State of the HIV Epidemic in Florida, 2016

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State of the HIV Epidemic in Florida, 2016

Florida Department of Health

HIV/AIDS Section

Data as of 6/30/2017

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

1

Technical Notes

HIV cases by year of diagnosis represent

HIV cases diagnosed in that year, regardless of AIDS status at time of diagnosis

AIDS and HIV cases by year of diagnosis are

not

mutually exclusive and

cannot be added togetherHIV prevalence data represent persons who were living with a diagnosis of HIV in the reporting area through the end of the calendar year (regardless of where they were diagnosed)2

Technical Notes, Continued

Adult cases represent ages 13 and older; pediatric cases are those under the age of 13. For data by year, the age is by age

at

diagnosis. For living data, the age is by current age at the end of the most recent calendar year, regardless of age at diagnosis

Unless otherwise noted, Whites are non-Hispanic, Blacks are non-Hispanic and

Other (which may be omitted in some graphs due to small numbers)

represents Asian, American Indian, or mixed racesUnless otherwise noted, area and county data will exclude Department of Corrections cases3

Implement routine HIV and Sexually Transmitted Disease (STD) screening in health care settings and priority testing in non-health care settings

Test and Treat (T & T): provide rapid access to treatment and ensure retention in care

Improve access to antiretroviral pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (

nPEP

)

Increase HIV awareness and community response through outreach, engagement, and messaging

Florida’s Plan to Eliminate HIV Transmission and Reduce HIV-related DeathsFour Key Components4

MSM:

Men who have sex with men

or male-to-male sexual contact

IDU:

Injection Drug UserMSM/IDU: Men who have sex with men or male-to-male sexual contact & injection drug user

Heterosexual: Heterosexual contact with person with HIV or known HIV riskOther: includes hemophilia, transfusion, perinatal and other pediatric risks and other confirmed risks

Definitions of Mode of Exposure Categories5

Rankings of HIV Case Rates by State1

Diagnosed in 2016, United States

Rate per 100,000 population

1 Source: US data: HIV Surveillance Report, 2016 (most recent available) Vol. 28, Table 24 (HIV data for all 50 states) http://www.cdc.gov/hiv/topics/surveillance/resources/reports/index.htm

6

Rankings of HIV Case Rates by MSA1

Diagnosed in 2016, United States

Rate per 100,000 population

1 Source: US data: HIV Surveillance Report, 2016 (most recent available) Vol. 28, Table 28 (HIV data for metropolitan statistical area (MSA) of residence) http://www.cdc.gov/hiv/topics/surveillance/resources/reports/index.htm7

The Epidemic in Florida

2015

2016Trend

 Population

119.9 million

20.2 million1.5% increase 

White56%White54% 

 Black

16%Black15% Hispanic24%Hispanic24% Other

2%Other3%

Persons diagnosed and Living with HIV (PLWH)2111,903114,772

2.6% increaseStrategic Long Term Goals 

Reduce the annual number of HIV Cases34,708

4,9725.6%

increaseIncrease the percent of PLWH Retained in Care66.6%66.1%

0.8% decreaseIncrease the percent of with a Suppressed Viral Load59.6%

60.3%1.2% increaseReduce the annual number of HIV-infected babies born in Florida to less than 5

98

11% decreaseAdditional Indicators

 Reduce annual number of AIDS Cases4

2,1292,1190.5% decrease

Reduce the annual number of HIV-related resident deaths 873864

1.0% decrease

8

HIV Cases by Year of Diagnosis,

1978–2016, Florida

9

101981

– First AIDS case report

1985 – First HIV antibody test in Florida1989 – “Crack” cocaine epidemic increases syphilis and AIDS cases1991 – First Ryan White Planning Group established1992 – The beginning of the highly active antiretroviral therapy (HAART)1993 – The Centers for Disease Control and Prevention (CDC) expands the case definition of AID1994 – Food and Drug Administration approved OraSure saliva HIV test1997

– Florida implemented physician and laboratory reporting of HIV infection by name on July 12006 – HIV reporting laws expanded in Florida2007 – Expansion of Electronic Laboratory Reporting 2013 – HIV increases as a result of recent increases in syphilis cases

Key events to note in the HIV/AIDS epidemic

HIV Tests Conducted in Florida

and

Seropositivity

Rates,

1 1986–2016

1Seropositivity rates are defined as the percent of positive over the number of tests conducted each year.

