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Current State of the HIV Epidemic Among MSM in Chicago

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In recognition of LGBT Health Awareness Week, CDPH hosted a community discussion on HIV and sexually transmitted infections (STIs) in the LGBT Community at Center on Halsted that included a keynote address from Commissioner Choucair, an overview of CDPH’s 2013 HIV/STI Surveillance Report from Nik Prachand and a panel discussion where local leaders including our own Tarek Mikati outlined how the community can use this information to combat the spread of HIV and STIs.

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Current State of the HIV Epidemic Among MSM in Chicago

  1. 1. Chicago Department of Public Health Commissioner Bechara Choucair, M.D. City of Chicago Mayor Rahm Emanuel Current State of the HIV Epidemic among MSM in Chicago March 28, 2014 Center on Halsted Nikhil Prachand, MPH Director, HIV/STI Surveillance, Epidemiology and Research
  2. 2. Trends in HIV/AIDS Diagnoses in Chicago – 20 Years
  3. 3. Living with HIV in Chicago, 2011 Diagnosed (+ Undiagnosed) City Total 21,555 (25,003) MSM 12,610 (14,627) Black MSM 4,862 (5,689) White MSM 4,607 (5,205) Latino MSM 2,348 (2,747) Asian MSM 160 (185)
  4. 4. 1,008 Total HIV Diagnoses (2011) City Prevalence ~ 0.9% MSM ~ 21%
  5. 5. HIV Infection Diagnoses by Select Characteristics, Chicago, 2011 82% 18% 6% 33% 23% 22% 12% 3% 55% 20% 16% 9% 69% 7% 3% 21% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
  6. 6. Inclusion of Transgender in Surveillance Reporting New HIV Diagnoses, 2011 81.0% Male 17.7% Female 1.3% Transgender
  7. 7. Racial Disparities Persist HIV Diagnoses, 2000-2011 0 200 400 600 800 1,000 1,200 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 NumberofDiagnoses Year of Diagnosis Black White Hispanic Other
  8. 8. 2007 2011 35% Recent Decreases among Black Women New HIV Diagnoses, 2007 and 2011
  9. 9. 0 50 100 150 200 250 300 350 400 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 NumberofDiagnoses Year of Diagnosis Black White Hispanic Other Decreases Still Leave Huge Disparity in Females FEMALE New HIV Diagnoses, 2000 - 2011
  10. 10. Little Decrease in Black or Latino Males in Past 5 Years Male HIV Diagnoses, 2000-2011 0 100 200 300 400 500 600 700 800 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 NumberofDiagnoses Year of Diagnosis Black White Hispanic Other
  11. 11. MSM continue to bear more of HIV burden New HIV Diagnoses, 2011 60% in 2007 44% in 2000
  12. 12. Almost 90% Decrease in IDU Since 2000 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 03/2013 0 100 200 300 400 500 600 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 NumberofDiagnoses Year of Diagnosis
  13. 13. Almost 50% decrease among HET 0 50 100 150 200 250 300 350 400 450 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 NumberofDiagnoses Year of Diagnosis
  14. 14. 15% Decrease among MSM 0 100 200 300 400 500 600 700 800 900 1,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 NumberofDiagnoses Year of Diagnosis MSM
  15. 15. 15% Decrease among MSM 0 100 200 300 400 500 600 700 800 900 1,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 NumberofDiagnoses Year of Diagnosis MSM
  16. 16. 0 50 100 150 200 250 300 350 400 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 NumberofDiagnoses Year of Diagnosis Black White Hispanic Other HIV: MSM by Race
  17. 17. HIV: MSM by Age Group 0 50 100 150 200 250 300 350 400 450 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 NumberofDiagnoses Year of Diagnosis 13-19 20-29 30-39 40-49 50-59 60+
