Figure 1 - Spectrum of HIV disease and reporting points

Transcription

1 Figure 1 - Spectrum of HIV disease and of HIV disease and reporting points COVER STORY: CDC ESTIMATE OF RECENT HIV INFECTIONS...1 HIV/AIDS HIGHLIGHTS...3 STD SURVEILLANCE...11 TECHNICAL NOTES...22 How is the HIV epidemic tracked? For more than 25 years, the Chicago Department of Public Health s STD/HIV/AIDS Division - Surveillance, Epidemiology and Research Section (SER) has monitored the epidemic through HIV/AIDS reporting activities. The HIV/AIDS reporting system tracks many aspects of the epidemic, including HIV and AIDS diagnoses, the number and characteristics of people living with HIV and AIDS, and deaths among persons with HIV and AIDS. Recently, the HIV reporting system was expanded to to be able to monitor new HIV infections as well. All of these components work together to provide the most complete profile of the epidemic that is possible. The newly enhanced reporting system collects data on people with HIV infection throughout the clinical spectrum of disease (see Figure 1), from seroconversion to death. Public health reporting programs receive this information from health care providers who diagnose HIV and AIDS and laboratories that perform HIV-related testing. What is incidence? HIV incidence is the number of new HIV infections in a specifi c population during a specifi c time period. Why is it important to estimate HIV infection? We need incidence estimates to evaluate prevention programs and target resources toward groups with recent infection rates. While the existing reporting system has allowed us to identify new HIV and AIDS diagnoses, until now we had not been able to determine the number of new infections. A new HIV diagnosis does not necessarily mean a new infection. Many people fi rst learn they have HIV years after their initial infection, and many do not know they are infected until they have progressed to AIDS. In Chicago, 30% of new HIV diagnoses are concurrent with (made within a year of) an AIDS diagnosis. If everyone at risk in Chicago was tested once per year, we could measure HIV incidence using the HIV reporting system. But many people do not test regularly, and many are not tested until they develop symptoms. New advances in testing technology have resulted in the development of tests that are able to distinguish recent infections (infections that occurred within the past 5-months) from more established infections. Using this technology, along with information collected through HIV case reports, we are able to track the epidemic at an earlier stage of disease than was previously possible, allowing us to understand how the epidemic is spreading and where prevention interventions are most urgently needed. High Risk Behavior Figure 1 - Spectrum of HIV disease and reporting points HIV Infection (INCIDENCE) HIV Test -----Diagnosis Progression to AIDS AIDS Diagnosis Death

2 How does the HIV incidence reporting system relate to routine HIV reporting? HIV incidence reporting is an extension of the populationbased HIV reporting system and is the first of its kind worldwide. It enables local and state health departments to use their existing reporting infrastructure to collect the information necessary to estimate HIV incidence from all newly diagnosed HIV cases that are reported. In addition to data currently collected through standard reporting, HIV incidence reporting requires retesting of the remnant blood from the initial diagnostic HIV test and information about individuals HIV testing and treatment history. This is all made possible thanks to the continuous work of Chicago health care providers who report HIV/AIDS cases. The combination of the standard EIA test and a test called the BED assay is known as the serologic testing algorithm for recent HIV seroconversion (STARHS). A person who is HIV positive on the standard EIA diagnostic test and determined recent on the BED test is classified as a recent infection. How is the estimate calculated? The components that are needed to estimate HIV incidence are STARHS results and information about HIV testing history for newly diagnosed HIV cases in Chicago. Statistical techniques are then used to extrapolate to the general population. When will Chicago have local estimates of recent HIV infections? CDC will be providing detailed information and materials describing how to calculate the estimate of recent infections for Chicago and all other jurisdictions funded to conduct HIV incidence reporting nationwide. The Division s Surveillance, Epidemiology and Research Section will modify these materials for local use and will release local estimates late this summer. STD/HIV/AIDS Chicago 2

3 Figure 2. People Living with HIV and AIDS and HIV and AIDS Diagnoses by Year, Chicago, (as of 6/30/2008) 22,500 2,500 Number of People Living with HIV/AIDS 20,000 17,500 15,000 12,500 10,000 7,500 5,000 AIDS Diagnoses HIV Diagnoses HIV-Related Deaths Living with HIV/AIDS 2,000 1,500 1, Number of Diagnoses or Deaths 2, Year Overall Trends Since the beginning of the epidemic, 35,735 cases of HIV and AIDS have been reported in Chicago. There are currently 21,367 people living with HIV and AIDS that were diagnosed in Chicago. AIDS diagnoses have declined considerably since the peak in the mid-1990s. The number of diagnosed AIDS cases increased between , declined considerably from , and has remained relatively stable since through 2006 (see Figure 2). After increasing steadily since reporting began, the number of HIV diagnoses (which includes new HIV diagnoses regardless of stage of the disease) peaked in 2001 and has been steadily declining through However, this varies for difefrent demographic populations and rrisk groups. Between , more than 2,000 HIV and AIDS cases were diagnosed each year. Data for 2006 are still provisional and are likely to increase. As the number of new diagnoses stays relatively constant, and with infected people living longer, the number of people living with HIV/AIDS continues to increase considerably each year. The following section presents Chicago data on HIV and AIDS through 2006 as of June 30, STD/HIV/AIDS Chicago 3

4 Table 1. AIDS Diagnosis Rates by Year of Diagnosis and Selected Characteristics, Chicago, (as of 6/30/2008) Chicago* Illinois** U.S.*** Characteristic No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate Sex Male , , , Female , Race/Ethnicity NH Black NA 17, NH White NA 10, Hispanic NA 6, NH Other/Unknown < NA 674 NA Total Cases , , , , Note: Use caution when interpreting data based on 20 or fewer events, the rate/percent is unreliable. Number and rate are suppressed if count is <5. NH= Non-Hispanic *Data for 2006 are provisional; rates per 100,000 population using 2005 population projections. **Rates per 100,000 population using 2006 US Census Bureau Population Estimates. ***Rates per 100,000 population using 2006 US Census Bureau Population Estimates; rates by gender per 100,000 adults/adolscents. The 2006 AIDS diagnosis rate for Chicago was 27.6 per 100,000 population, nearly triple the rate for the state of Illinois (9.4 per 100,000) and more than twice the US rate for 2006 (12.3 per 100,000). The AIDS rate for non- Hispanic (NH) Blacks in Chicago was more than twice the AIDS rate in NH Whites and Hispanics (47.9 vs per 100,000 and 16.6 per 100,000). While all race/ethnicity groups have experienced declines since 1995, differences in the AIDS rates between NH Blacks and NH Whites and Hispanics have persisted. The AIDS rate in NH Blacks was 2.3 times higher than NH Whites and Hispanics in 1995, and in 2006, the AIDS rate was more than 2.7 times higher in NH Blacks than in NH Whites and Hispanics. Since 1995, Hispanics and Whites have had similar AIDS rates. STD/HIV/AIDS Chicago 4

