HIV/AIDS Epidemiology Partnership 11b

1
HIV/AIDS EpidemiologyPartnership 11b
Monroe County
Excluding Dept. of Corrections
Data as of 12/31/2004
2
A Few Words on the Instability of
Small Numbers When there are few cases to begin
with, a change of 1 or 2 can result in a
misleadingly high percentage change. For
example There were 10 HIV cases in 2002 and 12
in 2004. This would be a 20 increase, but an
increase of just 2 cases is not considered
substantive. Small numbers of cases also give
rise to unstable rates, for the same
reason. Trend lines may look erratic, too. For
this reason, some slides found in other
partnerships have been omitted in this
partnership slide set.
3
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

4
HIV Prevalence Estimates and Cumulative HIV
AIDS Cases, Partnership 11b, through 2004
5
AIDS Cases, Deaths and Persons Living with AIDS
(PLWA), by YearPartnership 11b, 1985-2004
AIDS cases by year of diagnosis. AIDS deaths by
year of death. The AIDS surveillance case
definition was expanded for adults/adolescents in
1993. Data as of 01/31/04.
6
Presumed Living MSM HIV/AIDS Cases by Zip Code,
Partnership 11b through 2004 (data as of 01/31/05)
Presumed Living MSM HIV/AIDS Cases
N506
NIRs are not redistributed. Includes MSM/IDU
cases.
7
Presumed Living IDU HIV/AIDS Cases by Zip Code,
Partnership 11b, through 2004 (data as of
01/31/05)
Presumed Living IDU HIV/AIDS Cases
N82
NIRs are not redistributed. Includes MSM/IDU
cases.
8
Presumed Living Heterosexual HIV/AIDS Cases by
Zip Code, Partnership 11b, through 2004 (data as
of 01/31/05)
Presumed Living Heterosexual HIV/AIDS Cases
N36
NIRs are not redistributed.
9
Presumed Living HIV/AIDS Cases by Zip Code and
Race/Ethnicity Partnership 11b, through
2004 (data as of 01/31/05)
N652
Total includes all races, some which are not on
map.
10
Presumed Living HIV/AIDS Cases by Zip Code and
Sex Partnership 11b, through 2004 (data as of
01/31/05)
N652
11
AIDS Case Rate per 100,000 Population by Year
of Report Partnership 11b, 1995-2004
Population rates calculated from annual
population estimates.
12
HIV Case Rate per 100,000 Population (HIV
regardless of AIDS status) by Year of Report,
Partnership 11b, 1998-2004
Population rates calculated from annual
population estimates. Data does not reflect HIV
incidence. HIV data includes those cases that
have converted to AIDS. These HIV cases cannot
be added with AIDS cases to get combined totals
since the categories are not mutually exclusive.
13
AIDS Cases and HIV (regardless of AIDS status)
Cases by Year of Report, Partnership 11b,
1985-2004
The AIDS surveillance case definition was
expanded for adults/adolescents in 1993. HIV
infection reporting was implemented July 1997.
A reporting blitz occurred in 1996. Comment
Active surveillance for AIDS cases results in
90 of diagnosed cases being reported. Reported
HIV cases tend to reflect more recent
transmission than AIDS cases. HIV (regardless of
AIDS status) cases includes those cases that
have converted to AIDS. These HIV cases cannot
be added with AIDS cases to get combined totals
since the categories are not mutually exclusive.
This is a preferred way to monitor temporal
trends in HIV infection. HIV case reporting has
greatly augmented the ability to characterize the
epidemic.
14
Resident HIV/AIDS Deathsby Year, Partnership
11b, 1995 - 2003
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.
15
Resident HIV/AIDS Death Rates Per 100,000
Population, by Race/Ethnicity, Partnership 11b,
2003
MALES Rate ratios BlacksWhites, 11
Source Office of Vital Statistics (Death Data)
DOH, Office of Planning, Evaluation and Data
Analysis (2003 Population Estimates)
16
Adult AIDS Cases by Sex and Year of
Report Partnership 11b, 1995-2004
17
Percent of Adult HIV Cases (regardless of AIDS
Status) by Sex and Year of Report Partnership
11b, 1998-2004
HIV data includes those cases that have converted
to AIDS. These HIV cases cannot be added with
AIDS cases to get combined totals since the
categories are not mutually exclusive.
18
Partnership 11b
Adult HIV Cases (regardless of AIDS status)
by Sex, 2004 (N35)
Adult AIDS Cases by Sex, 2004 (N42)
2000 Adult Census Population 47 Females and
53 Males
HIV data includes those cases that have converted
to AIDS. These HIV cases cannot be added with
AIDS cases to get combined totals since the
categories are not mutually exclusive.
19
Adult AIDS Cases by Race/Ethnicity and Year of
Report Partnership 11b, 1995-2004

