To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Created: 12/04/14 Revision: 10/30/15 Epidemiology of HIV Among Persons Aged 50 or Older Reported in Florida, Through 2014 Florida Department of Health HIV/AIDS Section Division of Disease Control and Health Protection Annual data trends as of 12/31/2014 Living (Prevalence) data as of 06/30/2015

HIV and AIDS Case Data Adult cases represent ages 13 or older, pediatric cases are those under the age of 13. For data by year, the age is by age of diagnosis. For living data, the age is by current age at the end of the most recent calendar year, regardless of age at diagnosis. Unless otherwise noted, whites are non-Hispanic and blacks are non-Hispanic. Total statewide data will include Department of Correction Cases (DOC) unless otherwise noted. County data will exclude DOC cases. HIV prevalence data are generated later in the year, usually in July, when most of the “expected” death data are complete. HIV and AIDS Case Data Adult cases represent ages 13 or older, pediatric cases are those under the age of 13. For data by year, the age is by age of diagnosis. For living data, the age is by current age at the end of the most recent calendar year, regardless of age at diagnosis. Unless otherwise noted, whites are non-Hispanic and blacks are non-Hispanic. Total statewide data will include Department of Correction Cases (DOC) unless otherwise noted. County data will exclude DOC cases. HIV prevalence data are generated later in the year, usually in July, when most of the “expected” death data are complete. Unless otherwise note, cases with an unknown or blank country of birth were eliminated from these analyses.

Adult HIV Infection and AIDS Cases, by Age Group at Diagnosis, Reported in 2014, Florida HIV N=6,132 AIDS N=2,678 Adult HIV Infection and AIDS Cases, by Age Group at Diagnosis, Reported in 2014, Florida Note: HIV cases tend to be younger than AIDS cases. HIV cases tend to reflect more recent transmission than AIDS cases, and thus present a more current picture of the epidemic. HIV (N=6,132) Ages 13-19 20-29 30-39 40- 49 50+ % of Cases 3 28 23 22 23 AIDS (N=2,678) % of Cases 1 17 23 26 33 Note: HIV cases tend to be younger than AIDS cases. HIV cases tend to reflect more recent transmission than AIDS cases, and thus present a more current picture of the epidemic.

Adult HIV Infection Cases by Age Group at Diagnosis, and Year of Report, 2005-2014, Florida Newly reported HIV cases among persons age 50 or older increased by 5 percentage points from 2005 (18% of total) to 2014 (23% of total). In contrast, newly reported cases among persons age 40-49 each decreased over this same time period by 7 percentage points. Over the past ten years, persons aged 13-39 continue to represent the majority of cases. Newly reported HIV cases among persons age 50 or older increased by 5 percentage points from 2005 (18% of total) to 2014 (23% of total). In contrast, newly reported cases among persons age 40-49 decreased over this same time period by 7 percentage points. Over the past ten years, persons aged 13-39 continue to represent the majority of cases.

Adult AIDS Cases by Age Group at Diagnosis, and Year of Report, 2005-2014, Florida Newly reported AIDS cases among persons age 50 or older increased by 11 percentage points from 2005 (22% of total) to 2014 (33% of total). In contrast, newly reported AIDS cases among persons age 40-49 decreased over this same time period by 11 percentage points. Over the past ten years, persons aged 13-39 continue to represent the majority of cases. Newly reported AIDS cases among persons age 50 or older increased by 11 percentage points from 2005 (22% of total) to 2014 (33% of total). In contrast, newly reported AIDS cases among persons age 40-49 decreased over this same time period by 11 percentage points. Over the past ten years, persons aged 13-39 continue to represent the majority of cases.

Adult HIV Infection Cases, by Age Group at Diagnosis, and Year of Report, 2005–2014, Florida Over the past ten years, the proportion of newly reported adult HIV cases among those in the 20-29 and 50+ age groups increased by 7 and 5 percentage points, respectively. In contrast, the proportion of newly reported adult HIV cases among those in the 30-39 and 40-49 age groups decreased by 6 percentage points respectively for both, over the same time period. Percent (%) of Cases ___ 13-19 20-29 30-39 40-49 50+ 2005 3 21 29 29 18 2006 3 21 29 30 16 2007 4 22 27 28 19 2008 3 21 25 30 21 2009 4 24 24 28 21 2010 5 25 23 26 22 2011 4 27 22 24 22 2012 4 28 22 24 22 2013 3 27 23 24 23 2014 3 28 23 23 23 Over the past ten years, the proportion of newly reported adult HIV cases among those in the 20-29 and 50+ age groups increased by 7 and 5 percentage points, respectively. In contrast, the proportion of newly reported adult HIV cases among those in the 30-39 and 40-49 age groups decreased by 6 percentage points respectively for both, over the same time period.

