This document provides an organizational chart and descriptions of the STD/HIV surveillance program in Louisiana. It shows the data management and analysis units for STD and HIV data housed in different systems. It also lists contacts for HIV surveillance data and describes how prevention and counseling data are managed. Quick definitions of epidemiological terms and examples of rates and counts are provided.

1. 1

2. Debbie
(Data Management/Analysis Unit)
Jessica Fridge
Surveillance Manager
STD
Surveillance
*Mohammad -
*Catherine
STD Data are
housed and
managed in
PRISM
HIV Surveillance
*Demerial
*Rashad
*Elliott – *Carmen
*Tania –
*Lakeesha/*Josette
HIV Data are housed
and managed in
eHARS
Joe Foxhood
IT Staff –
Craig/George
Programmers –
James
Cortlandt
Everett
Rey
Prevention
Data
Supervisor
(VACANT)
manage all
counseling and
testing data.
Approx. 100,000
tests a year
Positives found
from Counseling
and Testing are
used for HIV
surveillance data.
Megan
Wright
(Services Data)
Rebekah
Antoine
Brantley
(CAPUS Analyst)
Tesha
Washington
and Data Entry
Staff (Tinh, Denise,
Beverly)
2

3. 3

4. Quick Definitions
 Incidence: The number of new infections
 New Diagnoses: The number of newly diagnosed cases of a
disease
 Prevalence: The total number of cases of disease existing in a
population
 Morbidity: another term for illness. Prevalence measures the
level of morbidity
 Mortality: another term for death
* These can be presented
as case counts, rates, or percentages….
4

5. Quick Definitions
 Incidence: (“NEW CASES”) The number of newly diagnosed cases
of a disease (New HIV cases, New syphilis cases)
 Prevalence: (“PERSONS LIVING”) The total number of cases of
disease existing in a population (Persons living with HIV/AIDS)
Incidence
Prevalence
Death/Move out of jurisdiction
5

6. Counts and Rates
 A count is a total or a tally (total number of disease cases
for example)
 Ex: 9,000 new cases of gonorrhea
 Ex: 1,200 new cases of HIV
 Ex: 423 new cases of primary and secondary syphilis
 A rate (or case rate) is a proportion: generally, the total
number of cases divided by the population
 Ex: the gonorrhea case rate was 24.3 per 100,000 people
6

7. RATES
 Incidence rate: number of new cases of a
disease divided by the number of persons at risk
for the disease
 Prevalence rate: total number of cases of a
disease in a population divided by the total
population
 Mortality rate: Number of deaths due to a
disease divided by the total population
7

8. Rate Example
Number of New
HIV Cases, 2013
Population
In 2013
2013 HIV Case Rate
Per 100,000
Black 904 1,398,276 64.7
Hispanic 60 148,463 40.4
White 315 2,731,007 11.5
 2013 New HIV Diagnoses, by Race
Black HIV Case Rate:
904 ÷ 1,398,276 Blacks in Louisiana in 2013 = 0.0006465
0.0006465 * 100,000 = 64.65 HIV Diagnoses per 100,000 Blacks in Louisiana
1.6
times
5.6
times
8

9. STD/HIV Surveillance
 Louisiana Sanitary Code requires reporting of
known or suspected cases of:
 HIV
 AIDS
 HIV Related Lab Results (CD4 counts, viral
loads, etc.)
 Syphilis
 Chlamydia
 Gonorrhea
 HIV, AIDS and syphilis are all reportable as a
pregnancy condition
9

10. HIV and AIDS National Rankings,
2012
 Louisiana
 Ranked 4th for estimated HIV case rates and 3rd for estimated AIDS case rates
 HIV case rate: 27.1 per 100,000 (US rate is 15.3 per 100,000)
 AIDS case rate: 18.4 per 100,000 (US rate is 8.9 per 100,000)
 New Orleans MSA
 Ranked 5th in HIV case rates and 4th in AIDS case rates
 Baton Rouge MSA
 Ranked 4th in HIV case rates and 2nd in AIDS case rates
*2013 Rankings should be available in February 2015

