# Presentation: 730652

## HIV

**HIV**
**Progress Review**
**August 4, 2003**

## Public Health Impact of HIV/AIDS 

**in the United States**

- SOURCES: CDC/NCHSTP and CDC/NCHS.

**HIV (Estimated)**

**AIDS**

**  **
**   ****Persons newly infected with HIV each year:  40,000 **
**   ****Persons living with HIV (as of 2000):  850,000 – 950,000**
**   ****Of those persons living with HIV,  180,000 – 280,000 (19-33%) do not know  **
**    ****that they are infected    **
**            **

**  **
**   ****New AIDS cases in 2001:  43,158**
**   ****Cumulative AIDS cases reported to CDC (as of 12/2001):  816,149**

## Public Health Impact of HIV/AIDS 

- SOURCES: CDC/NCHSTP; CDC/NCHS; and Holtgrave DR and Pinkerton, SD. Updates of Cost of Illness and Quality of Life Estimates for Use in Economic
- Evaluations of HIV Prevention Programs. J Acquir Immune Defic Syndr Hum Retrovirol: Volume 16(1). September 1, 1997. 54-62

**HIV/AIDS Treatment Costs (Estimated)**

**Deaths from HIV/AIDS**

**   ****Number of deaths**** due to HIV/AIDS (2000):  14,477**
**   ****Cumulative deaths in persons with AIDS (as of 12/2001):  467,910**

** **
**  ****Lifetime treatment cost:  $155,000 per person **

**Public Health Impact of HIV/AIDS **
**in the United States**

## Public Health Response to HIV/AIDS 

| HIV/AIDS Prevention Components and Strategies |  |
| --- | --- |
| HIV Community Planning
HIV/AIDS Epidemiological & Behavioral Surveillance                                                                                             
Counseling, Testing, and Referral Services (CTR)
Partner Notification (Partner Counseling and Referral Services) 
Evaluation
Capacity Building
Technical Assistance 
Health Education and Risk Reduction | Perinatal Transmission Prevention
STD & TB Prevention Activities
HIV and AIDS Surveillance
Monitoring New Infections
Prevention for HIV-Infected Persons
Public Information
Laboratory Support
Research
Youth and School-Based Education
Training  |

| Care, Services, and Treatment of HIV/AIDS |  |
| --- | --- |
| Primary Health Care (including oral health, outpatient mental health, and outpatient substance abuse treatment)
Early Intervention/Counseling and Testing Services
HIV/AIDS Therapies
Prevention with HIV-Infected Persons
Home-Based Health Care
Health Insurance
Support Services | Case Management
Training of Health Care Professionals
Local Planning for Services Delivery
Needs Assessment
Outreach
Capacity Building
Technical Assistance
Demonstration of New Models of Care |

## Estimated AIDS Incidence, Prevalence, and 

**Estimated AIDS Incidence, Prevalence, and **
**Deaths, by Year of Diagnosis/Death**

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

-  NOTE: Data are adjusted for reporting delays.

## 13-1. Estimated Number of New AIDS Cases, 

**by Year of Diagnosis**

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

- Black

- White

- Hispanic *

- Asian/Pacific Islander

- American Indian/Alaska Native

**Number of new cases per 100,000**

**1998**

**1999**

**2000**

**2001**

**2010 target = 1.0**

-  NOTE: Data are for persons ages 13 and over.  Data are adjusted for reporting delays.

**Year of diagnosis**

- * Persons of Hispanic origin may be of any race.

## Estimated Number of AIDS Cases, 

**by Gender and Year of Diagnosis**

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

- Males

- Females

**Number of cases**

-  NOTE: Data are adjusted for reporting delays.

## Estimated Percent Distribution of AIDS Cases, 

**Estimated Percent Distribution of AIDS Cases, **
**by Exposure Category and Year of Diagnosis**

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

- NOTE: Data are for persons ages 13 and over.  Data are adjusted for reporting delays and estimated proportional redistribution of cases reported without a risk. Data include AIDS cases reported in U.S. dependencies, possessions, and independent nations in free association with the U.S.

