1 HIV/STD in Texas Ann Robbins Texas Department of State Health Services June 2009

2 In 2007, there were 122,717 reported diagnoses of sexually transmitted diseases.

3 Chlamydia Cases,

4 Chlamydia Case Rates by Year of Report and Race/Ethnicity - Texas,

5 Chlamydia Case Rates by County 2007

6 Gonorrhea Cases,

7 Gonorrhea Case Rates by Race/Ethnicity

8 Gonorrhea Case Rates by County 2007

9 Primary and Secondary Syphilis Cases by Year of Report,

10 P&S Syphilis Case Rates by Year of Report and Sex, Female Male

11 P&S Syphilis Case Rates by Year of Report and Race/Ethnicity - Texas,

12 P&S Syphilis Case Rates by County - Texas, 2008

13 P&S Syphilis Cases by Year of Report by Sex and MSM Risk,

14 Between 2003 and 2007, the number of Texans living with HIV/AIDS increased by 30%.

15 Persons Living with HIV/AIDS, New Diagnoses of HIV/AIDS, and Deaths among those with HIV/AIDS

16 Half of the PLWHA in Texas live in Houston or Dallas

17 Texas Persons Living with HIV/AIDS (PLWHA) by County 2006

18 Persons living with HIV/AIDS by Area, 2006

19 Rate of PLWHA by Geographic Area, 2006

20 The rate of living HIV cases among Blacks in Texas is 3 to 4 times higher than the rate in Whites or Latinos.

21 Number and Rate of PLWHA by Race/Ethnicity, The number of black persons living with HIV/AIDS surpassed that of whites in The rate in 2007 was 4-5 times higher for blacks than for others. NumberRate

22 Rate of new HIV/AIDS in Black women is 8 times higher than rate in Latinas, 20 times higher than rate in White women.

23 New Diagnoses of HIV/AIDS, by Sex, Race/Ethnicity and Mode, 2006

24 New Diagnoses, Number and Rate, by Sex and Race/Ethnicity, 2006

25 Over 5,000 newly acquired HIV infections in Texas in 2007 –Blacks accounted for 39% –Latinos accounted for 30% –Whites/Others accounted for 31% 2007 Incidence Estimate

26 One in…are Living with HIV/AIDS One in 378 of all Texans One in 498 of White Texans One in 565 of Hispanic Texans One in 112 of Black Texans

27 Impact of HIV/ AIDS Persons Living with HIV/AIDS, 2006: Area = Multi-County Eligible Metropolitan Area / Transitional Grant Area (Health Resources and Services Administration Ryan White Part A Funding Areas)

28 In Texas, heterosexual transmissions account for a growing number of newly diagnosed HIV cases, but MSM still make up the majority of new diagnoses.

29 Men who have sex with men account for more than half of both PLWHA and new diagnoses in Texas

30 Mode of transmission in new and living cases of HIV in Texas, 2007

31 HIV/AIDS among Childbearing Women & Perinatal Infections

32 Late Diagnosis of HIV

33 1 in 3 Texans with HIV was diagnosed with AIDS within 1 year of first HIV + test

34 % of Texans with HIV and AIDS Diagnoses within 1 Month and 1 Year

35 BRFSS: HIV Testing Behavior HIV Testing History EverIn Past Year Hispanic 41%15% Black 64%28% White 41%10% Ever Tested for HIV among persons aged years, Texas, 2007

36 Estimated Percentages Newly infected in 2007 and unaware of their status Hispanic64% 55% 58% 59% Black White/Other Overall Incidence Surveillance: 2007 Incidence Estimate

37 Effect of Awareness on Transmission ~25% Unaware of Infection ~75% Aware of Infection People with HIV/AIDS: 1,039,000-1,185,000 New Sexual Infections Each Year: ~32,000 Accounting for: ~54% of New Infections ~46% of New Infections Marks, et al AIDS 2006;20:

38 Refining Transmission Rates by Knowledge of Serostatus 1-3 Unaware of HIV seropositivity –Transmission rate estimated at 8.8 to 10.8% Aware of HIV seropositivity –Transmission rate estimated at 1.7 to 2.4% 1. Holtgrave DR et al. Int J STD AIDS. 2004;15(12): Marks G et al. AIDS. 2006;20(10): Holtgrave, Pinkerton. JAIDS

39 Percent Reporting HIV Test, 2005 Behavioral Risk Factor Surveillance System

40 Consequences of Late Diagnosis Late testing results in missed opportunities for preventing HIV infections Late diagnosis may also increase the costs of hospital care and management of opportunistic infections, especially immediately after diagnosis –Direct care costs in the year following HIV diagnosis were more than 200% higher for patients who presented late* Late diagnosis and entry to care are associated with less favorable prognosis and survival *HB Krentz, MC Auld, MJ Gill (2004)

41 Consequences & Cost Delayed entry into care is associated with less favorable prognosis and survival Delayed entry into care is associated with increased cost of hospital care and management of opportunistic infections –Mean annual costs for late presenters were 2.2 times greater than those for early presenters* –Hospitalizations and immediate initiation of drug therapy main drivers of cost Increased costs were present even when age, gender, risk factor, education, ethnicity and living arrangements were held constant* *Krentz HB, Auld MC, Gill MJHIV Medicine 2004, 5:93-98

42 Participation in Care and Treatment

43 Number and Proportion out of Care, Texas 2007

44 Complexity Intersecting and Accelerating Epidemics –Psychiatric involvement Major depression Substance use and abuse Need to address structural factors –Constrict or eliminate choices –Physically, socially, psychologically separate and isolate

45 Results: Bivariate Linear Correlations Between Social Determinants and Teen Pregnancy Rates, 1999 Teen Pregnancy Rate Poverty.44* Social Capital-.78* Income Inequality.53* Crosby RA et al. J Adolesc Health. 2006;38(5): Pearson correlation coefficients across 48 states with available data, df = 46 *P <.01

46 Social Determinants of STIs and AIDS Cases US States, 1999 GonorrheaSyphilisChlamydiaAIDS Cases Poverty *.099 Social Capital -.671*-.591*-.532*-.498* Income Inequality *.469* Holtgrave DR et al. Sex Transm Infect. 2003;79(1):62-4. Pearson correlation coefficients across 48 states with available data, df = 46 *P <.01

47 Technology... Biomedical prevention interventions –Vaccine –Circumcision –Pre-exposure prophilaxis Increasing relative insensitivity of WB –Antigen testing –NAAT