Epidemiology of HIV Infection Trends in Florida Reported through 2013

Epidemiology ofHIV Infection Trends

in Florida Reported through 2013

Florida Department of HealthHIV/AIDS and Hepatitis Section

Division of Disease Control and Health ProtectionAnnual data as of 12/31/2013

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Created: 12/27/13

Revision: 04/18/14

HIV and AIDS Case Data

HIV Infection reporting represents newly reported HIV cases, regardless of AIDS status at time of report.

HIV infection cases classified as Stage 3 (AIDS) became reportable in Florida in 1981.

HIV infection cases (without an AIDS diagnosis) became reportable in Florida on July 1, 1997.

AIDS cases and HIV infection cases by year of report are NOT mutually exclusive and CANNOT be added together.

Frozen databases of year-end data are generated at the end of each calendar year. These are the same data used for Florida CHARTS and all grant-related data where annual data are included.

HIV prevalence data are prepared later in the year, when most of the “expected” death data are complete, usually in July.

HIV and AIDS Case Data (con’t) Adult cases represent ages 13 and older, pediatric cases

are those under the age of 13. For data by year, the age is by age of diagnosis. For living data, the age is by current age at the end of the most recent calendar year, regardless of age at diagnosis.

Unless otherwise noted, whites are non-Hispanic and blacks are non-Hispanic.

Total statewide data will include Department of Correction Cases (DOC) unless otherwise noted. County data will exclude DOC cases.

HIV “incidence estimates” are approximations of the numbers of people who are newly infected, which include those whose infection has not yet been diagnosed or reported.

Surveillance Case Definition for AIDS in Florida under age 6

Laboratory evidence and/or medical documentation by a physician of a person with a positive confirmatory HIV antibody test and/or positive virologic test (qualitative or quantitative) and

For children under age 6: Has been diagnosed with one or more AIDS-defining illness

(Opportunistic Infections)

Surveillance Case Definition for AIDS in Florida age 6 and older

Laboratory evidence and/or medical documentation by a physician of a person with a positive confirmatory HIV antibody test and/or positive virologic test (qualitative or quantitative) and

For persons 6 years of age or older: Has a CD4 absolute lymphocyte count below 200, or a CD4

of less than 14% total lymphocytes and/or Has been diagnosed with one or more AIDS-defining illness

(i.e., Opportunistic Infections) excluding multiple or recurrent bacterial infections

Surveillance Case Definition for HIV in Florida

Laboratory CriteriaPositive result on a screening test for HIV antibody, followed by a positive result on a confirmatory test for HIV antibody (e.g., Western blot, IFA, multispot, etc)

ORPositive result or report of a detectable quantity of any of the following HIV virologic (non-antibody) tests:

• HIV nucleic acid (DNA or RNA) detection test (e.g., polymerase chain reaction [PCR]) Has a CD4 of less than 14 percent total lymphocytes

• HIV p24 antigen test, (excluding neutralization assay)• HIV isolation (viral culture)

HIV Infection Reporting in Florida

HIV Case Reporting in Florida is based on a positive antibody or antigen test for HIV:

HIV (not AIDS) cases became reportable in Florida on 07/1997, but only via confirmatory Western Blot (antibody) HIV tests. Reporting was NOT retroactive. Previously positive tests required re-testing with a confirmatory test before they could become reportable.

Viral load (antigen) HIV tests became reportable in Florida on 11/20/2006.

As of 2009, all states now have confidential name-based HIV infection reporting.

Private MDs Medical Records Death Certificates Laboratories Medical Examiners Counseling & Testing Sites

Correctional Facilities Hospitals (ICD-9), Billing HIV Patient Care Clinics Registries (e.g., AZT, TB,

Cancer)

Reporting Sources of HIV and AIDS Cases

Surveillance for HIV/AIDS relies on reporting from the above sources. Additionally, local public health professionals are responsible for case finding and/or epidemiologic follow-up, resulting in a very high completeness of reporting and decent classification of exposure (risk) category.

The Epidemic in FloridaPopulation in 2013: 19.2 million

(4th in the nation)Newly diagnosed** HIV infections in 2013: 4,864

(2nd in the nation in 2011)Newly diagnosed** AIDS cases in 2013: 2,532

(3rd in the nation in 2011) Cumulative pediatric AIDS cases reported through 2013: 1,547

(2nd in the nation in 2011)

Persons diagnosed and living***with HIV disease through 2012: 105,627

(3rd in the nation in 2010)HIV prevalence estimate through 2012: 125,000

(11.4% of the U.S. estimate for 2010)

HIV incidence estimates 2010: 3,454(There was a 30% decrease from 2007-2010)

HIV-related deaths in 2012: 923(Down 8.2% from 2011.

The first time to ever be under 1,000 deaths in a given year.)

