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7/17/2012

The HIV Epidemic in Alameda County


Neena Murgai, Ph.D., MPH Deputy Director, Epidemiology and Surveillance Director Collaborative Community Planning Council Meeting July 18th, 2012

Outline of Presentation

Newly Diagnosed HIV cases


Demographic characteristics Case rates by d demographic groups Trends in rates, overall and by demographic and risk groups Geographic distribution

Persons Living with HIV/AIDS


Demographic characteristics Demographic characteristics by each mode of transmission Geographic distribution

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Considerations in Interpreting Surveillance Data

Data likely underestimate true burden of HIV because:


Estimates of new diagnoses of HIV infection are subject to reporting delays Data only include persons who have been tested/diagnosed and reported to the health department HIV-infected persons who are unaware of their diagnosis/infection are not included

Data are li i d f certain groups, e.g. youth, D limited for i h transgendered persons, because of small counts or current reporting methods

Newly Diagnosed HIV Cases, Newly Diagnosed AIDS Cases, Deaths and Persons Living With HIV/AIDS, Alameda County 2006-2011
Indicator Number newly diagnosed HIV cases (with or without AIDS) Number newly diagnosed AIDS cases Number deaths Number of persons living with HIV/AIDS (PLWHA) 2006 2007 2008 2009 2010 2011* 624 233 225 94 281 238 90 203 169 87 247 143 95 213 80 50 164 65 22

4,111 4,302 4,418 4,570 4,733 4,875

Note: * Data in 2011 are subject to reporting delays and should be considered preliminary

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Data to Inform Prevention Priorities: New HIV Cases

Impact of new HIV diagnoses among groups- by sex, race/ethnicity, age, mode of transmission Comparison of burden among demographic groups (case rates) How HIV diagnoses have impacted these groups over time (trends) Concentration of new HIV diagnoses by city and region

Comparison of Newly Diagnosed HIV Cases and Alameda County Residents by Sex Newly Diagnosed HIV Cases 2009-2011(n= 624)
1% 16%
Male Female MTF

Alameda County 2010 (n=1,514,654)

49% 51%

Male Female

83%

Note: Data include persons diagnosed with HIV regardless of stage of disease (i.e., with or without AIDS)

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Comparison of Newly Diagnosed HIV Cases and Alameda County Residents by Race/Ethnicity Newly Diagnosed HIV Cases 2009-2011(n= 624)
2% 10% 25% 19%
White AfrAmer Latino API Other/Unk

Alameda County 2010 (n=1,514,654)


4%
White AfrAmer Latino API Other/Unk

27%

34%

44%

23%

12%

Note: Data include persons diagnosed with HIV regardless of stage of disease (i.e., with or without AIDS)

Comparison of Newly Diagnosed Male HIV Cases to Alameda County by Race/Ethnicity Newly Diagnosed HIV Cases 2009-2011 (n=526)
2% 10% 27% 20%
White AfrAmer Latino API Other/Unk

Alameda County Males (n=742,287)


5%
White AfrAmer Latino API Other/Unk

26%

34%

41%

23%

12%

Note: Data include persons diagnosed with HIV regardless of stage of disease (i.e., with or without AIDS)

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Comparison of Newly Diagnosed Female HIV Cases to Alameda County by Race/Ethnicity Newly Diagnosed HIV Cases 2009-2011 (n=98) Alameda County Females (n=771,967)
5% 8% 15% 17%
White AfrAmer Latino API Other/Unk White AfrAmer Latino API Other/Unk

27%

33%

60%

22%

13%

Note: Data include persons diagnosed with HIV regardless of stage of disease (i.e., with or without AIDS)

Comparison of Newly Diagnosed HIV Cases and Alameda County Residents by Age Group Newly Diagnosed HIV Cases 2009-2011(n= 624)
4% 19% 24% 16%
012yrs 1319yrs 2029yrs 3049yrs 50+yrs

Alameda County 2010 (n=1,514,654)

