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HIV Epidemiology Trends
for Women, Adolescents,
and Children
Kate Goodin, MPH
Senior Epidemiologist
Florida Department of Health
Division of Disease Control and Health Protection
Bureau of Communicable Diseases
HIV/AIDS and Hepatitis Prevention Section
Disclosures of Financial Relationships
This speaker has no significant financial
relationships with commercial entities to
disclose.
This speaker will not discuss any off-label
use or investigational product during the
program.
This slide set has been peer-reviewed to ensure that there are no
conflicts of interest represented in the presentation.
Objectives
• Recognize the distribution and patterns
of HIV infection in these populations
• Discuss recent transmission trends
Background
• Information presented
– Reported cases of HIV infection, 2008-2011
– Measured data, not estimates
– Does not account for:
• Unreported
• Undiagnosed
OVERALL TRENDS
The Epidemic in Florida, 2011
Population: 18.8 million 
(4th
in nation)
Cumulative AIDS cases: 124,069
(3rd in nation)
60% White
16% Black
22% Hispanic
2% Other*
Cumulative pediatric AIDS cases: 1,543
(2nd in nation)
Cumulative HIV (not AIDS) cases: 47,695
(2nd in nation of 46 states with HIV name reporting)
Persons living with HIV/AIDS: 97,436 
(3rd in nation)
HIV prevalence estimate: at least 130,000
HIV Incidence Estimates are approximately
5,000 per year, 2006-2009
Deaths due to HIV/AIDS: 1,005 (2011)
*Other = Asian/Pacific Islanders; American Indians/Alaskan Natives; multi-racial.
Trend data as of 12/31/2011, Living data as of 05/16/2012
29% White
49% Black
20% Hispanic
2% Other*
Number of Cases
HIV Infection Cases and Rates*, by Year of Report,
Florida, 2002-2011
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year of Report
*Source: Population estimates are provided by FloridaCHARTS
HIV Infection Case Rates* by County of
Residence,** Reported in 2011, Florida
82
16
1
35
4
12
3
5
24
21
93
2
1
1
2
5
6
5
3
21
376
12
2
3
2
27
7
65
1
11
21
10
5
66
Statewide Data:
N=5,904
State Rate = 36.7
Rate per 100,000 population
71
7
7
49
14
75
494
62
244
337
72
65
140
14
49
0
0.1 to 15.0
15.1 to 30.0
> 30.0
3
10
11
50
6
15
19
2
404
119
4
1038
45
31
*Population data are from FloridaCHARTS
**County totals exclude Department of Corrections cases (N=169).
77
1441
WOMEN
Adult HIV Infection Cases, by Sex,
Reported in the United States* and Florida
U.S., 2010
Florida, 2011
N=47,129
N=6,027
24%
21%
Males
Females
79%
76%
*Source: US data, CDC HIV surveillance report, Vol. 22, Table 1a, 2011 data not available, HIV cases are
Estimated reports for 46 states with confidential HIV reporting.
Adult AIDS Cases by Sex, Reported in the
United States* and Florida
U.S., 2010
Florida, 2011
N=33,015
N=3,441
32%
25%
Males
Females
75%
*Source: US data, CDC HIV surveillance report, Vol. 22, Table 2a, 2011 data not available.
68%
Adult HIV Infection Cases, by Sex and
Race/Ethnicity, Reported in 2011, Florida
Males
Females
N=4,608
N=1,419
White
Black
Hispanic
Other*
25%
2%
15%
1%
19%
34%
39%
65%
*Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races
Adult Female HIV Infection Cases, by Mode of Exposure
and Year of Report, 2002–2011, Florida
2,500
Cases
2,000
1,500
1,000
500
0
2002
2003
2004
2005
2006
2007
2008
Year of Report
IDU
Note: NIRs redistributed.
Heterosexual
2009
2010
2011
Summary
• Overall HIV infections in Florida have
been decreasing
• About a quarter of new HIV infections in
Florida are in women
• However, about a third of new AIDS
diagnosis are in women
• New HIV infections in women are more
likely to be among black women
Blacks make up a majority of HIV
infection cases in both men and women
95%
A. True
B. False
se
Fa
l
Tr
ue
5%
PEDIATRIC AND PERINATAL
CASES
Perinatally Acquired HIV Infected Cases, Born in Florida,
by Year of Birth, 1979-2011
120
Number of Cases
100
80
60
40
20
0
1979 1982 1985 1988 1991 1994 1997 2000 2003 2006 2009
Year of Birth
Note: Includes all perinatally acquired HIV Infection cases born in Florida.
