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HIV/AIDS Epidemiology Partnership 13

Citrus, Lake, Marion and Sumter Counties. Excluding Dept. of Corrections. HIV/AIDS Epidemiology Partnership 13. Bureau of HIV/AIDS Surveillance Section (850) 245-4430, or SC 205-4430 Incidence data as of 01/06/06 Prevalence and Death data as of 04/05/06. HIV Case Reporting.

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HIV/AIDS Epidemiology Partnership 13

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  1. Citrus, Lake, Marion and Sumter Counties Excluding Dept. of Corrections HIV/AIDS EpidemiologyPartnership 13 Bureau of HIV/AIDS Surveillance Section (850) 245-4430, or SC 205-4430 Incidence data as of 01/06/06 Prevalence and Death data as of 04/05/06

  2. HIV Case Reporting • Reflects good demographic information • Tends to represent more recent infections • Now includes all reported HIV cases regardless of AIDS status • No retroactive reporting prior to July 1997 • Patients are tested on a self-selected basis • Anonymous tests are not reported • Data represents a minimum estimate of HIV prevalence

  3. HIV Prevalence Estimates and Cumulative HIV & AIDS Cases, Partnership 13, through 2005

  4. AIDS Cases, Case Deaths and Persons Living with AIDS (PLWA), by Year*Partnership 13, 1986-2005 *AIDS cases by year of diagnosis. AIDS case deaths by year of death. AIDS case deaths are individuals reported in HARS with AIDS whose status is now dead. They may or may not have died of AIDS-related illness. **The AIDS surveillance case definition was expanded for adults/adolescents in 1993. Data as of 04/05/06. done ah-AC

  5. 0 1 - 5 6 - 10 Over 10 Presumed Living MSM* HIV/AIDS Cases By Zip Code, Partnership 13, through 2005 Presumed Living MSM HIV/AIDS Cases N=352 NIRs are not redistributed. Excludes DOC, homeless, and cases with unknown zips. *Includes MSM/IDU cases. Data as of 04/05/06

  6. Presumed Living IDU HIV/AIDS Cases 0 1 - 5 Over 5 Presumed Living IDU* HIV/AIDS Cases By Zip Code, Partnership 13, through 2005 N=175 NIRs are not redistributed. Excludes DOC, homeless, and cases with unknown zips. *Includes MSM/IDU cases. Data as of 04/05/06

  7. Presumed Living Heterosexual HIV/AIDS Cases 0 1 - 5 6 - 10 Over 10 Presumed Living Heterosexual HIV/AIDS Cases By Zip Code, Partnership 13, through 2005 N=270 NIRs are not redistributed. Excludes DOC, homeless, and cases with unknown zips. Data as of 04/05/06

  8. Presumed Living HIV/AIDS Cases By Zip Code and Race/Ethnicity Partnership 13, through 2005 1 Dot = 3 cases Dots are randomly placed within zip codes. Hispanic Black, not-Hispanic White, not-Hispanic N=937 Total includes all races, some which are not on map. Excludes DOC, homeless, and cases with unknown zips. Data as of 04/05/06

  9. 1 Dot = 3 cases Dots are randomly placed within zip codes. Female Male Presumed Living HIV/AIDS Cases By Zip Code and Sex Partnership 13, through 2005 N=947 Excludes DOC, homeless, and cases with unknown zips. Data as of 04/05/06

  10. AIDS Cases By Year of Report, Partnership 13, 1996-2005 Era of HAART Comment: The advent of HAART was associated with decreases in AIDS cases in the late 1990’s. Generally, AIDS cases Remained fairly stable in the early 2000’s, with an increase in 2004 due to increased CD4 testing statewide. Increasingly, a diagnosis of AIDS reflects late diagnosis of HIV and limited access to treatment.

  11. AIDS Case Rate per 100,000 Population* By Year of Report, Partnership 13, 1996-2005 *Population rates calculated from annual population estimates. Comment: The advent of HAART was associated with decreases in AIDS cases in the late 1990’s. Newly reported AIDS cases remained fairly stable in the early 2000’s, with an increase in 2004 due to increased CD4 testing statewide. Generally, a diagnosis of AIDS reflects late diagnosis of HIV and limited access to treatment.

