New Jersey HIV/AIDS Epidemiologic Profile 2010

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APPENDIX A: Study Methodology

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New Jersey HIV/AIDS Epidemiologic Profile 00

Estimated HIV/AIDS Cases, Deaths and Persons Living with HIV/AIDS -- New Jersey, 989-008 In 008, the latest complete year of diagnosis data, there were 350 new HIV and AIDS diagnoses and 953 deaths. of Cases and of Deaths 7000 6000 5000 4000 3000 000 0 0 989 AIDS reporting only Number of Deaths Person Living w ith HIV/AIDS 990 99 99 993 994 995 996 997 998 999 000 00 00 003 004 HIVand AIDS reporting Nam ed HIV reporting started 005 006 007 008 40000 35000 30000 5000 0000 5000 00 5000 Newly Diagnosed Cases of HIV/AIDS 0 of Persons Living with HIV/AIDS

HIV/AIDS in New Jersey As of December 3, 00, 75,00 cumulative HIV/AIDS cases have been diagnosed and reported in New Jersey including,355 pediatric cases (those < years of age) and 3,85 cases diagnosed among inmates. More than half (39,5) of the cumulative HIV/AIDS cases have died, leaving 35,688 persons living with HIV/AIDS in New Jersey which includes,575 incarcerated persons.

Persons Living with HIV/AIDS by Sex New Jersey, 00 N=35,688 Women,349 35 Men 3,339 65

Population by Race/Ethnicity -- New Jersey, 00 Population New Jersey, 009 N=8,707,739 Persons Living with HIV/AIDS New Jersey, 00 N=35,688 Asian/Pac 695,08 8 Othr 7,3,45,84 7 Asian/Pac 350 White 7,903 Othr 38 8,047 3 Black,73,997 3 White 5,368478 6 Black 9,50 54

HIV/AIDS and Race/Ethnicity Blacks and s comprise more than three-quarters of persons living with HIV/AIDS in New Jersey. However, the disparity of HIV/AIDS among Blacks and s relative to the population has been consistent for the last few years. The number of cases among Asian Pacific Islanders rose from 77 between 99 to 995, to 95 between 996 and 000, between 00 to 005, and 3 between 006 and 00*. Nonetheless, the rate of HIV/AIDS per,000 population among Asians and Pacific Islanders in NJ remains the lowest by race/ethnicity among all groups including Whites. Rates by race/ethnicity are even more disparate for women compared with men. Data for 009 and 00 are incomplete.

Percentage Persons Living with HIV/AIDS by Sex and Race/Ethnicity -- New Jersey, 00 Male (N=3,339) Female (N=,349) White, 5,738 5 Asian/Pac Isl 55 Other 53 5,37 4 White,980 6 Asian/Pac Isl 95 Othr/Unk 85,406 9 Black,,9 49 Black 7,783 63

Rate per,000 Persons Living with HIV/AIDS by Race/Ethnicity -- New Jersey, 00 Black, non-,63 554 White, non- 47 Asian/Pac Isl 50 0 500 0 500 000

Rate per,000 Persons Living with HIV/AIDS by Sex and Race/Ethnicity New Jersey, 00 Race Male Rate Female Rate Total Rate Black, non-,367 49,039 7,783 63,6 9,50 54,63 5,64 4 759,406 9 339 8.047 554 White, non- 5,93 5 7,980 6 7 7,903 47 Asian/Pac Isl 55 74 95 7 350 50 Other 53 - - 85 - Total 3,339 547,349 78 35,688 40 Note: Population data as of July 009 Bridged-Race estimates

Rate per,000 Persons Living with HIV/AIDS by Sex and Race/Ethnicity -- New Jersey, 00,000,039,600,00,6 Black White 800 759 Asian/Pac Isl 400 0 7 Males 74 7 339 Females 7

HIV/AIDS and Country of Birth Status Immigration status is not contained in the HIV/AIDS registry. Foreign-born is the closest proxy available to track infections among persons living with HIV/AIDS who were not born in the Unites States*. Overall, 5,764 (7) of 35,688 persons living with HIV/AIDS in New Jersey were born in the United States, followed by,773 (4) in Puerto Rico, 606 () in Haiti (), and 3,77 () all other. Country of birth is unknown in 8 of cases. Foreign-born status varies by race/ethnicity. * United States does not include US dependencies.

Persons Living with HIV/AIDS By Race/Ethnicity* and Foreign-Born Status -- New Jersey, 00 Place of Birth White non- Black non- Asian/ Pac Isl Total United States 6590 83 5844 83 337 39 9 5,65 7 Not United States 749 9 8 3840 48 7 6 7,085 0 Missing/Unknown 564 7 04 5 070 3 33 9,69 8 Total 7,903 9,50 8,047 350 35,450 * This chart does not include 38 persons living with HIV/AIDS of other and unknown race/ethnicity.

