HIV/AIDS IN FOREIGN-BORN NEW YORKERS

Transcription

1 HIV/AIDS IN FOREIGN-BORN NEW YORKERS Ellen Weiss Wiewel, MHS HIV Epidemiology and Field Services Program New York City Department of Health and Mental Hygiene Needs Assessment Committee, Planning Council January 19, 2010

2 Plan for Today Foreign-born persons in NYC HIV surveillance procedures HIV/AIDS in NYC among foreign-born Implications

3 Foreign-born Persons in NYC

4 Numbers of foreign-born persons 36% of NYC population is foreign-born 3 million of our 8 million residents were born outside the US Foreign-born persons are from many countries Most-represented regions are Caribbean, Asia, Central & South America (including Mexico), and Europe People from Puerto Rico and other US dependencies are not foreign-born Growing foreign-born population in NYC and US NYC in 1990: 28% foreign-born, 2 million US: 8% in 1990 to 11% in 2000 Source: US Census 2000

5 Source: The Health of immigrants in New York City, NYC DOHMH, 2006

6 Health of foreign-born persons Foreign-born New Yorkers were less likely than US-born New Yorkers to: Have a personal doctor (74% vs. 85%) Have any health insurance (73% vs. 90%) Always get needed medical care (86% vs. 91%) Have had two or more heterosexual-sex partners in the last 12 months (males: 17% vs. 20%; females: 6% vs. 9%) Foreign-born and US-born New Yorkers were equally likely to be tested for HIV in the last 12 months (29%) or ever (55-56%) Source: 2007 NYC Community Health Survey. Epiquery: NYC Interactive Health Data System.

7 HIV Surveillance Procedures

8 Conducting HIV/AIDS Surveillance Counting diagnoses and deaths Multiple sources: Electronic lab reports Medical chart reviews Provider reports Patient interviews

9 HIV in Foreign-Born New Yorkers

10 New HIV Diagnoses in NYC, Area of Birth Unknown, 1,202, 16% Foreignborn, 2,077, 27% US-born, 4,014, 52% US dependency, 375, 5% In , 7,668 New Yorkers were newly diagnosed with HIV. 2,077 persons (27%) were born in a foreign country. As reported to the New York City Department of Health and Mental Hygiene by September 30, 2008.

11 Comparing all New Yorkers with HIV Diagnoses, Area of Birth All New Yorkers New Yorkers newly diagnosed with HIV 36% foreign-born 27% foreign-born In , foreign-born people overall were less likely than US-born New Yorkers to be newly diagnosed with HIV. As reported to the New York City Department of Health and Mental Hygiene by September 30, 2008, and US Census 2000.

12 New HIV Diagnoses in NYC, Number of HIV diagnoses 6,000 5,000 4,000 3,000 2,000 1,000 Percent of HIV diagnoses 27% 27% made to foreign-born persons25% 24% 21% 20% 17% 4,713 Non-foreign-born persons 4,075 3,599 3,122 3,083 2,825 2,766 Foreign-born persons 971 1, ,010 1,056 1,021 30% 25% 20% 15% 10% 5% Percent of HIV diagnoses made to foreignborn persons % Year of HIV diagnosis New Yorkers newly diagnosed with HIV are increasingly likely to be foreign-born. Numbers of diagnoses among foreign-born increased modestly. As reported to the New York City Department of Health and Mental Hygiene by September 30, 2008.

13 New HIV Diagnoses in NYC, Region of birth among foreign-born Europe, 106, 5% Asia, 112, 5% Other/Not Specified, 33, 2% Middle East, 23, 1% South America, 303, 15% Caribbean, 811, 39% Central America, 344, 17% Africa, 345, 17% The Caribbean accounts for more new HIV diagnoses among New Yorkers than any other foreign region. As reported to the New York City Department of Health and Mental Hygiene by September 30, 2008.

14 HIV Diagnoses Among Persons Born in the Caribbean, by UHF Neighborhood, East Flatbush Flatbush in central Brooklyn is the UHF neighborhood with the largest number (403) and percent (32%) of new HIV diagnoses who are Caribbean-born. As reported to the New York City Department of Health and Mental Hygiene by September 30, 2007.

15 HIV Diagnoses Among Persons Born in Central & South America, by UHF Neighborhood, The UHF neighborhood of West Queens has the largest number (351) and percent (32%) of new HIV diagnoses born in Central or South America (including Mexico). As reported to the New York City Department of Health and Mental Hygiene by September 30, 2007.

16 New HIV Diagnoses in NYC, Most frequent foreign countries of birth JAM AICA, 192 DOM INICAN REPUBLIC, 243 M EXICO, 184 TRINIDAD AND TOBAGO, 101 COLOM BIA, 80 HAITI, 154 GUYANA, 74 HONDURA S, 70 ECUADOR, 49 GHANA, 42 PERU, 32 CUBA, 32 EL SALVADOR, 29 NIGERIA, 27 INDIA, 26 BRAZIL, 25 BARBADOS, Among newly diagnosed foreign-born New Yorkers, the largest number come from the Dominican Republic. Next are Jamaica, Mexico, Haiti, and Trinidad and Tobago. As reported to the New York City Department of Health and Mental Hygiene by September 30, 2008.

