Wisconsin HIV/AIDS Surveillance Annual Review: Slide Set New diagnoses, prevalent cases, and deaths through December 2014 April 2015 P-00484 Wisconsin

Wisconsin HIV/AIDS Surveillance Annual Review: Slide SetNew diagnoses, prevalent cases, and deaths through

December 2014

April 2015

P-00484

Wisconsin Department of Health Services

Objectives

• Explain basic data concepts used in epidemiology

• Describe current Wisconsin HIV/AIDS surveillance data



Data concepts

• HIV prevalence or prevalent cases– Number of people living with HIV at a given time

• New HIV diagnoses– When a case is first detected and reported

• HIV incidence– When the infection is acquired


Data concepts

• Adjusted or imputed risk– Some individuals are reported without a known

risk exposure– Data are adjusted to account for cases with

unknown risk through imputation• Known risks of individuals with similar characteristics

are applied to those with unknown risk• Imputed risk exposures are estimates, not actual case

counts


Data concepts

• Adjusted or imputed risk: example– If 11 Black women, ages 45-64, were diagnosed

with HIV with the following risk exposure, the individual with unknown risk would be assigned “proportions of likely risk”


Data concepts

• Rates per 100,000 population– Rates used when comparing

the impact of HIV across two or more groups

– When underlying population sizes of groups are different, numbers alone may give the wrong impression

– Rate shows what impact of HIV would be if the population sizes were identical


Black White0

102030405060708090

10084

95

HIV Diagnosis Numbers

Num

ber

of C

ases

Black White0

1020304050607080

67

6

HIV Diagnosis Rate

Rate

per

100

,000

pop

ulati

on

Data concepts

• Rate ratios– Method for quantifying

the difference in impact of HIV across populations

– Each population is compared to a reference group

– Black males vs. White males: 66/6=11-fold higher


Male0

10

20

30

40

50

60

70

80

66

25

86

2

HIV Diagnosis Rate

Black

Hispanic

Asian

White

American Indian

Rate

per

100

,000

pop

ulati

on

Data concepts

• Statistical significance– Used to determine whether a change is likely due to

random fluctuation or a real difference


HIV diagnosis rate, Wisconsin, 2005-2014

2005 2006 2007 2008 2009 2010 2011 2012 2013 201402468

1012141618

HIV diagnosis rate

Rate

per

100

,000

pop

ulati

on


Flow of individuals with HIV in and out of Wisconsin



Total cases


1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

0

100

200

300

400

500

600

Year of Diagnosis

Num

ber o

f HIV

Dia

gnos

es

Three-year rolling average of the number of new HIV diagnoses, Wisconsin, 1984 - 2014

Total cases


Number and rate of new HIV diagnoses, Wisconsin, 2005-2014

2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

50

100

150

200

250

300

0.0

1.0

2.0

3.0

4.0

5.0

6.0

254 250276

239

285

251 246224

256

2264.6 4.5

4.9

4.2

5.0

4.4 4.33.9

4.53.9

Number Rate

Year of Diagnosis

Num

ber o

f Dia

gnos

es

Rate

per

100

,000

Pop

ulati

on

HIV diagnosis rates across the U.S.


MD GA NJ TX NV IL US CA AR AL OK PA CT M

I IN NM COM

N KSW

V NE ALND W

Y VT ID0

5

10

15

20

25

30

35

40

16.2 15

8.2 7.75.9

4.6 4.1

State of Residence at Diagnosis

Rate

per

100

,000

Pop

ulati

on

HIV diagnosis rate by state, 2013

CDC HIV Surveillance Report, 2013, V25, Table 18.

Cases by sex


Percent distribution of new HIV diagnoses by sex, Wisconsin, 2014

Males85%

Females15%

Cases by sex


HIV diagnosis rate by sex, Wisconsin, 2005-2014

2005 2006 2007 2008 2009 2010 2011 2012 2013 20140.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

2.3

1.2

6.9 6.7

Female Male

Year of Diagnosis

Rate

per

100

,000

Pop

ulati

on

Cases by sex and age


Percent distributions of new HIV diagnoses by age at diagnosis and sex, Wisconsin, 2014

<515-1920-2425-2930-3435-3940-4445-4950-5455-59

60+

-30% -20% -10% 0% 10% 20% 30%

3%

24%12%

12%

9%21%

18%3%

5%24%

17%13%

11%9%

6%10%

2%4% Male (n=192)

Female (n=34)

Percent of New Diagnoses

Age

at D

iagn

osis

(Yea

rs)

