1. HIV/AIDS in Utah Edwin Espinel HIV Counseling & Testing, Partner Services Program Coordinator University of Utah May 2013 Utah Department of Health Bureau of Epidemiology Communicable Disease Analysis and Reporting Program

2. The Whip Lash Zone

3. Every 9 ½ Minutes.. Someone in the US is infected with HIV

4. Lifetime Risk of HIV Diagnosis in 33 States, 2004-2005 Blacks: 1 in 16 for men 1 in 30 for women Hispanics: 1 in 35 for men 1 in 114 for women American Indian/Alaska Native: 1 in 103 for men 1 in 278 for women Asian American/Pacific Islander: 1 in 169 for men 1 in 540 for women Whites: 1 in 104 for men 1 in 588 for women Hall et al. JAIDS. 2008; 49: 294-297.

5. 1 in 16 Black men will be diagnosed with HIV Hall et al. JAIDS. 2008; 49: 294-297.1

6. 1 in 30 Black women will be diagnosed with HIV Hall et al. JAIDS. 2008; 49: 294-297.1

7. 1 in 35 Hispanic men will be diagnosed with HIV Hall et al. JAIDS. 2008; 49: 294-297.1

8. HIV does not discriminate… It is important that everyone in the community knows how HIV is spread and how to prevent it. It is your responsibility Remember to fight against the conditions that lead to the spread of HIV, and not against the people who have it.

9. Epidemiology of HIV in the U.S.

10. 33% rate of late diagnosis (AIDS w/in 1 yr.) Nearly half of persons who are diagnosed positive not engaged in regular HIV care More than 18,000 people with AIDS die each year

11. U.S. Treatment Cascade For every 100 individuals living with HIV in the U.S., it is estimated that: 80 are aware of their HIV status. 62 have been linked to HIV care. 41 stay in HIV care. 36 get antiretroviral therapy (ART). 28 are able to adhere to their treatment and sustain undetectable viral loads.

12. U.S. Treatment Cascade US Treatment Cascade

13. HIV in the U.S. Prejean J, Song R, Hernandez A, Ziebell R, Green T, et al. (2011) Estimated HIV Incidence in the United States, 2006- 2009. PLoS ONE 6(8): e17502. doi:10.1371/journal.pone.0017502.

14. Estimates of New HIV Infections in the U.S., 2006‐2009 “relatively stable,” approx. 50,000 annual infections 61% MSM, 27% heterosexual, 9% IDU Blacks: 44% new HIV infections vs. 14% of population Hispanics: 20% of new HIV infections vs. 16% of population Black women (15X) and Hispanic women (4X) HIV infection rates compared to white women Young black MSM only group with sig. increase in HIV infections (06‐09) (Prejean et al. PLoS One, vol. 6, 2011)

15. Rates of AIDS Diagnoses in the U.S., 2009 Overall rate: 11.2 per 100,000 Black/African American: 44.4 per 100,000 Multiple Races: 15.1 per 100,000 Hispanic/Latino: 13.9 per 100,000 Native Hawaiian/Pacific Islander: 11.2 per 100,000 American Indian/Alaska Native: 6.6 per 100,000 White: 4.7 per 100,000 Asian: 3.1 per 100,000 (CDC. HIV Surveillance Report; 2009 vol. 21. Feb 2011)

16. Diagnosed HIV Infections, Utah, 2006-2010 20062007200820092010 HIV Infections 12612112812782

17. HIV Infection by Transmission Category, Utah, 2010

18. People Living w/ HIV Infection by Race/Ethnicity, Utah, 2010* *By end of December 31 st, 2010

19. 2011 HIV/AIDS Highlights in Utah White individuals accounted for 62% of the new infections, followed by Hispanics (23%), Asians (6%), Black/African Americans (4%), and Multi- Racial (2%). There were 2% with an unknown Race or Ethnicity

20. Current Population Trends in the Hispanic/Latino Population 1 in 3 U.S. Residents will be Latino in 2050. Pew Research Institute Our nation’s future economic prosperity depends on a healthy and thriving Latino population.

21. Utah Hispanics Between 1990 and 2011, Utah Hispanics were predicted to increase by 126.4% compared to the 15.4% for the non-Hispanic population

23. Migration

24. Refugee Community Estimated 25,000 refugees have been resettled in Utah – Somali, Sudanese and Bosnian are the largest groups 2008 – 914 2009 – 1100 2010 – 1000 (expected) – Bhutanese, Iraqi, Karen and Somali

25. Hope It ’ s Not Urgent

26. Which way do you go?

27. Social Determinants of Health (Dahlghren European Health Policy Conference 1995)

28. Goals of the U.S. National HIV/AIDS Strategy (NHAS) Reduce new HIV infections Increase access to care and improve health outcomes for people living with HIV Reduce HIV‐related disparities and health inequities Achieve a more coordinated national response to the HIV epidemic

30. Utah HIV/AIDS Strategy 1.HIV Testing 2.Condom Distribution 3.Prevention with Positives – a seamless transition into care 4.Policy

31. Utah HIV/AIDS Strategy HIV Testing – 8000 HIV tests by 12/31/2012 Condom Distribution – 200,000 by 12/31/2012 – Promote positive attitudes toward condom use, build self- efficacy for practicing safer sex and increase intention to use condoms

32. Utah HIV/AIDS Strategy Prevention with Positives – a seamless transition into care – Increase % of newly diagnosed into care by 10% by 12/31/2012 – Increase % of newly diagnosed MSM, Hispanics and Blacks by 10% by 12/31/2012

33. Utah HIV/AIDS Strategy Policy: – In collaboration with DOC, improve mandatory HIV testing practices of inmates for more accurate & effective testing and immediately reduce cost by 12/31/2013 Achieve a more coordinated national response to the HIV epidemic: – Federal & state partners – HHS Region VIII

34. National Response

35. Utah HIV Prevention & Treatment Team PROJECT REALITY Utah AIDS Foundation

36. Working Together, We Can Change the Course of the Epidemic

37. TOGETHER, Let’s End Discrimination FREE HUGS AIDS Campaign PROJECT REALITY

38. Thank You Edwin Espinel HIV Counseling & Testing, Partner Services Program Coordinator Utah Department of Health 288 North 1460 West Salt Lake City, UT 84116 Office: 801-538-9480 Email: eespinel@utah.goveespinel@utah.gov