New Jersey HIV/AIDS Epidemiologic Profile 2011

Transcription

1 New Jersey HIV/AIDS Epidemiologic Profile 2011

2 HIV/AIDS in New Jersey New Jersey ranks 5th among 46 states with long-term namebased reporting in the rate of HIV (not AIDS) infection among adults and adolescents in 2010 and 3rd in the rate of adults and adolescents living with HIV in As of December 31, 2011, 76,506 cumulative HIV/AIDS cases have been reported in New Jersey including 1,363 pediatric cases (those <12 years of age) and 3,893 cases reported among inmates. More than half (40,763) of the cumulative cases have died, leaving 35,743 persons living with HIV/AIDS in New Jersey which includes 1,734 incarcerated persons. In 2009, the latest complete year of diagnosis data, there were 1,385 new HIV and AIDS diagnoses and 841 deaths 2 reported among persons with HIV/AIDS. 1 Centers for Disease Control and Prevention. HIV Surveillance Report, 2010; vol Published March Accessed April 2, Deaths are among persons diagnosed in any year but occurring in 2009.

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5 HIV/AIDS Among Prisoners New Jersey ranked 6th among states in the percentage of inmates in state or federal prison with HIV/AIDS in It is estimated that more then two percent (2.1%) of inmates in New Jersey are infected with HIV/AIDS compared with 1.5% of inmates nationally.* Prisoners comprise 5% of cumulative case reports as well as 5% of persons living with HIV/AIDS in New Jersey at the end of % (1,452) of men and 2% (282) of women. * U.S. Department of Justice. Bureau of Justice Statistics, Table 1, HIV in Prisons, December Available at bjs.ojp.usdoj.gov/index.cfm?ty=pbdetail&iid=1747.

6 Prisoner Diagnoses as a Percentage of all HIV/AIDS Diagnoses by Year -- New Jersey,

7 HIV/AIDS Among Females New Jersey ranked 2nd among states in the percentage of cumulative female AIDS (not HIV) diagnoses through 2009 (29% versus 21%) and third in the percentage of female AIDS cases diagnosed in 2009.* Although both the prevalence of HIV/AIDS among females and the percentage of cases diagnosed in recent years in New Jersey remains higher than the national average, both are declining. In recent years, about one-quarter of new AIDS diagnoses nationally are in females. In New Jersey, 30% of HIV/AIDS diagnoses in 2009 were in females. As of December 31, 2011, 34% of persons living with HIV/AIDS in New Jersey are female. * Centers for Disease Control and Prevention. Division of HIV/AIDS Prevention-Surveillance and Epidemiology. Special Data Request, December 2010.

8 Persons Living with HIV/AIDS by Sex New Jersey, 2011 N=35,743 Male 23,471 66% Female 12,312 34%

9 Number Adult/Adolescent HIV/AIDS Diagnoses by Sex -- New Jersey,

10 Percentage HIV/AIDS Diagnoses by Sex New Jersey,

11 The current version of ehars (November 2011) has the capacity to record transgender-specific information. Transgender indicates a discrepancy between 1) Sex at birth and 2) Current gender identity. Issues in the tabulation of TG data: 1. No population estimates for TG people in the US exists so rates cannot be calculated 2. Small cell sizes Transgender Cases 3. Current HIV risk transmission categories are not tailored to TG persons (i.e., MSM) CDC has promised a Guidance for National HIV Surveillance Programs: Working with Transgender- Specific Data.

12 HIV Surveillance: Adult HIV Case Report Form

13 HIV/AIDS and Race/Ethnicity Black African-Americans and Hispanics comprise more than three-quarters of persons living with HIV/AIDS in New Jersey. However, the disparity of HIV/AIDS among Blacks and Hispanics relative to the population has been consistent in recent years. Disparities in HIV infection among Blacks and Hispanics relative to the population are greater for women compared with men. The rate of HIV/AIDS per 100,000 population among Asians and Pacific Islanders in NJ remains the lowest by race/ethnicity among all groups including Whites. Hudson County followed by Middlesex County have the largest number of Asians and Pacific Islanders living with HIV/ AIDS, however Essex County has the highest rate.