HIV Counseling and Testing data as of 6/3/2016.11

What trends have we seen in Florida over the past ten years (2007–2016)?

12

HIV Cases by Year of Diagnosis, 2007–2016, Florida

13

10 year % change (2007–2016) = 47% decrease

AIDS Cases by Year of Diagnosis, 2007–2016, Florida

14

Perinatally Acquired HIV Cases, Born in Florida,by Year of Birth, 1979–2016, N=1,238

Year of Birth

Number of Cases

% Change from previous year

200718

200811

-39%20099-18%20106

-33%20113-50%2012

8167%

20131025%20146-40%2015950%

20168-11%

1992–1994 introduction of HAART1

1Hightly active antiretroviral therapy (HAART) is an HIV treatment that suppresses viral load and reduces HIV transmission15

Infants Perinatally Exposed to HIV 1

, 2016, Florida, N=483

Perinatal HIV exposed, no transmission =

475

Perinatal HIV transmission = 8Pediatric HIV (not AIDS) = 71 Hillsborough

1 Lee1 Leon1 Marion1 Okaloosa1 St. Lucie

1 Miami-DadePediatric AIDS = 11 Orange

1Pediatric exposure data as of 9/30/2017.Numbers on counties are infants perinatally exposed to HIV.16

Adult (Age 13+) HIV Case Rates

1

by Sex and Year of Diagnosis, 2007–2016, Florida

Male to Female Ratio

2007 = 2.7 to 1

2016 = 3.8 to 1

1Source: Population data are provided by Florida CHARTS as of 6/30/2017.17

Adult (Age 13+) HIV Cases, by Race/Ethnicity

and Year of Diagnosis, 2007–2016, Florida

18

1

Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.

Proportion of Adult (Age 13+) HIV Cases, by

Race/Ethnicity and Year of Diagnosis,

2007–2016, Florida

19

1

Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.

HIV Cases Among Asians and American Indians,

by Race/Ethnicity

Diagnosed 1982–2016, Florida

20

Adult (Age 13+) HIV Cases Among Asians and American Indians, By Year of Diagnosis,

1982–2016, Florida

21

Adult (Age 13+) HIV Cases, by Age Group at Diagnosis and Year of Diagnosis, 2007–2016, Florida

22

Adult (Age 13+) HIV Cases by Mode of Exposure and Year of Diagnosis,

2007–2016,

Florida

23

Adult (Age 13+) Male HIV Cases, by Mode of Exposure and Year of Diagnosis, 2007–2016, Florida

24

Adult (Age 13+) Female HIV Cases by Mode of Exposure and Year of Diagnosis, 2007–2016, Florida

25

Where are the Diagnosed Cases

of HIV occurring In Florida?

26

Rates of Diagnoses of HIV among Adults (Age 13+)

2016, United States and Six Dependent Areas

1N = 40,202 Rate = 14.7

1

Source: Centers for Disease Control and Prevention. Data as of 6/30/2016.27

HIV Case Rates

1

by County of Residence

2

Diagnosed in 2016, Florida

1

Source: Population data for all ages were provided by Florida CHARTS as of 6/30/2017.2County totals exclude cases from Department of Corrections and Federal Correctional Institutions (N=207). Numbers on counties are cases diagnosed.

Statewide Data:N= 4,972State Rate = 24.6Rate per 100,000 population28

HIV Cases by County of Residence,

Diagnosed in 2016, and Testing Facilities,

1

Florida

Statewide Data:

N= 4,972

CasesTesting Sites

1Public HIV counseling and testing sites in Florida.29

Demographics of the HIV Cases in

florida

30

Percentage of Adult (Age 13+) HIV and AIDS Cases

Diagnosed in 2016 and Population,

by Race/Ethnicity, Florida

Florida Adult

Population Estimates

N=17,191,788

HIV N=4,955AIDS N=2,11731

1Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.

