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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]