New Jersey HIV/AIDS Epidemiologic Overview, 2017 (Data based upon the HIV/AIDS Reporting System ehars, unless otherwise noted.)

New Jersey HIV/AIDS Epidemiologic Overview, 2017 (Data based upon the HIV/AIDS Reporting System ehars, unless otherwise noted.) New Jersey Department of Health Division of HIV, STD, TB Services

INTRODUCTION We will discuss: Incidence new cases in 2015 True incidence is estimated to be about 10% greater than cases reported to the NJ Department of Health; the 10% includes unreported as well as undiagnosed cases. Prevalence persons living with HIV in 2017. Diagnosis Trends (2011 to 2015) and comparison to National figures. HIV data will be examined by demographic status: gender, age, race, and exposure category Review geographic dispersion of HIV in NJ. NJ Care Continuum. All surveillance data is based upon cases entered in the registry by December 31, 2017.

HIV INFECTION IN NEW JERSEY New Jersey ranked 6th among the 50 states in the rate of adults and adolescents living with HIV/AIDS in 2015 and 11th in the rate of adults and adolescents diagnosed with HIV/AIDS in 2015. Cumulatively, 81,437 cases of HIV/AIDS have been reported in New Jersey. As of December 31, 2017; 37,411 individuals were known to be alive and residing in New Jersey. Prevalent cases include 17,973 (48%) persons living with HIV only and 19,438 (52%) persons living with AIDS. In 2015, there were 1,170 new diagnoses with HIV/AIDS in New Jersey. # of HIV/AIDS diagnoses in NJ for three most-affected subpopulation: 1) Hispanic/Latino MSM (not including MSM/IDU): 203. 2) Black MSM (not including MSM/IDU): 190. 3) Black Heterosexual Women: 130. Between 2011 and 2015, the number of new adult/adolescent HIV/AIDS diagnoses decreased by 2%. The percentage of concurrent HIV and AIDS diagnoses (cases that have already progressed to AIDS at the time of first diagnosis) has remained consistent over the last decade. In 2015, a quarter (25%) of new cases were concurrent HIV and AIDS diagnoses.

Incidence Rates of HIV Infection Among Adults and Adolescents, 2016 - United Sates Rates per 100,000: 16.8 in the South, 11.2 in the Northeast, 10.2 in the West, and 7.5 in the Midwest. NJ = 15.2

Number HIV/AIDS Diagnoses by Stage of Disease New Jersey, 2011-2015

HIV/AIDS and Gender New Jersey has historically had one of the highest proportions of HIV infections occurring in females, although the proportion of female cases is declining. New Jersey ranked 5 th in the number of cumulative HIV diagnoses among females in the U.S. through 2015. NJ ranked 7 th nationally in the rate of new infections; 24.2% of diagnoses in 2015 were among females. New Jersey ranked 8th nationally in the rate of adult and adolescent females living with HIV infection through 2016. A third (32.4%) of 2017 prevalent cases are among females, compared with a quarter of prevalent cases nationally.

Number HIV/AIDS Diagnoses by Gender New Jersey, 2011-2015

Transgender Cases -- New Jersey, December 31, 2017 Cumulative Cases (N=113) Gender N % M to Female 110 97% F to Male 1 1% Other gender ID 2 2% Race/Ethnicity N % White 6 5% Black 62 55% Hispanic 44 39% Other/Unknown 1 1% Age at Diagnosis N % 13-24 36 32% 25-34 51 45% 35-44 18 16% 45+ 8 7% Transmission N % Sex 98 87% IDU-Related 3 3% Unknown 12 11% Prevalent Cases (N=93) Gender N % M to Female 90 97% F to Male 1 1% Other gender ID 2 2% Race/Ethnicity N % White 7 8% Black 52 56% Hispanic 33 35% Other/Unknown 1 1% Age at Diagnosis N % 13-24 30 32% 25-34 41 44% 35-44 16 17% 45+ 6 6% Transmission N % Sex 80 86% IDU-Related 2 2% Unknown 11 12%

