Missouri St. Louis TGA 2016 HIV Epidemiological Profile St. Louis TGA Part A Planning Council Prepared by the City of St. Louis Department of Health Center for Health Information, Research, and Planning Planning Council, May, 2017 1
Table of Contents Introduction St. Louis Transitional Grant Area Map HIV Disease Prevalence HIV/AIDS Incidence Unmet Need Other Sexually Transmitted Diseases Summary 2
Introduction: Purpose To create a better understanding of the HIV/AIDS epidemic in our area Compares trends in HIV/AIDS cases in the last few years To identify subpopulations disproportionately affected by the disease 3
Introduction: Sources Mandatory Reporting of HIV & AIDS Cases omissouri Department of Health and Senior Services (MDHSS) o Illinois Department of Public Health (IDPH) HIV/AIDS Reporting System (ehars) oall positive test results o Demographic information Demographic Information (Census) 4
TGA - Transitional Grant Area PLWH/A People living with HIV or AIDS MOT Mode of Transmission o MSM Men who have sex with men (includes homosexual and bisexual) o IDU Intravenous drug user o MSM/IDU Men who have sex with men and are intravenous drug users o Hetero Persons infected by a partner of the opposite sex o Peds HIV infected child due to prenatal or perinatal exposure o NIR No indicated risk Introduction: Commonly Used Terms HIV Disease Categorization that includes those with HIV infection and AIDS disease (HIV/AIDS) 5
Introduction: Context WHO o People living with HIV (PLWH) o People living with AIDS (PLWA) o People living with HIV Disease (PLWH/A) WHAT o Incidence o Prevalence WHERE omo St. Louis TGA 6
Missouri St. Louis TGA 7
Demographics: Who do We Save? othe St. Louis Region is the largest urban area in Missouri as of 2010 census, has more than 2,000,000 residents ost. Louis County is the most populated county in the region, with a little over 1,000,000 residents othe region s population is approximately 75 percent White, 20 percent Black, 3 percent Asian, Hispanic is less than 1 percent 8
Socio-economic Status o Over 36 percent of the population s household income is less than $50,000 o Approximately 20 percent of the population live below 100 Federal Poverty Level; 10 percent had less than high school education o Over 10 percent of the population are uninsured 9
HIV/AIDS Prevalence Those currently living with HIV or AIDS, this includes all cases that have been diagnosed as of 12/31/2016 (MO) 10
HIV/AIDS Prevalence COUNTY RACE SEX AGE GROUP MOT SUBPOPULATIONS 11
HIV/AIDS Prevalence- County MO, St. Louis TGA HIV Disease Prevalence Rates, Missouri St. Louis TGA County Total Living HIV Disease as of 12/31/2012 Total Living HIV Disease as of 12/31/2013 Total Living HIV Disease as of 12/31/2014 Total Living HIV Disease as of 12/31/2015 Total Living HIV Disease as of 12/31/2016 Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate FRANKLIN CO. 49 48.4 50 49.1 49 48.0 50 48.8 54 52.5 JEFFERSON CO. 126 57.2 127 57.4 126 56.6 128 57.2 134 59.8 LINCOLN CO. 16 30.0 18 33.4 19 35.0 20 36.6 24 43.4 ST CHARLES CO. 210 56.9 220 58.8 226 59.5 244 63.3 254 65.0 ST LOUIS CITY 3199 1002.6 3249 1021.9 3280 1035.2 3310 1051.2 3410 1095.0 ST LOUIS CO. 1874 187.3 1964 196.2 2067 206.5 2148 214.4 2256 225.9 WARREN CO. 8 24.4 10 30.3 10 30.1 12 35.8 13 38.5 MO-TGA Total 5482 261.5 5638 268.1 5777 273.8 5912 279.4 6145 290.3 *Rates are per 100,000 persons 12
HIV/AIDS Epidemic in the MO, St. Louis TGA As of 2016: o o Cumulative HIV/AIDS cases reported in the St. Louis Region: 10,036 o AIDS: 6,549 o Deaths: 3,891 o 3,508 AIDS deaths People living with HIV/AIDS: o 6145 people currently live in the St. Louis Region 13
Characteristics of People Living with HIV/AIDS, 2016 Characteristics N % Rates (per 100,000) Sex Race/Ethnicity Male 5,051 82% 497 Female 1,094 18% 100 Total 6,145 291.1 African American 3434 56% 838.5 White 2427 39% 157.7 Hispanic 169 3% 284.0 Other 113 2% 109 Unknown 2 - - Total 6,145 100% 291.1 14
HIV/AIDS Prevalence: County MO St. Louis TGA, 2016 Population by County MO St. Louis TGA Prevalence of PLWHA by County MO ST. Louis TGA, 2016 (n=6145) ST LOUIS CO. 47% WARREN CO. 2% FRANKLIN CO. 5% JEFFERSON CO. 10% Disproportionate Impact: 15% of MO St Louis TGA population live in City of St. Louis, while the St. Louis City accounts for 56% of HIV/AIDS cases in the MO St. Louis TGA. ST LOUIS CITY 15% ST CHARLES CO. 18% LINCOLN CO. 3% ST LOUIS CITY 56% ST LOUIS CO. 37% WARREN CO. 0% FRANKLIN CO. 1% JEFFERSON CO. 2% LINCOLN CO. 0% ST CHARLES CO. 4% 15
Rate per 100,000 people 300 290 HIV/AIDS Prevalence Rate MO St. Louis TGA Prevalence Rates of HIV Disease MO, St. Louis 2009-2016 MO-TGA Total 290.3 280 270 268.1 273.8 279.4 260 250 240 258.5 248.6 253.9 261.5 230 220 2009 2010 2011 2012 2013 2014 2015 2016 Years 16
HIV/AIDS Prevalence: Race/Ethnicity MO St. Louis TGA Hispanic 3% Population By Race/ethnicity, MO ST. Louis TGA Black 19% Other 5% Other 2% (n=89) Hispanic 3% (n=161) Prevalence PLWH/A by Race/Ethnicity, MO St. Louis TGA, 2016 (n=6145) Unknown 0% (n=2) Disproportionate Impact: Prevalence White rate of HIV Disease among black 73% is approximately 6 times higher than Whites (830.7 cases per 100,000 blacks, vs 152.3 cases per 100,000 whites) White 39% (n=2389) Black 56% (n=3271) Black White Hispanic Other Black White Hispanic Other Unknown 17
HIV/AIDS Prevalence: Sex Population by Sex, MO St. Louis TGA, 2015 Prevalence of PLWH/A by Sex, MO St. Louis TGA, 2016 (n=6145) Female 18% (n=1094) Female 52% Disproportionate Impact: Males have the highest rate Male of HIV disease prevalence in 48% the St. Louis TGA (495.6 per 100,000 males), which is approximately FIVE times more the prevalence rate for females (100.2 per 100,000 females) Male 82% (n=5051) Male Female Male Female 18
