Trends in HIV Incidence and Prevalence in the United States Irene Hall, PhD, FACE 7th International Workshop on HIV Transmission Washington, DC, July 20, 2012 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention
Incidence Prevalence Transmission potential Review
Using estimates from new incidence methodology
HIV Incidence by Sex, United States, 1977-2009
HIV Incidence by Race/ethnicity, United States, 1997-2009
HIV Incidence by Transmission Category, Unites States, 1977-2009
Estimated annual percent change among MSM 13-29y: All, 8.1%, 95% CI 1.9%-14.9%; black, 12.2%, 95% CI 4.2%-20.9%; all other NS.
HIV Prevalence in the United States 1,148,200 persons living with HIV infection, year-end 2009 207,600 (18.1%) persons with undiagnosed HIV infection
Prevalence, Rate per 100,000 Estimated Rates of Adults and Adolescents Living with HIV Infection (Prevalence), by Age Group, 2009 United States 900 800 700 600 500 400 300 200 100 0 854 770 421 448 149 102 13 24 25 34 35 44 45 54 55 64 65 Age Group
Prevalence, Rate per 100,000 Estimated Rates of Adults and Adolescents Living with HIV Infection (Prevalence), by Race/Ethnicity, 2009 United States 1,800 1,600 1,685 1,400 1,200 1,000 800 600 400 200 228 136 617 392 223 537 0 American Indian/Alaska Native Asian Black/African American Native Hispanic/Latino Hawaiian/Other Pacific Islander Race/ethnicity White Multiple races
Prevalence, Number Estimated Numbers of Adults and Adolescents Living with HIV Infection (Prevalence), by Transmission Category, 2009 United States 700,000 600,000 500,000 400,000 592,100 N = 1,148,200 300,000 200,000 100,000 113,200 70,200 60,200 100,600 207,100 0 Male-to-male sexual contact Injection drug use Injection drug use Male-to-male - Males - Females sexual contact and injection drug use Transmission category Heterosexual contact - Males Heterosexual contact - Females
Stall et al. AIDS Behav (2009) 13:615 629
HIV Prevalence in the United States 1,148,200 persons living with HIV infection, year-end 2009 207,600 (18.1%) persons with undiagnosed HIV infection
Percentage Percentage Percentages and rates of HIV transmission attributed to persons aware and unaware of their HIV infection 100 80 18% TR=10.4/100 100 80 49% 60 60 40 82% 20 TR=2.7/100 0 People living with HIV 2009 Diagnosed Undiagnosed 40 20 51% 0 New infections Infections from undiagnosed Infections from diagnosed CDC. HIV Surveillance Supplemental Report 2012;17(No. 3, part A). AIDS 2012;26:887 896.
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Number Estimated Number of Adults and Adolescents Living with HIV Infection (Diagnosed and Undiagnosed) * and Percent Undiagnosed United States, 1985-2008 1,200,000 1,000,000 No. living with undiagnosed HIV infection No. living with diagnosed HIV infection Percent undiagnosed 100 80 800,000 600,000 400,000 60 40 Percent 200,000 20 0 0 Year * HIV prevalence was estimated based on national HIV surveillance data for adults and adolescents (aged 13 years at diagnosis) reported through June 2010 using extended backcalculation. The number of undiagnosed HIV infections was derived by subtracting the estimated number of diagnosed living cases from the estimated overall HIV prevalence
Estimated rate of males aged 13 years living with HIV infection, 2008 United States Chen et al. Prevalence of undiagnosed HIV infection among persons aged 13 years National HIV Surveillance System, United States, 2005-2008. MMWR 2012;61(Suppl.):57-64.
Estimated rates of males aged 13 years living with HIV infection and undiagnosed HIV infection, 2008 United States Chen et al. Prevalence of undiagnosed HIV infection among persons aged 13 years National HIV Surveillance System, United States, 2005-2008. MMWR 2012;61(Suppl.):57-64.
Percentage of MSM with diagnosed and undiagnosed HIV infection, 2008 United States Chen et al. Prevalence of undiagnosed HIV infection among persons aged 13 years National HIV Surveillance System, United States, 2005-2008. MMWR 2012;61(Suppl.):57-64.
Number of persons with HIV engaged in selected stages of the continuum of HIV care United States 100% 80% 62% 41% 36% 28% CDC. Vital Signs: HIV Prevention Through Care and Treatment United States. MMWR 2011;60:1618-1623
Percentage Percentage of MSM living with HIV (diagnosed) at the end of 2009 who received care in 2009, 13 U.S. jurisdictions 60 50 40 41 48 51 30 20 10 0 Black Hispanic or Latino White Hall et al. JAIDS DOI: 10.1097/QAI.0b013e318249fe90
Behavior Among MSM, race/ethnicity, age, not associated with having UAI with a partner with negative or unknown HIV status at last sex Heffelfinger et al. Poster #1091, CROI 2012.
Summary Overall, HIV incidence relatively stable Incidence increased among young MSM, particularly young black MSM Disparities exist Incidence Prevalence overall and undiagnosed prevalence Care, treatment, and suppressed viral load Comprehensive prevention strategy must address continuum of care as well as other factors (e.g., risk behavior, STIs, policy)
National HIV/AIDS Strategy Reducing the number of people who become infected with HIV Increasing access to care and optimizing health outcomes for people living with HIV; and, Reducing HIV-related health disparities The White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States. Washington D.C.: White House, July 13, 2010.
Questions? www.cdc.gov/nchhstp/atlas The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention