Status of the HIV/AIDS Epidemic San Francisco

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1 Status of the HIV/AIDS Epidemic San Francisco Applied Research, Community Health, Epidemiology and Surveillance Branch Presented to HIV Health Services Planning Council July

2 HIV/AIDS Surveillance System HIV and AIDS (HIV infection stage 3) mandate reporting to local health department Residence at HIV/AIDS diagnosis Dual reporting system April 2006: HIV reporting regulations include all confirmed HIV and HIV viral loads January 2009: CD4 counts reportable 2

3 HIV/AIDS Surveillance System Predominately active system Health department staff visit medical facilities, use a variety of data sources (e.g. lab and pathology reports, ICD codes), review medical records and complete case report form Collect follow up information through routine reporting of lab test results and periodic reviews of medical records Obtain mortality status through review of local death certificates, other health departments, and match with the National Death Index 3

4 Measures of Disease Frequency Prevalence - the number of people with a particular condition in a defined population at a specified time (includes old and new cases) Incidence - the occurrence of NEW cases of disease in a defined population over a specified period of time 4

5 Number of New HIV Diagnoses/Death New HIV diagnoses, deaths and prevalence, San Francisco ,469 14,676 14,928 15,138 15,326 15,506 15,724 15, Year Living HIV cases New HIV diagnoses Deaths 25,000 20,000 15,000 10,000 5,000 0 Number of Living HIV Cases 5

6 Characteristics of Persons Living with HIV, December 31, 2013 and 2013 New Diagnoses PLWH (N=15,901) HIV DX in 2013 (N=359) Number % Number % Gender Male Female Transgender 14, % 6% 2% % 6% 3% Risk MSM MSM PWID PWID Heterosexual Other/Unidentified 11,708 2, % 15% 6% 3% 2% % 9% 6% 4% 4% 6

7 Characteristics of Persons Living with HIV, December 31, 2013 and 2013 New Diagnoses 7 PLWH (N=15,901) HIV DX in 2013 (N=359) Number % Number % Race/Ethnicity White 9,760 61% % African American 2,038 13% 44 12% Latino 2,795 18% 88 25% API/Native Amer % 52 14% Current Age (as of 12/2013) < 30 years 604 4% % years 1,870 12% % years 4,777 30% 88 25% years 5,600 35% 32 9% years 1,689 11% 9 3% 65+ years 1,361 9% 3 1%

8 Number of Cases/Deaths HIV infection stage 3 cases, deaths, and prevalence, , San Francisco 10,000 8,000 6,000 4,000 2, Year of Diagnosis/Death Persons living with HIV infection stage 3 HIV infection stage 3 cases HIV infection stage 3 deaths 8

9 Underlying Causes of Death Among Persons with HIV Infection, Underlying Cause of Death N=1, N=1,060 HIV Non-AIDS cancer Drug overdose Heart disease Suicide Liver disease Number (%) Number (%) 821 (63.2%) 511 (48.2%) 89 ( 6.6%) 119 (11.2%) 46 ( 3.5%) 96 ( 9.1%) 87 ( 6.7%) 85 ( 8.0%) 34 ( 2.6%) 46 ( 4.3%) 27 ( 2.1%) 24 ( 2.3%) 9

10 Underlying Causes of Death by Age Among Persons with HIV Infection, Age at Death (years) HIV Non- AIDS cancer Heart Disease Drug Overdose Suicide Liver Disease No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) (2) 0 (0) 1 (1) 4 (4) 2 (4) 0 (0) (9) 4 (3) 4 (5) 17 (17) 6 (13) 1 (4) (35) 20 (17) 12 (14) 34 (35) 15 (33) 11 (46) (36) 46 (39) 38 (44) 35 (36) 15 (33) 8 (33) (11) 24 (20) 16 (18) 6 (6) 3 (7) 2 (8) (8) 25 (21) 16 (18) 0 (0) 5 (11) 2 (8) 10

11 Five-year survival probability 1 after AIDS for persons diagnosed between 2001 and 2013 by race/ethnicity, exposure category, and gender, San Francisco Percent Surviving 5 Years 100% 85% 86% 91% 88% 90% 78% 82% 84% 85% 78% 78% 84% 80% 70% 70% 60% 50% 30% 20% 10% 0% 0% Race Exposure Category Gender Overall 1 Calculated from Kaplan-Meier method. 2 Transfemale data include all transgender cases. Transmale data are not released separately due to potential small population size. 11

12 Characteristics of Persons Living with HIV Seen in San Francisco Jails, as of December 2013 Gender Male Female Transgender Race/Ethnicity White African-American Latino API/Native American Risk MSM MSM-PWID PWID Other/ No Reported Risk 12 PLWH (N= 15,901) 92% 6% 2% 61% 13% 18% 7% 74% 15% 6% 5% PLWH with history of jail (N= 1,082 ) 76% 16% 8% 37% 42% 16% 3% 21% 42% 31% 6%

13 Living HIV Cases Co-Infected with Hepatitis C, as of December 31, % 80% 60% 87% 66% 69% 86% 72% 89% 89% 20% 0% 100% 34% 31% 28% 13% 14% 11% 11% Male Female Transgender White African Latino API/Native American American 80% 60% 43% 60% 93% 93% Living HIV/AIDS Cases without Hepatitis C Living HIV/AIDS Cases with Hepatitis C 57% 20% 0% 7% 7% 13 MSM MSM-PWID PWID No Reported Risk / Other

