HIV & AIDS Cases in Alameda County

Presentation to the CCPCAugust 24, 2011

Elaine Bautista & Alex Marr

What is Epidemiology?

The study of the distributions (who, where and when) and determinants (what and why) of morbidity (sickness) and mortality (death) among human populations

AIDS Epidemiology Terminology

Proportion = Percent of cases

Incidence = new cases in time period

Prevalence = existing cases in time period

Cumulative = all cases ever reported regardless if alive or deceased

Rate

The occurrence of an event (disease), accounting for the size of the population

Infers a measure of time Allows for comparisons of populations The number of cases occurring during a

specific time period divided by the population during that time period

Usually expressed per 1,000 or 100,000

Rate (Cont.)

Case Rate

Example: the rate in Alameda County for 2000 is:

and the rate among African Americans in 2000 is:

* 100,000 Number of casesTotal Population = Rate

225___ 1,443,741

x 100,000 = 15.6

x 100,000 = 60.2 _127___ 211,124

When stratified by race and sex, some HIV diagnostic values are too low to ascertain a case rate. We present the full race breakdown by percentage of new HIV diagnoses. However, we focused on the following three races with high enough counts for the 2006-2010 trend: Latino African American White

As HIV surveillance by name was implemented in 2006, HIV diagnostic data before 2006 may not be comparable.

For the purposes of this presentation, cases (including transgender cases) are categorized by the Sex at birth.

Caveats – Potential Limitations

HIV/AIDS Diagnoses, Deaths and persons Living with HIV/AIDS

Alameda Co. California

Diagnosis of HIV, 2010 108 --

Diagnosis of AIDS, 2010 137 --

Average HIV/AIDS Rate, 2008-10 19.8 per 100,000

--

Cumulative diagnosis of HIV, 1980-2010

1,413 41,892

Cumulative diagnosis of AIDS infection, 1980-2010

8,038 159,329

Cumulative deaths in persons with HIV

23 1,385

Cumulative deaths in persons with AIDS

4,345 88,842

HIV & AIDS Infections by Year of Diagnosis and Deaths among Persons with HIV Infection

HIV/AIDS Cases by Sex

Source: Centers for Disease Control and Prevention (CDC). eHARS. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2006-2010].

Number of Newly Reported HIV (non-AIDS) Cases,Alameda County 2006-2010

Annual HIV/AIDS Case rates by Race/Ethnicity and Year of Diagnosis

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

Per 1

00,0

00 re

side

nts

All Races African Amer Asian/Pac Isl Latinos Whites

Source: Centers for Disease Control and Prevention (CDC). eHARS. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2006-2010].

Percentage of Newly Reported HIV (non-AIDS) Cases By Race/Ethnicity, Alameda County 2006-2010

Source: Centers for Disease Control and Prevention (CDC). eHARS. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2006-2010].

Percentage of Newly Reported HIV (non-AIDS) Cases By Race/Ethnicity, Alameda County 2006-2010

Latino21%

White35%

Asian/Pacific Islander

27%

African American/Black13%

Multi-Race4%

All Females by Race/Ethnicity, Alameda County, 2008 Population

White12%

Latino13%

Asian/Pacific Islander

5%

African American/Black

70%

Percent of Reported HIV Cases Among Females by Race Ethnicity, Alameda County (2006-2010)

Newly Reported HIV/AIDS Infections by Reported Transmission Mode and Sex, Alameda County 2000-2010

Newly Reported HIV/AIDS Infections among Males by Reported Transmission Mode and Race/Ethnicity, Alameda County, 2000-2010

Latino Males

Newly Reported HIV/AIDS Infections among Females by Reported Transmission Mode by Race/Ethnicity, Alameda County, 2000-2010

Latina

Injection Drug Users (includes IDU and MSM&IDU)

0

20

40

60

80

100

120

140

160

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

# of

Cas

es

Latino Amer Indian/Alaska Nat African Amer White Asian/Pac Isl Multi-race

Case Rates of Newly Reported HIV (non-AIDS) Cases by Race/Ethnicity,Alameda County 2006-2010

0

10

20

30

40

50

60

2006 2007 2008 2009 2010

Cas

e R

ate

Per

100

,000

P

op

ula

tio

n

Year of HIV Diagnosis

HIV (non-AIDS) Cases Among MalesAlameda County 2006-2010

Latino African American/Black White

0

10

20

30

40

50

60

2006 2007 2008 2009 2010Cas

e R

ate

Per

100

,000

Po

pu

lati

on

Year of HIV Diagnosis

HIV (non-AIDS) Cases Among Males and FemalesAlameda County 2006-2010

Latino African American/Black White

Source: Centers for Disease Control and Prevention (CDC). eHARS. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2006-2010].

