Austin TGA Grant No.

H89HA00036

The Austin Transitional Grant Area (TGA) consists of five central Texas counties: Bastrop,
Caldwell, Hayes, Travis and Williamson.

HIV/AIDS Epidemiology

Demographic Characteristics of General Population in the TGA

Over 1.7 million people reside in the Austin Transitional Grant Area (TGA) and the majority
(58.0%) lives in Travis County. The TGA is predominately White (54.1%) and young; 68.1% of
all persons are less than 45 years old. The racial/ethnic composition of the TGA is slowly
changing. In 2000, White non-Hispanics accounted for 61.5% of the population and Hispanics
26.2%. In 2010, Hispanics comprise 33.1% (Table B). In 2000, 20.3% of Spanish-speaking
households were linguistically isolated; by 2008, a total of 31,263 Spanish-speaking households
or 24.0% were linguistically isolated (source: US Census Bureau). Over two-thirds (69.0%) of
all African American TGA residents live in Travis County; similarly, 77.0% of all individuals of
other races/ethnicities reside in Travis County.

Table A: Distribution of the Austin TGA general population, by sex and age, 2010.
Male Female Total
Age (yrs) (N=883,071) (N=829,576) (N=1,712,647)
0-12 149,064 144,473 293,537
13-19 80,871 76,871 157,742
20-44 383,823 331,138 714,961
≥45 269,313 277,094 546,407
Source: Texas State Data Center & Office of the State Demographer, 2010.

Table B: Percentage distribution of Austin TGA population

by race/ethnicity and county, 2010.
Race/ Bastrop Caldwell Hays Travis Williamson TGA
Ethnicity N=81,717 N=38,724 N=164,078 N=992,773 N=435,355 N=1,712,647
White 59.6 43.7 62.2 46.6 68.1 54.1
African
A
m
er
ic
an 8.2 8.7 3.4 9.3 5.9 7.8
Hispanic 31.2 46.9 32.8 37.4 22.3 33.1
Other 0.9 0.8 1.6 6.7 3.7 5.0
Source: Texas State Data Center & Office of the State Demographer, 2010.

Table C: HIV cases & rates per 100,000 among persons in Austin TGA,
by race/ethnicity and sex, diagnosed 2008-2009.
Males Females Total
Race/ethnicity N % Rate N % Rate N % Rate
White 188 45.9 20.6 21 26.6 2.3 209 42.7 11.6
African American 68 16.6 53.2 34 43.0 26.3 102 20.9 39.7
Hispanic 144 35.1 25.6 22 27.8 4.5 166 34.0 15.8

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 Austin TGA Grant No. H89HA00036

Asian-Pacific
Is.& Multiracial 10 2.4 12.4 2 2.5 2.5 12 2.5 7.5
Total 410 100.0 24.4 79 100.0 5.0 489 100.0 14.9
Source: Texas eHARS (unadjusted for reporting delays), 2010.
HIV/AIDS Cases by Demographic Characteristics and Exposure Categories
During 2008-2009, HIV infection was diagnosed for 489 persons of whom 83.8% were male and
16.2% were female (Table C). For this two year period, less than half of newly diagnosed HIV
cases were White non-Hispanic (42.7%), about one-fifth were African American (20.9%), and
34.0% were Hispanic. Rates were significantly higher among African Americans, approximately
three times higher than among both Whites and Hispanics. Table D shows that the distribution
of risk differs by race/ethnicity in the TGA. The most common risk factor was male-to-male
sexual contact (70.8%) for all races/ethnicities. Among African Americans (46.3%), Hispanics
(75.4%), and Whites (78.5%), most new HIV cases were in the male-to-male sexual contact
exposure category.
Table D: HIV cases among persons in the Austin TGA,
by exposure category and race/ethnicity, diagnosed 2008-2009.
Asian-PI &
M
ult
i
ra
African cia
White American Hispanic l Total
Exposure N % N % N % N % N %
Category
Male-to-male sex 164 78.5 47 46.3 125 75.4 10 83.3 346 70.8
Injection drug use 12 5.7 9 8.6 7 4.2 1 8.3 29 5.9
MSM & IDU 13 6.4 1 0.9 5 2.7 0 0.0 19 3.9
Heterosexual 20 9.3 42 41.3 29 17.7 1 8.3 92 18.8
Other/Perinatal 0 0.0 1 1.0 0 0.0 0 0.0 1 0.2
Not Classified 0 0.0 2 2.0 0 0.0 0 0.0 2 0.4
Total 209 100.0 102 100.0 166 100.0 12 100.0 489 100
Source: Texas eHARS (risk statistically redistributed), 2010.

The unadjusted rates of newly diagnosed HIV and AIDS cases decreased slightly from 2008 to
2009 (Figure 1). This may be a result of extensive cleaning and updating of the Texas
HIV/AIDS Reporting System (HARS). Texas transitioned to a new surveillance system (HARS
to eHARS) in 2009, which affected all years of data. Additionally, several other de-duplication
and death updates were performed. Subsequently, many records were deleted from Texas
eHARS because they represented deceased cases, were duplicate records, represented out-of-
state cases, changed diagnostic status to seroreverters, or the cases’ respective race could not be
confirmed. Approximately 81% of all newly diagnosed cases of HIV and AIDS were reported in
Travis County, and the county accounts for about 58% of the TGA population.