17 New HIV Diagnoses among New Yorkers, Annualized rates of diagnosis by country of birth Annualized rate per 100,000 New Yorkers born in each country As reported to the New York City Department of Health and Mental Hygiene by September 30, 2008.

18 New HIV Diagnoses in NYC, Gender distribution by area of birth Foreign-born Non-foreign-born Female, 658, 32% Female, 1,416, 25% Male, 1,419, 68% Male, 4,175, 75% The ratio of males to females diagnosed with HIV is about 2:1 for foreign-born New Yorkers and about 3:1 for nonforeign-born. As reported to the New York City Department of Health and Mental Hygiene by September 30, 2008.

19 New HIV Diagnoses in NYC, by Known Transmission Risk (males) IDU, 37, 4% Foreign-born Perinatal, 2, 0% Heterosexual male, 161, 18% Other, 1, 0% Non-foreign-born IDU, 370, 12% Perinatal, 10, 0% Heterosexual male, 264, 9% Other, 0, 0% MSM, 704, 78% MSM, 2,342, 79% In , 78-79% of males diagnosed with HIV and with a known risk were MSM, among both foreign-born and nonforeign-born. Among foreign-born, 18% were in the heterosexual category and 4% IDU. Among non-foreign-born males, 9% were in the heterosexual category and 12% IDU. As reported to the New York City Department of Health and Mental Hygiene by September 30, 2008.

20 New HIV Diagnoses in NYC, by Known Transmission Risk (females) Foreign-born Non-foreign-born IDU, 10, 2% Perinatal, 14, 1% IDU, 113, 11% Heterosexual female, 514, 98% Heterosexual female, 904, 88% Among HIV diagnoses, 99% of foreign-born females with known risk were in the heterosexual transmission category. This was also the largest risk category among non-foreign-born females (88%), an additional 11% of whom were in the IDU category. As reported to the New York City Department of Health and Mental Hygiene by September 30, 2008.

21 Concurrent Diagnosis of HIV/AIDS, by Region of Birth % of HIV diagnoses that are concurrent with AIDS 40% 30% 20% 10% 0% 22% 30% 39% 35% 34% Africa Asia Caribbean Cent. & S. America 20% Europe 22% Middle East Non-foreignborn Foreignborn overall: 33% Concurrent HIV/AIDS was diagnosed more frequently among foreign-born New Yorkers from almost every region (33% overall) than non-foreign-born (22%). This public health failure urgently requires attention! * HIV diagnosed concurrently with AIDS (within 31 days of HIV diagnosis). As reported to the New York City Department of Health and Mental Hygiene by September 30, 2008.

22 Initiation of HIV-Related Medical Care After Diagnosis of HIV, by Region of Birth % of HIV diagnoses that initiated care within three months 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 72% 76% 85% 77% 81% 75% 91% Foreignborn overall: 78% 0% Non-foreignborn Africa Asia Caribbean Cent. & S. Region of birth America Europe Middle East Among persons diagnosed with HIV in , foreign-born New Yorkers from every region were more likely to initiate care within 3 months (78% overall) than non-foreign-born (72%). The difference held when limited to persons diagnosed with HIV only (non-aids): 69% vs. 65%. * Care initiation is defined as having a reported CD4 or viral load test within three months of HIV diagnosis. As reported to the New York City Department of Health and Mental Hygiene by September 30, 2008.

23 First CD4 Count After Diagnosis of HIV, by Region of Birth Median first CD4 count Foreignborn overall: Nonforeign-born Africa Asia Caribbean Cent. & S. Region of birth America Europe Middle East Among persons diagnosed with HIV in and initiating care within 3 months, foreign-born New Yorkers from almost every region had a lower median CD4 count (269 overall) than non-foreign-born (352). As reported to the New York City Department of Health and Mental Hygiene by September 30, 2008.

24 Mortality Rate Among Persons With HIV/AIDS, 2007 by Region of Birth Crude mortality rate per 1,000 PWHA Foreignborn overall: Non-foreignborn Africa Asia Caribbean Central & South Region of birth America Europe Middle East Mortality was slightly lower in foreign-born than nonforeign-born PWHA overall. However, mortality among New Yorkers born in the Caribbean and Europe exceeded that among non-foreign-born. As reported to the New York City Department of Health and Mental Hygiene by September 30, 2008.

25 Implications

26 Programmatic needs Routine HIV testing urgently needed for foreignborn New Yorkers High % concurrent HIV/AIDS More advanced infection at diagnosis Ongoing efforts to expand testing are already in place Better linkage to care needed for all newly diagnosed persons Foreign-born more likely to initiate medical care within 3 months than non-foreign-born Field Services Unit facilitates linkage to care Culturally sensitive, multilingual HIV/STD materials and services may need to be customized for foreign-born populations

27 Legal backdrop HIV surveillance (DOH) cannot release your serostatus to anyone HARS records are not subject to subpoena Neither can they be opened by court order All New Yorkers, regardless of documentation status, are entitled to care and treatment Medicaid requires proof of citizenship ADAP and Ryan White do not, but require proof of NYS residency

28 For more information Our web site: City intranet; point to Information Sharing, Health Topics A-Z, click on AIDS DOH HIV/AIDS Epi statistics: Customized data requests Call waiver of inadmissibility for immigrants Call

29 Thank you.