5 Table 2. AIDS Cases by Year of Diagnosis and Selected Characteristics, Chicago, (as of 6/30/2008) * Characteristic No. % No. % No. % No. % No. % No. % No. % Sex Male Female Race/Ethnicity NH Black NH White Hispanic NH Other Transmission Group # Male Sex w/male Injection Drug Use MSM and IDU Heterosexual ## Other Age Group < Total , Note: Use caution when interpreting data based on 20 or fewer events, the rate/percent is unreliable. Number and rate are suppressed if count is <5. Percentages may not add up tp 100% due to rounding. NH= Non-Hispanic *Data for 2006 are not complete due to delays in reporting. #Cases with unknown risk have been re-distributed based on age/gender/race/ethnicity distribution of known cases. Men who have sex wtih men and inject drugs. ##Includes perinatal transmission, blood transfusion and hemophilia. Since 2000, the number of AIDS cases has declined by 23%, from 976 AIDS diagnoses in 2000 to 745 diagnoses in The number of AIDS diagnoses declined in both males and females from 2000 to 2006 at a similar rate. AIDS diagnoses in males declined 22.4% and 23.8% in females. Men who have sex with men continue to represent the largest percentage of AIDS diagnoses, accounting for half (51.2%) of AIDS cases in The proportion of AIDS diagnoses attributable to male-to-male sexual contact has fluctuated over the past 7 years, but the greatest change is observed between 2005 and 2006 with an 18% decline. The most significant decline is observed in IDUs who experienced more than a 51.8% decline between 2000 and In 2000, 30.8% of AIDS diagnoses were due to IDU and by 2006, 19.2% of AIDS diagnoses were due to IDU. People aged account for the largest percentage of AIDS cases (34.1%), followed closely by those aged (27.1%). Together, those aged account for nearly two-thirds of all AIDS diagnoses in NH Blacks in Chicago continue to be disproportionately affected by AIDS. Of all AIDS diagnoses in 2006, NH Blacks accounted for 59.9%; representing three times as many AIDS cases as among NH White (19.8%) or Hispanic (17.4%). STD/HIV/AIDS Chicago 5

6 Table 3. HIV Diagnoses* by Year of Diagnosis and Selected Characteristics, Chicago, (as of 6/30/2008) ** Characteristic No. % No. % No. % No. % No. % No. % No. % Sex Male 1, , , , , , , Female Race/Ethnicity NH Black 1, , , , NH White Hispanic NH Other/Unknown Transmission Group # Male Sex w/male , , , Injection Drug Use MSM and IDU Heterosexual ## Other Age Group < Total 1, , , , , , , Note: Use caution when interpreting data based on 20 or fewer events, the rate/percent is unreliable. Number and rate are suppressed if count is <5. Percentages may not add up tp 100% due to rounding. *HIV diagnoses are the number of people newly diagnosed with HIV in a given year, at any stage of disease. **Data for 2006 are not complete due to delays in reporting. NH= Non-Hispanic #Cases with unknown risk have been re-distributed based on age/gender/race/ethnicity distribution of known cases. Men who have sex wtih men and inject drugs. ##Includes perinatal transmission, blood transfusion and hemophilia. The number of women diagnosed with HIV has declined by 30.0% between 2000 and This decline is sharper than that among men who experienced a 16.4% decline during this time period. In 2006, NH Blacks comprised the majority of HIV diagnoses (55.6%), followed by NH Whites (25.4%), and Hispanics (15.5%). The new redistribution method used to assign unidentifi ed modes of transmission into known transmission groups provides a more accurate picture of how HIV transmission has changed over time. In 2006, male-tomale sexual contact was the leading mode of transmission (62.2%). Heterosexual contact is the second leading mode of transmission (21.6%), followed closely by IDU (12.7%). IDU has declined by more than 60% since 2000, from 548 in 2000 to 198 in out of every 10 (55.2%) new HIV diagnoses are made in individuals aged 30-49; this distribution is similar to that for new AIDS diagnoses. While individuals under the age of 19 account for a small percentage (4.8%) of HIV diagnoses, they have experienced a considerable increase of nearly 30.0% since STD/HIV/AIDS Chicago 6

