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HIV/AIDS Epidemiology Florida

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Title: HIV/AIDS Epidemiology Florida


1
HIV/AIDSEpidemiologyFlorida
2006
  • Bureau of HIV/AIDS Surveillance Section
  • (850) 245-4430, or SC 205-4430
  • Incidence data as of 12/31/2006
  • Prevalence and Death data as of 04/05/07

2
The Epidemic in Florida2006
65 White 14 Black 17 Hispanic 4 Other
Population 18.4 million ? (4th in
nation)Cumulative AIDS cases 105,551(3rd in
nation)Cumulative pediatric AIDS cases
1,515(2nd in nation)Cumulative HIV (not AIDS)
cases 37,184(since July 1997)Persons living
with HIV/AIDS (PLWHAs) 81,832 (reported cases)
HIV prevalence estimate 125,000
Other Asian/Pacific Islanders American
Indians/Alaskan Natives multi-racial.
3
Reporting Sources of HIV/AIDS Cases
  • Correctional Facilities
  • Hospitals (ICD-9), Billing
  • HIV Patient Care Clinics
  • Registries (e.g., AZT, TB, Cancer)
  • Private MDs
  • Medical Records
  • Death Certificates
  • Laboratories
  • Medical Examiners
  • Counseling
  • Testing Sites

Comment Most diseases rely on passive
surveillance for case finding. Surveillance for
HIV/AIDS is active and passive, with workers
specifically dedicated to case finding and/or
epidemiologic follow-up, resulting in a very high
completeness of reporting and decent
classification of exposure (risk) category.
4
HIV/AIDS Surveillance, Florida A Few General
Comments
  • High completeness of reporting of diagnosed,
    reportable cases (90).
  • Good timeliness of reporting 82 of AIDS within
    6 months of diagnosis 76 of HIV within 2 months
    of positive test.
  • There are delays in reporting of newly diagnosed
    (incident) cases and deaths, but often trends in
    cases by year of report can be used as a
    reasonable proxy for incidence or cases by year
    of diagnosis). Using the year of report does not
    involve any reporting delays.

5
HIV Case Reporting
  • Reflects good demographic information.
  • Tends to represent more recent infections.
  • No retroactive reporting in Florida prior to
    implementation in July 1997.
  • Patients are tested on a self-selected basis.
  • Anonymous tests are not reported.
  • Data provides a minimum estimate of HIV
    prevalence.
  • All states now have HIV infection reporting.
  • Unless otherwise noted, HIV cases are HIV
    regardless of AIDS status cases.
  • These HIV data may include those cases that have
    converted to AIDS. These HIV cases cannot be
    added with AIDS cases to get combined totals
    since the categories are not mutually exclusive.

6
AIDS Rates per 100,000 Population Reported by
County of Residence Florida, 2006
Based on 2006 statewide population estimates, the
2006 state rate is 32.0 per 100,000 population.
County totals exclude Department of
Corrections cases (N175). Numbers on counties
are cases reported.
7
HIV Cases Reported by County of
Residence Florida, 2006
N4,931
Based on 2006 statewide population estimates, the
2006 state rate is 33.5 per 100,000 population.
County totals exclude Department of
Corrections cases (N293). This map does not
reflect HIV incidence. Numbers on counties are
cases reported.
8
Percent of Reported Adult AIDS Cases and
Population by Area, Florida, 2006
2006 Florida Population Estimates, DOH, Office
of Planning, Evaluation and Data Analysis, ages
13
9
Percent of Reported Adult HIV Cases and
Population by Area, Florida, 2006
2006 Florida Population Estimates, DOH, Office
of Planning, Evaluation and Data Analysis, ages
13
10
AIDS Cases By Year of Report, Florida, 1997-2006
Era of HAART
Comment The advent of HAART was associated with
decreases in AIDS cases in the late 1990s.
Generally, AIDS cases remained fairly stable in
the early 2000s, with an increase in 2004 due to
increased CD4 testing statewide. Increasingly, a
diagnosis of AIDS reflects late diagnosis of HIV
and limited access to treatment.
11
AIDS Case Rate per 100,000 Population By Year
of Report, Florida, 1996-2005
Population rates calculated from annual
population estimates. Comment The advent of
HAART was associated with decreases in AIDS cases
in the late 1990s. Generally, AIDS
cases remained fairly stable in the early 2000s,
with an increase in 2004 due to increased CD4
testing statewide. Increasingly, a diagnosis of
AIDS reflects late diagnosis of HIV and limited
access to treatment.
12
AIDS Increases in Florida, 2004 and Leveling
Back in 2005
  • The increases were simultaneous, all
    demographic subgroups (age, race, sex) and most
    zip codes.
  • This suggests that to a great extent the
    increases may be due to a system-wide improvement
    in case detection and reporting more so than an
    increase in actual occurrence of disease in 2004.
    Changes in 2004 include
  • A large volume of HIV testing in publicly
    funded settings coincided with improved ways to
    link positives into care.
  • Linkage into care more CD4 testing greater
    detection of those with immunologically defined
    AIDS.
  • Further study may be warranted to rule in or
    rule out alternative, contributing factors.