Characteristics of People Living with HIV/AIDS, 2016 Age Characteristics N % Rates (per 100,000) Under 13 16 < 1% 4.3 13-24 317 5% 105.4 25-44 2297 37% 416.6 45-64 3125 51% 532.5 65+ 390 6% 126.1 Total 6,145 19
HIV/AIDS Prevalence: Age Group Population by Age Group, MO ST. Louis TGA Percent of PLWH/A by Age Group MO, St. Louis TGA, 2016 65 & Older 15% Under 13 17% 65 & Older 6% 13-24 5% Under 13 <1% Disproportionate 45-64 Impact: 28% 25-44 year olds make up 38% of the PLWH/A. 25-44 26% 13-24 14% 45-64 51% 25-44 38% Under 13 13-24 25-44 45-64 65 & Older Under 13 13-24 25-44 45-64 65 & Older 20
Characteristics of People Living with HIV/AIDS, 2016 MOT White N(%) Black (n(%) Hispanic (n%) Other/Unknown (n(%) Total MSM 1,859(47.0%) 1,920(48.5%) 105(2.7%) 74(1.7%) 3,958 IDU 74(32.6%) 146(64.3%) <5 <5 227 MSM & IDU 84(47.5%) 87(49.2%) <5 <5 177 Heterosexual 199(19.5%) 772(75.5%) 30(2.9%) 21(2.1%) 1,022 Other/NIR 211(27.7%) 509(66.9%) 26(3.4%) 15(2.0%) 761 Total 2,427 3,434 169 115 6,145 21
HIV/AIDS Prevalence: MOT Other/Unk/NR 12% (n=761) Prevalence of PLWH/A by MOT, MO St. Louis TGA, 2016 N=6145 Heterosexual 17% (n=1022) MSM & IDU 3% (n=177) IDU 4% MSM 64.4% (n=3958) MSM IDU MSM & IDU Heterosexual Other/Unk/NR 22
Percentage HIV/AIDS Prevalence Subpopulation: Males, by Race/Ethnicity 60% 50% 51.9% Prevalence HIV Disease Among Males by Race/Ethnicity, MO St. Louis TGA, 2016 (N=5051) 43.7% 40% 30% 20% 10% 0% 2.7% 1.8% Black White Hispanic Other/Unknown Race Category Other/Unknown was not stratified by Race in this report 23
Percentage of Female HIV/AIDS Prevalence Subpopulation: Female, by Race/Ethnicity 80% 74.3% Prevalence of HIV Disease Among Females by Race/Ethnicity, MO St. Louis TGA, 2016 (n=1094) 70% 60% 50% 40% 30% 20% 10% 0% 20.2% 3.1% 2.4% Black White Hispanic Other/Unknown Race *Race category Other/Unknown/NR was not stratified by Gender in this report 24
Rate per 100,000 people HIV/AIDS Prevalence Subpopulation: Males, by Known Race/Ethnicity 1600 1400 HIV Disease Prevalence Rate Among Males by Know Race/Ethnicity, MO St. Louis TGA 2016 (N=4946) 1392.7 1200 1000 800 600 400 200 426.5 282.5 0 Black Hispanic White Race/Ethnicity Category Other/Unknown was not stratified by Race in this report 25
Rate per 100,000 population HIV/AIDS Prevalence Subpopulation: Females, by Known Race (N=1068) 400 350 HIV Disease Prevalence Rate Among Females by Known Race/Ethnicity MO, St. Louis, TGA 20146 361.0 300 250 200 150 100 108.2 50 0 27.2 Black Hispanic White Race/Ethnicity *Race category Other/Unknown/NR was not stratified by Gender in this report 26
Percentage of Male HIV/AIDS Prevalence Subpopulation: Males by MOT & Race HIV Disease Among Males by MOT & Race/Ethnicity MO St. Louis TGA, 2016 (n=5051) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 84.3% 77.8% 73.3% Disproportionate Impact: MSM reported as the highest risk category among males of all races 8.2% 3.5% 1.6% 3.3% 3.8% 5.9% 1.5% 3.0% 2.6% 11.6% 11.9% 7.7% MSM IDU MSM & IDU Heterosexual Other/Unk/NR MOT Black White Hispanic *Race category Other/Unknown was not stratified by Gender in this report 27
Percentage of Female HIV/AIDS Prevalence Subpopulation: Females by MOT & Race 80% HIV Disease Among Females by MOT & Race/Ethnicity, MO St. Louis TGA 2016 (N=1094) 70% 60% 50% 40% 68.4% 64.3% 64.7% Disproportionate Impact: heterosexual reported as the highest risk category among females of all races 30% 25.1% 29.4% 20% 17.2% 18.6% 10% 0% 6.5% 5.9% IDU Heterosexual Other/Unk/NR Race by MOT Black White Hispanic *Race category Other/Unknown was not stratified by Gender in this report 28
Percentages HIV/AIDS Prevalence Subpopulation: Age Group & Race/Ethnicity 40% 35% 30% 25% 20% 15% 10% Percentage of HIV Disease by Age Group and Race/Ethnicity MO, St. Louis, 2016 Disproportionate Impact: 45 & older make up 71% of the PLWH/A for White population while in Hispanic 60% of the cases are in age group 35-54. 10.5% 16.0% 16.6% 33.1% 34.5% 28.0% 26.6% 37.2% 20.7% 5% 0% 3.0% 0.1% 0.6% 1.1% Under 18 19-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55 & older Race/Ethnicity Black White Hispanic Other/Uknw 29
HIV/AIDS Incidence Incidence is the number of newly diagnosed cases within a specific time period. 30
HIV/AIDS Incidence COUNTY RACE/ETHNICITY SEX AGE GROUP MOT SUBPOPULATIONS 31
HIV/AIDS Incidence by County MO St. Louis TGA Missouri St. Louis TGA New HIV/AIDS Diagnosis Rates County HIV Disease Incidence as of 12/31/2012 HIV Disease Incidence as of 12/31/2013 HIV Disease Incidence as of 12/31/2014 HIV Disease Incidence as of 12/31/2015 HIV Disease Incidence as of 12/31/2015 Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate FRANKLIN CO. 2 2.0 1 1.0 2 2.0 1 1.0 1.0 1.0 JEFFERSON CO. 4 1.8 3 1.4 4 1.8 6 2.7 6.0 2.7 LINCOLN CO. 0 0.0 2 3.7 0 0.0 2 3.7 3.0 5.4 ST CHARLES CO. 17 4.6 13 3.5 12 3.2 19 4.9 16.0 4.1 ST LOUIS CITY 127 39.8 113 35.5 90 28.4 102 32.4 121.0 38.9 ST LOUIS CO. 136 13.6 108 10.8 120 12.0 108 10.8 108.0 10.8 WARREN CO. 0 0.0 1 3.0 0 0.0 2 6.0 1.0 3.0 MO-TGA Total 286 13.6 241 11.5 228 10.8 240 11.3 256 12.1 *Rates are per 100,000 persons 32
HIV/AIDS Incidence by Race/Ethnicity MO St. Louis TGA HIV Incidence AIDS Incidence Race/Ethnicity 2014 2015 2016 2014 2015 2016 Cases % Cases % Cases % Cases % Cases % Cases % White 51 29.0% 56 30.1% 57 27.9% 16 30.8% 19 35.2% 16 30.8% Black 120 68.2% 117 62.9% 133 65.2% 32 61.5% 28 51.9% 35 67.3% Hispanic 3 1.7% 4 2.2% 6 2.9% 2 3.8% 3 5.6% 0 0.0% Other 2 1.1% 9 4.8% 8 3.9% 2 3.8% 4 7.4% 1 1.9% Unknown 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Total 176 186 204 52 54 52 33