Adult AIDS Cases, by Age Group at Diagnosis, and Year of Report, 2005–2014, Florida Adult AIDS Cases, by Age Group at Diagnosis, and Year of Report, 2005–2014, Florida From 2005 to 2014, the proportion of newly reported adult AIDS cases has shown increases for both the 20-29 and 50+ age groups. Over the past ten years, newly reported adult AIDS cases among those in the 20-29 and 50+ age groups have increased by 6 and 11 percentage points respectively. In contrast, decreases were observed among those in the 30-39 (6 percentage points) and 40-49 (11 percentage points) age groups over the same time period. Percent (%) of Cases 13-19 20-29 30-39 40-49 50+ 2005 1 11 29 37 22 2006 1 12 29 37 21 2007 1 13 27 35 24 2008 1 13 26 34 25 2009 2 14 26 33 25 2010 1 14 23 33 28 2011 2 14 23 32 29 2012 1 15 25 29 30 2013 1 16 24 30 30 2014 1 17 23 26 33 From 2005 to 2014, the proportion of newly reported adult AIDS cases has shown increases for both the 20-29 and 50+ age groups. Over the past ten years, newly reported adult AIDS cases among those in the 20-29 and 50+ age groups have increased by 6 and 11 percentage points respectively. In contrast, decreases were observed among those in the 30-39 (6 percentage points) and 40-49 (11 percentage points) age groups over the same time period.

HIV Infection Cases Among Persons Aged 50 or Older, Aged 50 or Older, by Age of Diagnosis and Year of Report, 2005-2014, Florida HIV Infection Cases Among Persons Aged 50 or Older, by Age of Diagnosis and Year of Report, 2005-2014, Florida Changes in reporting laws have caused fluctuations in HIV cases. To elaborate, enhanced reporting laws were implemented in Nov. 2006, and the expansion of electronic lab reporting (ELR) in 2007 led to an artificial peak in HIV cases in 2008 which was subsequently followed by a general decline in reported cases through 2012. Another surge in the expansion of ELR in 2012 was followed by another increase in newly reported cases of HIV infection in 2013. An additional increase was observed in 2014 compared to the previous year. Over the years, the majority of HIV infection cases were among those aged 50-59. 50-59 60-69 70+ 2005 881 276 57 2006 801 229 48 2007 942 269 56 2008 1,182 330 89 2009 824 244 62 2010 781 215 62 2011 788 263 59 2012 703 221 59 2013 889 294 65 2014 1,017 344 73 Changes in reporting laws have caused fluctuations in HIV cases. To elaborate, enhanced reporting laws were implemented in Nov. 2006, and the expansion of electronic lab reporting (ELR) in 2007 led to an artificial peak in HIV cases in 2008 which was subsequently followed by a general decline in reported cases through 2012. Another surge in the expansion of ELR in 2012 was followed by another increase in newly reported cases of HIV infection in 2013. An additional increase was observed in 2014 compared to the previous year. Over the years, the majority of HIV infection cases were among those aged 50-59.

AIDS Cases Among Persons Aged 50 or Older, by Age of Diagnosis and Year of Report, 2005-2014, Florida AIDS Cases Among Persons Aged 50 or Older, by Age of Diagnosis and Year of Report, 2005-2014, Florida From 2005 to 2014, the number of newly diagnosed AIDS cases have decreased among those in the 50-59 (15%) and 70 or older (23%) age group; while cases among those in the 60-69 age group increased by 2%. 50-59 60-69 70+ 2005 728 213 52 2006 760 212 57 2007 642 187 39 2008 851 251 64 2009 745 217 59 2010 644 204 50 2011 683 205 56 2012 556 190 46 2013 688 196 56 2014 618 218 40 From 2005 to 2014, the number of newly diagnosed AIDS cases have decreased among those in the 50-59 (15%) and 70 or older (23%) age group; while cases among those in the 60-69 age group increased by 2%.

Newly Reported HIV Infection Cases by Age Group at Diagnosis, 2005-2014, Florida Newly Reported HIV Infection Cases by Age Group at Diagnosis, 2005-2014, Florida Note: The relative increases in cases age 50+ reflect the changing face of the HIV epidemic over time. Age < 50 Age 50 + 2005 5,639 1,214 2006 5,520 1,078 2007 5,421 1,267 2008 6,112 1,601 2009 4,353 1,130 2010 3,815 1,058 2011 3,871 1,110 2012 3,511 983 2013 4,198 1,248 2014 4,698 1,434 Note: The relative increases in cases age 50+ reflect the changing face of the HIV epidemic over time.

Misconceptions About HIV/AIDS Among Persons Aged 50 or Older HIV/AIDS in the United States is generally regarded as a young person’s disease. HIV/AIDS heavily affects only those in young adulthood and early middle age. Persons over 50 are not at risk for HIV/AIDS. Misconceptions About HIV/AIDS Among Persons Aged 50 or Older HIV/AIDS in the United States is generally regarded as a young person’s disease. HIV/AIDS heavily affects only those in young adulthood and early middle age. Persons over 50 are not at risk for HIV/AIDS. SEX DOES NOT END AT 50 Supporting facts: Many older adults are sexually active and thus are as vulnerable as younger persons to acquiring HIV through sexual transmission. A recent survey of sexual behavior among older adults by Lindau et al. (2007), showed that 73% of persons aged 57 – 64 had had sex during the past year, as had 53% of those aged 65 – 74 and 26% of those aged 75 – 85 [1]. Older women may be especially at risk for HIV infection because age-related vaginal thinning and dryness can lead to tears in the vaginal area [2]. Some older persons inject drugs or smoke crack cocaine, which can put them at risk for HIV infection. HIV transmission through drug use accounts for more than 16% of AIDS cases among person aged 50 or older [3]. In fact, in one study [4], researchers found that drug users 50 years or older who smoked crack engaged in behaviors that were deemed extremely risky (e.g., injecting drugs, having multiple sex partners, and exchanging sex for drugs or money). References: [1] Landau, S.T., Schumm, M.A., Laumann, E.O., et al. (2007). A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 357, 762 – 774. [2] Center for AIDS Prevention Studies. (1997, September). What are HIV prevention needs of adults over 50 [fact sheet 29E]. Retrieved from http://caps.ucsf.edu/uploads/pubs/FS/pdf/over50FS.pdf on February 27, 2012. [3] HIV among older adults. (2000). AIDS Reader, 10(7), 430 – 440. [4] Kwiatkowski, C. F. and Booth, R. E. (2003). HIV risk behaviors among older American drug users. Journal of Acquired Immune Deficiency Syndromes, 33(suppl2), S131 – S137. SEX DOES NOT END AT 50

TRUTHS About HIV/AIDS Among Persons Aged 50 or Older Older persons with HIV/AIDS are more likely to live alone. Older persons with HIV/AIDS may be at higher risk for social isolation, including depression and social stigma. Older persons with HIV/AIDS are at increased risk for mortality. TRUTHS About HIV/AIDS Among Persons Aged 50 or Older Older persons with HIV/AIDS are more likely to live alone. Older persons with HIV/AIDS may be at higher risk for social isolation, including depression and social stigma. ~ In fact, many older people live in assisted living communities, where there is still great stigma attached to HIV/AIDS, which is often associated with homosexuality and/or substance abuse. Management may be resistant to providing HIV/AIDS educational materials or presentations in their facilities. Older persons with HIV/AIDS are at increased risk for mortality. ~ Older HIV-infected persons, even those who are living longer because of Highly Active Antiretroviral Therapy (HAART), may begin to develop other chronic health conditions related to aging, such as hypertension, diabetes, and Alzheimer’s disease. HAART can affect, and possibly worsen, these medical conditions [1]. Furthermore, the decreased immune function that results from aging makes older persons more vulnerable to rapid progression of HIV infection to AIDS. References: [1] Cuzin, L., Delpierre, C., Gerard, S., et al. (2007). Immunologic and clinical responses to highly active antiretroviral therapy in patients with HIV infection aged >50 years. Clinical Infectious Diseases, 45, 654 – 657.

Concerns About Persons Aged 50 or Older Which demographic, social and illness factors influence the use of health and social services? What factors affect service use among older persons with HIV/AIDS? How do older persons with HIV/AIDS utilize health and social services compared to their younger counterparts? Concerns About Persons Aged 50 or Older Which demographic, social and illness factors influence the use of health and social services? What factors affect service use among older persons with HIV/AIDS? How do older persons with HIV/AIDS utilize health and social services compared to their younger counterparts? Prevention Challenges: Some older persons, compared to those who are younger, may be less knowledgeable about HIV/AIDS and therefore less likely to protect themselves. Many do not perceive themselves as at risk for HIV, do not use condoms, and do not get tested for HIV. More to the point, one study [1] found that only 13% of older women surveyed said that condoms were effective prevention. Also, in another study [2], almost 60% of older single women who haven been sexually active during the past 10 years had engaged in sex without a condom. Health care professionals (e.g., doctors and nurses) may be influenced by the stereotype that older patients are not sexually active or do not use drugs and consequently may not consider discussing HIV/AIDS with older patients and thus may miss opportunities to deliver prevention messages, offer HIV testing, or make an early diagnosis that could help their patients get early care. In fact, in one study [3] relating to sexuality among older persons, only 38% of men and 22% of women said that they had discussed sex with their doctor since age 50. Stigma of HIV/AIDS may be more severe among older persons, leading them to hide their diagnosis from family and friends. Also, older persons may have fewer surviving friends and smaller social network to provide support and care. In fact, they may more than likely be caregivers themselves, as about one third of AIDS patients are dependent on an older parent for financial, physical or emotional support [4]. References: [1] Henderson, S. J., Bernstein, L. B., George, D. M., et al. (2004). Older women and HIV: How much do they know and where are they getting their information? Journal of the American Geriatric Society, 52, 1549 – 1553. [2] Lindau, S. T., Leitsch, S. A., Lundberg, K. L., et al. (2006). Older women’s attitudes, behavior, and communication about sex and HIV: a community-based study. Journal of Women’s Health, 6, 747 – 753. [3] Lindau, S. T., Schumm, M. A., Laumann, E. O., et al. (2007). A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 357, 762 – 774. [4] Nokes, K. (Ed.). (1996). HIV/AIDS and the older adult. Washington, D.C.: Taylor & Francis

