HIVAIDS Epidemiology Partnership 10

1
HIV/AIDS EpidemiologyPartnership 10
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 10, through 2005
4
AIDS Cases, Case Deaths and Persons Living with
AIDS (PLWA), by YearPartnership 10, 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.
5
Presumed Living MSM HIV/AIDS Cases By Zip Code,
Partnership 10, through 2005
Presumed Living MSM HIV/AIDS Cases
N4,986
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 By Zip Code,
Partnership 10, through 2005
N1,175
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 By
Zip Code, Partnership 10, through 2005
N3,633
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 10, through 2005
N12,461
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
Presumed Living HIV/AIDS Cases By Zip Code and
Sex Partnership 10, through 2005
N12,747
Excludes DOC, homeless, and cases with unknown
zips. Data as of 04/05/06
10
AIDS Cases By Year of Report, Partnership 10,
1996-2005
Era of HAART
Comment The advent of HAART was associated with
decreases in AIDS cases in the late 1990s.
Generally, AIDS cases Fluctuated in the early
2000s, 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 10, 1996-2005
Population rates calculated from annual
population estimates. Comment The advent of
HAART was associated with decreases in AIDS cases
in the late 1990s. Newly reported AIDS cases
fluctuated in the early 2000s, 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 10,
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 10, 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 10, 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 6 in HIV cases and an increase of
26 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
Adult AIDS Cases by Sex and Year of
Report Partnership 10, 1996-2005
MF Ratio 1996 2.51 2005 2.31
Comment AIDS cases tend to represent HIV
transmission that occurred many years ago. The
relative increases in male 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
Adult HIV Cases by Sex and Year of
Report Partnership 10, 1998-2005
MF Ratio 1996 1.51 2005 2.91
Comment The trend for HIV cases by sex is the
same 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 10
Adult HIV Cases by Sex, 2005 (N1,011)
Adult AIDS Cases by Sex, 2005 (N824)
Comment Partnership 10s Adult Population is
50 Male and 50 Female, therefore male cases are
disproportionately impacted.
18
Adult AIDS Cases by Race/Ethnicity and Year of
Report Partnership 10, 1996-2005

• Factors Affecting Disparities
• Late diagnosis of HIV.
• Access to/acceptance of care.
• Delayed prevention messages.
• Stigma.
• Non-HIV STDs in the community.
• Prevalence of injection drug use.
• Complex matrix of factors related to
  socioeconomic status