Percentage HIV/AIDS Incidence: Race MO St. Louis TGA 80% 70% 60% 50% HIV & AIDS Incidence Comparison, by Race/Ethnicity MO, St. Louis, 2016 67.3% 65.2% Disproportionate impact: In Missouri- St. Louis TGA, out of all the newly diagnosed cases of HIV or AIDS, the majority were Black (67% for AIDS and 65% for HIV). 40% 30% 30.8% 27.9% 20% 10% 0% 2.9% 0.0% 3.9% 1.9% 0.0% 0.0% White Black Hispanic Other Unknown Race HIV Incidence (n=204) AIDS Incidence (n=52) 34
Rate per 100,000 HIV/AIDS Incidence: Race MO St. Louis TGA 50 45 40 35 45.2 HIV & AIDS Incidence Comparison, by Race/Ethnicity MO, St. Louis, 2012-2016 41.0 30 25 20 15 10 5 19.9 5.8 10.1 4.7 0 2012 2013 2014 2015 2016 Year of Diagnosis White Black Hispanic 35
Percentage HIV Incidence Comparison, Race HIV Incidence Comparison by Race/Ethnicity MO, St. Louis-TGA, 2012-2016 80% 70% 60% 50% 68.2% 62.9% 65.2% Disproportionate impact: Over the past three years the majority of HIV newly diagnosed cases has been consistently black 40% 30% 29.0% 30.1% 27.9% 20% 10% 0% 4.8% 1.7% 2.2% 2.9% 3.9% 1.1% White Black Hispanic Other Race/Ethnicity 2014 (n=178) 2015 (n=186) 2016 (n=204) 36
Percentage AIDS Incidence Comparison, Race 80% 70% 60% 50% 40% 30% 30.8% 35.2% AIDS Incidence Comparison from 2014-2016, by Race/Ethnicity MO, St. Louis-TGA 30.8% 61.5% 51.9% 67.3% Disproportionate impact: Over the past three years the majority of AIDS newly diagnosed cases has been consistently black 20% 10% 0% 7.4% 5.6% 3.8% 3.8% 0.0% White Black Hispanic Other Race/Ethnicity 1.9% 2014 (n=52) 2015 (n=54) 2016 (n=52) 37
HIV/AIDS Incidence- Sex MO St. Louis, TGA HIV Incidence AIDS Incidence Gender 2014 2015 2016 2014 2015 2016 Cases % Cases % Cases % Cases % Cases % Cases % Male 142 80.7% 149 80.1% 170 83.3% 42 80.8% 46 85.2% 40 76.9% Female 34 19.3% 37 19.9% 34 16.7% 10 19.2% 8 14.8% 12 23.1% Total 176 186 204 52 54 52 38
HIV/AIDS Incidence by Sex MO St. Louis-TGA HIV Incidence (n=204) AIDS Incidence (n=52) Female 17% N=34 Female 23% N=12 Male 83% N=170 Male 77% N=40 Male Female Male Female 39
Rate per 100,000 People HIV/AIDS Incidence: Sex MO, St. Louis TGA 25.0 23.5 HIV & AIDS Comparison, by sex MO, St. Louis TGA, 2012-2016 20.0 20.6 15.0 10.0 5.0 4.5 4.2 0.0 2012 2013 2014 2015 2016 Male Female 40
HIV/AIDS Incidence: Age Group MO St. Louis TGA Missouri St. Louis TGA New HIV/AIDS Diagnosis by Age Group HIV Incidence AIDS Incidence Age 2014 2015 2016 2014 2015 2016 Cases % Cases % Cases % Cases % Cases % Cases % Under 13 4 2.3% 1 0.5% 3 1.5% 0 0.0% 1 1.9% 0 0.0% 13-24 62 35.2% 72 38.7% 62 30.4% 7 13.5% 8 14.8% 9 17.3% 25-44 91 51.7% 88 47.3% 97 47.5% 32 61.5% 23 42.6% 19 36.5% 45-64 19 10.8% 23 12.4% 41 20.1% 13 25.0% 20 37.0% 22 42.3% 65 & Older 0 0.0% 2 1.1% 1 0.5% 0 0.0% 2 3.7% 2 3.8% Total 176 186 204 52 54 52 41
Percentage 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% HIV/AIDS Incidence: Age Group MO, St. Louis TGA Disproportionate impact: About 78% of newly diagnosed HIV cases are in the 13-24 & 25-44 age group. 1.5% 0.0% HIV & AIDS Comparison, by Age Group MO, St. Louis TGA, 2016 30.4% 17.3% 47.5% 36.5% 20.1% 42.3% Key point: The majority of newly diagnosed AIDS cases are in the older age groups (25-64). 0.5% 3.8% Under 13 13-24 25-44 45-64 65 & Older Age Groups HIV Incidence (n=204) AIDS Incidence (n=52) 42
Percentage HIV Incidence Comparison: Age Group MO, St. Louis TGA 60% 50% HIV Incidence by Age Group MO, St. Louis TGA 2014-2016 51.7% 47.3% 47.5% 40% 30% 20% 10% 0% 38.7% 35.2% 30.4% 20.1% 12.4% 10.8% 2.3% 0.5% 1.5% 0.0% 1.1% 0.5% Under 13 13-24 25-44 45-64 65 & Older Age Group 2014 (n=176) 2015 (n=186) 2016 (n=204) 43
AIDS Incidence Comparison: Age Group MO St. Louis TGA 70% 60% AIDS Incidence by Age Group MO, St. Louis- TGA, 2014-2016 61.5% 50% 40% 42.6% 36.5% 37.0% 42.3% 30% 25.0% 20% 10% 0% 1.9% 0.0% 0.0% 13.5% 14.8% 17.3% 3.7% 0.0% Under 13 13-24 25-44 45-64 65 & Older 2014 2015 2016 3.8% 44
HIV/AIDS Incidence by MOT MO St. Louis TGA Missouri St. Louis TGA New HIV/AIDS Diagnosis by MOT HIV Incidence AIDS Incidence MOT 2014 2015 2016 2014 2015 2016 Cases % Cases % Cases % Cases % Cases % Cases % MSM 111 63.1% 117 62.9% 136 66.7% 29 55.8% 32 59.3% 32 59.3% IDU 1 0.6% 5 2.7% 6 2.9% 1 1.9% 2 3.7% 1 1.9% MSM & IDU 6 3.4% 3 1.6% 0 0.0% 2 3.8% 0 0.0% 0 0.0% Heterosexual 30 17.0% 42 22.6% 44 21.6% 11 21.2% 11 20.4% 15 27.8% Other/NIR 28 15.9% 19 10.2% 18 8.8% 9 17.3% 9 16.7% 4 7.4% Total 176 186 204 52 54 52 45
Percentage HIV/AIDS Incidence: MOT MO, St. Louis TGA HIV & AIDS Incidence Comparison, by MOT MO, St. TGA, 2016 70% 60% 66.7% 59.3% 50% 40% 30% 20% 10% 0% 27.8% 21.6% 2.9% 8.8% 7.4% 1.9% 0.0% 0.0% MSM IDU MSM & IDU Heterosexual Other/NIR Mode of Transmission HIV Incidence (n=186) AIDS Incidence (n=54) 46
Percentage HIV Incidence: MOT MO, St. Louis TGA 70% 60% 66.7% 63.1% 62.9% HIV Incidence Comparison from 2014-2016, MOT MO, St. Louis TGA 50% 40% 30% 20% 17.0% 22.6% 21.6% 15.9% 10% 0% 10.2% 8.8% 2.7% 2.9% 3.4% 0.6% 1.6% 0.0% MSM IDU MSM & IDU Heterosexual Other/NIR Mode of Transmission 2014 (n=176) 2015 (n=186) 2016 (n=204) 47
Percentage AIDS Incidence: MOT MO, St. Louis TGA 70% AIDS Incidence Comparison by MOT MO, St. Louis TGA, 2014-2016 60% 59.3% 59.3% 55.8% 50% 40% 30% 20% 21.2% 20.4% 27.8% 17.3% 16.7% 10% 0% 7.4% 3.7% 3.8% 1.9% 1.9% 0.0% 0.0% MSM IDU MSM & IDU Heterosexual Other/NIR Mode of Transmission 2014 (n=52) 2015 (n=54) 2016 (n=52) 48
HIV/AIDS Incidence: AGE Group MO, St. Louis TGA, 2012-2016 HIV/AIDS Incidence Comparison by Age Group MO, St. Louis TGA Under 25 25-44 45-64 60% 60% 60% 50% 40% 50% 40% 45.5% 45.3% 50% 40% 32.5% 30% 20% 28.9% 30% 20% 30% 20% 21.3% 24.6% 10% 10% 10% 0% 2012 2013 2014 2015 2016 0% 2012 2013 2014 2015 2016 0% 2012 2013 2014 2015 2016 49