57% White15% Black23% Hispanic 4% Other*

*Other = Asian/Pacific Islanders; American Indians/Alaskan Natives; multi-racial. **Data by year of diagnosis for 2013 are incomplete and should be interpreted with care *** Living (prevalence) data as of 06/30/2013

29% White49% Black20% Hispanic 2% Other*

Pediatric HIV Infection Cases N=2,576

Population Estimates N= 2,870,836

Pediatric* HIV Infection Cases and State Population**

in Children <13 years of age, by Race/Ethnicity, Reported* through 2013, Florida

10%

74%

14% 2%

WhiteBlackHispanicOther

43%

21%

29%

6%

90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 130

20

40

60

80

100

120 Aged < 2 years at AIDS diagnosis

Aged >= 2 years at AIDS diagnosis

Year of Diagnosis

Nu

mb

er o

f C

ases

Pediatric AIDS Cases by Age Group at Diagnosis and Year of

Diagnosis, 1990-2013, Florida

These data represent an 90% decline in pediatric AIDS cases by year of diagnosis from 1992 (N=178) to 2013 (N=17). Due to reporting lags, 2013 data by year of diagnosis are provisional. Data as of 03/31/2014.

N=1,545

Perinatally Acquired HIV Infected Cases,Born in Florida,

by Year of Birth, 1979-2013

Birth # % change

2001 382002 21 -45%2003 20 -5%2004 13 -35%2005 14 8%2006 19 36%2007 17 -11%2008 11 -35%2009 9 -18%2010 6 -33%2011 3 -50%2012 8 167%2013 9 13%

Note: These data represent a 92% decline in HIV-perinatally infected births from 1993 (N=110) to 2013 (N=9). These data include ALL perinatally acquired HIV Infection cases BORN in Florida.2013 data are provisional. None of the babies born since 2010 have developed AIDS.Data as of 03/31/2014.

79 81 83 85 87 89 91 93 95 97 99 01 03 05 07 09 11 130

20

40

60

80

100

120

Year of Report

Nu

mb

er o

f C

ases

HIV Infection Case Rates* by County of Residence,**Reported in 2013, Florida

*Population data were provided by Florida CHARTS as of 01/06/2014.**County totals exclude Department of Corrections cases (N=108). Numbers on counties are cases reported.

Statewide Data:N= 5,938

State Rate = 30.9Rate per 100,000 population

0 0.1 to 15.015.1 to 30.0> 30.0

0

1044

0

0

0

0

0

9

5

1

5

5

42

4

7

2

3

2

1

9

1

1

151

18

49

1

1125

19

1

12

13

12

7

6

46

111

4

3

8

3

99

40

72

52 12

46

25

42

71

52

49

161

25

63

210

42

86

414

143625

403

470

341

14

6

110

AIDS Case Rates* by County of Residence,**Reported in 2013, Florida

0 0.1 to 15.015.1 to 30.0> 30.0

Statewide Data:N=3,282

State Rate = 17.1Rate per 100,000 Population

*Population data provided by Florida CHARTS as of 01/06/2014.**County totals exclude Department of Corrections cases (N=66). Numbers on counties are cases reported.