## 13-2–13-4. Estimated Number of New AIDS Cases in 

**Men, by Exposure Category and Year of Diagnosis**

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

**Number of new cases**

- NOTE: Data are for persons ages 13 and over.  Data are adjusted for reporting delays and estimated proportional redistribution of cases reported without a risk.  Data include AIDS cases reported in U.S. dependencies, possessions, and independent nations in free association with the U.S.

- Men who inject drugs (Obj. 13-3)

- Men who have sex with men (Obj. 13-2)

- Men who have sex with men & inject drugs (Obj. 13-4)

**1998**

**1999**

**2001**

**2000**

**Year of diagnosis**

## 13-3. Estimated Number of New AIDS Cases in 

**Persons who Inject Drugs, by Year of Diagnosis**

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

- Both sexes

- Men

- Women

**Number of new cases**

**1998**

**1999**

**2000**

**2001**

- NOTE: Data are for persons ages 13 and over.  Data are adjusted for reporting delays. Data include AIDS cases reported in U.S. dependencies, possessions, and independent nations in free association with the U.S.

**Year of diagnosis**

## 13-5. Estimated number of New HIV Cases† 

**in 25 States, by Year of Diagnosis**

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

- NOTE:  Objective is developmental.  Proposed baseline and update data shown.  A 2010 target has not been set.  Data are for persons ages 13 and over.      Data are from 25 States with confidential, name-based HIV reporting prior to 1994.  Data are adjusted for reporting delays.

**Number of new cases**

**1998**

**1999**

**2001**

**2000**

**Year of diagnosis**

- † Includes persons diagnosed with AIDS who were not previously diagnosed with HIV.

## 13-6a. Percent of Unmarried Sexually Active Females 

-  SOURCE: National Survey of Family Growth (NSFG), CDC/NCHS.

**Percent**** **

**Hispanic**

**Black, not Hispanic**

**2010 target**

**13-6a. Percent of Unmarried Sexually Active Females **
**Whose Partner Used a Condom at Last Intercourse, **
**by Race/Ethnicity and Age, 1995**

**White, not Hispanic**

**18-19**

**25-29**

**35-44**

**20-24**

**30- 34**

**Age cohort**

-  NOTE: Data are for females ages 18-44 years.

## 13-6a. Percent of Unmarried Sexually Active Females 

**Whose Partner Used a Condom at Last Intercourse, **
**by Urbanicity and Education, 1995**

-  SOURCE: National Survey of Family Growth (NSFG), CDC/NCHS.

- NOTE: Data for the total population and by urbanicity are for females ages 18-44 years.  Education data are for females ages 25-44 years.

**Percent**

**Total**

**Rural**
**(Non–MSA)**

**High **
**school**
**graduate**

**Urban**
**(MSA)**

**Less than **
**high **
**school**

**At least **
**some **
**college**

- MSA: Metropolitan Statistical Area.

**2010 target**

## 13-8. Percent of Substance Abuse Treatment 

**Facilities that Offer HIV Counseling and **
**Education to Clients**

- SOURCE: 1997-1998: Uniform Facility Data Set (UFDS), SAMHSA.  2000, 2002: National Survey of Substance Abuse Treatment Services (N-SSATS), SAMHSA.

**Percent of facilities**

**1997**

**1998**

**2000**

**1999**

**Data not collected**

**2010 target**

**Year**

**2001**

**2002**

**Data not collected**

## 13-11. Percent of TB Patients Tested for HIV, 

**by Race/Ethnicity**

- SOURCE: National TB Surveillance System, CDC/DTBE.

**Percent**** **

**Total**

**Asian or**
**Pacific Islander ***

**Black, **
**not Hispanic**

**American Indian**
**or Alaska Native ***

**Hispanic ****

**White, **
**not Hispanic**

**1998**

**2001**

**2010 target**

- NOTE: Data are for persons ages 25-44 years.

- * Includes persons of Hispanic and non-Hispanic origin.

- ** Persons of Hispanic origin may be of any race.

## 13-13. Estimated Percent of HIV-Infected Persons 

- NOTE: Data are for persons 13 years and over.  Data are from 100 focus sites in 11 U.S. cities.