Adult (Age 13+) HIV Case Rates

1

by Sex and Race/Ethnicity, Diagnosed in 2016, Florida

Ratios:

Males

Black to White, 5.3 to 1

Hispanic to White, 2.8 to 1Females Black to White, 13.4 to 1 Hispanic to White, 1.8 to 1321

Source: Population estimates are provided by Florida CHARTS as of 6/20/2017.

Adult (Age 13+) AIDS Case Rates

1

by Sex and Race/Ethnicity, Diagnosed in 2016, Florida

Ratios:

Males

Black to White, 6.8 to 1

Hispanic to White, 2.2 to 1Females Black to White, 15.2 to 1 Hispanic to White, 1.6 to1331

Source: Population estimates are provided by Florida CHARTS as of 6/20/2017.

Adult (Age 13+) HIV Cases, by Sex and

Age Group at Diagnosis, Diagnosed in 2016, Florida

34

Adult (Age 13+) Male HIV Cases, by Race/Ethnicity and

Age Group at Diagnosis, Diagnosed in 2016, Florida

35

1

Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.

Adult (Age 13+) Female HIV Cases, by Race/Ethnicity and

Age Group at Diagnosis, Diagnosed in 2016, Florida

36

1

Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.

Adult (Age 13+) HIV Cases, by Sex and

Mode of Exposure, Diagnosed in 2016, Florida

Male

N=3,881

Female

N=1,074

IDU

MSM/IDU

Heterosexual

Other

MSM

37

1

Other Risk includes hemophilia, transfusion, perinatal and other pediatric risks as well as other confirmed risks.

1

Other includes Asian/Pacific Islander, Native Alaskan/American Indian and Multi-racial individuals.

2 Other Risk includes hemophilia, transfusion, perinatal and other pediatric risks as well as other confirmed risks.

Adult (Age 13+) Male HIV Cases

by Race/Ethnicity and Mode of Exposure,Diagnosed in 2016, Florida38

1

Other includes Asian/Pacific Islander, Native Alaskan/American Indian and Multi-racial individuals.

2 Other Risk includes hemophilia, transfusion, perinatal and other pediatric risks as well as other confirmed risks.

Adult (Age 13+) Female HIV Cases

by Race/Ethnicity and Mode of Exposure,Diagnosed in 2016, Florida39

HIV Cases by Select Country of Birth,

1

Diagnosed in 2016, Florida

40Cases

1

Select countries of birth include countries with 50 or more cases.

HIV Cases by Select Country of Birth

1

Outside the US, Diagnosed 2007–2016, Florida41

1

Select countries of birth include countries with 50 or more cases. Excludes cases unknown country of birth.

The dashed lines represent primarily black countries of birth, whereas the solid lines (except other) represent Hispanic countries of birth.

Acute

1

Infections, Diagnosed from NAAT2 Positive Clients, 2012–2017, Florida42549,627 NAATs82

Acute Infections1Acute HIV infection refers to the phase of infection 2-4 weeks after transmission before HIV antibodies have developed. 2Nucleic acid amplification tests (NAAT) administered from 4/16/2012 through 7/31/2017.

HIV/Co-morbidity data

43

Adult (Age 13+) Syphilis

1

and HIV Cases Diagnosed 2007–2016, Florida

1

Source: Infectious Syphilis data provided by the STD & Viral Hepatitis Section.

2

Co-infected persons are infected with both HIV and syphilis at the same time. 44SyphilisHIVCo-infected2