HIV/AIDS Incidence: MSM Group MO, St. Louis TGA, 2012-2016 HIV/AIDS MSM Group Incidence Comparison by Race Under 25 MO, St. Louis TGA Black White 100% 100% 90% 90% 80% 82.6% 79.0% 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 10% 20% 10% 10.1% 9.7% 0% 2012 2013 2014 2015 2016 0% 2012 2013 2014 2015 2016 50
HIV/AIDS Incidence: Female Heterosexual Cases MO, St. Louis TGA, 2012-2016 HIV/AIDS Females Heterosexual Incidence Comparison by Race MO, St. Louis TGA White Black 100% 90% 80% 70% 60% 50% 42.9% 40% 30% 21.4% 20% 10% 0% 2012 2013 2014 2015 2016 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 57.1% 71.4% 2012 2013 2014 2015 2016 51
Unmet Need Unmet need is defined as the proportion of people leaving with HIV/AIDS in on our region who do not have evidence of HIV medical care (tested for CD4 or Viral load) during a specific year. 52
Unmet Need MO St. Louis TGA, 2016 Unmet Needs Characteristics 2012 2013 2014 2015 2016 2016 2015 2014 2013 2012 Race Trend line Unmet Need Black/African American Ma 34.6% 32.5% 30.6% 29.6% 30.3% 795 737 741 764 780 Black/African American Fe 28.9% 27.0% 25.3% 25.7% 28.4% 231 201 192 198 204 White Male 37.2% 35.4% 33.9% 33.2% 34.9% 770 723 730 753 783 White Female 25.5% 26.9% 24.6% 25.1% 24.4% 54 53 50 53 50 Hispanic 42.8% 39.9% 40.8% 42.9% 42.0% 71 69 64 61 62 Other / UNKNOWN 34.7% 31.3% 31.3% 28.6% 26.1% 30 26 26 25 26 Gender Male 36.0% 34.1% 32.4% 31.5% 32.6% 1,649 1,535 1,545 1,590 1,633 Female 28.7% 27.0% 25.5% 26.2% 27.6% 302 274 258 264 272 Mode of Exposure MSM 35.8% 34.0% 31.9% 30.8% 31.9% 1262 1,172 1,184 1,228 1,258 IDU 34.1% 32.7% 29.2% 16.6% 30.0% 68 30 62 70 75 MSM/IDU 32.3% 30.1% 32.0% 42.3% 36.2% 64 91 57 50 52 HRH 31.2% 29.0% 28.9% 28.3% 30.0% 307 269 260 249 258 Pediatric Exposure 41.5% 41.9% 32.7% 39.2% 46.3% 25 20 16 18 17 Other 37.5% 36.0% 33.3% 33.3% 37.5% 9 8 8 9 9 Not Reported 34.1% 31.9% 30.6% 31.9% 31.6% 216 219 216 230 236 Current Age 0-12 yrs 57.9% 52.6% 26.7% 21.4% 25.0% 4 3 4 10 11 13-24 28.2% 28.6% 24.6% 28.3% 30.3% 96 94 84 102 98 25-44 34.9% 32.5% 28.7% 29.9% 31.3% 718 668 692 710 762 45-64 34.3% 32.7% 31.4% 30.7% 31.7% 990 920 915 917 920 65 & older 45.4% 42.3% 31.5% 36.8% 36.7% 143 124 108 115 114 Total 34.8% 32.9% 31.3% 30.6% 31.7% 1,951 1,809 1,803 1,854 1,905 53
Who were less likely to receive medical care? oin 2016, the St. Louis TGA reported 3104 people living with HIV o38.7% (1203) living with HIV in our region did not have evidence of care othat same year there was 3041 people living with AIDS o24.5% (748) of people living with AIDS did not have evidence of care otherefore, unmet need among PLWH/A in 2016 was 31.7% (1951) 54
National Strategy and Indicators Goal 2. Access to care Early diagnosis Viral suppression Survival HIV + HIV - HIV + Diagnosed Care & Treatment Health Outcome Goal 1. New infections Linkage to care Retention in care Goal 3. Health disparities 55
