Trends in HIV Incidence and Prevalence in the United States

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1 Trends in HIV Incidence and Prevalence in the United States Irene Hall, PhD, FACE 7th International Workshop on HIV Transmission Washington, DC, July 20, 2012 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

2 Incidence Prevalence Transmission potential Review

3

4 Using estimates from new incidence methodology

5

6

7

8

9 HIV Incidence by Sex, United States,

10 HIV Incidence by Race/ethnicity, United States,

11 HIV Incidence by Transmission Category, Unites States,

12

13 Estimated annual percent change among MSM 13-29y: All, 8.1%, 95% CI 1.9%-14.9%; black, 12.2%, 95% CI 4.2%-20.9%; all other NS.

14

15 HIV Prevalence in the United States 1,148,200 persons living with HIV infection, year-end ,600 (18.1%) persons with undiagnosed HIV infection

16 Prevalence, Rate per 100,000 Estimated Rates of Adults and Adolescents Living with HIV Infection (Prevalence), by Age Group, 2009 United States Age Group

17 Prevalence, Rate per 100,000 Estimated Rates of Adults and Adolescents Living with HIV Infection (Prevalence), by Race/Ethnicity, 2009 United States 1,800 1,600 1,685 1,400 1,200 1, American Indian/Alaska Native Asian Black/African American Native Hispanic/Latino Hawaiian/Other Pacific Islander Race/ethnicity White Multiple races

18 Prevalence, Number Estimated Numbers of Adults and Adolescents Living with HIV Infection (Prevalence), by Transmission Category, 2009 United States 700, , , , ,100 N = 1,148, , , , ,200 70,200 60, , ,100 0 Male-to-male sexual contact Injection drug use Injection drug use Male-to-male - Males - Females sexual contact and injection drug use Transmission category Heterosexual contact - Males Heterosexual contact - Females

19 Stall et al. AIDS Behav (2009) 13:

20 HIV Prevalence in the United States 1,148,200 persons living with HIV infection, year-end ,600 (18.1%) persons with undiagnosed HIV infection

21 Percentage Percentage Percentages and rates of HIV transmission attributed to persons aware and unaware of their HIV infection % TR=10.4/ % % 20 TR=2.7/100 0 People living with HIV 2009 Diagnosed Undiagnosed % 0 New infections Infections from undiagnosed Infections from diagnosed CDC. HIV Surveillance Supplemental Report 2012;17(No. 3, part A). AIDS 2012;26:

22 Number Estimated Number of Adults and Adolescents Living with HIV Infection (Diagnosed and Undiagnosed) * and Percent Undiagnosed United States, ,200,000 1,000,000 No. living with undiagnosed HIV infection No. living with diagnosed HIV infection Percent undiagnosed , , , Percent 200, Year * HIV prevalence was estimated based on national HIV surveillance data for adults and adolescents (aged 13 years at diagnosis) reported through June 2010 using extended backcalculation. The number of undiagnosed HIV infections was derived by subtracting the estimated number of diagnosed living cases from the estimated overall HIV prevalence

23 Estimated rate of males aged 13 years living with HIV infection, 2008 United States Chen et al. Prevalence of undiagnosed HIV infection among persons aged 13 years National HIV Surveillance System, United States, MMWR 2012;61(Suppl.):57-64.

24 Estimated rates of males aged 13 years living with HIV infection and undiagnosed HIV infection, 2008 United States Chen et al. Prevalence of undiagnosed HIV infection among persons aged 13 years National HIV Surveillance System, United States, MMWR 2012;61(Suppl.):57-64.

25 Percentage of MSM with diagnosed and undiagnosed HIV infection, 2008 United States Chen et al. Prevalence of undiagnosed HIV infection among persons aged 13 years National HIV Surveillance System, United States, MMWR 2012;61(Suppl.):57-64.

26 Number of persons with HIV engaged in selected stages of the continuum of HIV care United States 100% 80% 62% 41% 36% 28% CDC. Vital Signs: HIV Prevention Through Care and Treatment United States. MMWR 2011;60:

27 Percentage Percentage of MSM living with HIV (diagnosed) at the end of 2009 who received care in 2009, 13 U.S. jurisdictions Black Hispanic or Latino White Hall et al. JAIDS DOI: /QAI.0b013e318249fe90

28

29 Behavior Among MSM, race/ethnicity, age, not associated with having UAI with a partner with negative or unknown HIV status at last sex Heffelfinger et al. Poster #1091, CROI 2012.

30 Summary Overall, HIV incidence relatively stable Incidence increased among young MSM, particularly young black MSM Disparities exist Incidence Prevalence overall and undiagnosed prevalence Care, treatment, and suppressed viral load Comprehensive prevention strategy must address continuum of care as well as other factors (e.g., risk behavior, STIs, policy)

31 National HIV/AIDS Strategy Reducing the number of people who become infected with HIV Increasing access to care and optimizing health outcomes for people living with HIV; and, Reducing HIV-related health disparities The White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States. Washington D.C.: White House, July 13, 2010.

32 Questions? The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

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