Cases by sex and age


HIV diagnosis rate by sex and age, Wisconsin, 2005-2014

2005 2006 2007 2008 2009 2010 2011 2012 2013 20140.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

9.2

15.3

10.18.3

3.32.13.3

1.7

Year of Diagnosis

Rate

per

100

,000

Pop

ulati

on Male 13-29

Male 30-59

Female 13-29Female 30-59

HIV among transgender individuals


Black Hispanic White Asian Multi-racial

0

2

4

6

8

10

12

14

10

42

1

2

4

1

1

Ages 30-59 Ages 13-29

Race/Ethnicity

Num

ber o

f Dia

gnos

es

Number of HIV diagnoses among transgender individuals by race/ethnicity and age, Wisconsin, 2005-2014

Race/ethnicity


19821984

19861988

19901992

19941996

19982000

20022004

20062008

20102012

20140%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

33%

67%

% White % Non-White

Year of Diagnosis

Perc

ent

Multi-racialAsian

American Indian

Hispanic

Black

White

Percentage of new HIV diagnoses among Whites and persons of color, Wisconsin, 1982-2014

2014 diagnoses (n=226)

Sex and race/ethnicity: rates


Male Female0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0 46.7

10.2

19.5

2.9

11.7

3.6

8.6

2.80.3

Black Hispanic AI/AN Asian White

Sex

Rate

per

100

,000

Pop

ulati

on

HIV diagnosis rate by sex and race/ethnicity, Wisconsin, 2014

Risk exposure


HIV diagnoses by estimated risk exposure group*, Wisconsin, 2005-2014

2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

50

100

150

200

250

MSM (incl. MSM/PWID) High-Risk Heterosexual PWID

Year of Diagnosis

Estim

ated

Num

ber o

f Dia

gnos

es

*Data have been statistically adjusted to account for those with unknown risk.

Risk exposure


Percentage of HIV diagnoses by sex and estimated risk exposure group*, Wisconsin, 2014

Female Male Total0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

74%

5%

15%23%

4% 7%0.0294117647058823

91%

78%

MSM (incl. MSM/PWID) High Risk Heterosexual PWID Other

Perc

ent o

f New

Dia

gnos

es W

ithi

n Ea

ch

Cate

gory

*Data have been statistically adjusted to account for those with unknown risk.

Age at diagnosis by risk


Median age at HIV diagnosis by reported risk exposure, and among MSM by race/ethnicity, Wisconsin, 2014

Total (n=226)

High-Risk Heterosexual (n=14)

PWID (n=6)

MSM (n=140)

Black (n=56)

Hispanic (n=21)

White (n=54)

0 10 20 30 40 50 60

32

43

53

29

25

25

36

Median Age at Diagnosis (Years)*Includes MSM/PWID

MSM*

HIV-exposed infants


Diagnostic status of HIV-exposed infants born in Wisconsin, 1985-201419

8519

8619

8719

8819

8919

9019

9119

9219

9319

9419

9519

9619

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

0920

1020

1120

1220

1320

14

0

5

10

15

20

25

30

35Seroreverter

HIV Infected

Unresolved

Birth Year

Num

ber o

f Bir

ths

Young MSM: race/ethnicity


HIV diagnoses among MSM, ages 13-29, by race/ethnicity, Wisconsin, 2005-2014

2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

10

20

30

40

50

60White Black Hispanic

Year of Diagnosis

Estim

ated

Num

ber o

f Dia

gnos

es

*Data have been statistically adjusted to account for those with unknown risk; includes MSM/PWID.


GeographyNumber of HIV diagnoses by county of residence* at diagnosis, Wisconsin, 2014

Price

Dane

Clark

Polk

Grant

Vilas

Iron

Bayfield

Sawyer

Rusk

Oneida

Marathon

Sauk

Douglas

Forest

Iowa

Dunn

Taylor

Marinette

Rock

Oconto

Wood

Dodge

BarronLincoln

Monroe

Jackson

Ashland

Burnett

Vernon

Juneau

Chippewa

Portage

Shawano

Buffalo

Langlade

Green

Pierce

St Croix

Columbia

Brown

Lafayette

Waushara

Eau Claire

Fond du Lac

Florence

Door

Racine

Adams

Washburn

Waupaca

Richland

Crawford

Jefferson

Walworth

OutagamieTrempealeau

Waukesha

ManitowocWinnebago Calumet

La CrosseMarquette

Sheboygan

Pepin

Washington

Green Lake

Kewaunee

Menominee

Kenosha

Ozaukee

Milwaukee

Number of HIV Diagnoses

1 - 34 - 1125132

*Excludes 3 cases diagnosed in the Department of Corrections

Prevalence: In-migration


Number of newly reported cases of HIV infection moving into Wisconsin, 2005-2014

2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

20

40

60

80

100

120

140

160

180

200

123

173

Year of Report

Num

ber o

f Rep

orte

d Ca

ses

Late testers


Percentage of new HIV diagnoses with concurrent AIDS diagnosis or progressing to AIDS within one year, Wisconsin, 2011-2014