Number Adult/Adolescent HIV/AIDS Diagnoses by Age Group -- New Jersey, 2011-2015

HIV/AIDS and Age While over two-thirds of prevalent cases were 45 or older in 2016; there appears to an increase in the proportion of persons being diagnosed at an earlier age. Between 2008-2014, the number of diagnoses increased among males aged 13 to 34 years, especially those aged 13 to 24. In this latter group, the number of diagnoses rose from 162 in 2008 to 178 in 2014, increasing from 10% of male diagnoses in 2008 to 20% in 2014. Among women, the absolute number of diagnoses decreased in all age groups. However, the proportion of cases among females ages 13 to 24, increased from 9% of diagnoses in 2008 to12% of diagnoses in 2014..

Number HIV/AIDS Diagnoses by Race/Ethnicity -- New Jersey, 2011-2015

Number of persons Living with HIV/AIDS, 2017 by Gender and Race in New Jersey

NUMBER AND PERCENTAGE OF HIV/AIDS DIAGNOSED IN 2015 BY RACE/ETHNICITY AND SEX NEW JERSEY NJ males diagnosed HIV/AIDS 2015, N=887 NJ Females diagnosed HIV/AIDS 2015, N=283 NJ ehars as of 12/31/ 2017.

POPULATION (2016) AND PLWHA (2017) BY RACE/ETHNICITY NEW JERSEY New Jersey Population 2016, N=8,944,469 Persons Living with HIV/AIDS New Jersey, 2017, N=37,411 July 2017 Bridged-Race estimates for 2016 population NJ ehars as of 12/31/ 2017.

PERCENT FOR ADULT/ADOLESCENT HIV/AIDS DIAGNOSES BY AGE GROUP AND SEX -- NJ, 2015 Men (aged 13+,N=885) Women (aged13+,n=280) 50%

Number Adult/Adolescent HIV/AIDS Diagnoses by Race/Ethnicity and Age Group -- New Jersey, 2015 Black Hispanic White

HIV/AIDS and Mode of Transmission The number and percentage of new HIV/AIDS diagnoses due to IDU transmission in NJ diminished in recent years. In 2015, only 3.4% of men diagnosed with HIV/AIDS were IDU, this figure was 5.0% for women. Currently, 17% of persons living with HIV/AIDS in is attributed to IDU exposure. MSM has become the highest HIV/AIDS risk in NJ population. 57.5% of NJ men diagnosed with HIV/AIDS in 2015 were MSM. 55% of Black men diagnosed HIV/AIDS in 2015 were MSM and 64% of Hispanics men were MSM. The disparity of new cases in minorities is particularly pronounced for young MSM.

Number of Women Diagnosed HIV/AIDS by Exposure Category -- New Jersey, 2011-2015

Number of Men Diagnosed HIV/AIDS by Exposure Category -- New Jersey, 2011-2015

NEW HIV/AIDS CASES DIAGNOSED BY EXPOSURE CATEGORY, 2015 NEW JERSEY Males diagnosed with HIV/AIDS 2015, N=887 Females Diagnosed HIV/AIDS 2015, N=283

PLWHA BY EXPOSURE CATEGORY NEW JERSEY EHARS DATA AS OF 12/31/2017 Males Living with HIV/AIDS 2017, N=25,308 Females Living with HIV/AIDS 2017, N=12,103

HIV/AIDS Cases Diagnosed in 2015 by Planning Area New HIV/AIDS Cases Diagnosed in CY2015 per 100,000 2015 population, by Planning Area Statewide rate= 13.1 per 100,000 5.0 8.9 9.0 13.9 14.0 22.9 8 2 6 1 23.0 + 3 9 ehars Data as of 12/31/2017, 2015 population from 2017 estimated 5 7 Planning Area: 2015 New Cases Rate 1 Jersey City TGA 23.5 2 Newark EMA 20.3 3 Mercer 14.5 4 Atlantic-Cape May TGA 13.6 5 Cumberland 10.3 6 Bergen-Passaic TGA 9.7 7 NJ Portion of Philadelphia EMA 9.3 8 Middlesex-Somerset-Hunterdon 7.6 9 Monmouth-Ocean 5.2