Comment In 2005, blacks accounted for 84 of
reported AIDS cases, but only 21 of the
population. Hispanic cases remained fairly
stable at 6 in 1996 to 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
Adult Male AIDS Cases by Race/Ethnicity and Year
of Report Partnership 10, 1996-2005
Comment For most of the past 10 years, white and
black males have fluctuated over time accounting
for more than 50 of AIDS cases among men.
Other races represent less than 1 of the cases
and are not included.
20
Adult Female AIDS Cases by Race/Ethnicity and
Year of Report Partnership 10, 1996-2005
Comment For most of the past 10 years, black
women accounted for more than 70 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 10, 1998-2005
Comment In absolute numbers, from 2000-2005, HIV
cases among blacks decreased by 22, while
increasing by 66 among whites. The decreases
among blacks may correspond to some extent with
recent targeted prevention, while the increases
among whites may be associated with recent
increases in HIV transmission among white MSM.
22
Percent of Adult Male HIV Cases by Race/Ethnicity
and Year of Report Partnership 10, 1998-2005
Comment The percent of black male HIV cases has
decreased from 57 in 1998 to 31 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
Percent of Adult Female HIV Cases by
Race/Ethnicity and Year of Report Partnership 10,
1998-2005
Comment Although the majority of HIV cases among
women are black, the percent of black female HIV
cases has decreased from 78 in 1998 to 76 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
10, 2005
MALES Rate ratios BlacksWhites, 3.01
HispanicsWhites, 1.01 FEMALES Rate ratios
BlackWhites, 27.11 HispanicsWhites, 2.21
Comment Among black males, the AIDS case rate is
3 times higher than among white males. Among
black females, the AIDS case rate is 27-fold
greater than among white females. Hispanic male
rates are 1 time higher and Hispanic female
rates are 2 times higher than the rates among
their white counterparts. 2005 Partnership 10
Population Estimates, DOH, Office of Planning,
Evaluation and Data Analysis.
25
Reported HIV Case Rates per 100,000 PopulationBy
Sex and Race/Ethnicity, Partnership 10, 2005
MALES Rate ratios BlacksWhites, 2.01
HispanicsWhites, 1.01 FEMALES Rate ratios
BlackWhites, 18.31 HispanicsWhites, 3.31
Comment Among black males, the HIV case rate is
2 times higher than among white males. Among
black females, the AIDS case rate is 18-fold
greater than among white females. Hispanic male
rates are 1 time higher and Hispanic female
rates are 3 times higher than the rates among
their white counterparts. 2005 Partnership 10
Population Estimates, DOH, Office of Planning,
Evaluation and Data Analysis.
26
Adult HIV and AIDS Cases, by Race/Ethnicity And
Partnership 10 Population Estimates, 2005
2005 Partnership 10 Population Estimates
(N1,464,500)
AIDS (N824)
HIV (N1,011)
Comment In this snapshot of 2005, blacks are
over-represented among the AIDS cases, accounting
for 56 of adult cases, but only 21 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 10 Population
Estimates, Adults (Ages 13), DOH, Office of
Planning, Evaluation and Data Analysis
27
Adult AIDS Cases by Sex and Race/EthnicityPartner
ship 10, 2005
Females (N249)
Males (N575)
Comment In this snapshot of 2005, blacks are
over-represented among the AIDS cases, accounting
for 46 of adult cases among men and 86 of the
adult cases among women. Other includes
Asian/Pacific Islanders and Native
Alaskans/American Indians
28
Adult HIV Cases by Sex and Race/EthnicityPartners
hip 10, 2005
Males (N752)
Females (N259)
Comment In this snapshot of 2005, blacks are
over-represented among the HIV cases, accounting
for 32 of adult cases among men and 78 of the
adult cases among women.
29
Percent of AIDS Cases By Age of Diagnosis and
Year of Report Partnership 10, 1996-2005
Comment The percent of newly reported cases has
shown increases among the 40-49 and 50 age
groups over the past several years.
30
Percent of Adult HIV Cases By Age Group,
Partnership 10, 1998-2005
Comment The percent of newly reported cases has
shown increases among the 40-49 and 50 age
groups over the past several years.
31
Percent of Adult AIDS Cases by Sex and Age Group
at Diagnosis Partnership 10, 2005
Males (N575)
Females (N249)
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 10, 2005
Males (N752)
Females (N259)
Percent
Percent
Note HIV cases tend to be younger than AIDS
cases 15 of male HIV cases and 27 of female
HIV cases occur among those aged 13-29, compared
with only 8 of male AIDS cases and 22 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 10, 1996-2005
Comment From 2000 2005, MSM AIDS cases
increased by 9, while heterosexual male cases
increased by 31 and IDU male cases decreased 36.
Note NIRs redistributed.
35
Adult Female AIDS Cases by Exposure Category and
Year of Report, Partnership 10, 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 10, 1998-2005
Comment From 2000 2005, MSM HIV cases
increased by 91, while heterosexual male cases
decreased by 16 and IDU male cases decreased 53.
Note NIRs redistributed.
37
Adult Female HIV Cases by Exposure Category and
Year of Report, Partnership 10, 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 10, 2005
AIDS (N575)
HIV (N752)
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 10, 2005
Note NIRs redistributed.
AIDS (N249)
HIV (N259)
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 10, 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 PLWHAs represent
those in need of care and secondary prevention
initiatives to prevent further transmission. The
increase in number of PLWHAs 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 04/05/06).
41
Annual Prevalence Adult Female HIV/AIDS Cases By
Mode of Exposure (NIRs redistributed)
Partnership 10, 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 PLWHAs represent
those in need of care and secondary prevention
initiatives to prevent further transmission. The
increase in number of PLWHAs 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 04/05/06).
42
Percentage of Reported HIV/AIDS Cases By Age of
Diagnosis vs. Current Age, Partnership 10
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 18 by age at diagnosis 8 by current
age 50 yr 15 by age at diagnosis. 26 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)7,173
PLWHAs thru 200512,877
43
Living Adult HIV/AIDS CasesBy Sex and
Race/Ethnicity Partnership 10, through December
2005
Males N8,842
Females N4,035
Comment In this snapshot of of living HIV/AIDS
cases through 2005, the majority of males are
white (45) and the majority of females are black
(80). 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 10, through
2005
MALES Rate ratios BlacksWhites, 21
HispanicsWhites, 10 FEMALES Rate ratios
BlackWhites, 171 HispanicsWhites, 21
Comment Among black males, the HIV/AIDS case
rate for cases alive and reported through 2005 is
2 times higher than among white males. Among
black females, the AIDS case rate is 17 times
higher than among white females. Hispanic male
rates 1 times higher and Hispanic female rates
are 2 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
10, Data through 2005
White, non-Hispanic N(3,963)
Black, non-Hispanic N(3,444)
Hispanic N(1,206)
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
10, Data through 2005
White, non-Hispanic N(444)
Black, non-Hispanic N(3,179)
Hispanic N(260)
Heterosexual
IDU

• Comment Among female PLWHAs, the distribution of
  risk among whites differs from that among 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 10,
1995 - 2004
Source Office of Vital Statistics, Death
CertificatesA 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 10,
2004
MALES Rate ratios BlacksWhites,
31 FEMALES Rate ratios BlackWhites, 161
Other includes Asian/Pacific Islander, American
Indian/Alaska Native, Multiracial and/or
Other/Unknown races. Comment In 2004, black
males were 3 times as likely as white males to
die of HIV/AIDS. The HIV/AIDS death rate among
black females was 19 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_ct
rl/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
529-37
51
For Florida HIV/AIDS Surveillance Data Contact
[phone] Lorene Maddox, MPH Ext.
2613 Tracina Bush Ext. 2612 Allison
Herring, BS Ext. 2517 Internet
http//www.doh.state.fl.us/disease_ctrl/aids/index
.html Intranet http//dohiws.doh.state.fl.u
s