**Percent**** **

**1999**

**2001**

**2010 target**

**Any antiretroviral therapy                (Obj. 13-13c)**

***Pneumocystis carinii***** **
**pneumonia (PCP) **
**prophylaxis**
**(Obj. 13-13e)**

**Highly active **
**antiretroviral **
**therapy (HAART)  (Obj. 13-13d)**

***Mycobacterium avium***** **
**complex (MAC) **
**prophylaxis**
**(Obj. 13-13f)**

**1997**

**13-13. Estimated Percent of HIV-Infected Persons **
**who Receive Treatment According to Guidelines**

- SOURCE: Adult/Adolescent Spectrum of HIV Disease (ASD) Surveillance Project, CDC/NCHSTP.

## 13-14. Deaths Due to HIV Infection, 

**by Race/Ethnicity, 2001****†**

- SOURCE: National Vital Statistics System (NVSS-M), CDC/NCHS.

**Age-adjusted death rate per 100,000**

**Total**

**Asian or**
**Pacific Islander ***

**Black, **
**not Hispanic**

**American Indian**
**or Alaska Native ***

**Hispanic ****

**White, **
**not Hispanic**

- NOTE: Data are age adjusted to the 2000 standard population

**2010 target**

- * Includes persons of Hispanic and non-Hispanic origin.

- ** Persons of Hispanic origin may be of any race.

- † Data are preliminary

## 13-14. Deaths Due to HIV Infection, 

**by Gender and Education Level, 2001****†**

- SOURCE: National Vital Statistics System (NVSS-M), CDC/NCHS.

**Age-adjusted death rate per 100,000**

**Total**

**Male**

**High **
**school**
**graduate**

**Female**

**Less than **
**high **
**school**

**At least **
**some **
**college**

**2010 target**

- NOTE: Data are age adjusted to the 2000 standard population.  Data by education are for persons aged 25-64 years and are from 46 reporting States and D.C.

- † Data are preliminary

## 13-15, 13-16.  Estimated Time Between 

**HIV Infection, AIDS Diagnosis, and Death**

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

- * Data are from 25 States with confidential, name-based HIV reporting prior to 1994.  Data are adjusted for reporting delays.

**Percent**

**HIV cases* diagnosed **_**>**_** 1 month **
**before AIDS diagnosis **
**(Obj. 13-15) ****

**AIDS cases dying within 12 months **
**of AIDS diagnosis **
**(Obj. 13-16)****

**1998**

**2001**

- ** Objective is developmental.  Proposed baseline and update data shown.  A 2010 target has not been set.

- NOTE: Data for objective 13-16 include AIDS cases reported in U.S. dependencies, possessions, and independent nations in free association with the U.S.

## Percent of AIDS Patients Surviving At Least 1 Year After 

**Percent of AIDS Patients Surviving At Least 1 Year After **
**Diagnosis of Their First AIDS-Defining Opportunistic Illness, **
**by Year of Diagnosis**

- SOURCE: HIV/AIDS Surveillance Supplement Report 2002; 8(1):4.

## HIV Infections† in 25 States, by Year of Diagnosis

**HIV Infections****† ****in 25 States, by Year of Diagnosis**

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

- NOTE:  Objective is developmental.  Proposed baseline and update data shown.  A 2010 target has not been set.  Data are from 25 States with confidential,      name-based HIV reporting prior to 1994.  Data are adjusted for reporting delays.

**Number of new infections**

**1998**

**1999**

**2001**

**2000**

**Year of diagnosis**

- † Includes children diagnosed with AIDS who were not previously diagnosed with HIV.

## Perinatally-Acquired AIDS Cases

**by Year of Diagnosis **

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

**Year of diagnosis**

**Number of cases**

- NOTE: Data are adjusted for reporting delays.

## Developmental Objectives

***       *****†***** ******Proposed baseline and update data shown in this presentation.  A 2010 target has not yet been set.***

**13-05 ****†****        New HIV cases**
**13-06b        Condom use**
**13-07 ****	****      Knowledge of Serostatus**
**13-09 ****	****      HIV/AIDS, STD, and TB education in State prisons **
**13-10 ****	****      HIV counseling and testing in State prisons**
**13-12****	****      Screening for STDs and immunization for hepatitis B at HIV**
** ****	****      ****counseling and testing sites**
**13-13a,b ****†****   HIV-infected persons who are treated according to guidelines**
**13-15 ****†****        HIV cases diagnosed **_**>**_** 1 month before AIDS diagnosis**
**13-16 ****†****        AIDS cases who die within 12 months of AIDS diagnosis**
**13-17 ****†****        Perinatally-acquired HIV infection cases**

## CDC’s HIV 

**CDC’s HIV **
**Prevention Programs**

## Mission

**Mission**

- Prevent HIV infection and reduce the incidence of HIV-related illness and death, in collaboration with community, state, national and international partners.