13
HIV Cases By Year of Report, Florida, 1998-2006
Comment Generally, HIV cases remained fairly
stable with an increase in 2002 due to increased
HIV testing statewide as part of the Get to
Know Your Status campaign. Since that time,
newly reported HIV cases have decreased each year.
14
HIV Case Rate per 100,000 Population By Year of
Report, Florida, 1998-2006
Population rates calculated from annual
population estimates. Comment Generally, HIV
cases remained fairly stable with an increase in
2002 due to increased HIV testing statewide as
part of the Get to Know Your Status campaign.
Since that time, newly reported HIV cases
have decreased each year.
15
AIDS and HIV Cases By Year of Report, Florida,
1981-2006
The AIDS surveillance case definition was
expanded for adults/adolescents in 1993. HIV
infection reporting was implemented July 1997.
Comment From 2003 to 2005, there
was a decrease of 11 in HIV cases and an
increase of 8 in AIDS cases. The HIV decrease
may reflect an actual decrease in transmission,
while the AIDS increase in 2004 appears to be
partially due to enhanced laboratory reporting of
CD4 counts and viral loads. Increasingly, in the
era of HAART, a diagnosis of AIDS reflects
treatment issues like access to care, adherence
and viral resistance.
16
United States
Pediatric (Ages lt13) AIDS Cases By
Race/Ethnicity Diagnosed through 2005 (N9,078)
2000 Population By Race/Ethnicity (Ages lt13)
(N52,190,294)
These numbers do not represent actual cases in
persons with a diagnosis of AIDS. Rather,
these numbers are point estimates of cases
diagnosed that have been adjusted for reporting
delays. The estimates have not been adjusted for
incomplete reporting. 2006 data not available.
17
Percent of Adult AIDS Cases by Sex and Year of
Report, Florida, 1997-2006
MF Ratio 1997 2.71 2006 2.21
Comment AIDS cases tend to represent HIV
transmission that occurred many years ago. The
relative increases in female cases reflect the
changing face of the AIDS epidemic over time.
The male-to-female ratio is the number or
percent of cases among males divided by the
number or percent of female cases.
18
Percent of Adult HIV Cases By Sex and Year of
Report, Florida, 1998-2006
MF Ratio 1998 1.61 2006 2.31
Comment The trend for HIV cases by sex is the
opposite of that for AIDS cases. Recent trends
in HIV transmission are best described by the HIV
case data. The relative increases in male HIV
cases might be attributed to proportional
increases in HIV transmission among men who have
sex with men (MSM), which may influence future
AIDS trends. There is additional evidence to
support this MSM hypothesis, which we will now
examine more closely.
19
Pediatric AIDS Cases by Age Group and Year of
Diagnosis, Florida, 1990-2006
N1,316
These data represent a 86 decline in pediatric
AIDS cases diagnosed from 1992 (N178) to 2006
(N25). Include cases in persons aged gt12
yrs. at AIDS diagnosis with a ped risk aged lt12,
(N160). Due to reporting lags 2005 2006
data are provisional. Data as of 09/06/07
20
FLORIDA
2006 Florida Population Estimates (Ages
lt13) (N 2,941,177)
Pediatric HIV/AIDS Cases By Race/Ethnicity Repor
ted through 2006 (N2,066)
Include cases in persons aged gt12 yrs. at HIV or
AIDS diagnosis with a ped risk aged lt12. 2006
data are provisional. 2006 Population Estimates,
DOH, Office of Planning, Evaluation and Data
Analysis
21
UNITED STATES
Adult AIDS Cases by Gender Data for 2005,
(N41,900)
2000 Adult Census Population by Gender (N
229,708,176)
Comment The US Adult Population is 49 Male
and 51 Female, therefore male cases are
disproportionately impacted.
22
FLORIDA
Total Adult AIDS Cases by Gender 2006, (N4,949)
Total Adult HIV Cases by Gender 2006, (N5,187)
Comment Floridas Adult Population is 49
Male and 51 Female, therefore male cases are
disproportionately impacted.
23
Number of Adult AIDS Cases by Race/Ethnicity And
Year of Report, Florida, 1990-2006
Comment Increasingly, in the era of HAART, a
diagnosis of AIDS reflects treatment issues,
e.g., late diagnosis of HIV, access to/acceptance
of care, and adherence/viral resistance.
Increases in 2004 were due to an increase in
testing, not an increase in AIDS morbidity. AIDS
cases among blacks have predominated, accounting
for 53 of cases in 2006, compared with 28 among
whites and 18 among Hispanics. Blacks
account for only 15 of the population in
Florida. Other includes American Indian/Alaska
Native, Asian/Pacific Islander, and
multi-racial. The AIDS case definition was
expanded in 1993. Data as of 12/31/06.
24
Number of Adult AIDS Cases by Race/Ethnicity And
Year of Report, Florida, 1997-2006
Comment Increasingly, in the era of HAART, a
diagnosis of AIDS reflects treatment issues,
e.g., late diagnosis of HIV, access to/acceptance
of care, and adherence/viral resistance.
Increases in 2004 were due to an increase in
testing, not an increase in AIDS morbidity. AIDS
cases among blacks have predominated, accounting
for 53 of cases in 2006, compared with 28 among
whites and 18 among Hispanics. Blacks
account for only 15 of the population in
Florida. Other includes American Indian/Alaska
Native, Asian/Pacific Islander, and
multi-racial. The AIDS case definition was
expanded in 1993. Data as of 12/31/06.
25
Percent of Adult AIDS Cases by Race/Ethnicity
And Year of Report, Florida, 1997-2006
  • Factors Affecting Disparities
  • Late diagnosis of HIV.
  • Access to/acceptance of care.
  • Delayed prevention messages.
  • Stigma.
  • Non-HIV STDs in the community.
  • Prevalence of injection drug use.
  • Complex matrix of factors related to
    socioeconomic status

