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Outline of Presentation
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Data are li i d f certain groups, e.g. youth, D limited for i h transgendered persons, because of small counts or current reporting methods
Newly Diagnosed HIV Cases, Newly Diagnosed AIDS Cases, Deaths and Persons Living With HIV/AIDS, Alameda County 2006-2011
Indicator Number newly diagnosed HIV cases (with or without AIDS) Number newly diagnosed AIDS cases Number deaths Number of persons living with HIV/AIDS (PLWHA) 2006 2007 2008 2009 2010 2011* 624 233 225 94 281 238 90 203 169 87 247 143 95 213 80 50 164 65 22
Note: * Data in 2011 are subject to reporting delays and should be considered preliminary
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Impact of new HIV diagnoses among groups- by sex, race/ethnicity, age, mode of transmission Comparison of burden among demographic groups (case rates) How HIV diagnoses have impacted these groups over time (trends) Concentration of new HIV diagnoses by city and region
Comparison of Newly Diagnosed HIV Cases and Alameda County Residents by Sex Newly Diagnosed HIV Cases 2009-2011(n= 624)
1% 16%
Male Female MTF
49% 51%
Male Female
83%
Note: Data include persons diagnosed with HIV regardless of stage of disease (i.e., with or without AIDS)
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Comparison of Newly Diagnosed HIV Cases and Alameda County Residents by Race/Ethnicity Newly Diagnosed HIV Cases 2009-2011(n= 624)
2% 10% 25% 19%
White AfrAmer Latino API Other/Unk
27%
34%
44%
23%
12%
Note: Data include persons diagnosed with HIV regardless of stage of disease (i.e., with or without AIDS)
Comparison of Newly Diagnosed Male HIV Cases to Alameda County by Race/Ethnicity Newly Diagnosed HIV Cases 2009-2011 (n=526)
2% 10% 27% 20%
White AfrAmer Latino API Other/Unk
26%
34%
41%
23%
12%
Note: Data include persons diagnosed with HIV regardless of stage of disease (i.e., with or without AIDS)
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Comparison of Newly Diagnosed Female HIV Cases to Alameda County by Race/Ethnicity Newly Diagnosed HIV Cases 2009-2011 (n=98) Alameda County Females (n=771,967)
5% 8% 15% 17%
White AfrAmer Latino API Other/Unk White AfrAmer Latino API Other/Unk
27%
33%
60%
22%
13%
Note: Data include persons diagnosed with HIV regardless of stage of disease (i.e., with or without AIDS)
Comparison of Newly Diagnosed HIV Cases and Alameda County Residents by Age Group Newly Diagnosed HIV Cases 2009-2011(n= 624)
4% 19% 24% 16%
012yrs 1319yrs 2029yrs 3049yrs 50+yrs
53%
Note: Data include persons diagnosed with HIV regardless of stage of disease (i.e., with or without AIDS)
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Newly Diagnosed Male and Female HIV Cases by Mode of Transmission, Alameda County 2009-2011
Male (n=526)
Female (n=98)
4% 6% 7% 10%
IDU Hetero Other MSM MSM&IDU
11.2% 36.7%
IDU Hetero Other
73%
52.0%
Note: Data include persons diagnosed with HIV regardless of stage of disease (i.e., with or without AIDS)
Annual Average Rates of Newly Diagnosed HIV Cases by Selected Characteristics, Alameda County 2009-2011
Three Year Average Number TOTAL SEX Male Female RACE/ETHNICITY White AfrAmer Af A Latino API Other/Unk 53 91 40 20 3 173 33 208 Three Year Average Rate per 100,000 13.7 23.3 4.2 10.3 49.5 11.6 5.0 5.5
5X 5X
Note: * Data in 2011 are subject to reporting delays and should be considered preliminary
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Average Annual Rates of Newly Diagnosed HIV Cases by Sex, Alameda County 2009-2011
25
23.3
20
R Ratesper100,000
15
13.7
~5X
4.2
10
Sex
Average Annual Rates of Newly Diagnosed HIV Cases by Race/Ethnicity, Alameda County 2009-2011
60 50
49.5
Ratesper100,000
40 30 20
~5X
13.7 10.3
~5X
11.6 5.0 5.5
10 0 Total
White
AfrAmer
Latino
API
Other/Unk
Race/Ethnicity
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Average Annual Rates of Newly Diagnosed HIV Cases by Race/Ethnicity, Alameda County 2009-2011
60 50
49.5
Ratesper100,000
13.7
10.3
1X
Race/Ethnicity
Average Annual Rates of Newly Diagnosed HIV Cases by Age Group, Alameda County 2009-2011
30 25
23.2
24.1 24 1
24.0 24 0
Ratesper100,000
20 15 10
1X
13.7 14.7
5.8
5 0 Total 1319yrs 2029yrs 3039yrs 4049yrs 5059yrs 60yrs&over
3.6 36
AgeGroup