0

0 0

0

0

0

0

0

5

1

5

43

27

79

1

6

4

1

44

8

1

36

2

6

6

1

4

11

60

4

2

6 30

8

37

7

35

10

27

30

83

17

1640

11

151

25

10

38

125

16 4

226

4

7

70911

498

231

310

49

199

70

10

5

Florida Areas

Area 5

Pasco

Pinellas

Area 4

BakerClay

DuvalNassau

St Johns

Area 3

Alachua Bradford Columbia

Dixie Gilchrest Hamilton

Lafayette Levy Putnam

Suwannee Union

Area 10

Broward

Area 8

Charlotte DeSoto

Glades Sarasota

Hendry Collier

Lee

Area 6

Hernando

Hillsborough

Manatee

Area 2a

Bay Calhoun

Gulf Holmes Jackson

Washington

Area 11a

Dade

Area 1

Escambia

Okaloosa

Santa Rosa

Walton

Area 9

Palm Beach

Area 7

Brevard

Orange

Osceola

Seminole

Area 14

Hardee

Highlands

Polk

Area 15

Indian RiverMartin

OkeechobeeSt Lucie

Area 12

Flagler

Volusia

Area 13

CitrusLake

MarionSumter

Area 11b

Monroe

Area 2b

Franklin Gadsden Jackson

Jefferson Leon Liberty

Madison Taylor Wakulla

ES

CA

MB

IA

SA

NTA

RO

SA

OK

ALO

OS

A

WA

LTO

N HOLMES

WS

BAY

JACKSON

CN

GF

LIB

ER

TY

FK

GD

LEON

WK

JF

TAYLOR

MD

SW

LF

DIXIE

LEVY

CB

NASSAU

MARION

PASCO

PT

CLAY

BK DUVAL

ST

JO

HN

S

VL

ORANGE

BR

EV

AR

D

OSCEOLA

POLKHBPN

DESOTO

LEEHENDRY

COLLIER

MARTIN

ST LUCIE

OBHG

10

9

15

7

12

4

3

2

1

13

6

8

14

SS

FG

MONROE DADE

PALM BEACH

GLADESCHARLOTTE

IRHR

SMHN

CTST

LAKE

GC AL

BF

HM

5

11

BROWARD

MA

*Source: Population estimates are provided by FloridaCHARTS

Adult HIV Infection Cases and Population*

by Area, Reported in 2013, Florida

1 2a 2b 3 4 5 6 7 8 9 10 11a 11b 12 13 14 150

5

10

15

20

25

30

% HIV Cases % of Floridas Population

Area

Per

cen

t b

y A

rea

Adult AIDS Cases and Population* by Area, Reported in 2013, Florida

*Source: Population estimates are provided by FloridaCHARTS

1 2a 2b 3 4 5 6 7 8 9 10 11a 11b 12 13 14 150

5

10

15

20

25

% HIV Cases % of Floridas Population

Area

Per

cen

t b

y A

rea

HIV Infection Cases and Rates*,by Year of Report, 2004-2013, Florida

Note: Enhanced laboratory reporting (ELR) laws in 2006 and the expansion of ELR in 2007 led to an artificial peak in newly reported cases of HIV infection in 2008. This was followed by a general decline in reported cases through 2012. Another surge in the expansion of ELR in 2012 was followed by another increase in newly reported cases of HIV infection in 2013. These trends were observed across most race/sex/risk groups throughout the state.*Source: Population estimates are provided by Florida CHARTS as of 01/06/2014.

Year Rate04 44.205 38.906 36.607 37.108 42.109 29.710 26.111 26.612 23.813 30.9

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

1,0002,0003,0004,0005,0006,0007,0008,0009,000

7,7196,954 6,684 6,867

7,853

5,5574,913 5,044 4,531

5,938

Year of Report

Nu

mb

er o

f C

ases

Note: Enhanced laboratory reporting (ELR) laws in 2006 and the expansion of ELR in 2007 led to an artificial peak in newly reported cases of AIDS in 2008. This was followed by a general decline in reported cases through 2012. Another surge in the expansion of ELR in 2012 was followed by another increase in newly reported cases of AIDS in 2013. These trends were observed across most race/sex/risk groups throughout the state.*Source: Population estimates are provided by Florida CHARTS as of 01/06/2014.

AIDS Cases and Rates*,by Year of Report, 2004-2013, Florida

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

1,000

2,000

3,000

4,000

5,000

6,0005,356

4,633 4,829

3,6684,616

4,038

3,173 3,2952,652

3,282

Year of Report

Nu

mb

er o

f C

ases

Year Rate04 30.605 25.906 26.507 19.808 24.809 21.610 16.911 17.412 13.913 17.1

Proportion of Adult HIV Infection Cases, by Sex and

Year of Report, 2004-2013, Florida

Note: In 2013, 77% of the adult HIV infection cases were male, compared to only 70% in 2004. Over the past ten years, the proportion of HIV infection cases among men has increased while the proportion among women has decreased. The result is an increase in the male-to-female ratio, from 2.3:1 in 2004 to 3.3:1 in 2013. The relative increase in male HIV cases might be attributed to proportional increases in HIV transmission among men who have sex with men (MSM).

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

20

40

60

80

100

Year of Report

Pro

po

rtio

n o

f C

ases

M:F Ratio

2004 2.3:1

2013 3.3:1

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

20

40

60

80

Year of Report

Proportion of Adult AIDS Cases, by Sex and

Year of Report, 2004-2013, Florida

Note: Although the proportion of adult AIDS cases among men and women has remained fairly level, the proportion of male AIDS cases increased from 69% in 2004 to 71% in 2013. As the proportion of males increase, the ratio of males-to-females increases as well, thus the male-to-female ratio inclined slightly from 2.3:1 in 2004 to 2.5:1 in 2013.

Pro

po

rtio

n o

f C

ases

M:F Ratio

2004 2.3:1

2013 2.5:1

U.S., 2011N=49,273

Note: Florida has a higher proportion of female cases reported in the most recent year, compared to the U.S.*Source: U.S. data, CDC HIV surveillance report, Vol. 23, Table 1a, 2012 data not available. HIV cases are estimated reports for all 50 states with confidential HIV reporting.

Adult HIV Infection Cases, by Sex,Reported in the United States* and Florida

Florida, 2013N=5,916

77%

23%

79%

21%

MaleFemale

U.S., 2011N=32,052

Note: Florida has a higher proportion of female cases reported in the most recent year, compared to the U.S.*Source: U.S. data, CDC HIV surveillance report, Vol. 23, Table 2a, 2012 data not available.

Adult AIDS Cases by Sex,Reported in the United States* and Florida

Florida, 2013N=3,279

71%

29%

75%

25%

MaleFemale

Note: In 2013, a larger proportion of AIDS cases were reported among women compared to the proportion of HIV infection reported among women.