HIV Cases Among Persons Aged 50 or Older, HIV Infection Cases Among Persons Aged 50 or Older, by Sex and Year of Report, 2005-2014, Florida Male M:F Ratio 2005 2.5:1 2014 3.4:1 Female HIV Cases Among Persons Aged 50 or Older, by Sex and Year of Report, 2005-2014, Florida Over the past ten years, 71% or more of newly reported HIV cases among persons 50 or older were male. Although annual trends have remained fairly level for most of the years, the male to female ratio increased from 2.5:1 in 2005 to 3.4:1 in 2014. Percent (%) of Cases Year Male Female 2005 72 28 2006 72 28 2007 71 29 2008 73 27 2009 72 28 2010 73 27 2011 72 28 2012 73 27 2013 72 28 2014 77 23 Over the past ten years, 71% or more of newly reported HIV cases among persons 50 or older were male. Although annual trends have remained fairly level for most of the years, the male to female ratio increased from 2.5:1 in 2005 to 3.4:1 in 2014.

AIDS Cases Among Persons Aged 50 or Older, by Sex and Year of Report, 2005-2014, Florida Male M:F Ratio 2005 3.1:1 2014 2.3:1 Female AIDS Cases Among Persons Aged 50 or Older, by Sex and Year of Report, 2005-2014, Florida Over the past ten years, 69% or more of newly reported AIDS cases among persons 50 or older were male. Although the annual trends have remained fairly level throughout the years, the male to female ratio decreased yielding a male to female ratio of 3.1:1 in 2005 to 2.3:1 in 2014. Percent (%) of Cases Male Female 2005 76 24 2006 71 29 2007 69 31 2008 72 28 2009 69 31 2010 69 31 2011 69 31 2012 71 29 2013 71 29 2014 70 30 Over the past ten years, 69% or more of newly reported AIDS cases among persons 50 or older were male. Although the annual trends have remained fairly level throughout the years, the male to female ratio decreased yielding a male to female ratio of 3.1:1 in 2005 to 2.3:1 in 2014.

Male HIV Infection Cases Among Persons Aged 50 or Older, Aged 50 or Older, by Race/Ethnicity and Year of Report, 2005-2014, Florida Black White Hispanic Male HIV Infection Cases Among Persons Aged 50 or Older, by Race/Ethnicity and Year of Report, 2005-2014, Florida From 2005 to 2014, the proportion of newly reported male HIV cases ages 50 or older decreased by 17 percentage points among black males. In contrast, cases increased among white and Hispanic males by 18 and 3 percentage points respectively during the same time period. Race/Ethnicity 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 White, non-Hispanic 31 36 37 36 37 38 39 41 48 49 Black, non-Hispanic 45 44 44 43 45 43 38 40 30 28 Hispanic 20 18 18 18 17 18 21 19 21 23 From 2005 to 2014, the proportion of newly reported male HIV cases ages 50 or older decreased by 17 percentage points among black males. In contrast, cases increased among white and Hispanic males by 18 and 3 percentage points respectively during the same time period.

Female HIV Infection Cases Among Persons Aged 50 or Older, by Race/Ethnicity and Year of Report, 2005-2014, Florida Black White Hispanic Female HIV Infection Cases Among Persons Aged 50 or Older, by Race/Ethnicity and Year of Report, 2005-2014, Florida Although white and Hispanic newly reported female HIV cases have fluctuated throughout the years – at times – crossing paths, HIV cases among Hispanic females have increased 4 percentage points from 2005 to 2014, while HIV cases among white females remain fairly level over the years. In contrast, the proportion of newly reported HIV cases among black females age 50 or older decreased 4 percentage points during the same time period. Race/Ethnicity 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 White, non-Hispanic 15 16 19 16 17 13 18 15 15 16 Black, non-Hispanic 68 66 63 71 65 74 66 69 69 64 Hispanic 16 16 16 10 17 12 15 15 14 20 Although white and Hispanic newly reported female HIV cases have fluctuated throughout the years – at times – crossing paths, HIV cases among Hispanic females have increased 4 percentage points from 2005 to 2014, while HIV cases among white females remain fairly level over the years. In contrast, the proportion of newly reported HIV cases among black females age 50 or older decreased 4 percentage points during the same time period.