Persons Living with HIV/AIDS in 2017 by County Prevalence Rate: Persons Living with HIV/AIDS as of 12/31/2017 per 100,000 population (Bridged Race Estimates for July 1, 2016) Statewide rate= 418 per 100,000 0.0-199 200-420 421-599 600 + 11 18 7 8 16 20 21 17 14 6 13 4 12 10 5 1 3 9 19 15 2 Counties: N (Rates) 1 Essex 9601 (1205) 2 Hudson 5098 (752) 3 Union 2883 (519) 4 Atlantic 1371 (506) 5 Passaic 2460 (484) 6 Mercer 1539 (415) 7 Cumberland 620 (403) 8 Camden 1909 (374) 9 Monmouth 1902 (304) 10 Middlesex 2160 (258) 11 Salem 155 (244) 12 Cape May 219 (232) 13 Burlington 888 (198) 14 Somerset 638 (191) 15 Bergen 1793 (191) 16 Warren 198 (186) 17 Morris 872 (175) 18 Gloucester 470 (161) 19 Ocean 818 (138) 20 Hunterdon 161 (129) 21 Sussex 174 (122) Data as of 12/31/2017

Socio-economic Status in New Jersey The percentage of New Jersey s population living in poverty is lower than the nation as a whole. More than ten percent (10.4%) of New Jersey s residents had incomes below the poverty level in 2016 compared to 15.1% nationally (Source: 2012-2016 American Community Survey 5-Year estimates). Counties with the lowest percentage of residents living below the poverty level (richest counties) are Hunterdon, Morris and Somerset. The richer counties tend to have lower HIV prevalence. Conversely, counties with the highest percentage of residents living below the poverty level (poorest counties) tend to have higher HIV incidence and prevalence. Essex, Hudson, Atlantic, Passaic, Mercer, Cumberland and Camden counties had the highest HIV/AIDS prevalence rates in 2017 and the highest poverty rates in 2016.

Living with HIV/AIDS, 2017 Poverty Rates in 2016 by County Statewide rate = 10.4% Counties: N (Rates) 1 Essex 9601 (1205) 2 Hudson 5098 (752) 3 Union 2883 (519) 4 Atlantic 1371 (506) 5 Passaic 2460 (484) 6 Mercer 1539 (415) 7 Cumberland 620 (403) 8 Camden 1909 (374) 9 Monmouth 1902 (304) 10 Middlesex 2160 (258) 11 Salem 155 (244) 12 Cape May 219 (232) 13 Burlington 888 (198) 14 Somerset 638 (191) 15 Bergen 1793 (191) 16 Warren 198 (186) 17 Morris 872 (175) 18 Gloucester 470 (161) 19 Ocean 818 (138) 20 Hunterdon 161 (129) 21 Sussex 174 (122) Data as of 12/31/2017 6 14 1 13 7 21 8 18 9 17 5 20 19 12 2 3 11 10 15 16 4 4.5 6.2 (17-21) 6.9 10.6 (11-16) 10.8 12.0 (7-10) 12.6 + (1-6) Counties: Poverty Rates 1 Cumberland 18.4% 2 Passaic 17.2% 3 Essex 16.3% 4 Hudson 15.6% 5 Atlantic 14.2% 6 Salem 12.6% 7 Camden 12.0% 8 Cape May 11.9% 9 Mercer 11.1% 10 Ocean 11.0% 11 Union 10.6% 12 Middlesex 8.6% 13 Warren 8.3% 14 Gloucester 7.8% 15 Monmouth 7.1% 16 Bergen 6.9% 17 Burlington 6.2% 18 Sussex 6.0% 19 Morris 5.4% 20 Somerset 5.2% 21 Hunterdon 4.5%