30% 9% 15% 30%

012yrs 1319yrs 2029yrs 3049yrs 50+

53%

Note: Data include persons diagnosed with HIV regardless of stage of disease (i.e., with or without AIDS)

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Newly Diagnosed Male and Female HIV Cases by Mode of Transmission, Alameda County 2009-2011

Male (n=526)

Female (n=98)

4% 6% 7% 10%
IDU Hetero Other MSM MSM&IDU

11.2% 36.7%
IDU Hetero Other

73%

52.0%

Note: Data include persons diagnosed with HIV regardless of stage of disease (i.e., with or without AIDS)

Annual Average Rates of Newly Diagnosed HIV Cases by Selected Characteristics, Alameda County 2009-2011
Three Year Average Number TOTAL SEX Male Female RACE/ETHNICITY White AfrAmer Af A Latino API Other/Unk 53 91 40 20 3 173 33 208 Three Year Average Rate per 100,000 13.7 23.3 4.2 10.3 49.5 11.6 5.0 5.5

5X 5X

Note: * Data in 2011 are subject to reporting delays and should be considered preliminary

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Average Annual Rates of Newly Diagnosed HIV Cases by Sex, Alameda County 2009-2011
25

23.3

20

R Ratesper100,000

15

13.7

~5X
4.2

10

0 Total Male Female

Sex

Average Annual Rates of Newly Diagnosed HIV Cases by Race/Ethnicity, Alameda County 2009-2011
60 50

49.5

Ratesper100,000

40 30 20

~5X
13.7 10.3

~5X
11.6 5.0 5.5

10 0 Total

White

AfrAmer

Latino

API

Other/Unk

Race/Ethnicity

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Average Annual Rates of Newly Diagnosed HIV Cases by Race/Ethnicity, Alameda County 2009-2011
60 50

49.5

Ratesper100,000

40 30 20 10 0 Total White AfrAmer Latino API Other/Unk

13.7

10.3

1X

11.6 5.0 5.5

Race/Ethnicity

Average Annual Rates of Newly Diagnosed HIV Cases by Age Group, Alameda County 2009-2011
30 25

23.2

24.1 24 1

24.0 24 0

Ratesper100,000

20 15 10

1X
13.7 14.7

5.8
5 0 Total 1319yrs 2029yrs 3039yrs 4049yrs 5059yrs 60yrs&over

3.6 36

AgeGroup

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Summary Findings:Characteristics of New HIV Cases

New HIV diagnoses in Alameda County are predominantly among males, African Americans, and MSM O 60% of HIV diagnoses among women are among Over f di African Americans; about half of new HIV diagnoses among women are attributed to heterosexual contact The burden of new HIV diagnoses among males is 5 times that for females African Americans bear 5 times the burden of new HIV diagnoses compared to Whites or L i di d hi Latinos Adults 20-49 years old have the greatest burden of new HIV diagnoses

Trends: Changes in HIV Diagnoses Over Time

Trends in rates can be variable due to small number of cases, especially in smaller subgroups cases Three years of data were combined to calculate average annual case rates for greater reliability Apparent changes in rates over time (decline or increase) may not be statistically significant because of variability despite using this approach Trends do highlight the impact of HIV among different groups over the course of the epidemic

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Trends in Newly Diagnosed HIV Cases by Sex, Alameda County 2006-2011


30 25 2 Rateper100,000 20 15 10 5 0 200810 200911 200608 200709

Female Male All

Trends in Newly Diagnosed HIV Cases by Race/Ethnicity, Alameda County 2006-2011


70 60 50 Rateper100,000 40 30 20 10 0 200608 200709 200810 200911 AfrAmer API Latino White All

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Trends Newly Diagnosed HIV Cases by Age Group, Alameda County 2006-2011
35 30 25 Rateper100,000 1319yrs 20 15 10 5 0 200810 200911 200608 200709 2029yrs 3039yrs 4049yrs 5059yrs 60&over All