Male HIV Infection Cases, by Age at Diagnosis, Race/Ethnicity, and Year of Report, 2005-2014, Florida White, non-Hispanic Black, non-Hispanic Hispanic Less than 50 years 50+ years Male HIV Cases, by Age at Diagnosis, Race/Ethnicity, and Year of Report, 2005-2014, Florida <50 Years Old Race/Ethnicity 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 White, non-Hispanic 1,385 1,336 1,326 1,565 950 804 868 826 910 1,150 Black, non-Hispanic 1,590 1,542 1,438 1,757 1,336 1,207 1,195 1,087 1,243 1,386 Hispanic 917 936 977 1,024 830 772 827 748 1,020 1,145 50+ Years Old White, non-Hispanic 268 283 329 421 298 293 306 290 426 539 Black, non-Hispanic 395 341 398 502 367 333 302 286 272 312 Hispanic 178 142 160 215 139 136 169 134 190 249

Female HIV Infection Cases, by Age at Diagnosis, Race/Ethnicity, and Year of Report, 2005-2014, Florida White, non-Hispanic Black, non-Hispanic Hispanic 50+ years Less than 50 years Female HIV Infection Cases, by Age at Diagnosis, Race/Ethnicity, and Year of Report, 2005-2014, Florida <50 Years Old Race/Ethnicity 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 White, non-Hispanic 260 275 290 271 201 109 156 130 153 182 Black, non-Hispanic 1,106 1,035 1,050 1,115 811 707 622 546 628 571 Hispanic 244 265 221 238 133 139 124 106 152 154 >50 Year Old White, non-Hispanic 52 47 69 70 52 38 56 39 52 54 Black, non-Hispanic 234 198 230 311 205 208 208 185 244 209 Hispanic 55 49 60 45 53 33 46 39 51 64

Male HIV Infection Cases Among Persons Aged 50 or Older Aged 50 or Older by Mode of Exposure and Year of Report, 2005-2014, Florida Male HIV Infection Cases Among Persons Aged 50 or Older by Mode of Exposure and Year of Report, 2005-2014, Florida Over the past ten years, men who have sex with men (MSM) remains as the primary mode of exposure among male HIV cases age 50 or older in Florida, followed by heterosexual contact. Note: NIRs redistributed. Mode 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 MSM 426 403 458 639 422 413 430 407 577 743 IDU 111 89 106 113 78 74 51 43 58 74 MSM/IDU 34 30 34 32 15 12 17 7 17 27 HETEROSEXUAL 299 255 301 380 301 276 297 260 243 262 Over the past ten years, men who have sex with men (MSM) remains as the primary mode of exposure among male HIV cases age 50 or older in Florida, followed by heterosexual contact.

Female HIV Infection Cases Among Persons Aged 50 or Older by Mode of Exposure and Year of Report, 2005-2014, Florida Female HIV Infection Cases Among Persons Aged 50 or Older by Mode of Exposure and Year of Report, 2005-2014, Florida The heterosexual risk continues to be the dominant mode of exposure among females ages 50 or older. Note: NIRs redistributed. Mode 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 IDU 43 55 50 49 40 31 33 32 38 34 Heterosexual 301 246 317 388 274 252 283 236 315 295 The heterosexual risk continues to be the dominant mode of exposure among females ages 50 or older.

HIV Infection Cases Among Persons Aged 50 or Older by Exposure Category, Age at Diagnosis and Sex, Diagnosed through 2014, Florida HIV Infection Cases Among Persons Aged 50 or Older by Exposure Category, Age at Diagnosis and Sex, Diagnosed through 2014, Florida Through 2014, there were more cases of men (4,349) reported with HIV than women (1,553). The majority of men aged 50 or older contracted HIV from primarily from MSM risk followed by heterosexual contact. Among women aged 50 or older, more than 88% acquired HIV through heterosexual contact. Through 2014, there were more cases of men (4,349) reported with HIV than women (1,553). The majority of men aged 50 or older contracted HIV from primarily from MSM risk followed by heterosexual contact. Among women aged 50 or older, more than 88% acquired HIV through heterosexual contact.

