FULTON COUNTY GOVERNMENT RYAN WHITE PART A PROGRAM. Atlanta Eligible Metropolitan Area HIV/AIDS Unmet Need Estimate

FULTON COUNTY GOVERNMENT RYAN WHITE PART A PROGRAM Atlanta Eligible Metropolitan Area HIV/AIDS Unmet Need Estimate Southeast AIDS Training and Education Center Department of Family and Preventative Medicine Emory University School of Medicine December 2011

TABLE OF CONTENTS INTRODUCTION... 6 Contributions... 6 Background... 6 Executive Summary... 7 Key Findings... 7 METHODOLOGY... 8 Data Sources... 8 HIV/AIDS Surveillance Data... 8 Laboratory Data... 8 Framework... 8 Population Size... 9... 9 Calculated Results... 10 Strengths and Limitations... 10 ANALYSIS AND RESULTS... 11 Regional Estimates... 11 Table 1 2007 and 2010 HIV/AIDS Unmet Need Percentages by Georgia Region & HIV Status... 11 Chart 1 2007 and 2010 HIV/AIDS Cases by Georgia Region & HIV Status... 12 Chart 2 2007 and 2010 HIV/AIDS Unmet Need by Georgia Region & HIV Status... 12 Estimates by Gender... 13 Table 2 2007 and 2010 HIV/AIDS Unmet Need Percentages by Georgia Region, Gender & HIV Status... 13 Chart 3 2007 and 2010 HIV/AIDS Cases by Georgia Region, Gender & HIV Status... 14 Chart 4 2007 and 2010 HIV/AIDS Unmet Need by Georgia Region, Gender & HIV Status 14 Estimates by Race... 15 Table 3 2007 and 2010 HIV/AIDS Unmet Need Percentages by Georgia Region, Race & HIV Status... 15 Chart 5 2007 and 2010 HIV/AIDS Cases by Georgia Region, Race & HIV Status... 16 Chart 6 2007 and 2010 HIV/AIDS Unmet Need by Georgia Region, Race & HIV Status... 16 Estimates by Age... 17 Table 4 2010 HIV/AIDS Unmet Need Percentages by Georgia Region, Age & HIV Status 17 Chart 7 2010 HIV/AIDS Cases by Georgia Region, Age & HIV Status... 18 2

Chart 8 2010 HIV/AIDS Unmet Need by Georgia Region, Age & HIV Status... 18 Estimates by Risk Factor... 19 Table 5 2007 and 2010 HIV/AIDS Unmet Need Percentages by Georgia Region, Risk Factor & HIV Status... 19 Chart 9 2007 and 2010 HIV/AIDS Cases by Georgia Region, Risk Factor & HIV Status... 20 Chart 10 2007 and 2010 HIV/AIDS Unmet Need by Georgia Region, Risk Factor & HIV Status... 20 Estimates by High Risk Subpopulation... 21 Table 6 2007 and 2010 HIV/AIDS Unmet Need Percentages by Georgia Region, High Risk Subpopulation & HIV Status... 21 Chart 11 2007 and 2010 HIV/AIDS Cases by Georgia Region, High Risk Subpopulations & HIV Status... 22 Chart 12 2007 and 2010 HIV/AIDS Unmet Need by Georgia Region, High Risk Subpopulation & HIV Status... 22 DISCUSSION... 23 APPENDIX... 25 Unmet Need Estimates by Geographic Location... 25 Table 7 Georgia... 25 Table 8 Atlanta EMA... 26 Table 9 Georgia Non-EMA... 27 Unmet Need Estimates by Gender and Geographic Location... 28 Table 10 Georgia Men... 28 Table 11 Atlanta EMA Men... 29 Table 12 Georgia Women... 30 Table 13 Atlanta EMA Women... 31 Unmet Need Estimates by Race/Ethnicity and Geographic Location... 32 Table 14 Georgia Black Race... 32 Table 15 Atlanta EMA Black Race... 33 Table 16 Georgia White Race... 34 Table 17 Atlanta EMA White Race... 35 Table 18 Georgia Hispanic Ethnicity... 36 Table 19 Atlanta EMA Hispanic Ethnicity... 37 Table 20 Georgia Other Race... 38 Table 21 Atlanta EMA Other Race... 39 Table 22 Georgia Unknown Race... 40 Table 23 Atlanta EMA Unknown Race... 41 3

Unmet Need Estimates by Age and Geographic Location... 42 Table 24 Georgia Younger than 2 Years... 42 Table 25 Atlanta EMA Younger than 2 Years... 43 Table 26 Georgia 2-12 Years... 44 Table 27 Atlanta EMA 2-12 Years... 45 Table 28 Georgia 13-17 Years... 46 Table 29 Atlanta EMA 13-17 Years... 47 Table 30 Georgia 18-24 Years... 48 Table 31 Atlanta EMA 18-24 Years... 49 Table 32 Georgia 25-29 Years... 50 Table 33 Atlanta EMA 25-29 Years... 51 Table 34 Georgia 30-34 Years... 52 Table 35 Atlanta EMA 30-34... 53 Table 36 Georgia 35-39 Years... 54 Table 37 Atlanta EMA 35-39 Years... 55 Table 38 Georgia 40-44 Years... 56 Table 39 Atlanta EMA 40-44 Years... 57 Table 40 Georgia 45-49 Years... 58 Table 41 Atlanta EMA 45-49 Years... 59 Table 42 Georgia 50-54 Years... 60 Table 43 Atlanta EMA 50-54 Years... 61 Table 44 Georgia 55-59 Years... 62 Table 45 Atlanta EMA 55-59 Years... 63 Table 46 Georgia 60-64 Years... 64 Table 47 Atlanta EMA 60-64 Years... 65 Table 48 Georgia 65 Years and Older... 66 Table 49 Atlanta EMA 65 Years and Older... 67 Unmet Need Estimates by Risk Factor and Geographic Location... 68 Table 50 Georgia Heterosexual... 68 Table 51 Atlanta EMA Heterosexual... 69 Table 52 Georgia MSM... 70 Table 53 Atlanta EMA MSM... 71 Table 54 Georgia IDU... 72 Table 55 Atlanta EMA IDU... 73 4

Table 56 Georgia MSM/IDU... 74 Table 57 Atlanta EMA MSM/IDU... 75 Table 58 Georgia Other Risk... 76 Table 59 Atlanta EMA Other Risk... 77 Table 60 Georgia Risk Not Specified... 78 Table 61 Atlanta EMA Risk Not Specified... 79 Unmet Need Estimates by Special Interest Population Subgroups and Geographic Location... 80 Table 62 Georgia White MSM... 80 Table 63 Atlanta EMA White MSM... 81 Table 64 Georgia Non-White MSM... 82 Table 65 Atlanta EMA Non-White MSM... 83 Table 66 Georgia MSM or MSM/IDU 13-30 Years... 84 Table 67 Atlanta EMA MSM or MSM/IDU 13-30 Years... 85 Table 68 Georgia Heterosexual 13-30 Years... 86 Table 69 Atlanta EMA Heterosexual 13-30 Years... 87 Table 70 Georgia Women 15-44 Years... 88 Table 71 Atlanta EMA Women 15-44 Years... 89 Table 72 Georgia Non-White Women... 90 Table 73 Atlanta EMA Non-White Women... 91 REFERENCES... 92 5

