# Presentation: 095298

## HIV/AIDS in the United States:

**HIV/AIDS in the United States:**
**An Update**

**Kevin Fenton, MD, PhD, FFPH**
**National Center for HIV/AIDS, Viral Hepatitis, **
**STD, and TB Prevention**
**March 25, 2008**

## Overview

- NCHHSTP mission, priorities
- HIV/AIDS epidemic in the United States
- HIV Prevention
- Challenges, Priorities, Opportunities
- Summary

## About NCHHSTP

**About NCHHSTP**

- 

## About NCHHSTP:

- NCHSTP established in 1995
- Viral hepatitis added in 2006
- Staff: over 900 domestic FTEs and nearly 300 field staff in U.S.
- Center supports both domestic and global activities
- Rated “Effective” by OMB PART

## NCHHSTP Mission:

- Maximize public health and safety nationally and internationally through the elimination, prevention, and control of disease, disability, and death caused by
- 	HIV/AIDS
- 	Non-HIV Retroviruses
- 	Viral Hepatitis
- 	Other Sexually Transmitted Diseases
- 	Tuberculosis
- 	Non-Tuberculosis Mycobacteria

**NCHHSTP Mission:**

## NCHHSTP Structure:

## NCHHSTP Priorities:

- Program collaboration and Service integration (PCSI)
- Reducing Health Disparities
- Maximizing Global Synergies

## NCHHSTP Workgroups

**Global Perinatal**

## NCHHSTP FY08 Priorities:

- Publish **PCSI white paper** and research priorities
- Publish integrated **surveillance report**
- Publish guidelines on **integrated surveillance**
- Develop **national mobilization** on PCSI
- Continue directors **site visits** to rural US and territories

- Publish green paper for research on tracking the **social determinants**
- Strengthen **external communications** to partners (e.g. blog, connections)
- Heighten **meta-leadership** for prevention across federal agencies
- Complete **NCHHSTP 2020 strategic plan**
- Identify opportunities for **strategic partnerships** for prevention

## HIV/AIDS in the United States

**HIV/AIDS in the United States**

- 

## Prevalent HIV infections 

*Source: Glynn M, Rhodes  P.  2005 HIV Prevention Conference*

**Prevalent HIV infections **

- Number HIV infected         **1,039,000 – 1,185,000**
- Number unaware of their HIV infection**252,000 - 312,000 (24%-27%)**

## HIV Prevalence by age, sex and race/ethnicity, 1999-2006

**HIV Prevalence by age, sex and race/ethnicity, 1999-2006**

- 1-Significantly different from non-Hispanic whites & Mexican-Americans; 2-Significantly different from 18-29 yrs old; 3-Significantly different from females;* Estimate unstable. Based on fewer than 10 HIV+ persons. Note: nationally representative sample of the civilian, noninstitutionalized household population. Source: CDC, NCHS, National Health and Nutrition Examination Survey, 1999-2006.

**Female **

**40-49 years****2**

**18-29 years **

**30-39 years **

**All**

**Male****3**

**NH white **

**NH Black****1**** **

**Mexican American********* **

## Estimated AIDS Cases and Deaths, 1985-2006

- Note: Data have been adjusted for reporting delays.
- “Estimated AIDS Cases and Deaths, 1985-2006, U.S. and Dependent Areas.”

**Deaths**

**AIDS Cases**

- 1993 Definition implementation

- Beginning of  HAART

## Estimated AIDS Prevalence, 1985-2006 

**Estimated AIDS Prevalence, ****1985-2006 **

- Note: Data have been adjusted for reporting delays. “Estimated AIDS Prevalence, 1985-2006—US and Dependent Areas.”

- Persons living with AIDS

- 1993 Definition implementation

**99% increase in PLWA 1996-2006**

## AIDS cases by race/ethnicity and year of diagnosis, 1985-2006

**Percent of Cases**

**Year of Diagnosis**

**Black, not Hispanic**

**Hispanic**

**API**

**AI/AN**

**White, not Hispanic**

**AIDS cases by race/ethnicity and year of diagnosis, 1985-2006**

- Note: Data have been adjusted for reporting delays. “Proportion of AIDS Cases Among Adults and Adolescents, by Race/Ethnicity and Year of Diagnosis, 1985 – 2006, US and Dependent Areas.”

**48%**

**20%**

**1%**

**<1%**

**29%**

## AIDS Cases by Year of Diagnosis, 1985 – 2006

**Percent of Cases**

**Year of Diagnosis**

**Male-to-male sexual contact**

**Injection drug use (IDU)**

**Heterosexual contact**

**Male-to-male sexual contact/ IDU**

- Note. Data adjusted for reporting delays and estimated proportional redistribution of cases initially reported without risk.* Heterosexual contact with a person known to have, or to be at high risk for, HIV infection. “Proportion of AIDS Cases Among Adults and Adolescents, by Transmission Category and Year of Diagnosis, 1985-2006—US and Dependent Areas.”

**AIDS Cases by Year of Diagnosis, 1985 – 2006**

**32%**

**43%**

**5%**

**19%**

## Reported AIDS Cases and Population by Race/Ethnicity, 2006

- *Total includes 357 persons of unknown or multiple races. “Proportion of AIDS Cases and Population by Race/Ethnicity, Reported in 2006—50 States and DC.”

**AIDS Cases**
- N* = 37,911

**U.S. Population**
- N = 299,398,484

**White **
**30%**

**Black**
**49%**

**Hispanic**
** ****19%**

**Asian/Pacific Islander, 1%**

**American Indian, **
**Alaska Native <1%**

**Asian/Pacific**
** ****Islander, 5%**

**American Indian,**
**Alaska Native, <1%**

**Reported AIDS Cases and Population by Race/Ethnicity, 2006**

## HIV/AIDS Cases, Adults and Adolescents, 2006 — 33 States

- Note: Data from 33 states with confidential, name-based HIV reporting since at least 2003. Data have been adjusted for reporting delays and cases without risk factor information were proportionally redistributed. * Heterosexual contact with a person known to have, or to be at high risk for, HIV infection. “Proportion of HIV/AIDS Cases among Adults and Adolescents, by Sex and Transmission Category, 2006—33 States.”

**HIV/AIDS Cases, Adults and ****Adolescents, 2006 — 33 States**

## Estimated AIDS Cases in Males through 2006

- 81% of 973,354 cases of AIDS in adults and adolescents diagnosed through 2006, were males
- 4% of cases in males were aged 13-24 years
- 64% of cases in males aged 13-24 were attributed to male-to-male sexual contact
- During 2006, 43% of adult and adolescent AIDS cases were MSM

- Note: Data have been adjusted for reporting delays and for estimated proportional redistribution of cases in persons initially reported without an identified risk factor. “Estimated AIDS Cases in Adult/Adolescent Males through 2006, 50 States and DC.”

## Proportion of AIDS Cases, Male Adults & Adolescents, 2002-2006

- Note: Data adjusted for reporting delays and cases without risk factor information were proportionally redistributed.* Includes hemophilia, blood transfusion, perinatal exposure, and risk not reported or identified.”Proportion of AIDS Cases among Male Adults and Adolescents by Transmission Category and Race/Ethnicity, 2002-2006—US and Dependent Areas.”

**Percent of Cases**

**Proportion of AIDS Cases, Male Adults & Adolescents, 2002-2006**

**Race/ethnicity**

## Estimated AIDS Cases Among MSM, 1985-2006

- Note: Data have been adjusted for reporting delays and for estimated proportional redistribution of cases in persons initially reported without an identified risk factor. “Estimated AIDS Cases Among MSM, 1985-2006, U.S. and Dependent Areas.”

## MSM AIDS Cases by Region and Race/Ethnicity, 2006

- Note: Data adjusted for reporting delays and estimated proportional redistribution of cases initially reported without risk. “Estimated Number of AIDS Cases among Adult and Adolescent MSM, By Region and Race/Ethnicity, 2006—50 States and DC.”

