1. SOUTH CAROLINA EPIDEMIOLOGIC PROFILE 2009

2. Data available in an Integrated Epidemiologic Profile Core Epi Section Socio-demographic characteristics of the general population in South Carolina Scope of the HIV/AIDS epidemic Indicators of risk for HIV infection in the population Ryan White CARE Act (RWCA) Section Patterns of service utilization of HIV infected persons in South Carolina Number and characteristics of persons who know they are HIV+ but who are not receiving HIV primary medical care

3. Question #1: Question #1: What are the sociodemographic characteristics of the population?

4. Selected demographic information: South Carolina and United States South CarolinaUnited States Population (2008 estimates) 4,479,800304,059,724 Proportion of Persons Living in Non- Metropolitan Areas 35%16% Median Age37.136.4 Racial/Ethnic Distribution of Pop. % White % African-American % Hispanic % Other 65 29 4 3 66 12 15 7 Educational Attainment % High school grad. or higher % Bachelor’s degree or higher 82 23 85 28 Unemployment Rate, 2008 7.8% 6.6% Median Household Income, 2008$43,508$51,233 Sources: U.S. Census Bureau, Kaiser Family Foundation.

5. Percent of each racial/ethnic pop. living below federal poverty level; S.C., 2008 POVERTY GAPS Source: U.S. Census Bureau

6. Question #2: What is the impact of HIV/AIDS on the population?

7. South Carolina HIV/AIDS Rankings AIDS cases have been reported in S.C. since 1981 and confirmed cases of HIV infections have been reportable since 1986. In 2007, S.C. ranked 8 th among all states and District of Columbia in AIDS case rates at 16.8 per 100,000 population. In 2007, S.C. ranked 7 th among all states and District of Columbia in AIDS case rates among female cases at 13.0 per 100,000 population. Source: www.statehealthfacts.org

8. South Carolina HIV/AIDS incidence, prevalence, and deaths Note: Number of cases diagnosed in S.C. only; excludes out of state cases returning to S.C. Number of Cases

9. Disproportionate S.C. HIV impact by gender SEX No. (%) S.C. Total Population No. (%) of Total Estimated Living With HIV/AIDS, 2008 No. (%) of Total HIV-Only Diagnosis, 2007-2008 Male2,181,663 (49%)10,105 (69%)646 (70%) Female2,298,173 (51%)4,539 (31%)280 (30%) Total4,479,80014,644 (100%)926 (100%) Source: U.S. Census Data; S.C. DHEC.

10. Proportion of persons living with HIV/AIDS by race/ethnicity, 2008

11. Disproportionate HIV impact by race/ethnicity/gender, S.C. Gender & Race/Ethnicity No. (%) SC Total Pop. No. (%) of Total Persons Living With HIV/AIDS, 2008 No.(%) of Total HIV Only Diagnosis, 2007-2008 Black Males603,440 (13%)6901 (47%)486 (50%) Black Females678,720 (15%)3752 (26%)235 (24%) White Males1,505,390 (33%)2851 (19%)166 (17%) White Females1,541,850 (34%) 673 (5%)50 (5%) Hispanic Males 95,730 (2%) 311 (2%)17 (2%) Hisp. Females 73,190 (2%) 87 (1%) 14 (1%) Source: U.S. Census Data; S.C. DHEC.

12. Disproportionate HIV impact by age, S.C. Age Range No. (%) SC Population No. (%) of Total Persons Living with HIV/AIDS, 2008 No. (%) of Total HIV-Only Diagnosis, 2007-2008 < 13 Years724,209 (18%)44 (<1%)5 (<1%) 13 – 19 Years411,579 (10%)132 (<1%)73 (8%) 20 – 44 Years1,467,669 (37%)7,224 (49%)641 (69%) 45+ Years1,408,565 (35%)7,244 (49%)209 (23%)

13. Proportion of people living with HIV/AIDS by risk exposure, 2008 N=11,074 Note: Total excludes cases with no risk identified.