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New HIV diagnoses in Alameda County are predominantly among males, African Americans, and MSM O 60% of HIV diagnoses among women are among Over f di African Americans; about half of new HIV diagnoses among women are attributed to heterosexual contact The burden of new HIV diagnoses among males is 5 times that for females African Americans bear 5 times the burden of new HIV diagnoses compared to Whites or L i di d hi Latinos Adults 20-49 years old have the greatest burden of new HIV diagnoses
Trends in rates can be variable due to small number of cases, especially in smaller subgroups cases Three years of data were combined to calculate average annual case rates for greater reliability Apparent changes in rates over time (decline or increase) may not be statistically significant because of variability despite using this approach Trends do highlight the impact of HIV among different groups over the course of the epidemic
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Trends Newly Diagnosed HIV Cases by Age Group, Alameda County 2006-2011
35 30 25 Rateper100,000 1319yrs 20 15 10 5 0 200810 200911 200608 200709 2029yrs 3039yrs 4049yrs 5059yrs 60&over All
North County: Albany, Berkeley Oakland Area: Oakland, Emeryville, Piedmont, Alameda Central County: San Leandro, San Lorenzo, Ashland, Cherryland, Fairview, Castro Valley, Hayward South County: Union City, Fremont, Newark, Sunol Tri-Valley: Livermore, Dublin, Pleasanton
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Region
OaklandArea Central County SouthCounty
NorthCounty N th C t
Between 2006 and 2011 HIV case rates remained stable among males and females Th There was an slight d li i case rates among Af i li ht decline in t African Americans in recent years; however this apparent decline is not statistically significant Among 20-49 year olds, case rates declined slightly in the last 3 years New cases of HIV are predominantly in the Oakland and Central C C l County areas and most concentrated i the cities of d d in h i i f Oakland, Hayward, San Leandro, and Berkeley.
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AIDS Cases, Deaths and Persons Living with AIDS (PLWA) by Calendar Year, Alameda County 1980-2011
4,000 3,500 3,000 2,500 Number 2,000 1,500 1,000 500 0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 CalendarYear AIDScasesdiagnosed Deaths PLWA
ART
HAART
Proportions of PLWHA by demographics and mode of transmission can highlight priority populations f HIV care and services l ti for d i Demographic composition by mode can further highlight important target populations Geographic location/concentration of PLWHA in the county can help identify areas of need and gaps i access to HIV care and services in d i
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Males (n=3969)
Females (n=906)
4% 3%
White
4% 3% 12% 15%
White AfrAmer Latino API Other/Unk
17%
36%
40%
66%
Males (n=3969)
0.2% 0.3% 6%
012yrs 1319yrs 2029yrs
Females (n=906)
1% 1% 6%
012yrs
49% 45%
40%
3049yrs 50+
52%
50+
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Males (n=3969)
Females (n=906)
4% 6% 7% 72% 10%
MSM IDU MSM&IDU HeteroContact Other
14%
20%
IDU HeteroContact Other
66%
PLWHA: MSM by Age Group and Race/Ethnicity (n=2866) Alameda County 2011 Age Group
0.2% 7%
012yrs 1319yrs 2029yrs
Race/Ethnicity
4% 3%
White
18%
48% 45%
40%
3049 50+
35%
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PLWHA: Heterosexual Males and Females by Race/Ethnicity, Alameda County 2011 Heterosexual Males (n=397) Heterosexual Females (597)
4% 4% 15%
White
4% 3% 13% 14%
White AfrAmer Latino API Other/Unk AfrAmer Latino API Other/Unk
17%
60%
66%
PLWHA: Heterosexual Males and Females by Age Group, Alameda County 2011 Heterosexual Males (n=397) Heterosexual Females (597)
0.3% 6%
012yrs 1319yrs 2029yrs
2%
46% 52%
37%
3049yrs 50+
57%
50+
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Race/Ethnicity
49
2% 2% 4%
18%
74%
10
2
0 (FM)FemaletoMale (MF)MaletoFemale
Transgendered PLWHA by Select Characteristics, Alameda County 2011 (n=51) Age Group
25 20 15 10 5 0 012 1319 2029 3039 4049 5059 60& yrs yrs yrs yrs yrs yrs over
Mode of Transmission
20 2% 13 8 2% 7 3 80% 16%
MSM IDU MSM&IDU HeteroContact Other/Unk
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Number
Sex
2,000
Number
1,000
500
Race/Ethnicity
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Number
1,000 800 600 400 200 0 012yrs 1319yrs 2029yrs 3039yrs 4049yrs 5059yrs 60&over PLWA(n=3441) PLWH(n=1434)
Age
Number
ModeofTransmission
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Number
2,000 1,500 1,000 500 0 MSM Hetero Contact IDU MSM&IDU Other/Unk PLWA(n=3441) PLWH(n=1434)
ModeofTransmission
Region
CentralCounty
TriValleyArea SouthCounty
NorthCounty
TriValleyArea
1000
2000
3000
2000
4000
