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Supplement to HIV and AIDS Surveillance (SHAS)

Supplement to HIV and AIDS Surveillance (SHAS). Introduction. SHAS was a CDC-funded project designed to provide an in depth description of people diagnosed with HIV/AIDS in MN, including information about the care and treatment they were receiving.

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Supplement to HIV and AIDS Surveillance (SHAS)

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  1. Supplement to HIV and AIDS Surveillance(SHAS)

  2. Introduction SHAS was a CDC-funded project designed to provide an in depth description of people diagnosed with HIV/AIDS in MN, including information about the care and treatment they were receiving. The purpose of this information was to provide planning groups, providers, and health agencies with data that could be used to develop strategies and interventions to prevent HIV infection and improve care. CDC provided a questionnaire for the project. See the “Minnesota Supplement to HIV Surveillance (SHAS) Project Summary” on the MDH website for further detail and information about the project.

  3. Anoka Carver Chisago Dakota Hennepin Isanti Ramsey Scott Sherburne Washington Wright The 11 Minnesota Counties in the Minneapolis-St. Paul EMA EMA = Eligible Metropolitan Area

  4. Minnesota SHAS Eligibility Criteria • Resident of the EMA for > 1 year • > 18 years of age • Case of HIV infection or AIDS diagnosed at least 6 months ago, but not more than 3 years ago • Agreed to SHAS participation after contact by a MDH Disease Investigator for routine disease intervention OR Volunteered for SHAS by calling the SHAS interviewer

  5. SHAS Cases with HIV (non-AIDS) Interviewed Aug 2000- Dec 2003 Compared to HARS EMA HIV (non-AIDS) Cases Diagnosed 1999-2003

  6. SHAS Cases with AIDS Interviewed Aug 2000-Dec 2003 Compared to HARS EMA AIDS Cases Diagnosed 1999-2003

  7. Agencies/Groups Given Formal SHASPromotional Presentations • Minnesota AIDS Project (an AIDS organization) • Clinic 42 (an AIDS Clinic) • Hennepin County Infectious Disease Clinic ( main clinic in MN for HIV care) Note: Interviewer often promotes SHAS with individuals/groups/clinics and distributes/posts flyers describing SHAS

  8. Agencies/Groups Presented SHAS Data • Minnesota Department of Health STD and HIV Section (prevention/surveillance personnel) • African American Health Care Worker Network • Needs Assessment and Evaluation Committee of the Minnesota HIV Services Planning Council

  9. SHAS Limitations • Biased sample of HIV/AIDS cases • SHAS cases may not be representative of entire EMA HIV/AIDS population • Greater MN cases not included, so data may not be representative of that population • Answers to questions are self-reported • Recall bias • Social Desirability Bias • Limited sample size

  10. Demographic Data

  11. SHAS Participants: Gender

  12. SHAS Participants: Race/Ethnicity

  13. SHAS Participants: Category of Exposure (HARS)

  14. Socioeconomic Data

  15. SHAS Participants: Socioeconomic Status (N=215) • 51% Employed • Median number of hours worked per week = 39.0 hours (Average = 33.1 hours) • Job change since diagnosis: 100/215 (47%) Reasons • Quit / laid-off due to AIDS 60/100 (60%) • Decreased hours/ changed jobs or tasks due to HIV 19/100 (19%) • Other reasons not HIV-related 21/100 (21%) • 11% = Sole provider for children (<18 years old) • 41% Ever in Jail/Detention/Prison (1 refusal)

  16. SHAS Participants: Socioeconomic Status Source of Main Financial Support (N=215)

  17. SHAS Participants: Socioeconomic Status Household Income Before Taxes (N=215) Received or applied for public assistance, welfare, social security: 138/215 (64%)

  18. Drug Use

  19. SHAS Participants: Drug Use(N=203)(Excludes African-Born) • Ever had alcohol = 99% • Possible alcohol problem = 54% • Non-IDU drug use ever = 62% • Non-IDU Drug use in 12 months prior to interview = 27% • Injected drugs ever = 18% • Injected in 12 months prior to interview = 3% (excludes 35 cases that used only marijuana and 7 cases that used marijuana and nitrites) 83% used any illegal drug

  20. SHAS Participants: Non-Injecting Drug Use (Excludes African-Born) * In the 12 months prior to interview. ** Only non-AIDS cases diagnosed 1999-2003 (as in HARS) (85 cases)

  21. SHAS Participants: Crack Use (Excludes African-Born)

  22. SHAS Participants: Injecting Drug Use (Excludes African-Born) • Injected drugs ever = 37/203 (18%) • 51% in a shooting gallery (n=19) Of the 37 IDU’S: • 54% shared needles (n=20) Most often shared with: • Friends 60% • Strangers 25% • Lovers 10% • MSM 5% • 2 cases may have shared needles/equipment. 2 cases who did not share needles shared equipment

  23. SHAS Participants: Injecting Drug Use (Excludes African-Born) (N=203) Ever Use Note: Only 6 cases injected in the 12 months prior to the interview.

  24. Sexual Behavior

  25. Number of Sexual Partners in Lifetime by Declared Sexual Orientation* Range # of Cases Median # of Partners 1 – 3,000 Males Homosexual/Gay Heterosexual 56 37 40 20 1 – 2,000 1-33 Bisexual 13 Male 6 1-100 Female 5 Females Heterosexual 44 9 1 – 99 *Excludes persons with a prostitution history

  26. SHAS Participants: Sexually Transmitted Diseases (Excludes African-Born) • Ever had STD = 66% (133/203) • Last received treatment at: • Private MD/Community/Public Clinic 35% (47/133) • STD Clinic 37% (49/133) • Emergency Room 14% (18/133) • Other 14% (19/133/) • STD after HIV diagnosis: 25 cases were treated for an STD > 6 months after learning of their HIV diagnosis. However, we do not always know the specific STD for which they were treated (list includes HSV, HPV, and syphilis that could be recurrent or old infections recently treated). We do know 8 cases had either gonorrhea, trichomonas, or chlamydia infections after HIV diagnosis.