11. Example:
 In 2012, the New Orleans MSA ranks 5th in HIV case rates
 37.3/100,000
 …..but ranks 22nd in HIV case counts
 457 HIV cases
 Washington, DC had 1,947 new HIV diagnoses but ranked
9th for its HIV case rate (33.3 per 100,000)
 New York City had 5,025 new HIV diagnoses but ranked
14th for its HIV case rate (25.3 per 100,000)
11

12. Louisiana ranks: (in rates per 100,000 population)
 3rd Primary and Secondary Syphilis (9.2 per 100,000)
 423 cases
 1st Congenital Syphilis (51.3 per 100,000 live births)
 32 cases
 1st Gonorrhea (188.4 per 100,000)
 8,669 cases
 2nd Chlamydia (624.5 per 100,00)
 28,739 cases
12
STD National Rankings,
2013

13. Public Health Regions – 9
Metropolitan Statistical Areas – 9
Parishes - 64
13

14. Parishes in Public Health Region Parishes in MSA
Region 1:New Orleans Jefferson, Orleans, Plaquemines, St. Bernard Jefferson, Orleans, Plaquemines, St. Bernard,
St. Charles, St. James, St. John the Baptist,
St. Tammany
Region 2:Baton Rouge Ascension, E. Baton Rouge, E. Feliciana,
Iberville, Pointe Coupee, W. Baton Rouge,
W. Feliciana
Ascension, E. Baton Rouge, E. Feliciana,
Iberville, Livingston, Pointe Coupee, St. Helena,
W. Baton Rouge, W. Feliciana
Region 3:Houma Assumption, Lafourche, St. Charles,
St. James, St. John the Baptist, St. Mary,
Terrebonne
Lafourche, Terrebonne
Region 4:Lafayette Acadia, Evangeline, Iberia, Lafayette,
St. Landry, St. Martin, Vermilion
Acadia, Iberville, Lafayette, St. Martin,
Vermilion
Region 5:Lake Charles Allen, Beauregard, Calcasieu, Cameron,
Jefferson Davis
Calcasieu, Cameron
Region 6:Alexandria Avoyelles, Catahoula, Concordia, Grant,
La Salle, Rapides, Vernon, Winn
Grant, Rapides
Region 7:Shreveport Bienville, Bossier, Caddo, Claiborne, DeSoto,
Natchitoches, Red River, Sabine, Webster
Bossier, Caddo, DeSoto
Region 8:Monroe Caldwell, E. Carroll, Franklin, Jackson,
Lincoln, Madison, Morehouse, Ouachita,
Richland, Tensas, Union, W. Carroll
Ouachita, Union
Region 9: Hammond/Slidell Livingston, St. Helena, St. Tammany,
Tangipahoa, Washington
Tangipahoa
14

15. Louisiana’s 9 Public Health Regions
15

16. Defining New Orleans and Baton Rouge
 New Orleans MSA/EMA
 Jefferson, Orleans, Plaquemines, St Bernard, St Charles, St James, St John
the Baptist, St Tammany (8 parishes)
 New Orleans Region:
 Jefferson, Orleans, Plaquemines, St Bernard (4 parishes)
 Baton Rouge MSA/TGA
 Ascension, East Baton Rouge, East Feliciana, Iberville, Livingston, Pointe
Coupee, St Helena, West Baton Rouge, West Feliciana (9 parishes)
 Baton Rouge Region:
 Ascension, East Baton Rouge, East Feliciana, Iberville, Pointe Coupee,
West Baton Rouge, West Feliciana (7 parishes)
16

17. Parishes/Zip Codes
 East Baton Rouge Parish – to represent “Baton Rouge”
 Orleans Parish – to represent “New Orleans”
 We can provide zip code level data but there has to be
a very specific and approved reason. We also limit data
releases for zip codes when the case count is too small.
 zip code level data is shared internally and for
prevention and services purposes.
17

18. Your Key Contacts For HIV Surveillance Data
*Debbie Wendell
*Jessica Fridge
*Demerial Banks
*Elliott Brannon – Perinatal data
18

19. Monitoring the Spectrum of HIV Infection
Sentinel Events
HIV Exposure
(Children)
HIV Infection
HIV Diagnosis
HIV Report
AIDS
Diagnosis
AIDS Report
DeathINCIDENCE
PREVALENCE
1st CD4
count/VL
19

20. Louisiana’s 2012 Rankings
Louisiana ranks: (in rates per 100,000 population)
 4th in HIV diagnosis rates (27.1 per 100,000)
 3rd in AIDS diagnosis rates (18.4 per 100,000)
 New Orleans MSA
 5th in HIV diagnosis rates (37.3 per 100,000)
 4th in AIDS diagnosis rates (25.1 per 100,00)
 Baton Rouge MSA
 4th in HIV diagnosis rates (38.1 per 100,000)
 2nd in AIDS diagnosis rate (27.5 per 100,000)
20

21. Rates of Diagnoses of HIV Infection among Adults and Adolescents, 2012—
United States and 6 Dependent Areas
N = 48,651 Total Rate = 18.4
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have
been statistically adjusted to account for reporting delays, but not for incomplete reporting.

22. Estimated HIV Case Rates by MSA, 2012
47.3
41.8
38.6 38.1 37.3
35.2
33.3 33.3 33.2
29.2
27.2
25.6 25.3 24.4
21.8 21 20.7 20.5 20.3 20.2
0
5
10
15
20
25
30
35
40
45
50
EstimatedHIVCaseRate
MSA
Southern MSAs
***In 2012, 16 of the top 20 MSAs in the United States were located in the south.

23. New HIV Diagnoses
Louisiana, 2013
Number of Cases Proportion of Cases
Sex
Male
Female
990
308
76%
24%
Race
Black
White
Hispanic
Other
904
315
60
19
70%
24%
5%
2%
Reported Risk
Men who have sex with men (MSM)
Injection Drug Use (IDU)
MSM/IDU
High Risk Heterosexual
Perinatal Infection
Unknown/not reported
599
56
24
158
1
460
72%
7%
3%
19%
<1%
--
In 2013, there were 1,298 new HIV diagnoses in Louisiana

24. New HIV Diagnoses
Louisiana, 2013
Number of
Cases
Proportion of Cases
Age
13-19
20-24
25-34
35-44
45 and older
66
252
367
284
328
5%
19%
28%
22%
26%
Region
1 - New Orleans
2 - Baton Rouge
3 - Houma
4 - Lafayette
5 - Lake Charles
6 - Alexandria
7 - Shreveport
8 - Monroe
9 - Hammond/Slidell
439
263
60
100
45
86
144
89
72
34%
20%
5%
8%
4%
7%
11%
7%
6%

25. New HIV and AIDS Diagnoses
Louisiana, 2004-2013
1,056
972 991
1,089 1,099
1,208
1,125
1,218
1,045
1,298
864
799
765
804
841
786 798 779 779
731
0
200
400
600
800
1000
1200
1400
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
NumberofDiagnoses
Year of Diagnosis
HIV AIDS

26. Persons Living with HIV infection
Number of People
Living with HIV
Proportion
Sex
Male
Female
13,281
5,614
70%
30%
Race
Black
White
Hispanic
Other/Unk/Multirace
12,923
5,022
729
221
68%
27%
4%
1%
Age
<25 years
25-34 years
35-44 years
45-54 years
55-64 years
65 and older
1,214
3661
4658
5670
2952
740
6%
19%
25%
30%
16%
4%
*15.8% of all people living with HIV infection are not aware/have not been diagnosed! So
these numbers are underestimate! The percent unaware differs by age group and is
highest among youth.
• People living with HIV in all 64 parishes. At the end of 2013 there were 18,895
people living with HIV infection in Louisiana

27. Persons Living with HIV Infection (PLWH)
Louisiana, 2004-2013
Hurricane
Katrina
27
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
PersonsLivingwithHIV
YEAR

