Facing the Future of HIV and STD in Texas Epidemiology, Impact, and Priorities

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Facing the Future of HIV and STD in Texas Epidemiology, Impact, and Priorities

  1. 1. Facing the Future of HIV and STD in Texas: Epidemiology, Impact, and Priorities
  2. 2. Outline <ul><li>STD Epidemiology – Ed Weckerly </li></ul><ul><li>HIV Epidemiology – Nita Ngo </li></ul><ul><li>Implications– Ann Robbins </li></ul>
  3. 3. STD Epidemiology Ed Weckerly Texas Department of State Health Services
  4. 4. Primary and Secondary Syphilis Cases: Texas, 1971-2009
  5. 5. P&S Syphilis Case Rates by County: Texas, 2009
  6. 6. P&S Syphilis Case Rates by Race/Ethnicity: Texas, 1998-2009
  7. 7. P&S Syphilis Case Rates* by Year of Report and Sex: Texas, 1998-2009 * Rate = Cases per 100,000 population. Female Male
  8. 8. P&S Syphilis Cases by Sex and MSM: Texas, 2002-2009
  9. 9. HIV Status Among P&S Syphilis Cases by Sex and MSM: Texas, 2009
  10. 10. Congenital Syphilis Cases: Texas, 1991-2009
  11. 11. Chlamydia Cases: Texas, 1988-2009
  12. 12. Chlamydia Case Rates by County: Texas, 2009
  13. 13. Chlamydia Cases by Year of Report: Texas, 2000-2009
  14. 14. Chlamydia Case Rates Among Women by Race/Ethnicity: Texas, 1991-2009 Hispanic Black White
  15. 15. Gonorrhea Cases: Texas, 1971-2009
  16. 16. Gonorrhea Case Rates by County: Texas, 2009
  17. 17. Gonorrhea Case Rates by Race/Ethnicity: Texas, 1991-2009
  18. 18. Gonorrhea Cases by Age Group and Race/Ethnicity: Texas, 2009
  19. 19. Repeat Infections <ul><li>Rough estimate looking at only chlamydia and gonorrhea cases reported in one calendar year </li></ul><ul><li>Over 6,000 chlamydia and 1,300 gonorrhea cases appeared to be legitimate re-infections using very conservative matching </li></ul><ul><li>Expedited Partner Therapy </li></ul>
  20. 20. Final Points <ul><li>In 2009, reportable STD rates among Blacks for chlamydia, gonorrhea and P&S syphilis were 2 to 9 times greater than case rates among Hispanics and 6 to 13 times greater than rates among Whites </li></ul><ul><li>In 2009, 68% of all reportable STDs were reported among 15-24 year-olds </li></ul><ul><ul><li>1 in 39 young people </li></ul></ul><ul><ul><li>1 in 14 young Blacks </li></ul></ul>
  21. 21. Final Points <ul><li>The CDC estimates that at least half of new gonorrhea and chlamydia infections go undiagnosed and unreported </li></ul>
  22. 22. HIV Epidemiology Nita Ngo Texas Department of State Health Services
  23. 23. Texas: The Big Picture <ul><li>Since 1980: </li></ul><ul><ul><li>>107,000 Texans have been diagnosed with HIV </li></ul></ul><ul><ul><li>>41,000 Texans with HIV have died </li></ul></ul><ul><li>As of year end 2008, 62,772 Texans were known to be living with HIV </li></ul>
  24. 24. Newly Diagnosed HIV Cases, Deaths, and Persons Living with HIV, Texas, 1980-2008 New HIV Cases Deaths among HIV Cases Living with HIV
  25. 25. Persons Living with HIV, Texas 1987
  26. 26. Persons Living with HIV, Texas 1997
  27. 27. Persons Living with HIV, Texas 2007
  28. 28. Estimated Persons Living with HIV – Diagnosed and Undiagnosed: Texas, 2008
  29. 29. Texas: The Big Picture <ul><li>HAART is here, but in 2008… </li></ul><ul><ul><li>4,293 Texans were newly-diagnosed with HIV </li></ul></ul><ul><ul><li>2,758 Texans living with HIV progressed to AIDS </li></ul></ul><ul><ul><li>1,280 Texans living with HIV died </li></ul></ul>
  30. 30. Newly-diagnosed HIV Cases*: Texas, 1999-2008 *AIDS cases were diagnosed with AIDS within 1 month of HIV diagnosis
  31. 31. HIV Diagnoses by Sex, Age, and Race/Ethnicity
  32. 32. Newly-diagnosed HIV Case Rates by Sex: Texas, 1999-2008
  33. 33. Newly-diagnosed HIV Case Rates by Race/Ethnicity: Texas, 1999-2008
  34. 34. Newly-diagnosed HIV Cases by Race/Ethnicity: Texas, 2008 43% 29% 26% 2% Texas Population n= 24,383,647 New HIV Cases n=4,293 48% 11% 36% 5% White Hispanic Other/Unknown Black
  35. 35. Newly-diagnosed HIV Case Rates by Age: Texas, 1999-2008
  36. 36. Newly-diagnosed HIV Cases by Mode of Transmission: Texas, 1999-2008 *High risk heterosexual contact with a person known to have HIV or a higher risk of acquiring HIV
  37. 37. Perinatal HIV Transmission, Texas, 1990-2008
  38. 38. Late Diagnosis
  39. 39. Late Diagnosis <ul><li>Nearly 25% of Texans diagnosed with HIV are diagnosed with AIDS within one month of their HIV diagnosis </li></ul><ul><li>Everyday in Texas, an average of 3 people first learn they are HIV positive when they have already developed AIDS </li></ul>
  40. 40. Concurrent HIV/AIDS Diagnoses* by Race/Ethnicity and Sex, Texas 2008 *AIDS diagnosis occurred within 1 month of HIV diagnosis
  41. 41. Concurrent HIV/AIDS Diagnoses* by Geographic Area, Texas 2008 *AIDS diagnosis occurred within 1 month of HIV diagnosis ^Dallas, Harris, Bexar, Tarrant, and Travis counties
  42. 42. Incidence Surveillance <ul><li>HIV surveillance data are able to describe who becomes newly-diagnosed with HIV in a given year </li></ul><ul><li>HIV incidence surveillance is intended to estimate who is becoming newly-infected in a given year </li></ul>
  43. 43. Incidence Surveillance <ul><li>It is estimated that 61% of persons infected with HIV in 2008 were not diagnosed in that year </li></ul>
  44. 44. Summary <ul><li>Over 4,000 persons are diagnosed with HIV in Texas annually </li></ul><ul><li>A quarter of newly diagnosed HIV cases are late diagnoses </li></ul><ul><li>Blacks are disproportionately affected by HIV, with rates of diagnosis nearly 7 times and 5 times greater than whites and Hispanics, respectively </li></ul>
  45. 45. Summary <ul><li>MSM continue to represent the largest proportion of newly diagnosed HIV cases </li></ul><ul><li>Number of persons known to be living with HIV continues to increase annually </li></ul><ul><li>Incidence surveillance allows us to identify which populations are becoming newly infected with HIV </li></ul>
  46. 46. Implications Ann Robbins Texas Department of State Health Services
  47. 47. Focus has been primarily individual, but individuals acquire STD/HIV in relationships <ul><li>Social/Sexual networks as level of intervention </li></ul><ul><ul><li>Concurrency & super spreaders </li></ul></ul><ul><li>Internet hookups and information source </li></ul><ul><li>Social and structural influencers and intervention </li></ul><ul><li>Community viral load/bacterial penetration </li></ul>
  48. 48. Pushing Down the Load <ul><li>Treatment access and efficacy </li></ul><ul><ul><li>Increases in unmet need for treatment </li></ul></ul><ul><li>Early detection is key </li></ul>
  49. 49. Technology Reshapes Understanding and Response <ul><li>Amplified testing </li></ul><ul><li>Point of care testing for HIV, syphilis, hepatitis C </li></ul><ul><li>HIV testing algorithms </li></ul><ul><ul><li>Change patterns of testing and surveillance </li></ul></ul>
  50. 50. New Partners? New Approaches? <ul><li>Health reform and the future of categorical funding </li></ul><ul><li>Biomedical intervention </li></ul><ul><li>Emphasis on social and ecological levels of intervention </li></ul>

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