2011 2012 2013 20140%5%

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

28% 30% 29% 25%

7%8%

4%

Progression to AIDS within 1 year (excluding concurrent diagnoses)*Concurrent diagnosis of HIV and AIDS

Year of Diagnosis

Perc

ent o

f Dia

gnos

es

* Those diagnosed with HIV infection during 2014 have not had one full year to evaluate progression to AIDS and therefore this category is excluded in the 2014 bar.

Late testers by demographic group


Percentage of new HIV diagnoses with a concurrent AIDS diagnosis, by demographic group, Wisconsin, 2014

Fem

ale

Mal

e

Whi

te

Blac

k

His

pani

c

MSM

*

PWID

Hig

h Ri

skH

eter

osex

ual

Unk

now

n R

isk

Age

s 13

-29

Age

s 30

an

d O

lder

Ove

rall

0%

5%

10%

15%

20%

25%

30%

35%

40%

Perc

enta

ge o

f New

Dia

gnos

es

*MSM includes MSM/PWID

HIV care continuum


HIV care continuum, 2013 new diagnoses and prevalent cases, ages 13 years and older, Wisconsin

At High Risk for HIV

Living with HIV

Diagnosed and Living with HIV

Linkage within 3 months of

Diagnosis

Care Marker Retained in Care

Suppressed Viral Load

100%83%

64%49% 51%

Estimated

Based on Surveillance Data


Prevalence: In-migration


Number of prevalent cases in Wisconsin who received their initial HIV diagnosis in another state, by top five states of initial HIV diagnosis

Wisconsin diagnoses, 75%

Non-Wisconsin diagnoses, 25%

Unaware of HIV infection: United States


Estimated number unaware of their HIV infection, by demographic group, Wisconsin, 2014

MSMHeterosexual

IDUBy risk exposure

AsianAmerican Indian

Multi-racialHispanic or Latino

BlackWhite

By race/ethnicity

65+55-64 years44-54 years35- 44 years25-34 years13-24 years

By age

Total

0% 10% 20% 30% 40% 50% 60%16%

19%6%

22%19%

14%15%15%

12%

5%7%

8%14%

26%51%

14%

Percent unawareCenters for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2012. HIV Surveillance Supplemental Report 2014;19(no.3). http://www.cdc.gov/hiv/library/reports/surveillance/. Published November 2014. Accessed April 2015.

Wisconsin known prevalence: 6,899

Estimated number of people living with HIV in Wisconsin

who are unaware of their HIV infection: 1,125

http://www.cdc.gov/hiv/library/reports/surveillance/

Unaware of HIV infection: Wisconsin


Estimated percentage of those with HIV who are unaware of their HIV infection, by demographic group, United States, 2012

MSMHeterosexual

IDUBy risk exposure

AsianAmerican Indian

Multi-racialHispanic or Latino

BlackWhite

By race/ethnicity

65+55-64 years44-54 years35- 44 years25-34 years13-24 years

By age

Total

0 200 400 600 800 1000 1200769

23142

201014

153464

432

21100

220238

344279

1125

Number unawareCenters for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2012. HIV Surveillance Supplemental Report 2014;19(no.3). http://www.cdc.gov/hiv/library/reports/surveillance/. Published November 2014. Accessed April 2015.

http://www.cdc.gov/hiv/library/reports/surveillance/

Prevalence: age


Prevalent cases of HIV infection by current age as of December 31, 2014, and cases reported during 2014 by age at diagnosis, Wisconsin

diag_age

<5 05-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+0%

5%

10%

15%

20%

25%

Age at diagnosis for cases diagnosed in 2014 (n=226)Current age, prevalent cases (n=6,899)

Perc

ent o

f pre

vale

nt c

ases

Prevalence: selected demographic groups


Prevalence of HIV in selected demographic groups, age 18 and older, Wisconsin, 2014

MSM Non-MSM males Females0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

29.9%

0.4% 0.5%

8.5%

0.2% 0.2%2.4%

BlackHispanicWhite

Demographic Group

Estim

ated

HIV

Pre

vale

nce

Wit

hin

Dem

ogra

phic

Gro

up

Estimates generated from surveillance data and state-specific estimates of MSM populations in: Lieb S., et al. Statewide estimation of populations of MSM in the United States. Public Health Reports 2011;126(1):60-72 and CDC’s estimate that 16% of MSM are unaware of their HIV infection, and 14% of other populations are unaware of their HIV infection. Imputed risk calculations were also used for individuals with missing risk information.