28. Rates of Black & White Persons Living with an
HIV Diagnosis, by County, Louisiana, 2010
Black Rates
White Rates

29. Key Trends in Louisiana
 There is a significant racial disparity for HIV and AIDS diagnoses in Louisiana
 HIV case rate for blacks is almost 6 times higher than whites
 Although Blacks make up only 32% of the state’s population, 70% of newly-
diagnosed HIV cases and 68% of all people living with HIV infection in
Louisiana.
 Increase in the proportion of new cases among men who have sex with men
(MSM)
 Over the past 10 years, the proportion of all new diagnoses among MSM has
increased from 49% in 2004 to 72% in 2013.
 Over the past 10 years, the proportion of new male diagnoses among MSM
has increased from 66% of male diagnoses in 2004 to 84% of all male
diagnoses in 2013.
 A quarter of all new diagnoses occur among youth (age 13-24 year olds). The vast
majority of these are among persons 20-24 years old.
 In 2013, there were 318 new HIV diagnoses among 13-24 year olds. 79% of
these were among 20-24 year olds
 Of the 318 diagnoses among youth, 81% were male and 83% were black. 29

30. Perinatal HIV Surveillance
 We track all women who are HIV positive and give birth in
Louisiana. We conduct follow-up on all of the babies to
determine if they are HIV positive or HIV negative.
 If a mother and infant are properly treated, there is less
than 1% chance the baby will be infected.
 Many states do not have a single case of mother-to-child
transmission of HIV
30

31. Perinatal Surveillance
 Each year we have approximately 160-180 mothers give
birth to infants in Louisiana.
31
YEAR Number of moms Number of positive
babies (%)
2009 175 3 (2%)
2010 179 5 (3%)
2011 161 4 (2%)
2012 164 7 (4%)
2013 165 0 (0%)
The vast majority of the mothers are diagnosed before their pregnancy.
Louisiana state law now requires an HIV and syphilis test at first prenatal care
visit and a repeated test in the third trimester.

32. HIV Tests
Louisiana, 2007-2013
58,599
67,730
100,571 99,465
102,539
98,571
95,656
1.0
1.0
0.9
1.0
1.2
1.1 1.1
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
0
15,000
30,000
45,000
60,000
75,000
90,000
105,000
2007 2008 2009 2010 2011 2012 2013
PercentPositive
NumberofHIVTests
Year
Total Tests % Positivity

33. HIV Testing by Test Type
Louisiana, 2004-2013
0
20,000
40,000
60,000
80,000
100,000
120,000
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
NumberofTests
Year
Conventional Rapid
95%
rapid

34. Comparison of Tests vs. Surveillance Data
by Region, Louisiana, 2013
Region % of PLWH % of New HIV
Dx (Surv)
% of HIV Tests
1 – New Orleans 34% 34% 46%
2 – Baton Rouge 25% 20% 19%
3 – Houma 4% 5% 2%
4 – Lafayette 8% 8% 8%
5 – Lake Charles 5% 4% 4%
6 – Alexandria 4% 6% 3%
7 – Shreveport 8% 11% 9%
8 – Monroe 5% 7% 6%
9 – Slidell/Hammond 6% 5% 2%

35. HIV Continuum of Care
Louisiana, 2013
100%
69%
54%
49%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Persons living with
HIV
In HIV care Retained in HIV care Viral suppression
(<=200)
Percentage
18,199
9,774
12,536
8,831
70% of PLWH in care were virally
35

36. Your Key Contacts For STD Surveillance Data
*Jessica Fridge
*Mohammad Rahman
*Catherine Desmarais
*Elliott Brannon – congenital syphilis data
36

37. STDs across the nation
 In 2013:
 1,401,906 cases of chlamydia
 333,304 cases of gonorrhea
 Gonorrhea and chlamydia are primarily diagnosed among people
age 15-24 years old.
 Women face the most serious long-term health consequences.
Undiagnosed STDs cause 24,000 women to become infertile each
year.
 17,375 cases of primary and secondary syphilis
 MSM account for 75% of all P&S syphilis cases
 348 cases of congenital syphilis
 Only 25 states reported 1 or more cases of CS in 2013 37

38. Louisiana ranks: (in rates per 100,000 population)
 2nd Chlamydia (624.5 per 100,00)
 28,739 cases
 1st Gonorrhea (188.4 per 100,000)
 8,669 cases
 3rd Primary and Secondary Syphilis (9.2 per 100,000)
 423 cases
 1st Congenital Syphilis (51.3 per 100,000 live births)
 32 cases
38
STD National Rankings,
2013