Percentage of People Living with Diagnosed HIV HIV Continuum of Care Among Cases 13 +,2015 90% 80% 70% 77% 60% 50% 40% 30% 54% 48% 20% 10% 0% Linked to Care Retained in Care Retained in Care, virally suppressed Stages 11% Not retained in care, virally suppressed Linked to Care - Derived from adults and adolescents newly diagnosed with HIV disease in the St. Louis TGA MO in 2015 with a CD4 or viral load lab result within three months of diagnosis. Retained in Care - Derived from number of adults and adolescents diagnosed with HIV through 2014 and living in 2015 who resided in the St. Louis TGA MO at the time of their most recent diagnosis of HIV or stage 3 (AIDS) who had at least two CD4 or viral load lab results in 2014 which were collected at least 3 months apart. Virally Suppressed, Retained in Care Derived from number of adults and adolescents diagnosed with HIV through 2014 and living in 2015 who resided in the St. Louis HIV Care Region at the time of their most recent diagnosis of HIV or stage 3 (AIDS) who were considered to be retained in care and whose most recent viral load lab result in 2014 was 200 copies/ml or less. 56
OTHER SEXUALLY TRANSMITTED DISEASES 57
Number of cases Rate per 100,000 people Chlamydia Case Counts & Rates Chlamydia Case Counts and Rates MO, St. Louis TGA, 2011-2015 11,800 11,700 563.7 570 565 11,600 560 11,500 11,400 11,300 11,200 11,747 536.9 538.8 536.8 550.4 11,620 555 550 545 540 535 11,100 11,000 11,215 11,288 11,292 530 525 10,900 2011 2012 2013 2014 2015 520 Case counts Rates 58
Number of cases Rate per 100,000 people Gonorrhea Case Counts & Rates 4,500 Gonorrhea Case Counts and Rates MO, St. Louis TGA, 2011-2015 250 4,000 3,500 3,000 2,500 190.1 186.4 178.8 165.2 202.4 200 150 2,000 1,500 3,962 3,894 3,745 3,475 4,273 100 1,000 50 500-2011 2012 2013 2014 2015 Case counts Rates 0 59
Gonorrhea Case Counts & Rates by Sex Gonorrhea Case Rates by Sex MO, St. Louis TGA, 2011-2015 250 200 150 191.4 188.8 232.6 174.2 100 50 0 2011 2012 2013 2014 2015 Males Females 60
Number of cases Rate per 100,000 people P&S Syphilis Case Counts & Rates 160 140 P&S syphilis Case Counts and Rates, 2011-2015 MO, St. Louis TGA 6.5 7 6 120 100 80 60 40 3.9 4.2 82 88 4.8 101 136 4.5 96 5 4 3 2 20 1-2011 2012 2013 2014 2015 Case counts Rates 0 61
Summary o Continue increase in HIV/AIDS new diagnosis among males under 25 in the St. Louis TGA, Region, Particularly among black MSM, and Latino o Among people newly diagnosed with HIV disease: o Despite the decreasing trend in late diagnosis approximately one quarter were diagnosed late o Nearly 1 in 4 were not linked to care within 3 month of diagnosis o Among people living with HIV o Nearly 30% did not have evidence of receiving care o Nearly 46% were not retained in care o About 41% were not virally suppressed 62
Thanks for your Consideration Questions Or Comments 63