EPID 623-88 Introduction to Analysis and Interpretation of HIV/STD Data

1. EPID 623-88Introduction to Analysis and Interpretation of HIV/STD Data Introduction: STDs and HIV—a brief background Manya Magnus, Ph.D. Summer 2001

2. Objectives • To briefly describe magnitude of STD and HIV problem in the United States • To discuss relationship between classical STDs and HIV

3. Magnitude of the problem • Annual global incidence of curable STDs is 333 million cases • The top four most common are gonorrhea (62 million), chlamydia (89 million), syphilis (12 million) and trichomonas (170 million) • An estimated 250 million new infections occur each year • 15 million new cases diagnosed annually in the United states • 3 million of these cases in US are teenagers • Annual cost of major STDs in US: almost $17 million

5. TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND ASSOCIATED DISEASES OR SYNDROMES - BACTERIA

6. TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND ASSOCIATED DISEASES OR SYNDROMES- BACTERIA

7. TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND ASSOCIATED DISEASES OR SYNDROMES - VIRUSES

8. TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND ASSOCIATED DISEASES OR SYNDROMES - VIRUSES

9. TWENTY-FIVE SEXUALLY TRANSMITTED PATHOGENS AND ASSOCIATED DISEASES OR SYNDROMES - OTHER

10. Gonorrhea — Reported rates: United States, 1970–1999 and the Healthy People year 2000 objective

11. Gonorrhea — Rates by region: United States, 1981–1999 and the Healthy People year 2000 objective

12. Gonorrhea — Rates by state: United States and outlying areas, 1999 Note: The total rate of gonorrhea for the United States and outlying areas (including Guam, Puerto Rico and Virgin Islands) was 131.4 per 100,000 population. The Healthy People year 2000 objective is 100 per 100,000 population.

13. Gonorrhea — Rates by race and ethnicity: United States, 1981–1999 and the Healthy People year 2000 objective Note: "Other" includes Asian/Pacific Islander and American Indian/Alaska Native populations. Black, White, and Other are non-Hispanic.

14. Syphilis — Reported cases by stage of illness: United States, 1941–1999

15. Primary and secondary syphilis — Reported rates: United States, 1970–1999 and the Healthy People year 2000 objective

16. Primary and secondary syphilis — Rates by state: United States and outlying areas, 1999 Note: The total rate of primary and secondary syphilis for the United States and outlying areas (including Guam, Puerto Rico and Virgin Islands) was 2.5 per 100,000 population. The Healthy People year 2000 objective is 4.0 per 100,000 population.

17. Primary and secondary syphilis — Rates by region: United States, 1981–1999 and the Healthy People year 2000 objective

18. Chlamydia — Reported rates: United States, 1984–1999

19. Chlamydia — Rates by state: United States and outlying areas, 1999 Note: *The New York City rate was 360.7 per 100,000 population. No cases were reported outside of New York City. The total rate of chlamydia for the United States and outlying areas (including Guam, Puerto Rico and Virgin Islands) was 250.9 per 100,000 population.

20. Chlamydia — Rates by region: United States, 1984–1999

21. Chlamydia — Rates by gender: United States, 1984–1999

22. Chlamydia — Positivity among 15-24 year old women tested in family planning clinics by state, 1999 Note: States reported chlamydia positivity data on at least 500 women aged 15-24 years screened during 1999 except for Rhode Island; for Puerto Rico, ‑ chlamydia positivity data were reported for August-December only. SOURCE: Regional Infertility Prevention Programs; Office of Population Affairs; Local and State STD Control Programs; Centers for Disease Control and Prevention

23. Chlamydia — Age- and gender-specific rates: United States, 1999

24. Chlamydia — Rates by region: United States, 1984–1999

25. HIV/AIDS • Relationship between classical STDs and HIV • Increases in HIV transmission in presence of STDs. • Increased genital track shedding of virus (transmission) • Increased attraction of CD4+ lymphocytes to mucosa (transmission) • Micro-abrasions of genital tissueincreased portals of entry/exit (transmission/acquisition) • Increased attraction of CD4+ lymphocytes to mucosa (acquisition)

26. Estimated Number of Persons Living with AIDS, 1993 -1998, by Sex, United States 250 200 Men 150 Thousands 100 Women 50 0 1993 1994 1995 1997 1998 1996 Year

27. Estimated Number of Persons Living with AIDS, 1993 - 1998, by Race/Ethnicity, United States 140 120 White, not Hispanic 100 Black, not Hispanic 80 Thousands 60 Hispanic 40 American Indian/ 20 Alaska Native Asian/Pacific Islander 0 1993 1994 1995 1996 1997 1998 Year

28. Estimated Number of Persons Living with AIDS, 1993 -1998, by Region, United States 120 100 80 South Northeast Thousands 60 40 West North Central 20 U.S. dependencies and possessions 0 1993 1994 1995 1996 1997 1998 Year

29. Proportion of AIDS Cases, by Race/Ethnicity and Year of Report,1985-1999, United States 70 White, not Hispanic 60 50 Black, not Hispanic 40 Percent of Cases 30 Hispanic 20 American Indian/ 10 Asian/Pacific Islander Alaska Native 0 1985 1987 1989 1991 1993 1995 1997 1999 Year of Report

30. Adult/Adolescent AIDS Cases by Exposure Category and Year of Diagnosis, 1985 - June 1999 United States 80 70 Men who have sex with men (MSM) 60 50 40 Percent of Cases Injection drug use (IDU) 30 Heterosexual contact 20 MSM & IDU Other 10 0 June 1985 1987 1989 1991 1993 1995 1997 1999 Year of Diagnosis Other includes cases with other or unreported risk exposure. Data adjusted for reporting delays and risk redistribution.

31. AIDS Cases and Deaths Reported through 1999, United States Cases Deaths Adult/Adolescent 724,656 425,357 8,718 5,084 Children 733,374 430,441 Total

32. AIDS Rates per100,000 Population Reported in1999 6.3 3.4 VT 6.4 1.5 1.1 6.8 4.0 3.8 NH 2.0 2.9 42.3 23.5 2.2 MA 6.6 RI 10.8 3.1 17.9 3.0 16.4 CT 4.0 25.1 NJ 13.4 4.9 6.1 24.7 12.8 DE 7.3 3.8 29.5 MD 7.9 16.4 13.7 9.7 6.4 161.5 7.0 DC 10.4 13.8 18.4 4.4 5.3 7.6 24.7 21.5 10.9 15.2 15.9 Rate per 100,000 36.2 19.5 <5 2.4 5 - 14.9 8.4 15+ PR 32.1 VI 32.6