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HIV Epidemiology in New York State and New York CityLou Smith, MD, MPHDirector, Division of Epidemiology, Evaluation and ResearchAIDS Institute, New York State Department of Health
Sarah Braunstein, PhD, MPHDirector, HIV Epidemiology and Field Services ProgramNew York City Department of Health and Mental Hygiene
Trends in HIV and AIDS Cases*New York State, 1984 - 2012
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
1984 1986 1988 1990 1992 1994 1996 1998 2000^ 2002 2004 2006 2008 2010 2012
Num
ber of PLWD
HI
Num
ber o
f AID
S D
iagn
oses
and
Dea
ths
People living withHIV (non-AIDS) atthe end of each yearNumber
diagnosed eachyear with AIDS
Number of deaths each year among AIDS cases
People living withAIDS at the end of
each year
*Data as of April 2014^HIV named reporting began in NYS in 2000;deaths among HIV and AIDS cases are reported starting in 2000. NYSDOH/AI/BHAE
Number of deathsamong HIV & AIDScases each year
New York State Mother-to-Child HIV Transmission Number and Rate of HIV Infected Infants by Year of Delivery, 1997* - 2013
11.5
8.7
6.9
3.6 3.8 3.2
1.22.6 2.3
1.7 1.4 1.32.1
0.7 1.3 0.8 0.5
0
2
4
6
8
10
12
0
20
40
60
80
100
120
Year of DeliveryNumber Rate
n=99 n=81 n=62 n=28 n=27 n=23 n=8 n=16 n=13 n=10 n=8 n=6 n=11 n=3 n=6 n=3 n=2
Num
ber o
f HIV
Infe
cted
Infa
nts
*1997 data is February – December n=Number of infected infants identified
NYSDOH/AI/BHAE
Legal Basis for HIV Surveillance in New York State• HIV Reporting and Partner Services Law implemented
June 1, 2000, required reporting to New York State• Medical providers required to report new diagnoses of HIV, AIDS,
and HIV-related illness and known sex or needle-sharing partners • Laboratories conducting HIV-related tests required to report results
• Changes in the reporting law have broadened the permissible uses of surveillance data• 2000 – 2010: HIV epidemiology, partner notification• 2010 – 2014: deduplication, assess comorbidity, direct health
department program needs• 2014: sharing with medical providers for linkage and retention
4
NYSDOH/AI/BHAE
New York State HIV Laboratory Reporting
6/2000 to 6/2005 6/2005 to presentHIV antibody WB or IFA
confirmed (+) tests
WB or IFA confirmed (+)
testsCD4 lymphocytes <500 cells/mm3
or <29%All values
HIV nucleic acid tests
Any detectable value All values
Resistance and subtype results Not reportable
Genotype nucleotide sequence
5
NYSDOH/AI/BHAE
Trends in HIV and AIDS* New York State, 2002-2012
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Num
ber of PLWD
HI
Num
ber o
f HIV
Dia
gnos
es a
nd D
eath
s New HIV diagnoses
People living with HIV (non-AIDS)
Deathsamong persons
with HIV/AIDS
People living with AIDS
*Data as of April 2014. New HIV diagnoses include those diagnosed concurrently with AIDS.HIV named reporting began in NYS in 2000. NYSDOH/AI/BHAE
7
Age Distribution of Newly Diagnosed HIV* Cases New York State, 2012**
0
5
10
15
20
25
30
35
40
12 &under
13-19 20-29 30-39 40-49 50-59 60+
Perc
ent o
f Cas
es
Age (years) in 2012
Female
Male
N=3,316Average=36 yrs
*Regardless of subsequent or concurrent AIDS diagnosis**Data as of April 2014 NYSDOH/AI/BHAE
8
N = 743
N = 2,573
New HIV Diagnoses* by Race/Ethnicity,New York State, 2012**
Race/Ethnicity Number of HIV Diagnoses
% of Total HIV Diagnoses
Rate per 100,000
Population***
NYS Total 3,316 100% 16.7Non-Hispanic
White 672 20.3% 6.1
Non-Hispanic Black 1,393 42.0% 45.4
Hispanic 1,019 30.7% 27.0
Asian/PI 83 2.5% 4.5
Native Am 4 0.1% 5.1
Multi-race 145 4.4% --*Regardless of concurrent or subsequent AIDS diagnosis .**Data as of March 2014*** Age-standardized NYSDOH/AI/BHAE
9
Newly Diagnosed HIV Cases by Transmission RiskNew York State, 2002-2012*
0
1000
2000
3000
4000
5000
6000
2002 2004 2006 2008 2010 2012
MSM Fem. Pres. Het. Heterosexual UnknownIDU MSM/IDU Pediatric Blood Prod.