Geographic Definitions: Region by Cities

North County: Albany, Berkeley Oakland Area: Oakland, Emeryville, Piedmont, Alameda Central County: San Leandro, San Lorenzo, Ashland, Cherryland, Fairview, Castro Valley, Hayward South County: Union City, Fremont, Newark, Sunol Tri-Valley: Livermore, Dublin, Pleasanton

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HIV Cases (2006-2011) by City and Region (n=1299) City


OAKLAND ALAMEDA EMERYVILLE PIEDMONT HAYWARD SANLEANDRO CASTROVALLEY SANLORENZO FREMONT UNIONCITY NEWARK BERKELEY ALBANY LIVERMORE DUBLIN PLEASANTON

Region
OaklandArea Central County SouthCounty

TriValley NorthCounty SouthCounty CentralCounty OaklandArea

NorthCounty N th C t

TriValley 0 200 400 600 800 0 500 1000

Summary Findings:Trends and Geographic Concentration

Between 2006 and 2011 HIV case rates remained stable among males and females Th There was an slight d li i case rates among Af i li ht decline in t African Americans in recent years; however this apparent decline is not statistically significant Among 20-49 year olds, case rates declined slightly in the last 3 years New cases of HIV are predominantly in the Oakland and Central C C l County areas and most concentrated i the cities of d d in h i i f Oakland, Hayward, San Leandro, and Berkeley.

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AIDS Cases, Deaths and Persons Living with AIDS (PLWA) by Calendar Year, Alameda County 1980-2011
4,000 3,500 3,000 2,500 Number 2,000 1,500 1,000 500 0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 CalendarYear AIDScasesdiagnosed Deaths PLWA

ART

HAART

Data to Inform Priorities in Care and Services: PLWHA

Proportions of PLWHA by demographics and mode of transmission can highlight priority populations f HIV care and services l ti for d i Demographic composition by mode can further highlight important target populations Geographic location/concentration of PLWHA in the county can help identify areas of need and gaps i access to HIV care and services in d i

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PLWHA Males and Females by Race/Ethnicity, Alameda County 2011

Males (n=3969)

Females (n=906)

4% 3%
White

4% 3% 12% 15%
White AfrAmer Latino API Other/Unk

17%

36%

AfrAmer Latino API Other/Unk

40%

66%

PLWHA Male and Females by Age Group, Alameda County 2011

Males (n=3969)
0.2% 0.3% 6%
012yrs 1319yrs 2029yrs

Females (n=906)
1% 1% 6%
012yrs

49% 45%

40%

1319yrs 2029yrs 3049yrs

3049yrs 50+

52%

50+

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PLWHA Males and Females by Mode of Transmission, Alameda County 2011

Males (n=3969)

Females (n=906)

4% 6% 7% 72% 10%
MSM IDU MSM&IDU HeteroContact Other

14%

20%
IDU HeteroContact Other

66%

PLWHA: MSM by Age Group and Race/Ethnicity (n=2866) Alameda County 2011 Age Group
0.2% 7%
012yrs 1319yrs 2029yrs

Race/Ethnicity

4% 3%
White

18%

48% 45%

40%

AfrAmer Latino API Other/Unk

3049 50+

35%

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PLWHA: Heterosexual Males and Females by Race/Ethnicity, Alameda County 2011 Heterosexual Males (n=397) Heterosexual Females (597)

4% 4% 15%
White

4% 3% 13% 14%
White AfrAmer Latino API Other/Unk AfrAmer Latino API Other/Unk

17%

60%

66%

PLWHA: Heterosexual Males and Females by Age Group, Alameda County 2011 Heterosexual Males (n=397) Heterosexual Females (597)
0.3% 6%
012yrs 1319yrs 2029yrs

2%

46% 52%

37%

012yrs 1319yrs 2029yrs 3049yrs

3049yrs 50+

57%

50+

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Transgendered PLWHA by Select Characteristics, Alameda County 2011 (n=51) Gender