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African Americans and Whites make up similar proportions of male PLWHA; among women African Americans comprise two-thirds of PLWHA MSM is the most common mode of transmission among males; heterosexual contact is the most common mode among females Most PLWHA who are MSM are 30 years and older African Americans and Whites comprise a similar proportion of MSM, b L i i f S but Latinos comprise a much l i h lower proportion Transgender PLWHA are predominantly male-to-female, African American and MSM
Acknowledgements
Epidemiology Team Elaine Bautista Epidemiologist Kate B h K t Buchacz E id Epidemiologist (CDC A i i l it Assignee) ) Ross Fineman Epidemiology Intern Alex Marr Epidemiologist Surveillance Staff George Banks Public Health Investigator Karen Francisco Public Health Investigator Maly Sok Surveillance Clerk David Tucker Public Health Investigator Information Systems Staff Wei Chen Information Systems Analyst
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Appendix A
New HIV Cases: Trends
Trends in Newly Diagnosed HIV Cases: Race/Ethnic Disparities Among Males and Females, Alameda County 2006-2011 Male (n= 1078)
100 90 80 Rateper100,000 Rateper100,000 70 60 50 40 30 20 10 0 200608 200709 200810 200911 AfrAmer API Latino White AllMale 45 40 35 30 25 20 15 10 5 0 200608 200709 200810 200911 AfrAmer Latino White AllFemale All Female
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Trends in Newly Diagnosed HIV Cases Among Males and Females by Age Group, Alameda County 2006-2011 Male (n= 1078)
50 45 40 Rateper100,000 1319yrs 2029yrs 3039yrs 4049yrs 5059yrs 60&over AllMale 200810 200911 200608 200709 30 25 20 15 10 5 0 Rateper100,000 35 50 45 40 35 30 25 20 15 10 5 0 200810 200911 200608 200709 2029yrs 3039yrs 4049yrs 5059yrs AllFemale
Trends in Newly Diagnosed HIV Cases Among African American Males and Females by Age Group, Alameda County 2006-2011 African American Males (n=438)
200 180 160 Rateper100,000 120 100 80 60 40 20 0 200608 200709 200810 200911 Rateper100,000 140 1319yrs 2029yrs 3039yrs 4049yrs 5059yrs 60&over AllMale
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Between 2006 and 2011 there was a decline in case rates among African American females; this decline was not statistically significant Among African Americans 20-49 year old, case rates have been variable among males in this time period; among females, rates have declined slightly
Trends in Newly Diagnosed HIV Cases by Mode of Transmission, Alameda County 2006-2011 Male (n=1078)
80% 70% 60% Percentage 50% 40% 30% 20% 10% 0% 200608 200709 200810 200911 MSM&IDU (n=54) Hetero Contact (n=100) Other(n=78) IDU(n=53) Percentage MSM(n=793) 80% 70% 60% 50% 40% 30% 20% 10% 0% 200608 200709 200810 200911 Hetero Contact (n=164) Other(n=61) IDU(n=38)
Female (n=263)
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Trends in Newly Diagnosed HIV Cases Among MSM by Race/Ethnicity, Alameda County 2006-2011 (n=793)
40% 35% 30% Percentage 25% AfrAmer 20% 15% 10% 5% 0% 200810 200911 200608 200709 API Latino White Other/Unk
Trends in Newly Diagnosed HIV Cases Among MSM by Age Group, Alameda County 2006-2011 (n=793)
35% 30% 25% Percentage 20% 15% 10% 5% 0% 200608 200709 200810 200911 1319yrs 2029yrs 3039yrs 4049yrs 5059yrs 60&over 60 & over
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Summary Findings:TrendsbyMode
Between 2006 and 20011, for new HIV cases, MSM was the predominant mode of transmission among males; among females the predominant mode was heterosexual contact Among MSM, African Americans and Whites comprised the highest proportion of new HIV cases in this period The 20-49 year age groups made up the highest proportions of new HIV cases in this period
Appendix B
PLWHA by Modes of Transmission
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PLWHA: MSM & IDU by Age Group and Race/Ethnicity (n=257) Alameda County 2011 Age Group Race/Ethnicity
4%
1% 3%
012yrs
49% 47%
PLWHA: IDU Males and Females by Race/Ethnicity, Alameda County 2011 IDU Males (n=274) IDU Females (n=178)
3% 1% 13% 21%
1% 2% 6%
White AfrAmer Latino API Other/Unk
18%
62%
73%
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PLWHA: IDU Males and Females by Age Group, Alameda County 2011 IDU Males (n=274)
0.4%
31%
012yrs
39% 59%
69%
50+
Summary Findings:PLWHAbyMode
Most PLWHA who are MSM & IDU are 30 years and older Whites comprise a higher proportion of MSM & IDU PLWHA than African Americans African Americans females are a higher proportion of PLWHA who are IDU than males
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