7 Table 4. HIV Diagnoses* in 2006: Race/Ethnicity and Age by Sex and Mode of Transmission, Chicago, (as of 6/30/2008) Race/Ethnicity Age at Diagnosis Total Gender and NH Black NH White Hispanic NH Oth/Unk < Transmission Grp. # N % N % N % N % No. % No. % No. % No. % No. % No. % Males Male Sex w/ Male Injection Drug Use <5 - < MSM and IDU <5 - <5-0 - < Heterosexual <5 - < Other <5-0 - <5 - <5-0 - <5 - < Total Males , Females Heterosexual Injection Drug Use < < Other <5-0 - <5-0 - <5 - <5 - < Total Females All Male Sex w/ Male Injection Drug Use <5 - < MSM and IDU <5 - <5-0 - < Heterosexual Other <5 - <5 - <5 - < Total Chicago Cases** , Note: Use caution when interpreting data based on 20 or fewer events, the rate/percent is unreliable. Number and rate are suppressed if count is <5. Data for 2006 are not complete due to delays in reporting. *HIV diagnoses are the number of people newly diagnosed with HIV in a given year, at any stage of disease. **The sum of "ALL" cases and percentages may not add up to those in "Total Chicago Cases" due to rounding resulting from risk re-distribution NH = Non-Hispanic #Cases with unknown risk have been re-distributed based on gender/race/ethnicity distribution of known cases. Men who have sex wtih men and inject drugs. Table 4 shows the number of newly diagnosed HIV cases in 2006 for race/ethnicity and age by gender and mode of transmission. Unidentified modes of transmission have been redistributed into known transmission categories, providing a more accurate profile of 2006 HIV diagnoses across multiple demographic groups. Male-to-male sexual contact is the leading mode of transmission for males diagnosed with HIV in 2006 across all race/ethnicity groups. Among NH White and Hispanic males, however, male-to-male sexual contact is the predominant mode of transmission (90.9% and 81.9% respectively). For NH Black males diagnosed with HIV, male-to-male sexual contact accounted for two thirds of diagnoses and injection drug use (IDU) accounted for 19.0% of diagnoses. Heterosexual contact accounts for more than half of HIV diagnoses among females diagnosed with HIV in 2006 for all race/ethnicity groups. This proportion is considerably higher among NH Black and NH White women (79.1% and 76.5% respectively). While heterosexual contact is the leading mode of transmission for Hispanic women (57.1%), injection drug use is responsible for 33.3% of HIV transmissions. Among adolescents and young adults up to 29 years of age, male-to-male sexual contact is the predominant mode of transmission for males and heterosexual contact for females. Injection drug use accounts for at least a third of HIV diagnoses for both men and women aged 50 and over. STD/HIV/AIDS Chicago 7

8 Table 5. People Living with HIV /AIDS*: Mode of Transmission by Sex and Race/Ethnicity, Chicago, through 2006 (as of 6/30/2008) Race/Ethnicity Total NH Black NH White Hispanic NH Other/Unk Gender/Transmission Grp. # N % N % N % N % N % Males Male Sex w/ Male 4, , , , Injection Drug Use 2, , MSM and IDU , Heterosexual Other Total Males 8, , , , Females Heterosexual 1, , Injection Drug Use 1, , Other Total Females 3, , All Male Sex w/ Male 4, , , , Injection Drug Use 3, , MSM and IDU , Heterosexual 2, , Other Total Chicago Cases 11, , , , Note: Use caution when interpreting data based on 20 or fewer events, the rate/percent is unreliable. Number and rate are suppressed if count is <5. Percentages may not add up tp 100% due to rounding. * Includes people with AIDS and people with HIV infection in whom AIDS has not developed. NH = Non-Hispanic #Cases with unknown risk have been re-distributed based on age/gender/race/ethnicity distribution of known cases. Men who have sex wtih men and inject drugs. Includes perinatal transmission, blood transfusion and hemophilia. Of the 21,367 people living with HIV or AIDS, 78.4% are men, 54.3% are NH Black, and 54.7% are MSM. Among NH Black men living with HIV/AIDS, 54.8% were infected as a result of male-to-male sexual contact, and 26.4% as a result of injection drug use. As observed with HIV diagnoses, the majority of NH White men were infected primarily through male-to-male sexual contact (89.6%). Overall, male-to-male sexual contact was the leading mode of transmission among males living with HIV/AIDS (69.8%), while heterosexual transmission was the leading mode of transmission among women (57.6%). In both males and females living with HIV and AIDS, IDU was the second leading mode of transmission (16.2% in males, 36.6% in females). In NH White females living with HIV/AIDS, however, IDU was the leading mode of transmission (49.6%, followed by heterosexual transmission, 46.8%). STD/HIV/AIDS Chicago 8

9 Table 6. People Living with AIDS by Community Area, Chicago, 2006 (as of 6/30/2008) Community Area Prevalent Cases Prevalence Rate Community Area Prevalent Cases Prevalence Rate 1 Rogers Park Washington Park West Ridge Hyde Park Uptown 839 1, Woodlawn Lincoln Square South Shore North Center Chatham Lake View Avalon Park Lincoln Park South Chicago Near North Side Burnside Edison Park <5-48 Calumet Heights Norwood Park Roseland Jefferson Park Pullman Forest Glen South Deering North Park East Side Albany Park West Pullman Portage Park Riverdale Irving Park Hegewisch Dunning Garfield Ridge Montclare Archer Heights Belmont Cragin Brighton Park Hermosa McKinley Park Avondale Bridgeport Logan Square New City Humboldt Park West Elsdon West Town Gage Park Austin Clearing West Garfield Park West Lawn East Garfield Park Chicago Lawn Near West Side West Englewood North Lawndale Englewood South Lawndale Gr. Grand Crossing Lower West Side Ashburn Loop Auburn Gresham Near South Side Beverley Armour Square Washington Heights Douglas Mount Greenwood <5-36 Oakland Morgan Park Fuller Park O'Hare Grand Boulevard Edgewater 629 1, Kenwood Chicago Total 10, U.S. Total ** 436, Note: Use caution when interpreting data based on 20 or fewer events, the rate/percent is unreliable. Number and rate are suppressed if count is <5. People living with AIDS through Rate per 100,000 population using 2005 population projections. Includes all persons with unknown/undetermined community area. **Rate per 100,000 population using 2006 US Census Bureau, Population Estimates Program. Table 6 shows the number of people living with AIDS and the corresponding rate by community area. There has been at least one AIDS case in all of Chicago s 77 community areas. Four of the 10 highest prevalence rates in the city are found on the north side in the Uptown, Edgewater, Lakeview and Rogers Park community area. Three of the 10 highest AIDS prevalence rates are found on the west side in the East Garfi eld Park, West Garfi eld Park and Near West Side community areas. The remaining three highest prevalence rates are located in the on the south side in the Washington Park, Woodlawn, Oakland, and Grand Boulevard community areas. STD/HIV/AIDS Chicago 9