HIV InfectionN=5,916

AIDSN=3,279

Adult HIV Infection and AIDS Cases, by Sex, Reported in 2013, Florida

77%

23%

MaleFemale

71%

29%

- Amount of HIV already in the community- Late diagnosis of HIV or AIDS*

- Access to/acceptance of care*

- Stigma, denial*,

- Discrimination, homophobia*

- HIV/AIDS complacency*

- Poverty and unemployment

*Factors that HIV/AIDS initiatives can impact.

Underlying Factors Affecting HIV/AIDS Disparities

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

500

1000

1500

2000

2500

3000

3500

Year of Report

Adult HIV Infection Cases, by Race/Ethnicity, and Year of Report, 2004–2013, Florida

Note: Over the past ten years, HIV infection cases decreased among blacks by 32% and among whites by 21%. There was a 1% overall increase among Hispanics for this same period. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.

Num

ber o

f Cas

es

Black

White

Hispanic

Other*

Proportion of Adult HIV Infection Cases, by Race/Ethnicity, and Year of Report, 2004-2013, Florida

Note: From 2004 to 2013, the proportion of adult HIV cases among blacks decreased by 6 percentage points. In contrast, increases were observed among both whites (1 percentage point) and Hispanics (6 percentage points) over this same time period.

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

10

20

30

40

50

60

Year of Report

Prop

ortio

n of

Cas

es

Black

White

Hispanic

Other*

Adult Male HIV Infection Cases, by Race/Ethnicity, and Year of Report, 2004–2013, Florida

Note: Over the past ten years, black men represented the highest proportion (> 35%) of male HIV infection cases by race/ethnicity. From 2004 to 2013, the percentage of male HIV cases increased among Hispanics by 7 percentage points. In contrast, the HIV cases decreased by 1 percentage point among whites and 5 percentage points among blacks over the same time period. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.

2004 2005 2006 2007 2008 2009 2010 2011 2012 201305

101520253035404550

Year of Report

Per

cen

t o

f C

ases

Black

White

HispanicOther*

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

10

20

30

40

50

60

70

80

Year of Report

Adult Female HIV Infection Cases, by Race/Ethnicity, and Year of Report, 2004–2013, Florida

Note: HIV case disparities are more evident among women than men. For the past ten years, black women represented over 63% of the cases each year. From 2004 to 2013, the proportion of cases by race/ethnicity among women remained fairly stable. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.

Black

White

Hispanic

Other*

Per

cen

t o

f C

ases

Adult AIDS Cases, by Race/Ethnicity, and Year of Report, 1990–2013, Florida

Note: This 22 year trend shows the change in the epidemic over time. The peak in AIDS cases in 1993 can be associated with the expansion of the AIDS surveillance case definition. The overall declines in new AIDS cases among all race/ethnic groups are due in part to the success of highly active antiretroviral therapies, introduced in 1996. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.

90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 130

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

Year of Report

Nu

mb

er o

f C

ases Black

White

Hispanic

Other*

04 05 06 07 08 09 10 11 12 130

500

1,000

1,500

2,000

2,500

3,000

Year of Report

Adult AIDS Cases, by Race/Ethnicity, and Year of Report, 2004–2013, Florida

Note: The overall declines in new AIDS cases among all race/ethnic groups are due in part to the success of highly active antiretroviral therapies, introduced in 1996. From 2004 to 2013, the proportion of adult AIDS cases decreased by 42% among whites, 41% among blacks and 26% among Hispanics. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.

Nu

mb

er o

f C

ases

Black

White Hispanic

Other*

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

10

20

30

40

50

60

Year of Report

Proportion of Adult AIDS Cases, by Race/Ethnicity, and Year of Report, 2004–2013, Florida

Note: Historically, blacks account for over 50% of the reported AIDS cases each year. Of the adult AIDS cases reported in 2013, 26% were white, compared to 51% black and 21% Hispanic. Over the past 10 years, the proportion of AIDS cases has remained fairly level among all race/ethnic groups. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.

Pro

po

rtio

n o

f C

ases

Black

White Hispanic

Other*

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

10

20

30

40

50

60

Year of Report

Proportion of Adult Male AIDS Cases, by Race/Ethnicity, and Year of Report, 2004-2013, Florida

Note: For most of the past 10 years, black males accounted for nearly 50% of all AIDS cases among men. Over the past ten years, the proportion of adult male AIDS cases decreased among whites (2 percentage points) and blacks (1 percentage point), yet increased among Hispanics (4 percentage points). From 2004 to 2013, the proportion of adult male AIDS cases remained fairly level among the other race/ethnicity group.*Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.

Black

WhiteHispanic

Other*

Pro

po

rtio

n o

f C

ases

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

10

20

30

40

50

60

70

80

Year of Report

Proportion of Adult Female AIDS Cases, by Race/Ethnicity, and Year of Report, 2004–2013, Florida

Note: AIDS case disparities are more evident among women than men. From 2004 to 2013, black women represented 70% or more of the female AIDS cases for most of the years. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.