Aging and HIV Infection Aging and HIV Infection Studies have suggested that aging is an important risk factor in accelerated HIV disease progression* HIV infection and aging both greatly impact the immune system With an immune system doubly challenged, those aging with HIV will likely confront more health challenges such as Diabetes, heart disease, and other co-morbidities Fatigue, malnutrition, and bone problems Menopause issues (for women) Aging and HIV Infection Studies have suggested that aging is an important risk factor in accelerated HIV disease progression* HIV infection and aging both greatly impact the immune system With an immune system doubly challenged, those aging with HIV will likely confront more health challenges such as Diabetes, heart disease, and other co-morbidities Fatigue, malnutrition, and bone problems Menopause issues (for women) *Adler WH, Baskar PV, Chrest FJ, Dorsey-Cooper B, Winchurch RA, Nagel JE. HIV infection and aging: mechanisms to explain the accelerated rate of progression in the older patient. Mech Ageing Dev 1997 Jun; 96 (1-3): 137-55

Adults Living with HIV Disease, by Sex and Current Age Group, Diagnosed through 2014, Florida Males N=78,644 Female N=31,147 Adults Living with HIV Disease, by Sex and Current Age Group, Diagnosed through 2014, Florida Note: Males living with HIV disease have a higher proportion of cases who are currently 40 years of age or older (77%), compared with females living with HIV disease (71%). Males (N=78,644) Ages % of Cases 13-19 0 20-29 9 30-39 14 40-49 28 50+ 49 Females, (N=31,147) 13-19 1 20-29 8 30-39 19 40-49 29 50+ 42 Note: Males living with HIV disease have a higher proportion of cases who are currently 40 years of age or older (77%), compared with females living with HIV disease (71%).

Annual Prevalence of Adults Living with HIV Disease by Current Age Group, 1995-2014, Florida Annual Prevalence of Adults Living with HIV Disease by Current Age Group, 1995-2014, Florida As a result of declining deaths, annual HIV/AIDS diagnoses have exceeded deaths since 1995, and the number of persons reported with HIV/AIDS who are presumed to be alive have been increasing. Since the year 1995, prevalent cases have increased more than 199% for ages <50 and more than 1,830% for ages 50+. In the past year the prevalence increased by nearly 1% for PLWHA ages <50 and 11% for PLWHA ages 50+. *PLWHA = Persons Living with HIV/AIDS. These data represent adults living with HIV disease diagnosed in Florida regardless of their current residence. Year Age <50 Aged 50+ 1995 19,052 2,550 1996 21,374 3,054 1997 25,092 3,947 1998 29,192 5,142 1999 32,847 6,255 2000 36,077 7,600 2001 39,301 9,121 2002 42,121 10,736 2003 44,915 12,528 2004 47,653 14,768 2005 49,587 17,102 2006 51,094 19,588 2007 52,989 22,581 2008 54,761 25,709 2009 55,904 29,089 2010 56,422 32,471 2011 56,653 36,153 2012 56,549 40,181 2013 56,642 44,472 2014 57,119 49,240 As a result of declining deaths, annual HIV/AIDS diagnoses have exceeded deaths since 1995, and the number of persons reported with HIV/AIDS who are presumed to be alive have been increasing. Since the year 1995, prevalent cases have increased more than 199% for ages <50 and more than 1,830% for ages 50+. In the past year the prevalence increased by nearly 1% for PLWHA ages <50 and 11% for PLWHA ages 50+. *PLWHA = Persons Living with HIV/AIDS. These data represent adults living with HIV disease diagnosed in Florida regardless of their current residence.

Gender # of Cases Adults Living with HIV Disease by Sex and Current Age Group Diagnosed through 2014, Florida Adults Living with HIV Disease by Sex and Current Age Group Diagnosed through 2014, Florida Note: Florida’s Adult Population (age 13+) is: 49% Male and 51% Female. Age <50, (N=58,313) Gender # of Cases Males 40,368 Females 17,945 Aged 50 or Older, (N=51,478) Males 38,276 Females 13,202 Note: Florida’s Adult Population (age 13+) is: 49% Male and 51% Female.

Adults Aged 50 or Older Living with HIV Disease by Sex and Race/Ethnicity, Diagnosed through 2014, Florida Adults Aged 50 or Older Living with HIV Disease by Sex and Race/Ethnicity, Diagnosed through 2014, Florida Note: The proportion of cases by race/ethnicity varies by sex. *Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and multi-racial individuals. Males, N=38,276 Race/Ethnicity # of Cases White 15,734 Black 13,949 Hispanic 7,998 Other* 595 Females, N=13,202 White 2,142 Black 8,729 Hispanic 2,111 Other 220 Black Black Note: The proportion of cases by race/ethnicity varies by sex. *Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and multi-racial individuals.