10 Figure 3. AIDS Prevalence Rates by Community Area, Chicago, through 2006 (as of 6/30/2008) AIDS Prevalence Rate per 100,000 AIDSRate 1-4 Cases Roger Park 2 West Ridge 3 Uptown 4 Lincoln Square 5 North Center 6 Lake View 7 Lincoln Park 8 Near North Side 9 Edison Park 10 Norwood Park 11 Jefferson Park 12 Forest Glen 13 North Park 14 Albany Park 15 Portage Park 16 Irving Park 17 Dunning 18 Montclare 19 Belmont Cragin 20 Hermosa 21 Avondale 22 Logan Square 23 Humboldt Park 24 West Town 25 Austin 26 West Garfield Park 27 East Garfield Park 28 Near West Side 29 North Lawndale 30 South Lawndale 31 Lower West Side 32 Loop 33 Near South Side 34 Armour Square 35 Douglas 36 Oakland 37 Fuller Park 38 Grand Boulevard 39 Kenwood 40 Washington Park 41 Hyde Park 42 Woodlawn 43 South Shore 44 Chatham 45 Avalon Park 46 South Chicago 47 Burnside 48 Calumet Heights 49 Roseland 50 Pullman 51 South Deering 52 East Side 53 West Pullman 54 Riverdale 55 Hegewisch 56 Garfield Ridge 57 Archer Heights 58 Brighton Park 59 McKinley Park 60 Bridgeport 61 New City 62 West Elston 63 Gage Park 64 Clearing 65 West Lawn 66 Chicago Lawn 67 West Englewood 68 Englewood 69 Greater Grand Crossing 70 Ashburn 71 Auburn Gresham 72 Beverly 73 Washington Heights 74 Mount Greenwood 75 Morgan Park 76 O'Hare 77 Edgewater STD/HIV/AIDS Chicago 10

11 Sexually Transmitted Diseases among Adolescents in Chicago Compared to adults, adolescents and young adults are disproportionately affected by sexually transmitted diseases (STDs). Common bacterial STDs like chlamydia and gonorrhea often do not present with symptoms in women and men. Since most infections are asymptomatic, the vast majority of persons with infection do not seek STD screening or testing services. Because women are more likely to not show symptoms for the most common STDs compared with men, they are less likely to be diagnosed and treated. Infection with STDs can result in serious long-term health consequences, including pelvic inflammatory disease, tubal (ectopic) pregnancy, chronic pelvic pain, cancer, and infertility. Furthermore, inflammatory STDs like gonorrhea and chlamydia facilitate the transmission of HIV by increasing an individual s chances of acquiring human immunodeficiency virus (HIV) infection if exposed, and raising the possibility of passing HIV onto partners who are uninfected. Co-infection with STDs increases the likelihood of HIV transmission by three to five times, as STD-associated mucosal inflammation serves as a portal of entry and exit for HIV. The HIV epidemic in a community can be mitigated through the successful identifi cation and treatment of the common STDs. Adolescents face many obstacles in obtaining proper diagnosis and treatment even when they present with symptoms. Adolescents may be reluctant to seek care, and may experience barriers that make access to health care and screening services difficult to obtain. The high rates of STDs among adolescents in Chicago highlight the need for expanded STD screening and early treatment to prevent some of the most devastating effects of untreated infections. New Study Shows One in Four Female Adolescents Infected with STDs in the United States A new Centers for Disease Control and Prevention (CDC) study presented in March 2008 indicates that one in four (26%) female adolescents (aged 14-19) in the United States has at least one of the most common sexually transmitted infections (STIs) including human papillomavirus (HPV), chlamydia, herpes simplex virus, and trichomoniasis. Based on the overall STI prevalence of 26 percent, the authors estimate that about 3.2 million adolescent females in the United States are infected with one of these STIs. Key fi ndings of the study included the following: The most common STI was cancer- and genital wart associated HPV (18.3%), followed by chlamydia (3.9%), trichomoniasis (2.5%), and HSV-2 (1.9%). Among the teenage girls who had an STI, 15% had more than one infection. By race, African American teenage girls had the highest prevalence, with an overall STI prevalence of 48% compared to 20% among both Whites and Mexican Americans. Overall, approximately half of all the teens in the study reported ever having had sex. Among these girls, the STI prevalence was 40%. Even among girls reporting only one lifetime partner, one in fi ve (20.4%) had at least one STI. Girls with three or more partners had a prevalence of over 50%. The predominant STI was HPV. Data on 838 female adolescents (aged 14-19) who participated in the National Health and Nutrition Examination Survey (NHANES), a continuous annual study that examines a nationally representative sample of the U.S. household population to assess a broad range of health issues, were analyzed. Adolescents and Young Adults Are Disproportionately Affected by Gonorrhea and Chlamydia in Chicago The adolescent population of Chicago comprises 16.3% of the general population, yet accounts for more than 60% of new infections of gonorrhea and chlamydia. In 2007, 5,664 gonorrhea and 14,781 chlamydia cases were reported among adolescents aged years in Chicago, accounting for 60.3% of all gonorrhea and 66.6% of all chlamydia cases reported in Chicago. The highest rates occur among the year age group for both gonorrhea (1,220.9 per 100,000 population) and chlamydia (3,230.5 per 100,000 population), far exceeding national disease rates by nine to STD/HIV/AIDS Chicago 11