14 Population by Race/Ethnicity New Jersey, 2011 Population New Jersey, 2010 N=8,791,894 Persons Living with HIV/AIDS New Jersey, 2011 N=35,743 Source: Population data as of July 2010 Bridged-Race estimates

15 Percentage Persons Living with HIV/AIDS by Sex and Race/Ethnicity -- New Jersey, 2011 Male (N=23,471) Female (N=12,272)

16 Rate per 100,000 Persons Living with HIV/AIDS by Race/Ethnicity -- New Jersey, 2011

17 Rate per 100,000 Persons Living with HIV/AIDS by Sex and Race/Ethnicity New Jersey, 2011 Race Male Female Total No. % Rate No. % Rate No. % Rate Black, non-hispanic 11, ,079 7, ,242 19, ,634 Hispanic 5, , White, non- Hispanic 5, , , Asian/Pac Islander Other Total 23, , ,

18 Rate per 100,000 Persons Living with HIV/AIDS by Sex and Race/Ethnicity -- New Jersey, 2011

19 Asian Pacific Islander County of Residence Number Asian/Pac Isl Living with HIV/AIDS 2011 Asian Pac Isl Population U.S. Census 2010 Prevalence Rate Asian/Pac Isl Living with HIV/AIDS Rank by Number Living with HIV/AIDS Atlantic County Bergen County , Burlington County Camden County Cape May County Cumberland County Essex County 39 37, Gloucester County Hudson County 80 88, Hunterdon County Mercer County Middlesex County , Monmouth County Morris County Ocean County Passaic County Salem County Somerset County Sussex County Union County Warren County Rate for all other counties combined Is 44.9 per 100,000

20 Foreign-Born Persons in New Jersey New Jersey has the third highest proportion of foreignborn residents in the nation. More than 20% of New Jersey s population is foreign-born, defined as those born outside the US, Puerto Rico, Guam or the US Virgin Islands. About 45% of New Jersey s foreign-born are from Latin America and the Caribbean, 31% from Asia, 18% from Europe and 4% from Africa. Bergen County has the most foreign-born Whites, Essex the most foreign-born Blacks, Middlesex the most foreignborn Asians, and Hudson the most foreign-born Hispanics. Kelly, L., Lamothe-Galette, C., Li, Y.,& O Dowd, K. The Health of the Newest New Jerseyans: A Resource Guide. Center for Health Statistics, Office of Policy & Strategic Planning, New Jersey Department of Health & Senior Services, Trenton, NJ. February 2011.

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22 Lifting of the HIV Entry Ban 42 CFR Part 32: Medical Examination of Aliens Removal of HIV Infection From Definition of Communicable Disease of Public Health Significance Effective January 4, 2010 Removes references to HIV from the scope of examinations for people entering the U.S. Individuals are no longer inadmissible based solely on the fact they are infected with HIV Aliens are not required to undergo HIV testing as part of the required medical examination for U.S. immigration CDC analysis: additional immigrant HIV cases per year

23 HIV/AIDS and Country of Birth Status Immigration status is not contained in the HIV/AIDS registry. Country of birth not U.S. is the closest proxy available to track infections among persons living with HIV/AIDS who are foreign-born. Overall, 25,898 (72%) of 35,743 persons living with HIV/ AIDS in New Jersey were born in the United States, followed by 1,350 (4%) born in Puerto Rico, 621 (2%) born in Haiti, and 3,263 (9%) born in the rest of the world. Country of birth is unknown in 4,451 (12%) of cases and varies by race/ ethnicity. Diagnoses of HIV/AIDS among the foreign-born may be decreasing. Note: U.S. does not include Puerto Rico or other U.S. dependencies

