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.

1. HIV/AIDS IN THE UNITED STATES:
EPIDEMIOLOGY AND AN
OVERVIEW OF HIGH-IMPACT
PREVENTION MEASURES
Melody 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 Areas
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, 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 Areas
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 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 Transmission
2010 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 stable
for 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 Areas
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, 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 Areas
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, but not for incomplete reporting.
a Hispanics/Latinos can be of any race.

8. Trends in Sex and Race/Ethnicity
2010
Males Diagnosed: 37, 910
• Black/African American: 45 percent
• White: 29 percent
• Hispanic/Latino: 22 percent
Females 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 29,194 100.0
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.

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: 13,357
By Race
• Black/African American: 10,842
• White: 10,396
• Hispanic/Latino: 6,803
By 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 = 48,079
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, 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 = 487,414
Note: 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 Prevention
National 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 care
Interventions • 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 Summary
HIV testing
• Including routine opt-out testing in health care
settings and targeted testing programs for high-risk
populations
Prevention with HIV-positive individuals
• Helping people living with HIV reduce their risk of
transmitting HIV to others
Condom and needle distribution
• Available for people at high risk of acquiring HIV
Geographic focus
• Increasing funding to cities with higher incidences
Structural 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