2006 Indiana HIV Incidence Richard T. Passey Indiana State Department of Health Office of Clinical Data and Research HIV Incidence Surveillance

Need for HIV Incidence Surveillance Gives cutting edge picture of epidemic Targets at risk populations for prevention and testing Planners redistribute resources

New Infection of HIV Is Difficult to Pinpoint in Time How do we pinpoint when someone becomes infected? –Asymptomatic window period –Individual’s testing pattern is essential

Incidence Defined The number of NEW INFECTIONS in a given time period; usually one year

HIV Incidence Defined Not just new HIV diagnoses Incidence is NEW HIV INFECTIONS –Excludes those with HIV infections longer than one year –May be higher or lower than new HIV diagnoses –Accounts for HIV not yet tested: about 25% –Not changed by increased or decreased testing rates

2006 National HIV Incidence Calculation First Method: Point Estimate for 2006 (Reference JAMA Article) –Laboratory Test (STARHS/BED) Can classify infection as less than 156 days Not for individual; for population surveillance –Testing and Treatment History –Core HIV Surveillance Data

2006 U.S. HIV Incidence Estimation Point Estimate 56, /100,000 rate 40% Higher than Previous Estimate 40, /100,000

2006 U.S. HIV Incidence by Gender 73% Male 34.3/100,000 rate 27% Female 11.9/100,000 rate

2006 U.S. HIV Incidence by Transmission 53% Men that have Sex with Men (MSM) 12% Injection Drug User (IDU) 4% MSM/IDU 31% Heterosexual

2006 National HIV Incidence Age % 26.8/100, % 42.6/100, % 30.7/100, % 6.5/100,000

National HIV Incidence by Race/Ethnicity 35% White Rate 11.5/100,000 17% Hispanic Rate 29.3/100,000 Almost three times the rate of white individuals 45% Black Individuals Rate of 83.7/100,00 for Black Seven times the rate of white individuals

Artist’s Depiction of HIV Virus Particle

2006 National HIV Incidence Calculation Second Method Confirmatory for STARHS –Statistical Back Calculation Approach Looked at HIV incidence since 1970’s

HIV Incidence by Back Calculation for U.S. Incidence first noticed in 1977 Peaked mid 80’s at 130,000 Low point early 1990’s at 49,000 Second peak late 90’s at 58,000 Since 2000 stayed at roughly 55,000

One Area of Success Overall HIV incidence among IDU has decreased 80% in the U.S. From 35,000 in 1990 to 6,600 in 2006

Conclusions for National HIV Incidence Racial Disparities are Greater than Expected Incidence Rate is 40% Higher than Expected and has been for Years Young, Black, MSM at Most Risk

Prevention, and Testing Plan

Indiana 2006 HIV Incidence New Statewide Calculation is Cutting Edge –STARHS Lab Test –Core HIV Surveillance –Testing and Treatment History

Indiana 2006 HIV Incidence (New Infections) Local Estimate is 639 CDC Estimate is 700

Indiana HIV Diagnosis Compared to Incidence (Infected) for Diagnosed with HIV/AIDS 10.0 per 100, Diagnosed with HIV not AIDS 6.2 per 100, Incidence for HIV not AIDS 12.3 per 100,000 (double) 700 Incidence for HIV not AIDS 13.5 per 100,000

Indiana 2006 HIV Incidence Stratified by Gender Women 6.9/100,000 HIV incidence rate 29% (187) new HIV infections (incidence) Men 17.5/100,000 HIV incidence rate 71% (452) new HIV infections

Indiana 2006 HIV Incidence Stratified by Race White 60% of 2006 incidence Rate is 8.2/100,000 Other (Minorities) 40% of incidence Rate is 45.8/100, times higher rate for other than white

Indiana 2006 HIV Incidence Stratified by Age % 17.3/100, % 26.3/100, % 5.6/100,000

Indiana 2006 HIV Incidence Stratified by Transmission MSM 55% of incidence in 2006 Other 45% Could not be further separated Includes IDU, Heterosexual, and No Reported Risk

Conclusions on Indiana Statewide HIV Incidence HIV Incidence Rate Double that of HIV Diagnosis Rate Racial Disparities are Alarming Young Minority MSM at Greatest Risk

2006 Indiana HIV Incidence Estimation ‡ HIV Incidence Estimate*Std. Dev.**HIV/AIDS Diagnosis*** STRATACount%Rate/100,000Count Sex Male Female Race/Ethnicity White Other  Diagnosis Age Transmission MSM N/A67271 Other  (IDU,HET,NRR) N/A Total ±

‡Source: Indiana State Department of Health, Office of Clinical Data and Research, January 1, 2006 to December 31, 2006; Reported through August 1, 2008 *Incidence Estimate-Estimated Number of New HIV Infections. Estimations will vary according to STRATA. **Std. Dev-Standard Deviation of Incidence Estimate 'Count' ***HIV/AIDS Diagnosis-Newly Reported HIV/AIDS Cases to ISDH though August 31, 2008 and diagnosed January 1, 2006 – December 31, 2006 ±Total-Non-Stratified (includes all variables) HIV Incidence Estimation. Each set of STRATA separately equals the number represented in the 'Total' with the exception of 'Std. Dev.'.  Other categories-Represent All Race/Ethnicity's other than Whites and All Transmissions other than MSM. Categories represented in 'Other' were too small separately to accurately estimate Incidence when stratifying. NRR-No Reported Risk

Bibliography Estimation of HIV Incidence in the United States, Irene Hall et. al., JAMA, August 6, 2008, vol. 300, No. 5 Estimating HIV Incidence in the United States from HIV/AIDS Surveillance Data and Biomarker HIV Test Results, John Karon et al., Statistics in Medicine 2008 Morbidity and Mortality Weekly Report, Prejean, J et. al., ( Sept.12, 2008 vol. 57,no. 36 pp

Images of HIV Virus Particles: Russell Knightly Media Custom Medical Stock Photo (CMSP) AIDS Pathology Department of Microbiology University Otago, New Zealand Taken from

Cartoons – United Nations World AIDS Day HIV/AIDS Cartoon Exhibition Dec. 1, 2006 – Made by the World Health Organization, UN AIDS and the Office of the High Commissioner for Human Rights