1. Katarina Grande, HIV Surveillance Coordinator Casey Schumann, HIV Epidemiologist Wisconsin Department of Health Services Statewide Action Planning Group meeting Milwaukee, WI April 16, 2015 HIV/AIDS Surveillance Annual Review Wisconsin Department of Health Services

2. Objectives Explain basic data concepts used in epidemiology Describe current Wisconsin and Milwaukee HIV/AIDS surveillance data Discuss reflections on the data Develop specific talking points relevant to your community Wisconsin Department of Health Services

4. Data concepts HIV prevalence or prevalent cases – Number of people living with HIV at a given time New HIV diagnoses – When a case is first detected and reported HIV incidence – When the infection is acquired Wisconsin Department of Health Services

5. Data concepts Adjusted or imputed risk – Some individuals are reported without a known risk exposure – Data are adjusted to account for cases with unknown risk through imputation Known risks of individuals with similar characteristics are applied to those with unknown risk Imputed risk exposures are estimates, not actual case counts Wisconsin Department of Health Services

6. Data concepts Adjusted or imputed risk: example – If 11 Black women, ages 45-64, were diagnosed with HIV with the following risk exposure, the individual with unknown risk would be assigned “proportions of likely risk” Wisconsin Department of Health Services

7. Data concepts Rates per 100,000 population – Rates used when comparing the impact of HIV across two or more groups – When underlying population sizes of groups are different, numbers alone may give the wrong impression – Rate shows what impact of HIV would be if the population sizes were identical Wisconsin Department of Health Services

8. Data concepts Rate ratios – Method for quantifying the difference in impact of HIV across populations – Each population is compared to a reference group – Black males: 66.8/5.7=11.7 Wisconsin Department of Health Services

9. Data concepts Statistical significance – Used to determine whether a change is likely due to random fluctuation or a real difference Wisconsin Department of Health Services HIV diagnosis rate by sex, Wisconsin, 2005-2014

10. Wisconsin Department of Health Services

11. Flow of individuals with HIV in and out of Wisconsin Wisconsin Department of Health Services

13. HIV diagnosis rates across the U.S. Wisconsin Department of Health Services HIV diagnosis rate by state, 2013 CDC HIV Surveillance Report, 2013, V25, Table 18.

14. Total cases Wisconsin Department of Health Services Three-year rolling average of the number of new HIV diagnoses, Wisconsin, 1984 - 2014

15. Cases by sex Wisconsin Department of Health Services HIV diagnosis by sex, Wisconsin, 2014

16. Cases by sex and age Wisconsin Department of Health Services HIV diagnosis rate by sex and age, Wisconsin, 2005-2014

17. HIV among transgender individuals Wisconsin Department of Health Services Number of HIV diagnoses among transgender individuals by race/ethnicity and age, Wisconsin, 2005-2014

18. Race/ethnicity Wisconsin Department of Health Services Multi-racial Asian American Indian Hispanic Black White Percentage of new HIV diagnoses among Whites and persons of color, Wisconsin, 1982-2014 2014 diagnoses (n=226)

19. Sex and race/ethnicity: rates Wisconsin Department of Health Services HIV diagnosis rate by sex and race/ethnicity, Wisconsin, 2014

20. Risk exposure Wisconsin Department of Health Services HIV diagnoses by estimated risk exposure group*, Wisconsin, 2005-2014

21. Risk exposure Wisconsin Department of Health Services Percentage of HIV diagnoses by sex and estimated risk exposure group*, Wisconsin, 2014

22. Young MSM: race/ethnicity Wisconsin Department of Health Services HIV diagnoses among MSM, ages 13-29, by race/ethnicity, Wisconsin, 2005-2014

23. Age at diagnosis by risk Wisconsin Department of Health Services Median age at HIV diagnosis by reported risk exposure, and among MSM by race/ethnicity, Wisconsin, 2014

24. Wisconsin Department of Health Services Geography Number of HIV diagnoses by county of residence* at diagnosis, Wisconsin, 2014 Number of HIV Diagnoses 1 - 3 4 - 11 25 132 *Excludes 3 cases diagnosed in the Department of Corrections

25. Late testers Wisconsin Department of Health Services Percentage of new HIV diagnoses with concurrent AIDS diagnosis or progressing to AIDS within one year, Wisconsin, 2011-2014

