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April 201 4

Wisconsin Department of Health Services HIV/AIDS Surveillance Annual Review, 2013 Addendum: City of Milwaukee. April 201 4. BACKGROUND AND OVERVIEW OF HIV CASES IN THE CITY OF MILWAUKEE. INTRODUCTION.

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April 201 4

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  1. Wisconsin Department of Health Services HIV/AIDS Surveillance Annual Review, 2013 Addendum: City of Milwaukee April 2014

  2. BACKGROUND AND OVERVIEW OF HIV CASES IN THE CITY OF MILWAUKEE Wisconsin Department of Health Services

  3. INTRODUCTION This document serves as an addendum to the Wisconsin Department of Health Services HIV/AIDS Surveillance Annual Review:New diagnoses, prevalent cases, and deaths through December 31, 2013, available at: http://www.dhs.wisconsin.gov/publications/P0/P00484.pdf This report provides selected HIV surveillance data for the City of Milwaukee. Wisconsin Department of Health Services

  4. OVERVIEW: Figure 1: Estimated HIV diagnosis rates per 100,000 in 2011, selected metro areas in the United States Fort Lauderdale, FL: 54 Washington DC: 38 Chicago, IL, 22 Cities, population >500,000: 20 Milwaukee Area: 10 Wisconsin Department of Health Services Source: CDC HIV Surveillance Report, 2011, V 23, Table 19

  5. OVERVIEW: HIV diagnoses and rates per 100,000, Wisconsin, Milwaukee County, and City of Milwaukee, 2013 • Wisconsin: 255 diagnoses; rate: 4.5 • Milwaukee County: 129 diagnoses (51% of Wisconsin); rate: 13.5 • City of Milwaukee: 111 diagnoses (86% of Milwaukee County); rate: 18.7 Note: Rates per 100,000 provided by CDC in the previous slide and those provided in this slide calculated by the Wisconsin Department of Health Services use different data and cannot be compared. Wisconsin Department of Health Services

  6. NEW HIV DIAGNOSES These include cases of HIV diagnosed in the City of Milwaukee in 2013 Wisconsin Department of Health Services

  7. TOTAL DIAGNOSESFigure 2. Number of HIV diagnoses in the City of Milwaukee and percentage of Wisconsin diagnoses, 2004-2013 Wisconsin Department of Health Services

  8. SEX AND AGE Figure 3. Number of HIV diagnoses by sex and age group, City of Milwaukee, 2004-2013 Males 15-29 Males 30+ Females 30+ Females 15-29 Wisconsin Department of Health Services

  9. TRANSGENDER INDIVIDUALSFigure 4. HIV diagnoses among transgender individuals by race/ethnicity, City of Milwaukee, 2004-2013 Wisconsin Department of Health Services

  10. SEX AND RACE/ETHNICITY: RATESFigure 5. HIV diagnosis rates per 100,000 by sex and race/ethnicity, City of Milwaukee, 2009-2013 Wisconsin Department of Health Services

  11. RISK EXPOSUREFigure 6. Percent of HIV diagnoses by sex and estimated risk exposure group*, City of Milwaukee, 2013 Male (n=90) Female (n=21) Heterosexual 6% Heterosexual, 76% Wisconsin Department of Health Services * Data have been statistically adjusted to account for unknown risk. See technical notes.

  12. RISK EXPOSUREFigure 7. Number of HIV diagnoses by estimated risk exposure group*, City of Milwaukee, 2004-2013 MSM** Heterosexual IDU Wisconsin Department of Health Services * Data have been statistically adjusted to account for unknown risk. See technical notes. ** MSM includes those who have also injected drugs.

  13. AGE AT DIAGNOSIS BY RISKFigure 8: Median age at HIV diagnosis by risk exposure*, and among MSM** by race/ethnicity, City of Milwaukee, 2013 MSM Wisconsin Department of Health Services *Risk exposure categories exclude 30 cases with unknown risk exposure. **MSM includes those who have also injected drugs.

  14. YOUNG MSM: RACE/ETHNICITY Figure 9. Number of HIV diagnoses in MSM* ages 15-29, by race/ethnicity, City of Milwaukee, 2004-2013 Wisconsin Department of Health Services *Data have been statistically adjusted to account for unknown risk. See technical notes. MSM includes those who have also injected drugs.

  15. NEW DIAGNOSES: ZIP CODESFigure 10. HIV diagnoses by zip code, City of Milwaukee, 2011-2013 1 dot = 1 HIV diagnosis Note: Dots are distributed randomly within the zip code of residence at diagnosis and do not reflect actual addresses. Wisconsin Department of Health Services

  16. NEW DIAGNOSES: ZIP CODESFigure 11. HIV diagnoses in Black MSM* under age 30, by zip code, City of Milwaukee, 2011-2013 1 dot** = 1 HIV diagnosis *MSM includes MSM/IDU **Dots are distributed randomly within the zip code of residence at diagnosis and do not reflect actual addresses. Wisconsin Department of Health Services

  17. MILWAUKEE DISPARITYFigure 12. City of Milwaukee’s share of Wisconsin’s HIV diagnoses and population by demographic characteristic, 2013 Wisconsin Department of Health Services Source: American Community Survey 5 year (2008-2012) population estimates