Comment In 2006, blacks accounted for 52 of
reported AIDS cases, but only 15 of the
population. Hispanic cases remain stable at 18
in 2006. Disparities are even more evident among
women Annually, more than 70 of female AIDS
cases have been reported among black women since
1988. HIV case reporting, implemented in
mid-1997, has shown a very similar distribution
of cases by race/ethnicity and sex. Other
includes American Indian/Alaska Native,
Asian/Pacific Islander, and Multi-racial.
26
Percent of Adult MALE AIDS Cases By
Race/Ethnicity and Year of Report Florida,
1997-2006
Comment For most of the past 10 years, black
males accounted for more than 50 of AIDS cases
among men. Other races represent less than 1
of the cases and are not included.
27
Percent of Adult FEMALE AIDS Cases By
Race/Ethnicity and Year of Report Florida,
1997-2006
Comment For most of the past 10 years, black
women accounted for more than 70 of AIDS cases
among women. Other races represent less than 1
of the cases and are not included.
28
Number of Adult HIV Cases by Race/Ethnicity And
Year of Report, Florida, 1998-2006
Comment In absolute numbers, from 1999-2006, HIV
cases among blacks decreased by 31, while
increasing by 13 among whites and 21 among
Hispanics. The decreases among blacks may
correspond to some extent with recent targeted
prevention, while the increases among whites may
be associated with recent increases in HIV
transmission among white and Hispanic MSM.
29
Percent of Adult HIV Cases by Race/Ethnicity and
Year of Report Florida, 1998-2006
Comment In absolute numbers, from 1999-2006, HIV
cases among blacks decreased by 31, while
increasing by 13 among whites and 21 among
Hispanics. The decreases among blacks may
correspond to some extent with recent targeted
prevention, while the increases among whites may
be associated with recent increases in HIV
transmission among white and Hispanic MSM.
30
Percent of Adult MALE HIV Cases by
Race/Ethnicity and Year of Report Florida,
1998-2006
Comment The percent of black male HIV cases has
decreased from 51 in 1998 to 41 in 2006.
Increases have been observed among both white and
Hispanic male HIV cases over this same time
period. Other races represent less than 1 of
the cases and are not included.
31
Percent of Adult FEMALE HIV Cases by
Race/Ethnicity and Year of Report Florida,
1998-2006
Comment Although the majority of HIV cases among
women are black, the percent of black female HIV
cases has decreased from 74 in 1998 to 66 in
2006. Increases have been observed among both
white and Hispanic female HIV cases over this
same time period. Other races represent less
than 1 of the cases and are not included.
32
Percent of Adult HIV Cases by Race/Ethnicity and
Year of Diagnosis Florida, 1999-2006
Percentage change from 1999 2006 Whites
2 Blacks -42 Hispanics 13 The decline
could be an indicator of a reduction in actual
HIV incidence, data as of 05/31/07.
33
Percent of Adult MALE HIV Cases by
Race/Ethnicity and Year of Diagnosis Florida,
1999-2006
Percentage change from 1999 2005 White males
-5 Black males -37 Hispanic males
21 Data as of 05/31/07
34
Percent of Adult FEMALE HIV Cases by
Race/Ethnicity and Year of Diagnosis Florida,
1999-2006
Percentage change from 1999 2004 White
females -9 Black females -47 Hispanic
females -10 Data as of 05/31/07
35
2000 US Population and Estimated Numbers
of Adult AIDS and HIV Cases by
Race/Ethnicity Reported in 2005, US
2000 US Census Population Data (N229,708,176)
AIDS (N44,140)
HIV (N37,930)
Comment In 2005, blacks are over-represented
among the AIDS and HIV cases, accounting for 50
of adult AIDS cases and 49 of adult HIV cases,
but only 11 of the adult population. Hispanics
represent 11 of the adult population and account
for 19 of the adult AIDS cases and 18 of the
adult HIV cases. A group is disproportionately
impacted to the extent that the percentage of
cases exceeds the percentage of
population. Other includes Asian/Pacific
Islanders, Native Alaskans/American Indians and
mixed races. HIV data are ONLY from 33 states
with confidential name-based HIV infection
reporting.
36
Estimates of diagnosed Adult AIDS CasesBy Sex
and Race/Ethnicity United States, 2005
Males N (32,430)
Females N (11,710)
These numbers do not represent actual cases in
persons with a diagnosis of AIDS. Rather,
these numbers are point estimates of cases
diagnosed that have been adjusted for reporting
delays. The estimates have not been adjusted for
incomplete reporting.
37
2006 Florida Population Estimates and Adult AIDS
and HIV Cases by Race/Ethnicity Reported in 2006,
Florida
2006 Florida Population Estimates (N15,481,273
)
AIDS (N4,949)
HIV (N5,187)
Comment In 2006, blacks are over-represented
among the AIDS and HIV cases, accounting for 53
of adult AIDS cases and 49 of adult HIV cases,
but only 15 of the adult population. Hispanics
represent 19 of the adult population and account
for 18 of the adult AIDS cases and 20 of the
adult HIV cases. A group is disproportionately
impacted to the extent that the percentage of
cases exceeds the percentage of
population. Other includes Asian/Pacific
Islanders, Native Alaskans/American Indians and
mixed races. 2006 Florida Population Estimates,
Adults (Ages 13), DOH, Office of Planning,
Evaluation and Data Analysis
38
Reported Adult AIDS CasesBy Sex and Race
Ethnicity, Florida, 2006
Males N (3,390)
Females N (1,559)
Comment In this snapshot of 2006, blacks are
over-represented among the AIDS cases, accounting
for 45 of adult cases among men and 68 of the
adult cases among women. Other includes
Asian/Pacific Islanders, Native Alaskans/American
Indians and mixed races
39
Reported Adult HIV Cases By Sex and
Race/Ethnicity, Florida, 2006
Males N (3,608)
Females N (1,579)
Comment In this snapshot of 2006, blacks are
over-represented among the HIV cases, accounting
for 41 of adult cases among men and 66 of the
adult cases among women. Other includes
Asian/Pacific Islanders, Native Alaskans/American
Indians and mixed races
40
THE FORMULA USED FOR CALCULATING THE RATE IS
  • A specific example, using Florida AIDS data
  • Number of AIDS Cases Reported in 1996 X 100,000
    7,300 X 100,000
  • Estimated Population of Florida in 1996
    14,000,000
  • 52.1 per 100,000 population
  • (This is the same rate as 5.21 per 10,000
    population or 0.521 per 1,000 or
  • 0.0521 percent.)
  • Rates allow direct comparison of the burden of
    disease on various communities, by taking the
    population size into account.

