1. 2011 HIV Surveillance Report Matthew Mietchen, MPH Utah Department of Health Bureau of Epidemiology 288 North 1460 West Salt Lake City, UT 84116 Office: 801-538-6191 Email: epi@utah.govepi@utah.gov

2. Question? Why Is HIV/AIDS An Important Public Health Issue? Why Does HIV/AIDS Get So Much Attention?

3. HIV Surveillance So why does public health conduct surveillance on HIV disease? – Monitor trends – Detect outbreaks – Evidence based or data driven interventions – Linkage to Care

11. Human Immunodeficiency Virus HIV/AIDS

12. HIV Infection Classification System HIV Infection, Stage 1 – CD4+ T-lymphocyte count of >500 cells/µl (>29%) HIV Infection, Stage 2 – CD4+ T-lymphocyte count of 200-499 cells/µl (14-28%) HIV Infection, Stage 3 (AIDS) – CD4+ T-lymphocyte count of <200 cells/µl (<14) or – AIDS-defining condition HIV Infection, Stage Unknown – No CD4+ T-lymphocyte count and percentage

20. People Living with HIV Infection

25. People Living w/ HIV Infection, Utah, 2011* *By end of December 31 st, 2011 Stage 1Stage 2Stage 3 (AIDS)Stage UnknownTotal 207 (7.9%) 776 (29.6%) 1,410 (53.9%) 221 (8.6%) 2,614 -Stage 3 (AIDS) and Unknown decreased from 2010 -Stage 2 increased by 2% from 2010

31. Three General Areas In Public Health Addressing HIV Surveillance Prevention Treatment and Care

32. Challenges to Surveillance Rates based on reported cases and not necessarily actual cases Unknown information and risk factors Health policies relating to the disease – Immigration Waiver – Prison Testing Laboratory tests – Time & Costs – False positives/negatives – Rapid testing technologies Public Acceptance – Risk perception – Poor Reporting

33. Myth Busting (aka Education) More challenging now then ever! What is the number one answer when asking High School students about the fluids that transfer HIV?

34. Answer – Saliva Why are we not talking about HIV any more? HB 363 – ‘Abstinence Only’ Education

35. Treatment and Care Issues and Trends Increasing number of PLWHA on programs each year but funding is level or decreasing – A number of ADAPs have closed to new patients Better treatments are being developed (smaller pill burden, less side effects) but at increasing costs HIV is now seen as a chronic disease Changing goals and responsibilities due to the Patient Protection and Affordable Care Act

36. Importance of Collaboration Early Identification of Individuals Unaware of Status – New initiative of CDC (prevention programs) and HRSA (treatment programs) Linkage to Care – Important to assist newly diagnosed individuals to enter medical care and stay in medical care Partnerships between areas (surveillance, prevention, treatment and care) and between HIV and non-HIV programs.

37. Linkage to Care Newly diagnosed patients who have a CD4+ or Viral Load laboratory test performed within the 3 months following their diagnosis suggests a linkage to HIV care has occurred. Issues with Linkage to Care – Pt might see provider but no labs performed – Under reporting of laboratory tests

39. The Prevention to Care Continuum: Multiple Steps to Maximize Impact * Hader SL, Kamanu Elias N, West-Ojo T, et al, DC DOH, Conceptual Framework HIV Testing is the Linchpin of the Districts Response… Full Benefits of Testing can not be realized without Linkage to Care

40. HPTN 052 Clinical Trial 2011 Breakthrough of the Year by Science Healthy HIV infected adults entered into care and taking anti-retrovirals before their immune systems begins to decline, are 96% less likely to spread the virus. – M.S. Cohen et al. Prevention of HIV-1 Infection with Early Antiretroviral Therapy. New England Journal of Medicine DOI: 10.1056/NEJMoa1105243 (2011).

41. “On its own, treatment as prevention is not going to solve the global HIV/AIDS problem. Yet when used in combination with other HIV prevention methods— such as knowing one’s HIV status through routine testing, proper and consistent condom use, behavioral modification, needle and syringe exchange programs for injection drug users, voluntary, medically supervised adult male circumcision, preventing mother-to-child transmission, and, under some circumstances, antiretroviral use among HIV- negative individuals—we now have a remarkable collection of public health tools that can make a significant impact on the HIV/AIDS pandemic.” Anthony S. Fauci, M.D., NIAID Director

42. National HIV/AIDS Strategy (NHAS) Reduce New HIV Infections Increase Access to Care and Improve Health Outcomes for People Living with HIV Reduce HIV-Related Disparities and Health Inequalities Achieve a More Coordinated National (LOCAL) Response to the HIV Epidemic

43. Key NHAS Figures 575,000 American lives lost 56,000 new U.S. infections per year 1,100,000 Americans living with HIV 50% of people in U.S. know someone with HIV 375,000 HIV infections averted A new HIV infection every 9 ½ minutes $19.2 billion annual domestic investment 1 in 5 PLWH are unaware of their status

44. Vision for the NHAS The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.

45. Resources 2010 Treatment Guidelines – http://cdc.gov/std/treatment/2010/default.htm http://cdc.gov/std/treatment/2010/default.htm EPT – http://cdc.gov/std/ept/default.htm http://cdc.gov/std/ept/default.htm General STD Information – http://cdc.gov/std/general/default.htm http://cdc.gov/std/general/default.htm Utah Department of Health Websites – http://health.utah.gov/epi/report.html (Reporting) http://health.utah.gov/epi/report.html – http://health.utah.gov/cdc/std.htm (Utah STD Info) http://health.utah.gov/cdc/std.htm – http://health.utah.gov/cdc/sp.htm (HIV/STD Data) http://health.utah.gov/cdc/sp.htm – http://www.catchtheanswers.com/healthcare (CT/GC Info) http://www.catchtheanswers.com/healthcare

46. Thank You Matthew S. Mietchen, MPH HIV/STD Epidemiologist Bureau of Epidemiology Utah Department of Health 288 North 1460 West Salt Lake City, UT 84116 Office: 801-538-6207 Email: mmietche@utah.govmmietche@utah.gov