• 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

20
Adult Male AIDS Cases by Race/Ethnicity and Year
of Report Partnership 11b, 1995-2004
21
Adult HIV Cases (regardless of AIDS status) by
Race/Ethnicity and Year of Report Partnership
11b, 1998-2004
HIV data includes those cases that have converted
to AIDS. These HIV cases cannot be added with
AIDS cases to get combined totals since the
categories are not mutually exclusive.
22
Adult Male HIV Cases (regardless of AIDS status)
by Race/Ethnicity and Year of Report Partnership
11b, 1998-2004
HIV data includes those cases that have converted
to AIDS. These HIV cases cannot be added with
AIDS cases to get combined totals since the
categories are not mutually exclusive.
23
Reported Adult AIDS Case Rates per 100,000
Populationby Sex and Race/EthnicityPartnership
11b, 2004
2004 FL Population Estimates, DOH, Office of
Planning, Evaluation and Data Analysis
24
Reported Adult HIV Case Rates per 100,000
Population(regardless of AIDS status)by Sex and
Race/Ethnicity Partnership 11b, 2004
2004 FL Population Estimates, DOH, Office of
Planning, Evaluation and Data Analysis HIV data
does not reflect HIV incidence. HIV data includes
those cases that have converted to AIDS. These
HIV cases cannot be added with AIDS cases to get
combined totals since the categories are not
mutually exclusive.
25
Adult HIV and AIDS Cases, by Race/Ethnicity
vs. Partnership 11b Population, 2004
HIV (regardless of AIDS)
AIDS
2004 Partnership 11b Population
N71,867
N 35
N 42
2004 Partnership 11b Population, DOH, Office of
Planning, Evaluation and Data Analysis. Other
includes Asian/Pacific Islander, or American
Indian/Alaska Native, Multiracial or Other
race. HIV data includes those cases that have
converted to AIDS. These HIV cases cannot be
added with AIDS cases to get combined totals
since the categories are not mutually exclusive.
26
Living HIV and AIDS Casesby Sex and Race
Ethnicity Partnership 11b, through 2004
Males (N653)
Females (N58)
27
Percent of Adult AIDS Cases by Selected Age
Groups Partnership 11b, 1995-2004
28
Adult HIV Cases (regardless of AIDS Status) by
Selected Age Groups Partnership 11b, 1998-2004
HIV data includes those cases that have converted
to AIDS. These HIV cases cannot be added with
AIDS cases to get combined totals since the
categories are not mutually exclusive.
29
Partnership 11b
Adult HIV Cases (regardless of AIDS status) by
Age group at dx 2004, (N35)
Adult AIDS Cases by Age group at dx 2004, (N42)
Percent
Percent
HIV data includes those cases that have converted
to AIDS. These HIV cases cannot be added with
AIDS cases to get combined totals since the
categories are not mutually exclusive.
30
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.
• NIR - No identified risk. Information regarding
  risk for HIV was unknown, not determined or
  denied. This information is updated when
  determined.

31
Adult AIDS Cases by Exposure Category and Year of
Report Partnership 11b, 1995-2004
Note NIRs redistributed.
32
Adult HIV Cases (regardless of AIDS status) by
Exposure Category and Year of Report
Partnership 11b, 1998-2004
HIV data includes those cases that have converted
to AIDS. These HIV cases cannot be added with
AIDS cases to get combined totals since the
categories are not mutually exclusive.
Note NIRs redistributed.
33
Cumulative Adult AIDS Cases by Mode of Exposure
and Sex Partnership 11b, Data through 2004
Males (N1,095)
Females (N69)
Note NIRs redistributed.
34
Annual Prevalence Adult Male HIV/AIDS Cases by
Mode of Exposure (NIRs redistributed)
Partnership 11b, Reported 1990-2004
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 03/20/05).
35
Annual Prevalence Adult Female HIV/AIDS Cases by
Mode of Exposure (NIRs redistributed)
Partnership 11b, Reported 1995-2004
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 03/20/05).
36
Percentage of Reported HIV/AIDS Cases By Age,
Partnership 11b, 2000 Through 2004
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 14 by age at diagnosis 3 by current
age 50 yr 12 by age at diagnosis. 29 by
current age.
By Age at Diagnosis HIV cases plus AIDS cases,
Diagnosed from 2000 2004, N452
By Current Age PLWHAs through 2004, N656


37
Living HIV/AIDS Casesby Sex and Race/Ethnicity
Partnership 11b, Data through 2004
Males N597
Females N57
Data as of March 20, 2005
38
Living Adult Male HIV/AIDS Cases (PLWHAs) by
Race/Ethnicity and Mode of Exposure Partnership
11b, Data through 2004
White, non-Hispanic N(485)
Black, non-Hispanic N(41)
Hispanic N(64)
Hetero
MSM
IDU
Comment Among male PLWHAs, the distribution of
risk among blacks differs from that among whites
and Hispanics.
Adjustments have been made to redistribute NIR
cases. Data as of March 20, 2005.
39
Living Adult Female HIV/AIDS Cases (PLWHAs) by
Race/Ethnicity and Mode of Exposure Partnership
11b, Data through 2004
White, non-Hispanic N(31)
Black, non-Hispanic N(19)
Hispanic N(6)
Hetero.
IDU
Comment Among female PLWHAs, the distribution of
risk among whites differs from that among blacks
and Hispanics.
Adjustments have been made to redistribute NIR
cases. Data as of March 20, 2005.
40
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
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• 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
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For Florida HIV/AIDS Surveillance Data Contact
[phone] Lorene Maddox, MPH Ext.
2613 Tracina Bush Ext. 2612 Deslyn
Thornhill, MPH Ext. 2517 Internet
http//www.doh.state.fl.us/disease_ctrl/aids/index
.html Intranet http//dohiws.doh.state.fl.us