RATE Number of cases in a specified time X
100,000 Population at that time
41
HIV and AIDS Cases in Adult Men by
Race/Ethnicity Rate per 100,000 Population,
Florida, 2006
AIDS Rate ratios Black-to-White 6.11
Hispanic-to-White 2.01
HIV Rate ratios Black-to-White 5.21
Hispanic-to-White 2.21
Data Based on 2006 Florida Population Estimates,
DOH, Office of Planning, Evaluation and Data
Analysis
HIV data includes those cases that have converted
to AIDS. These HIV cases cannot be added with
AIDS cases to get combined totals since the
categories are not mutually exclusive. HIV data
does NOT reflect incidence of diagnosis, only
incidence of report.
42
HIV and AIDS Cases in Adult WomenBy
Race/Ethnicity Rate per 100,000 Population,
Florida, 2006
AIDS Rate ratios Black-to-White 17.31
Hispanic-to-White 2.91
HIV Rate ratios Black-to-White 15.61
Hispanic-to-White 2.71
2006 Florida Population Estimates, DOH, Office
of Planning, Evaluation and Data Analysis HIV
data includes those cases that have converted to
AIDS. These HIV cases cannot be added with AIDS
cases to get combined totals since the categories
are not mutually exclusive. HIV data does NOT
reflect incidence of diagnosis, only incidence of
report.
43
Reported Adult AIDS Case Rates per 100,000
PopulationBy Sex and Race/Ethnicity, Florida,
2006
MALES Rate ratios BlacksWhites, 6.11
HispanicsWhites, 2.01 FEMALES Rate ratios
BlackWhites, 17.31 HispanicsWhites, 2.91
Comment Among black males, the AIDS case rate
for 2006 is 6 times higher than among white
males. Among black females, the AIDS case rate
is 17 times higher than among white females.
Hispanic male rates are 2 times higher and
Hispanic female rates are3 times higher than the
rates among their white counterparts. 2005
Florida Population Estimates, DOH, Office of
Planning, Evaluation and Data Analysis for ages
13.
44
Reported Adult HIV Case Rates per 100,000
PopulationBy Sex and Race/Ethnicity, Florida,
2006
MALES Rate ratios BlacksWhites, 5.21
HispanicsWhites, 2.21 FEMALES Rate ratios
BlackWhites, 15.61 HispanicsWhites, 2.71
Comment Similar to AIDS, among black males, the
HIV case rate for 2006 is 5 times higher than
among white males. Among black females, the HIV
case rate is 16 times higher than among white
females. Hispanic male rates are 2 times higher
and Hispanic female rates are 3 times higher than
the rates among their white counterparts. 2006
Florida Population Estimates, DOH, Office of
Planning, Evaluation and Data Analysis for ages
13.
45
UNITED STATES
Cumulative AIDS Cases by Age Group Data through
12/2005 (N929,987)
2000 Census Population By Age Group (N
281,421,906)
Percent
Percent
These numbers do not represent actual cases in
persons with a diagnosis of AIDS. Rather,
these numbers are point estimates of cases
diagnosed that have been adjusted for reporting
delays. The estimates have not been adjusted for
incomplete reporting.
46
Percent of Adult Cases By Age Group, Florida,
2006
AIDS (N4,949)
HIV (N5,187)
Percent
Percent
Comment HIV cases tend to be younger than AIDS
cases. HIV cases tend to reflect more recent
transmission than AIDS cases, and thus present a
more current picture of the epidemic. 15 of all
new HIV cases were under the age of 25.
47
Percent of Adult AIDS Cases by Sex and Age Group
at Diagnosis Florida, 2006
Males (N3,390)
Females (N1,559)
Percent
Percent
Comment Females tend to be diagnosed with AIDS
at a younger age than males, suggesting earlier
onset of sexual activity and exposure to HIV,
possibly through sex with older male partners.
48
Percent of Adult HIV Cases by Sex and Age Group
at Diagnosis Florida, 2006
Males (N3,608)
Females (N1,579)
Percent
Percent
Note HIV cases tend to be younger than AIDS
cases 24 of male HIV cases and 31 of female
HIV cases occur among those aged 13-29, compared
with only 12 of male AIDS cases and 18 of
female AIDS cases in this age group. HIV cases
tend to reflect more recent transmission than
AIDS cases, and thus present a more current
picture of the epidemic. This suggests that
Youth should be targeted.
49
Percent of AIDS Cases By Age of Diagnosis and
Year of Report Florida, 1997-2006
Comment The percent of newly reported cases has
shown increases among the 40-49 and 50 age
groups over the past several years.
50
Percent of Adult HIV Cases By Age Group,
Florida, 1998-2006
Comment The percent of newly reported cases has
shown increases among the 20-29 and 50 age
groups over the past several years.
51
Definitions
  • MSM Male Sex with Male
  • IDU Injecting Drug Use
  • MSM/IDU Male Sex with Male/Injecting Drug Use
  • Hetero Heterosexual contact with person with
    HIV/AIDS or known HIV risk
  • NIR No Identified Risk