Definitions of Mode of Exposure Categories MSM = Men who have sex with men or Male-to-male sexual contact with person with HIV/AIDS or known HIV risk IDU = Injection Drug User MSM/IDU = Men who have sex with men or Male-to-male sexual contact & Injection Drug User Heterosexual = Heterosexual contact with person with HIV/AIDS or known HIV risk OTHER = includes hemophilia, transfusion, perinatal, other pediatric risks and other confirmed risks. NIR = Cases reported with No Identified Risk Redistribution of NIRs = This illustrates the effect of statistically assigning (redistributing) the NIRs to recognized exposure (risk) categories by applying the proportions of historically reclassified NIRs to the unresolved NIRs. Definitions of Mode of Exposure Categories MSM = Men who have sex with men or Male-to-male sexual contact with person with HIV/AIDS or known HIV risk IDU = Injection Drug User MSM/IDU = Men who have sex with men or Male-to-male sexual contact & Injection Drug User Heterosexual = Heterosexual contact with person with HIV/AIDS or known HIV risk OTHER = includes hemophilia, transfusion, perinatal, other pediatric risks, and other confirmed risks. NIR = Cases reported with No Identified Risk Redistribution of NIRs = This illustrates the effect of statistically assigning (redistributing) the NIRs to recognized exposure (risk) categories by applying the proportions of historically reclassified NIRs to the unresolved NIRs.

Adults Aged 50 or Older Living with HIV Disease by Sex and Mode of Exposure, Diagnosed through 2014, Florida Adults Aged 50 or Older Living with HIV Disease by Sex and Mode of Exposure, Diagnosed through 2014, Florida Note: NIRs redistributed. Male-to-male sexual contact is the primary risk among males aged 50+ (61%), followed by heterosexual contact (23%) and IDU (10%). Heterosexual contact is the primary risk among females aged 50+ (82%), followed by IDU (17%). Males, N=38,276 Exposure # of Cases MSM 23,448 IDU 3,954 MSM/IDU 2,199 Heterosexual 8,630 Other 45 Females, N=13,202 IDU 2,304 Hetero 10,838 Other 60 MSM Heterosexual Note: NIRs redistributed. Male-to-male sexual contact is the primary risk among males aged 50+ (61%), followed by heterosexual contact (23%) and IDU (10%). Heterosexual contact is the primary risk among females aged 50+ (82%), followed by IDU (17%).

Adults Aged 50 or Older Living with HIV Disease by Sex, Race/Ethnicity, Current Age and Mode of Exposure Diagnosed through 2014, Florida Adults Aged 50 or Older Living with HIV Disease by Sex, Race/Ethnicity, Current Age and Mode of Exposure Diagnosed through 2014, Florida

Rates* of Persons Aged 50 or Older Living with HIV Disease, by County of Residence,** Diagnosed through 2014, Florida Statewide Data: 678.6 per 100,000, population N=51,478 0.1 - 300.0 300.1 - 600.0 600.1 - 900.0 over 900.0 Rates* of Persons Aged 50 or Older Living with HIV Disease, by County of Residence,** Diagnosed through 2014, Florida * Rates are based on 2014 population (denominator) data from Florida CHARTS. ** County totals exclude Department of Corrections cases (N=1,808). * Rates are based on 2014 population (denominator) data from Florida CHARTS. ** County totals exclude Department of Corrections cases (N=1,808).

Living with HIV Disease, Diagnosed through 2014, Florida Adults Aged 50 or Older, Living with HIV Disease, Diagnosed through 2014, Florida 74% resided in the following counties at the time of diagnosis: Dade County 25% Broward County 19% Palm Beach County 8% Orange County 7% Hillsborough County 6% Duval County 5% Pinellas County 4% Adults Aged 50 or Older, Living with HIV Disease, Diagnosed through 2014, Florida 74% resided in the following counties at the time of diagnosis: Dade County 25% Broward County 19% Palm Beach County 8% Orange County 7% Hillsborough County 6% Duval County 5% Pinellas County 4%

Adults Aged 50 or Older, Living with HIV Disease, For Counties with a 50+ Population Over 100,000 Diagnosed through 2014, Florida Adults Aged 50 or Older, Living with HIV Disease, For Counties with a 50+ Population Over 100,000 Diagnosed through 2014, Florida *Population data are from Florida CHARTS as of 07/09/2015 **Case rate per 100,000 population ****County totals exclude Department of Correction cases (N=1,808). A total of 45,014 persons aged 50 and older were living with HIV/AIDS in counties where the 50 and older population totaled more than 100,000. The HIV/AIDS case rate for these cases was 746.6 per 100,000 population (compared to the state rate of 654.8 for all HIV/AIDS cases of persons aged 50 and older). The highest rates were found in: Broward County (1456.7), Miami-Dade County (1409.7), and Orange County (979.6). Duval County followed closely with an HIV disease rate of (789.6) per 100,000 population. A total of 36,823 (74%) of these cases were reported from the seven most populous counties: Miami-Dade, Broward, Palm Beach, Orange, Hillsborough, Duval, and Pinellas. *Population data are from Florida CHARTS as of 07/09/2015 ** PLWHA = PERSONS LIVING WITH HIV/AIDS ***Case rate per 100,000 population Special note: County totals exclude Department of Correction cases (N=1,808).