14 No. of Cases w/ STD Number of HIV cases diagnosed with an STD by year of STD diagnosis, , San Francisco Year of STD Diagnosis MSM Non-MSM 14

15 Race/Ethnicity of Female Living with HIV Compared to the General Population of San Francisco, December 31, 2013 Living Female HIV Cases N= 906 San Francisco Female Population* N= 396,773 Latina % API/NA 74 8% Other 23 3% API/NA % Other % AA 366 White % Latina % AA % White *United State 2010 Census data

16 Race/Ethnicity of Male Living with HIV Compared to the General Population of San Francisco, December 31, 2013 AA % Male HIV Cases N= 14,638 Latino % API/NA 872 Other 6% 288 2% API/NA 125,517 31% San Francisco Male Population* N=407,157 Other % White % Latino % AA % White 179,919 44% 16 *United State 2010 Census data

17 HIV Cases by Gender and Health Coverage at Time of Initial HIV Diagnosis, Jail, 0.4% HSF, 8.1% Male N= 1,089 Medicaid, 6.5% Medicare, 0.9% VA, 1.2% Other Public, 3.8% Female N= 87 None, Transgender N= % Missing, 12.2% None, 19.5% Missing, 9.2% HSF, 20.7% Jail, 1.1% Private, 39.7% Missing, 15.0% HSF, 15.0% Medicaid, 15.0% Private, 8.0% Other Public, 10.3% Medicaid, 31.0% None, 35.0% Medicare, 5.0% Other Public, 15.0% 17

18 Trends in Health Coverage at Time of HIV Diagnosis by Gender, , San Francisco Female 100% 80% 60% 20% 0% 100% 80% 60% 20% 0% Public Private None Missing Male Public Private None Missing 100% 80% 60% 20% 0% Transgender Public Private None Missing 18

19 Trends in Health Coverage at Time of HIV Diagnosis by Race/Ethnicity, , San Francisco 100% 80% 60% 20% 0% White Public Private None Missing 100% 80% 60% 20% 0% African American Public Private None Missing 100% 80% 60% 20% 0% Latino % 80% 60% 20% 0% Other Public Private None Missing Public Private None Missing 19

20 Percent Percent Percent Trends in Health Coverage at Time of AIDS Diagnosis by Gender, , San Francisco Female Male Public Private None Missing Transgender

21 Number of Homeless Cases Trends in Number and Percent of Diagnosed Cases Homeless at Time of Diagnosis, % 42 13% % 10% 10% 9% 9% 9% Year of HIV Diagnosis Homeless Cases Homeless % 25% 20% 15% 10% 5% 0% Percent of diagnosed cases 21

22 Characteristics of Transgender and HIV Cases, Diagnosed % 50% 50% Transgender HIV Cases (N=103) ALL HIV Cases (n=3,655) 33% 30% 28% 20% 19% 14% 22% 19% 13% 10% 0% White African American Latino Other/Unknown 22

23 Characteristics of People Living with HIV/AIDS, San Francisco EMA as of 12/31/12 Gender Male Female Transgender Race/Ethnicity White African-American Latino Asian/Pac Islander San Mateo Marin San Francisco 83.1% 16.2% 0.7% 49.4% 13.5% 26.1% 10.0% 87.0% 12.1% 0.9% 73.0% 6.6% 16.2% 2.7% 92.0% 5.7% 2.7% 61.8% 12.8% 17.3% 5.4% Risk MSM MSM-IDU IDU Heterosexual 59.2% 5.5% 11.4% 12.1% 66.2% 8.9% 5.5% 11.9% 73.6% 14.8% 6.2% 3.2% 23

24 Estimated Number and Percent of PLWH/A Not in Care San Francisco EMA, July 1, June 30, 2012 Total number Number not in care Percent not in care Persons Living with AIDS 12,541 1, % Persons Living with HIV, aware 8,250 1, % Persons Living with HIV/AIDS 20,791 2, % * Care markers: CD4 and viral load testing or receiving antiretroviral therapy. ** Data sources: lab reporting, medical record review, MediCal data, ADAP.,ARIES. 24

25 Continuum of HIV care among persons diagnosed with HIV, , San Francisco 100% 90% 80% 70% 60% 50% 30% 20% 10% 0% 100% 100% 100% 100% New diagnoses 86% 84% 86% 89% Linked to care within 3 months of diagnosis 62% 63% % % 297 Retained in care for 3-6 months after linkage 52% % Diagnoses 2010 Diagnoses 2011 Diagnoses 2012 Diagnoses 51% % 236 Retained in care for 6-12 months after linkage 46% % 58% % 316 Viral suppression within 12 months among all new diagnoses 25

26 HIV/AIDS Receiving Care in SF Evaluated HIV laboratory tests performed in 2013 San Francisco Among the 13,699 HIV infected person receiving care in San Francisco 3,869 (28%) were OOJ cases 26

27 Living San Francisco HIV cases by care status and current residence status, 2013 Received care OOJ 11% Not in care, lostto-follow-up 9% Received care in SF 61% Not in care, current OOJ address 7% Not in care, current SF address 12% OOJ = Out of SF Jurisdiction 27

28 QUESTIONS? Maree Kay Parisi

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