MSM: race/ethnicityEstimated populations sizes and prevalence of HIV diagnoses among MSM, ages 18 and older, by race/ethnicity, Wisconsin

Estimates generated from surveillance data and state-specific estimates of MSM populations in: Lieb S., et al. Statewide estimation of populations of MSM in the United States. Public Health Reports 2011;126(1):60-72 and CDC’s estimate that 16% of MSM are unaware of their HIV infection. Imputed risk calculations were also used for individuals with missing risk information.

Prevalence: Black sub-populations


Prevalence of HIV in Black sub-populations, Wisconsin, 2014

Prevalence: Black MSM, Wisconsin


Percentage of Black MSM living with HIV in Wisconsin compared to other greatly affected populations globally

Adapted from The Foundation for AIDS Research Issue Brief: “HIV and the Black Community: Do #Black(GAY)lives Matter?, references: Rosenberg 2014, Baral 2013, El Bassel 2013, Baral 2012.

Prevalence: county


Prevalent cases of HIV infection by county, Wisconsin, 2014

Price6

Clark12

Vilas6

Polk14

Iron2

Grant18

Bayfield6

Rusk9

Sawyer32 Oneida

13Forest

3

Taylor2

Douglas37

Dunn14

Sauk28

Iowa13

Marinette18

Oconto8

Wood41

Dodge39

Barron29 Lincoln

6

Ashland8

Burnett14

Jackson2

Monroe17

Vernon8

Juneau11

Chippewa30

Portage30Buffalo

4

Langlade5

Adams13

Green16

Pierce13

Washburn7

Columbia29

Waupaca21

Lafayette2

Richland3

Jefferson30

Waushara14

Calumet12

Shawano7

Crawford8

Trempealeau6

Door16

Manitowoc39

Marquette7 Sheboygan

18

Pepin2

Door16

Washington42

Kewaunee8

Green Lake12

Menominee8

Ozaukee30

Marathon68

St. Croix60

Eau Claire59

Fond du Lac52

Walworth52

Winnebago86

Rock175

Brown246

Outagamie110

Waukesha192

Racine240

La Crosse122

Kenosha241

Dane855

Milwaukee3359

Number of Cases0-50

51-100

101-500

501-1000

1001-3359


Deaths


Number of deaths, by cause of death, among persons ever reported with HIV in Wisconsin, 1982-2012

*503 cases had an unknown cause of death and were not included in this analysis

19821983

19841985

19861987

19881989

19901991

19921993

19941995

19961997

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20120

50

100

150

200

250

300

350

HIV listed as underlying cause of deathHIV not listed as underlying cause of death

Year of death

Num

ber o

f dea

ths

Median age at death, HIV as

underlying cause: 49.5

Deaths


Median age at death by underlying cause of death, among persons ever reported with HIV in Wisconsin, 1982-2012

19821984

19861988

19901992

19941996

19982000

20022004

20062008

20102012

0

10

20

30

40

50

60

Median age, HIV not listed as underlying cause of death

Median age, HIV listed as underlying cause of death

Year of Death

Num

ber o

f Dea

ths

Full reports

• For additional information and methodology, visit our website: https://www.dhs.wisconsin.gov/aids-hiv/data.htm– Statewide report: https://

www.dhs.wisconsin.gov/publications/p0/p00484.pdf

– City of Milwaukee report: https://www.dhs.wisconsin.gov/publications/p0/p00484a.pdf

https://www.dhs.wisconsin.gov/aids-hiv/data.htm

https://www.dhs.wisconsin.gov/aids-hiv/data.htm

https://www.dhs.wisconsin.gov/publications/p0/p00484.pdf

https://www.dhs.wisconsin.gov/publications/p0/p00484.pdf

https://www.dhs.wisconsin.gov/publications/p0/p00484a.pdf



Documents

Wisconsin HIV/AIDS Surveillance Annual Review: Slide Set New diagnoses, prevalent cases, and deaths through December 2014 April 2015 P-00484 Wisconsin