Healthy People 2010 Focus Area 13: HIV Progress Review August 30, 2007

HIV/AIDS in the United States HIV/AIDS –More than 1 million persons estimated to be living with HIV in 2003: Of those, approximately one quarter did not know that they were infected –Federal spending on HIV related medical care in 2005: $11.6 billion –Lifetime cost of care: $385,200* Note: * From the time entering HIV care, projected life expectancy for a person with an initial CD4+ cell count less than 350 cells/µL is 24.2 years, and the lifetime cost of care for such a person’s treatment is $385,200 when rebates and other discounts on HIV medications are taken into consideration. Sources: Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003, National HIV Prevention Conference, June 2005, Atlanta., Abstract 595; Schackman, BR, Gebo KA, Walensky, RP et. al., The Lifetime Cost of Current Human Immunodeficiency Virus Care in the United States. Medical Care, Volume 44, Number 11, November 2006.

AIDS –Estimated new cases diagnosed in 2005: 40,608 –Cumulative cases diagnosed (as of 12/2005): 952,629 –Number of deaths in 2005: 16,316 –Cumulative deaths (as of 12/2005): 530,756 HIV/AIDS in the United States Source: HIV/AIDS Surveillance Report, CDC/NCHHSTP.

HIV/AIDS Incidence & Deaths New AIDS cases New AIDS cases among men who have sex with men New AIDS cases among persons who inject drugs New AIDS cases among men who have sex with men & inject drugs New HIV cases Deaths due to HIV infection 13-17b.Perinatally-acquired AIDS HIV/AIDS Treatment 13-13d. Treatment according to guidelines – Highly active antiretroviral therapy Highlighted Objectives ImprovingGetting worseLittle or no change * Target met * Percent of targeted change achieved is between -10% and 10%. Developmental

Note: Data are for persons 13 years and over. Data have been adjusted for reporting delays. Under the 1993 case definition, an HIV-positive person also has AIDS when his or her CD4+ cell count has fallen below 200 cells per microliter or when CD4+ cells account for fewer than 14 percent of all lymphocytes. Source: HIV/AIDS Reporting System, CDC/NCHHSTP. Estimated AIDS Incidence, Prevalence, and Deaths Year of diagnosis or death Number of new cases/deaths In thousands P r e v a l e n c e ( i n t h o u s a n d s ) Incidence Prevalence Deaths

Note. Rates are shown for the five areas with the highest and lowest rates. Data have been adjusted for reporting delays. *Includes persons whose area of residence is unknown or missing. Source: HIV/AIDS Reporting System, CDC/NCHHSTP. Estimated Prevalence of Persons Living with AIDS, 2005 < > Total rate=174.5* Rate per 100,000 population NJ MD DC ,

Rate per 100,000 population MSA of >500,000 Northeast Midwest South West Reported AIDS Cases by Region and Metropolitan Size, 2005 MSA of 50, ,000 Non-metropolitan areas Note: MSA = Metropolitan statistical area. Source: HIV/AIDS Reporting System, CDC/NCHHSTP.

Estimated number of cases per 100,000 population Note: American Indian includes Alaska Native. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: HIV Surveillance System, CDC/NCHHSTP. White Black Hispanic Asian Total New AIDS Cases Obj American Indian Decrease Desired 2010 Target:

Percent of cases Distribution of New AIDS Cases Note: Data are for persons 13 years and over. Less than 1% of new AIDS cases were reported in Asian/Pacific Islanders and American Indian/Alaska Natives during this time period. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Data have been adjusted for reporting delays. Source: HIV/AIDS Reporting System, CDC/NCHHSTP. Black Hispanic White Year of diagnosis

Number of Cases per 100,000 population Total Asian White American Indian Hispanic Black Total Asian White American Indian Hispanic Black New AIDS Cases by Gender and Race/Ethnicity, 2005 Note: Data are for persons 13 years and over. American Indian includes Alaska Native. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: HIV/AIDS Reporting System, CDC / NCHHSTP. Females Males Decrease Desired 2010 Target: 1 Obj

New AIDS Cases by Transmission Category Note: * Includes hemophelia, blood transfusion, perinatal exposure, and risk factors not reported or identified. Data are for persons aged 13 years and over. Data have been adjusted for reporting delays and cases without risk factor information were proportionally redistributed. Source: HIV/AIDS Reporting System, CDC/NCHHSTP. Females Males Men who have sex with men (MSM)MSM & IDU Injection drug use (IDU) Heterosexual contact Other/Unknown* 70% 10% 4% 16% <1% 41% % 1% 58% 27% 55% 18% 27% 70% 2% 18% 16% Obj. 13-2, 13-3, 13-4