12 For comparison, the national rate for gonorrhea was cases per 100,000 population and cases per 100,000 population for chlamydia in the general population of the United States in In Chicago, 23,096 chlamydia cases and 9,549 gonorrhea cases were reported in 2006, accounting for the most commonly reported communicable diseases in the city. The rate of chlamydia in Chicago (797.5 per 100,000 population) was more than double the U.S. national rate (347.8 per 100,000 population). The rate of gonorrhea in Chicago (329.7 per 100,000 population) was almost three times the U.S. national rate (120.9 per 100,000 population). Since the majority of chlamydia and gonorrhea infections are asymptomatic, a large proportion of disease morbidity goes unrecognized and therefore unreported. Estimates of the true community prevalence of gonorrhea and chlamydia can be expected to be 2-4 times the number of cases identified through passive surveillance reporting. Teens At-Risk for STDs: Sexual Behaviors, Biology, Risk Taking, and Education Data from the Youth Risk Behavior Survey (YRBS) indicate that Chicago teenagers engage in early sexual activity and are at-risk for sexually transmitted diseases like gonorrhea and chlamydia, and unintended pregnancy. Since 1991, the CDC-sponsored Youth Risk Behavior Survey is conducted every two years in the Chicago Public Schools and is designed to monitor changes in the prevalence of behaviors that contribute to the leading causes of death, disease, and injury among youth. The survey is representative of teenagers enrolled in Chicago Public High schools, and data were collected from 968 students in 23 public high schools in Chicago during the fall of Overall, more than half (55.1%) of CPS high school students had engaged in sexual intercourse during their lifetime. The prevalence of sexual intercourse increased with grade level: 39.3% of 9th graders, 48.6% of 10th graders, 72.2% of 11th graders, and 74.9% of 12th graders reported having ever had sexual intercourse. Overall, the prevalence of condom use was 63.0%, and of multiple sex partners was 14.2%. Other Key Findings: Overall, the prevalence of having had sexual intercourse during their lifetime was signifi cantly higher among non-hispanic Black (70.0%) than Hispanic (45.2%) CPS high school students; and signifi cantly high among 12th graders (74.9%) and 11th graders (72.2%) than among 9th graders (39.3%) and 10th graders (48.6%) In 2003, the percentage of CPS high school students who had intercourse for the fi rst time before age 13 was signifi cantly higher than that of high school students nationwide (13.2% vs. 7.4%) Among CPS high school students, 19.6% had engaged in sexual intercourse with four or more sexual partners during their lifetime. During the three months preceding the survey, 42.3% of CPS high school students had engaged in sexual intercourse with one or more people (currently sexually active). Among the 42.3% of currently sexually active CPS high school students, 20.7% had consumed alcohol or used drugs before the last sexual intercourse. Of those who were currently sexually active, 66.6% had used a condom during the last sexual intercourse. Among the 42.3% of currently sexually active CPS high school students, 8.6% reported either they or their partners had used birth control pills to prevent pregnancy before last intercourse. In 2003, 8.9% of CPS high schools students reported that they had been pregnant or gotten someone pregnant. Psychological factors such as the general sense of invulnerability, the desire to try new experiences, and the willingness to take risks, including the frequent changing of sexual partners or having a partner who has multiple partners, may place adolescents at increased risk for STDs. The lack of basic knowledge of STDs contributes to risk-taking behaviors among adolescents. Furthermore, many adolescents may fi nd it diffi cult to use condoms consistently and correctly, due to poor communication and sexual negotiation skills. Biological factors such as cervical ectopy in the developing female cervix very likely make adolescents more susceptible to STDs than older women. Cervical ectopy occurs normally in the developing adolescent cervix when the cells that line the inner canal of the cervix occur on the outer surface, making infection with chlamydia and gonorrhea more likely. Prevention interventions that address the complex dynamics of adolescent risk behaviors, biological and psychological factors, and educational needs are warranted to prevent further STD transmission in this population. STD/HIV/AIDS Chicago 12

13 Table 7. Trends in Gonorrhea Cases by Selected Characteristics, Chicago, (as of 6/30/2007) Year of Report Characteristic N % N % N % N % N % N % Sex Male 7, , , , , , Female 6, , , , , , Race/Ethnicity NH Black 10, , , , , , NH White NH Other Hispanic Unknown 3, , , , , , Age Group Less than , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , Total* 14, , , , , , Note: Groups may not total 100% due to rounding. *Includes cases with unknown sex or age. Since 2001, there has been a 31% decline in the number of reported gonorrhea cases. The same pattern is observed nationally, though the declines in Chicago have been more extreme. Males and females are equally affected by gonorrhea. Nearly 77% of 2006 gonorrhea cases were NH Black. NH Whites and Hispanics comprised just 6% of cases in Approximately 16% of cases were reported with unknown race/ethnicity making interpretation diffi cult. In 2006, the total number of reported cases for those aged was almost twice the number of reported cases for those years of age. More than 58% of cases occurred among people younger than 25 years of age. STD/HIV/AIDS Chicago 13

14 Table 8. Reported Gonorrhea Cases by Community Area Community Area, Chicago, 2006 (as of 6/30/2007) Community Area Gonorrhea Cases Rate Community Area Gonorrhea Cases Rate 1 Rogers Park Washington Park 167 1, West Ridge Hyde Park Uptown Woodlawn Lincoln Square South Shore North Center Chatham Lake View Avalon Park Lincoln Park South Chicago Near North Side Burnside Edison Park <5-48 Calumet Heights Norwood Park Roseland Jefferson Park Pullman Forest Glen South Deering North Park <5-52 East Side Albany Park West Pullman Portage Park Riverdale Irving Park Hegewisch Dunning <5-56 Garfield Ridge Montclare Archer Heights Belmont Cragin Brighton Park Hermosa McKinley Park Avondale Bridgeport Logan Square New City Humboldt Park West Elsdon West Town Gage Park Austin Clearing <5-26 West Garfield Park 231 1, West Lawn East Garfield Park 245 1, Chicago Lawn Near West Side West Englewood 465 1, North Lawndale Englewood 459 1, South Lawndale Gr. Grand Crossing Lower West Side Ashburn Loop Auburn Gresham Near South Side Beverley Armour Square Washington Heights Douglas Mount Greenwood Oakland Morgan Park Fuller Park O'Hare <5-38 Grand Boulevard Edgewater Kenwood Chicago Total 9, Note: Use caution when interpreting data cased on 20 or fewer events, the rate/percent is unreliable. Number and rate are suppressed if count is <5. Includes all persons with unknown/undetermined community area. **Rate per 100,000 population using 2006 US Census Bureau, Population Estimates Program. Table 8 shows the number of gonorrhea cases and rate per 100,000 population by community area, as well as the cumulative number for Chicago and the United States. Figure 4 shows gonorrhea rates by community area. The highest rates are on the west side in the East and West Garfi eld Park, and on the south side in Englewood. and West Englewood. STD/HIV/AIDS Chicago 14