52
Reported Adult AIDS Cases by Mode of
ExposureUnited States vs. Florida
Florida N104,036
United States N956,019
Note NIRs NOT redistributed.
Data through December 2006
Data through December 2004
CDC HIV/AIDS Surveillance Update Vol. 17, Table
17, Pg. 36
Florida Monthly Surveillance Report Jan 2006,
Table 3, Pg 25
Comment The proportion of MSM and IDU is higher
in the US (44 and 24 respectively ) compared
with Florida (40 and 16 respectively). The
higher percentage of heterosexual risk cases in
Florida (24) compared with the US (13) leads
to the higher percentage of NIRs in Florida (14)
compared to the US (10).
53
Reported Adult HIV (not AIDS) Cases By Mode of
Exposure, United States vs. Florida
Florida N34,857
United States N249,950
Note NIRs NOT redistributed.
Data through December 2006
Data through December 2005
Florida Monthly Surveillance Report Jan 2006,
Table 4, Pg 26
CDC HIV/AIDS Surveillance Update Vol. 17, Table
18, Pg. 37 For 42 states
Comment The proportion of MSM for the US is the
same as that for Florida (33). However, the
percent of IDU cases are higher in the US (14
vs. 8) and heterosexual cases are lower (19 vs.
32). NIR cases are more than one fourth of all
of the cases for both the US and Florida.
54
New Jersey N32,031 (Reported as of June 30, 2005)
Living HIV/AIDS Adult Cases by Exposure
Category for Selected States
New York N99,521 All HIV cases reported and
confirmed from 06/2000-12/2005 and AIDS cases
from 1983-12/2005
Note NIRs NOT redistributed.
Florida N75,734 (Reported as of December 2005)
California N91,576 (Reported HIV/AIDS cumulative
through December 31, 2005)
Comment The proportion of MSM and IDU is higher
in the other states compared with Florida. The
higher percentage of heterosexual risk cases in
Florida compared with the other states leads to
the higher percentage of NIRs in Florida.
55
Redistribution of PLWA Cases with No Identified
Risk (NIRs), Florida, Through 2006
Raw Data
Redistributed
NIR
Hetero.
Hetero.
MSM
MSM
IDU
IDU
Comment This illustrates the effect of
statistically assigning (redistributing) the NIRs
to recognized exposure (risk) categories by
applying the proportions of historically
reclassified NIRs to the unresolved NIRs. The
largest impact of this procedure is on the
heterosexuals, going from 44 to 61 of the total
PLWHAs (but see Nwanyanwu et al., AJPH, 1993).
All risk data in this presentation have NIRs
redistributed, except for the zip code
maps. PLWHA reported persons living with
HIV/AIDS.
56
Reported Adult AIDS Cases by Mode of
ExposureCumulative vs. 2006, Florida
2006 N4,949
Through 2006 N104,036
Note NIRs redistributed.
Comment In more recent years, the percentages
of cases with a heterosexual has increased,
whereas the Percentages of cases with an MSM or
IDU risk have decreased.
57
Adult Male AIDS Cases by Exposure Category and
Year of Report, Florida, 1997-2006
Comment From 2001 2006, MSM AIDS cases
increased by 11, while heterosexual male cases
increased by 6 and IDU male cases decreased 25.
Note NIRs redistributed.
58
Adult Female AIDS Cases by Exposure Category and
Year of Report, Florida, 1997-2006
Comment The heterosexual risk continues to be
the dominant mode of exposure among
females. Note NIRs redistributed.
59
Adult Male HIV Cases by Exposure Category and
Year of Report, Florida, 1998-2006
Comment From 2001 2006, MSM HIV cases
increased by 8, while heterosexual male cases
decreased by 20 and IDU male cases decreased
34. Note NIRs redistributed
60
Adult Female HIV Cases by Exposure Category and
Year of Report, Florida, 1998-2006
Comment The heterosexual risk continues to be
the dominant mode of exposure among
females. Note NIRs redistributed.
61
Adult Male Cases By Mode of Exposure, Florida,
2006
AIDS N(3,390)
HIV N(3,608)
Note NIRs redistributed.
Comment The recent increase among MSM is
indicated by the higher percent of MSM among HIV
cases compared to AIDS cases, as HIV cases tend
to represent a more recent picture of the
epidemic.
62
Adult Female Cases By Mode of Exposure, Florida,
2006
AIDS N(1,559)
HIV N(1,579)
Note NIRs redistributed.
Comment The ongoing increase among heterosexual
risk compared with IDU is indicated by the higher
percent of heterosexuals among HIV cases compared
to AIDS cases, as HIV cases tend to represent a
more recent picture of the epidemic.
63
HIV Prevalence Estimates and Cumulative HIV
AIDS Cases, Florida, through 2006
64
AIDS in the U.S.
The 2 cause of death in African Americans aged
25-44.
An average 40,000 new HIV infections in the US
per year. An average 6,000 in Florida per year.