Adult (Age 13+) Infectious Syphilis Case Rates

1

by Sex and Year of Diagnosis, 2007–2016, Florida

Male to Female Ratio

2007 = 5.3 to 1

2016 = 8.5 to 1

1Source: Population data are provided by Florida CHARTS as of 6/30/2017.45

Adult (Age 13+) HIV Cases with STD1 by Typeand Year of STD Report,

2 2007–2016, Florida

Year of STD ReportSyphilis

ChlamydiaGonorrhea

Number of Co-infected Cases

Number of Co-infected CasesNumber of Co-infected Cases

20073255396882008404

6376942009438721

7312010

533819775201155987881820126231,132

1,00520136521,225

1,19420147941,401

1,3252015865

1,5541,7342016936

1,8282,013

10 year % change: Syphilis 188% Chlamydia 239% Gonorrhea 193%46

1Sexually transmitted disease (STD)2Source: PRISM, STD Section as of 6/30/2017

Males

N=4,515

Females

N=1,316

Living HIV/HBV

1

Co-infected Adult (Age 13+) Cases by Sex and Mode of Exposure, Year-end 2016, Florida471Source: Hepatitis B (HBV) data, which includes both acute and chronic cases were generated from MERLIN as of 6/30/2017.2 Other Risk includes hemophilia, transfusion, perinatal and other pediatric risks as well as other confirmed risks.

IDU

MSM/IDU

Heterosexual

Other

MSM

Males

N=7,655

Females

N=2,901

Living HIV/HCV

1

Co-infected Adult (Age 13+) Cases by Sex and Mode of Exposure, Year-end 2016, Florida481Source: Hepatitis C (HCV) data, which includes both acute and chronic cases were generated from MERLIN as of 6/30/2017.2 Other Risk includes hemophilia, transfusion, perinatal and other pediatric risks as well as other confirmed risks.

IDU

MSM/IDU

Heterosexual

Other

MSM

HIV Prevalence and care in Florida

49

Rates of Adults (Age 13+) Living with Diagnosed HIV Year-end 2015, United States and Six Dependent Areas

1

N = 988,955 Rate = 364.3

1

Source: Centers for Disease Control and Prevention. Data as of 6/30/2016 50

1

County totals exclude cases from Department of Corrections and Federal Correctional Institutions (N=3,975).

Numbers on counties are number of cases reported.

Living Case Counts

N=110,979

Persons Living with HIV by County of Residence

1 Year-end 2016, Florida132851

One-In-Statements for Adults (Age 13+)

Living with HIV in Florida, Year-end 2016

One in 150 adults in Florida were known to be living with HIV

One in 284 Whites were living with HIVOne in 47 Blacks were living with HIVOne in 181 Hispanics were living with HIV

52

Adults (Age 13+) Living with HIV

Year-end 2016, Florida, N=114,608

53

Transgender

1

Adults (Age 13+) Living with HIV

Year-end 2016, Florida

54

1

Limitations: Transgender data were not aggressively collected or recorded until 2013.2Mode of exposure for transgender adults is based on risk associated with birth sex.

HIV CARE in

florida

55

HIV Care Continuum Definitions

HIV Diagnosed

: The number of persons known to be diagnosed and living in Florida with HIV (PLWH) at the end of 2016, from data as of 6/30/2017Ever in Care: PLWH with at least one documented Viral Load (VL) or CD4 lab, medical visit, or prescription from HIV diagnosis through 3/31/2017Currently in Care: PLWH with at least one documented VL or CD4 lab, medical visit, or prescription from 1/1/2016 through 3/31/2017Retained in Care: PLWH with two or more documented VL or CD4 labs, medical visits, or prescriptions at least three months apart from 1/1/2016 through 6/30/2017Suppressed Viral Load: PLWH with a suppressed VL (<200 copies/mL) on the last VL from 1/1/2016 through 3/31/2017

56

114,772

105,895

84,10569,254Persons Living with HIV (PLWH) in Floridaalong the HIV Care Continuum in 2016

135,986 are estimated to be living with HIV, accounting for 21,214 (15.6%) who are unaware of their HIV status.85% of the 4,972 diagnosed with HIV in 2016 had documented HIV-related care within 3 months of diagnosis.82% of PLWH in care had a suppressed viral load.86% of PLWH retained in care had a suppressed viral load.

57Percent of PLWH (%)

MSM

1

Living with HIV (PLWH) in Florida,along the HIV Care Continuum in 2016

61,16457,09045,854

87% of the 3,089 diagnosed with HIV in 2016 had documented HIV-related care within 3 months of diagnosis.85% of PLWH in care had a suppressed viral load.94% of PLWH retained in care had a suppressed viral load.