10
*December 2013 NYSDOH/AI/BHAE
Newly diagnosed HIV cases by county, 2012
11
Total # of newly diagnosed cases in NYS, 2012: 726(including inmates, excludes NYC)
Total # of newly diagnosed cases in NYS, 2012: 697(excluding inmates and NYC)
NYSDOH/AI/BHAE & NY LINKS
Median Initial* CD4 Count of Persons Newly Diagnosed with HIV: New York State 2006-2012
317320
331353 352
372372
0
50
100
150
200
250
300
350
400
2006 2007 2008 2009 2010 2011 2012
CD4 lymphocytes (cells/mm3)
12
*Includes only cases with CD4 count within 3 months of diagnosis. Cases that developed AIDS with 30 days of HIV diagnosis are included. Case data as of September 2013 with laboratory data as of November 2013.
Year of HIV Diagnosis
NYSDOH/AI/BHAE
Linkage to Care within 3 Months of HIV Diagnosis by Region: New York State - 2012
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Syracuse
Rochester
New York City
Nassau Suffolk
M. Hudson
L. Hudson
Buffalo
Binghamton*
Albany
New York State
% linked
13
NHAS 2015 Goal 85%
*Based on less than 20 persons. NYSDOH/AI/BHAE
Age Distribution of Persons Living with Diagnosed HIV Infection: New York State, December 2012*
0%
5%
10%
15%
20%
25%
30%
35%
<13 13-19 20-24 25-29 30-39 40-49 50-59 60+
Perc
ent o
f Cas
es
Age (years) in 2012
N=132,174Average= 47.9 yrs
*Data as of April 2014 NYSDOH/AI/BHAE
14
Time to AIDS Diagnosis for New HIV Cases that WereNot Concurrent HIV/AIDS Diagnoses, NYSby Year of HIV Diagnosis
0%
10%
20%
30%
40%
0 1 2 3 4 5 6 7 8 9 10 11
Cum
ulat
ive
Perc
ent
w/A
IDS
Dia
gnos
is
Years after HIV Diagnosis
20% of persons diagnosed with HIV (not AIDS) in 2002 had developed AIDS within 2 years. 2005
20062007
20082009
20102011
20042003
2002
15
NYSDOH/AI/BHAE
10% of persons diagnosed with HIV (not AIDS) in 2011 had developed AIDS within 2 years.
Cascade of HIV CareNew York State, 2012
154,000
132,000
86,000
75,000
68,000
0 50,000 100,000 150,000
Estimated HIV InfectedPersons
Persons Living w/ DiagnosedHIV Infection
Cases w/any HIV Care duringthe year*
Cases w/continuous careduring the year**
Virally suppressed ( n.d. or ≤200/ml) at test closest to
end-of-year
* Any VL or CD4 test during the year** At least 2 tests, at least 3 months apart
86% of infected
56% of infected65% of PLWDHI
48% of infected56% of PLWDHI
44% of infected51% of PLWDHI
79% of cases w/any care
16
Viral Suppression among Persons Living with Diagnosed HIV Infection by Risk and Race/Ethnicity: New York State, 2012
0% 10% 20% 30% 40% 50% 60% 70%
Unknown
Pediatric Risk
Blood Products
Female Pres. Het.
Heterosexual
MSM-IDU
IDU
MSM
Multirace**
Native Amer.*
Asian/PI
Hispanic
Black nonHispanic
White nonHispanic
% viral suppression
17
NYS average 51%
*Based on a small number of persons (n=100). **Multirace care measures are likely less reliable due to the method used to calculate multirace status.
