1. Wisconsin HIV/AIDS Surveillance Annual Review: Slide Set New diagnoses, prevalent cases, and deaths through December 2014 April 2015 P-00484 Wisconsin Department of Health Services

2. Objectives Explain basic data concepts used in epidemiology Describe current Wisconsin HIV/AIDS surveillance data 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 vs. White males: 66/6=11-fold higher 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, 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. Total cases Wisconsin Department of Health Services Three-year rolling average of the number of new HIV diagnoses, Wisconsin, 1984 - 2014

14. Total cases Wisconsin Department of Health Services Number and rate of new HIV diagnoses, Wisconsin, 2005-2014

15. 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.

16. Cases by sex Wisconsin Department of Health Services Percent distribution of new HIV diagnoses by sex, Wisconsin, 2014

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

18. Cases by sex and age Wisconsin Department of Health Services Percent distributions of new HIV diagnoses by age at diagnosis and sex, Wisconsin, 2014

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

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

21. 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)

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

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

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

25. 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

26. HIV-exposed infants Wisconsin Department of Health Services Diagnostic status of HIV-exposed infants born in Wisconsin, 1985-2014

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

28. 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

29. Prevalence: In-migration Wisconsin Department of Health Services Number of newly reported cases of HIV infection moving into Wisconsin, 2005-2014

30. 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

31. 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

32. HIV care continuum Wisconsin Department of Health Services HIV care continuum, 2013 new diagnoses and prevalent cases, ages 13 years and older, Wisconsin

33. Wisconsin Department of Health Services

34. 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

35. 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

36. Unaware of HIV infection: Wisconsin Wisconsin Department of Health Services Estimated percentage of those with HIV who are unaware of their HIV infection, by demographic group, United States, 2012 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/

37. 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

38. 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.

39. 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 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. Imputed risk calculations were also used for individuals with missing risk information.

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

41. 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.

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

43. Wisconsin Department of Health Services

44. 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

45. Deaths Wisconsin Department of Health Services Median age at death by underlying cause of death, among persons ever reported with HIV in Wisconsin, 1982-2012

46. Full reports For additional information and methodology, visit our website: https://www.dhs.wisconsin.gov/aids- hiv/data.htm https://www.dhs.wisconsin.gov/aids- hiv/data.htm – Statewide report: https://www.dhs.wisconsin.gov/publications/p0/p00484.pdf https://www.dhs.wisconsin.gov/publications/p0/p00484.pdf – City of Milwaukee report: https://www.dhs.wisconsin.gov/publications/p0/p00484a.pdf https://www.dhs.wisconsin.gov/publications/p0/p00484a.pdf