  12. HIV Cases By Year of Report, Partnership 13, 1998-2005 Comment: Generally, HIV cases remained fairly stable with an increase in 2002 due to increased HIV testing statewide as part of the “Get to Know Your Status” campaign. Since that time, newly reported HIV cases have decreased each year.

  13. HIV Case Rate per 100,000 Population* By Year of Report, Partnership 13, 1998-2005 Comment: Generally, HIV cases remained fairly stable with an increase in 2002 due to increased HIV testing statewide as part of the “Get to Know Your Status” campaign. Since that time, newly reported HIV cases have decreased each year.

  14. AIDS Cases and HIV Cases By Year of Report, Partnership 13, 1986-2005 *The AIDS surveillance case definition was expanded for adults/adolescents in 1993. **HIV infection reporting was implemented July 1997. Comment: From 2003 to 2005, there was a decrease of 2% in HIV cases and an increase of 35% in AIDS cases. The HIV decrease may reflect an actual decrease in transmission, while the AIDS increase in 2004 appears to be partially due to enhanced laboratory reporting of CD4 counts and viral loads. Increasingly, in the era of HAART, a diagnosis of AIDS reflects treatment issues like access to care, adherence and viral resistance.

  15. Males Females Adult AIDS Cases by Sex and Year of Report Partnership 13, 1996-2005 M:F Ratio* 1996 1.7:1 2005 2.8:1 Comment: AIDS cases tend to represent HIV transmission that occurred many years ago. The relative increases in female cases reflect the changing face of the AIDS epidemic over time. *The male-to-female ratio is the number or percent of cases among males divided by the number or percent of female cases.

  16. Males Females Adult HIV Cases by Sex and Year of Report Partnership 13, 1998-2005 M:F Ratio* 1996 1.6:1 2005 1.6:1 Comment: The trend for HIV cases by sex is the opposite of that for AIDS cases. Recent trends in HIV transmission are best described by the HIV case data. The relative increases in male HIV cases might be attributed to proportional increases in HIV transmission among men who have sex with men (MSM), which may influence future AIDS trends.

  17. Partnership 13 Adult HIV Cases by Sex, 2005 (N=95) Adult AIDS Cases by Sex, 2005 (N=89) Comment: Partnership 13’s Adult Population is: 50% Male and 50% Female, therefore male cases are disproportionately impacted.

  18. White Black Hispanic Adult AIDS Cases by Race/Ethnicity and Year of Report Partnership 13, 1996-2005 • Factors Affecting Disparities • Late diagnosis of HIV. • Access to/acceptance of care. • Delayed prevention messages. • Stigma. • Non-HIV STD’s in the community. • Prevalence of injection drug use. • Complex matrix of factors related to socioeconomic status Comment: In 2005, blacks accounted for 31% of reported AIDS cases, but only 8% of the population. Hispanic cases increased from 9% in 1996 to 22% in 2005. Disparities are even more evident among women: Annually, more than 70% of female AIDS cases have been reported among black women since 1988. HIV case reporting, implemented in mid-1997, has shown a very similar distribution of cases by race/ethnicity and sex. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and Multi-racial.

  19. White, non- Hispanic Black, non- Hispanic Hispanic Adult Male AIDS Cases by Race/Ethnicity and Year of Report Partnership 13, 1996-2005 Comment: For most of the past 10 years, white males accounted for more than 50% of AIDS cases among men. *Other races represent less than 1% of the cases and are not included.

  20. Black, non- Hispanic White, non- Hispanic Hispanic Adult Female AIDS Cases by Race/Ethnicity and Year of Report Partnership 13, 1996-2005 Comment: For most of the past 10 years, white and black women fluctuated over time accounted for more than 50% of AIDS cases among women. *Other races represent less than 1% of the cases and are not included.

  21. Adult HIV Cases by Race/Ethnicity and Year of Report Partnership 13, 1998-2005 White, non-Hispanic Black, non-Hispanic Hispanic Comment: In absolute numbers, from 1999-2004, HIV cases among blacks, whites and Hispanics fluctuated over the years.

  22. White, non- Hispanic Hispanic Black, non- Hispanic Percent of Adult Male HIV Cases by Race/Ethnicity and Year of Report Partnership 13, 1998-2005 Comment: The percent of black male HIV cases has increased from 39% in 1998 to 44% in 2005. Increases have been observed among both white and Hispanic male HIV cases over this same time period. *Other races represent less than 1% of the cases and are not included.