26. HIV care continuum Wisconsin Department of Health Services HIV care continuum, 2014 new diagnoses and prevalent cases, ages 13 years and older, Wisconsin

27. Wisconsin Department of Health Services

28. Unaware of HIV infection: United States Wisconsin Department of Health Services Estimated number unaware of their HIV infection, by demographic group, Wisconsin, 2014 Percent unaware Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data— United States and 6 dependent areas—2012. HIV Surveillance Supplemental Report 2014;19(no.3). http://www.cdc.gov/hiv/library/reports/surveillance/. Published November 2014. Accessed April 2015. http://www.cdc.gov/hiv/library/reports/surveillance/ Wisconsin known prevalence: 6,899 Estimated number of people living with HIV in Wisconsin who are unaware of their HIV infection: 1,125

29. Prevalence: age Wisconsin Department of Health Services Prevalent cases of HIV infection by current age as of December 31, 2014, and cases reported during 2014 by age at diagnosis, Wisconsin

30. Prevalence: selected demographic groups Wisconsin Department of Health Services Prevalence of HIV in selected demographic groups, age 18 and older, Wisconsin, 2014 Estimates generated from surveillance data and state-specific estimates of MSM populations in: Lieb S., et al. Statewide estimation of populations of MSM in the United States. Public Health Reports 2011;126(1):60-72 and CDC’s estimate that 16% of MSM are unaware of their HIV infection, and 14% of other populations are unaware of their HIV infection. Imputed risk calculations were also used for individuals with missing risk information.

31. Wisconsin Department of Health Services MSM: race/ethnicity Estimated populations sizes and prevalence of HIV diagnoses among MSM, ages 18 and older, by race/ethnicity, Wisconsin

32. Prevalence: Black MSM, Wisconsin Wisconsin Department of Health Services Percentage of Black MSM living with HIV in Wisconsin compared to other greatly affected populations globally Adapted from The Foundation for AIDS Research Issue Brief: “HIV and the Black Community: Do #Black(GAY)lives Matter?, references: Rosenberg 2014, Baral 2013, El Bassel 2013, Baral 2012.

33. Prevalence: county Wisconsin Department of Health Services Prevalent cases of HIV infection by county, Wisconsin, 2014

34. Wisconsin Department of Health Services

35. Deaths Wisconsin Department of Health Services Number of deaths, by cause of death, among persons ever reported with HIV in Wisconsin, 1982-2012 *503 cases had an unknown cause of death and were not included in this analysis Median age at death, HIV as underlying cause: 49.5

36. Wisconsin Department of Health Services

37. HIV diagnosis rates in Milwaukee compared to county, state, and U.S. Wisconsin Department of Health Services City of Milwaukee HIV rate compared to county, Wisconsin (2014), and United States (2013)

38. Race/ethnicity and sex Wisconsin Department of Health Services HIV diagnosis rate by sex and race/ethnicity, city of Milwaukee, 2010-2014

39. Risk exposure Wisconsin Department of Health Services HIV diagnoses by estimated risk exposure group*, city of Milwaukee, 2005-2014

40. Risk exposure, sex, race/ethnicity, age Wisconsin Department of Health Services Number of HIV diagnoses by selected sex, race/ethnicity, age and risk group*, City of Milwaukee, 2012-2014

41. New diagnoses: zip codes Wisconsin Department of Health Services HIV diagnoses by zip code of residence*, city of Milwaukee, 2012-2014 * Dots are placed randomly within zip codes and do not reflect the actual case residence. 1 dot = 1 HIV diagnosis

42. New diagnoses among young Black MSM: zip codes Wisconsin Department of Health Services HIV diagnoses among young (ages 13-29) Black MSM by zip code of residence*, City of Milwaukee, 2012-2014 * Dots are placed randomly within zip codes and do not reflect the actual case residence. 1 dot = 1 HIV diagnosis

43. HIV testing Wisconsin Department of Health Services New positivity rate at publically-funded counseling and testing sites in the city of Milwaukee for various populations, 2009-2014