Black

White

Hispanic

Other*

AIDSN=32,052

2011 U.S.Population Data

N=311,587,816

HIV**N=49,273

Total HIV and AIDS Cases Diagnosed in 2011 and Population, by Race/Ethnicity, United States*

Note: In 2011, blacks are over-represented among the HIV and AIDS cases, accounting for 47% of HIV cases and 50% of AIDS cases, but only 13% of the population. Similarly, Hispanics represent 17% of the population and account for 21% of the HIV cases and 20% of the AIDS cases. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. *Source: U.S. data, CDC HIV surveillance report, Vol. 23, Tables 1a & 2a, 2012 data not available, **HIV infection data are estimated reports from all 50 states with confidential name-based HIV infection reporting.***Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races.

28%

47%

21%

4%

26%

50%

20%

4%

63%

13%

17%

7%

White Black Hispanic Other*

AIDSN=3,279

2013 Florida* Population Estimates

N=16,344,612

HIVN=5,916

Note: Blacks comprise only 15% of the adult population in Florida, but represent 43% of adult HIV infection cases and 51% of adult AIDS cases reported in 2013. Hispanics comprise 22% of Florida’s adult population, yet account for 26% of the HIV infection cases and 21% of the AIDS cases.*Source: Population estimates are provided by Florida CHARTS as of 02/05/2014.**Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races.

Adult HIV Infection and AIDS Cases Reported in 2013 and Population,

by Race/Ethnicity, Florida

30%

43%

26%

2%

26%

51%

21%

2%

59%

14%

22%

4%


Note: In this snapshot of 2013, HIV cases by race/ethnicity among males is more evenly split compared to HIV cases among females where blacks are over-represented, accounting for 66% of adult cases among women. *Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races

Adult HIV Infection Cases, by Sex and Race/Ethnicity,

Reported in 2013, FloridaMales

N=4,542FemalesN=1,374

34%

36%

29%2%

17%

66%

16% 1%


Adult AIDS Cases, by Sex and Race/Ethnicity,

Reported in 2013, Florida

MalesN=2,336

FemalesN=943

Note: In this snapshot of 2013, blacks are over-represented among the AIDS cases, accounting for 44% of adult cases among men and 69% of the adult cases among women. *Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races

30%

44%

24%2%

14%

69%

14% 3%


THE FORMULA USED FOR CALCULATING THE RATE

IS:

– A specific example, using Florida AIDS data:

Number of AIDS Cases Reported in 1996 X 100,000 = 7,300 X 100,000 Estimated Population of Florida in 1996 14,000,000

= 52.1 per 100,000 population(This is the same rate as 5.21 per 10,000 population or 0.521 per 1,000 or0.0521 percent.)

Rates allow direct comparison of the burden of disease on various communities, by taking the population size into account.

RATE = Number of cases in a specified time X 100,000Population at that time

HIV Infection and AIDS Cases and Rates*

Among Adult Males by Race/EthnicityReported in 2013, Florida

AIDS rate ratios: Black-to-White – 6.1:1 Hispanic-to-White – 2.1:1

HIV AIDSRace/Ethnicity Cases Rate Cases RateWhite 1,537 32.6 706 15.0Black 1,629 145.0 1,024 91.2Hispanic 1,297 72.4 562 31.4Other 79 26.3 44 14.6

Total 4,542 57.3 2,336 29.5

HIV rate ratios: Black-to-White – 4.4:1 Hispanic-to-White – 2.2:1

*Source: Population estimates are provided by Florida CHARTS as of 02/05/2014.

AIDS rate ratios: Black-to-White – 19.4:1 Hispanic-to-White – 2.6:1

HIV AIDSRace/Ethnicity Cases Rate Cases RateWhite 231 4.7 132 2.7Black 901 72.3 654 52.5Hispanic 224 12.1 132 7.1Other 18 5.2 25 7.2

Total 1,374 16.3 943 11.2

HIV rate ratios: Black-to-White – 15.4:1 Hispanic-to-White – 2.6:1

HIV Infection and AIDS Cases and Rates* Among Adult Females by Race/Ethnicity


*Source: Population estimates are provided by Florida CHARTS as of 02/05/2014.

Note: Similar to AIDS, black men and, to an even greater extent, black women are over-represented in the HIV epidemic. The HIV case rate for 2013 is nearly 5 times higher among black men than the rate among white men. Among black women, the HIV case rate is 15-fold greater than the rate among white women. Hispanic male and female HIV case rate is higher than the rate among their white counterparts. *Source: Population estimates are provided by Florida CHARTS as of 02/05/2014.

Adult HIV Infection Case Rates* by Sex and Race/Ethnicity, Reported in 2013, Florida

Rate Ratios:MALES Black:White, 4.4:1 Hispanic:White, 2.2:1

FEMALES Black:White, 15.4:1 Hispanic:White, 2.6:1

Male Female0

20

40

60

80

100

120

140

160

32.6

4.7

145

72.372.4

12.1

White Black Hispanic

Rat

e p

er 1

00,0

00

Adult AIDS Case Rates* by Sex and Race/Ethnicity, Reported in 2013, Florida

Note: Black men are over-represented in the HIV epidemic. In 2013, the AIDS case rate among black males is 6 times higher than the rate among white males. Among black females, the AIDS case rate is 19-fold greater than the rate among white females. Both Hispanic male and female case rate is higher than the rate among their white counterparts. *Source: Population estimates are provided by Florida CHARTS as of 02/05/2014.