39,001

1Men who have sex with men (MSM) includes MSM and MSM/ Injection Drug Use (IDU) cases. 58

Persons Living with HIV (PLWH) in Florida by Race

along the HIV Care Continuum in 2016

88% of whites, 80% of blacks, and 88% of Hispanics diagnosed with HIV in 2016 that had documented HIV care within 3 months of diagnosis. 87% of whites, 77% of blacks, and 87% of Hispanics in care had a suppressed viral load.90% of whites, 81% of blacks, and 90% of Hispanics retained in care had a suppressed viral load.59

Percent of PLWH (%)

60

Percentage of Persons Living with HIV (PLWH)

in Florida, who were Retained in Care1 in 2016

1

Retained in Care: PLWH with two or more documented viral load (VL) or CD4 labs, medical visits or prescriptions at least three months apart, 1/1/2016 through 6/30/2017.

Statewide Data:

N=114,77266% Retained in Care

61

Percentage of Persons Living with HIV (PLWH) in Florida who had a Suppressed Viral Load (VL)

1 in 2016

Statewide Data:

N=114,77260% Suppressed VL

1

PLWH with a suppressed VL (<200 copies/mL) on the last VL from 1/1/2016 through 3/31/2017.

Percent of Unmet Need Care Services of Persons Living with HIV (PLWH) in Florida, Collected from Medical Monitoring Project (MMP)1

Data

1

Source: MMP 2009–2014 health survey participants2 Percent of persons surveyed who claimed they received the specific service.3

Percent of persons who did NOT receive the specific service who had a need for that service.62

Top Three ResponsesStigmaLow Socio-Economic Status

Homelessness, Poverty

Self Care is a Lower Priority TransportationOther ConsiderationsPsycho-Social FactorsEducation and AwarenessStructural/SystemicPrimary Barriers to Retention in Care of PLWH in Florida, Provider Perspective63

1

Source: Medical Monitoring Project (MMP) 2009–2014 survey healthcare provider participants

HIV-1 Antiretroviral Drug Resistance1 in Florida, 2016

1

Source:

eHARS and Stanford HIV Drug Resistance Database. Persons whose HIV was diagnosed in Florida in 2016 with a genotype sequence obtained within three months of diagnosis2

PI = protease inhibitors .3 NRTI = nucleoside reverse transcriptase inhibitors .4 NNRTI = non-nucleoside reverse transcriptase inhibitors .5 IN = integrase inhibitors.64

Florida HIV-Related Deaths

65

HIV Mortality in Florida

Technical Notes

Resident HIV deaths due to HIV represent persons who resided in Florida and whose underlying cause of death was HIV, regardless if they were reported with HIV in Florida or not. (Source: Death certificate data from the Florida Department of Health, Bureau of Vital Statistics)

HIV case deaths are known cases of HIV, regardless of AIDS status, reported in Florida and are known to be dead, regardless of the cause or residence at death. (Source: Florida HIV Reporting System, eHARS from the Florida Department of Health, Bureau of Communicable Diseases)

66

10 year % change (2007–2016) = 43%

Resident Deaths Due to HIV by Year of Death,

2007–2016, Florida67

Rate

1

of Resident Deaths

2

due to HIV, by Race/Ethnicity and Year of Death, 2007–2016, Florida1Source: Population data were provided by Florida CHARTS. 2Source: Florida Department of Health, Bureau of Vital Statistics, Death Certificates.3

Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial. 68

Ratios:

Males

Black to White, 5.0 to 1

Hispanic to White, 0.7 to 1

Females

Black to White, 15.5 to 1

Hispanic to White, 1.3 to 1

1Source: Population data were provided by Florida CHARTS (as of 6/30/2017). 2Source: Florida Department of Health, Bureau of Vital Statistics, Death Certificates (as of 6/30/2017).