  23. Black, non- Hispanic White, non- Hispanic Hispanic Percent of Adult Female HIV Cases by Race/Ethnicity and Year of Report Partnership 13, 1998-2005 Comment: Although the majority of HIV cases among women are black, the percent of black female HIV cases has decreased from 48% in 1998 to 58% in 2005. Increases have been observed among both white and Hispanic female HIV cases over this same time period. *Other races represent less than 1% of the cases and are not included.

  24. Reported AIDS Case Rates per 100,000 PopulationBy Sex and Race/Ethnicity, Partnership 13, 2005 MALES Rate ratios Blacks:Whites, 7.8:1 Hispanics:Whites, 6.9:1 FEMALES Rate ratios Black:Whites, 10.3:1 Hispanics:Whites, 10.9:1 Comment: Among black males, the AIDS case rate is 8 times higher than among white males. Among black females, the AIDS case rate is 10-fold greater than among white females. Hispanic male rates are 7 times higher and Hispanic female rates are 11 times higher than the rates among their white counterparts. *2005 Partnership 13 Population Estimates, DOH, Office of Planning, Evaluation and Data Analysis.

  25. Reported HIV Case Rates per 100,000 PopulationBy Sex and Race/Ethnicity, Partnership 13, 2005 MALES Rate ratios Blacks:Whites, 11.8:1 Hispanics:Whites, 6.0:1 FEMALES Rate ratios Black:Whites, 19.6:1 Hispanics:Whites, 4.7:1 Comment: Among black males, the HIV case rate is 12 times higher than among white males. Among black females, the AIDS case rate is 19-fold greater than among white females. Hispanic male rates are 6 times higher and Hispanic female rates are 5 times higher than the rates among their white counterparts. *2005 Partnership 13 Population Estimates, DOH, Office of Planning, Evaluation and Data Analysis.

  26. Black Hispanic Other White Adult HIV and AIDS Cases, by Race/Ethnicity And Partnership 13 Population Estimates, 2005 2005 Partnership 13 Population Estimates* (N=667,229 ) AIDS (N=89 ) HIV (N=95 ) Comment: In this snapshot of 2004, blacks are over-represented among the AIDS cases, accounting for 33% of adult cases, but only 8% of the adult population. A group is disproportionately impacted to the extent that the percentage of cases exceeds the percentage of population. *Other includes Asian/Pacific Islanders and Native Alaskans/American Indians. *2005 Partnership 13 Population Estimates, Adults (Ages 13+), DOH, Office of Planning, Evaluation and Data Analysis

  27. Adult AIDS Cases by Sex and Race/EthnicityPartnership 13, 2005 Females (N=32) Males (N=57) Comment: In this snapshot of 2005, blacks are over-represented among the AIDS cases, accounting for 30% of adult cases among men and 37% of the adult cases among women. *Other includes Asian/Pacific Islanders and Native Alaskans/American Indians

  28. Adult HIV Cases by Sex and Race/EthnicityPartnership 13, 2005 Males (N=59) Females (N=36) Comment: In this snapshot of 2005, blacks are over-represented among the HIV cases, accounting for 44% of adult cases among men and 59% of the adult cases among women.

  29. Percent of AIDS Cases By Age of Diagnosis and Year of Report Partnership 13, 1996-2005 Comment: The percent of newly reported cases has shown increases among the 30-39 and 40-49 age groups over the past several years.

  30. Percent of Adult HIV Cases By Age Group*, Partnership 13, 1998-2005 Comment: The percent of newly reported cases has shown increases among the 30-39 and 50+ age groups over the past several years.

  31. Percent of Adult AIDS Cases by Sex and Age Group at Diagnosis Partnership 13, 2005 Males (N=57) Females (N=32) Percent Percent Comment: Females tend to be diagnosed with AIDS at a younger age than males, suggesting earlier onset of sexual activity and exposure to HIV, possibly through sex with older male partners.

  32. Percent of Adult HIV Cases by Sex and Age Group at Diagnosis Partnership 13, 2005 Males (N=59) Females (N=36) Percent Percent Note: HIV cases tend to be younger than AIDS cases: 20% of male HIV cases and 34% of female HIV cases occur among those aged 13-29, compared with only 7% of male AIDS cases and 16% of female AIDS cases in this age group. HIV cases tend to reflect more recent transmission than AIDS cases, and thus present a more current picture of the epidemic. This suggests that youth should be targeted.