Rate Ratios: MALES Black:White, 6.1:1 Hispanic:White, 2.1:1

FEMALES Black:White, 19.4:1 Hispanic:White, 2.7:1

Male Female0

10

20

30

40

50

60

70

80

90

100

15

2.7

91.2

52.5

31.4

7.1

White Black Hispanic

Rat

e p

er 1

00,0

00

*Source: CDC HIV surveillance report, Vol. 23, Tables 1a & 2a, 2012 data not available.**HIV cases are for all 50 states with confidential HIV reporting.Note: All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting.

Adult Cases, by Age Group at Diagnosis, Diagnosed in 2011, United States*

AIDSN=32,037

HIV Infection**N=49,081

13-19 20-29 30-39 40-49 50+0

5

10

15

20

25

30

35

5

32

23 23

17

Pe

rce

nt

of

Ca

se

s

13-19 20-29 30-39 40-49 50+0

5

10

15

20

25

30

35

2

18

25

31

24

Pe

rce

nt

of

Ca

se

s

Note: HIV cases tend to be younger than AIDS cases. The greatest proportion of HIV infection cases reported in 2013 were among those aged 20-29 (26%), followed by those aged 40-49 (25%). Conversely, the largest proportion of AIDS cases reported in 2013 was among persons aged 40-49 (30%), followed by those in the 50 and older age group with 29%.

Age Distribution of Adult HIV Infection CasesCompared with the Age Distribution of

Adult AIDS Cases, Reported in 2013, Florida

AIDSN=3,279


13-19 20-29 30-39 40-49 50+0

5

10

15

20

25

30

35

3

2623

2523

Pe

rce

nt

of

Ca

se

s

13-19 20-29 30-39 40-49 50+0

5

10

15

20

25

30

35

1

15

24

30 29

Pe

rce

nt

of

Ca

se

s

Note: HIV cases tend to reflect more recent transmission than AIDS cases, and thus present a more current picture of the epidemic. With regard to the age group with the highest percent of HIV infection cases, recent estimates show that among males, 28% of HIV infection cases occur among those in the 20-29 age group, whereas among females, 27% of HIV infection cases occur among those in the 50 and older age group.

Adult HIV Infection Cases, by Sex and Age Group at Diagnosis, Reported in 2013, Florida

MalesN=4,542

FemalesN=1,374

13-19 20-29 30-39 40-49 50+0

5

10

15

20

25

30

3

28

23 2422

Pe

rce

nt

of

Ca

se

s

13-19 20-29 30-39 40-49 50+0

5

10

15

20

25

30

4

20

23

26 27

Pe

rce

nt

of

Ca

se

s

Note: In 2012, recent estimates show that among males, 30% of HIV infection cases occur among those aged 40-49 and 50+ (respectively for both), whereas among females, 30% of HIV Infection Cases occur among those in the 50+ age group.

Adult AIDS Cases, by Sex and Age Group at Diagnosis, Reported in 2013, Florida

MalesN=2,336

FemalesN=943

13-19 20-29 30-39 40-49 50+0

5

10

15

20

25

30

35

1

17

24

29 29

Pe

rce

nt

of

Ca

se

s

13-19 20-29 30-39 40-49 50+0

5

10

15

20

25

30

35

1

11

25

33

29

Pe

rce

nt

of

Ca

se

s

Over the past ten years, the proportion of newly reported adult HIV cases has shown increases for both the 20-29 (7 percentage points) and 50+ (7 percentage points) age groups. In contrast, the proportion of newly reported adult HIV cases among those in the 30-39 and 40-49 age groups decreased by 10 and 4 percentage points respectively, over the same time period.

Adult HIV Infection Cases, by Age Group at Diagnosis, and Year of Report, 2004–2013, Florida

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

5

10

15

20

25

30

35

13-19 20-29 30-39 40-49 50 +

Year of Report

Pro

po

rtio

n o

f C

ases

Adult AIDS Cases, by Age Group at Diagnosis, and Year of Report, 2004–2013, Florida

Over the past ten years, the proportion of newly reported cases has shown increases for both the 20-29 and 50+ age groups. The 20-29 age group increased by 4 percentage points and the 50+ age group increased by 8 percentage points over the past ten years. In contrast, the 30-39 age group decreased by 8 percentage points and the 40-49 age group decreased by 5 percentage points over the past ten years. The 13-19 age group remained relatively level throughout the years.