60 50 40 30 20

Race/Ethnicity
49

2% 2% 4%

18%

White AfrAmer Latino API Other/Unk

74%
10

2
0 (FM)FemaletoMale (MF)MaletoFemale

Transgendered PLWHA by Select Characteristics, Alameda County 2011 (n=51) Age Group
25 20 15 10 5 0 012 1319 2029 3039 4049 5059 60& yrs yrs yrs yrs yrs yrs over

Mode of Transmission

20 2% 13 8 2% 7 3 80% 16%
MSM IDU MSM&IDU HeteroContact Other/Unk

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PLWH/A by Sex, Alameda County 2011

4,500 4,000 4 000 3,500 3,000

Number

2,500 2,000 1,500 1,000 500 0 Male Female PLWA(n=3441) PLWH(n=1434)

Sex

PLWH/A by Race/Ethnicity, Alameda County 2011


2,500

2,000

Number

1,500 PLWA(n=3441) PLWH(n=1434)

1,000

500

0 White AfrAmer Latino API Other/Unk

Race/Ethnicity

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PLWH/A by Age Group, Alameda County 2011


1,800 1,600 1,400 1,200

Number

1,000 800 600 400 200 0 012yrs 1319yrs 2029yrs 3039yrs 4049yrs 5059yrs 60&over PLWA(n=3441) PLWH(n=1434)

Age

Female PLWH/A by Mode of Transmission, Alameda County 2011


700 600 500

Number

400 300 200 100 0 HeteroContact IDU Other/Unk PLWA(n=3441) PLWH(n=1434)

ModeofTransmission

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Male PLWH/A by Mode of Transmission, Alameda County 2011


3,500 3,000 2,500

Number

2,000 1,500 1,000 500 0 MSM Hetero Contact IDU MSM&IDU Other/Unk PLWA(n=3441) PLWH(n=1434)

ModeofTransmission

PLWHA by City and Region, Alameda County 2011 (n=4875) City


OAKLAND ALAMEDA EMERYVILLE PIEDMONT HAYWARD SANLEANDRO CASTROVALLEY SANLORENZO ASHLAND BERKELEY ALBANY FREMONT UNIONCITY SUNOL LIVERMORE DUBLIN PLEASANTON SouthCounty S hC OaklandArea

Region

CentralCounty

TriValleyArea SouthCounty
NorthCounty

NorthCounty CentralCounty OaklandArea

TriValleyArea

1000

2000

3000

2000

4000

20

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Summary Findings:PLWHA Characteristics

African Americans and Whites make up similar proportions of male PLWHA; among women African Americans comprise two-thirds of PLWHA MSM is the most common mode of transmission among males; heterosexual contact is the most common mode among females Most PLWHA who are MSM are 30 years and older African Americans and Whites comprise a similar proportion of MSM, b L i i f S but Latinos comprise a much l i h lower proportion Transgender PLWHA are predominantly male-to-female, African American and MSM

Acknowledgements
Epidemiology Team Elaine Bautista Epidemiologist Kate B h K t Buchacz E id Epidemiologist (CDC A i i l it Assignee) ) Ross Fineman Epidemiology Intern Alex Marr Epidemiologist Surveillance Staff George Banks Public Health Investigator Karen Francisco Public Health Investigator Maly Sok Surveillance Clerk David Tucker Public Health Investigator Information Systems Staff Wei Chen Information Systems Analyst

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Appendix A
New HIV Cases: Trends

Trends in Newly Diagnosed HIV Cases: Race/Ethnic Disparities Among Males and Females, Alameda County 2006-2011 Male (n= 1078)
100 90 80 Rateper100,000 Rateper100,000 70 60 50 40 30 20 10 0 200608 200709 200810 200911 AfrAmer API Latino White AllMale 45 40 35 30 25 20 15 10 5 0 200608 200709 200810 200911 AfrAmer Latino White AllFemale All Female

Female (n= 263)