  33. Acronyms • MSM - Men who have sex with men (includes homosexual and bisexual). • IDU - Injecting drug user. This category assumes that needle-sharing has taken place. • Hetero - Persons infected by a partner of the opposite sex. • Blood - Persons exposed through receipt of contaminated: blood/blood products, transplanted tissue/organs or artificial insemination. This category includes both confirmed and suspect cases pending investigation. • Other/Unknown - Confirmed other risks.

  34. Adult Male AIDS Cases by Exposure Category and Year of Report, Partnership 13, 1996-2005 Comment: From 2000 – 2005, MSM HIV cases decreased by 3%, while heterosexual male cases increased by 30% and IDU male cases increased 17%. Note: NIRs redistributed.

  35. Adult Female AIDS Cases by Exposure Category and Year of Report, Partnership 13, 1996-2005 Comment: The heterosexual risk continues to be the dominant mode of exposure among females. Note: NIRs redistributed.

  36. Adult Male HIV Cases by Exposure Category and Year of Report, Partnership 13, 1998-2005 Comment: From 2000 – 2005, MSM HIV cases increased by 72%, while heterosexual male cases increased by 55% and IDU male cases increased 28%. Note: NIRs redistributed.

  37. Adult Female HIV Cases by Exposure Category and Year of Report, Partnership 13, 1998-2005 Comment: The heterosexual risk continues to be the dominant mode of exposure among females. Note: NIRs redistributed.

  38. Total Adult Male Cases by Mode of Exposure and Sex Partnership 13, 2005 AIDS (N=57) HIV (N=59) Note: NIRs redistributed. Comment: The recent increase among MSM is indicated by the higher percent of MSM among HIV cases compared to AIDS cases, as HIV cases tend to represent a more recent picture of the epidemic.

  39. Total Adult Female Cases by Mode of Exposure and SexPartnership 13, 2005 Note: NIRs redistributed. HIV (N=36) AIDS (N=32) Comment: The ongoing increase among heterosexual risk compared with IDU is indicated by the higher percent of heterosexuals among HIV cases compared to AIDS cases, as HIV cases tend to represent a more recent picture of the epidemic.

  40. Annual Prevalence Adult Male HIV/AIDS Cases By Mode of Exposure (NIRs redistributed) Partnership 13, Reported 1996-2005 *Adjustments have been made to account for the redistribution of cases with no identified risk (NIR). **HIV infection reporting was implemented July 1997. Comment: PLWHA’s represent those in need of care and secondary prevention initiatives to prevent further transmission. The increase in number of PLWHA’s is due to a combination of factors: survival time is increasing, those recently reported are more likely to be alive, and the annual number of persons reported with HIV or AIDS exceeds the number of deaths. MSM is the predominant mode of exposure. MSM cases are increasing the fastest. (data as of 03/20/06).

  41. Annual Prevalence Adult Female HIV/AIDS Cases By Mode of Exposure (NIRs redistributed) Partnership 13, Reported 1996-2005 *Adjustments have been made to account for the redistribution of cases with no identified risk (NIR). **HIV infection reporting was implemented July 1997. Comment: PLWHA’s represent those in need of care and secondary prevention initiatives to prevent further transmission. The increase in number of PLWHA’s is due to a combination of factors: survival time is increasing, those recently reported are more likely to be alive, and the annual number of persons reported with HIV or AIDS exceeds the number of deaths. Heterosexual cases are increasing the fastest. (data as of 03/20/06).

  42. Percentage of Reported HIV/AIDS Cases* By Age of Diagnosis vs. Current Age, Partnership 13 Comment: Age at diagnosis among recently diagnosed HIV/AIDS cases (alive or dead) is most useful for planning primary HIV prevention. However, the distribution of living HIV/AIDS cases by current age, which is shifted towards the older age groups due to survival time, is most useful to focus on “prevention for positives”, i.e., secondary prevention. It is also useful to target those in need of care and treatment and support for medication adherence. 13-29 yr: 22% by age at diagnosis 8% by current age 50+ yr: 16% by age at diagnosis. 24% by current age. By Age at Diagnosis: HIV cases plus AIDS cases, Diagnosed from 2001 – 2005. By Current Age: PLWHAs through 2005. *Number of HIV/AIDS cases (2001-2005)=638; PLWHAs thru 2005=947