524,060 AIDS DEATHS 1.039 1.185
million people living with HIV in the US
25 new HIV infections in people under 25. In 13
to 19-year-olds, male-to-female ratio 11.
100,000 people living with HIV in Florida.
Based on 2003 CDC data and estimates Based on
2005 CDC estimates
Bureau of HIV / AIDS 2003 estimate
65
Persons Living with AIDS U.S., Florida
Source U.S. Data CDC, HIV/AIDS Surv.
Suppl. Report, 200517(No. _) Florida Data
HARS, alive and reported through 2006, as of
04/05/07. Note NIRs redistributed. MF ratio
U.S., 3.41. Fla., 2.61.
66
AIDS Cases, Case Deaths and Persons Living with
AIDS (PLWA), by Year Florida, 1987-2006
AIDS cases by year of diagnosis. AIDS case
deaths by year of death. AIDS case deaths are
individuals reported in HARS with AIDS whose
status is now dead. They may or may not have died
of AIDS-related illness. The AIDS surveillance
case definition was expanded for
adults/adolescents in 1993. Data as of 04/05/07.
67
Persons Living with HIV and AIDS (PLWHAs)
Reported by County of Residence Florida, Data
Through 2006
N77,632
PLWHA Cases
County totals exclude Department of Corrections
cases (N4,200). Numbers on counties are cases
reported. Data as of 04/05/07
68
Persons Living with HIV and AIDS (PLWHAs) Rates
per 100,000 Population Reported by County of
Residence Florida, Data Through 2006
N77,632
PLWHA Rates Per 100,000
County totals exclude Department of Corrections
cases (N4,200). Numbers on counties are cases
reported. Data as of 04/05/07
69
HIV Prevalence Estimates
93,000-107,000 (mid-range 100,000)
  • Approximately 1 in 168 (0.6) Floridians are
    currently living with HIV infection
  • 1 in 346 Whites
  • 1 in 46 Blacks
  • 1 in 176 Hispanics

70
Percentage of Reported HIV/AIDS Cases By Age of
Diagnosis vs. Current Age, Florida
Comment Age at diagnosis among recently
diagnosed HIV/AIDS cases (alive or dead) is most
useful for planning primary HIV prevention.
However, the distribution of living HIV/AIDS
cases by current age, which is shifted towards
the older age groups due to survival time, is
most useful to focus on prevention for
positives, i.e., secondary prevention. It is
also useful to target those in need of care and
treatment and support for medication adherence.
13-29 yr 22 by age at diagnosis 10 by
current age 50 yr 15 by age at diagnosis. 27
by current age.
By Age at Diagnosis HIV cases plus AIDS cases,
Diagnosed from 2001 2006.
By Current Age PLWHAs through 2006.


Number of HIV/AIDS cases (2001-2006)48,799
PLWHAs thru 81,832
71
Percent of Living Adult HIV/AIDS Cases by Sex and
Current Age Group Florida, Data through 2006
Males (N54,467)
Females (N25,365)
Percent
Percent
Comment Females tend to be diagnosed with AIDS
at a younger age than males, suggesting earlier
onset of sexual activity and exposure to HIV,
possibly through sex with older male partners.
Data as of 04/05/07
72
Percent of Living MALE Adult HIV/AIDS Cases by
Race/ethnicity and Current Age Group Florida,
Data through 2006, N56,002
Other races are lt1 of cases.
73
Percent of Living FEMALE Adult HIV/AIDS Cases by
Race/ethnicity and Current Age Group Florida,
Data through 2006, N24,785
Other races are lt1 of cases.
74
Living HIV/AIDS Cases by Race/Ethicity Compared
to FL Population Estimates
2006 Florida Population Estimates (N18,422,450)
Living HIV/AIDS Cases Through 2006 (N81,832 )
Comment In this snapshot of living HIV/AIDS
cases through 2005, 51 are black, whereas only
16 of Floridas population are black. This
indicates a disparity of HIV/AIDS in the black
population. Data includes Dept of Corrections
cases. Other includes Asian/Pacific Islanders
and Native Alaskans/American Indians. Data as of
04/05/07 2006 Florida Population Estimates, DOH,
Office of Planning, Evaluation and Data Analysis
75
Living Adult HIV/AIDS CasesBy Sex and
Race/Ethnicity Florida, through December 2006
Males N54,467
Females N25,365
Comment In this snapshot of living HIV/AIDS
cases through 2006, among males 42 are black and
the majority of females are black (70). Data
includes Dept of Corrections cases. Other
includes Asian/Pacific Islanders and Native
Alaskans/American Indians. Data as of 04/05/07
76
Reported PLWHA Rates per 100,000 Population By
Sex and Race/EthnicityFlorida, through 2006
MALES Rate ratios BlacksWhites, 51
HispanicsWhites, 20 OthersWhites,
11 FEMALES Rate ratios BlackWhites, 171
HispanicsWhites, 31 OthersWhites, 21
Other includes Asian/Pacific Islander, American
Indian/Alaska Native and/or Other/Unknown Races.
Comment Among black males, the HIV/AIDS case
rate for cases alive and reported through 2006 is
5 times higher than among white males. Among
black females, the AIDS case rate is 17 times
higher than among white females. Hispanic male
rates 2 times higher and Hispanic female rates
are 3 times higher than the rates among their
white counterparts. Data includes Department of
Corrections cases. 2006 Total Florida Population
Estimates, DOH, Office of Planning, Evaluation
and Data Analysis
77
Annual Prevalence of Adult HIV/AIDS
CasesFlorida, 1995-2006
As a result of declining deaths, annual HIV/AIDS
diagnoses have exceeded deaths since 1995, and
the number of persons reported with HIV/AIDS that
are presumed to be alive has been increasing.
Since the year 1995, prevalent cases have
increased by over 372. In the past year the
prevalence increased by 8. Data as of 04/05/07
78
Annual Prevalence of Adult HIV/AIDS CasesBy
Sex, Florida, 1996-2006
Although increases are seen among both men and
women, women account for an increasing
proportion of persons living with AIDS. In 2006,
women accounted for 31 of person living with
AIDS, compared with 25 in 1996.
79
Annual Prevalence of Adult Male HIV/AIDS CasesBy
Race/Ethnicity, Florida, 1996-2006
80
Living Adult HIV/AIDS Cases (PLWHAs) By Mode of
Exposure and Sex Florida, Data through 2006
Males N(54,467)
Females N(25,365)
Note NIRs redistributed.
Comment The recent increase among MSM is
indicated by the higher percent of MSM among HIV
cases compared to AIDS cases, as HIV cases tend
to represent a more recent picture of the
epidemic.
81
Living Adult Male HIV/AIDS Cases (PLWHAs) By
Race/Ethnicity and Mode of Exposure Florida,
Data through 2006
White, non-Hispanic N(20,472)
Black, non-Hispanic N(23,457)
Hispanic N(11,812)
  • Comment Among male PLWHAs, the distribution of
    risk among blacks differs from that among whites
    and Hispanics. MSM represents the highest risk
    for all races. White males have the smallest
    percentage of heterosexual contact cases. Note
    Adjustments have been made to redistribute NIR
    cases. Data as of 04/05/07.
  • Data includes Dept. of Corrections.
  • Other includes hemophilia, transfusion,
    perinatal and other pediatric risks and other
    confirmed risks.