24 HIV Surveillance: Adult HIV Case Report Form

25 Persons Living with HIV/AIDS By Race/Ethnicity 1 and Foreign-Born Status -- New Jersey, 2011 Place of Birth White non- Hispanic Black non- Hispanic Hispanic Asian/ Pac Isl Total No. % No. % No. % No. % No. % United States 2 6, , , , Not United States , , , Unknown , , , Total 7, , , , This chart does not include 230 persons living with HIV/AIDS of other and unknown race/ethnicity. 2 U.S. does not include Puerto Rico or other U.S. dependencies

26 HIV/AIDS Diagnoses by Foreign Born Status and Year of Diagnosis New Jersey, US* Born Not US Born Unknown Year No. % No. % No. % ,505 75% % 191 9% ,455 77% % 119 7% ,312 75% % 111 6% ,086 73% % 121 8% ,084 77% % 79 6% ,120 81% % 75 5% * Note: U.S. does not include Puerto Rico or other U.S. dependencies

27 HIV/AIDS and Exposure New Jersey ranks 2 nd among the 50 states in the percentage (48%) of cumulative AIDS cases diagnosed through 2009 with IDU exposure which is almost twice the percentage (26%) of cumulative AIDS cases with IDU exposure nationally. New Jersey ranks 49th among the 50 states in the percentage (25%) of cumulative AIDS cases with MSM exposure which is nearly half the percentage (47%) of cumulative AIDS cases with MSM exposure nationally. New Jersey ranks 14th among the 50 states in the percentage (21%) of cumulative AIDS cases with High Risk Heterosexual contact exposure compared with 18% of cumulative AIDS cases with High Risk Heterosexual contact exposure nationally. New Jersey: Estimated Numbers of AIDS Diagnoses Among Adults and Adolescents, by Transmission Category, Cumulative through Retrieved from

28 Estimated Adult / Adolescent AIDS Diagnoses by Exposure, Cumulative through 2009 New Jersey United States Source: New Jersey: Estimated Numbers of AIDS Diagnoses Among Adults and Adolescents, by Transmission Category, Cumulative through Retrieved from

29 HIV/AIDS and Risk Transmission Information According to CDC s standard, at least 85% of newly reported HIV cases should have risk factor information one year following the close of the diagnosis year. The proportion of cases reported in New Jersey without risk transmission information has been steadily increasing. 1. More than half (52%) of cases in recent years are reported with no transmission risk 2. One-third (32%) of all prevalent cases do not have risk information as of the end of 2011.

30 Percentage HIV/AIDS Diagnoses by Facility Type New Jersey,

31 Percentage HIV/AIDS Diagnoses Reported with Risk Information by Facility Type -- New Jersey,

32 Persons Living with HIV/AIDS by Sex and Unmodified Exposure New Jersey, 2011 N=35,743

33 Persons Living with HIV/AIDS by Sex and Unmodified Exposure New Jersey, 2011 Male (N=23,471) Female (N=12,272)

34 Number Adult/Adolescent HIV/AIDS Diagnoses by Unmodified Exposure -- New Jersey,

35 Adult/Adolescent Diagnoses by Major Unmodified Exposure Categories New Jersey, YEAR MSM MSM% IDU IDU% HETRO HET% UNKN UNKN%

36 Number Adult/Adolescent Male HIV/AIDS Diagnoses by Unmodified Exposure -- New Jersey,

37 Percentage Adult/Adolescent Male HIV/AIDS Diagnoses by Unmodified Exposure -- New Jersey,

38 Number Adult/Adolescent Female HIV/AIDS Diagnoses by Unmodified Exposure -- New Jersey,

39 Percent Adult/Adolescent Female HIV/AIDS Diagnoses by Unmodified Exposure -- New Jersey,

40 Estimated Males Living with HIV/AIDS by Race/Ethnicity and Unmodified Exposure Category -- New Jersey, 2011 Exposure Category White non- Hispanic Black non- Hispanic Hispanic Other/ Unknown 1 Total No. % No. % No. % No. % No. % Male-to-male sex 3, , , , Injection Drug Use , , , MSM/IDU Heterosexual sex with -Injection Drug User Partner with HIV , , Partner with other risk Pediatric exposure Other/Unknown , , , ,974 Total 5, , , , Other includes Asian/Pacific Islander and American Indian/Alaska Native. The categories of unknown race/ethnicity and other race/ ethnicity are combined due to the small number of cases in the other category. 2 The categories of other exposure and unknown exposure are combined due to the small number of cases in the other category.