  18. LATE TESTERS Figure 13. Percent of HIV diagnoses with concurrent AIDS diagnosis or progressing to AIDS within one year, City of Milwaukee, 2011-2013 Unknown * Those diagnosed with HIV infection during 2013 have not had one full year to evaluate progression to AIDS and therefore this category is excluded. Wisconsin Department of Health Services

  19. SUMMARYHIV diagnoses in the City of Milwaukee, 2013 • Total • 111 diagnoses in 2013 • Sex and gender • Males, 81% of 2013 diagnoses • 18 diagnoses in transgender individuals, 2004-2013; 14 under age 30 • Race/Ethnicity by sex: • Males: rates in Blacks 4-fold and rates in Hispanics 2-fold greater than Whites • Females: rates in Blacks more than 6-fold and rates in Hispanics 3-fold greater than Whites • Geography • Milwaukee disparity: The City of Milwaukee accounted for 44% of diagnoses in Wisconsin but only 10% of the state’s population. • Late testers • Late testers: About 30% of individuals diagnosed in the City of Milwaukee during 2012 progressed to AIDS within one year of diagnoses, which is slightly lower than the statewide estimate (37%). Wisconsin Department of Health Services

  20. SUMMARYHIV diagnoses in the City of Milwaukee, 2013 • Risk and Race • Adjusted risk • Total: 71% MSM (including MSM/IDU), 19% Heterosexual, and 10% IDU • Males: 87% MSM (including MSM/IDU), 6% Heterosexual, 7% IDU • Females: 76% Heterosexual, 24% IDU • Black MSM: • Accounted for 42% of new diagnoses in the City of Milwaukee in 2013 • Black MSM under age 30: • 82% of diagnoses in MSM under age 30 of all races • Median age at diagnoses is 24, compared to age 33 for all 2013 City of Milwaukee diagnoses • Quadrupled from 2004-2010, then declined modestly • Top 5 zip codes: 53209, 53208, 53216, 53206, 53210 account for >50% of Milwaukee diagnoses among young Black MSM. Wisconsin Department of Health Services

  21. PREVALENT CASES Prevalence is the number of people living with HIV infection at a given point in time Wisconsin Department of Health Services

  22. ESTIMATED PREVALENCE* BY DEMOGRAPHIC GROUPFigure 14. Impact of HIV on selected demographic groups, ages 15-59 years, Wisconsin, as of December 31, 2013 Less than 1.0% * The estimated prevalence is adjusted to account for the CDC’s estimate that 15.8% of HIV-infected persons are unaware of their infection and therefore not reported. The percent of males that are MSM was calculated using published estimates (Lieb, 2011). Wisconsin Department of Health Services

  23. PREVALENCE: ZIP CODESFigure 15. Reported cases of HIV infection presumed to be alive, by zip code, City of Milwaukee, as of December 31, 2013 Number of Cases (n=3,128) 5-49 50-100 101-188 189-281 Wisconsin Department of Health Services

  24. SUMMARYHIV prevalence in the City of Milwaukee as of December 2013 Prevalent cases in the City of Milwaukee 3,128 cases reported and assumed to be living in Milwaukee An additional 600 estimated unaware of HIV infection Estimated HIV prevalence by risk and race in Wisconsin General population: 2 in 1,000 (0.2%) Blacks: 0.4% non-MSM males; 0.6% females MSM: 32% Black; 8% Hispanic; 3% White Geography 46% of Wisconsin’s prevalent HIV cases are in Milwaukee 7 zip codes account for 51% of Milwaukee prevalent cases Wisconsin Department of Health Services

  25. HIV TESTING AND SYPHILIS DATA Wisconsin Department of Health Services

  26. TESTS AND DIAGNOSESFigure 16. HIV tests and new positives from publically-funded counseling and testing sites, number of HIV diagnoses, and syphilis/HIV co-infections, City of Milwaukee, 2009-2013 New positives and diagnoses Publically-funded HIV tests Wisconsin Department of Health Services 2009 tests and positives from test sites data are estimates.

  27. TESTS AND DIAGNOSESFigure 17. HIV tests and new positives from publically-funded counseling and testing sites, number of new HIV diagnoses, and syphilis/HIV co-infections, Black MSM under age 30, City of Milwaukee, 2009-2013 HIV tests City of Milwaukee new HIV diagnoses New positives and diagnoses Publically-funded HIV tests New positives from test sites Primary and secondary syphilis/HIV co-infections Wisconsin Department of Health Services 2009 tests and positives from test sites data are estimates.

  28. TEST SITES: POSITIVITY RATESFigure 18. Positivity rate at publically-funded counseling and testing sites in various populations, City of Milwaukee, 2009-2013 HIV positivity rate Wisconsin Department of Health Services

  29. TEST SITES: POSITIVITY RATESFigure 19. Positivity rate at publically-funded counseling and testing sites in Black MSM by age group, City of Milwaukee, 2009-2013 Age group Wisconsin Department of Health Services Percent positive

  30. SUMMARYHIV testing and syphilis/HIV co-infection data in the City of Milwaukee, 2009-2013 Tests Total tests, about 8,000 per year 2009-2013 Tests in Black MSM under age 30, increased four-fold 2009-2013 New diagnoses Peaked in 2010 and declined modestly 2010-2013 Positivity rate Overall, 0.7% (7 in 1,000) Black MSM, 3.4% (higher in 18-44 year age groups) Syphilis/HIV co-infection Increased 2009-2013, relatively small numbers Wisconsin Department of Health Services

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