Download HIV/AIDS in Michigan January 1, 2009

HIV/AIDS in Michigan
January 1, 2009
Michigan Department of Community Health
HIV/STD/VH/TB Epidemiology Section
Division of Communicable Diseases
Bureau of Epidemiology
Thanks go to Jada Koushik of the Section staff for creating this slide set.
1
Quarterly HIV/AIDS Report,
Michigan
January 2009
„
„
This presentation was created as a
companion to the Quarterly HIV/AIDS
Report for January 1, 2009.
Please refer to the quarterly report for
further details, definitions and technical
notes.
2
Section 1
Data on Prevalent Cases
3
Estimate of HIV Prevalence
The prevalence estimate is based on, and includes, the
number of persons with HIV/AIDS reported by name
but also contains:
• Persons who have not yet been tested
• Persons tested but not yet reported to MDCH
• Persons tested but reported anonymously
These slides present both estimated prevalence as well as reported
prevalence. This slide defines these terms while the next one illustrates the
HIV prevalence estimates for Michigan.
HIV prevalence estimates in this report are based on adding the
following three components and rounding: 1) the number of cases
living with HIV/AIDS, 2) the number of known HIV+ cases not yet
reported by name, estimated at 10 percent of the reported living
HIV/AIDS cases, and 3) the number of HIV+ cases that have not
yet been tested, estimated at 21 percent of the total cases living
with HIV/AIDS (identical to the CDC estimate).
44
# Persons est. or reported living with HIV/AIDS
Persons living in MI with HIV/AIDS
by Sex
18000
18200
16000
14000
13878
12000
14030
Estimate of HIV
Prevalence
10696
10000
8000
6000
4170
4000
Reported Living
with HIV/AIDS
3182
2000
0
Total
Male
Female
The yellow bars display MDCHs estimate and includes unreported and untested
persons. The blue bars represent the total number of persons reported with
HIV/AIDS in the categories displayed at the bottom of the bars.
5
10000
Estimate of HIV
Prevalence
8000
Reported Living
with HIV/AIDS
6000
4000
Multi, Unk
& Other
Asian &
Am Indian
Hispanic
0
Black
2000
White
# Persons est. or reported living with HIV/AIDS
Persons living in MI with HIV/AIDS
by Race & Ethnicity
To put these data in perspective, 59% of infected people are black while the State of
Michigan’s population is approximately 14% black.
The yellow bars display MDCHs estimate and includes unreported and untested
persons. The blue bars represent the total number of persons reported with
HIV/AIDS in the categories displayed at the bottom of the bars.
6
7000
Estimate of
HIV
Prevalence
6000
5000
4000
Reported
Living with
HIV/AIDS
3000
2000
Unk
60+
50-59
40-49
30-39
25-29
20-24
0
13-19
1000
0-12
# Persons est. or reported living with HIV/AIDS
Persons living in MI with HIV/AIDS
by Age at Diagnosis, Ages 0-60+
The yellow bars display MDCHs estimate and includes unreported and untested
persons. The blue bars represent the total number of persons reported with
HIV/AIDS in the categories displayed at the bottom of the bars.
7
Reported Prevalence
Reported Living with HIV/not AIDS:
All living persons confidentially reported with HIV infection,
excluding those with AIDS.
Reported Living with AIDS:
All living persons confidentially reported who meet the AIDS
case definition.
Reported Living with HIV/AIDS:
All living persons confidentially reported with HIV infection,
including those with AIDS.
Reported prevalence includes persons who were living in Michigan at the time of
their initial HIV diagnosis, regardless of current residence. This follows CDC policy
on assigning residence.
84
Reported Persons Living with HIV/AIDS
in MI by Sex & Race (n=13,878)
5814
4341
5000
4000
2353
3000
2000
125
Hispanic
females
435
Hispanic
males
Black
females
White
males
0
White
females
632
1000
Black
males
Reported Prevalence
6000
*These categories are arranged by number of cases from
high to low.
Reported Prevalence by SEX & RACE (n=13,878)
All Males
10,696
White Males
4,241
Black Males
5,814
Hispanic Males
435
Other Males
206
All Females
3,182
White Females
632
Black Females
2,353
Hispanic Females 125
Other Females
72
9
861
900
750
600
450
313
208
109
150
Hispanic
males
White
females
Black
females
White
males
0
67
16
Hispanic
females
300
Black
males
Rates Per 100,000 Population
Prevalence Rates of Reported Persons Living with
HIV/AIDS in MI by Sex & Race
Prevalence Rates Per 100,000 Population by SEX & RACE
All Males
215
White Males
109
Black Males
861
Hispanic Males
208
Other Males
97
All Females
62
White Females
16
Black Females
313
Hispanic Females 67
Other Females
34
10
Reported Persons Living with
HIV/AIDS in MI by Race (n=13,878)
8167
8000
6000
4873
5000
4000
3000
Asian/PI
Hispanic
White
0
66
44
168
Multi, Unk
& Other
560
1000
Am
Indian/AN
2000
Black
Reported Prevalence
7000
Reported Prevalence by RACE
Black
8,167
White
4,873
Hispanic
560
Asian/PI
66
Am Indian/AN
44
Multi/Unk/Other
168
11
573
NOTE: Rates are not available for
“Multi, Unk & Other” category.
600
500
400
300
141
200
81
62
Asian/PI
Hispanic
White
0
Am
Indian/AN
28
100
Black
Rates Per 100,000 Population
Prevalence Rates of Reported Persons Living with
HIV/AIDS in MI by Race
*Please note that rates are not available for Multi, Unk, &
Other category.
Prevalence Rates Per 100,000 Population by RACE
Black
573
White
62
Hispanic
141
Asian/PI
28
Am Indian/AN
81
No rate is shown for the multi/unk/other category because the population
size needed for the denominator is unknown
12
Risk Transmission Categories
•Risk transmission categories are the hierarchical risk
categories that have been used for displaying HIV
transmission risk in Michigan and national HIV/AIDS
statistics since the 1980’s.
•The order from top to bottom is meant to represent the
most likely route through which HIV is transmitted, and
thus implies that some modes of transmission are more
efficient than others.
Risk Transmission Categories
Risk transmission categories are the hierarchical risk categories
that have been used for displaying HIV transmission risk in the
Michigan and national HIV/AIDS statistics since the 1980’s. When
the transmission categories were created, the order from top to
bottom was meant to represent the most likely route through
which HIV was transmitted, and thus implies that some modes of
transmission are more efficient than others. The hierarchy was
established based on what was known at the beginning of the
epidemic about how HIV was transmitted, when almost all cases
were among men and there was little documented heterosexual
transmission. Since then, the hierarchy has not changed
appreciably even though our understanding of the most efficient
HIV transmission routes has changed.
1335
Persons Living with HIV/AIDS
by Risk (n=13,878)
MSM
47%
IDU
12%
MSM/IDU
4%
Blood
1%
Undetermined
17%
Perinatal
1%
Heterosexual
18%
Heterosexual category includes:
HRH (High Risk Heterosexuals)
Males and females whose sexual partners are known to be HIV-infected or at high
risk for HIV. The partners meet one of the following criteria: a history of sexual
contact with bi-sexual males (for females), IDU, hemophiliacs, HIV+ transfusion
recipients, or other HIV+ persons of unknown risk.
PH (Presumed Heterosexual)-Female
Females whose only reported risk is heterosexual contact, and their male partners'
risk and HIV status is unknown.
IDU (Injection Drug User)
Persons who have a history of injecting drugs.
Perinatal
HIV transmission from mother to child during birth or through breastfeeding.
MSM (Men who have sex with men)
Males who have a history of sexual contact with other men or with both men and
women.
MSM/IDU
MSM who also have a history of injecting drugs.