41 Estimated Females Living with HIV/AIDS By Race/Ethnicity and Unmodified Exposure Category -- New Jersey, 2011 Exposure Category White non- Hispanic Black non- Hispanic Hispanic Other/ Unknown 1 Total No. % No. % No. % No. % No. % Injection Drug Use , , Heterosexual sex with -Injection Drug User , Bisexual Male Partner with HIV , , Partner with other risk Pediatric Exposure Other/Unknown , ,560 Total 1, , , , Other includes Asian/Pacific Islander and American Indian/Alaska Native. The categories of unknown race/ethnicity and other race/ ethnicity are combined due to the small number of cases in the other category. 2 The categories of other exposure and unknown exposure are combined due to the small number of cases in the other category.

42 HIV/AIDS and Age Nearly two-thirds of prevalent cases are in persons ages 45 or older. Between , there were shifts in age at HIV or AIDS diagnosis. Diagnoses among persons ages as a percentage of all HIV and AIDS diagnoses decreased 37% from 41% of all diagnoses in 2000 to 26% of diagnoses in In contrast, diagnoses for persons ages 45 and older increased as a share of total diagnoses during this time period. The most dramatic change in diagnoses by age group between 2000 and 2009 was seen among persons Diagnoses as a share of all diagnoses among this group increased 150%, rising from 6% of diagnoses in 2000 to 15% of diagnoses in Eighty-seven percent of diagnoses among year olds between 2007 and 2009 were among Blacks and Hispanics.

43 Percentage Persons Living with HIV/AIDS by Age Group -- New Jersey, 2011

44 Number New Adult/Adolescent HIV/AIDS Diagnoses by Age Group -- New Jersey,

45 Percentage New Adult/Adolescent HIV/AIDS Diagnoses by Age Group -- New Jersey,

46 HIV/AIDS Diagnoses Persons Ages by Sex and Race/Ethnicity -- New Jersey, Persons Ages Race/Ethnicity Males Females Total No. % No. % No. % White non-hispanic Black non-hispanic Hispanic Asian/Pacific Islander Other/Unknown Total

47 Pediatric HIV/AIDS Cases New Jersey ranks 3rd among states in the estimated rate of children living with a diagnosis of HIV infection at the end of Perinatal transmission was reduced to three percent in New Jersey in 2009.

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49 HIV Testing in New Jersey The CDC estimates that of the nearly 1.2 million people living with HIV in the United States, roughly one in five remains undiagnosed and is therefore unaware of his or her illness.1 HIV testing rates in the United States have increased in recent years, and the percentage of persons identified late in their disease progression has decreased. Still, less than half of adult Americans indicate ever having been tested for HIV. Nearly onethird (32%) of persons with HIV in the United States are still diagnosed late in their disease progression. The percentage of persons in New Jersey who report ever being tested is slightly higher than the national rate. However, a higher percentage of HIV diagnoses (38%) among New Jerseyans in 2007 occurred late.2 1. Centers for Disease Control and Prevention. HIV Surveillance United States, MMWR 2011; 60(21): Centers for Disease Control and Prevention. Vital Signs: HIV Testing and Diagnosis Among Adults United States, MMWR 2010; 59(47):