  43. Living Adult HIV/AIDS CasesBy Sex and Race/Ethnicity Partnership 13*, through December 2005 Males N=621 Females N=326 Comment: In this snapshot of of living HIV/AIDS cases through 2005, the majority of males are white (52%) and the majority of females are black (49%). *Data excludes Dept. of Corrections cases. **Other includes Asian/Pacific Islanders and Native Alaskans/American Indians. Data as of 04/05/06

  44. Reported PLWHA Rates per 100,000 Population By Sex and Race/EthnicityPartnership 13*, through 2005 MALES Rate ratios Blacks:Whites, 6:1 Hispanics:Whites, 3:0 FEMALES Rate ratios Black:Whites, 13:1 Hispanics:Whites, 5:1 Comment: Among black males, the HIV/AIDS case rate for cases alive and reported through 2005 is 6 times higher than among white males. Among black females, the AIDS case rate is 13 times higher than among white females. Hispanic male rates 3 times higher and Hispanic female rates are 5 times higher than the rates among their white counterparts. Data excludes Department of Corrections cases. *2005 Total Florida Population Estimates, DOH, Office of Planning, Evaluation and Data Analysis **Other includes Asian/Pacific Islander, American Indian/Alaska Native and/or Other/Unknown Races.

  45. Living Adult Male HIV/AIDS Cases (PLWHAs) By Race/Ethnicity and Mode of Exposure Partnership 13*, Data through 2005 White, non-Hispanic N=(326) Black, non-Hispanic N=(199) Hispanic N=(91) Heterosexual MSM IDU • Comment: Among male PLWHAs, the distribution of risk among whites differs from that among blacks and Hispanics. MSM represents the highest risk for all races. White males have the smallest percentage of heterosexual contact cases. Note: Adjustments have been made to redistribute NIR cases. Data as of 04/05/06. • *Data excludes Dept. of Corrections. • **Other includes hemophilia, transfusion, perinatal and other pediatric risks and other confirmed risks.

  46. Living Adult Female HIV/AIDS Cases (PLWHAs) By Race/Ethnicity and Mode of Exposure Partnership 13*, Data through 2005 White, non-Hispanic N=(120) Black, non-Hispanic N=(158) Hispanic N=(40) Heterosexual IDU • Comment: Among female PLWHAs, the distribution of risk among differs from that among whites, blacks and Hispanics. Heterosexual contact is the majority risk for all races. Adjustments have been made to redistribute NIR cases. Data as of 04/05/06. • *Data excludes Dept. of Corrections. • **Other includes hemophilia, transfusion, perinatal and other pediatric risks and other confirmed risks.

  47. Resident HIV/AIDS Deathsby Year, Partnership 13, 1995 - 2004* Source: Office of Vital Statistics, Death Certificates*A change in coding of HIV/AIDS deaths from ICD-9 to ICD-10, effective in 1999, has resulted in an estimated increase of approximately 14% in the annual number of HIV/AIDS deaths.

  48. Resident HIV/AIDS Death Rates Per 100,000 Population, by Race/Ethnicity, Partnership 13, 2004 MALES Rate ratios Blacks:Whites, 8:1 Hispanics:Whites, 3:1 FEMALES Rate ratios Black:Whites, 3:1 Hispanics:Whites, 5:1 Comment: In 2004, black males were 8 times as likely as white males to die of HIV/AIDS. The HIV/AIDS death rate among Hispanic females was 5 times higher than among white females. Source: Office of Vital Statistics (Death Data) DOH, Office of Planning, Evaluation and Data Analysis (2004 Population Estimates)

  49. Some Useful Links CDC HIV/AIDS Surveillance Reports (State and Metro Data): http://www.cdc.gov/hiv/stats/hasrlink.htm MMWR (Special Articles on Diseases, Including HIV/AIDS): http://www.cdc.gov/mmwr/ U.S. Census Data (Available by State, County): http://www.census.gov Florida Dept. of Health, Bureau of HIV/AIDS Website (Slide Sets, Fact Sheets, Monthly Surveillance Report, Counseling & Testing Data, etc., etc.): http://www.doh.state.fl.us/disease_ctrl/aids/index.html

  50. “The reason for collecting, analyzing and disseminating information on a disease is to control that disease. Collection and analysis should not be allowed to consume resources if action does not follow.” --Foege WH et al. Int. J of Epidemiology 1976; 5:29-37

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