Houston/Harris Houston/Harris County County HIV EpidemiologyHIV Epidemiology

Bureau of HIV/STD and Viral Hepatitis PreventionJune 2013

Epidemiology- the study of the distribution (who, what, where, when) and determinants (why, how) of health-related states in specified populations Use epidemiology to control health problems Epidemiology is the basic science of public health. It is a

quantitative discipline based on principles of statistics and research methodologies.

Epidemiology deals with groups of people rather than individuals. Health-related states are NOT randomly distributed in

human populations

Definition of epidemiology

Uses of Epidemiology

Identify the cause of disease and the factors that increase a person’s risk for disease

To control health problems and the spread of disease Planning and targeting prevention efforts Monitoring and evaluating interventions

Establish baseline data Was the intervention effective?

Research Aim: describe, explain, predict, and control

Understanding and formulating new policy National HIV/AIDS Strategy and focus on reducing HIV-related health disparities

Funding decisions What is the burden of disease in a community?

Nationwide HIV Overview

More than 1.1 million people are living with HIV in the US.

18% of HIV positive persons are unaware of their status.

Over 18,000 people diagnosed with AIDS die each year. At the end of 2009, over 641,000 people with AIDS

have died since the epidemic began.

Source: CDC

Source: CDC

New Diagnoses by Sub-Population

From 2008-2010:•Decrease in new infections among black women•Continuing increase in new infections among young MSM

HIV Incidence Surveillance Incidence has remained stable

since mid-1990s. In 2010, estimated 47,500 new

infections nationwide Impact most severe among

young, black and Hispanic MSM, white MSM in 30s and 40s, and black women.

HIV incidence surveillance began in 2005 to provide population-based estimates of the number of new HIV infections per year.

Uses new methodology to determine recent from long-standing infections.

Source: CDC

Houston/Harris County Overview Houston/Harris County

City of Houston most populous city in Texas and fourth most populous in US Least densely populated major metro area Most racially and ethnically diverse major

metro area Combined Population= 4,111,503 Harris Co.= 1,703 sq. miles

Est. 2013 Population= 4,343,023 HDHHS Jurisdiction for surveillance and

partner services is Houston/Harris County The Houston-Sugar Land-Baytown MSA is

a Census-defined area consisting of 10 counties Population= 5,946,800

Sources: Census 2010, Kinder Institute 2012 , Texas DSHS Population Projections 2012

Jurisdictional Areas

2013 Epi Profile: page 9

2013 Houston Area Integrated Epidemiological Profile for

HIV/AIDS Prevention and Care Services Planning Houston Area Characteristics

Employment Household Income Poverty Educational Attainment Health Insurance Foreign-Born and Linguistic Isolation Fertility and Mortality Rates Selected Causes of Death Disability

Nationwide County Comparison

Chlamydia: Harris Co. ranked 3rd in cases Gonorrhea: Harris Co. ranked 5th in cases P&S Syphilis: Harris Co. ranked 8th in

cases

HIV: Houston Metropolitan ranked 12th in rate of new HIV diagnoses

AIDS: Houston ranks 12th in rate of AIDS diagnoses

Source: CDC Surveillance Reports (HIV: 2010, STD: 2011)

Almost 70,000 people are living with HIV in Texas.

Over 20,000 people are living with HIV in Houston/Harris County.

Houston/Harris Co. HIV Diagnoses, 1999- 2011

Source: eHARS- HDHHS

New HIV Diagnoses by Sex

0

10

20

30

40

50

60

70

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year of Diagnosis

Rat

e p

er 1

00,0

00

Houston/Harris Co: Male Houston/Harris Co: Female Houston/Harris Co: Total

Jan

’99

: H

IV r

ep

ort

ab

le b

y n

am

e in

TX

Growing Gap between Deaths and Number of PLWH

2013 Houston Area Integrated Epidemiological Profile for

HIV/AIDS Prevention and Care Services Planning HIV/AIDS in the Houston Area

HIV Incidence New Diagnoses of HIV Persons Living with HIV (PLWH) Mapping of New Diagnoses and PLWH Deaths of PLWH New Diagnoses, Prevalence, and Mortality: Five-Year

Trends

Houston/Harris Co. HIV Diagnoses, 2011HIV by Risk

Source: eHARS- HDHHS, unknown risk re-distributed using the CDC’s multiple imputation technique

60.8%

5.3%

2.0%

31.2%

0.8%

MSM

IDU

MSM/IDU

Heterosexual

Perinatal/Other

When examining risk by sex,

MSM accounted for 79.5% of transmission risk in males

Houston/Harris Co. HIV Diagnoses, 2011HIV Rates by Age

Source: eHARS- HDHHS

0.923.7

78.758.1

41.340.7

43.145.4

27.426.3

9.7

0 20 40 60 80 100

0-14 yrs15 - 19 yrs20 - 24 yrs25 - 29 yrs30 - 34 yrs35 - 39 yrs40 - 44 yrs45 - 49 yrs50 - 55 yrs55 - 59 yrs

60+ yrs

Rate per 100,000

Chlamydia and Gonorrhea — Age- and sex-specific rates Houston/Harris County, 2011

