The HIV/AIDS Epidemic in the United States

1
The HIV/AIDS Epidemic in the United States
Jennifer Kates, M.A., M.P.A. Vice President and
Director, HIV Policy Kaiser Family
Foundation KaiserEDU.org Tutorial February 2006
2
The U.S. Epidemic Snapshot of Key Data
Figure 1
Note Data are estimates. Sources CDC, 2005
Glynn, K. et al., CDC, "Estimated HIV prevalence
in the United States at the end of 2003",
Presentation at the National HIV Prevention
Conference, 2005 Fleming, P., et al., HIV
Prevalence in the United States 2000, 9th
Conference on Retroviruses and Opportunistic
Infections, 2002.
3
New AIDS Cases, Deaths, and People Living with
AIDS, 1985-2004
Figure 2
People Living with AIDS
New AIDS Cases
People Living with AIDS
Deaths and New AIDS Diagnoses
Deaths among People with AIDS
2004
Note Data are estimates. Source CDC, Data
Request, 2006.
4

• Impact on Communities of Color

5
Proportion of AIDS Cases, by Race/Ethnicity,
1985-2004
Figure 3
Percent of AIDS Diagnoses
White, non-Hispanic
African American
Latino
American Indian/ Alaska Native
Asian/Pacific Islander
2004
Note Data are estimates. Source CDC, Data
Request, 2006.
6
AIDS Diagnoses and Population, by Race/Ethnicity,
2004
Figure 4
AIDS Cases
U.S. Population
42,514
293,655,404
White, non-Hispanic
28
69
African American
49
13
Latino
14
4
20
Asian/Pacific Islander
1
1
lt1
AI/AN
Notes U.S. Population estimates do not include
U.S. dependencies, possessions, and associated
nations persons who reported more than one race
were included in multiple categories. May not
total 100 due to rounding. Total AIDS diagnoses
in 2004 include persons of unknown race or
multiple races. AI/AN American Indian/Alaskan
NativeSources CDC, HIV/AIDS Surveillance
Report, Vol. 16, 2005 U.S. Census Bureau,
Population Estimates Program, 2004 Population
Estimates.
7

• Impact on Women

8
Women as a Share of New AIDS Diagnoses
Figure 5
Note Data are estimates. Sources CDC, Data
Request, 2006.
9
New AIDS Diagnoses by Race/Ethnicity and Sex,
2004
Figure 6
2 Other
1 Other
17 White
33 White
15 Latina
67 African American
44 African American
20 Latino
Women N 11,109
Men N 30,203
Note Data are estimates for adults/adolescents
and do not include cases from the U.S.
dependencies, possessions, and associated
nations, and cases of unknown residence. Source
CDC, HIV/AIDS Surveillance Report, Vol. 16, 2005.
10
Figure 7
Reported HIV Cases Among Teen Girls and Younger
Women, 2003












Notes Data based on persons age at diagnosis,
from 41 areas with confidential name-based HIV
surveillance for adults and adolescents in 2003.
Source CDC, HIV/AIDS Surveillance in
Adolescents, L265 Slide Series Through 2003.
11
HIV Spread Primarily Through Sex, Increasingly
Heterosexual
Figure 8
Heterosexual
3
13 Other
31 Heterosexual
19 IDU
65 MSM
42 MSM
6 Other
22 IDU
1985
2004
Notes Data are estimates. May not total 100 due
to rounding. Sources CDC, Presentation by Dr.
Harold Jaffe, HIV/AIDS in America Today,
National HIV Prevention Conference, 2003 CDC,
HIV/AIDS Surveillance Report, Vol. 16, 2005.
12

• Regional, State, Local
• Impact

13
AIDS Case Rate per 100,000 Population by Region,
2004
Figure 9
Notes Case rates calculated by KFF data do not
include U.S. territories and possessions.
Sources CDC, HIV/AIDS Surveillance Report, Vol.
16, 2005 U.S. Census Bureau, Population
Estimates Program, 2004 Population Estimates.
14
Top 10 States by AIDS Case Rate per 100,000
Population, 2004
Figure 10
U.S. Rate 15.0
Source CDC, HIV/AIDS Surveillance Report, Vol.
16, 2005.
15
Top 10 States by AIDS Case Rate per 100,000
African Americans, 2004
Figure 11
U.S. Rate 73.9
Note Data not available for U.S. dependencies,
possessions, and independent nations in free
association with the United States. Source
Kaiser Family Foundation, State Health Facts
(CDC, Special Data Request, November 2005).
16
Top 10 States by AIDS Case Rate per 100,000
Among Women, 2004
Figure 12
U.S. Rate 9.5
Source Kaiser Family Foundation, State Health
Facts (CDC, Special Data Request, November 2005).
17
Top 10 MSAs by AIDS Case Rate per 100,000
Population, 2004
Figure 13
U.S. Rate 15.0
Note MSAs with 500,000 or more population.
Source CDC, HIV/AIDS Surveillance Report, Vol.
16, 2005.
18

• Federal Funding of Health Care and Prevention
  Services for HIV/AIDS

19
Federal Funding for HIV/AIDS by Category, FY 2005
Figure 14
US Billions
Total 19.7 billion
Not including international research which is
counted in the research and prevention
categories. Sources Kaiser Family Foundation,
Federal Funding for HIV/AIDS The FY 2006 Budget
Request, 2/05 DHHS, Office of Budget/ASBTF,
2/05 SSA, Office of the Actuary, 4/05 CMS,
Office of the Actuary, 2/05 State Department,
Office of the Global AIDS Coordinator U.S.
Congress, FY 2005 Consolidated Appropriations
Bill and Conference Report.
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Major Federal Sources of Funding for HIV/AIDS Care
Figure 15