Perinatally Acquired HIV Infection Cases Born in Florida, by
Mother’s Mode of Exposure and Year of Birth, 1979-2011
Born 1979-1993
Born 1994-2011
N =626
N =567
Mother's risk
not specified
27%
15%
1%
0%
Heterosexual
contact
15%
Injection drug
use
17%
Transfusion
58%
67%
Time of Maternal HIV Testing Among Perinatally Acquired
HIV Infection Cases Born in Florida, 2005-2011 (N=79)
23%
1%
10%
Before Pregnancy (N=37)
During Pregnancy (N=14)
At Delivery (N=8)
After Birth (N=18)
Unknown (N=1)
18%
48%
Perinatally Acquired HIV Infection Cases in Children
Whose Mom’s HIV status was Known Prior to Delivery
Born in Florida 2005-2010
Adequate Prenatal Care
Began by
4th
Any Prenatal ART
month with 5+ visits
AZT and/or antiretrovirals
65%
41%
35%
59%
Yes
No
Perinatally Acquired HIV Infection Cases in Children
Whose Mom’s HIV status was Known Prior to Delivery
Born in Florida 2005-2010
ART During Labor
Elective Caesarean
Delivery
AZT and/or antiretrovirals
24%
61%
39%
76%
Yes
No
Perinatally Acquired HIV Infection Cases in Children
Born in Florida 2005-2010
Received any Neonatal ART
Breastfed
89%
76%
24%
11%
No
Yes
Cumulative Pediatric HIV/AIDS Cases, by “Expanded”
Modes of Exposure, Reported through 2011, Florida
2%
1%
1%
1%
25%
22% Mom-Injection Drug User
11% Mom-Sex w/ Injection Drug User
2% Mom-sex w/ Male Sex with Male
<1%
1%
34% Mom-sex w/ person w/ HIV/AIDS
1% Mom-Blood Recipient
22%
<1% Mom-sex w/ blood recipient
25% Mom-HIV/AIDS, Risk Unknown
2% Ped-Hemophilia*
1% Ped-Transfus/Transplant*
34%
1% Ped-Confirmed Other*
11%
2%
*Note: 5% (exploded pieces) are NOT perinatal transmission cases
1% Ped-No Identified Risk*
Summary
• Perinatal HIV infections have decreased
dramatically in Florida
• Over 50% of perinatal HIV infections
were born to mothers who did not know
their HIV status prior to conception
• Only about a third of mothers of
perinatally HIV infected babies received
adequate prenatal care
Perinatally acquired HIV infections are most commonly
associated with which maternal risk factor?
A. Injection drug use
B. Heterosexual
contact
C. Transfusions
D. Other
85%
10%
0%
A.
B.
C.
5%
D.
What proportion of perinatally acquired HIV infections were
born through elective caesarian?
A. 12%
B. 76%
C. 39%
D. 54%
41%
32%
14%
A.
B.
14%
C.
D.