Chlamydia rates do not include the following: n=2 missing sex, n=24 missing age

Gonorrhea rates do not include the following: n=3 missing sex, n=6 missing ageSource: HDHHS

Male Rate (per 100,000)

2.25

386.51

565.97

252.32

113.35

79.39

42.39

02004006008001,000

Female Rate (per 100,000)

8.38

940.06

844.23

249.34

96.66

36.65

11.67

0 200 400 600 800 1,000

Under 15 years

15-19 years

20-24 years

25-29 years

30-34 years

35-39 years

40+ years

Male Rate (per 100,000)

2.25

386.51

565.97

252.32

113.35

79.39

42.39

02004006008001,000

Female Rate (per 100,000)

8.38

940.06

844.23

249.34

96.66

36.65

11.67

0 200 400 600 800 1,000

Under 15 years

15-19 years

20-24 years

25-29 years

30-34 years

35-39 years

40+ years

Female Rate (per 100,000)

50.69

1,552.39

529.46

232.30

52.46

4,650.25

4,682.43

0 1,000 2,000 3,000 4,000 5,000

Under 15 years

15-19 years

20-24 years

25-29 years

30-34 years

35-39 years

40+ years

Male Rate (per 100,000)

5.93

792.60

1,064.55

478.91

204.61

102.72

45.88

01,0002,0003,0004,0005,000

Female Rate (per 100,000)

50.69

1,552.39

529.46

232.30

52.46

4,650.25

4,682.43

0 1,000 2,000 3,000 4,000 5,000

Under 15 years

15-19 years

20-24 years

25-29 years

30-34 years

35-39 years

40+ years

Male Rate (per 100,000)

5.93

792.60

1,064.55

478.91

204.61

102.72

45.88

01,0002,0003,0004,0005,000

Chlamydia

Gonorrhea

Source: eHARS- HDHHS, unknown risk re-distributed using the CDC’s multiple imputation technique

What is the population of MSM in Houston/Harris County?

Source: eHARS- HDHHS, unknown risk re-distributed using the CDC’s multiple imputation technique

HIV Diagnoses — Rates by race/ethnicity Houston/Harris

County, 1999–2011

0

20

40

60

80

100

120

140

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year of Diagnosis

Ra

te p

er

10

0,0

00

Hispanic Black/African-Amer. White Other

Source: eHARS- HDHHS

Nationally: 1 in 16 black men will be diagnosed with HIV at some point in his lifetime

Total Population vs. HIV-Infected

STD Rates by race/ethnicity, Houston/Harris Co.

Syphilis (P&S)

Chlamydia Gonorrhea

Source: STD*MIS- HDHHS

Contributing Factors to HIV/STD Disparities

Higher prevalence in community Houston: highest rate of PLWHA in

TX Stigma and/or discrimination

Houston: larger % of foreign-born and language other than English at home vs. TX overall

Access to quality medical care and testing→ Delayed diagnosis and treatment Houston: higher % of uninsured

than TX overall Social determinants of health

Houston: median household income ~$7000 lower than TX median

Houston: lower % of high school graduates than TX overall

HIV Prevalence Rate, by Income

“STD disparities reflect socioeconomic disparities, which in turn reflect deep-rooted racial inequalities” (CDC, 2007)

Individual sexual risk behavior does not account for the observed racial disparities in STDs (CDC, 2007)

Source: Houston Area Comprehensive Plan, Graph: CDC, NHBS-HET-1 2006−2007

HIV Co-Morbidity

Why focus on STDs? STDs can cause infertility, chronic pelvic pain, damage of internal

organs, cancer, paralysis, sores and lesions, blindness, dementia, and/or death.

Those infected with STDs are 2-5 times more likely to acquire HIV if exposed.

If a person living with HIV/AIDS is infected with another STD, transmission of HIV to another person via sexual contact is more likely.

HIV Co-Morbidity in Houston/Harris Co. From January- December 2012, 39.0% of all interviewed primary

and secondary syphilis cases were also HIV positive. This is an increase in co-morbidity as 31.2% of cases were HIV positive in 2011.

From January- December 2012, 58.1% of all interviewed primary and secondary syphilis cases among MSM were also HIV positive. This is an increase in co-morbidity as 52.1% of cases were HIV positive.

Source: STD*MIS- HDHHS

Source: STD*MIS- HDHHS

Source: STD*MIS- HDHHS

2013 Houston Area Integrated Epidemiological Profile for

HIV/AIDS Prevention and Care Services Planning Risk for HIV/AIDS in the Houston Area

HIV Testing and Awareness of Status Chlamydia Trends Gonorrhea Trends Infectious Syphilis Trends

HIV Service Utilization Linkage to Care Met Need Treatment Cascade

Profile of Out-of-Care Special Topics

Priority Populations Co-Infection

Acknowledgements

HIV/STD Surveillance Team and Bureau of Epidemiology, HDHHS

Monica Slentz, Community Health Planning, Evaluation & Research, HDHHS

Bureau of HIV/STD and Viral Hepatitis Prevention, HDHHS

Ryan White Grants Administration and Ryan White Planning Council’s Office of Support for Houston EMA

Houston HIV Community Planning Group (CPG) and Ryan White Planning Council (RWPC)

TB/HIV/STD Epidemiology and Surveillance, Texas Dept. of State Health Services