44. Syphilis and HIV diagnoses Wisconsin Department of Health Services Syphilis diagnoses in Milwaukee County from 2004-2013, and syphilis or syphilis-HIV diagnoses in Milwaukee County among males ages 13-29 from 2012-2014 Centers for Disease Control and Prevention. Syphilis & MSM (Men Who Have Sex With Men) – CDC Fact Sheet. http://www.cdc.gov/std/syphilis/stdfact-msm-syphilis.htm. Accessed 4/9/2015. http://www.cdc.gov/std/syphilis/stdfact-msm-syphilis.htm Wisconsin Department of Health Services. Sexually Transmitted Disease in Wisconsin 2013: Milwaukee County. https://www.dhs.wisconsin.gov/publications/p0/p00415-2013-milwaukee.pdf. Accessed 4/9/2015. https://www.dhs.wisconsin.gov/publications/p0/p00415-2013-milwaukee.pdf

45. Quiz answers 1.Number of new HIV diagnoses in Wisconsin in 2014: 226 2.There were 5 times as many males diagnosed with HIV during 2014 than females 3.Communities of color: 67% of 2014 diagnoses 4.Proportion of all people living with HIV in Wisconsin who are virally suppressed: 51% Wisconsin Department of Health Services

46. Quiz answers 5. The risk profile for all new 2014 HIV diagnoses in Wisconsin: – MSM: 78% – Heterosexual: 15% – Persons who inject drugs: 7% 6. Trends in new diagnoses over the past decade: – All cases: stable – Older males: stable – Older females: decreasing – High-risk heterosexual: decreasing – History of injection drug use: decreasing – Black MSM under age 30: increasing Wisconsin Department of Health Services

47. Quiz answers 7. Milwaukee County makes up 58% of all new diagnoses statewide 8. 1/3 of individuals newly diagnosed with HIV in recent years are diagnosed with AIDS at the same time, or within one year of their initial HIV diagnosis 9. Number of people living with HIV in Wisconsin at the end of 2014: 6899 10. Estimated percent of people in the U.S. living with HIV and unaware of their infection: 14% Wisconsin Department of Health Services

48. Skill-building activity Form groups of three [2 min: reflect] Take a few minutes to reflect and write down which piece(s) of data left the largest impact on you, and why you found it impactful [3 min: discuss] Share your reflections in your group Wisconsin Department of Health Services

49. Skill-building activity Data communication and messaging [15 min: brainstorm] Brainstorm at least three specific talking points related to the data presented today that you think would be important to take back to your community (doesn’t have to related to the data slides you just presented to your group). Consider your audience—who would you target with this information? (Peers? Program staff? Group of community leaders? A client? Media? Policymakers? Students?) – Also consider: What data would be of most interest to your community? What format/communication style would be most effective at getting the message across? What are some ideas you have for addressing the issue/reversing a distressing data trend? Anticipate what questions your audience might ask Why is it important to share these data? Wisconsin Department of Health Services

50. Skill-building activity Data communication and messaging [15 min: practice] Each group member gets five minutes to practice presenting their talking points as though they were presenting to their target audience. Other group members should ask the presenter questions. [5 min: large group discussion] Discuss: – What worked well in your data presentation and data communication? – What are some ways you could reach larger audiences with this information? Wisconsin Department of Health Services

51. Prevalence: In-migration Wisconsin Department of Health Services Number of prevalent cases in Wisconsin who received their initial HIV diagnosis in another state, by top five states of initial HIV diagnosis

52. Prevalence: Black sub-populations Wisconsin Department of Health Services Prevalence of HIV in Black sub-populations, Wisconsin, 2014

53. Late testers by demographic group Wisconsin Department of Health Services Percentage of new HIV diagnoses with a concurrent AIDS diagnosis, by demographic group, Wisconsin, 2014

54. HIV diagnosis rates in Milwaukee Metropolitan area compared to other geographical areas Wisconsin Department of Health Services HIV diagnosis rate by Metropolitan Statistical Area, 2013 Centers for Disease Control and Prevention. HIV Surveillance Report, 2013; vol.25. http://www.cdc.gov/hiv/library/reports/surveillance/. Published February 2015. Accessed 3/20/2015.http://www.cdc.gov/hiv/library/reports/surveillance/

55. HIV testing: positivity rates Wisconsin Department of Health Services New positivity rate at publically-funded counseling and testing sites in the city of Milwaukee, Black MSM by age group, 2009-2014