HIV Continuum, Florida 4/26/2017 Number and Percentage of Persons Diagnosed and Living with HIV (PLWH) Engaged in Selected Stages of the Continuum of HIV Care Aged 50 or Older, Florida, 2014 51,478 47,122 37,059 71% 72% 32,092 34,122 Definitions The diagnosis-based HIV care continuum shows each step of the continuum as a percentage of the number of people living with diagnosed HIV as of the end of 2014. HIV Diagnosed: The number of persons known to be diagnosed and living in Florida with HIV disease (PLWH) through 2014, regardless of AIDS status or where diagnosed, as of 06/30/15. Ever in Care: PLWH with at least 1 documented viral load (VL) or CD4 lab, medical visit or prescription since HIV diagnosis. In Care: PLWH with at least 1 documented VL or CD4 lab, medical visit or prescription in 2014. Retained in care: PLWH with 2 or more documented VL or CD4 labs, medical visits or prescriptions (at least 3 months apart) in 2014. On ART: Estimated PLWH on antiretroviral therapy (ART) in 2014. The 2013 FL MMP data are used to estimate the number and percentage of people receiving medical care and who have a documented ART prescription in their medical records in the observed year. From the 2013 FL MMP data, 95% of those in care were on ART. Suppressed Viral Load: PLWH with a suppressed viral load (<200 copies/mL) on last viral load in 2014. 87% of those diagnosed with HIV in 2014 had documented HIV-related care within 3 months of diagnosis 87% of PLWH in care had a suppressed viral load in 2014 (1) HIV Diagnosed: Persons diagnosed and living with HIV (PLWH) in Florida through the end of 2014. Ever in Care: PLWH with at least 1 documented viral load (VL) or CD4 lab, medical visit or prescription since HIV diagnosis. In Care: PLWH with at least 1 documented VL or CD4 lab, medical visit or prescription in 2014. Retained in Care: PLWH with 2 or more documented VL or CD4 labs, medical visits or prescriptions (at least 3 months apart) in 2014. On ART: This bar was omitted on tables with demographic and risk breakdowns because the estimated value is based on small numbers. Suppressed Viral Load: PLWH with a suppressed VL (<200 copies/mL) on last VL in 2014.

Deaths* Among Adults with HIV Disease by Age and Sex, 2014, Florida State Deaths Deaths* Among Adults with HIV Disease by Age and Sex, 2014, Florida Males N=1,081 Females N=486 Deaths* Among Adults with HIV Disease by Age and Sex, 2014, Florida Note: Overall, the majority of deaths among adults with HIV disease are individuals aged 50 and older. In 2014, the proportion of males (68%) aged 50 and older who died with HIV disease is higher than the proportion of females (56%) aged 50 and older. * Adult (13+) cases diagnosed with HIV disease in Florida, who died regardless of the cause or residence at death. Data as of 06/30/2014 Males (N=1,081) Ages % of Cases 13-19 0 20-29 4 30-39 9 40-49 19 50+ 68 Females, (N=486) 30-39 17 40-49 23 50+ 56 Note: Overall, the majority of deaths among adults with HIV disease are individuals aged 50 and older. In 2014, the proportion of males (68%) aged 50 and older who died with HIV disease is higher than the proportion of females (56%) aged 50 and older. * Adult (13+) cases diagnosed with HIV disease in Florida, who died regardless of the cause or residence or place at death. Data as of 06/30/2015 35 15

THINGS TO PONDER Old age is NOT a safety net. Older people also need to be checked for HIV/AIDS! Sex does NOT end at 50. Life BEGINS at 50!! THINGS TO PONDER Old age is NOT a safety net. Older people also need to be checked for HIV/AIDS! Sex does NOT end at 50. Life BEGINS at 50!!

For Florida HIV/AIDS Surveillance Data Contact: (850) 245-4444 Lorene Maddox, MPH Ext. 2613 Tracina Bush, BSW Ext. 2612 Madgene Moise, MPH Ext. 2373 Visit Florida’s internet site for: Monthly Surveillance Reports Slide Sets and Fact Sheets Annual Reports and Epi Profiles http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/index.html Visit CDC’s HIV/AIDS internet site for: Surveillance Reports, fact sheets and slide sets http://www.cdc.gov/hiv/topics/surveillance/resources/reports/index.htm For Florida HIV/AIDS Surveillance Data Contact: (850) 245-4444 Lorene Maddox, MPH Ext. 2613 Tracina Bush, BSW Ext. 2612 Madgene Moise, MPH Ext. 2373 Visit Florida’s internet site for: Monthly Surveillance Reports Slide Sets and Fact Sheets Annual Reports and Epi Profiles http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/index.html Visit CDC’s HIV/AIDS internet site for: Surveillance Reports, fact sheets and slide sets http://www.cdc.gov/hiv/topics/surveillance/resources/reports/index.htm