New HIV/AIDS Diagnoses by Foreign Born Status and Year of Diagnosis New Jersey, 000-008 US Born Not US Born /Unknown Total Year 000,080 73 766 7,846 00,779 73 606 7,385 00,643 75 559 5,07 003,454 74 59 5,973 004,505 74 53 6,08 005,473 78 49,89 006,307 75 437 5,744 007,05 73 393 7,444 008,046 77 304 3,350

Major HIV/AIDS Adult and Adolescent Transmission Categories In the 980s, the CDC established a hierarchy to categorize transmission risk for persons reported with HIV/AIDS based on the likelihood the exposure would lead to infection. For surveillance purposes, cases are counted only once in the hierarchy with the exception of MSM/IDU. Persons with more than one reported risk exposure are listed in the category that appears first.. Men who have sex with men;. Injection drug use; 3. Men who have sex with men and inject drugs; 4. High risk heterosexual contact with a person with, or at, increased risk for HIV infection. http://wonder.cdc.gov/wonder/help/aids.html

HIV/AIDS and Transmission The proportion of cases reported in New Jersey without risk transmission information has been steadily increasing. Roughly half of all cases are currently reported with no transmission risk and 3 of all prevalent cases do not have risk information. Beginning in 004, New Jersey began using a modified risk hierarchy because of the large percentage of cases reported with no risk information. Cases with no reported risk where heterosexual contact with a person of unknown HIV status is indicated are now recoded as heterosexual contact with a person of unknown HIV risk.

Persons Living with HIV/AIDS by Sex and Unmodified versus Recoded Transmission New Jersey, 00 Unknown,046 3 N=35,688 MSM 7,80 Unknown 3,75 0 Other 86 N=35,688 MSM 7,80 Other 86 Het sex 6,990 0 MSM/IDU 800 IDU 8,70 3 Het sex 4,3 40 MSM/IDU 800 IDU 8,70 3

Persons Living with HIV/AIDS by Sex and Recoded Transmission New Jersey, 00 Male (N=3,339) Het sex 6,37 7 Othr/Unk 3,30 3 MSM, 7,80 34 Female (N=,349) Othr/Unk,457 IDU,953 4 MSM/IDU 800 3 IDU 5,7 Het sex 7,939 64

Estimated Persons Living with HIV/AIDS by Sex and Recoded Transmission Category -- New Jersey, 00 Transmission Category Male Female Total Male-to-male sex 7,80 34 N/A N/A 7,80 Injection Drug Use 5,7,953 4 8,70 3 MSM/IDU 800 3 N/A N/A 800 Heterosexual sex with -Injection Drug User 383,75 0,658 5 -Bisexual male N/A N/A 6 6 - -HIV+ partner with other risk,0 9 3,84 6 5,06 5 -Partner with unknown risk 3,967 7 3,354 7 7,3 Pediatric Exposure Other/Unknown 36,768 380,077 3 9 74 3,845 Total 3,339,349 35,688

Estimated Males Living with HIV/AIDS by Race/Ethnicity and Recoded Transmission Category -- New Jersey, 00 Exposure Category Male-to-male sex Injection Drug Use MSM/IDU White non- 3,08 9 43 5 6 4 Black non-,847,888 38 5 5 3,838,383 67 33 5 3 Other/ Unknown a 7 4 9 9 6 7,43 5,49 80 Total 34 3 Heterosexual sex with -Injection Drug User 48 34 99-39 -HIV+ partner with other risk 8 5,7 0 534 9 36 9,993 9 -Partner with unknown risk 63,74 0 984 7 78 9 3,775 7 Pediatric exposure Other/Unknown b 43 737 3,340 76 560 0 4-35 39,504 Total 5,93,367 5,64 408 3,339 a. 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. b. The categories of other exposure and unknown exposure are combined due to the small number of cases in the other category.

Estimated Females Living with HIV/AIDS By Race/Ethnicity and Recoded Transmission Category -- New Jersey, 00 Exposure Category White non- Black non- Other/ Unknown a Total Injection Drug Use 670 34,80 3 456 9 7 9,953 4 Heterosexual sex with -Injection Drug User 5 3 70 9 307 3 6 3,75 0 -Bisexual Male 0 78 6 6 -HIV+ partner with other risk 4,995 6 76 30 5 8 3,84 6 -Partner with unknown risk 406,4 9 657 7 50 8 3,354 7 Pediatric Exposure Other/Unknown b 48 7 9 6 687 3 9 68 66 3 7 5 9 380,077 3 9 Total,980 7,783,406 80,349 a. 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. b. The categories of other exposure and unknown exposure are combined due to the small number of cases in the other category.