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

5

10

15

20

25

30

35

40

13-19 20-29 30-39 40-49 50 +

Year of Report

Pro

po

rtio

n o

f C

ases

Definitions of Mode of Exposure Categories

MSM = Men who have sex with men

IDU = Injection Drug Use

MSM/IDU = Men who have sex with men & Injection Drug Use

Heterosexual = Heterosexual contact with person with HIV/AIDS or known HIV risk

OTHER = includes hemophilia, transfusion, perinatal and other pediatric risks and other confirmed risks.

NIR = Cases reported with No Identified Risk

Redistribution of NIRs = This illustrates the effect of statistically assigning (redistributing) the NIRs to recognized exposure (risk) categories by applying the proportions of historically reclassified NIRs to the unresolved NIRs.

U.S. (2011)N=49,081

Florida (2013)N=5,916

Adult HIV Infection Cases by Mode of Exposure,Reported in the United States* and Florida

Note: NIRs redistributed. Similar to the AIDS data, the estimated proportion of reported MSM cases for the US is higher than that of Florida (62% vs. 59% respectively). Also, the proportion of IDU cases are higher in the U.S. (8% vs. 5%) and heterosexual cases are lower (27% vs. 34%) when compared to HIV Infection cases reported in Florida. *Source: US data, CDC HIV surveillance report, Vol. 23, Table 1a, (from all 50 states) 2012 data not available.

62%

7%

3%

27%

<1% MSM

IDU

MSM/IDU

Heterosexual

Other59%

5%

2%

34%

<1%

U.S. (2011)N=32,037

Florida (2013)N=3,279

Adult AIDS Cases by Mode of Exposure,Reported in the United States* and Florida

Note: NIRs redistributed. The proportion of MSM cases for the US is much higher than that of Florida (52% vs. 45% respectively). Additionally, the proportion of IDU cases are higher in the US (12% vs. 8%). The proportion of heterosexual cases are much lower for the US than that of Florida (31% vs. 43%). *Source: US data, CDC HIV surveillance report, Vol. 23, Table 2a, from all 50 states, 2012 data not available.

52%

12%

4%

30%1% MSM

IDU

MSM/IDU

Heterosexual

Other45%

8%

3%

43%

1%

45%

8%

3%

43%

1%

AIDSN=3,27

9


Adult HIV Infection and AIDS Cases, by Mode of Exposure,


Note: NIRs redistributed. In 2013, men who have sex with men (MSM) exposure (59%) was the highest risk for newly reported HIV cases followed by heterosexual sex (34%). Similarly, MSM exposure (45%) was the highest risk for newly reported AIDS cases, followed by heterosexual sex (43%). The higher proportion of MSM among HIV cases compared to AIDS cases, is indicative of a possible resurgence of HIV among MSM, as HIV cases represent a more recent picture of the epidemic.

59%

5%

2%

34%

0% MSM

IDU

MSM/IDU

Heterosexual

Other

Note: NIRs redistributed. For HIV infection and AIDS cases in men reported in 2013, men who have sex with men (MSM) was the most common risk factor (77% and 64% respectively) followed by cases with a heterosexual risk (17% for HIV and 26% for AIDS). HIV cases tend to represent a more recent picture of the epidemic.

AIDSN=2,336

HIV Infection N=4,542

Adult Male HIV Infection and AIDS Cases, by Mode of Exposure,


77%

4% 2% 16%

<1%

MSM

IDU

MSM/IDU

Heterosexual

Other

64%

7%

4%

26%<1%

12%

87%

1%

Note: NIRs redistributed. Among the female HIV and AIDS cases reported for 2013, heterosexual contact was the highest risk (91% and 87% respectively).

AIDSN=943


Adult Female HIV Infection and AIDS Cases, by Mode of Exposure,


8%

91%

1%

IDUHeterosexualOther

Note: NIRs redistributed. Men who have sex with men (MSM) remains as the primary mode of exposure among male HIV cases in Florida, followed by heterosexual contact.

Adult Male HIV Infection Cases, by Mode of Exposure and

Year of Report, 2004–2013, Florida

04 05 06 07 08 09 10 11 12 130

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

MSM IDU MSM/IDU Heterosexual

Year of Report

Cas

es

Note: NIRs redistributed. The heterosexual risk continues to be the dominant mode of exposure among females.

Adult Female HIV Infection Cases, by Mode of Exposure and


04 05 06 07 08 09 10 11 12 130

500

1,000

1,500

2,000

2,500IDU Heterosexual

Year of Report

Cas

es

Note: NIRs redistributed. Men who have sex with men (MSM) remains as the primary mode of exposure among male HIV cases in Florida, followed by heterosexual contact.

Adult Male AIDS Cases, by Mode of Exposure and


04 05 06 07 08 09 10 11 12 130

500

1,000

1,500

2,000

2,500

MSM IDU MSM/IDU Heterosexual

Year of Report

Cas

es

Note: NIRs redistributed. The heterosexual risk continues to be the dominant mode of exposure among females with AIDS.

Adult Female AIDS Cases, by Mode of Exposure and


04 05 06 07 08 09 10 11 12 130

200

400

600

800

1,000

1,200

1,400

IDU Heterosexual

Year of Report

Cas

es

85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 130

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%No. Tested % Positive

Year of HIV Test

No.

