Wisconsin Department of Health Services HIV/AIDS Surveillance Annual Review

1. Wisconsin Department of Health Services HIV/AIDS Surveillance Annual Review New diagnoses, prevalent cases, and deaths through December 31, 2012 April 2013

2. BACKGROUND AND OVERVIEW OF HIV CASES IN WISCONSIN Wisconsin Department of Health Services

3. Introduction • This annual review relies on HIV and AIDS diagnoses reported to the Wisconsin Department of Health Services HIV/AIDS Surveillance System through 2012. • The annual review is intended to assist planners of HIV prevention and care services to better serve those at risk of and living with HIV, to ensure effective use of existing resources, and to seek additional resources where most needed. • The tables and technical notes at the end of the PDF version of the annual review provide additional information. http://www.dhs.wisconsin.gov/aids-hiv/Stats/index.htm Wisconsin Department of Health Services

4. Methods Methodological changes that affect 2012 HIV/AIDS Surveillance Summary include: • Analyzing data by year of diagnosis rather than year of report. • Including a review of the National Death Index, in addition to Wisconsin Death Index. Wisconsin Department of Health Services

5. Figure 1: Flow of cases of HIV infection in and out of Wisconsin, 2012 New diagnoses in Wisconsin (n=241) Out of state cases moving into Wisconsin (n=159) New diagnoses Prevalent cases reported, (n=6,549) Out of state cases Cases already living in Wisconsin • Cases ever reported in Wisconsin but currently residing in another state (n ≈ 1,000) • Deaths through 2010 (n = 4,466; newly occurring or • retrospectively identified) Wisconsin Department of Health Services

6. NEW HIV DIAGNOSES These include cases of HIV diagnosed in Wisconsin in 2012 Wisconsin Department of Health Services

7. UNITED STATES Figure 2. HIV diagnosis rates per 100,000 population by state, 2011 Rate per 100,000 population IL U.S. MI IN MN WI IA Source: CDC HIV Surveillance Report, V 23, Table 19 Wisconsin Department of Health Services

8. TOTAL CASES Figure 3. Cases of HIV diagnosed in Wisconsin, 1983-2012 HIV diagnoses * Cases are shown using 3-year rolling averages Wisconsin Department of Health Services

9. CASES BY SEX Figure 4. HIV diagnoses per 100,000 population by sex, Wisconsin, 2003-2012 Male Rate per 100,000 population Female Wisconsin Department of Health Services

10. SEX AND AGE Figure 5. HIV diagnosis rates per 100,000 population by sex and age group, Wisconsin, 2003-2012 Males 15-29 Rate per 100,000 population Males 30+ Females 15-29 Females 30+ Wisconsin Department of Health Services

11. RACE/ETHNICITYFigure 6. Percent of HIV diagnoses in Whites and racial/ethnic minorities, Wisconsin, 1983-2012 2012 diagnoses (n=241) Multi-racial Asian Hispanic Black White Racial/ethnic minority HIV diagnoses White Wisconsin Department of Health Services

12. SEX AND RACE/ETHNICITY: RATESFigure 7. HIV diagnosis rates per 100,000 population by sex and race/ethnicity, Wisconsin, 2008-2012 Rate per 100,000 population Wisconsin Department of Health Services

13. AGEFigure 8. HIV diagnoses by age group, Wisconsin, 2012n=241 HIV diagnoses Wisconsin Department of Health Services

14. DIAGNOSIS BY AGE GROUPFigure 9. HIV diagnosis by age group and demographic characteristics, Wisconsin, 2012 * Data have been statistically adjusted to account for unknown risk. See technical notes. ** MSM includes those who have also injected drugs. Wisconsin Department of Health Services

15. RISK EXPOSUREFigure 10. HIV diagnoses by estimated risk exposure group*, Wisconsin, 2012 (n=241) Wisconsin Department of Health Services * Data have been statistically adjusted to account for unknown risk. See technical notes.

16. RISK EXPOSUREFigure 11. HIV diagnoses by estimated risk exposure group*, Wisconsin, 2003-2012 MSM HIV diagnoses (adjusted) Heterosexual IDU Wisconsin Department of Health Services * Data have been statistically adjusted to account for unknown risk. See technical notes.

17. RISK AND RACE/ETHNICITYFigure 12. HIV diagnoses by estimated risk exposure group* and race/ethnicity Wisconsin, 2012 HIV diagnoses (adjusted) Wisconsin Department of Health Services * Data have been statistically adjusted to account for unknown risk. See technical notes.

18. YOUNG MSM: RACE/ETHNICITY Figure 13. HIV diagnoses in MSM* ages 15-29, by race/ethnicity, Wisconsin, 2003-2012 Black HIV diagnoses (adjusted) White Hispanic * Data have been statistically adjusted to account for unknown risk. See technical notes. ** Includes Asians, American Indians, and multi-racial individuals. Wisconsin Department of Health Services

19. AGE AT DIAGNOSIS BY RISKFigure 14: Median age at HIV diagnosis by risk exposure*, and among MSM, by race/ethnicity, Wisconsin, 2012 Median age at HIV diagnosis MSM Wisconsin Department of Health Services * Excludes cases with unknown risk exposure.