## CDC’s  Domestic HIV Program

**CDC’s  Domestic HIV Program**

- 65 HIV prevention awards through state and local health departments
- approximately 900 indirectly funded community-based organizations (CBOs)
- 344 direct awards to non-governmental organizations
- 214 community-based organizations funded
- 61 surveillance grantees
- 106 prevention and research awards to research institutions and academic centers

## HIV/AIDS Budget

**HIV/AIDS Budget**
**Extramural and Intramural, FY 2001**

- SOURCE: CDC, HIV LEAD.

- Extramural
-      83%

- Intramural
-      17%

- Total:  $842 million

## CDC HIV/AIDS Budget (in millions) 

**CDC HIV/AIDS Budget (in millions) **
**FY 2001**

- SOURCE: CDC, HIV LEAD.

- Total:  $842 million

- 19.3%

- 56.1%

- 3%

- 1.4%

- 10%

- 9.4%

## CDC HIV/AIDS Budget by Race/Ethnicity 

**CDC HIV/AIDS Budget by Race/Ethnicity **
**FY 2001**

- SOURCE: CDC, HIV LEAD.

- Total:  $842 million

- 43.2%

- 29.5%

- 21.2%

- 3%

- 1.4%

- 1.7%

## Ryan White Comprehensive 

**Ryan White Comprehensive **
**AIDS Resources **
**Emergency (CARE) Act**

## Overview

**Overview**

- SOURCE: http://hab.hrsa.gov/history.htm.

## Ryan White Comprehensive AIDS 

**Resources Emergency (CARE) Act**

- SOURCE: HRSA/HIV-AIDS Bureau.

## Ryan White Comprehensive AIDS 

**Resources Emergency (CARE) Act**

- SOURCE: HRSA/HIV-AIDS Bureau.

## CARE Act Services

**Medications (ADAP)    (31.7%)**

**Medical Care (26.2%)**

**Medications (Discretionary) (4.9%)**

**Support Services (11.2%)**

**Case Management (7.0%)**

**State & Local Administration & Planning (8.8%)**

**Women, Children, Youth, & Families (Title IV)             (3.5%)**

**Demonstrations (SPNS), Emerging Communities & Planning Grants                   (2.5%)**

**Technical Assistance, Evaluation, Other      (2.5%)**

**Training (AETCs)  (1.7%)**

**CARE Act Services**
**CARE Act Spending FY 2001, $1.8 Billion**

- SOURCE: HRSA,HIV/AIDS Bureau.

## CARE Act Services

**CARE Act Services**
**Clinical Care Visits FY 2001 Title I & Title II**

## SOURCE: CARE Act Data Report (CADR), HRSA, HIV/AIDS Bureau.

## CARE Act Services

**Number of Individuals/Patients/Clients Served by**
**Service Category*, Title III, 2001**

- SOURCE: HRSA/HIV-AIDS Bureau.                        *All counts are unduplicated with the exception of those reported for outreach.

## CARE Act Services

**Number of Clients Served by Type of Service*, 2001**
**Title IV**

- SOURCE: HRSA/HIV-AIDS Bureau.                          * Clients may have received more than one service.

**Dental care**

**Primary care**

**HIV specialty care**

**Prenatal care**

**Developmental Assesment/             Early educational intervention**

**Clinical trials**

**Other clinical research**

**TB screening**

**Mental health services**

**Substance abuse services**

**Family planning**

## Profile of CARE Act Clients (2001)

- SOURCE: CARE Act Data Report (CADR), HRSA/ HIV-AIDS Bureau.

- African American (47%)

- Hispanic (20%)

- Asian American/ Pacific Islander (1%)

- White (30%)

- Two or more races/ Other race         (2%)