Undetermined category includes:
PH (Presumed Heterosexual)-Male
Males whose only reported risk is heterosexual contact, and their female partners'
risk and HIV status is unknown. PH male is a subcategory of undetermined instead
of heterosexual (like the PH female cases) because of the likelihood that a
1419
Black Males Living with HIV/AIDS
by Risk (n =5,814)
IDU
13%
MSM
53%
MSM/IDU
6%
Blood
0%
Undetermined
21%
Perinatal
1%
Heterosexual
6%
Heterosexual category includes:
HRH (High Risk Heterosexuals)
Males whose sexual partners are known to be HIV-infected or at high risk for HIV.
The partners meet one of the following criteria: IDU, hemophiliacs, HIV+
transfusion recipients, or other HIV+ persons of unknown risk.
IDU (Injection Drug User)
Persons who have a history of injecting drugs.
Perinatal
HIV transmission from mother to child during birth or through breastfeeding.
MSM (Men who have sex with men)
Males who have a history of sexual contact with other men or with both men and
women.
MSM/IDU
MSM who also have a history of injecting drugs.
Undetermined category includes:
PH (Presumed Heterosexual)-Male
Males whose only reported risk is heterosexual contact, and their female partners'
risk and HIV status is unknown. PH male is a subcategory of undetermined instead
of heterosexual (like the PH female cases) because of the likelihood that a
proportion of these cases are likely MSM
Unknown
Males with no identified risk.
1523
White Males Living with HIV/AIDS
by Risk (n =4,241)
IDU
4%
MSM
75%
MSM/IDU
6%
Undetermined
11%
Blood
2%
Perinatal
0%
Heterosexual
2%
Heterosexual category includes:
HRH (High Risk Heterosexuals)
Males whose sexual partners are known to be HIV-infected or at high risk for HIV.
The partners meet one of the following criteria: IDU, hemophiliacs, HIV+
transfusion recipients, or other HIV+ persons of unknown risk.
IDU (Injection Drug User)
Persons who have a history of injecting drugs.
Perinatal
HIV transmission from mother to child during birth or through breastfeeding.
MSM (Men who have sex with men)
Males who have a history of sexual contact with other men or with both men and
women.
MSM/IDU
MSM who also have a history of injecting drugs.
Undetermined category includes:
PH (Presumed Heterosexual)-Male
Males whose only reported risk is heterosexual contact, and their female partners'
risk and HIV status is unknown. PH male is a subcategory of undetermined instead
of heterosexual (like the PH female cases) because of the likelihood that a
proportion of these cases are likely MSM
Unknown
Males with no identified risk.
1624
Black Females Living with HIV/AIDS
by Risk (n =2,353)
Heterosexual
59%
Perinatal
2%
Blood
0%
IDU
21%
Undetermined
17%
Heterosexual category includes:
HRH (High Risk Heterosexuals)
Females whose sexual partners are known to be HIV-infected or at high risk for
HIV. The partners meet one of the following criteria: a history of sexual contact
with bi-sexual males, IDU, hemophiliacs, HIV+ transfusion recipients, or other
HIV+ persons of unknown risk.
PH (Presumed Heterosexual)-Female
Females whose only reported risk is heterosexual contact, and their male partners'
risk and HIV status is unknown.
IDU (Injection Drug User)
Persons who have a history of injecting drugs.
Perinatal
HIV transmission from mother to child during birth or through breastfeeding.
Undetermined category includes:
Unknown
Females with no identified risk.
1722
White Females Living with HIV/AIDS
by Risk (n =632)
Perinatal
2%
Undetermined
11%
IDU
18%
Heterosexual
67%
Blood
1%
Heterosexual category includes:
HRH (High Risk Heterosexuals)
Females whose sexual partners are known to be HIV-infected or at high risk for
HIV. The partners meet one of the following criteria: a history of sexual contact
with bi-sexual males, IDU, hemophiliacs, HIV+ transfusion recipients, or other
HIV+ persons of unknown risk.