INTRODUCTION Contributions The Southeast AIDS Training and Education Center (SEATEC) prepared this unmet need report on behalf of and in collaboration with the. Unmet need data and calculations were provided by the Georgia Department of Public Health (DPH), Epidemiology Branch, HIV Epidemiology Unit. Background According to the Centers for Disease Control and Prevention (CDC), in 2009, Georgia ranked 6th in the nation for the number of reported AIDS cases and for the number of reported cumulative AIDS cases. 1 Further, reported 40,328 people living with HIV/AIDS in Georgia in 2009, of which 43% had HIV non-aids and 57% had AIDS. 2 Sixty-three percent of these Georgians living with HIV/AIDS resided in the Eligible Metropolitan Area (EMA). 2 These surveillance estimates are indicative of the disproportionate burden of HIV disease, including AIDS, in the Atlanta EMA and Georgia statewide and subsequently the escalated need for HIV-related. The public health challenge that planning bodies face is that stigma, psychological factors, and socioeconomic factors associated with HIV prevent those aware of their HIV status from seeking medical care. The Ryan White Treatment and Modernization Act requires that program grantees estimate the number of individuals in their jurisdiction that know their HIV status, but are not receiving routine services. These data serve as input to Congress regarding the need for continued appropriations for HIV/AIDS treatment. Specifically, the 2000 Amendments to the CARE Act that requires the following of Part A and Part B grantees: 1. determine the size and demographics of the population of individuals with HIV disease and 2. determine the needs of such populations with particular attention to both individuals with HIV disease who know their HIV status and are not receiving HIV-related services and disparities in access and services among affected subpopulations and historically underserved communities. 3 Further, the Health Resources and Services Administration (HRSA) set a goal for HIV care services of 100% access and 0% disparity. Fulton County Government is responsible for the administration of the Ryan White Part A program in the Atlanta EMA. The results in this report are utilized to work towards goals of ensuring that all people living in the Atlanta EMA with HIV disease receive needed and supportive services and there are no disparities in the quality of care across subpopulations. In compliance with federal legislation and as part of on-going evaluation of access to care and quality of care, the Atlanta EMA Part A grantee collaborates with the to produce this report annually in an effort to identify the number of people living with HIV disease that are in need of HIV primary medical care, or have an unmet need. Unmet need estimates will inform local planning and resource 6

allocation with the goal to improve health. In order to make comparisons and provide a comprehensive picture of unmet need statewide, both the Atlanta EMA and Georgia statewide unmet need were calculated separately; in aggregate and by subpopulations. Assessing disparities across subpopulations enables Georgia Ryan White grantees and planning bodies to respond to the needs of emerging underserved groups. Specifically, this analysis allows the Part A Grantee to critically examine the extent and characteristics of unmet need, track progress in reducing unmet need over time, and ensure that local resources are directed towards activities that will make the greatest health impact for those persons living with HIV/AIDS in the Atlanta EMA. Executive Summary Utilizing the framework established by the University of California, San Francisco (UCSF), unmet need was calculated for the Atlanta EMA and Georgia statewide for the calendar year 2010. 4 Unmet need for is defined as no evidence of a viral load or CD4 laboratory test within the 12 month report period. The calculations in this report provide an estimate of the number of people living with HIV disease that are aware of their status and had an unmet need for during 2010. Estimates were calculated separately for people living with HIV (PLWH) non- AIDS/aware and people living with AIDS (PLWA), given that care needs vary significantly depending on disease progression. Key Findings* In 2010, there were 44,976 people living with HIV/AIDS in Georgia. Sixty-three percent of people living with HIV/AIDS in Georgia resided in the Atlanta EMA. The number of cases of people living with HIV disease in the Atlanta EMA (28,424) was significantly higher than the number of people living with HIV disease in Georgia non-ema (13,675). People living with HIV disease in the Atlanta EMA had a higher unmet need (56%) than Georgia non-ema (50%). PLWA in the Atlanta EMA had a higher unmet need (58%) than PLWH non-aids/aware in the Atlanta EMA (53%). In the Atlanta EMA, Men living with HIV disease had a higher unmet need (57%) than Women (53%); and people age 50 and older living with HIV disease had a higher unmet need (65%) than all other age groups. In the Atlanta EMA, Blacks and Whites living with HIV disease had an unmet need of 56%. * These estimates are based on the unmet need analysis and are not reflective of Georgia surveillance estimates. 7

METHODOLOGY Data Sources HIV/AIDS Surveillance Data Georgia began AIDS reporting in the early 1980s. The began name based HIV infection reporting in December 2003. These data are captured in the enhanced HIV/AIDS Reporting System (ehars). The surveillance system is managed by the HIV/AIDS Epidemiology Unit. Providers that conduct testing and treatment of HIV/AIDS are required by law to report all new diagnoses of HIV/AIDS and those individuals for whom they are assuming HIV/AIDS care on case report forms. Newly diagnosed cases are to be reported to the DPH at any point along the clinical spectrum of disease. For the purposes of this study, these surveillance data provided population estimates of HIV+/aware individuals, including AIDS and HIV non-aids, living in the Atlanta EMA and Georgia. Laboratory Data Georgia statewide private and public laboratories are required by law to report laboratory tests indicative of HIV infection, including all detectable and undetectable viral loads, CD4 counts, Western blots, and viral nucleotide sequence results to the DPH. These data are stored in the Georgia Laboratory and maintained by the HIV/AIDS Epidemiology Unit. In this analysis of unmet need, these data contributed to the estimates of HIV+/aware individuals that received as well as to the population estimates of HIV+/aware individuals living in the Atlanta EMA and Georgia. Framework In compliance with Ryan White HIV/AIDS Program legislation, unmet need was calculated for HIV+/aware, inclusive of PLWA and PLWH non-aids/aware. Further, unmet need was calculated separately by disease status, since care patterns vary based on severity of illness. The unmet need framework utilized in this study was developed by UCSF. For the study period, calendar year 2010, estimates were obtained for those people living in the Atlanta EMA and Georgia that are (1) diagnosed HIV+/aware (Population) and (2) diagnosed HIV+/aware and received primary medical care (In Care) based on laboratory data. By subtracting those people that are In Care from the Population, we obtained the number of people HIV+/aware lacking (Unmet Need). 4 Those individuals that we did not identify as In Care are assumed to be Out of Care. 4 For geographic comparison, Georgia statewide and Atlanta EMA unmet need were calculated separately, in aggregate and by subpopulations. Since HIV/AIDS continues to disproportionately affect specific demographic subpopulations, unmet need was calculated for population subgroups to determine if HIV-related patterns vary by socio-demographic variables. Analysis was conducted by race/ethnicity, gender, age, and risk factors. 8