ADOLESCENTS AND YOUNG
ADULTS
Reported HIV Cases in Those 13-24 Years of Age by Age Group
and Year of Diagnosis, Florida 2008-2011
1000
900
800
700
Count
600
500
400
300
200
100
0
2008
2009
2010
Year of Diagnosis
All Cases
13-19
20-24
2011
ADOLESCENT AND YOUNG
ADULT FEMALES
Reported HIV Cases in Females 13-24 Years of Age by Age Group
and Year of Diagnosis, Florida 2008-2011
300
250
Count
200
150
100
50
0
2008
2009
2010
Year of Diagnosis
All Cases
13-19
20-24
2011
Reported HIV Cases in Females 13-24 Years of Age by
Age Group and Transmission Category, Florida 2008-2011
13-19 Years of Age
NIR
10%
20-24 Years of Age
IDU
2%
Perinatal
1%
NIR
12%
IDU
4%
Other
0%
Perinatal
11%
Other
0%
Hetero
77%
Hetero
83%
ADOLESCENT AND YOUNG
ADULT MALES
Reported HIV Cases in Males 13-24 Years of Age by Age Group
and Year of Diagnosis, Florida 2008-2011
800
700
600
Count
500
400
300
200
100
0
2008
2009
2010
Year of Diagnosis
All Cases
13-19
20-24
2011
Reported HIV Cases in Males 13-24 Years of Age by Age
Group and Transmission Category, Florida 2008-2011
13-19 Years of Age
Other
0%
Hetero
10%
20-24 Years of Age
Perinatal
4%
NIR
5%
Hetero
9%
Perinatal
Other 0%
0%
NIR
5%
MSM/IDU
2%
IDU
1%
MSM/IDU
2%
IDU
1%
MSM
78%
MSM
83%
Reported HIV Cases in Males 13-19 Years of Age by
Transmission Category and Year of Diagnosis, Florida 2008-2011
2008
2009
3% 6%
6%
0%
2011
4%
1% 5%
0%
5%
0%
8%
1%
3%
2%
1%
1%
1%
0%
1%
79%
77%
5%
0%
11%
9%
10%
MSM
IDU
MSM/IDU
Hetero
Other
Perinatal
NIR
2010
81%
80%
Reported HIV Cases in Males 20-24 Years of Age by
Transmission Category and Year of Diagnosis, Florida 2008-2011
2010
2009
2008
0%
0%
0%
MSM
IDU
MSM/IDU
Hetero
Other
Perinatal
NIR
1%
0%
8%
0%
5%
2011
6%
7%
3%
2%
1%
1%
4%
1%
0%
4%
8%
10%
8%
0%
1%
1%
82%
80%
83%
84%
Reported HIV Cases in Males 13-24 Years of Age by Age Group
and Year of Diagnosis, Florida 2008-2011
20-24 Years of Age
140
350
120
300
100
250
80
200
Count
Count
13-19 Years of Age
60
150
40
100
20
50
0
0
2008
2009
2010
2011
2008
2009
Year of Diagnosis
Black
Hispanic
Other
2010
Year of Diagnosis
White
Black
Hispanic
Other
White
2011
Reported HIV Cases in Males 13-19 Years of Age by
Race/Ethnicity and Year of Diagnosis, Florida 2008-2011
Black
Hispanic
140
30
120
25
20
80
Count
Count
100
60
40
15
10
20
5
0
2008
2009
2010
2011
2008
Year of Diagnosis
Total
MSM
Hetero
25
Count
20
15
10
5
0
2010
Year of Diagnosis
Total
MSM
2010
Total
30
2009
2009
Year of Diagnosis
White
2008
0
Hetero
2011
MSM
Hetero
2011
Reported HIV Cases in Males 20-24 Years of Age by
Race/Ethnicity and Year of Diagnosis, Florida 2008-2011
Hispanic
350
140
300
120
250
100
200
80
Count
Count
Black
150
60
100
40
20
50
0
0
2008
2009
2010
2011
MSM
140
120
Count
100
80
60
40
20
0
2009
2010
Year of Diagnosis
Total
MSM
Hetero
2010
Total
Hetero
White
2008
2009
Year of Diagnosis
Year of Diagnosis
Total
2008
2011
MSM
Hetero
2011
Summary
• The number of new HIV infections in males
20-24 has been increasing over the past four
years
• This increase is seen in all racial/ethnic groups
• The number of new HIV infections among
males 13-19 has been decreasing over the
past four years
• This decrease is among black and Hispanics,
but there has been an increase among whites
The largest risk for transmission among
adolescent and young adult males is
A. Heterosexual
contact
B. Injection drug use
C. MSM
D. Perinatal infection
96%
4%
A.
0%
B.
0%
C.
D.
Among adolescents 13-19 years of age, all racial/ethnic groups
experienced a decrease in HIV infections reported in 2011
63%
A. True
B. False
se
Fa
l
Tr
ue
38%
Resources
Much of the information provided here was produced by the
Surveillance group within the HIV/AIDS and Hepatitis Prevention
Section. Additional information from them can be accessed at the
links below.
Florida Department of Health
http://www.doh.state.fl.us/Disease_ctrl/aids/index.html
Trends and Statistics
http://www.doh.state.fl.us/disease_ctrl/aids/trends/trends.html
Questions?
Contact Information:
Kate Goodin
850-245-4448
[email protected]