MSM ONLY, NUMBER AND PERCENT OF PERSONS DIAGNOSED WITH HIV/AIDS, 2011-2015 BY AGE GROUP NJ By Age Groups (for age 13+, N=2,122 )

Number and Percent of MSM only Diagnoses HIV/AIDS by Age Group in NJ, 2011-2015

MSM ONLY, NUMBER AND PERCENT OF PERSONS DIAGNOSED WITH HIV/AIDS, 2011-2015 BY RACE/ETHNICITY NEW JERSEY NJ MSM s diagnosed HIV/AIDS 2013-2017, N=2,122 NJ ehars as of 12/31/ 2017.

MSM Only Diagnosed HIV/AIDS by Race/Ethnicity New Jersey, 2011-2015

MSM Diagnosed HIV/AIDS 2011-2015 by County for NJ MSM Only (not including MSM/IDU) Statewide new HIV ifections among MSM 2011-2015 = 2,122 6-52 60-129 135-199 300 + 17 16 15 5 18 20 21 11 13 9 14 10 19 4 1 3 7 8 12 6 2 Counties: N 1 Essex 447 2 Hudson 376 3 Union 167 4 Passaic 147 5 Camden 138 6 Bergen 135 7 Middlesex 126 8 Monmouth 109 9 Mercer 87 10 Atlantic 61 11 Morris 52 12 Ocean 52 13 Somerset 50 14 Burlington 49 15 Cumberland 33 16 Gloucester 28 17 Salem 12 18 Warren 8 19 Cape May 6 20 Hunterdon 6 21 Sussex 6 Data as of 12/31/2017

MSM Living with HIV/AIDS through 2017 by County in NJ MSM only (not include MSM/IDU) Persons Living with HIV/AIDS through 2017 Statewide number = 10,672 35-190 200-445 500-799 2,000+ 21 15 16 4 19 17 20 12 14 9 11 10 18 8 2 3 6 7 13 5 1 Counties: # 1 Hudson 2027 2 Essex 2022 3 Union 757 4 Camden 689 5 Bergen 673 6 Middlesex 618 7 Monmouth 614 8 Passaic 558 9 Mercer 441 10 Atlantic 394 11 Burlington 325 12 Morris 313 13 Ocean 253 14 Somerset 216 15 Gloucester 188 16 Cumberland 154 17 Hunterdon 76 18 Cape May 70 19 Warren 54 20 Sussex 51 21 Salem 35 New Jersey ehars Data as of 12/31/2017

NJ HIV Care Continuum by Demographic Factors In comparison to the overall state VL suppression rate of 52%: Gender No difference in percentage of viral load suppression from overall population Race/Ethnicity White - 58% Black - 49% Mode of Exposure MSM 54% Unknown 48% Age at Diagnosis 55+ 55% 13-24 41%

KEY POINTS New HIV infections are down overall; between 2011 and 2015 there was a 2% decline in new infections: 17% among white, 7% among Black, but 17% increase among Hispanics. The only demographic group experiencing a growth in new infections is MSM, particularly for Hispanic men. MSM has become the highest risk factor for HIV/AIDS in NJ. 57.5% of new HIV/AIDS cases in 2015 was among MSM, particularly YMSM between the ages of 19 to 29. Racial ethnic disparities still exist. Seventy nine percent (79%) of persons living with HIV in 2017 were minority. A quarter (25%) of infections are diagnosed at a late stage; these cases are diagnosed concurrently with HIV and AIDS. 70% of persons known to be infected and still residing in NJ were retained in care in 2015, 52% of whom were virally suppressed.

QUESTIONS / INFORMATION CONTACT: BARBARA J. BOLDEN, PHD DIVISION OF HIV, STD AND TB SERVICES DIRECTOR, EPIDEMIOLOGIC SERVICES barbara.bolden@doh.nj.gov (609) 984-5940