HIV Infection in Women in Our Community: The Continuum of Care Lawrence J. D’Angelo, M.D., M.P.H. Director, Burgess and Youth Pride Clinics Division of Adolescent and Young Adult Medicine Children’s National Medical Center Professor of Pediatrics, Medicine, Epidemiology, Prevention and Community Health George Washington University Washington, D.C.

I Have No Disclosures Lawrence J. D’Angelo, MD, MPH Division of Adolescent and Young Adult Medicine Children’s National Health System Professor of Pediatrics, Medicine, Epidemiology and Prevention George Washington University

Diagnoses of HIV Infection among Female Adults and Adolescents by Race/Ethnicity, 2015—United States This slide presents the numbers and rates of diagnoses of HIV infection among female adults and adolescents in the United States.   In 2015, the rate (per 100,000 population) of diagnoses of HIV infection among black/African American females (26.2) was over 16 times as high as the rate for white females (1.6) and nearly 5 times as high as the rate for Hispanic/Latino females (5.3). Relatively few diagnoses of HIV infection were among American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander females, and females of multiple races; however, the rates for American Indian/Alaska Native females (5.6), females of multiple races (5.5), Native Hawaiian/other Pacific Islander females (3.5), and Asian females (1.7) were all higher than that for white females. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Data for the year 2015 are preliminary and based on 6 months reporting delay. Hispanics/Latinos can be of any race. Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Data for the year 2015 are preliminary and based on 6 months reporting delay. Rates are per 100,000 population. a Hispanics/Latinos can be of any race.

Diagnoses of HIV Infection Among Persons Aged 13 Years and Older, by Sex and Age Group, 2014 — United States and 6 Dependent Areas In 2014, the distribution of diagnoses of HIV infection by sex varied with age group at diagnosis in the United States and 6 dependent areas. In 2014, females accounted for an estimated 19% of adolescents aged 13 to 19 years with diagnosed HIV infection, compared with 11% of young adults aged 20 to 24 years and 21% of adults aged 25 years and older.   Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Age group assigned based on age at diagnosis. Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting.

Rates of Diagnoses of HIV Infection among Female Adults and Adolescents 2015—United States and 6 Dependent Areas N = 7,498 Total Rate = 5.4 In the United States and 6 dependent areas, the rate of diagnoses of HIV infection among female adults and adolescents was 5.4 per 100,000 population in 2015. The rate of diagnoses for female adults and adolescents ranged from zero per 100,000 in American Samoa, Guam, Northern Mariana Islands, and the Republic of Palau to 29.9 per 100,000 in the District of Columbia, 14.0 in Maryland, and 13.8 in Louisiana.    The District of Columbia (i.e., Washington, DC) is a city; use caution when comparing the HIV diagnosis rate in DC with the rates in states. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Data for the year 2015 are preliminary and based on 6 months reporting delay. Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Data for the year 2015 are preliminary and based on 6 months reporting delay.

Rates of Female Adults and Adolescents Living with Diagnosed HIV Infection Year-end 2014—United States and 6 Dependent Areas N = 235,813 Total Rate = 171.0 The rates (per 100,000 population) of female adults and adolescents living with a diagnosis of HIV infection at the end of 2014 in the United States and 6 dependent areas are shown in this slide.   Areas with the highest rates were the District of Columbia (1,332.8), the U.S. Virgin Islands (501.7), New York (437.9), Maryland (429.6), Florida (340.8), and Puerto Rico (326.6). The highest rates were in the majority of states in the south and along the East Coast. The District of Columbia (i.e., Washington, DC) is a city; use caution when comparing the HIV diagnosis rate in DC with the rates in states.    Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Data are based on address of residence as of December 31, 2014 (i.e., most recent known address). Persons living with diagnosed HIV infection are classified as adult or adolescent based on age at year-end 2014. Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Data are based on address of residence as of December 31, 2014 (i.e., most recent known address).

Rates of Female Adults and Adolescents Living with Diagnosed HIV Infection Ever Classified as Stage 3 (AIDS), Year-end 2014—United States and 6 Dependent Areas N = 126,340 Total Rate = 91.6 This slide presents the rates (per 100,000 population) of female adults and adolescents living with diagnosed HIV infection ever classified as stage 3 (AIDS) at the end of 2014 in the United States and 6 dependent areas.   Areas with the highest rates of females living with stage 3 (AIDS) were the District of Columbia (742.1), New York (262.0), Maryland (233.4), the U.S. Virgin Islands (224.6), Florida (191.6), and Puerto Rico (179.2). The District of Columbia (i.e., Washington, DC) is a city; use caution when comparing the stage 3 (AIDS) rate in DC with the rates in states. Data are based on address of residence as of December 31, 2014 (i.e., most recent known address). Persons living with stage 3 (AIDS) are classified as adult or adolescent based on age at year-end 2014. Note. Data are based on address of residence as of December 31, 2014 (i.e., most recent known address).

HIV Seroprevalence in Attendees of STD Clinics Baltimore, MD, February 1987-April 1987 % Positive Age Males Females 15-19 2.0 2.5 20-24 3.8 3.4 25-29 6.9 2.9 > 30 11.4 4.3 Quinn, et al. NEJM; 1988, 318:197

HIV Infected Youth in Care Burgess Clinic, Washington, D.C. May 2003 115 Patients in Care 67 (58%) are female and 48 (42%) are male 43 (36%) acquired infection perinatally Perinatally infected teens now largest source of new patients 34% now defined as having AIDS (58% Perinatal, 21% Behavioral Acquisition)

HIV Infected Youth in Care Burgess Clinic, Washington, D. C HIV Infected Youth in Care Burgess Clinic, Washington, D.C. (through April 15, 2006) 151 Patients in Care 80 (53%) female; 71 male (47%) 81 (54%) acquired infection perinatally Perinatally infected teens now largest source of new patients 48% of our patients defined as having AIDS

Behaviorally Acquired Transfusion/ Blood Products (Suspected) Burgess Clinic Demographics: The HIV Infected Adolescent (through April 15, 2009) Adolescent and Young Adults, ages 12-24 Clients Female Male N=188 69(38%) 117 (62%) Mode of Transmission Number of Clients Behaviorally Acquired 89 (45%) Perinatally Acquired 94 (50%) Sexual Assault 3 (2%) Transfusion/ Blood Products (Suspected) Unknown 2 (1%)

Adolescent Patients at SIS/Burgess Clinics Children’s National Medical Center Patient Demographics – Through April 1, 2012 Adolescent and Young Adults, ages 12-24 Clients Female Male N=268 101 (38%) 167 (62%) By age Number of Clients 13-15 44 (16%) 16-18 54 (20%) 18-20 73 (27%) 21-24 97 (36%) Total 268

Newly Diagnosed HIV Infected Individuals by Gender, Washington, DC, 2011-2015

Individuals Living with HIV in Washington, DC, 2015 and infected females, by race and ethnicity

New HIV Infections in Washington, DC, 2010-2014, by Gender

HIV “Disease Stage” at time of first recorded lab, Washington, DC, 2015

DOH/HAHSTA “Care Dynamics” report of certain care related factors

HIV Infection in Women in Our Community: The Continuum of Care Despite overall improvement in infection rates, prevalence of infection in women in our community continues to increase and leads the nation. At time of diagnosis, women have a slight advantage in terms of preservation of immune status. Significant improvement has occurred for both women and men in their “care dynamics”. There are few systematic differences in HIV infection in men and woman in our community other than mode of transmission. Successful longterm management of HIV will put a premium on managing collateral health conditions