There are three main components to the framework: population size, care patterns, and calculated results or unmet need. 4 Population sizes were obtained utilizing both the ehars and the GA Laboratory for those individuals HIV+/aware and living as of December 31, 2010. Population data were primarily obtained from ehars, but cases identified in the GA Laboratory, that may not have been in ehars because a case report form was not submitted for the individual, supplement the population counts. Further, PLWA are those people with a diagnostic status of AIDS in ehars or those in the GA Laboratory who have ever had a CD4 count below 200 and a positive western blot or detectable viral load. Western blot, viral load, and CD4 test results were obtained from the GA Laboratory for living HIV+/aware cases as of December 31, 2010. Having one viral load or CD4 test during the report period indicates the receipt of. 4 One exception to the UCSF framework for the calculations in this report is that the provision of anti-retroviral therapy was not an element in determining receipt of. Population Size People Living with AIDS (PLWA): the number of people diagnosed and living with CDC defined AIDS and reported in ehars and/or GA Laboratory Reporting as of December 31, 2010. It is presumed that all people living with AIDS are aware of their status. People Living with HIV/non-AIDS (PLWH non-aids/aware): the number of people diagnosed and living with HIV/non-AIDS and reported in ehars and/or GA Laboratory Reporting as of December 31, 2010. HIV+/aware = PLWA + PLWH non-aids/aware PLWA In Care: PLWA that have had at least one viral load or CD4 laboratory test reported in ehars and/or the GA Laboratory during December 31, 2010. PLWH non-aids/aware In Care: PLWH non-aids/aware that have had at least one viral load or CD4 laboratory test reported in ehars and/or the GA Laboratory during the 12-month period as of December 31, 2010. HIV+/aware In Care = PLWA In Care + PLWH non-aids/aware In Care 9

Calculated Results Unmet Need = Population In Care Strengths and Limitations In making planning decisions, it is important to consider the strengths and limitations of this unmet need analysis. Although the analysis is comprehensive, data and reporting limitations may underestimate the burden of HIV disease in the Atlanta EMA and in Georgia and subsequently the unmet need for HIV-related. Further, the receipt of one viral load or CD4 laboratory test in a calendar year is not indicative of routine comprehensive given the health requirements of living with HIV disease. By the end of 2010, DPH had made great strides in the completeness of HIV non-aids cases captured in ehars. As a result, in contrast to past unmet studies conducted in the Atlanta EMA, the 2010 unmet need analysis utilizes Georgia surveillance and laboratory data for both estimates of PLWA and PLWH non-aids/aware unmet need. This accomplishment has allowed a more accurate representation of unmet need in Georgia and the Atlanta EMA. Although Georgia surveillance data completeness is markedly improved, 100% completeness is not yet achieved and will be difficult to achieve given the complexity of HIV reporting, provider non-compliance with reporting, and an environment of decreasing resources. Further, laboratory and surveillance data are impacted by the completeness and timelines of reporting to. More specifically, there are some important considerations when interpreting unmet need results by subpopulation. Subpopulation results are estimates impacted by rounding. The sum of subpopulation counts do not precisely match overall totals by disease status. Additional layers of estimation are added when producing subgroup results by region. Finally, the utility of unmet need estimates by risk factor is restricted by the large number of individuals with non-cdc defined transmission categories in the Georgia surveillance data. 10

ANALYSIS AND RESULTS Regional Estimates In 2007 PLWH non-aids/aware and PLWA living in the Atlanta EMA had higher percentages of unmet need than Georgia statewide and Georgia non-ema. In 2010, the Atlanta EMA percentage for PLWA was the same statewide and only higher than Georgia non-ema. Overall, for 2010, the Atlanta EMA and throughout Georgia, PLWA had a higher unmet need proportion than PLWH non-aids/aware and HIV+ aware. Unlike 2007 where population counts were similar between Georgia non-ema and the Atlanta EMA, in 2010 Georgia non-ema had a significantly lower PLWA population count than the Atlanta EMA and a lower unmet need percentage. This may be a result of improved reporting practices in the Atlanta EMA and not necessarily a reflection of a population growth. PLWH non-aids/aware living in Georgia non-ema had the lowest unmet need percentage. Table 1 2007 and 2010 HIV/AIDS Unmet Need Percentages by Georgia Region & HIV Status Disease Status Georgia 2007 Georgia 2010 Atlanta EMA 2007 Atlanta EMA 2010 Georgia Non-EMA 2007 Georgia Non-EMA 2010 PLWA 61% 56% 65% 58% 57% 52% PLWH non- 50% 53% 55% 53% 47% 49% AIDS/aware HIV+/aware 56% 55% 61% 56% 52% 50% 11

Chart 1 2007 and 2010 HIV/AIDS Cases by Georgia Region & HIV Status 50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 17,645 23,436 Georgia 19,676 25,300 7,560 12,004 10,085 16,420 11,568 11,868 Atlanta EMA Georgia Non-EMA 6,335 7,340 2007 PLWA 2007 PLWH non-aids/aware 2010 PLWA 2010 PLWH non-aids/aware Chart 2 2007 and 2010 HIV/AIDS Unmet Need by Georgia Region & HIV Status 30,000 25,000 20,000 8,843 10,364 15,000 10,000 5,000 0 14,327 Georgia 14,210 6,383 4,140 4,703 9,524 7,574 6,753 Atlanta EMA Georgia Non-EMA 3,104 3,801 2007 PLWA 2007 PLWH non-aids/aware 2010 PLWA 2010 PLWH non-aids/aware 12

Estimates by Gender Throughout Georgia and in the Atlanta EMA, unmet need percentages have decreased amongst male and female PLWA since 2007. For PLWH non-aids/aware the unmet need percentage has increased for all groups except males of the Atlanta EMA, which decreased in 2010. In the Atlanta EMA, unmet need percentages were slightly higher for PLWA and PLWH non-aids/aware regardless of gender compared to Georgia statewide. In Georgia and in the Atlanta EMA, there were higher case counts, unmet need counts, and unmet need percentages for PLWA and PLWH non- AIDS/aware Men in comparison to Women within each disease status. Further, PLWA Men had a higher unmet need percentage than PLWH non-aids/aware Men, and those in the Atlanta EMA had the highest percentage of unmet need overall. Across disease status, in the Atlanta EMA and throughout Georgia, PLWA Women had a higher unmet need proportion than PLWH non- AIDS/aware Men and Women. Table 2 2007 and 2010 HIV/AIDS Unmet Need Percentages by Georgia Region, Gender & HIV Status Disease Status/ Gender Georgia Georgia Atlanta EMA Atlanta EMA 2007 2010 2007 2010 PLWA Men 62% 57% 67% 59% PLWA Women 57% 52% 59% 55% PLWH non-aids/aware 51% 53% 57% 54% Men PLWH non-aids/aware 49% 50% 50% 51% Women HIV+/aware Men 58% 55% 63% 57% HIV+/aware Women 53% 51% 55% 53% 13