82
Annual Prevalence Adult Male HIV/AIDS Cases By
Mode of Exposure (NIRs redistributed) Florida,
Diagnosed 1996-2006
Adjustments have been made to account for the
redistribution of cases with no identified risk
(NIR). MSMmale sex with male IDUinjection
drug use HIV infection reporting was
implemented July 1997. Comment PLWHAs represent
those in need of care and secondary prevention
initiatives to prevent further transmission. The
increase in number of PLWHAs is due to a
combination of factors survival time is
increasing, those recently reported are more
likely to be alive, and the annual number of
persons reported with HIV or AIDS exceeds the
number of deaths. MSM is the predominant mode of
exposure. MSM cases are increasing the fastest.
(data as of 04/05/07).
83
Annual Prevalence Adult Female HIV/AIDS CasesBy
Race/Ethnicity, Florida, 1996-2006
84
Living Adult Female HIV/AIDS Cases (PLWHAs) By
Race/Ethnicity and Mode of Exposure Florida,
Data through 2006
White, non-Hispanic N(4,059)
Black, non-Hispanic N(17,745)
Hispanic N(3,202)
  • Comment Among female PLWHAs, the distribution of
    risk among whites differs from that among blacks
    and Hispanics. Heterosexual contact is the
    majority risk for all races.
  • Adjustments have been made to redistribute NIR
    cases. Data as of 04/05/07.
  • Data includes Dept. of Corrections.
  • Other includes hemophilia, transfusion,
    perinatal and other pediatric risks and other
    confirmed risks.

85
Annual Prevalence Adult Female HIV/AIDS Cases By
Mode of Exposure (NIRs redistributed) Florida,
Diagnosed 1996-2006
Adjustments have been made to account for the
redistribution of cases with no identified risk
(NIR). IDUinjection drug use. HIV infection
reporting was implemented July 1997. Comment
PLWHAs represent those in need of care and
secondary prevention initiatives to prevent
further transmission. The increase in number of
PLWHAs is due to a combination of factors
survival time is increasing, those recently
reported are more likely to be alive, and the
annual number of persons reported with HIV or
AIDS exceeds the number of deaths. Heterosexual
cases are increasing the fastest. (data as of
04/05/07).
86
Percent of Reported Living HIV/AIDS Cases and
Population by Area, Florida, through 2006
Total living HIV/AIDS cases equals 81,832
(excluding Dept. of Corrections). Note Area 9
Palm Beach Co., Area 10Broward Co., Area
11aMiami-Dade Co. Data as of 04/05/07.
87
Percentage of HIV/AIDS Cases Deaths By Age of
Diagnosis vs. Current Age, Florida, 2006, N2,504
By Age at Diagnosis HIV cases plus AIDS cases,
Who died in 2006, regardless of cause.
Age at Death HIV/AIDS Case Deaths, 2006.


Data as of 04/05/07
88
Resident HIV/AIDS DeathsBy Year, Florida, 1994
2006
Rates are expressed as deaths per 100,000
population based on 2006 Population Estimates,
DOH, Office of Planning, Evaluation and Data
Analysis A new national system for coding death
certificates (ICD-10) began in 1999, which
resulted in an increase of approximately 14 in
the annual number of HIV/AIDS deaths. Comment
HIV/AIDS deaths decreased markedly from
1996-1998, associated with the advent of HAART in
1996. Deaths in 2006 were 60 lower than in the
peak year, 1995. A leveling of the trend since
1998 may reflect factors such as viral
resistance, late diagnosis of HIV, adherence
problems, and lack of access to or acceptance of
care. Racial/ethnic disparities are evident in
the death rate data. Source Office of Vital
Statistics and Bureau of HIV/AIDS, death
certificates coded to HIV/AIDS as underlying
cause.
89
Resident HIV/AIDS Deaths Total Deaths vs. Black
DeathsBy Year, Florida, 1998 2006
Source Office of Vital Statistics, Death
Certificates There was a 2.3 increase in total
HIV resident deaths from 2005 to 2006. There was
a 9.6 increase in black HIV resident deaths from
2005 to 2006.
90
Resident HIV/AIDS Death Rates Per 100,000
Population, by Race/Ethnicity, Florida, 2006
MALES Rate ratios BlacksWhites, 71
HispanicsWhites, 21 FEMALES Rate ratios
BlackWhites, 221 HispanicsWhites, 21
Comment In 2006, black males were 7 times as
likely as white males to die of HIV/AIDS, up from
6 in 2005. The HIV/AIDS death rate among black
females was 22 times higher than among white
females, up from 17 in 2005. Source Office of
Vital Statistics (Death Certificate Data) DOH,
Office of Planning, Evaluation and Data Analysis
(2006 Population Estimates)
91
Percent of Resident HIV/AIDS Deaths By
Race/Ethnicity and Year of Death, Florida,
1996-2006
Comment In 2006, the proportional distribution
of HIV resident deaths by race/ethnicity
was whites 25, blacks 61 and Hispanics 13.
This compares to 27, 57 an 14 respectively for
2005. Source Office of Vital Statistics (Death
Certificate Data)
92
Resident HIV/AIDS Death Rates Among Persons
25-44 Years of Age, by Sex and Race By Year of
Death, Florida, 1995-2006
Note 1995 was the peak year for HIV/AIDS
deaths. Source Death Data Office of Vital
Statistics, Death Certificates 1995-1999 rates
based on 1990 Census population 2000-present
rates based on 2000 Census
93
Death Rates From Leading Causes of Death Among
Persons 25-44 Years of Age By Year of Death,
Florida, 1987-2006
Note 1995 was the peak year for resident
HIV/AIDS deaths. In 2006, HIV/AIDS was the 4th
leading cause of death. Source Death data
Office of Vital Statistics, Death Certificates
Population data Annual mid-point
estimates, Office of Data, Planning and Evaluation
94
AIDS-Defining Conditions Most Commonly Reported
For Adults and Adolescents, Florida, 2006
Note data are not mutually exclusive, many
cases have more than 1 disease. As of 05/14/07, a
total of 4,948 adult/adolescent AIDS cases were
reported in 2006. PCP was the number one defining
AIDS condition, followed by Wasting Syndrome and
Candidiasis, esophageal.
95
Total HIV Antibody Tests Administered 1996-2005
96
Total HIV Seropositivity Rate 1992-2005
97
Impact of STDs on HIV Infection
  • Early detection and treatment of STDs has a major
    impact on sexual transmission of HIV.
  • Much of the heterosexually transmitted HIV
    infection can be prevented by reducing other
    underlying STDs.
  • STDs increase HIV infectivity and susceptibility.

98
Percent of Primary and Secondary Syphilis Cases
By Sex and Race/Ethnicity, Florida, 2006
Females (N93)
Males (N627)
8 of these cases are among adolescents (ages
13-19).
99
Percent of Gonorrhea Cases By Sex and
Race/Ethnicity Florida, 2006
Females (N11,768)
Males (N11,504)
28 of these cases are among adolescents (ages
13-19).
100
Percent of Chlamydia Cases By Sex and
Race/Ethnicity Florida, 2006
Females (N38,737)
Males (N10,488)
36 of these cases are among adolescents (ages
13-19).
101
Syphilis, Chlamydia, Gonorrhea and AIDS Rates
per 100,000 Population Florida, 1991-2006
Chlamydia data available for 1996-2006 only.
2006 STD data provisional.
102
Floridas Six Priority Populations for 2005
for Primary Secondary HIV Prevention Based on
the Florida Epi Profile, 2005
  • Black heterosexual women
  • White MSM
  • Black women who have sex with men who have
  • had sex with men women
  • Hispanic MSM
  • Adolescents and young adults
  • Injection drug users

Unofficial priorities. Note While identifying
these populations, it is essential to avoid
stigmatizing them.
103
Some Key Conclusions
  • In Florida, more than 10,000 HIV/AIDS cases per
    year have been reported from 1998-2005 there
    has been an increase compared to previous years
    that showed a leveling of a downward trend.
  • The number of persons living with HIV/AIDS has
    steadily risen to 75,734 cases through 2005.
  • Non-Hispanic blacks are disproportionately
    impacted by HIV/AIDS. The reasons for this are
    multi-factorial and complex.
  • HIV/AIDS deaths are 60 lower than when they
    peaked in 1996.

104
Some Key Conclusions (Continued)
  • Pediatric AIDS cases have decreased almost 92
    since they peaked in 1992.
  • MSM have consistently accounted for the greatest
    number of persons living with HIV/AIDS.
  • Recent indicators suggest that HIV transmission
    among MSM may be increasing.
  • PLWHA cases due to heterosexual contact are
    increasing quite fast, and are now almost equal
    in number to MSM cases.

105
For Florida HIV/AIDS Surveillance Data
Contact (850) 245-4444 Lorene Maddox, MPH
Ext. 2613 Tracina Bush, AA Ext. 2612
Brandi Knight, BS Ext. 2373
Internet http//www.doh.state.fl.us/disease_ct
rl/aids/index.html Intranet
http//dohiws.doh.state.fl.us CDCs Internet
site for HIV/AIDS Slides http//www.cdc.gov/hiv/
graphics.htm
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