• Medicaid
• Medicare
• Ryan White CARE Act
• Others include Department of Veterans Affairs
  SAMHSA Community and Migrant Health Centers

Sources Kaiser Family Foundation, Financing
HIV/AIDS Care A Quilt with Many Holes, May 2004
DHHS, Office of Budget/ASBTF, 4/05.
21
Medicaids Role in HIV/AIDS Care
Figure 16
Federal Medicaid Spending on HIV/AIDS Care as
Percent of Federal Spending on HIV/AIDS Care FY
2005

• Provides health long-term care coverage for
  more than 52 M low-income people
• Largest source of coverage for people with
  HIV/AIDS
• 250,000 Medicaid beneficiaries with HIV/AIDS
• Reflects epidemics impact on low-income
  populations
• Many with HIV/AIDS qualify through
  disability-related pathway
• Mandatory and Optional Services
• All states cover Rx drugs

Medicaid 49 (5.7B)
All Other 51 (6.0B)
Medicare
Total 11.7 B
Sources Kaiser Family Foundation, Medicare and
HIV/AIDS, 9/05 KCMU, The Medicaid Program at a
Glance, 1/05. Medicaid HIV/AIDS spending estimate
from CMS, Office of the Actuary, 2005, and HHS
Office of the Budget, 2005.
22
Medicares Role in HIV/AIDS Care
Figure 17
Medicare Spending on HIV/AIDS Care as Percent of
Federal Spending on HIV/AIDS Care FY 2005

• Covers nearly 42 M seniors and persons with
  disabilities
• Second largest source of HIV/AIDS coverage
• 100,000 Medicare beneficiaries with HIV/AIDS,
• Many have supplemental assistance, including
  Medicaid and ADAP to pay for drugs
• New Medicare Part D Drug Coverage
• Concerns about adequacy of formularies and
  transition of Dual Eligibles (ARVs yes, other
  Rx?)
• Effect on ADAP?

Medicaid
Medicare 25 (2.9B)
All Other 75(8.8B)
Total 11.7 B
Sources Kaiser Family Foundation, Medicare and
HIV/AIDS, 9/05 Kaiser Family Foundation,
Medicare at a Glance, 9/05. Medicare HIV/AIDS
spending estimate from CMS, Office of the
Actuary, 2005, and HHS Office of the Budget,
2005.
23
The Ryan White CARE Act
Figure 18

• Original intent relief to safety net (public
  hospitals)
• Important safety-net for uninsured and low-income
  individuals
• Discretionary program, not entitlement
• Only disease-specific discretionary grant program
  for care for people with HIV/AIDS
• Builds on Medicaid
• Gap filler in terms of eligibility AND services
• Services provided include comprehensive primary
  care support services, medications
• What you get depends on where you live
• 2.1 B in FY 2005

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Components of the CARE Act
Figure 19

• Title I Eligible Metropolitan Areas (Cities)
• Title II Funding to States
• Includes earmark for AIDS Drug Assistance Program
  (ADAP)
• Title III Funds early intervention services,
  capacity building, planning
• Title IV Funds Services for Women, Youth,
  Children, Infants
• Other Funding for AIDS Education and Training
  Centers, Dental Services, Special Projects of
  National Significance

ADAP Clients, by Income Level, June 2004
Unknown 3
gt300 FPL 5
201-300 FPL, 11
lt100 FPL 51
101-200 FPL 29
Sources DHHS, HRSA, HIV/AIDS Bureau KFF,
NASTAD, National ADAP Monitoring Report, April,
2005.
25
HIV Prevention
Figure 20

• Centers for Disease Control and Prevention (CDC)
• Most prevention funding
• Funds go to states some cities community based
  organizations other entities/programs
• Additional prevention funding also at Department
  of Veterans Affairs, SAMHSA, and other agencies
• National HIV prevention goal (reduce new
  infections by 50 by 2005) was not met

HIV Prevention Funding at CDC, FY 1995-2005 (US
Millions)
589.8
616.8
All Other 51 (6.0B)
656.6
Medicare
749.7
Ryan White
793.6
731.7
Sources CDC, Personal Communication, 2006 CDC,
HIV Prevention Strategic Plan Through 2005.
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CDCs Advancing HIV Prevention New Strategies
for A Changing Epidemic
Figure 21

• Announced in 2003
• Aims to
• reduce barriers to early diagnosis of HIV
• increase access to quality medical care,
  treatment, and ongoing prevention services for
  with HIV.
• Four Main Strategies
• Incorporate HIV testing as a routine part of care
  in traditional medical settings
• Implement new models for diagnosing HIV
  infections outside medical settings (e.g., rapid
  testing)
• Prevent new infections by working with people
  diagnosed with HIV and their partners
• Further decrease mother-to-child HIV transmission

Sources CDC, Advancing HIV prevention New
strategies for a changing epidemic. MMWR
200352329-332 CDC, AHP http//www.cdc.gov/hiv/
prev_prog/AHP/default.htm.
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Key Summary Points about the Domestic Epidemic
Figure 22

• Approaching 25 years of AIDS
• Tremendous successes in the U.S. including
• significant reduction in new infections since the
  1980s
• antiretroviral treatment and people living longer
• reduction in mother to child transmission
• But the U.S. epidemic is not over - troubling
  signs, potential increases among some populations
• Impact varies across country complex local
• Minority Americans, particularly African
  Americans, women, young people, men who have sex
  with men
• Many challenges remain for prevention, care,
  treatment, and research