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Trends in Newly Diagnosed HIV Cases Among Males and Females by Age Group, Alameda County 2006-2011 Male (n= 1078)
50 45 40 Rateper100,000 1319yrs 2029yrs 3039yrs 4049yrs 5059yrs 60&over AllMale 200810 200911 200608 200709 30 25 20 15 10 5 0 Rateper100,000 35 50 45 40 35 30 25 20 15 10 5 0 200810 200911 200608 200709 2029yrs 3039yrs 4049yrs 5059yrs AllFemale

Female (n= 263)

Trends in Newly Diagnosed HIV Cases Among African American Males and Females by Age Group, Alameda County 2006-2011 African American Males (n=438)
200 180 160 Rateper100,000 120 100 80 60 40 20 0 200608 200709 200810 200911 Rateper100,000 140 1319yrs 2029yrs 3039yrs 4049yrs 5059yrs 60&over AllMale

African American Females (n=177)


200 180 160 140 120 100 80 60 40 20 0 200608 200709 200810 200911 2029yrs 3039yrs 4049yrs AllFemale All Female

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Summary Findings:SelectedTrends in Case Rates

Between 2006 and 2011 there was a decline in case rates among African American females; this decline was not statistically significant Among African Americans 20-49 year old, case rates have been variable among males in this time period; among females, rates have declined slightly

Trends in Newly Diagnosed HIV Cases by Mode of Transmission, Alameda County 2006-2011 Male (n=1078)
80% 70% 60% Percentage 50% 40% 30% 20% 10% 0% 200608 200709 200810 200911 MSM&IDU (n=54) Hetero Contact (n=100) Other(n=78) IDU(n=53) Percentage MSM(n=793) 80% 70% 60% 50% 40% 30% 20% 10% 0% 200608 200709 200810 200911 Hetero Contact (n=164) Other(n=61) IDU(n=38)

Female (n=263)

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Trends in Newly Diagnosed HIV Cases Among MSM by Race/Ethnicity, Alameda County 2006-2011 (n=793)
40% 35% 30% Percentage 25% AfrAmer 20% 15% 10% 5% 0% 200810 200911 200608 200709 API Latino White Other/Unk

Trends in Newly Diagnosed HIV Cases Among MSM by Age Group, Alameda County 2006-2011 (n=793)
35% 30% 25% Percentage 20% 15% 10% 5% 0% 200608 200709 200810 200911 1319yrs 2029yrs 3039yrs 4049yrs 5059yrs 60&over 60 & over

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Summary Findings:TrendsbyMode

Between 2006 and 20011, for new HIV cases, MSM was the predominant mode of transmission among males; among females the predominant mode was heterosexual contact Among MSM, African Americans and Whites comprised the highest proportion of new HIV cases in this period The 20-49 year age groups made up the highest proportions of new HIV cases in this period

Appendix B
PLWHA by Modes of Transmission

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PLWHA: MSM & IDU by Age Group and Race/Ethnicity (n=257) Alameda County 2011 Age Group Race/Ethnicity

4%

1% 3%
012yrs

14% 48% 34%

White AfrAmer Latino API Other/Unk

49% 47%

1319yrs 2029yrs 3049 50+

PLWHA: IDU Males and Females by Race/Ethnicity, Alameda County 2011 IDU Males (n=274) IDU Females (n=178)

3% 1% 13% 21%

1% 2% 6%
White AfrAmer Latino API Other/Unk

18%

White AfrAmer Latino API Other/Unk

62%

73%

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PLWHA: IDU Males and Females by Age Group, Alameda County 2011 IDU Males (n=274)
0.4%

IDU Females (n=178)


2%

31%

012yrs 1319yrs 2029yrs 3049yrs

012yrs

39% 59%

1319yrs 2029yrs 3049yrs 50+

69%

50+

Summary Findings:PLWHAbyMode

Most PLWHA who are MSM & IDU are 30 years and older Whites comprise a higher proportion of MSM & IDU PLWHA than African Americans African Americans females are a higher proportion of PLWHA who are IDU than males

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