Chart 3 2007 and 2010 HIV/AIDS Cases by Georgia Region, Gender & HIV Status 30,000 25,000 20,000 5,498 5,860 15,000 3,239 5,394 5,676 10,000 5,000 0 17,938 19,189 2,328 2,982 13,109 12,251 13,608 2,054 9,240 8,899 5,506 GA PLWA Atlanta EMA PLWA GA HIV non-aids/aware Atlanta EMA HIV non-aids/aware 2007 Males 2007 Females 2010 Males 2010 Females Chart 4 2007 and 2010 HIV/AIDS Unmet Need by Georgia Region, Gender & HIV Status 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 3,154 11,173 3,073 1,782 2,829 1,380 2,642 10,949 6,194 7,697 6,201 7,243 1,020 3,120 1,523 4,792 GA PLWA Atlanta EMA PLWA GA HIV non-aids/aware Atlanta EMA HIV non-aids/aware 2007 Males Unmet Need 2007 Females Unmet Need 2010 Males Unmet Need 2010 Females Unmet Need 14

Estimates by Race In the Atlanta EMA and Georgia statewide, PLWA Whites and Blacks had higher unmet need percentages than PLWH non-aids/aware Whites and Blacks. Overall, PLWA Whites in the Atlanta EMA had the highest unmet need proportion. However, within PLWH non-aids/aware, Blacks had a higher unmet need percentage than Whites. Further, PLWA and PLWH non-aids/aware Whites and Blacks in the Atlanta EMA had higher unmet need proportions than in Georgia statewide. Unmet need estimates were also determined for Hispanic ethnicity, other race, and unknown race and are included in the Appendices. Hispanic PLWH non-aids/aware increased since 2007 from 47% to 51% and in PLWA decreased from 61% to 57% in the Atlanta EMA. Hispanics of the Atlanta EMA also had a lower percentage of unmet need in 2007 than Blacks and Whites but in 2010 the unmet need percentage rose above that of Blacks. Table 3 2007 and 2010 HIV/AIDS Unmet Need Percentages by Georgia Region, Race & HIV Status Disease Status/ Race Georgia 2007 Georgia Atlanta EMA 2007 Atlanta EMA 2010 2010 PLWA Black 61% 55% 65% 57% PLWA White 64% 61% 70% 63% PLWH non-aids/aware 52% 53% 56% 55% Black PLWH non-aids/aware 45% 47% 51% 44% White HIV+/aware Black 57% 54% 61% 51% HIV+/aware White 56% 55% 63% 56% 15

Chart 5 2007 and 2010 HIV/AIDS Cases by Georgia Region, Race & HIV Status 25,000 20,000 5,828 5,723 15,000 10,000 5,000 0 3,724 4,083 2,512 3,080 16,349 16,400 1,578 12,882 13,117 1,579 10,847 7,812 8,102 5,494 GA PLWA Atlanta EMA PLWA GA HIV non-aids/aware Atlanta EMA HIV non-aids/aware 2007 Black 2007 White 2010 Black 2010 White Chart 6 2007 and 2010 HIV/AIDS Unmet Need by Georgia Region, Race & HIV Status 16,000 14,000 12,000 10,000 3,701 3,477 8,000 6,000 4,000 2,000 0 1,677 1,933 1,588 2,141 9,925 8,981 689 6,218 6,704 6,924 808 5,041 4,450 3,096 GA PLWA Atlanta EMA PLWA GA HIV non-aids/aware Atlanta EMA HIV non-aids/aware 2007 Black Unmet Need 2007 White Unmet Need 2010 Black Unmet Need 2010 White Unmet Need 16

Estimates by Age Overall, the proportion of unmet need increases with age for PLWA. The percentage of unmet need for PLWA 50 years of age and older in the Atlanta EMA was the highest overall. More than sixty percent of Georgia PLWA cases 50 years of age and older reside in the Atlanta EMA. Among PLWH non-aids/aware, those 25 to 34 years of age had the highest percentage of unmet need. Further, all age groups in the Atlanta EMA had equal or higher unmet need proportions than their respective age groups in Georgia statewide. Unmet need estimates were also determined for 2 years and younger, 2 to 12 years, and 13 to 17 years of age and are included in the Appendices. 2007 data used different age groupings and are not discussed in this report. Table 4 2010 HIV/AIDS Unmet Need Percentages by Georgia Region, Age & HIV Status* Disease Status/ Age Georgia Atlanta EMA PLWA 18-24 38% 38% PLWA 25-34 45% 46% PLWA 35-44 52% 53% PLWA 45-49 56% 58% PLWA 50+ 62% 65% PLWH HIV non-aids/aware 18-24 54% 56% PLWH HIV non-aids/aware 25-34 57% 57% PLWH HIV non-aids/aware 35-44 53% 53% PLWH HIV non-aids/aware 45-49 50% 52% PLWH HIV non-aids/aware 50+ 50% 51% HIV+/aware 18-24 50% 51% HIV+/aware 25-34 53% 53% HIV+/aware 35-44 52% 53% HIV+/aware 45-49 54% 56% HIV+/aware 50+ 58% 61% *Disease status by age is not directly comparable to 2007 data, reflecting different age groupings. 17

Chart 7 2010 HIV/AIDS Cases by Georgia Region, Age & HIV Status * 30000 25000 20000 15000 10000 5000 0 9,622 4,717 5,442 6,148 3,158 3,627 5,607 6,744 4,503 4700 2598 491 1676 1411 273 Georgia (PLWA) Atlanta EMA (PLWA) Georgia PLWH/non- AIDS/aware 2,688 1,935 3,558 3000 783 Atlanta EMA PLWH/non- AIDS/aware Total Age 18-24 Total Age 25-34 Total Age 35-44 Total Age 45-49 Total Age 50+ Chart 8 2010 HIV/AIDS Unmet Need by Georgia Region, Age & HIV Status* 16000 14000 12000 10000 8000 6000 4000 2000 0 6,006 2,382 4,002 1,588 3,033 1,380 2,108 2,969 1,007 3,488 1,890 2,389 2680 1175 1711 775 188 763 103 435 Georgia (PLWA) Atlanta EMA (PLWA) Georgia PLWH/non- Atlanta EMA PLWH/non- AIDS/aware AIDS/aware Age 18-24 Age 25-34 Age 35-44 Age 45-49 Age 50+ *Disease status by age is not directly comparable to 2007 data, reflecting different age groupings. 18