15 Figure 4. Gonorrhea Rate (per 100,000) by Community Area, Chicago, 2006 (as of 6/30/2007) Gonorrhea Rates per 100,000 No cases Small numbers (suppressed) ROGERS PARK 2 WEST RIDGE 3 UPTOWN 4 LINCOLN SQUARE 5 NORTH CENTER 6 LAKE VIEW 7 LINCOLN PARK 8 NEAR NORTH SIDE 9 EDISON PARK 10 NORWOOD PARK 11 JEFFERSON PARK 12 FOREST GLEN 13 NORTH PARK 14 ALBANY PARK 15 PORTAGE PARK 16 IRVING PARK 17 DUNNING 18 MONTCLARE 19 BELMONT CRAGIN 20 HERMOSA 21 AVONDALE 22 LOGAN SQUARE 23 HUMBOLDT PARK 24 WEST TOWN 25 AUSTIN 26 WEST GARFIELD PARK 27 EAST GARFIELD PARK 28 NEAR WEST SIDE 29 NORTH LAWNDALE 30 SOUTH LAWNDALE 31 LOWER WEST SIDE 32 LOOP 33 NEAR SOUTH SIDE 34 ARMOUR SQUARE 35 DOUGLAS 36 OAKLAND 37 FULLER PARK 38 GRAND BOULEVARD 39 KENWOOD 40 WASHINGTON PARK 41 HYDE PARK 42 WOODLAWN 43 SOUTH SHORE 44 CHATHAM 45 AVALON PARK 46 SOUTH CHICAGO 47 BURNSIDE 48 CALUMET HEIGHTS 49 ROSELAND 50 PULLMAN 51 SOUTH DEERING 52 EAST SIDE 53 WEST PULLMAN 54 RIVERDALE 55 HEGEWISCH 56 GARFIELD RIDGE 57 ARCHER HEIGHTS 58 BRIGHTON PARK 59 MCKINLEY PARK 60 BRIDGEPORT 61 NEW CITY 62 WEST ELSDON 63 GAGE PARK 64 CLEARING 65 WEST LAWN 66 CHICAGO LAWN 67 WEST ENGLEWOOD 68 ENGLEWOOD 69 GREATER GRAND CROSSING 70 ASHBURN 71 AUBURN GRESHAM 72 BEVERLY 73 WASHINGTON HEIGHTS 74 MOUNT GREENWOOD 75 MORGAN PARK 76 OHARE 77 EDGEWATER Chicago Department of Public Health STD/HIV/AIDS Division Surveillance, Epidemiology and Research Section, October 2007 STD/HIV/AIDS Chicago 15

16 Table 9. Trends in Chlamydia Cases by Selected Characteristics, Chicago, (as of 6/30/2007) Year of Report Characteristic N % N % N % N % N % N % Sex Male 5, , , , , , Female 16, , , , , , Race/Ethnicity NH Black 14, , , , , , NH White NH Other 1, , Hispanic , , , , Unknown 5, , , , , , Age Group Less than , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , Total* 22, , , , , , Note: Groups may not total 100% due to rounding. *Includes cases with unknown sex or age. Three-quarters of Chlamydia reports are among females, both in Chicago and in the US overall. This sex disparity is likely a surveillance artifact resulting from the fact that screening guidelines target females almost exclusively, and reflecting differential patterns of health care utilization by women and men. As was the case with gonorrhea, most chlamydia cases were in NH Blacks (67%). NH Whites and Hispanics comprised just 13% of cases. Again, note that race/ethnicity is missing for approximately 19% of cases making data interpretation diffi cult. Overall, 85% of chlamydia cases occurred in individuals under the age of 30. Approximately 67%of cases were among persons less than 25 years of age. STD/HIV/AIDS Chicago 16

17 Table 10. Reported Chlamydia Cases by Community Area, Chicago, 2006 (as of 6/30/2007) Community Area Chlamydia Cases Rate Community Area Chlamydia Cases Rate 1Rogers Park Washington Park 355 2, West Ridge Hyde Park Uptown Woodlawn 497 1, Lincoln Square South Shore 861 1, North Center Chatham 504 1, Lake View Avalon Park 134 1, Lincoln Park South Chicago 475 1, Near North Side Burnside 51 1, Edison Park <5-48 Calumet Heights 180 1, Norwood Park Roseland 758 1, Jefferson Park Pullman 91 1, Forest Glen South Deering North Park East Side Albany Park West Pullman 600 1, Portage Park Riverdale 133 1, Irving Park Hegewisch Dunning Garfield Ridge Montclare Archer Heights Belmont Cragin Brighton Park Hermosa McKinley Park Avondale Bridgeport Logan Square New City Humboldt Park 807 1, West Elsdon West Town Gage Park Austin 2,137 1, Clearing West Garfield 496 2, West Lawn East Garfield Park 537 2, Chicago Lawn 751 1, Near West Side 482 1, West Englewood 870 1, North Lawndale 965 2, Englewood 881 2, South Lawndale Gr. Grand Crossing 687 1, Lower West Side Ashburn Loop Auburn Gresham 864 1, Near South Side 106 1, Beverley Armour Square Washington Heights 366 1, Douglas Mount Greenwood Oakland 75 1, Morgan Park Fuller Park 59 1, O'Hare Grand Boulevard 381 1, Edgewater Kenwood Chicago Total 23, Note: Use caution when interpreting data cased on 20 or fewer events, the rate/percent is unreliable. Number and rate are suppressed if count is <5. Includes all persons with unknown/undetermined community area. **Rate per 100,000 population using 2006 US Census Bureau, Population Estimates Program. Table 10 shows chlamydia cases and the rate per 100,000 population by community area, as well as the cumulative number for Chicago and the United States. The highest rates of chlamydia are on the west side, in North Lawndale and on the south side in Englewood. The geographic distribution of chlamydia cases is nearly identical to that of gonorrhea. STD/HIV/AIDS Chicago 17

18 Figure 5. Chlamydia Rate (per 100,000) by Community Area, Chicago, 2006 (as of 6/30/2007) Chlamydia Rates per 100,000 Small numbers (suppressed) ROGERS PARK 2 WEST RIDGE 3 UPTOWN 4 LINCOLN SQUARE 5 NORTH CENTER 6 LAKE VIEW 7 LINCOLN PARK 8 NEAR NORTH SIDE 9 EDISON PARK 10 NORWOOD PARK 11 JEFFERSON PARK 12 FOREST GLEN 13 NORTH PARK 14 ALBANY PARK 15 PORTAGE PARK 16 IRVING PARK 17 DUNNING 18 MONTCLARE 19 BELMONT CRAGIN 20 HERMOSA 21 AVONDALE 22 LOGAN SQUARE 23 HUMBOLDT PARK 24 WEST TOWN 25 AUSTIN 26 WEST GARFIELD PARK 27 EAST GARFIELD PARK 28 NEAR WEST SIDE 29 NORTH LAWNDALE 30 SOUTH LAWNDALE 31 LOWER WEST SIDE 32 LOOP 33 NEAR SOUTH SIDE 34 ARMOUR SQUARE 35 DOUGLAS 36 OAKLAND 37 FULLER PARK 38 GRAND BOULEVARD 39 KENWOOD 40 WASHINGTON PARK 41 HYDE PARK 42 WOODLAWN 43 SOUTH SHORE 44 CHATHAM 45 AVALON PARK 46 SOUTH CHICAGO 47 BURNSIDE 48 CALUMET HEIGHTS 49 ROSELAND 50 PULLMAN 51 SOUTH DEERING 52 EAST SIDE 53 WEST PULLMAN 54 RIVERDALE 55 HEGEWISCH 56 GARFIELD RIDGE 57 ARCHER HEIGHTS 58 BRIGHTON PARK 59 MCKINLEY PARK 60 BRIDGEPORT 61 NEW CITY 62 WEST ELSDON 63 GAGE PARK 64 CLEARING 65 WEST LAWN 66 CHICAGO LAWN 67 WEST ENGLEWOOD 68 ENGLEWOOD 69 GREATER GRAND CROSSING 70 ASHBURN 71 AUBURN GRESHAM 72 BEVERLY 73 WASHINGTON HEIGHTS 74 MOUNT GREENWOOD 75 MORGAN PARK 76 OHARE 77 EDGEWATER Chicago Department of Public Health STD/HIV/AIDS Division Surveillance, Epidemiology and Research Section, October 2007 STD/HIV/AIDS Chicago 18

19 Table 11. Trends in Primary and Secondary Syphilis Cases by Selected Characteristics, Chicago, (as of 6/30/2007) Year of Report Characteristic N % N % N % N % N % N % Sex Male Female Race/Ethnicity NH Black NH White NH Other <5 - Hispanic < Unknown Transmission Group Male sex w/male Heterosexual Males Females Male unknown Age Group Less than < Total* Note: Use caution when interpreting data based on 20 or fewer events, the rate/percent is unreliable. Number and rate are suppressed if count is <5. Percentages may not add up tp 100% due to rounding. *Includes cases with unknown sex or age. Between 2005 and 2006, syphilis cases of all stages decreased by 15%. Over this period, primary and secondary (P&S) syphilis cases decreased by 29% (44% among NH Whites, 11% among NH Blacks and 32% in Hispanics. In 2006, the overwhelming majority of P&S syphilis cases in Chicago were in men (90%), reflecting the continuing syphilis epidemic among men who have sex with men. In 2006, the highest proportion of P&S syphilis cases occurred in NH Blacks (49%) and in those aged Between 2005 and 2006 the number of PS syphilis cases in MSM decreased by 36%. Since MSM sexual contact is the leading mode of HIV transmission in Chicago, syphilis and HIV share similar routes of transmission. Infection with either increases the likelihood of transmitting or acquiring the other from an infected partner. The number of syphilis cases increased 41% between 2004 and Over this period, primary and secondary syphilis cases increased 90% among NH Whites and 58% in Hispanics. STD/HIV/AIDS Chicago 19

20 Table 12. Reported Primary and Secondary Syphilis Cases by Community Area, Chicago, 2006 (as of 6/30/2007) Community Area P & S Syphilis Cases Rate Community Area P & S Syphilis Cases Rate 1 Rogers Park Washington Park <5-2 West Ridge <5-41 Hyde Park Uptown Woodlawn <5-4 Lincoln Square <5-43 South Shore North Center <5-44 Chatham Lake View Avalon Park <5-7 Lincoln Park South Chicago Near North Side Burnside Edison Park Calumet Heights <5-10 Norwood Park Roseland Jefferson Park Pullman Forest Glen South Deering North Park East Side Albany Park West Pullman <5-15 Portage Park Riverdale Irving Park <5-55 Hegewisch Dunning Garfield Ridge Montclare Archer Heights Belmont Cragin <5-58 Brighton Park <5-20 Hermosa McKinley Park Avondale <5-60 Bridgeport <5-22 Logan Square New City <5-23 Humboldt Park West Elsdon <5-24 West Town Gage Park Austin Clearing West Garfield Park <5-65 West Lawn East Garfield Park <5-66 Chicago Lawn Near West Side <5-67 West Englewood North Lawndale <5-68 Englewood South Lawndale <5-69 Gr. Grand Crossing Lower West Side Ashburn Loop <5-71 Auburn Gresham Near South Side <5-72 Beverley <5-34 Armour Square Washington Heights Douglas <5-74 Mount Greenwood Oakland Morgan Park <5-37 Fuller Park O'Hare <5-38 Grand Boulevard Edgewater Kenwood <5 - Chicago Total Note: Use caution when interpreting data cased on 20 or fewer events, the rate/percent is unreliable. Number and rate are suppressed if count is <5. Includes all persons with unknown/undetermined community area. **Rate per 100,000 population using 2006 US Census Bureau, Population Estimates Program. Table 12 shows primary and secondary syphilis cases and the rate per 100,000 population by community area, as well as the cumulative number of Chicago and the most recent national data. The highest rates of PS syphilis are on the north side, in Uptown and Lakeview, and also on the south side, in Englewood. STD/HIV/AIDS Chicago 20