Rate1 of Resident Deaths

2 due to HIV Disease,by Sex and Race/Ethnicity, 2016, Florida69

Deaths Due to HIV Among Persons

Aged 25 to 44, 2016, Florida

HIV is the seventh leading cause of death overall

(down from sixth in 2015)HIV is the eighth leading cause among males (down from sixth in 2015)

HIV is the sixth leading cause among females (down from fifth in 2015)HIV is the ninth leading cause among Whites (same since 2014)HIV is the fifth leading cause among Blacks (down from fourth in 2015)HIV is the ninth leading cause of death among Hispanics (down from eighth in 2015)

70

Death Rates1 for the Top Seven Leading Causes of Death Among2 Persons 25–44 Years of Age, by Year of Death, 1988–2016, Florida

1

Source: Population data were provided by Florida CHARTS as of 6/30/2017. 2Source: Florida Department of Health, Division of Public Health Statistics and Performance Management, Bureau of Vital Statistics, Death Certificates (as of 6/30/2017).

71

summaries

72

Florida’s Top-Nine Priority Populations

1

for Primary

2 HIV Prevention

1MSM=(MSM and MSM/IDU cases) and IDU=(IDU and MSM/IDU cases), therefore the data are not mutually exclusive. 2Priorities are based on the average on HIV cases diagnosed 2014–2016 (as of 6/30/2017). These priorities are used to target those not infected with HIV to reduce transmission among those with high risk for HIV.73

1

MSM=(MSM and MSM/IDU cases) and IDU=(IDU and MSM/IDU cases), therefore the data are not mutually exclusive.

2Priorities are based on the number of cases living with HIV in Florida, year-end 2016 (as of 6/30/2017). These priorities are used to intervene and reduce progression of the disease among those known to be HIV-infected to prevent further infection in the community.

Florida’s Top-Nine Priority Populations

1

Prevention for Positives74

HIV Prevention Program Summary

HIV testing (routine and prioritized)

HIV/STD Partner Services

PrEP navigation services and programs Linkage to and re-engagement in care programs and services

Peer navigation programs and servicesPerinatal HIV/STD prevention, linkage to care, and medication adherence programs Social media, marketing, and community outreach 75

HIV Prevention Program Summary, Continued

Integrated HIV prevention and care planning

Community mobilization and engagement initiatives

Condom distribution, health education, and materialsEvidence-based risk reduction interventions

Correctional settings HIV testing, linkage, and education programs (prisons and jails)Florida HIV/AIDS Hotline and Website: 1-800-FLA-AIDS; 211BigBend.org 76

HIV Patient Care Program Summary

AIDS Drug Assistance Program (ADAP)

Medications for uninsured and underinsured

Health insurance premium and medication copayment assistance Ryan White Part B Care Services

Medical and support services for PLWHCase Management servicesLinkage to Care and Re-entry servicesNeeds Assessments and Client Satisfaction SurveysRyan White Regional ConsortiaCoordination of services with other Ryan White programs (e.g. Part A, C, D)77

HIV Patient Care Program Summary, Continued

Housing Opportunities for Persons with AIDS (HOPWA)

Short term and tenant-based housing assistance

Test and Treat ProgramLinkage for newly diagnosed individuals to medical and support servicesConsumer Advisory Group (CAG)Client Level Data Reporting to Health Resources and Services Administration (HRSA)

CAREWare/RSRAIMSHOPWA/CAPER78

HIV/AIDS surveillance data is frozen on June 30, following the end of each calendar year.

These are the same data used for Florida CHARTS and all grant-related data.

www.floridacharts.com/charts/CommunicableDiseases/default.aspxFlorida HIV/AIDS Surveillance Data Contacts

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection79

Lorene Maddox, MPH, Surveillance Data Analysis Manager Florida Department of HealthPhone: 850-901-6968Email: Lorene.Maddox@flhealth.gov

Emma Spencer, MPH, PhD, Surveillance Program ManagerFlorida Department of HealthPhone: 850-245-4432Email: Emma.Spencer@flhealth.gov

Yang Wang, MSPH, Data Linkage AnalystFlorida Department of HealthPhone: 850-901-6972Email: Yang.Wang@flhealth.gov Ashleigh Tiller, Data CoordinatorFlorida Department of HealthPhone: 850-901-6984Email: Ashleigh.Tiller@flhealth.gov Danielle Curatolo, Data AnalystFlorida Department of HealthPhone: 850-901-6983Email: Danielle.Curatolo@flhealth.gov