HIV/AIDS and Transmission Diagnoses among male IDUs sharply declined between 999 and 008 (9 to 7) while the percentage of MSMs increased from 9 in 999 to 40 in 008. Differences exist in the age at diagnosis for MSMs by race/ethnicity. A greater number of new diagnoses between 006 to 00 were reported among young African American MSM ages 3-4 years than any other age-race/ethnicity group of MSM. In contrast, the highest number of new HIV diagnoses among White MSM occurred in those age 35-44 with an almost equal number of diagnoses among White MSM over age 45. Diagnoses attributed to IDU decreased dramatically for women between 999 and 008 decreasing from 6 of cases in 999 to 8 of cases in 008.

Number Adult/Adolescent Male HIV/AIDS Diagnoses by Recoded Transmission -- New Jersey, 999-008 800 687 677 600 400 00 0 584 59 54 59 489 505 466 473 440 448 45 44 408 43 434 4 48 40 370 343 348 35 90 305 45 55 56 35 3 09 99 80 9 9 64 53 34 97 38 56 38 35 3 8 3 5 0 999 000 00 00 003 004 005 006 007 008 MSM IDU MSM/IDU Het sex Othr/Unk

Cumulative Overview of Adult/Adolescent Diagnoses New Jersey, 00-008 YEAR MSM MSM IDU IDU HETRO HET UNKN UNKN 00 44 0 448 053 48 07 9 003 408 35 6 967 49 33 004 43 90 4 94 47 39 6 005 4 35 3 840 45 366 0 006 370 99 89 48 3 9 007 40 8 34 9 675 47 0 5 008 348 6 97 7 635 47 54 9 TOTAL 80 78 4 5940 47 93 5

Number HIV/AIDS Diagnoses among MSMs by Race/Ethnicity and Age -- New Jersey, 006-00 N=,649 300 84 50 6 00 50 50 37 77 7 4 07 5 6 9 7779 3-4 5-34 35-44 45+ 0 6 7 0 4 Black White Asian/Pac Isl

Number Adult/Adolescent Female HIV/AIDS Diagnoses by Recoded Transmission -- New Jersey, 999-008 800 687 677 600 400 00 0 60 559 550 59 538 50 468 448 406 35 33 330 90 73 35 99 37 34 90 9 9 97 56 66 60 70 68 999 000 00 00 003 004 005 006 007 008 IDU Het sex Othr/Unk

HIV/AIDS and Age Seventy-nine percent of prevalent cases are ages 40 or older. Between 999-008, the percentage of diagnoses decreased among persons ages 5-34 and decreased more dramatically among persons ages 35-44 dropping from 40 of all cases in 999 to 6 of cases in 008. In contrast, the percentage of diagnoses increased slightly for persons 55+ and increased more notably among persons 3-4 from 6 of diagnoses in 999 to 5 of diagnoses in 008; 85 of diagnoses for 3-4 year olds in this time period were among Blacks and s. Diagnoses remained stable for persons ages 45-54. Overall during this period, diagnoses among 3-4 and 55+ comprised <0 of diagnoses each, persons 5-34 and 45-54 comprised just under a quarter of diagnoses each, and persons ages 35-44 comprised about one-third of all diagnoses.

Percentage Adult/Adolescents Living with HIV/AIDS by Age Group -- New Jersey, 00 50+ 5,336 43 3-9,545 7 30-39 4,990 4 40-49,7 36

Number New Adult/Adolescent HIV/AIDS Diagnoses by Age Group -- New Jersey, 999-008 00 65 0 964 950 800 600 400 00 844 658 703 75 704 587 6 57 57 473 55 479 490 453 456 4 49 443 39 394 407 06 9 56 75 74 85 03 8 0 59 7 79 56 80 70 93 430 365 335 334 357 33 07 70 4 33 0 999 000 00 00 003 004 005 006 007 008 3-4 5-34 35-44 45-54 55+

New HIV/AIDS Diagnoses Persons Ages 3-4 by Sex and Race/Ethnicity -- New Jersey, 006-008 Persons Ages 3 4 Race/Ethnicity Males Females Total White non- 55 4 5 5 80 4 Black non- 40 60 98 57 338 59 5 48 8 48 6 Asian/Pacific Islander 3 - - 3 Other/Unknown - - - - Total 398 7 570