- Asian/Pacific Islander

- American Indian/Alaska Native

## HIV/AIDS Cases among MSM by Age Group, 2001 – 2006, 33 States

- Note: Data adjusted for reporting delays and estimated proportional redistribution of cases initially reported without risk.  “Estimated Number of HIV/AIDS Diagnoses among Adult and Adolescent MSM, by Race, 2006—33 States.”

**HIV/AIDS Cases among MSM by Age Group, 2001 – 2006, 33 States**

**35-44**

**25-34**

**55+**

**13-24**

**45-54**

## HIV/AIDS Cases among MSM aged 13-24, 2001-2006, 33 States

- Note: Data adjusted for reporting delays and estimated proportional redistribution of cases initially reported without risk. “Estimated Number of HIV/AIDS Diagnoses among MSM aged 13-24, by Race, 2001-2006, 33 States.”

**HIV/AIDS Cases among MSM aged 13-24, 2001-2006, 33 States**

**Black, not Hispanic**

**White, not Hispanic**

**Hispanic**

**American Indian/Alaska Native**

**Asian, Pacific Islander**

## Est. HIV/AIDS Cases among MSM, aged 13-24, 2006 – 33 states

**Est. HIV/AIDS Cases among MSM, aged 13-24, 2006 – 33 states**

- Note: Data adjusted for reporting delays and estimated proportional redistribution of cases initially reported without risk. “Estimated Proportion of HIV/AIDS Diagnoses among MSM aged 13-24, by Race, 2006—33 States.”

**Asian/Pacific Islander, 1%**

**American Indian, **
**Alaska Native <1%**

**Hispanic**
** ****16%**

**Black**
**59%**

**White **
**23%**

## Rates of Est. HIV/AIDS Cases, 2006—33 States

- Note: Data have been adjusted for reporting delays. “Estimated Rates of HIV/AIDS Diagnoses among Adults and Adolescents, 2006—33 States.”

## AIDS Cases, Female Adults and Adolescents, 2002-2006

- Note:  Data adjusted for reporting delays; cases without risk factor information were proportionally redistributed.*Heterosexual contact with a man known to have, or to be at high risk for, HIV infection.
- ** Includes hemophilia, blood transfusion, perinatal exposure, and risk not reported or identified. US and  Dependent Areas.

**Percent of Cases**

**AIDS Cases, Female Adults and ****Adolescents, 2002-2006**

**Race/ethnicity**

## HIV/AIDS in Adolescents, 13-19 years, 2006

**HIV/AIDS in Adolescents, 13-19 years, 2006**

- Note: Data have been adjusted for reporting delays. * Includes 4 persons of unknown race or multiple races. “Proportion of HIV/AIDS Cases among Adolescents 13 to 19 Years of Age, by Race/Ethnicity, Diagnosed in 2006—33 States.”

**Notes:**
By far most youths diagnosed with HIV/AIDS are African American. They made up 69% of the 1,255 diagnoses in 2005 among 13 to 19 year olds. 

## Prevalence of Adults and Adolescents Living with AIDS 2005

**Prevalence of Adults and Adolescents Living with AIDS 2005**

## AIDS Cases among Adults and Adolescents, 2006

**Metropolitan Population**

**AIDS Cases among Adults and Adolescents, 2006**

## Est. Perinatally Acquired AIDS Cases, 1985-2006

- Note. Data have been adjusted for reporting delays.
- “Estimated Number of Perinatally Acquired AIDS Cases by Year of Diagnosis, 1985-2006—50 States and DC.”

