Houston/Harris County HIV Epidemiology

1. Houston/Harris County HIV Epidemiology Bureau of HIV/STD and Viral Hepatitis Prevention June 2013

2. Definition of epidemiology • 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

3. 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?

4. 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

5. New Diagnoses by Sub-Population • From 2008-2010: • Decrease in new infections among black women • Continuing increase in new infections among young MSM Source: CDC

6. 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

7. 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

8. Jurisdictional Areas 2013 Epi Profile: page 9

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

10. 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 12thin rate of new HIV diagnoses AIDS: Houston ranks 12th in rate of AIDS diagnoses Source: CDC Surveillance Reports (HIV: 2010, STD: 2011)

11. Almost 70,000 people are living with HIV in Texas. • Over 20,000 people are living with HIV in Houston/Harris County.

12. Houston/Harris Co. HIV Diagnoses, 1999- 2011 Jan ’99: HIV reportable by name in TX Source: eHARS- HDHHS

13. Growing Gap between Deaths and Number of PLWH

14. 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

15. Houston/Harris Co. HIV Diagnoses, 2011 HIV by Risk • When examining risk by sex, • MSM accounted for 79.5% of transmission risk in males Source: eHARS- HDHHS, unknown risk re-distributed using the CDC’s multiple imputation technique

16. Houston/Harris Co. HIV Diagnoses, 2011 HIV Rates by Age Source: eHARS- HDHHS

17. Chlamydia and Gonorrhea — Age- and sex-specific rates Houston/Harris County, 2011 Chlamydia Gonorrhea 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 age Source: HDHHS

18. What is the population of MSM in Houston/Harris County? Source: eHARS- HDHHS, unknown risk re-distributed using the CDC’s multiple imputation technique

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

20. HIV Diagnoses — Rates by race/ethnicity Houston/Harris County, 1999–2011 • Nationally: • 1 in 16 black men will be diagnosed with HIV at some point in his lifetime Source: eHARS- HDHHS

21. Total Population vs. HIV-Infected

22. STD Rates by race/ethnicity, Houston/Harris Co. Gonorrhea Chlamydia Syphilis (P&S) Source: STD*MIS- HDHHS

25. 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 Contributing Factors to HIV/STD Disparities “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) HIV Prevalence Rate, by Income Source: Houston Area Comprehensive Plan, Graph: CDC, NHBS-HET-1 2006−2007

26. 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

27. Source: STD*MIS- HDHHS

28. Source: STD*MIS- HDHHS

29. 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

30. 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