HIV Perinatal Exposures by Birth Year and Infection Status -- New Jersey, 993-00 Birth Year 993-999 000 00 00 003 004 005 006 007 008 009* 00* Infected () 347 5 8 6 0 5 9 4 0 5 9 4 0 5 3 3 Total Reported 46 8 4 07 94 85 74 00 6 0 *Years 009 and 00 data is incomplete

HIV/AIDS by Locality The overall HIV/AIDS prevalence rate as of December 3, 00 is 40 per,000 population in New Jersey. Nationally, NJ is one of 5 states with name-based reporting that had an HIV/AIDS prevalence rate of 400 or greater in 008. Prevalence is highest in Essex and Hudson counties. One and a quarter percent of persons in Essex County are living with HIV/AIDS as of December 3, 00. More than of the population of Newark and East Orange are living with HIV/AIDS and prevalence of persons living with HIV/AIDS in Irvington and Atlantic City are approaching.

Persons Living with HIV/AIDS in 00 by Planning Area Prevalence Rate: Persons Living with HIV/AIDS per,000 population by Planning Area Statewide rate= 40 per,000 0.0-99.9 00.0-399.9 400.0-599.9 8 6 600.0 + 4 9 Data as of /3/000 5 7 3 Planning Area: Prevalence Rate Jersey City EMA 769 Newark EMA 653 3 Atlantic-Cape May 444 4 Mercer Area 409 5 Cumberland EMA 40 6 Bergen-Passaic EMA 96 7 Southern NJ Area 30 8 Middlesex-Somerset-Hunterdon 9 Monmouth-Ocean Area 04

HIV/AIDS Cases Diagnosed in 008 by Planning Area New HIV/AIDS Cases Diagnosed in CY008 per,000 population, by Planning Area Statewide rate= 5.6 per,000 0.0 7.9 8.0 5.9 6.0 3.9 8 5 4.0 + 4 9 Data as of /3/00 6 7 3 Planning Area: New Cases Rate Jersey City EMA 5. Newark EMA 3.7 3 Mercer Area 8.4 4 Cumberland EMA 6.6 5 Atlantic-Cape May 3. 6 Southern NJ Area 0.9 7 Bergen-Passaic EMA 0. 8 Middlesex-Somerset-Hunterdon 9.3 9 Monmouth-Ocean Area 8.4

Persons Living with HIV/AIDS in 00 by County Prevalence Rate: Persons Living with HIV/AIDS per,000 population Statewide rate= 409.8 per,000 0.0-99.9 00.0-399.9 400.0-599.9 600.0 + 9 7 7 8 8 6 4 6 5 3 0 4 5 9 0 3 Counties: Prevalence Rates Essex 53. Hudson 769. 3 Atlantic 530.3 4 Passaic 57.7 5 Union 499. 6 Mercer 408.8 7 Cumberland 40.3 8 Camden 33.3 9 Monmouth 77.0 0 Middlesex 55. Salem 45.7 Cape May 00.9 3 Bergen 74.5 4 Somerset 73. 5 Burlington 7.5 6 Morris 55.4 7 Warren 36.8 8 Hunterdon 35.4 9 Gloucester 3.8 0 Ocean.9 Sussex.5 Data as of /3/00

HIV/AIDS Cases Diagnosed in 008 by County New HIV/AIDS Cases Diagnosed in CY008 per,000 population Statewide rate= 5.6 per,000 0.0 7.9 8.0 5.9 6.0 3.9 4.0 + Data as of /3/00 4 3 4 0 8 8 7 0 3 7 5 6 5 9 9 6 Counties: New Case Rates Essex 47.6 Hudson 5. 3 Mercer 8.4 4 Cumberland 6.6 5 Union 6.5 6 Passaic 6. 7 Atlantic 5. 8 Camden 4.5 9 Monmouth. 0 Somerset 0.5 Middlesex 9.4 Burlington 8.8 3 Gloucester 8.7 4 Salem 7.6 5 Cape May 7.3 6 Bergen 6.9 7 Morris 5.5 8 Hunterdon 5.4 9 Ocean 5.3 0 Warren.8 Sussex.3

Persons Living with HIV/AIDS in 00 in Impact Cities 0.0-99.9 00.0-399.9 400.0-599.9 600.0 + 7 3 8 0 6 5 Data as of /3/00 9 4 Ten Impact Initiative Cities Prevalence Rates: Newark 0.7 East Orange 079.8 3 Irvington 853.7 4 Atlantic City 85.6 5 Trenton 460.8 6 Jersey City 75.7 7 Paterson 60. 8 Plainfield 049.3 9 Camden 939. 0 Elizabeth 863.6

Prepared by Charlotte Sadashige Epidemiologic Unit Division of HIV/AIDS, STD, TB Services (609) 984-5940 charlotte.sadashige@doh.state.nj.us