HIV/AIDS in the United States
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HIV/AIDS in the United States: Epidemiology and an Overview of High-Impact Prevention Measures ...

HIV/AIDS in the United States: Epidemiology and an Overview of High-Impact Prevention Measures

By Melody Lehosit, Kaplan University School of Health Sciences

A presentation for National Public Health Week.

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HIV/AIDS in the United States Presentation Transcript

  • 1. HIV/AIDS IN THE UNITED STATES:EPIDEMIOLOGY AND ANOVERVIEW OF HIGH-IMPACTPREVENTION MEASURESMelody Lehosit, CRNI MS
  • 2. Introduction• Epidemiology: Population Trends of HIV Infection • Male/Female • Transmission • Ethnicity/Race • State Rates • Living With HIV in the U.S. • Deaths• High-Impact Prevention Measures
  • 3. Diagnoses of HIV Infection Among Adults and Adolescents by Sex, 2007–2010, 46 States and 5 U.S. Dependent AreasNote: Data includes persons with a diagnosis of HIV infection regardless of the stage of the disease at diagnosis. All displayed data has been statistically adjusted to account for reporting delays, but not for incomplete reporting.
  • 4. Diagnoses of HIV Infection Among Adults and Adolescents by Sex and Transmission Category, 2010, 46 States and 5 U.S. Dependent AreasNote: Data includes persons with a diagnosis of HIV infection regardless of the stage of the disease at diagnosis. All displayed data has been statistically adjusted to account for reporting delays and missing risk-factor information, but not for incomplete reporting.a Heterosexual contact with a person known to have, or to be at high-risk for, HIV infection.b Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.
  • 5. Trends in Sex and Transmission2010 Transmission in• 48,079 new DX Males• Males: 74 percent • Male-to-male: 77 percent• Females: 21percent Transmission in Females • Heterosexual contact: 86 percent*These rates have been stablefor the past 3 years. *Rates of new male-to-male transmission infections increased from 55 percent to 61percent. (CDC, 2011)
  • 6. Diagnoses of HIV Infection Among Adults and Adolescents, by Race/Ethnicity, 2007–2010, 46 States and 5 U.S. Dependent AreasNote: Data includes persons with a diagnosis of HIV infection regardless of the stage of the disease at diagnosis. All displayed data has been statistically adjusted to account for reporting delays, but not for incomplete reporting.a Hispanics/Latinos can be of any race.
  • 7. Diagnoses of HIV Infection Among Adults and Adolescents by Sex and Race/Ethnicity, 2010, 46 States 5 U.S. Dependent AreasNote: Data includes persons with a diagnosis of HIV infection regardless of the stage of the disease at diagnosis. All displayed data has been statistically adjusted to account for reporting delays, but not for incomplete reporting.a Hispanics/Latinos can be of any race.
  • 8. Trends in Sex and Race/Ethnicity2010Males Diagnosed: 37, 910• Black/African American: 45 percent• White: 29 percent• Hispanic/Latino: 22 percentFemales Diagnosed: 10,168• Black/African American: 62 percent• Hispanic/Latino: 18 percent• White: 17 percent (CDC 2011; CDC, 2012)
  • 9. Diagnosed HIV Infections Attributed to Male-to-Male Sexual Contact, by Race/Ethnicity, 2010, 46 States and 5 U.S. Dependent Areas Race/Ethnicity No. % American Indian/Alaska Native 119 0.4 Asian 584 2.0 Black/African American 10,842 37.1 a Hispanic/Latino 6,803 23.3 Native Hawaiian/Other Pacific Islander 53 0.2 White 10,396 35.6 Multiple Races 396 1.4 Total 29,194 100.0Note: Data includes persons with a diagnosis of HIV infection regardless of the stage of the disease at diagnosis. All displayed data has been statistically adjusted to account for reporting delays and missing risk-factor information, but not for incomplete reporting.a Hispanics/Latinos can be of any race.
  • 10. Diagnosed HIV Infections Attributed to Injection Drug Use, by Sex and Race/Ethnicity, 2010, 46 States and 5 U.S. Dependent Areas Males Females Total Race/Ethnicity No. % No. % No. American Indian/Alaska Native 6 0.2 15 1.1 21 Asian 22 0.9 9 0.6 31 Black/African American 1, 203 46.6 725 50.9 1,928 a Hispanic/Latino 836 32.4 220 15.4 1,056 Native Hawaiian/Other Pacific Islander 2 0.1 1 0.1 4 White 487 18.9 432 30.3 918 Multiple Races 25 1.0 24 1.7 49 Total 2,581 100.0 1,426 100.0 4,007 Note: Data includes persons with a diagnosis of HIV infection regardless of the stage of the disease at diagnosis. All displayed data has been statistically adjusted to account for reporting delays and missing risk-factor information, but not for incomplete reporting. a Hispanics/Latinos can be of any race.
  • 11. 2010 Trends by Number (N)High and Increased Transmission• Male-to-Male: 29,194• Heterosexual Contact: 13,357By Race• Black/African American: 10,842• White: 10,396• Hispanic/Latino: 6,803By Race—IV Drug Use• Black/African American: 1,928• Hispanic/Latino: 1,056• White: 918 (CDC, 2011)
  • 12. Rates of Diagnoses of HIV Infection Among Adults and Adolescents, 2010, 46 States and 5 U.S. Dependent Areas N = 48,079Note: Data includes persons with a diagnosis of HIV infection regardless of the stage of the disease at diagnosis. All displayed data has been statistically adjusted to account for reporting delays, but not for incomplete reporting.
  • 13. Rates of Adults and Adolescents Living With an AIDS Diagnosis, 2009, United States and 6 U.S. Dependent Areas N = 487,414Note: All displayed data has been statistically adjusted to account for reporting delays, but not for incomplete reporting.