PH (Presumed Heterosexual)-Female
Females whose only reported risk is heterosexual contact, and their male partners'
risk and HIV status is unknown.
IDU (Injection Drug User)
Persons who have a history of injecting drugs.
Perinatal
HIV transmission from mother to child during birth or through breastfeeding.
Undetermined category includes:
Unknown
Females with no identified risk.
1825
Exposure Categories
•Exposure categories convey all risks that a person is
documented to have engaged in that could have exposed
him or her to HIV.
•Like the traditional risk hierarchy categories, the exposure
categories are mutually exclusive, meaning that each
person is only included in one category.
•Michigan is unique in that it is the first state to display
mode of transmission using exposure categories.
Exposure Categories
The ‘Exposure Categories’ convey all risks that a person is
documented to have engaged in that could have exposed him or
her to HIV. Like the traditional risk hierarchy categories, the
Exposure Categories are mutually exclusive, meaning that each
person is only included in one category. However, the categories,
as presented, allow readers to see all the ways in which a person
may have been infected with HIV and, with the exception of
undetermined risk, are displayed in decreasing order of frequency.
1935
Exposure Categories for Prevalent
HIV/AIDS Cases (n=13,878)
MSM-44%
Any IDU 16%
Any MSM 52%
MSM & HRH-4%
MSM & IDU-3%
MSM, IDU & HRH-1%
MSM & Blood Products-0%
Heterosexual-18%
HRH & IDU-5%
IDU-6%
IDU & Blood Products-0%
Perinatal Exp-1%
Any Heterosexual 42%
Blood Products-1%
Undetermined-17%
NOTE: The “Any” percentages on this slide overlap
Exposure Categories are mutually exclusive: Each case is only
represented in one category. However, the “Any” summary
percentages on this slide are not mutually exclusive, that is, a
case can be counted in more than one category. For example, an
MSM/IDU is counted in both the Any MSM % and the Any IDU %.
20
Exposure Categories for Prevalent
HIV/AIDS Cases, Males Only (n=10,696)
MSM-57%
Any IDU 15%
Any MSM 67%
MSM & HRH-5%
MSM & IDU-4%
MSM, IDU & HRH-2%
MSM & Blood Products-0%
Heterosexual-5%
HRH & IDU-4%
IDU-6%
IDU & Blood Products-0%
Perinatal Exp-1%
Blood Products-1%
Any Heterosexual 33%
Undetermined-17%
NOTE: The “Any” percentages on this slide overlap
Exposure Categories are mutually exclusive: Each case is only
represented in one category. However, the “Any” summary
percentages on this slide are not mutually exclusive, that is, a
case can be counted in more than one category. For example an
MSM/IDU is counted in both the Any MSM % and the Any IDU %.
21
Exposure Categories for Prevalent
HIV/AIDS Cases, Females Only (n=3,182)
Heterosexual-62%
Any IDU 16%
HRH & IDU-11%
IDU-9%
IDU & Blood Products-0%
Perinatal Exp-2%
Blood Products-0%
Any Heterosexual 73%
Undetermined-16%
NOTE: The “Any” percentages on this slide overlap
Exposure Categories are mutually exclusive: Each case is only
represented in one category. However, the “Any” summary
percentages on this slide are not mutually exclusive, that is, a
case can be counted in more than one category. For example a
woman who is HRH and IDU is counted in both the Any
Heterosexual % and the Any IDU %.
22
Section 2
New Diagnoses, Deaths,
Prevalence
23
New Diagnoses, Deaths, and Prevalence of HIV/AIDS by Year
NOTE: New diagnoses
are not adjusted for
reporting delay so the
decrease is due to
reporting lag and not a
true decrease
The increase in HIV prevalence shows that the number of persons
diagnosed, while stable for the last several years, is greater than
the number of deaths each year. This directly contributes to the
increase in prevalence. The current reported prevalence of
HIV/AIDS in Michigan is 13,878. The prevalence of AIDS, which is
a subset of HIV/AIDS prevalence, is 7,410.