Figure 1: Rate per 100,000 of Diagnosed HIV and AIDS by year, Austin TGA 2000-2009.

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 Austin TGA Grant No. H89HA00036

25

rate per 100,000

20
15
10 AIDS
5
HIV
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Source: Texas eHARS (unadjusted for reporting delays), 2010.

In 2008-2009, according to Texas eHARS, a total of 342 new AIDS cases were diagnosed. Over
80% of those cases were male. By race/ethnicity, 42.4% of cases were White non-Hispanic,
20.2% of cases were African American, and 34.5% were Hispanic. The highest rates of cases
were among African American males and females, which were substantially higher than rates
among White non-Hispanics (Table E).

Table E: AIDS cases and rates per 100,000 among persons in Austin TGA,
by race/ethnicity & sex, diagnosed 2008-2009.
Males Females Total
Race/ethnicity N % Rate N % Rate N % Rate
White 130 45.8 14.2 15 25.9 1.7 145 42.4 8.0
African American 43 15.1 33.7 26 44.8 20.1 69 20.2 26.8
Hispanic 104 36.6 18.5 14 24.1 2.9 118 34.5 11.3
Other 7 2.5 8.7 3 5.2 3.8 10 2.9 6.3
Total 284 100.0 16.9 58 100.0 3.7 342 100.0 10.5
Source: Texas eHARS (unadjusted for reporting delay), 2010.

The risk for the majority of AIDS cases reported each year in the TGA is male-to-male sexual
contact (Figure 2). The percent of cases with male-to-male sexual contact as the risk has been
steadily increasing in the TGA, reversing a significant decreasing trend throughout the 1990s.
The proportion of AIDS cases reporting MSM risk in 2009 is similar to the proportion that
reported MSM risk in 1993. One reason for this change may be the increase in risky sexual
activities with anonymous or pseudonymous partners who meet over the Internet. In Austin and
Travis County, male-to-male sexual activity was associated with Internet partners (source: Vest
et al, Sexually Transmitted Disease, 2007).

Figure 2: Proportion of AIDS Cases by Exposure Category and Diagnosis Year, 1989-2009.

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 Austin TGA Grant No. H89HA00036

70

60

50
percent

40

30

20

10

0
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Male-to-Male Sex IDU M-M & IDU

Heterosexual Contact Other/Perinatal Not Classified

Source: Texas eHARS (risk statistically redistributed), 2010.

A total of 4,413 persons in the TGA were living with HIV infection as of 12/31/2009
(Attachment 3). Of those, a total of 1,750 persons were living with HIV (not AIDS). The steady
increase in the prevalence of HIV infection since 2000 is illustrated below in Figure 3.
According to the Texas Department of State Health Services (DSHS) the prevalence of AIDS has
increased 67.5% since 2000. Figure 4 indicates that highest prevalence rates of persons living
with HIV infection (PLWH/A) are consistently among African Americans. Rates among African
Americans living with HIV are approximately 3.5 times higher than other groups.
Figure 3: Number of Persons Living with HIV/AIDS, Austin TGA
5000
HIV
4000
AIDS
number

3000
2000
1000
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Source: Texas eHARS (unadjusted for reporting delays), 2010.

Figure 4: Rate per 100,000 of Persons Living with HIV Infection
by race/ethnicity, Austin TGA

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 Austin TGA Grant No. H89HA00036

1000
900
800
700 White
600
African American
rate

500
400 Hispanic
300 Other
200
100
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Source: Texas eHARS (unadjusted for reporting delays), 2010.

Almost half of PLWH/A are White non-Hispanic (49.1%), and 84.3% are males. The highest
burden of disease is among African Americans. The prevalence rate of HIV infection among
African American males is 2.5 times higher than among White males, and the rate among
African American females is almost twelve times higher than among White females (Table F).
Table F: Prevalence rate per 100,000 of HIV infection in the Austin TGA,
by race/ethnicity and sex, 2009.
Males Females Total
Race/ethnicity N % Rate N % Rate N % Rate
White 1968 52.9 427.6 199 28.8 44.1 2167 49.1 237.8
African American 709 19.1 1093.9 337 48.8 514.5 1046 23.7 802.7
Hispanic 998 26.8 345.3 142 20.6 57.1 1140 25.8 212.0
Other 47 1.3 113.7 13 1.49 32.1 60 1.4 73.3
Total 3722 100.0 435.1 691 100.0 85.7 4413 100.0 265.6
Source: Texas eHARS (unadjusted for reporting delays), 2010.

The Austin TGA is not the most populous Texas TGA, but its burden of HIV infection is high.
The prevalence of PLWH/A is the third highest in the state, higher than the more populous San
Antonio and Fort Worth TGAs (Figure 5). Only the Austin, Houston, and Dallas EMAs/TGAs
have HIV (not AIDS) prevalence rates in the triple digits (source: Texas DSHS, 2010).
Figure 5: Prevalence of Persons Living with HIV/AIDS, Texas EMAs/TGAs, 2009
450
404.4
400 364.6
350
300 265.6
250 244.6
195.9
200
150
100
50
0
Austin Dallas Fort Worth Houston San Antonio

Source: Texas DSHS (unadjusted for reporting delays), 2010.