  27. SHAS Participants: Prostitution (Excludes African-Born) EverLast 12 Months* Male 45/146 (31%) 13/146 (9%) Female 18/57 (32%) 6/57 (11%) * Note: Prostitution may have stopped after diagnosis if HIV diagnosis < 12 months ago.

  28. SHAS Participants: Men Who Had Sex With Men in the 12 Months Prior to the Interview(N=83) • Had at least 1 new partner = 66% (55/83) • The following questions were asked about the last time sex with steady and non-steady partners. • Risky* insertive anal sex by case with steady or non-steady partner = 5% (4/83) • Risky receptive anal sex by case = 11% (9/83) (excludes 4 cases with risky insertive anal sex) • Risky insertive oral sex by case = 20% (17/83) (excludes cases with anal insertive sex) • *Risky sex means no condom used or unsure and partner’s HIV status was negative or unknown per case.

  29. SHAS Participants: Risky Sex and Alcohol/Drug Usage Last Time Sex With Steady or Non-Steady Partner – Men with Men • Of the 13 cases with risky anal sex:* • 3 were drunk and on drugs • 1 was drunk • 2 were on drugs • 6 of 13 impaired by alcohol/drugs (46%) • Of the 17 cases with only risky oral sex: • 1 was drunk and on drugs • 2 were drunk • 1 was on drugs • 4 of 17 impaired by alcohol/drugs (24%) *With steady or non-steady partner

  30. SHAS Participants: Men Who Had Sex With Men in the 12 Months Prior to the Interview • 23/83 (28%) only had oral sex during their most recent sexual encounters with steady and non-steady partners (no anal sex)

  31. SHAS Participants: Men Who Had Sex With Women in the 12 Months Prior to Interview (N=50) • Had at least one new partner = 40% (20/50) • Risky vaginal sex 24% (12/50) • Alcohol or drug involvement = 42% (5/12) Note: 7/50 had sex with men and women during this time

  32. SHAS Participants: Women Who Had Sex With Men in the 12 Months Prior to Interview (N=50) • Had at least one new partner = 32% (16/50) • Risky vaginal sex = 16% (8/50) • Alcohol or drug involvement = 38% (3/8)

  33. SHAS PARTICIPANTS: CASES WITH RISKY SEX IN THE 12 MONTHS PRIOR TO THE INTERVIEW • 3/4 of the men “who had sex with men” with risky insertive anal sex did so after diagnosis of HIV infection • 7/9 of the men “who had sex with men” with risky receptive anal sex in the absence of insertive did so after diagnosis • 11/17 of the “men who had sex with men” with risky insertive oral sex without any insertive anal sex did so after diagnosis • 8/12 of the “men who had sex with women” with risky vaginal sex did so after diagnosis • 6/8 of the “women who had sex with men” with risky vaginal sex did so after diagnosis

  34. HIV Testing

  35. MN Diagnosed SHAS ParticipantsBy Test Site (N=188) 21% 21% 15% 14% 11% 9% 4% 1% 4% STD Clinic Physician/HMO Hospital Outpatient/AIDS Clinic/ER Hospital Inpatient Community Center Blood Bank/Plasma Center Prenatal/OB Clinic Correctional Other Note: 44% tested at an active surveillance site

  36. SHAS Participants: Reason for Testing (N=215)

  37. SHAS Participants: Minnesota Diagnosed Cases (N=188) • Test type when 1st tested • Anonymous 8% • Confidential 90% • Unsure 2% • Partner notification offered by MDH/MD/other • Yes 76% • No 20% • Unsure 4% • Of those offered partner notification (n=142) • MDH/MD notification 45% • Case notification 35% • Both 10% • Other (partner known+ or aware, etc) 10%

  38. Preventive Therapy

  39. SHAS Participants:Laboratory Tests (N=215)

  40. SHAS Participants:Hepatitis History (N=215) • NumberPercentage • Hepatitis A 8 4 • Hepatitis B 18 8 • Hepatitis C 25 15/25 IDU HX 12 • Other (2)/Unknown (3) 5 2 • Note: IDU ever is 2 times higher among SHAS cases compared to all cases. • Of those that never had Hepatitis B • Received hepatitis B vaccine = 75% (138/184) • Note: 13 cases unsure if vaccinated excluded from data

  41. SHAS Participants: Antiretroviral Therapy Ever received therapy = 69% (148/215) Of those never on therapy (n=67):

  42. SHAS Participants: Receiving Antiretroviral (ART) Therapy • 125 cases on ART at time of interview

  43. SHAS Participants: Receiving Antiretroviral (ART) Therapy But With Incomplete Adherence (N=53)

  44. SHAS Participants: Source of Advice on Taking Antiretrovirals

  45. SHAS Participants: Skin Testing for Tuberculosis

  46. Health Care

  47. SHAS Participants: Source of HIV Care Received HIV care in last year = 99.5% (214/215)

  48. SHAS Participants: Source of Health Insurance (N=215) Note: Percentages total >100 percent since some persons have multiple Insurance coverage

  49. SHAS Participants: Insurance Coverage (N=215) • Since HIV+ diagnosis: • Lost health insurance >30 in a row 9% • Kept insurance 87% • Never had insurance 4% • Last 12 months ever denied health care because couldn’t pay for it: • Yes 3% • No 97% • Delayed care in the last 12 months • Yes 7% • No 93%

  50. SHAS Participants: HIV Induced Health Problem or Impairment (N=215) Yes = 29% No = 71%

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