Estimates by Risk Factor Results by risk factor should be interpreted with caution due to the large number of cases without a specified risk factor throughout Georgia (4,513) and in the Atlanta EMA (8,724). Overall, similar to 2007, in 2010 PLWA injection drug users (IDU) in the Atlanta EMA had the highest proportion of unmet need. In 2007 this risk category was followed by PLWA men who have sex with men (MSM), but in 2010 PLWA IDU was followed by both PLWA MSM and PLWA heterosexuals. Despite the significant difference in their case counts, for which PLWA MSM was higher, the percentage of unmet need for these two groups was identical. In the Atlanta EMA, among PLWH non- AIDS/aware, unlike in 2007 where MSM had the highest percentage of unmet need, in 2010 IDU had the highest percentage of unmet need followed by MSM. Further, the percentages of unmet need were higher in the Atlanta EMA than in Georgia statewide for all respective risk categories. Table 5 2007 and 2010 HIV/AIDS Unmet Need Percentages by Georgia Region, Risk Factor & HIV Status Disease Status/ Risk Georgia 2007 Georgia Atlanta EMA 2007 Atlanta EMA Factor 2010 PLWA Heterosexual 59% 54% 61% 57% PLWA MSM 62% 56% 67% 57% PLWA IDU 71% 71% 74% 73% PLWA Not Specified 57% 51% 60% 54% PLWH HIV non- 45% 44% 47% 48% AIDS/aware Heterosexual PLWH HIV non- 51% 48% 57% 51% AIDS/aware MSM PLWH HIV non- 53% 61% 56% 64% AIDS/aware IDU PLWH HIV non- 50% 55% 54% 56% AIDS/aware Not Specified HIV+/aware Heterosexual 53% 51% 56% 54% HIV+/aware MSM 57% 53% 64% 55% HIV+/aware IDU 65% 69% 69% 71% HIV+/aware Not Specified 54% 53% 58% 55% 19

Chart 9 2007 and 2010 HIV/AIDS Cases by Georgia Region, Risk Factor & HIV Status 25,000 20,000 15,000 10,000 5,000 0 8,484 6,447 2,338 1,695 4,129 7,813 8,066 3,786 1,212 1,131 8,412 9,188 539 4,595 1,256 7,340 6,134 3,189 310 6,178 4,725 488 4,985 3,139 3,186 2,911 1,205 1,535 2,068 1,640 733 744 GA PLWA Atlanta EMA PLWA GA HIVnon-AIDS/aware Atlanta EMA HIV non-aids/aware 2007 Total Heterosexual 2007 Total MSM 2007 Total IDU 2007 Total Not Specified 2010 Total Heterosexual 2010 Total MSM 2010 Total IDU 2010 Total Not Specified Chart 10 2007 and 2010 HIV/AIDS Unmet Need by Georgia Region, Risk Factor & HIV Status 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 4,870 3,281 1,659 1,205 2,231 2,289 880 3,933 4,448 5,221 5,159 928 601 2,594 328 4,168 1,725 198 3,187 3,136 2,983 274 2,558 1,839 1,720 1,665 731 872 937 719 347 357 GA PLWA Atlanta EMA PLWA GA HIV non-aids/aware Atlanta EMA HIV non-aids/aware 2007 Heterosexual Unmet Need 2007 MSM Unmet Need 2007 IDU Unmet Need 2007 Not Specified Unmet Need Total 2010 Heterosexual Unmet Need 2010 MSM Unmet Need 2010 IDU Unmet Need 2010 Not Specified Unmet Need Total 20

Estimates by High Risk Subpopulation Overall, similar to 2007 data, in 2010 PLWA White MSM in Georgia and the Atlanta EMA had the highest unmet need percentage followed by PLWA Non-White MSM. Conversely, corresponding with results by race, among PLWH non-aids/aware, Non-White MSM had a higher unmet need proportion than White MSM in the Atlanta EMA. Unlike 2007, in 2010 PLWH non-aids/aware, Non-White MSM had a lower unmet need proportion than White MSM in Georgia statewide. In 2010 in the Atlanta EMA and statewide, data was collected for women ages 15-44 rather than 13 to 44. Within this group and among PLWH non-aids/aware, there was a higher proportion of unmet need than PLWA of the same group. Table 6 2007 and 2010 HIV/AIDS Unmet Need Percentages by Georgia Region, High Risk Subpopulation & HIV Status Disease Status/ Special Pop. Georgia 2007 Georgia 2010 Atlanta EMA 2007 Atlanta EMA 2010 PLWA White MSM 69% 62% 74% 63% PLWA Non-White MSM 64% 56% 67% 57% PLWA Women 15-44* 54% 50% 54% 50% PLWH HIV non-aids/aware 48% 44% 52% 44% White MSM PLWH HIV non-aids/aware 61% 32% 63% 49% Non-White MSM PLWH HIV non-aids/aware 61% 52% 60% 53% Women 15-44* HIV+/aware White MSM 62% 55% 68% 56% HIV+/aware Non-White 63% 53% 66% 54% MSM HIV+/aware Women 15-44* 57% 51% 57% 52% *2007 Women data is representative ages 13-44. 21

Chart 11 2007 and 2010 HIV/AIDS Cases by Georgia Region, High Risk Subpopulations & HIV Status 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 2,548 5,537 1,378 3,263 9,188 4,870 1,755 5,656 2,341 7,073 6,178 3,032 4,757 3,282 1,855 3,514 3,364 1,996 2,512 1,668 1,518 2,091 664 1,578 GA PLWA Atlanta PLWA GA HIV non-aids/aware Atlanta EMA HIV non-aids/aware 2007 White MSM 2007 Non-White MSM 2007 Women 13-44 2010 White MSM 2010 Non-White MSM 2010 Women 15-44 Chart 12 2007 and 2010 HIV/AIDS Unmet Need by Georgia Region, High Risk Subpopulation & HIV Status 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 1,265 2,974 689 5,159 1,709 3,646 1,272 2,953 4,054 929 2,044 2,983 1,989 1,109 2,347 2,418 2,071 1,474 1,588 1,055 725 923 348 689 GA PLWA Atlanta PLWA GA HIV non-aids/aware Atlanta EMA HIV non-aids/aware 2007 Unmet Need White MSM 2007 Unmet Need Non-White MSM 2007 Unmet Need Women 15-44 2010 Unmet Need White MSM 2010 Unmet Need Non-White MSM 2010 Unmet Need Women 15-44 22

DISCUSSION This study provides a depiction of the extent of unmet need for HIV in the Atlanta EMA and Georgia statewide. Although receipt of one viral load or CD4 laboratory test within a year is not equivalent to routine comprehensive HIV, it provides a clear indication of the receipt of medical services or lack thereof. Overall, in aggregate and by population subgroups, the Atlanta EMA has higher percentages of unmet need than Georgia Statewide. Based on study results, disease status is a strong predictor of unmet need. Since 2007 there has been a seven percent increase in PLWA in Georgia to 25,300 and with the cases that reside in the Atlanta EMA significantly rising from 50% to 64%. Across regions and subpopulations, PLWA had higher percentages of unmet need than PLWH. In the Atlanta EMA, PLWA had a total unmet need of 58%, which is a decrease from 2007 at 65%. Between races and gender categories there was a decrease in PLWA. PLWA Whites had an unmet need of 63%, down from 70%, and PLWA Blacks had an unmet need of 57%, down from 65%. By gender, PLWA Men had an unmet need of 59%, down from 67% and PLWA Women had an unmet need of 55% from 59%. Although the percentage of unmet need has decreased amongst PLWA, the unmet need in both PLWH non- AIDS/aware Men and Women in the Atlanta EMA was still lower. Looking at risk factors, in the Atlanta EMA, PLWA IDUs had an unmet need of 73%, only a one percent decrease from 2007 unmet need. PLWA MSM had an unmet need of 57 %, which was a ten percent decrease from 2007. Within this population, PLWA White MSM had an unmet need of 63%, significantly decreased from 74% in 2007. In parallel, unmet need was elevated across these PLWA subpopulations in Georgia. Gender, race and age also influence unmet need for HIV. Men, in the Atlanta EMA and Georgia statewide, had higher percentages of unmet need compared to Women regardless of disease status. In 2010 in the Atlanta EMA, 57% of HIV+/aware Men had an unmet need that decreased from 63% for in comparison to 53% of HIV+/aware Women, which decreased from 55%. Interestingly, although Blacks represent an overwhelming majority of HIV+/aware cases in the Atlanta EMA and Georgia statewide, among PLWA, Whites had a higher unmet need proportion than Blacks. Yet, among PLWH non-aids/aware, Blacks had a higher unmet need proportion. Further, among PLWA, unmet need increases with age. In the Atlanta EMA, 65% of PLWA 50 years of age and older had an unmet need, whereas PLWA ages 18 to 24 had an unmet need of 38%. Conversely, among PLWH non-aids/aware, unmet need decreases with age after age 24, where those 25-34 years of age in the Atlanta EMA had higher unmet need than those 50 years of age and older. Similar trends for age subpopulations exist across Georgia statewide. Although unmet need results by risk are limited by the high number of cases with non-cdc defined transmission categories, it is important to consider the differences in unmet need by risk category. In 2010, Injection drug users and MSM, separately, when combined, and regardless of disease status, 23

