1. Houston/Harris County HIV Epidemiology Bureau of HIV/STD and Viral Hepatitis Prevention June 2013

2. Epidemiology- the study of the distribution (who, what, where, when) and determinants (why, how) of health- related states in specified populations  Use epidemiology to control health problems  Epidemiology is the basic science of public health. It is a quantitative discipline based on principles of statistics and research methodologies.  Epidemiology deals with groups of people rather than individuals. Health-related states are NOT randomly distributed in human populations Definition of epidemiology

3. Uses of Epidemiology Identify the cause of disease and the factors that increase a person’s risk for disease To control health problems and the spread of disease Planning and targeting prevention efforts Monitoring and evaluating interventions  Establish baseline data  Was the intervention effective? Research  Aim: describe, explain, predict, and control Understanding and formulating new policy  National HIV/AIDS Strategy and focus on reducing HIV-related health disparities Funding decisions  What is the burden of disease in a community?

4. Nationwide HIV Overview More than 1.1 million people are living with HIV in the US. 18% of HIV positive persons are unaware of their status. Over 18,000 people diagnosed with AIDS die each year.  At the end of 2009, over 641,000 people with AIDS have died since the epidemic began. Source: CDC

5. New Diagnoses by Sub-Population From 2008-2010: Decrease in new infections among black women Continuing increase in new infections among young MSM

6. HIV Incidence Surveillance Incidence has remained stable since mid-1990s. In 2010, estimated 47,500 new infections nationwide  Impact most severe among young, black and Hispanic MSM, white MSM in 30s and 40s, and black women. HIV incidence surveillance began in 2005 to provide population- based estimates of the number of new HIV infections per year. Uses new methodology to determine recent from long- standing infections. Source: CDC

7. Houston/Harris County Overview Houston/Harris County  City of Houston most populous city in Texas and fourth most populous in US Least densely populated major metro area Most racially and ethnically diverse major metro area  Combined Population= 4,111,503  Harris Co.= 1,703 sq. miles Est. 2013 Population= 4,343,023  HDHHS Jurisdiction for surveillance and partner services is Houston/Harris County The Houston-Sugar Land-Baytown MSA is a Census-defined area consisting of 10 counties  Population= 5,946,800 Sources: Census 2010, Kinder Institute 2012, Texas DSHS Population Projections 2012

8. Jurisdictional Areas 2013 Epi Profile: page 9

9. 2013 Houston Area Integrated Epidemiological Profile for HIV/AIDS Prevention and Care Services Planning Houston Area Characteristics  Employment  Household Income  Poverty  Educational Attainment  Health Insurance  Foreign-Born and Linguistic Isolation  Fertility and Mortality Rates  Selected Causes of Death  Disability

10. Nationwide County Comparison  Chlamydia: Harris Co. ranked 3 rd in cases  Gonorrhea: Harris Co. ranked 5 th in cases  P&S Syphilis: Harris Co. ranked 8 th in cases  HIV: Houston Metropolitan ranked 12 th in rate of new HIV diagnoses  AIDS: Houston ranks 12 th in rate of AIDS diagnoses Source: CDC Surveillance Reports (HIV: 2010, STD: 2011)

11. Almost 70,000 people are living with HIV in Texas. Over 20,000 people are living with HIV in Houston/Harris County.

12. Houston/Harris Co. HIV Diagnoses, 1999- 2011 Source: eHARS- HDHHS Jan ’99: HIV reportable by name in TX

13. Growing Gap between Deaths and Number of PLWH

14. 2013 Houston Area Integrated Epidemiological Profile for HIV/AIDS Prevention and Care Services Planning HIV/AIDS in the Houston Area  HIV Incidence  New Diagnoses of HIV  Persons Living with HIV (PLWH)  Mapping of New Diagnoses and PLWH  Deaths of PLWH  New Diagnoses, Prevalence, and Mortality: Five-Year Trends

15. Houston/Harris Co. HIV Diagnoses, 2011 HIV by Risk Source: eHARS- HDHHS, unknown risk re-distributed using the CDC’s multiple imputation technique When examining risk by sex, MSM accounted for 79.5% of transmission risk in males

16. Houston/Harris Co. HIV Diagnoses, 2011 HIV Rates by Age Source: eHARS- HDHHS

17. Chlamydia and Gonorrhea — Age- and sex-specific rates Houston/Harris County, 2011 Chlamydia rates do not include the following: n=2 missing sex, n=24 missing age Gonorrhea rates do not include the following: n=3 missing sex, n=6 missing age Source: HDHHS Chlamydia Gonorrhea

18. Source: eHARS- HDHHS, unknown risk re-distributed using the CDC’s multiple imputation technique What is the population of MSM in Houston/Harris County?

19. Source: eHARS- HDHHS, unknown risk re-distributed using the CDC’s multiple imputation technique

20. HIV Diagnoses — Rates by race/ethnicity Houston/Harris County, 1999–2011 Source: eHARS- HDHHS Nationally: 1 in 16 black men will be diagnosed with HIV at some point in his lifetime

21. Total Population vs. HIV-Infected

22. STD Rates by race/ethnicity, Houston/Harris Co. Syphilis (P&S) Chlamydia Gonorrhea Source: STD*MIS- HDHHS

25. Contributing Factors to HIV/STD Disparities Higher prevalence in community  Houston: highest rate of PLWHA in TX Stigma and/or discrimination  Houston: larger % of foreign-born and language other than English at home vs. TX overall Access to quality medical care and testing→ Delayed diagnosis and treatment  Houston: higher % of uninsured than TX overall Social determinants of health  Houston: median household income ~$7000 lower than TX median  Houston: lower % of high school graduates than TX overall HIV Prevalence Rate, by Income “STD disparities reflect socioeconomic disparities, which in turn reflect deep- rooted racial inequalities” (CDC, 2007) Individual sexual risk behavior does not account for the observed racial disparities in STDs (CDC, 2007) Source: Houston Area Comprehensive Plan, Graph: CDC, NHBS-HET-1 2006−2007

26. HIV Co-Morbidity Why focus on STDs?  STDs can cause infertility, chronic pelvic pain, damage of internal organs, cancer, paralysis, sores and lesions, blindness, dementia, and/or death.  Those infected with STDs are 2-5 times more likely to acquire HIV if exposed.  If a person living with HIV/AIDS is infected with another STD, transmission of HIV to another person via sexual contact is more likely. HIV Co-Morbidity in Houston/Harris Co.  From January- December 2012, 39.0% of all interviewed primary and secondary syphilis cases were also HIV positive. This is an increase in co-morbidity as 31.2% of cases were HIV positive in 2011.  From January- December 2012, 58.1% of all interviewed primary and secondary syphilis cases among MSM were also HIV positive. This is an increase in co-morbidity as 52.1% of cases were HIV positive. Source: STD*MIS- HDHHS

29. 2013 Houston Area Integrated Epidemiological Profile for HIV/AIDS Prevention and Care Services Planning Risk for HIV/AIDS in the Houston Area  HIV Testing and Awareness of Status  Chlamydia Trends  Gonorrhea Trends  Infectious Syphilis Trends HIV Service Utilization  Linkage to Care  Met Need  Treatment Cascade Profile of Out-of-Care Special Topics  Priority Populations  Co-Infection

30. Acknowledgements HIV/STD Surveillance Team and Bureau of Epidemiology, HDHHS Monica Slentz, Community Health Planning, Evaluation & Research, HDHHS Bureau of HIV/STD and Viral Hepatitis Prevention, HDHHS Ryan White Grants Administration and Ryan White Planning Council’s Office of Support for Houston EMA Houston HIV Community Planning Group (CPG) and Ryan White Planning Council (RWPC) TB/HIV/STD Epidemiology and Surveillance, Texas Dept. of State Health Services