20. AGE AT DIAGNOSISFigure 15. Median age at HIV diagnosis for Black MSM*, 2003-2012, Wisconsin Circle size and number in circle represent the number of HIV diagnoses among Black MSM that year 30 Median age at HIV diagnoses 42 31 * Excludes cases with unknown risk exposure.

21. TRANSGENDER INDIVIDUALSFigure 16. HIV diagnoses among transgender individuals by race/ethnicity, Wisconsin, 2003-2012 HIV diagnoses Wisconsin Department of Health Services

22. 2012 DIAGNOSES BY COUNTYFigure 17. HIV diagnoses by county, Wisconsin, 2012 Wisconsin Department of Health Services

23. DIAGNOSIS BY GEOGRAPHYFigure 18. HIV diagnosis by geography and demographic characteristics, Wisconsin, 2012 Wisconsin Department of Health Services

24. Summary of HIV diagnoses in Wisconsin, 2012 • 2012 diagnoses in Wisconsin: 241 • Sex: • Males, 78% of new diagnoses • Males and females – stable rates, 2003-2012 • Gender: • 21 diagnoses in transgender individuals, 2003-2012 • Race/Ethnicity: • Males: Rates in Blacks 10 times and Hispanics 5 times higher than in Whites • Females: Rates in Blacks 25 times and Hispanics and Asians 5 times higher than in Whites • Geography • Diagnosis rates in Milwaukee 6 times higher than in Wisconsin excluding Milwaukee County Wisconsin Department of Health Services

25. Summary of HIV diagnoses by risk exposure in Wisconsin, 2012 • Risk Median age at diagnosis by risk • Men who have sex with men, 70% 33 • High-risk heterosexual, 21% 42 • Injection drug users, 7% 41 • MSM by race/ethnicity (all ages) Median age by race • Whites, 45% 43 • Blacks, 36% 23 • Hispanics, 15% 31 • Asians, 2% -- • Black MSM under age 30 • 58% of 2012 diagnoses (8% of male population, ages 15-29) • Diagnoses tripled 2003-2010, declined modestly 2010 – 2012 • Median age at diagnosis, 23 Wisconsin Department of Health Services

26. PREVALENT CASES Prevalence is the number of people living with HIV infection at a given point in time Wisconsin Department of Health Services

27. AWARE OF HIV INFECTION: UNITED STATESFigure 19. Percent aware of their HIV infection, by demographic group, United States, 2009 Wisconsin Department of Health Services Health Indictors Warehouse: http://www.healthindicators.gov/Indicators/HIV-infection-status-awareness-percent_942/Profile/Data

28. NUMBER UNAWARE OF HIV INFECTIONFigure 20. Estimated number unaware of their HIV infection, by demographic group, Wisconsin, 2012 Wisconsin Department of Health Services Uses estimates from Health Indictors Warehouse: http://www.healthindicators.gov/Indicators/HIV-infection-status-awareness-percent_942/Profile/Data

29. PREVALENCE: STATE OF DIAGNOSIS Figure 21. Prevalent cases of HIV infection by state of initial HIV diagnosis, Wisconsin, as of December 31, 2012n = 6,549 Wisconsin Department of Health Services

30. PREVALENCE: AGE Figure 22. Prevalent cases of HIV infection by current age as of 12/31/2012 and cases reported during 2012 by age at diagnosis, Wisconsin Percent Wisconsin Department of Health Services

31. ESTIMATED PREVALENCE* BY DEMOGRAPHIC GROUPFigure 23. Impact of HIV on selected demographic groups, ages 15-59 years, Wisconsin, as of December 31, 2012 Estimated HIV prevalence within demographic group Less than 1.5% Demographic Group * The estimated prevalence is adjusted to account for the CDC’s estimate that 18% of HIV-infected persons are unaware of their infection and therefore not reported. The percent of males that are MSM was calculated using published estimates (Lieb, 2011). Wisconsin Department of Health Services

32. PREVALENCE: GEOGRAPHYFigure 24. Reported cases of HIV infection presumed to be alive by county, Wisconsin, as of December 31, 2012 *Excludes 228 cases with the Wisconsin Department of Corrections as the last known address and 285 cases where county of residence is unknown. Wisconsin Department of Health Services

33. DEATHS Deaths are the number of people with HIV infection who died in a given year, irrespective of cause of death Wisconsin Department of Health Services

34. DEATHSFigure 25. Deaths due to any cause among persons reported with HIV infection by year of death, Wisconsin, 1990-2010 Number of deaths Wisconsin Department of Health Services

35. DEATHS: AGEFigure 26. Deaths due to any cause among persons reported with HIV infection, by median age at death, Wisconsin, 2001-2010n=1,251 Wisconsin Department of Health Services

36. Summary of HIV Prevalence and Deathsas of 12/31/2012 PREVALENT CASES Wisconsin, one-third rate of U.S. states 6,549 reported + 1,500 estimated unaware of HIV infection ≈ 8,000 Age 40% are age 50 or older Estimated HIV positive by risk and race General population: 2 in 1,000 Blacks: Non-MSM males, 1.2%; females, 0.7% MSM: Black, 27%; Hispanic, 7%; White, 3% Geography: Milwaukee County: 48%; Dane County, 12%; all other 4% or less DEATHS 89 in HIV-infected individuals in 2010 Wisconsin Department of Health Services