21 Figure 6. Reported Primary and Secondary Syphilis Case Rate by Community Area, Chicago, 2006 (as of 6/30/2007) P&S Syphilis Rates per 100,000 No cases Small numbers (suppressed) ROGERS PARK 2 WEST RIDGE 3 UPTOWN 4 LINCOLN SQUARE 5 NORTH CENTER 6 LAKE VIEW 7 LINCOLN PARK 8 NEAR NORTH SIDE 9 EDISON PARK 10 NORWOOD PARK 11 JEFFERSON PARK 12 FOREST GLEN 13 NORTH PARK 14 ALBANY PARK 15 PORTAGE PARK 16 IRVING PARK 17 DUNNING 18 MONTCLARE 19 BELMONT CRAGIN 20 HERMOSA 21 AVONDALE 22 LOGAN SQUARE 23 HUMBOLDT PARK 24 WEST TOWN 25 AUSTIN 26 WEST GARFIELD PARK 27 EAST GARFIELD PARK 28 NEAR WEST SIDE 29 NORTH LAWNDALE 30 SOUTH LAWNDALE 31 LOWER WEST SIDE 32 LOOP 33 NEAR SOUTH SIDE 34 ARMOUR SQUARE 35 DOUGLAS 36 OAKLAND 37 FULLER PARK 38 GRAND BOULEVARD 39 KENWOOD 40 WASHINGTON PARK 41 HYDE PARK 42 WOODLAWN 43 SOUTH SHORE 44 CHATHAM 45 AVALON PARK 46 SOUTH CHICAGO 47 BURNSIDE 48 CALUMET HEIGHTS 49 ROSELAND 50 PULLMAN 51 SOUTH DEERING 52 EAST SIDE 53 WEST PULLMAN 54 RIVERDALE 55 HEGEWISCH 56 GARFIELD RIDGE 57 ARCHER HEIGHTS 58 BRIGHTON PARK 59 MCKINLEY PARK 60 BRIDGEPORT 61 NEW CITY 62 WEST ELSDON 63 GAGE PARK 64 CLEARING 65 WEST LAWN 66 CHICAGO LAWN 67 WEST ENGLEWOOD 68 ENGLEWOOD 69 GREATER GRAND CROSSING 70 ASHBURN 71 AUBURN GRESHAM 72 BEVERLY 73 WASHINGTON HEIGHTS 74 MOUNT GREENWOOD 75 MORGAN PARK 76 OHARE 77 EDGEWATER Chicago Department of Public Health STD/HIV/AIDS Division Surveillance, Epidemiology and Research Section, October 2007 STD/HIV/AIDS Chicago 21

22 As the HIV epidemic and HIV reporting systems change, new opportunities arise to better describe the epidemic. Thus, in keeping with these changes we have a made a number of modifi cations to STD/HIV/AIDS Chicago. A description of the changes and other technical notes follow. 1) The data presented in this issue reflect all cases in the HIV/AIDS Reporting System (HARS) reported to the Offi ce of HIV/AIDS Surveillance (OHAS) as of June 30, When interpreting data in this report, keep in mind that the HARS database is updated continuously to reflect the most current and complete information on people infected and newly diagnosed with HIV/AIDS. 2) The HIV Diagnoses data presented in this issue include 3 categories of diagnoses: (1) a diagnosis of HIV infection (not AIDS), (2) a diagnosis of HIV infection with a later diagnosis of AIDS, and (3) concurrent diagnoses of HIV infection and AIDS. HIV cases include both laboratory-defined cases as well as HIV cases diagnosed by a physician without laboratory tests. AIDS represent a later stage in the HIV disease spectrum. Data from the HIV reporting system should be interpreted with caution. HIV surveillance reports may not be representative of all persons infected with HIV because not all infected persons have been tested. 3) The guidelines for cell suppression used in this report try to balance data accessibility with confi dentiality and confi dence in the stability of the estimates published. Rates and percentages based on twenty or fewer cases can vary widely just by random chance even when there is no meaningful statistical difference between measurements. Thus, the number and rate for categories with less than 5 cases are suppressed. 4) Report delay is defined as the interval between the date an HIV or AIDS case is diagnosed and the date the case is reported to the health department. Reporting delays are important when interpreting trends in case numbers and rates over time and especially, 2006, the most recent year of diagnosis. Almost 50% of HIV/AIDS cases were actually reported within the same calendar year in which they were diagnosed, and more than 85% of all cases are reported within two calendar years of diagnosis. Additional cases continue to be reported in subsequent years and new cases are identified through laboratory reporting and registry matches. Thus, the number of cases diagnosed for each year--even for remote years--are subject to change as new information is received from any of the reporting sources. 5) For surveillance purposes, HIV and AIDS cases are counted only once in a hierarchy of modes of transmission. Persons with more than one reported mode of transmission are classifi ed in the transmission mode fi rst in the hierarchy. The exception is men who have sex with men and also inject drugs, which has its own category. Persons whose transmission mode is classified as male-to-male sexual contact (MSM) include men who report sexual contact with other men and men who report sexual contact with both men and women. Persons whose mode of transmission is classifi ed as heterosexual contact are persons who report specifi c heterosexual contact with a person with, or at increased risk for, HIV infection (e.g., an injection drug user). Undetermined risk represents persons for whom an expanded investigation either was or is still being followed up by the health department and included cases in persons whose transmission history is incomplete. This and subsequent issues present data on mode of transmission where undetermined risk has been reclassifi ed. For this issue, cases with undetermined risk were re-classifi ed into known risk categories assuming that they follow the same distribution of cases with known risk. This redistribution is done for every sex/race/ethnicity/age category to use as much information as possible on cases with known risk. This type of redistribution method is commonly used by those presenting HIV reporting data and has been found to be quite accurate. STD/HIV/AIDS Chicago 22

23 HIV/AIDS Surveillance Program Chicago Department of Public Health 333 S. State Street, 2151 Chicago, Illinois Phone: (312) Fax: (312) Mail code: 3009 If you would prefer to receive an electronic copy of STD/HIV/AIDS Chicago via , please send to: In the subject line, please include the following; SUBSCRIBE: STD/HIV/AIDS CHICAGO Suggested citation: Chicago Department of Public Health, STD/HIV/AIDS Chicago, Summer, 2008 Contributors and editors for this issue: Managing Editor: Nanette Benbow, MAS, Director, Surveillance, Epidemiology and Research Irina Tabidze, MD, Epidemiologist, STD Surveillance Saadeh Ewaidah, MD. MPH, Epidemiologist, OHAS Charmaine Murray, Epidemiologist, STD Surveillance William Wong, MD, STD/HIV Medical Director Christopher Brown, MPH, MBA, Assistant Commissioner, Division of STD/HIV/AIDS Policy and Prevention Programs City of Chicago Richard M. Daley, Mayor STD/HIV/AIDS Chicago and a catalog of other CDPH publications are available at Revised: 8/13/08 STD/HIV/AIDS Chicago 23