39. Louisiana STD National Rankings
2010-2013
STD 2010 2011 2012 2013
Chlamydia 3rd 3rd 4th 2nd
Gonorrhea 2nd 1st 2nd 1st
P&S Syphilis 1st 1st 3rd 3rd
Congenital
Syphilis
1st 3rd 1st 1st
39

40. Trends in STD Cases
Louisiana, 2010-2013
Year 2010 2011 2012 2013
Chlamydia 29,151 31,614 27,253 28,739
Gonorrhea 8,912 9,169 8,873 8,669
P&S Syphilis 547 447 339 423
Early Latent Syphilis 740 488 343 276
Congenital Syphilis 33 18 32 40
40

41. Chlamydia
41
There were 28,739 cases of chlamydia diagnosed in Louisiana in 2013, a rate of
621.3 cases per 100,000. This represents a 4.5% rate increase from 2012 to 2013.
39%

42. Chlamydia in Louisiana, 2013
Chlamydia 28,739 100%
By Gender Male
Female
26%
74%
By Race Black
White
Hispanic
75%
22%
3%
By Age Group < 20 years
20-29 years
30 and older
34%
55%
11%
By Region New Orleans
Baton Rouge
Houma
Lafayette
Lake Charles
Alexandria
Shreveport
Monroe
Hammond/Slidell
24%
12%
8%
12%
5%
6%
16%
11%
7%
42

43. Gonorrhea
43
There were 8,669 cases of gonorrhea diagnosed in Louisiana in 2013, a rate of
187.4 cases per 100,000. This represents a 3% rate decrease from 2012 to 2013.
77%

44. Gonorrhea in Louisiana, 2013
8,669 100%
By Gender Male
Female
43%
57%
By Race Black
White
Hispanic
86%
13%
1%
By Age Group < 20 years
20-29 years
30 and older
31%
54%
15%
By Region New Orleans
Baton Rouge
Houma
Lafayette
Lake Charles
Alexandria
Shreveport
Monroe
Hammond/Slidell
25%
11%
7%
16%
4%
6%
16%
12%
4%
44

45. Primary and Secondary Syphilis
45
65%
There were 423 cases of P&S syphilis diagnosed in Louisiana in 2013, a rate of
9.1 cases per 100,000. This represents a 23% rate increase from 2012 to 2013.

46. Primary and Secondary (P&S) Syphilis
Louisiana, 2013
P&S Syphilis 423 100%
By Gender Male
Female
73%
27%
By Race Black
White
Hispanic
78%
20%
2%
By Age Group < 19 years
20-29 years
30 and older
13%
47%
40%
By Region New Orleans
Baton Rouge
Houma
Lafayette
Lake Charles
Alexandria
Shreveport
Monroe
Hammond/Slidell
22%
17%
5%
12%
2%
3%
30%
3%
1%
46

47. Congenital Syphilis, 2013
 In 2013, the CS rate was 63.4 per 100,000 live births. A total
of 40 cases. This rate is over 7 times the national rate of 8.7
per 100,000 live births.
47

48. Congenital Syphilis, Louisiana
2013
 93% of the mothers were Black / African American
and 65% of the mothers were between the ages 15-
24 years
 75% of the mothers received timely prenatal care
but still passed the infection to their infant.
 In 2013, 30% of the cases in Shreveport, 22% in
New Orleans, 12% in Monroe and 10% in
Alexandria.
48

49. When in doubt, email Debbie.Wendell@la.gov OR
Jessica.Fridge@la.gov and we will connect you with the right person!
49

50. Where to get surveillance data:
 HIV surveillance data: Jessica Fridge/Demerial Banks
 STD surveillance data: Mohammad
Rahman/Catherine Desmarais
 Any perinatal HIV or syphilis data: Elliott Brannon
 Other types of data come directly from the Prevention
or Services programs
50

51. Where you can find data
 Both of our websites:
 www.HIV411.org
 www.hiv.dhh.louisiana.gov
 www.std.dhh.louisiana.gov
 On the Public (P) Drive:
 P:SurveillanceReports and Fact Sheets
 Can find all of our Annual and Quarterly Reports, can also
find the CDC’s STD and HIV Surveillance Reports
 For HIV data requests, email Demerial Banks
 For STD data requests, email Mohammad Rahman
51