Race/ethnicity
Risk
NYSDOH/AI/BHAE
Newly Diagnosed HIV CasesNew York State, 2002-2012
18
0
1,000
2,000
3,000
4,000
5,000
6,000
2002 2004 2006 2008 2010 2012
NYS
NYC
NYSexclNYC
NYSDOH/AI/BHAE*Data as of April 2014
Monitoring Progress Toward the End of
the HIV Epidemic in New York State: The view from NYC
Sarah L. Braunstein, PhD MPH Director, HIV Epidemiology and Field Services Program,
NYC Department of Health and Mental Hygiene
HIV in New York City, 1981-2012 2012: 3,141 new HIV diagnoses
1,889 new AIDS diagnoses 1,578 deaths among PWH (607 HIV-related)
Data reported to NYC DOHMH through June 30, 2013.
New Diagnoses and Estimated Incidence in NYC, 2008-2012
4256 3936
3599 3474
3141
3584
3146
2733 2927
2076
0
500
1000
1500
2000
2500
3000
3500
4000
4500
2008 2009 2010 2011 2012*
Year New diagnoses of HIV Estimated HIV incidence
Num
ber
*2012 incidence data are preliminary. Estimates generated September 2013, by the CDC Stratified Extrapolation Approach (SEA). SEA combines results from the Serologic Testing
Algorithm for Recent Seroconversion (STARHS) with data on demographic characteristics, risk factor, initial diagnosis date, testing and treatment history from the HIV surveillance registry. Unknown risk factor was imputed using the Multiple Imputation procedure in SAS v9.2.
Data as reported to NYC DOHMH by June 30, 2013. HIV diagnoses includes diagnoses of HIV without AIDS and HIV concurrent with AIDS.
Death rates are age-adjusted to the citywide population of PWHA in 2012. 2012 death data are incomplete.
• ZIP codes in the Chelsea-Clinton, Central Harlem-Morningside Heights and Washington Heights-Inwood neighborhoods had the highest HIV diagnosis rates.
• ZIP codes in Chelsea-Clinton, West Queens and East Harlem had the highest HIV prevalence
• ZIP codes in Bayside-Little Neck, Port Richmond and Canarsie-Flatlands had the highest mortality among persons with HIV.
Geographic Distribution of HIV in NYC, 2012
Age-adjusted Death Rates Among Persons with HIV in NYC, 2001-2012
Data reported to NYC DOHMH by June 30, 2014. *2012 Deaths are incomplete – deaths among persons with HIV occurring outside NYC are not included.
0
5
10
15
20
25
30
35
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012*
Age-
adju
sted
dea
th ra
tes p
er 1
,000
mid
-yea
r PLW
HA
All-cause
Year of death
HIV-related
Non-HIV-related
162.9
104.1
62.0
25.9
0
30
60
90
120
150
180
Black Hispanic White API
HIV Diagnosis Rates Among Males and Females by Race/ethnicity in NYC, 2012
The HIV diagnosis rate among black males was over 1.5 times higher than the rate among Hispanic
males and over 2 times higher than the rate among white males.
56.4
19.4 4.6 2.6
0
30
60
90
120
150
180
Black Hispanic White API
The HIV diagnosis rate among black females was over 3 times higher than the rate among
Hispanic females and over 12 times higher than the rate among white females.
Data as reported to NYC DOHMH by June 30, 2013. API=Asian/Pacific Islander
New HIV Diagnoses Among Women in NYC, 2012
0
100
200
300
400
500
600
700
800
2008 2009 2010 2011 2012
Num
ber
Year of diagnosis
Data reported to NYC DOHMH through June 30, 2013.
Heterosexual
Unknown risk
Injection drug use
35.8% decline overall
New HIV Diagnoses Among MSM in NYC, 2008-2012
1923
1803 1794 1802 1719
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2008 2009 2010 2011 2012
Year of diagnosis
Num
ber
10.6% decline
Data reported to NYC DOHMH through June 30, 2013.