  18. 18. 0 20 40 60 80 100 120 140 160 180 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 NumberofDiagnoses Year of Diagnosis 13-19 20-29 30-39 40-49 50-59 60+ Black MSM: 2/3 New Diagnoses among Youth
  19. 19. White MSM: All Age Decline 0 20 40 60 80 100 120 140 160 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 NumberofDiagnoses Year of Diagnosis 13-19 20-29 30-39 40-49 50-59 60+
  20. 20. Latino MSM: Young Adults Increase 0 10 20 30 40 50 60 70 80 90 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 NumberofDiagnoses Year of Diagnosis 13-19 20-29 30-39 40-49 50-59 60+
  21. 21. 140 148 334 0 50 100 150 200 250 300 350 White MSM Latino MSM Black MSM Emerging Patterns – MSM New HIV Diagnoses, 2011
  22. 22. Syphilis in Young MSM Increasing 0 20 40 60 80 100 120 140 160 180 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 13-19 20-29 30-39 40-49 >=50 Numberofcases 2012: 43% Black; 33% White; 16% Latino 53% Syphilis Cases Co-Infected HIV
  23. 23. Behaviors and Other Characteristics
  24. 24. Sex Behaviors – Young MSM (18-29) HIV Behavioral Surveillance, 2011 Black White Hispanic Total (%) (%) (%) (%) Unprotected anal sex 54 57 67 59 Unknown status of most recent sex partner 34 29 51 38 Drug or alcohol w sex 34 55 49 46 # Male sex partners 3 4 3 3
  25. 25. National HIV Behavioral Surveillance 2011 Black White Hispanic (%) (%) (%) Lifetime Genital Herpes 2 4 3 Tested for STD 61 51 43 Diagnosed gonorrhea 5 3 8 Diagnosed chlamydia 4 4 6 Diagnosed syphilis 8 4 4 Other Sexually Transmitted Infections
  26. 26. National HIV Behavioral Surveillance 2011 Black White Hispanic Most recent casual partner was: (%) (%) (%) Younger than respondent 31 47 32 Older than respondent 46 38 50 Same Race as respondent 64 67 40 Sexual Network
  27. 27. Black White Hispanic (%) (%) (%) Most of the people in your neighborhood would not accept your sexuality 41 23 72 Go to another neighborhood to feel accepted 55 40 55 Feel unsafe in your neighborhood b/c you are an MSM? 12 7 17 Neighborhood has opportunities for MSM to meet, socialize, etc. 44 74 46 Neighborhood Influences Non-Boystown residents Boystown = 60613, 60640, 60660, 60657
  28. 28. National HIV Behavioral Surveillance 2011 Black White Hispanic (%) (%) (%) Ever homeless 16 2 5 Ever held in prison or jail 29 9 14 Currently Unemployed 23 7 13 HS Grad or Less 32 9 31 Social Determinants
  29. 29. National HIV Behavioral Surveillance 2011 Black White Hispanic (%) (%) (%) Met HIV testing guidelines 75 69 71 Received Free Condoms 87 80 81 HIV Testing and Condoms
  30. 30. 64% 67% 70% 20% 30% 40% 50% 60% 70% 80% 90% 2004 2008 2011 MSM Testing Annually For HIV HIV Behavioral Surveillance, 2011
  31. 31. National HIV Behavioral Surveillance 2011 Black White Hispanic (%) (%) (%) Ever heard of PrEP 32 38 23 Taken PrEP 0 1 2 Willing to take PrEP 58 50 53 PrEP
  32. 32. National HIV Behavioral Surveillance 2011 Black White Hispanic (%) (%) (%) Have Health Insurance 53 82 57 Have Regular Source of Medical Care 81 82 70 Health Care and Access
  33. 33. More HIV+ MSM Taking HIV Medication 2008 to 2011 Chicago Department of Public Health, NHBS, 2012. 44% 84% 90% 100% 50% 82% 0% 20% 40% 60% 80% 100% 2008 2011 PercentonART Years Black White Hispanic
  34. 34. Continuum of Care
  35. 35. 1,011 78% 19,391 61% 11,823 90% 87% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% # New HIV Diagnoses (2010) % Linked to Care within 3 months of HIV diagnosis # Diagnosed thru 2009 and living w/HIV in 2010 % Retained in Care (at least 1 visit in 2010) # Retained in Care % on ART % Virally Suppressed (<200 copies/mL) HIV Continuum of Care, Chicago, 2010 Linkage to Care Retention In Care ART and Viral Suppression
  36. 36. HIV Continuum of Care MSM by Race 275 77% 4,139 66% 2,747 90% 77% 175 85% 4,285 65% 2,797 88% 92% 116 84% 2,072 48% 999 100% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% # New HIV Diagnoses (2010) % Linked to Care within 3 months of HIV diagnosis # Diagnosed thru 2009 and living w/HIV in 2010 % Retained in Care (at least 1 visit in 2010) # Retained in Care % on ART % Virally Suppressed (<200 copies/mL) Black MSM White MSM Hispanic MSM
  37. 37. HIV Continuum of Care MSM by Race 275 77% 4,139 66% 2,747 90% 77% 175 85% 4,285 65% 2,797 88% 92% 116 84% 2,072 48% 999 100% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% # New HIV Diagnoses (2010) % Linked to Care within 3 months of HIV diagnosis # Diagnosed thru 2009 and living w/HIV in 2010 % Retained in Care (at least 1 visit in 2010) # Retained in Care % on ART % Virally Suppressed (<200 copies/mL) Black MSM White MSM Hispanic MSM
  38. 38. HIV Continuum of Care MSM by Race 275 77% 4,139 66% 2,747 90% 77% 175 85% 4,285 65% 2,797 88% 92% 116 84% 2,072 48% 999 100% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% # New HIV Diagnoses (2010) % Linked to Care within 3 months of HIV diagnosis # Diagnosed thru 2009 and living w/HIV in 2010 % Retained in Care (at least 1 visit in 2010) # Retained in Care % on ART % Virally Suppressed (<200 copies/mL) Black MSM White MSM Hispanic MSM
  39. 39. HIV Continuum of Care MSM by Race 275 77% 4,139 66% 2,747 90% 77% 175 85% 4,285 65% 2,797 88% 92% 116 84% 2,072 48% 999 100% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% # New HIV Diagnoses (2010) % Linked to Care within 3 months of HIV diagnosis # Diagnosed thru 2009 and living w/HIV in 2010 % Retained in Care (at least 1 visit in 2010) # Retained in Care % on ART % Virally Suppressed (<200 copies/mL) Black MSM White MSM Hispanic MSM
  40. 40. HIV Continuum of Care MSM by Race 275 77% 4,139 66% 2,747 90% 77% 175 85% 4,285 65% 2,797 88% 92% 116 84% 2,072 48% 999 100% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% # New HIV Diagnoses (2010) % Linked to Care within 3 months of HIV diagnosis # Diagnosed thru 2009 and living w/HIV in 2010 % Retained in Care (at least 1 visit in 2010) # Retained in Care % on ART % Virally Suppressed (<200 copies/mL) Black MSM White MSM Hispanic MSM
  41. 41. Envision a Plateau 275 100% 4,139 100% 2,747 100% 100%175 100% 4,285 100% 2,797 100% 100%116 100% 2,072 100% 999 100% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% # New HIV Diagnoses (2010) % Linked to Care within 3 months of HIV diagnosis # Diagnosed thru 2009 and living w/HIV in 2010 % Retained in Care (at least 1 visit in 2010) # Retained in Care % on ART % Virally Suppressed (<200 copies/mL) Black MSM White MSM Hispanic MSM
  42. 42. What to Look For… • 2012 Surveillance Data – Out in June • Continuum Analysis • Trends 2009 – 2011 • Mapping • Data to Action • Project CHAT – Behavioral Survey • 4th MSM Cycle of HIV Behavioral Survey • UIC- COIP (Jimenez, Ouellet) • Young MSM (13 to 17 years) – Facebook Recruitment • Northwestern (Mustanski, Newcomb)
  43. 43. facebook.com/ChicagoPublicHealth@ChiPublicHealth 312.747.9884 www.CityofChicago.org/Health HealthyChicago@CityofChicago.org Phone: 312-745-3204 Email: nik.prachand@cityofchicago.org

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