Tes

ted

% P

ositi

ve

HIV Tests Conducted in Florida and Seropositivity Rates*, 1986-2013

*Seropositivity rates are defined as the percent of positive over the number of tests conducted each year.

AIDS-Defining Conditions* Most Commonly Reported Among Adults,


AIDS Defining Condition # Cases % Cases

No Disease (Immune suppressed only)** 2,764 86%

Pneumocystis carinii pneumonia 148 5%

Wasting Syndrome 69 2%

Candidiasis, esophageal 128 4%

Toxoplasmosis of brain 28 1%

Pneumonia, recurrent 15 0%

Pulmonary Tuberculosis 28 1%

Herpes simplex virus 15 0%

HIV encephalopathy 15 0%

Kaposi's sarcoma 18 1%

Lymphomas (brain, Burkitt's or immunoblastic) 15 0%

Cytomegalovirus (CMV) disease 15 0%

Candidiasis, lung 8 0%

Cryptococcosis, extrapulmonary 8 0%

Total Cases 3,226

*Note: data are NOT mutually exclusive, many cases have more than one disease.**Immune suppressed: CD4 count <200ul or CD4 percent <14%.

Impact of STDs on HIV Infection

Early detection and treatment of Sexually Transmitted Diseases (STDs) has a major impact on sexual transmission of HIV.

Much of heterosexually transmitted HIV infections can be prevented by reducing other underlying STDs.

STDs increase HIV infectivity and susceptibility.

Chlamydia Cases, by Sex and Race/Ethnicity,Reported in 2013, Florida

MalesN=23,518

FemalesN=56,783

Note: 26% of these cases are among adolescents, ages 13-19.*Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races.

22%

42%

11%

25%

WhiteBlackHispanicOther

25%

38%

11%

26%

Gonorrhea Cases, by Sex and Race/Ethnicity, Reported in 2013, Florida

MalesN=11,178

FemalesN=9,712


19%

53%

10%

19%WhiteBlackHispanicOther

22%

55%

6% 17%

Primary and Secondary Syphilis Cases,by Sex and Race/Ethnicity,Reported in 2013, Florida

MalesN=1,383

FemalesN=133


33%

33%

27% 8% White

BlackHispanicOther 14%

71%

5%11%

Chlamydia*, Gonorrhea, Syphilis** and HIV Rates, Reported 1989-2013, Florida

* Note: Chlamydia data available starting 1994.** Note: Syphilis data include both Primary and Secondary Syphilis. Source: Data from 1988 to 2012 have been validated using Florida CHARTS as of 4/18/2014. FloridaCHARTS.com is provided by the Florida Department of Health, Division of Public Health Statistics and Performance Management. 2013 data is provisional as of 4/15/2014.

89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 130

100

200

300

400

500

600Chlamyda Gonorrhea Syphilis HIV

Year of Report

Rat

e p

er 1

00,0

00

Chlamydia, Gonorrhea, Syphilis* and HIV Cases, Reported 2004-2013, Florida

* Note: Syphilis data include both Primary and Secondary Syphilis. Source: STD data validated through Florida CHARTS as of 4/18/2014. FloridaCHARTS.com is provided by the Florida Department of Health, Division of Public Health Statistics and Performance Management. 2013 data is provisional as of 4/15/2014.

04 05 06 07 08 09 10 11 12 130

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000Chlamyda Gonorrhea Syphilis HIV

Year of Report

Cas

es

Florida’s Top-9 Priority Populations in 2013for Primary and Secondary HIV Prevention

Based on HIV Infection Cases, Reported 2011-2013

1. Black Heterosexual men and women2. White Men who have sex with Men3. Black Men who have sex with Men4. Hispanic Men who have sex with Men5. Hispanic Heterosexual men and women6. White Heterosexual men and women7. Black Injection Drug User 8. White Injection Drug User9. Hispanic Injection Drug User

Note: Florida’s top-9 priorities have remained the same since 2010.

“The reason for collecting, analyzing and

disseminating information on a disease is to control that disease. Collection

and analysis should not be allowed to consume

resources if action does not follow.”

--Foege WH et al. Int. J of Epidemiology 1976; 5:29-37

For Florida HIV/AIDS Surveillance DataContact: (850) 245-4444

Lorene Maddox, MPH Ext. 2613 Tracina Bush, BSW Ext. 2612 Madgene Moise, MPH Ext. 2373

Visit Florida’s internet site for:Monthly Surveillance Reports

Slide Sets and Fact SheetsAnnual Reports and Epi Profiles

http://www.doh.state.fl.us/disease_ctrl/aids/trends/trends.html

Visit CDC’s HIV/AIDS internet site for:Surveillance Reports, fact sheets and slide sets

http://www.cdc.gov/hiv/topics/surveillance/resources/reports/index.htm

Documents

Epidemiology of HIV Infection Trends in Florida Reported through 2013