Number of new cases Perinatally Acquired AIDS Source: HIV/AIDS Reporting System, CDC/NCHHSTP. Obj b Decrease Desired 2010 Target: Number of new cases

Female Hispanic Deaths due to HIV/AIDS, 2004 Note: I = 95% Confidence interval. HIV deaths are defined by ICD-10 codes B20 - B24. Data are age-adjusted to the 2000 standard population. American Indian includes Alaska Native. Persons of Hispanic origin may be any race. Education estimates are based on persons aged years. Source: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Total White American Indian Asian Black Male High School At least some college Less than High School Obj Decrease Desired 2010 Target: 0.7 Age-adjusted death rate per 100,000 standard population

Deaths due to HIV/AIDS by Health Service Area, Note: HIV deaths are defined by ICD-10 codes B20 - B24. Data are age-adjusted to the 2000 standard population. The 5 legend categories represent the following percentage of Health Service Areas (from lowest to highest): 10%, 20%, 40%, 20%, 10%. Source: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Obj < Age adjusted rate per 100,000 population 2010 Target: 0.7

New HIV/AIDS Cases Note: Data are for persons 13 years and over. A 2010 target has not been set. Data are from 33 states with confidential name-based HIV infection surveillance since at least Data have been adjusted for reporting delays. Source: HIV/AIDS Reporting System, CDC/ NCHHSTP. Number of cases Year of diagnosis 2003 Obj. 13-5

Male to male sexual contact Male to male sexual contact and Injection drug use Injection Drug Use Heterosexual contact * Distribution of HIV/AIDS by Transmission Category Year of diagnosis Percent of cases Note. Data are for persons 13 years and over. Data are from 33 states with confidential name-based HIV infection reporting since at least 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. Source: HIV/AIDS Reporting System, CDC/NCHHSTP. Obj. 13-2, 13-3,

Percent Sex-related Sex or drug-related Drug-related Sex or drug- related or STD Persons at Risk for HIV/AIDS, 2002 FemaleMale Note: I = 95% Confidence interval. Data are for persons 15 to 44 years of age. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: National Survey for Family Growth, Advance Data No. 377, CDC/NCHS. Type of Risk

Percent HIV Testing, 2002 Note: I = 95% Confidence interval. Data are for persons 15 to 44 years of age who had an HIV test, excluding tests done as part of blood donation. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. *Includes person who had five or more sex partners in the last year, exchanged sex for money or drugs, had sex with an injecting drug user, had male-to-male sex, or injected drugs themselves. Source: National Survey for Family Growth, Advance Data No. 363, CDC/NCHS. Persons Tested in Past 12 Months Total Male Female HispanicWhiteBlack Persons Ever Tested High Risk* Persons Tested in Past 12 Months

Highly Active Antiretroviral Treatment, 2003 NOTE: Data are for HIV infected persons 13 years and over. Data are from over 100 clinical sites in 11 U.S. cities. American Indian includes Alaska Native. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons were asked to select only one race category; selection of more than one race was not an option. Source: Adult and Adolescent Spectrum of HIV Disease (ASD) Surveillance Project, CDC / NCHHSTP. Percent Obj d FemaleMale AsianBlack Increase Desired 2010 Target: 95 Total American Indian White Hispanic

Developmental New AIDS cases AIDS among men who have sex with men 13-3 AIDS among persons who inject drugs AIDS among men who have sex with men and who inject drugs New HIV cases 13-6a. Condom use by partner – Females 13-6b. Condom use – Males Knowledge of serostatus HIV/AIDS counseling and education for persons in substance abuse treatment HIV/AIDS, STD, and TB education in State prisons HIV counseling and testing in State Prisons HIV testing in TB patients Screening for STDs and immunization for hepatitis B Treatment according to guidelines a. Viral load testing b. Tuberculin skin testing c. Any antiretroviral therapy d. Highly active antiretroviral therapy e. Pneumocystis carinii pneumonia prophylaxis f. Mycobacterium avium complex prophylaxis HIV infection deaths Interval between HIV infection and AIDS diagnosis Interval between AIDS diagnosis and death from AIDS 13-17a. Perinatally acquired HIV/AIDS diagnosed 13-17b. Perinatally acquired AIDS HIV diagnosed in adolescent and young females Deleted at the Midcourse Status of HIV/AIDS Objectives ImprovingGetting worseLittle or no change*Baseline onlyTarget met ^ ^ ^ ^ ^ * Percent of targeted change achieved is between -10% and 10%.

Over two thirds (10/14) of the measurable objectives and subobjectives are moving toward or have met their HP2010 targets. AIDS among persons who inject drugs and perinatally acquired AIDS have met their targets. The decline in AIDS incidence and death has leveled off since Disparities by race/ethnicity, age, gender, education and geographic location persist. Summary

Progress review data and slides are available on the web at: