 350 e v a l 60 300 e n c e 50 250 Deaths ( i n Number of new cases/deaths In thousands t 40 200 h o u s 30 150 a Prevalence n d 20 100 s ) 10 50 0 0 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 1985 Year of diagnosis or death Note: Data are for persons 13 years and over. Data have been adjusted for reporting delays. Under the 1993 case definition, an HIV-positive person also has AIDS when his or her CD4+ cell count has fallen below 200 cells per microliter or when CD4+ cells account for fewer than 14 percent of all lymphocytes. Source: HIV/AIDS Reporting System, CDC/NCHHSTP.

  6. Estimated Prevalence of Persons Living with AIDS, 2005 461.3 243.5 NJ 298.4 MD DC 2,060.9 298.8 23.2 12.6 24.2 19.0 20.2 Rate per 100,000 population <100 100 - 150 > 150 Total rate=174.5* Note. Rates are shown for the five areas with the highest and lowest rates. Data have been adjusted for reporting delays. *Includes persons whose area of residence is unknown or missing. Source: HIV/AIDS Reporting System, CDC/NCHHSTP.

  7. Reported AIDS Cases by Region and Metropolitan Size , 2005 Northeast Midwest South West Rate per 100,000 population MSA of >500,000 Non-metropolitan areas MSA of 50,000 - 500,000 Note: MSA = Metropolitan statistical area. Source: HIV/AIDS Reporting System, CDC/NCHHSTP.

  8. New AIDS Cases Decrease Desired 2010 Target: 1.0 Estimated number of cases per 100,000 population 100 80 Black 60 40 Hispanic 20 Total American Indian White Asian 0 1998 1999 2000 2001 2002 2003 2004 2005 Note: American Indian includes Alaska Native. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: HIV Surveillance System, CDC/NCHHSTP. Obj. 13-1

  9. Distribution of New AIDS Cases Percent of cases 70 White 60 50 40 Black 30 Hispanic 20 10 0 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 Year of diagnosis Note: Data are for persons 13 years and over.Less than 1% of new AIDS cases were reported in Asian/Pacific Islanders and American Indian/Alaska Natives during this time period. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Data have been adjusted for reporting delays. Source: HIV/AIDS Reporting System, CDC/NCHHSTP.

  10. New AIDS Cases by Gender and Race/Ethnicity, 2005 Decrease Desired Females 2010 Target: 1 Total Asian White American Indian Hispanic Black Males Total Asian White American Indian Hispanic Black 0 10 20 30 40 50 60 70 80 90 100 Number of Cases per 100,000 population Note: Data are for persons 13 years and over. American Indian includes Alaska Native. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: HIV/AIDS Reporting System, CDC / NCHHSTP. Obj. 13-1

  11. New AIDS Cases by Transmission Category Females Males 2005 2005 2% 1985 1% 7% 4% <1% 1985 16% 27% 10% 18% 41% 16% 70% 18% 27% 58% 70% 55% Men who have sex with men (MSM) MSM & IDU Other/Unknown* Heterosexual contact Injection drug use (IDU) Note: * Includes hemophelia, blood transfusion, perinatal exposure, and risk factors not reported or identified. Data are for persons aged 13 years and over. Data have been adjusted for reporting delays and cases without risk factor information were proportionally redistributed. Source: HIV/AIDS Reporting System, CDC/NCHHSTP. Obj. 13-2, 13-3, 13-4

  12. Perinatally Acquired AIDS 1000 800 600 400 200 0 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 Number of new cases Decrease Desired 2010 Target: 1.0 Number of new cases 120 100 80 60 40 20 0 2003 2005 2004 2002 Source: HIV/AIDS Reporting System, CDC/NCHHSTP. Obj. 13-17b

  13. Deaths due to HIV/AIDS, 2004 Decrease Desired 2010 Target: 0.7 Total Asian White American Indian Hispanic Black Female Male At least some college High School Less than High School Age-adjusted death rate per 100,000 standard population Note: I = 95% Confidence interval.HIV deaths are defined by ICD-10 codes B20 - B24.Data are age-adjusted to the 2000 standard population. American Indian includes Alaska Native. Persons of Hispanic origin may be any race. Education estimates are based on persons aged 25-64 years. Source: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Obj. 13-14

  14. Deaths due to HIV/AIDS by Health Service Area, 2000-2004 2010 Target: 0.7 Age adjusted rate per 100,000 population 0.0 < 1.0 1.0 - 2.9 3.0 - 5.9 6.0 - 20.5 Note: HIV deaths are defined by ICD-10 codes B20 - B24. Data are age-adjusted to the 2000 standard population. The 5 legend categories represent the following percentage of Health Service Areas (from lowest to highest): 10%, 20%, 40%, 20%, 10%. Source: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Obj. 13-14

  15. New HIV/AIDS Cases Number of cases 2002 2003 2001 2004 2005 Year of diagnosis Note: Data are for persons 13 years and over. A 2010 target has not been set. Data are from 33 states with confidential name-based HIV infection surveillance since at least 2001. Data have been adjusted for reporting delays. Source: HIV/AIDS Reporting System, CDC/ NCHHSTP. Obj. 13-5

  16. Distribution of HIV/AIDS by Transmission Category Percent of cases 60 Male to male sexual contact 50 40 Heterosexual contact * 30 20 Injection Drug Use Male to male sexual contact and Injection drug use 10 0 2001 2002 2003 2004 2005 Year of diagnosis Note. Data are for persons 13 years and over.Data are from 33 states with confidential name-based HIV infection reporting since at least 2001. Data have been adjusted for reporting delays and cases without risk factor information were proportionally redistributed. * Heterosexual contact with a person known to have or to be at high risk for HIV infection. Source: HIV/AIDS Reporting System, CDC/NCHHSTP. Obj. 13-2, 13-3, 13-4

  17. Persons at Risk for HIV/AIDS, 2002 Percent Male Female Sex or drug-related Sex-related Sex or drug- related or STD Drug-related Type of Risk Note: I = 95% Confidence interval. Data are for persons 15 to 44 years of age. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: National Survey for Family Growth, Advance Data No. 377, CDC/NCHS.

  18. HIV Testing, 2002 Persons Tested in Past 12 Months High Risk* Persons Tested in Past 12 Months PersonsEver Tested Percent 70 60 50 40 30 20 10 0 Female Male Total Black White Hispanic Note: I = 95% Confidence interval. Data are for persons 15 to 44 years of age who had an HIV test, excluding tests done as part of blood donation. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. *This includes persons indicating that they had five or more sex partners in the last year, exchange of sex for money or drugs, had sex with an injecting drug user, had male-to-male sex, or injected drugs themselves. Source: National Survey for Family Growth, Advance Data No. 363, CDC/NCHS.

  19. Highly Active Antiretroviral Treatment, 2003 Increase Desired Percent 2010 Target: 95 White American Indian Asian Black Hispanic Total Female Male NOTE: Data are for HIV infected persons 13 years and over. Data are from over 100 clinical sites in 11 U.S. cities. American Indian includes Alaska Native. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons were asked to select only one race category; selection of more than one race was not an option. Source: Adult and Adolescent Spectrum of HIV Disease (ASD) Surveillance Project, CDC / NCHHSTP. Obj. 13-13 d

  20. Status of HIV/AIDS Objectives 13-1. New AIDS cases 13-2. AIDS among men who have sex with men 13-3 AIDS among persons who inject drugs 13-4. AIDS among men who have sex with men and who inject drugs 13-5. New HIV cases 13-6a. Condom use by partner – Females 13-6b. Condom use – Males 13-7. Knowledge of serostatus 13-8. HIV/AIDS counseling and education for persons in substance abuse treatment 13-9. HIV/AIDS, STD, and TB education in State prisons 13-10. HIV counseling and testing in State Prisons 13-11. HIV testing in TB patients 13-12. Screening for STDs and immunization for hepatitis B 13-13. Treatment according to guidelines a. Viral load testing b. Tuberculin skin testing c. Any antiretroviral therapy d. Highly active antiretroviral therapy e. Pneumocystis carinii pneumonia prophylaxis f. Mycobacterium avium complex prophylaxis 13-14. HIV infection deaths 13-15. Interval between HIV infection and AIDS diagnosis 13-16. Interval between AIDS diagnosis and death from AIDS 13-17a. Perinatally acquired HIV/AIDS diagnosed 13-17b. Perinatally acquired AIDS 13-18. HIV diagnosed in adolescent and young females ^ ^ ^ ^ Deleted at the Midcourse ^ Target met Improving Little or no change* Getting worse Baseline only Developmental * Percent of targeted change achieved is between -10% and 10%.

  21. Summary • Over two thirds (10/14) of the measurable objectives and subojectives are moving toward or have met their HP2010 targets. • AIDS among persons who inject drugs and perinatally acquired AIDS have met their targets. • AIDS incidence and death have leveled off since 1998. • Disparities by race/ethinicity, age, gender, education and geographic location persist

  22. Progress review data and slides are available on the web at: http://www.cdc.gov/nchs/hphome.htm

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