0

10

20

30

40

50

60

2006 2007 2008 2009 2010Cas

e R

ate

Per

100

,000

P

op

ula

tio

n

Year of HIV Diagnosis

HIV (non-AIDS) Cases Among FemalesAlameda County 2006-2010

Latina African American/Black White

Case Rates of Newly Reported HIV (non-AIDS) Cases by Race/Ethnicity,Alameda County 2006-2010

0

1

2

3

4

5

2006 2007 2008 2009 2010

Cas

e R

ate

Per

100

,000

P

op

ula

tio

n

Year of HIV Diagnosis

HIV (non-AIDS) Cases Among Females, Alameda County 2006-2010

Latina White, Non-Latina

0

2

4

6

8

10

2006 2007 2008 2009 2010

Cas

e R

ate

Per

100

,000

P

op

ula

tio

n

Year of HIV Diagnosis

HIV (non-AIDS) Cases Among Males and Females, Alameda County 2006-2010

Latino White, Non-Latino

0

5

10

15

20

2006 2007 2008 2009 2010

Cas

e R

ate

Per

100

,000

P

op

ula

tio

n

Year of HIV Diagnosis

HIV (non-AIDS) Cases Among MalesAlameda County 2006-2010

Latino White, Non-Latino

HIV and AIDS Cases by Age GroupAlameda County, 2000-2010

HIV (non-AIDS) Cases by Age Group, Alameda County 2000-2010

0%5%

10%15%20%25%30%35%40%45%50%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Proportion of HIV (non-AIDS) Cases by Age Group,Alameda County 2000-2010

0-12 13-19 20-2930-39 40-49 50+

0

10

20

30

40

50

60

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Number of HIV (non-AIDS) Cases by Age Group,Alameda County 2000-2010

0-12 13-19 20-2930-39 40-49 50+

AIDS Cases by Age Group, Alameda County 2000-2010

Persons Living with HIV/AIDSAlameda County, 1990-2010

Demographic Characteristics of PLWH/A *(Includes cases residing in Alameda County but diagnosed elsewhere)

Demographic Characteristics of PLWH/A *(Includes cases residing in Alameda County but diagnosed elsewhere)

Case Fatality = the number of deaths in a sub-population

MALES

Race/Ethnicity

Cumulative Total HIV+ Cases

#Deaths Case Fatality

African Amer

3183 1529 48.0%

Amer Ind/AK Native

16 6 37.5%

Asian/Pac Isl

288 80 27.8%

Latino 1023 358 35.0%

White 3410 1872 54.9%

FEMALES

Race/Ethnicity

Cumulative Total HIV+ Cases

#Deaths Case Fatality

African Amer

963 331 34.4%

Amer Ind/AK Native

7 6 85.7%

Asian/Pac Isl

64 14 21.9%

Latina 156 45 28.9%

White 234 97 41.5%

Late Testers

The number of individuals who progress to AIDS within one year of initial HIV diagnosis. Includes those with HIV & AIDS simultaneous diagnosis.

As a % of AIDS Cases

3791

8038= 47.2%

As a % of all HIV Positive Cases

3791

9451= 40.1%

Late Testers

Percent Late Testers among each Demographic Characteristics (% of Group who were Late Testers)

Characteristics of Late Testers (n=3791)

Characteristics of Transgendered Persons in Alameda Co.

White3%

Black82%

Latino10% Asian/Pac Isl

3%

Multi-race2%

Race/Ethnicity

# Cases

Conclusions

The number of diagnosed HIV cases surpassed the number of AIDS cases in 2010.

HIV/AIDS cases are predominantly among Males. Females comprise 15-20% of diagnosed cases.

African Americans comprise the majority of HIV/AIDS cases, followed by Whites and Latinos.

HIV/AIDS is diagnosed predominantly among individuals aged 20-49. A slight increase in older adults age 50 years and above has been seen in recent years.

New way of looking at Persons Living with HIV/AIDS to include new residents who were diagnosed elsewhere.

New ways of looking at late testers. The use of the data will depend on the completeness of the surveillance data and the message being conveyed.