had the highest unmet need percentages in the Atlanta EMA and Georgia statewide. In the Atlanta EMA, PLWA IDUs and PLWA age 50 years and older had an unmet need of 73% and 65% respectively, this being the highest across all subpopulations. The results in this report demonstrate the extent and characteristics of HIV unmet need in the Atlanta EMA and Georgia statewide for local and statewide HIV planning and resource allocation. The continuous monitoring of unmet need is critical in evaluating progress towards the Atlanta EMA Part A Grantee s goal of ensuring that those people living with HIV/AIDS in the Atlanta EMA had 100% access to and that there are no disparities in the care provided. The methodology utilized in the 2007 and 2010 analysis will be employed in future Atlanta EMA unmet need studies and will therefore allow comparative and trend analysis of unmet need. 24

APPENDIX Unmet Need Estimates by Geographic Location Table 7 Georgia Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010 with AIDS (PLWA) as of 12/31/2010 25,300 with HIV (PLWH)/non- 12/31/2010 19,676 C-A HIV+/aware as of 12/31/2010 44,976 12/31/2010 11,090 the specified HIV primary medical care during the 12-month Row E. period as of 12/31/2010 9,312 F-D HIV+/aware who received the specified HIV during the 12-month period as Row F. of 12/31/2010 20,402 did not 14,210 56% A-D 10,364 53% B-E unmet need) 24,574 55% C-F 25

Table 8 Atlanta EMA Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 12/31/2010 16,420 12/31/2010 12,004 C-A 12/31/2010 28,424* 12/31/2010 6,896 Row E. 12/31/2010 5,621 F-D Row F. 12/31/2010 12,517 did not 9,524 58% A-D 6,383 53% B-E unmet need) 15,907 56% C-F *Due to missing information in demographic variable, the total number in the EMA does not equal the difference between the total numbers for Georgia total number non-ema. 26

Table 9 Georgia Non-EMA Quantified Estimate of Unmet Need for HIV Primary Care, Non-EMA, 2010 12/31/2010 7,340 12/31/2010 6,335 C-A 12/31/2010 13,675 12/31/2010 3,539 Row E. 12/31/2010 3,231 F-D Row F. 12/31/2010 6,770 did not 3,801 52% A-D 3,104 49% B-E unmet need) 6,905 50% C-F 27

Unmet Need Estimates by Gender and Geographic Location Table 10 Georgia Men Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Males 12/31/2010 19,189 12/31/2010 13,608 C-A 12/31/2010 32,797 12/31/2010 8,240 Row E. 12/31/2010 6,365 F-D Row F. 12/31/2010 14,605 did HIV 10,949 57% A-D 7,243 53% B-E unmet need) 18,192 55% C-F 28

Table 11 Atlanta EMA Men Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Males 12/31/2010 13,109 12/31/2010 8,899 C-A 12/31/2010 22,008 12/31/2010 5,412 Row E. 12/31/2010 4,107 F-D Row F. 12/31/2010 9,519 did HIV 7,697 59% A-D 4,792 54% B-E unmet need) 12,489 57% C-F 29

Table 12 Georgia Women Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Females 12/31/2010 5,860 12/31/2010 5,676 C-A 12/31/2010 11,536 12/31/2010 2,787 Row E. 12/31/2010 2,847 F-D Row F. 12/31/2010 5,634 did HIV 3,073 52% A-D 2,829 50% B-E unmet need) 5,902 51% C-F 30

Table 13 Atlanta EMA Women Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Females 12/31/2010 3,239 12/31/2010 2,982 C-A 12/31/2010 6,221 12/31/2010 1,457 Row E. 12/31/2010 1,459 F-D Row F. 12/31/2010 2,916 did HIV 1,782 55% A-D 1,523 51% B-E unmet need) 3,305 53% C-F 31

Unmet Need Estimates by Race/Ethnicity and Geographic Location Table 14 Georgia Black Race Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010 Black 12/31/2010 16,400 12/31/2010 13,117 C-A 12/31/2010 29,517 12/31/2010 7,419 Row E. 12/31/2010 6,193 F-D Row F. 12/31/2010 13,612 did HIV 8,981 55% A-D 6,924 53% B-E unmet need) 15,905 54% C-F 32

Table 15 Atlanta EMA Black Race Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Black 12/31/2010 10,847 12/31/2010 8,102 C-A 12/31/2010 18,949 12/31/2010 4,629 Row E. 12/31/2010 3,652 F-D Row F. 12/31/2010 8,281 did HIV 6,218 57% A-D 4,450 55% B-E unmet need) 10,668 56% C-F 33

Table 16 Georgia White Race Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010 White 12/31/2010 5,723 12/31/2010 4,083 C-A 12/31/2010 9,806 12/31/2010 2,246 Row E. 12/31/2010 2,150 F-D Row F. 12/31/2010 4,396 did HIV 3,477 61% A-D 1,933 47% B-E unmet need) 5,410 55% C-F 34

Table 17 Atlanta EMA White Race Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 White 12/31/2010 2,512 12/31/2010 1,578 C-A 12/31/2010 4,090 12/31/2010 924 Row E. 12/31/2010 889 F-D Row F. 12/31/2010 1,813 did not 1,588 63% A-D 689 44% B-E unmet need) 2,277 56% C-F 35

Table 18 Georgia Hispanic Ethnicity Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010 Hispanic 12/31/2010 1,072 12/31/2010 744 C-A 12/31/2010 1,816 12/31/2010 457 Row E. 12/31/2010 358 F-D Row F. 12/31/2010 815 did HIV 615 57% A-D 386 52% B-E unmet need) 1,001 55% C-F 36