0
100
200
300
400
500
600
700
800
2008 2009 2012 2011 2012
New HIV Diagnoses Among MSM by Race/Ethnicity in NYC, 2008-2012
Data reported to NYC DOHMH through June 30, 2013.
Year of diagnosis
Num
ber
Asian/Pacific Islander
Black
White
Hispanic
0
50
100
150
200
250
300
350
400
450
500
2008 2009 2012 2011 2012
New HIV Diagnoses Among MSM <30 in NYC, 2008-2012
Num
ber
Asian/Pacific Islander
Black
White
Hispanic
Year of diagnosis
0.9% decline overall
Data reported to NYC DOHMH through June 30, 2013.
0
50
100
150
200
250
300
350
400
2008 2009 2012 2011 2012
New HIV Diagnoses Among MSM >30 in NYC, 2008-2012
19.1% decline overall
Num
ber
Asian/Pacific Islander
Black
White Hispanic
Year of diagnosis
Data reported to NYC DOHMH through June 30, 2013.
Estimated HIV Incidence Among MSM in NYC, 2008-2012
1883
1664 1604
1748
1248
866
744 776
909
708
1008 913 830
843
514
0
500
1000
1500
2000
2500
2008 2009 2010 2011 2012*
Num
ber
Year Estimated HIV incidence among MSM overall Estimated HIV incidence among MSM <30Estimated HIV incidence among MSM ≥30
*2012 incidence data are preliminary. 1Estimates generated September 2013, by the CDC Stratified Extrapolation Approach (SEA). SEA combines results from the Serologic Testing
Algorithm for Recent Seroconversion (STARHS) with data on demographic characteristics, risk factor, initial diagnosis date, testing and treatment history from the HIV surveillance registry. Unknown risk factor was imputed using the Multiple Imputation procedure in SAS v9.2.
Acute HIV Infection by HIV Transmission Risk in NYC, 2008-2012
0
20
40
60
80
100
120
140
160
180
2008 2009 2010 2011 2012
MSM IDU Heterosexual Unknown
Num
ber
Year of diagnosis
Data reported to NYC DOHMH through June 30, 2013.
Acute HIV Infection Among MSM by Age and Race/ethnicity in NYC, 2012
0
5
10
15
20
25
30
35
Black Hispanic White API
13-19 20-24 25-29 30+
Num
ber
Race/ethnicity
Data reported to NYC DOHMH through June 30, 2013.
0%
20%
40%
60%
80%
100%
Estimated HIV-infected
Ever HIV-diagnosed
Ever linked toHIV care
Retained in HIVcare in 2012
Presumed everstarted on ART
Suppressed viral load (≤200
copies/mL) in 2012
Perc
enta
ge
100%
86% of infected
73% of infected
85% of
diagnosed 55% of
infected
74% of linked to
care
51% of infected
93% of
retained in care
41% of infected
82% of
started on ART
133,635
114,926
97,940
72,918 67,624
55,453
Largest gap: Linkage Retention
HIV Care Continuum for NYC, 2012
41% Suppressed
73% Linked
55% Retained
Data reported to NYC DOHMH through June 30, 2013.
Timely initiation of care is defined as first CD4 or VL drawn within 3 months (91 days) of HIV diagnosis, following a 7-day lag. Data reported to NYC DOHMH by June 30, 2013.
Initiation of Care Within 3 Months of HIV Diagnosis in NYC, 2008–2012
59% 60% 62% 68% 69%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2008 2009 2010 2011 2012
Tim
ely
initi
atio
n of
car
e (%
)
Year of HIV diagnosis
23.4%
34.1%
27.7%
39.5%
30.0%
43.2%
34.1%
48.4%
41.1%
57.7%
44.0%
60.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
By 6months
By 12months
By 6months
By 12months
By 6months
By 12months
By 6months
By 12months
By 6months
By 12months
By 6months
By 12months
2007 2008 2009 2010 2011 2012
% V
irally
supp
ress
ed
As reported to NYC DOHMH by December 31, 2013.
Viral Suppression at 6 and 12 Months After HIV Diagnosis in NYC, 2007-2012