14. Proportion of HIV/AIDS cases by risk exposure, 2007-2008 N=1,006 Note: Total excludes cases with no risk identified.

15. Proportional distribution of male HIV/AIDS cases by exposure category, diagnosed 1997-2008 Percent of Total Cases with Reported Risk

16. Figure 2.15: Proportional distribution of female HIV/AIDS cases by exposure category, diagnosed 1997-2008 Percent of Total Cases with Reported Risk

17. Deaths among persons with AIDS in South Carolina, 1988-2007 Source: Vital Records

18. Question #3: Who is at risk for becoming infected with HIV/AIDS? Note: Totals Exclude Cases with No Risk Identified; Risk Exposure is self-reported

19. Number of HIV/AIDS cases by year of diagnosis and risk, 1992 -2008 Excludes persons with no risk reported. Number of Cases

20. Proportion of men with HIV/AIDS who have sex with men by race/ethnicity, diagnosed 2007-2008 N=534

21. Proportion of heterosexual HIV/AIDS cases by race/sex, diagnosed 2007-2008 N=388

22. Proportion of injecting drug users diagnosed with HIV/AIDS 2007-2008 by race/sex N=78

23. Percent of injecting drug users diagnosed with HIV/AIDS 2007-2008 by age group N=78

24. Number of children <13 years old diagnosed with HIV/AIDS in South Carolina, 1993-2008 Number of Cases

25. Other STDs

26. How S.C. ranks in U.S. for STD rates/100,000 population  #3 for Chlamydia  #2 for Gonorrhea  #26 for Infectious Syphilis Source: Centers for Disease Control Updated: Nov. 2008

27. Year Number of Cases South Carolina reported Chlamydia cases by year of diagnosis, 1994 - 2008

28. Year Number of Cases South Carolina reported gonorrhea cases by year of diagnosis, 1994 - 2008

29. South Carolina reported Infectious Syphilis cases by year of diagnosis, 1994-2008 Number of Cases

30. Question #4: What are the patterns of service utilization of persons living with HIV/AIDS?

31. Ryan White Part B Clients, N=7,974 Persons Living with HIV/AIDS, N=14,644 Race/Ethnicity White, not-Hispanic22%24% Black, not-Hispanic73% Hispanic3% Other2%<1% Sex Male63%69% Female37%31% Transgender<1%--- Age Group <13<1% 13-244%1% 25-4448%49% 45+48%49% Characteristics of Ryan White Part B clients compared to S.C. persons living with HIV/AIDS in 2008

32. No. of clients receiving service Avg. no. of visits per client Medical Care4,3704.8 Medication (ADAP)2,887N/A Oral/Dental Care9432.4 Mental Health5912.7 Substance Abuse3874.0 Case Management6,4347.4 South Carolina Ryan White Part B Service Utilization by Service Type, 2008

33. Question #5: What are the number and characteristics of persons who know they are HIV+ but who are not receiving HIV primary medical care?

34. “In Care” and “Not in Care” defined: A person was reported as being “in care” if they had at least one CD4 or viral load test report from January 1, 2008 through December 31, 2008 A person with no CD4 or viral load test report in this time frame would be defined as “not in care”

35. 2008 S.C. HIV/AIDS cases estimated not in care vs. in care (N=15,871) Not in Care 42% In Care 58%

36. S.C. HIV/AIDS cases estimated not in care diagnosed through 2008 HIV-only vs. AIDS (N=6,638) HIV-only 60% AIDS 40%

37. S.C. HIV/AIDS cases diagnosed through 2008, comparison within select demographics estimated percentage not in care Female 72 28 26 69 4 1 9 22 38 Gender Race Age % <1 30 Male BlackWhite Hispanic Other/Unknown <20 20-29 30-3940-49 50+

38. S.C. HIV/AIDS cases diagnosed through 2008 comparison within mode of exposure in care vs. not in care N=5269N=2168N=4567N=216 Excludes cases with no risk identified, N=3,651.

39. S.C. HIV/AIDS cases estimated not in care diagnosed through 2008 by location (N=6,571) Rural 28% Urban 72%

40. 40 to 59 60+ S.C. HIV/AIDS cases not in care diagnosed through 2008 by county Percentage 20 to 39

41. People living with HIV/AIDS Men who have Sex with Men (MSM), particularly African-American Males as well as White Males High Risk Heterosexuals, primarily African-Americans who account for 8 out of every 10 persons living with HIV/AIDS Recommendations Based on Epi Data Continue to focus prevention efforts on:

42. Jacob Ramsey S.C. DHEC STD/HIV Division 803-898-0711 ramseyjm@dhec.sc.govramseyjm@dhec.sc.gov