  • 14. What to Do?• Overall rates stable• Black/African American male rates increasing• Latino rates disproportionate, increasing• Male-to-male transmission rates increasing• Urban rates increasing• Female heterosexual rates of transmission (CDC, 2012)
  • 15. Prevention Works• More people living with HIV• People in the U.S. know their status• Stable rates?• CDC estimates 5 transmissions per 100 people living with HIV• Specific targets needed (CDC, 2012)
  • 16. High-Impact PreventionNational HIV/AIDS Strategy Target High-Risk Groups• Science/Medication • Gay and Bisexual Men• Cost Efficiency • Communities of Color• Specific Interventions • Women• Geography • Youth • IV Drug Users • Transgendered (CDC, 2011a)
  • 17. Funding Decisions Partners Cities• National Association of State and • Atlanta Territorial AIDS Directors (NASTAD)• Urban Coalition for HIV/AIDS • Baltimore Prevention Services (UCHAPS) • Chicago• National Minority AIDS Council • Fort Lauderdale (NMAC)• National Association of County and • Houston City Health Officials (NACCHO) • Los Angeles• The AIDS Institute • New York• Local, state, and territorial health departments • Miami Allocation • Philadelphia • San Francisco• Minimum funding to all jurisdictions • Matched funds to burden • 37 percent of Americans• Competitive funding projects with HIV live in these 10• Direct funding for heavily affected cities cities (CDC, 2011b)
  • 18. 5-Year Plan Goals Plan Priorities• Lower new infections by 25 percent • Intensify HIV prevention in communities where HIV is most• Increase percentage of people living heavily concentrated with HIV who know of their infection from 79 percent to 90 percent • Expand targeted use of effective• Reduce HIV transmission rate by combinations of evidence-based HIV 30 percent prevention approaches• Increase those linked to care within 3 months from 65 percent to 85 • Educate all Americans about the percent threat of HIV and how to prevent it• Increase the proportion of HIV- • Increase the dialog—like we are diagnosed gay and bisexual men, African Americans, and Hispanic/ doing today Latinos with undetectable viral load by 20 percent (treatment works!) (CDC, 2011a)
  • 19. Proven HIV • HIV testing and linkage to careInterventions • Comprehensive prevention with HIV positive individuals • Condom distribution • Antiretroviral therapy • Access to condoms and sterile syringes • Prevention programs for people living with HIV and their partners (social marketing, media, and mobilization) • Prevention programs for people at high risk of HIV infection • Substance abuse treatment • Screening and treatment for other sexually transmitted infections (CDC, 2111b)
  • 20. HIV Testing• Routine Ages 13 to 64 in health care settings (opt-out)• Routine All pregnant women• Targeted Gay PRIDE events, fairs, parks, drug-treatment clinics; increased targeting in specific communities• Screening STD and HIV testing (Bowles, et al. 2008; CDC, 2011b)
  • 21. Comprehensive Prevention• Make the call: Link to care and treatment• Test for efficacy: Reduce viral loads with treatment• Ask and educate: Improve compliance with medication• Behavioral interventions for HIV-positive individuals • Availability of condoms • Availability of sterile needles• Interventions to prevent mother-to-child HIV transmission • ARV medication • Partner testing/counseling during L/D• Referrals • Other medical services (social services, substance abuse) • Mental health services (CDC, 2111b)
  • 22. AVR• Antiretroviral Therapy • Treating early means less transmission• Pre-Exposure Prophylaxis (PrEP) • Planning, education, personnel, supported (no meds with CDC funds)• Non-Occupational Post-Exposure Prophylaxis (nPEP) for High-Risk Groups
  • 23. Intervention SummaryHIV testing• Including routine opt-out testing in health care settings and targeted testing programs for high-risk populationsPrevention with HIV-positive individuals• Helping people living with HIV reduce their risk of transmitting HIV to othersCondom and needle distribution• Available for people at high risk of acquiring HIVGeographic focus• Increasing funding to cities with higher incidencesStructural initiatives• Aligning structures, policies, and regulations to enable optimal HIV prevention, care, and treatment (CDC, 2011a)
  • 24. High-Impact Prevention (CDC)• Health Department funding • $359 million annually, FY 2012–FY 2016 (assumes level funding)• Better matching for HIV prevention dollars• Expanded testing initiative• Saving lives and money
  • 25. Questions?Thank you for your time and thoughtful attention
  • 26. References• Centers for Disease Control, [CDC]. (2011). HIV Surveillance - Epidemiology of HIV Infection [PowerPoint]. Retrieved from www.cdc.gov/hiv/topics/surveillance/resources/slides/general/• Centers for Disease Control, [CDC]. (2011a). High-impact HIV prevention. Retrieved from www.cdc.gov/hiv/strategy/dhap/pdf/nhas_booklet.pdf• Centers for Disease Control. [CDC]. (2011b). CDC’S new high-impact approach to HIV prevention funding for health departments. Retrieved from www.cdc.gov/hiv/topics/funding/PS12- 1201/resources/factsheet/pdf/foa-partner.pdf• Centers for Disease Control. (2012). e-HAP information from the CDC’s division of HIV/AIDS prevention. Retrieved from www.cdc.gov/hiv/ehap/resources/fyi/031412/index.htm• Boles, K., et.al. (2007). Implementing rapid HIV testing in outreach and community settings: Results from an advancing HIV prevention demonstration project conducted in seven U.S. cities. Public Health Reports s3(123) Retrieved from www.publichealthreports.org/archives/issueopen.cfm?articleID=2137