## Challenges and

**Challenges and**
**Opportunities**

- 

## Epidemic drivers:  MSM and African Americans

**Epidemic drivers:  ****MSM and African Americans**

- Safer sex fatigue
- HIV treatment optimism
- Substance abuse (e.g., alcohol, methamphetamine)
- Changing demographic characteristics
- Evolving social and sexual networks (e.g., internet chat rooms)

- Higher rates of other STDs
- Substance abuse
- Incarceration
- Poverty
- Racism and discrimination
- Stigma and homophobia

- African Americans

- MSM

## Domestic HIV/AIDS Prevention Challenges:

- One quarter of those with HIV infection **undiagnosed**
**MSM** remain at increased HIV risk
**African Americans** and other communities of color at increased HIV risk
- Availability of effective treatments has led to **complacency** about HIV risk

## Domestic HIV/AIDS Prevention Challenges:

- HIV/AIDS **stigma** persists
- Changing patterns and distribution of **substance abuse** (e.g., methamphetamines)
**Internet** as means for meeting partners
- Need more **culturally competent interventions** and greater scale up of interventions

## Domestic HIV/AIDS Prevention Priorities

- Increase knowledge of HIV infection through **testing**
- Identify **effective interventions** for at-risk and HIV-infected persons and increase the use of these interventions
- Ensure **cost-effective allocation** of prevention resources to match changing profile of the epidemic
- Implement **surveillance systems** to better monitor HIV epidemic, risk behavior, and prevention programs

## Recent Accomplishments:

- Decreased HIV/AIDS cases among IDUs
- Decreased HIV/AIDS cases among females
- Increased number of persons who have been tested for HIV
- Decreased pediatric AIDS cases to 37 in 2006

## Recent Accomplishments:

- Refocused HIV prevention efforts
- More than 3,600 agencies trained on effective behavioral interventions
- New programs for YMSM of color and transgender persons
- New research on biomedical prevention strategies
- Heightened National Response to HIV/AIDS Among African Americans
- 2007 HIV Testing initiative
- Early diagnosis screening program

## Recent Accomplishments:

- Improved surveillance, monitoring, and evaluation
- Confidential, name-based HIV reporting adopted in 48 states
- New HIV incidence and behavioral surveillance systems
- Program Evaluation and Monitoring System (PEMS)
- Medical Monitoring Project

## Major initiatives

**Major initiatives**

- 

## Advancing the CDC 2006 HIV Testing Recommendations

- Major citywide testing initiatives
- NY, LA, Oakland, DC
- Numerous emergency departments making HIV screening routine
- Supportive policies issued by 38 professional organizations
- Some states have harmonized laws
- 14 states have changed laws to remove barriers to testing; 7 states have introduced legislation*

- *As of March 2008.

## FY07 HIV Testing Initiative

- FY 2007 $45 million
- $35 million  to health departments to increase HIV testing for populations disproportionately affected by HIV—primarily African Americans unaware of their HIV status
- $10 million to support training, capacity building, social marketing, program evaluation, and technical assistance
- HIV tests available mainly in clinical settings – EDs, CHCs, STD clinics, and correctional health facilities

- *As of March 2008.

## FY07 HIV Testing Initiative Awardees:

## Heightened National Response in African Americans

- Four key pillars:
- Expand the reach of prevention services
- Increase opportunities for diagnosing and treating HIV/AIDS
- Develop new, effective prevention interventions for African American
- Mobilize broader community action

## Community Mobilization

**Community Mobilization**

- The March 8, 2007 Partnership meeting brought together >75 leaders to mobilize response to HIV/AIDS in the African American community

## Example of Heightened National Response Activities

- Dr. Ronald Mason, President, Jackson State University
- Led the development of a campus wide HIV/AIDS awareness and prevention agenda for JSU.
- Sent a letter to the presidents of 53 historically black colleges and universities discussing the importance of the education sector’s involvement in HIV Prevention.

## Take Charge. Take the Test. 

**Take Charge. Take the Test. **

- Single African American women
- Ages 18-34
- Who make less than $30,000 per year
- Have some college education or less
- Reside in specific areas of Philadelphia and Cleveland   based on AIDS data
- Are having unprotected sex with men

## Summary

- HIV/AIDS  continues to evolve with marked geographic heterogeneity and a high burden among African Americans and MSM
- Stigma, homophobia, prevention workforce issues, and the Internet are major challenges
- Renewed commitment to increased partnerships, testing, and integration of services.

## Thank you

**Thank you**

- 	National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Preventionhttp://www.cdc.gov/nchhstp