24
HIV/AIDS Deaths in MI by Race & Sex
NOTE: Deaths occurring in 2007 and 2008 are not complete at this time
This figure shows the number of HIV-infected Michigan
residents who have been reported as deceased by a local
health department, the department of vital records via a
data match or death certificate, or an alternate source.
The number of deaths increased in all race/sex groups
from the beginning of the epidemic through
approximately 1994-1995. The number of deaths
decreased markedly between 1995 and 1998 and then
were relatively stable until 2001. It should be noted that
the percent decrease in deaths among white males
(73%) between 1995 and 2001 was more pronounced
than the percent decrease among black males (57%),
and the percent decrease among white females (55%)
was larger than the percent decrease among black
females (38%). Encouragingly, the number of deaths in
black males has fallen substantially from 2001 to 2005
(40%), even in comparison to white males (24%), black
females (25%), and white females (11%), but the
number of deaths among black males still exceeds that
of any other race/sex group.
25
Black Males
White Males
Black Females
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
500
450
400
350
300
250
200
150
100
50
0
1987
Number of Deaths
HIV Related Deaths in MI
by Race & Sex 1987-2006 (All Ages)
White Females
Year of Death
In 2006 for the first time the number of HIV deaths among black
women exceeded those among white men.
26
Leading Causes of Death Among Black Men
in MI, 1990-2006 (Ages 25-44)
1. Homicide
300
2. Heart
Disease
250
3. Accidents
200
4. Cancer
150
5. HIV/AIDS
100
6. Suicide
50
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
0
1990
Number of Deaths
350
Year of Death
27
Leading Causes of Death Among White Men
in MI, 1990-2006 (Ages 25-44)
600
1. Accidents
2. Heart Disease
400
3. Suicide
300
4. Cancer
200
5. Cirrhosis
13. HIV/AIDS
100
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
0
1990
Number of Deaths
500
Year of Death
28
Leading Causes of Death Among Black Women
in MI, 1990-2006 (Ages 25-44)
120
1. Cancer
2. Heart
Disease
3. Homicide
80
4. Accidents
60
5. Stroke
40
5. HIV/AIDS
20
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
0
1990
Number of Deaths
100
Year of Death
29
Leading Causes of Death Among White Women
in MI, 1990-2006 (Ages 25-44)
400
1. Cancer
2. Accidents
300
3. Heart
Disease
4. Suicide
250
200
5. Cirrhosis
150
14. HIV/AIDS
100
50
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
0
1990
Number of Deaths
350
Year of Death
30
Section 3
Geographic Distribution of
HIV/AIDS
31
Reported HIV Prevalence and Prevalence Rates by
Residence at Diagnosis
*To mitigate the effect of small numbers of cases, reported HIV prevalence
rates and case numbers for multi-county health departments are listed for
the health department as a whole and not the individual counties.
32
Section 4
Information on Perinatally
HIV Exposed Infants
33
Infection Status of Perinatal HIV
Exposures, 2001-2008
Number of Infants
75
60
45
19
28
41
38
31
30
34
15
0
36
28
17
4
2002
17
Unknown
Not Infected
HIV or AIDS
32
17
19
2
1
2
1
3
6 0
2003
2004
2005
2006
2007
2008
Since 1994, the CDC and other organizations involved in perinatal HIV
transmission have recommended that HIV-positive pregnant women receive doses
of zidovudine (ZDV or AZT) prenatally and at labor and delivery and that children
born to these women receive ZDV neonatally. Despite these recommendations,
only 57% of births to HIV-positive women are documented by MDCH to have
received all three arms of therapy. For more information, please see the annual
Missed Opportunity report, which can be found at:
http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_2982_46000_46003166892--,00.html
34