Table 19 Atlanta EMA Hispanic Ethnicity Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Hispanic 12/31/2010 750 12/31/2010 314 C-A 12/31/2010 1,064 12/31/2010 323 Row E. 12/31/2010 154 F-D Row F. 12/31/2010 477 did HIV 427 57% A-D 160 51% B-E unmet need) 587 55% C-F 37

Table 20 Georgia Other Race Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010 Race Other Row E. 12/31/2010 455 12/31/2010 355 C-A 12/31/2010 810 12/31/2010 273 12/31/2010 201 F-D 12/31/2010 474 Row F. did HIV 182 40% A-D 154 43% B-E unmet need) 336 41% C-F 38

Table 21 Atlanta EMA Other Race Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Race Other 12/31/2010 336 12/31/2010 150 C-A 12/31/2010 486 12/31/2010 195 Row E. 12/31/2010 79 F-D Row F. 12/31/2010 274 did HIV 141 42% A-D 71 47% B-E unmet need) 212 44% C-F 39

Table 22 Georgia Unknown Race Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010 Race Unknown 12/31/2010 1,661 12/31/2010 1,534 C-A 12/31/2010 3,195 12/31/2010 636 Row E. 12/31/2010 374 F-D Row F. 12/31/2010 1,010 did HIV 1,025 62% A-D 1,160 76% B-E unmet need) 2,185 68% C-F 40

Table 23 Atlanta EMA Unknown Race Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Race Unknown Row E. 12/31/2010 551 12/31/2010 537 C-A 12/31/2010 1,088 12/31/2010 246 12/31/2010 165 F-D 12/31/2010 411 Row F. did HIV 305 55% A-D 372 69% B-E unmet need) 677 62% C-F 41

Unmet Need Estimates by Age and Geographic Location Table 24 Georgia Younger than 2 Years Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010 Age <2 12/31/2010 7 12/31/2010 60 C-A 12/31/2010 67 12/31/2010 1 Row E. 12/31/2010 6 F-D Row F. 12/31/2010 7 did not receive the specified HIV primary medical care 6 86% A-D 54 90% B-E unmet need) 60 90% C-F 42

Table 25 Atlanta EMA Younger than 2 Years Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Age <2 12/31/2010 0 12/31/2010 22 C-A 12/31/2010 22 during the 12-month period as of 12/31/2010 - Row E. 12/31/2010 4 F-D Row F. 12/31/2010 4 did not receive the specified HIV primary medical care 0 0% A-D 18 82% B-E unmet need) 18 82% C-F 43

Table 26 Georgia 2-12 Years Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Age 2 to 12 12/31/2010 34 12/31/2010 209 C-A 12/31/2010 243 during the 12-month period as of 12/31/2010 19 Row E. 12/31/2010 55 F-D Row F. 12/31/2010 74 did not receive the specified HIV primary medical care 15 44% A-D 154 74% B-E unmet need) 169 70% C-F 44

Table 27 Atlanta EMA 2-12 Years Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Age 2 to 12 12/31/2010 20 12/31/2010 87 C-A 12/31/2010 107 during the 12-month period as of 12/31/2010 12 Row E. 12/31/2010 41 F-D Row F. 12/31/2010 53 did HIV 8 40% A-D 46 53% B-E unmet need) 54 50% C-F 45

Table 28 Georgia 13-17 Years Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Age 13 to 17 12/31/2010 58 12/31/2010 101 C-A 12/31/2010 159 12/31/2010 36 Row E. 12/31/2010 66 F-D Row F. 12/31/2010 102 did HIV 22 38% A-D 35 35% B-E unmet need) 57 36% C-F 46

Table 29 Atlanta EMA 13-17 Years Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Age 13 to 17 12/31/2010 35 12/31/2010 65 C-A 12/31/2010 100 during the 12-month period as of 12/31/2010 23 Row E. 12/31/2010 45 F-D Row F. 12/31/2010 68 did HIV 12 34% A-D 20 31% B-E unmet need) 32 32% C-F 47

Table 30 Georgia 18-24 Years Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Age 18 to 24 12/31/2010 491 12/31/2010 1,411 C-A 12/31/2010 1,902 12/31/2010 303 Row E. 12/31/2010 648 F-D Row F. 12/31/2010 951 did HIV 188 38% A-D 763 54% B-E unmet need) 951 50% C-F 48

Table 31 Atlanta EMA 18-24 Years Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Age 18 to 24 12/31/2010 273 12/31/2010 783 C-A 12/31/2010 1,056 during the 12-month period as of 12/31/2010 170 Row E. 12/31/2010 348 F-D Row F. 12/31/2010 518 did HIV 103 38% A-D 435 56% B-E unmet need) 538 51% C-F 49

Table 32 Georgia 25-29 Years Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Age 25 to 29 12/31/2010 962 12/31/2010 2,231 C-A 12/31/2010 3,193 12/31/2010 548 Row E. 12/31/2010 927 F-D Row F. 12/31/2010 1,475 did HIV 414 43% A-D 1,304 58% B-E unmet need) 1,718 54% C-F 50

Table 33 Atlanta EMA 25-29 Years Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Age 25 to 29 12/31/2010 597 12/31/2010 1,397 C-A 12/31/2010 1,994 during the 12-month period as of 12/31/2010 342 Row E. 12/31/2010 579 F-D Row F. 12/31/2010 921 did HIV 255 43% A-D 818 59% B-E unmet need) 1,073 54% C-F 51

Table 34 Georgia 30-34 Years Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Age 30 to 34 12/31/2010 1,636 12/31/2010 2,469 C-A 12/31/2010 4,105 12/31/2010 875 Row E. 12/31/2010 1,093 F-D Row F. 12/31/2010 1,968 did HIV 761 47% A-D 1,376 56% B-E unmet need) 2,137 52% C-F 52

Table 35 Atlanta EMA 30-34 Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Age 30 to 34 12/31/2010 1,079 12/31/2010 1,603 C-A 12/31/2010 2,682 during the 12-month period as of 12/31/2010 559 Row E. 12/31/2010 710 F-D Row F. 12/31/2010 1,269 did HIV 520 48% A-D 893 56% B-E unmet need) 1,413 53% C-F 53

Table 36 Georgia 35-39 Years Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Age 35 to 39 12/31/2010 2,536 12/31/2010 2,550 C-A 12/31/2010 5,086 12/31/2010 1,255 Row E. 12/31/2010 1,152 F-D Row F. 12/31/2010 2,407 did HIV 1,281 51% A-D 1,398 55% B-E unmet need) 2,679 53% C-F 54

Table 37 Atlanta EMA 35-39 Years Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Age 35 to 39 12/31/2010 1,657 12/31/2010 1,629 C-A 12/31/2010 3,286 during the 12-month period as of 12/31/2010 806 Row E. 12/31/2010 753 F-D Row F. 12/31/2010 1,559 did HIV 851 51% A-D 876 54% B-E unmet need) 1,727 53% C-F 55

Table 38 Georgia 40-44 Years Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Age 40 to 44 12/31/2010 4,208 12/31/2010 3,057 C-A 12/31/2010 7,265 12/31/2010 2,001 Row E. 12/31/2010 1,486 F-D Row F. 12/31/2010 3,487 did HIV 2,207 52% A-D 1,571 51% B-E unmet need) 3,778 52% C-F 56