50 Number Adult/Adolescent HIV/AIDS Diagnoses by Stage of Disease -- New Jersey,

51 Percentage Simultaneous HIV/AIDS Diagnoses New Jersey,

52 HIV Incidence Surveillance HIV Incidence Surveillance provides the information needed to estimate the number of new HIV infections per year in the United States. The estimate includes persons diagnosed and reported as well as those infected but not yet diagnosed or reported. The NJDHSS Division of HIV, STD, TB Services has been funded by CDC to conduct Incidence Surveillance since We were one of 18 sites to contribute data to the national incidence estimates from 2006 through 2009 published in the August 3, 2011 edition of PLoS ONE. For additional information:

53 National HIV Incidence The annual number of new infections from 2006 to 2009 was stable overall with an estimated 48,100 new infections in the United States in Although the annual number of infections was stable from 2006 to 2009, there was a 20% increase in HIV incidence among people aged years driven by a 34% increase in young MSM. Among MSM aged 13-29, HIV incidence among African-American MSM increased 48% from 2006 to Prejean J, Song R, Hernandez A, Ziebell R, Green T, et al. (2011) Estimated HIV Incidence in the United States, PloS ONE 6(8): e17502.doi: /journal.pone

54 Number HIV/AIDS Diagnoses among MSMs by Race/Ethnicity and Age -- New Jersey,

55 HIV/AIDS by Locality The overall HIV/AIDS prevalence rate as of December 31, 2011 is 407 per 100,000 population in New Jersey. The overall rate of new HIV and AIDS diagnoses is 15.8 per 100,000 population in Prevalence is highest in Essex and Hudson counties. More than 12 of every 1,000 persons in Essex County are living with HIV/AIDS as of December 31, Cities with the highest prevalence are East Orange and Newark. More than 2% of the population of East Orange and Newark are living with HIV/AIDS. HIV/AIDS prevalence is five times higher in these cities than the Statewide rate. Eight of the ten Impact cities have HIV/AIDS prevalence rate over 1%.

56 Persons Living with HIV/AIDS in 2011 by Planning Area Prevalence Rate: Persons Living with HIV/AIDS per 100,000 population by Planning Area Statewide rate= 407 per 100, Planning Area: Prevalence Rate 1 Jersey City EMA Newark EMA Atlantic-Cape May Mercer Area Cumberland EMA Bergen-Passaic EMA Southern NJ Area Middlesex-Somerset-Hunterdon Monmouth-Ocean Area 203

57 HIV/AIDS Cases Diagnosed in 2009 by Planning Area New HIV/AIDS Cases Diagnosed in CY2009 per 100,000 population, by Planning Area Statewide rate= 15.8 per 100, Data as of 12/31/ Planning Area: New Cases Rate 1 Newark EMA Jersey City EMA Cumberland EMA Mercer Area Atlantic-Cape May Bergen-Passaic EMA Southern NJ Area Monmouth-Ocean Area Middlesex-Somerset-Hunterdon 7.1

58 Persons Living with HIV/AIDS in 2011 by County Prevalence Rate: Persons Living with HIV/AIDS per 100,000 population 21 3 Statewide rate= per 100, Counties: Prevalence Rates 1 Essex Hudson Passaic Atlantic Union Mercer Cumberland Camden Monmouth Middlesex Salem Cape May Bergen Somerset Burlington Morris Warren Gloucester Ocean Hunterdon Sussex Data as of 12/31/2011

59 HIV/AIDS Cases Diagnosed in 2009 by County New HIV/AIDS Cases Diagnosed in CY2009 per 100,000 population Statewide rate= 15.8 per 100, Data as of 12/31/ Counties: New Case Rates 1 Essex Hudson Cumberland Passaic Atlantic Mercer Union Camden Monmouth Cape May Burlington Somerset Middlesex Morris Bergen Gloucester Salem Ocean Sussex Hunterdon Warren 1.8

60 Persons Living with HIV/AIDS in 2011 in Impact Cities Data as of 12/31/ Ten Impact Initiative Cities Prevalence Rates: 1 East Orange Newark Irvington Atlantic City Trenton Paterson Jersey City Plainfield Camden Elizabeth 868