Table 39 Atlanta EMA 40-44 Years Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Age 40 to 44 12/31/2010 2,846 12/31/2010 1,929 C-A 12/31/2010 4,775 12/31/2010 1,308 Row E. 12/31/2010 915 F-D Row F. 12/31/2010 2,223 did HIV 1,538 54% A-D 1,014 53% B-E unmet need) 2,552 53% C-F 57

Table 40 Georgia 45-49 Years Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Age 45 to 49 12/31/2010 5,442 12/31/2010 3,158 C-A 12/31/2010 8,600 12/31/2010 2,409 Row E. 12/31/2010 1,570 F-D Row F. 12/31/2010 3,979 did HIV 3,033 56% A-D 1,588 50% B-E unmet need) 4,621 54% C-F 58

Table 41 Atlanta EMA 45-49 Years Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Age 45 to 49 12/31/2010 3,627 12/31/2010 1,935 C-A 12/31/2010 5,562 12/31/2010 1,519 Row E. 12/31/2010 928 F-D Row F. 12/31/2010 2,447 did HIV 2,108 58% A-D 1,007 52% B-E unmet need) 3,115 56% C-F 59

Table 42 Georgia 50-54 Years Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Age 50 to 54 12/31/2010 4,212 12/31/2010 2,272 C-A 12/31/2010 6,484 12/31/2010 1,741 Row E. 12/31/2010 1,160 F-D Row F. 12/31/2010 2,901 did HIV 2,471 59% A-D 1,112 49% B-E unmet need) 3,583 55% C-F 60

Table 43 Atlanta EMA 50-54 Years Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Age 50 to 54 12/31/2010 2,767 12/31/2010 1,292 C-A 12/31/2010 4,059 12/31/2010 1,081 Row E. 12/31/2010 647 F-D Row F. 12/31/2010 1,728 did HIV 1,686 61% A-D 645 50% B-E unmet need) 2,331 57% C-F 61

Table 44 Georgia 55-59 Years Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Age 55 to 59 12/31/2010 2,755 12/31/2010 1,263 C-A 12/31/2010 4,018 12/31/2010 1,051 Row E. 12/31/2010 641 F-D Row F. 12/31/2010 1,692 did HIV 1,704 62% A-D 622 49% B-E unmet need) 2,326 58% C-F 62

Table 45 Atlanta EMA 55-59 Years Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Age 55 to 59 12/31/2010 1,770 12/31/2010 738 C-A 12/31/2010 2,508 12/31/2010 638 Row E. 12/31/2010 366 F-D Row F. 12/31/2010 1,004 did HIV 1,132 64% A-D 372 50% B-E unmet need) 1,504 60% C-F 63

Table 46 Georgia 60-64 Years Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Age 60 to 64 12/31/2010 1,456 12/31/2010 677 C-A 12/31/2010 2,133 12/31/2010 493 Row E. 12/31/2010 310 F-D Row F. 12/31/2010 803 did HIV 963 66% A-D 367 54% B-E unmet need) 1,330 62% C-F 64

Table 47 Atlanta EMA 60-64 Years Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Age 60 to 64 12/31/2010 923 12/31/2010 387 C-A 12/31/2010 1,310 12/31/2010 271 Row E. 12/31/2010 182 F-D Row F. 12/31/2010 453 did HIV 652 71% A-D 205 53% B-E unmet need) 857 65% C-F 65

Table 48 Georgia 65 Years and Older Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010, Age 65+ 12/31/2010 1,199 12/31/2010 505 C-A 12/31/2010 1,704 12/31/2010 331 Row E. 12/31/2010 224 F-D Row F. 12/31/2010 555 did HIV 868 72% A-D 281 56% B-E unmet need) 1,149 67% C-F 66

Table 49 Atlanta EMA 65 Years and Older Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Age 65+ 12/31/2010 688 12/31/2010 271 C-A 12/31/2010 959 12/31/2010 156 Row E. 12/31/2010 113 F-D Row F. 12/31/2010 269 did HIV 532 77% A-D 158 58% B-E unmet need) 690 72% C-F 67

Unmet Need Estimates by Risk Factor and Geographic Location Table 50 Georgia Heterosexual Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010 Heterosexual 12/31/2010 3,186 12/31/2010 1,640 C-A 12/31/2010 4,826 12/31/2010 1,466 Row E. 12/31/2010 921 F-D Row F. 12/31/2010 2,387 did not 1,720 54% A-D 719 44% B-E unmet need) 2,439 51% C-F 68

Table 51 Atlanta EMA Heterosexual Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 Heterosexual 12/31/2010 1,535 12/31/2010 744 C-A 12/31/2010 2,279 12/31/2010 663 Row E. 12/31/2010 387 F-D Row F. 12/31/2010 1,050 did HIV 872 57% A-D 357 48% B-E unmet need) 1,229 54% C-F 69

Table 52 Georgia MSM Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010 MSM 12/31/2010 9,188 12/31/2010 6,178 C-A 12/31/2010 15,366 12/31/2010 4,029 Row E. 12/31/2010 3,195 F-D Row F. 12/31/2010 7,224 did HIV 5,159 56% A-D 2,983 48% B-E unmet need) 8,142 53% C-F 70

Table 53 Atlanta EMA MSM Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 MSM 12/31/2010 7,340 12/31/2010 4,985 C-A 12/31/2010 12,325 12/31/2010 3,172 Row E. 12/31/2010 2,427 F-D Row F. 12/31/2010 5,599 did HIV 4,168 57% A-D 2,558 51% B-E unmet need) 6,726 55% C-F 71

Table 54 Georgia IDU Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010 IDU 12/31/2010 1,695 12/31/2010 539 C-A 12/31/2010 2,234 12/31/2010 490 Row E. 12/31/2010 211 F-D Row F. 12/31/2010 701 did HIV 1,205 71% A-D 328 61% B-E unmet need) 1,533 69% C-F 72

Table 55 Atlanta EMA IDU Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 IDU 12/31/2010 1,212 12/31/2010 310 C-A 12/31/2010 1,522 12/31/2010 332 Row E. 12/31/2010 112 F-D Row F. 12/31/2010 444 did HIV 880 73% A-D 198 64% B-E unmet need) 1,078 71% C-F 73

Table 56 Georgia MSM/IDU Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010 MSM/IDU Row E. 12/31/2010 1,004 12/31/2010 380 C-A 12/31/2010 1,384 12/31/2010 367 12/31/2010 189 F-D 12/31/2010 556 Row F. did HIV 637 63% A-D 191 50% B-E unmet need) 828 60% C-F 74

Table 57 Atlanta EMA MSM/IDU Quantified Estimate of Unmet Need for HIV Primary Care, EMA, 2010 MSM/IDU 12/31/2010 795 12/31/2010 270 C-A 12/31/2010 1,065 12/31/2010 288 Row E. 12/31/2010 128 F-D Row F. 12/31/2010 416 did HIV 507 64% A-D 142 53% B-E unmet need) 649 61% C-F 75