Impact of Age and Race on New HIV Infections among Men who have Sex with Men in Los Angeles County 2008-2010 - PowerPoint PPT Presentation

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Impact of Age and Race on New HIV Infections among Men who have Sex with Men in Los Angeles County 2008-2010

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Impact of Age and Race on New HIV Infections among Men who have Sex with Men in Los Angeles County 2008-2010 Shoshanna Nakelsky, MPH Division of HIV and STD Programs – PowerPoint PPT presentation

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Title: Impact of Age and Race on New HIV Infections among Men who have Sex with Men in Los Angeles County 2008-2010


1
Impact of Age and Race on New HIV Infections
among Men who have Sex with Men in Los Angeles
County 2008-2010
  • Shoshanna Nakelsky, MPH
  • Division of HIV and STD Programs
  • Los Angeles County Department of Public Health

1
2
Overview
  • Background
  • LAC Population
  • MSM
  • HIV Incidence Surveillance System
  • Methods
  • Results
  • New HIV cases diagnosed
  • HIV incidence estimates for young MSM
  • Conclusions

2
3
Los Angeles County
  • Most populous county in U.S. nearly 10M
  • Area 4,000 square miles
  • City of LA (4M) plus 88 incorporated cities and
    unincorporated areas
  • One of the most racially and ethnically
    diverse areas in U.S.
  • Urban, suburban, and rural areas

4
2013 Estimated Number of Persons Living with HIV
in Los Angeles County (LAC)
2,000
10,500
45,500
(1) Estimate that 18.1 of HIV in LA County are
unaware of their infection from CDC
estimate. (2) Of 4,200 notifications pending
investigation, estimate about 2,000 who have
detectable VL or confirmatory test to be
unduplicated cases.
4
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
5
New HIV Diagnoses By Gender LAC, 2010
5
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
6
New HIV Diagnoses by Age Group LAC, 2010
Age Group (years)
6
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
7
New HIV Diagnoses by Race/Ethnicity LAC, 2010
Race/Ethnicity
7
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
8
Mode of Transmission among Newly Diagnosed Cases,
LAC 2010
MSM Men who have sex with men IDU Injection
drug use HET heterosexual transmission risk
8
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
9
New HIV Diagnoses among MSM by Age Group, LAC
2010
Age Group (years)
9
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
10
Proportion of Young MSM (18-29 years) by Race,
LAC 2010
10
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
11
HIV Incidence Surveillance (HIS)
  • National effort developed and funded by the
    Centers for Disease Control and Prevention (CDC)
  • Provides first reliable and scientifically valid
    estimates of newly acquired infections
  • Estimates HIV incidence for those who
  • Test Early
  • Test Late
  • Never Test

12
HIV Incidence Surveillance (2)
  • Estimates the number and rate of new HIV
    infections
  • Improves ability to allocate resources for
    prevention and care

13
Methods Analysis Population
  • Eligibility for inclusion in the estimation
    process
  • Resided in LAC at the time of HIV diagnosis
  • Diagnosed in 2008-2010
  • 18-29 years of age
  • Male
  • Sex with males as a risk factor

13
14
Data Sources Enhanced HIV/AIDS Reporting System
(EHARS)
  • Demographic Data
  • Age
  • Race/ethnicity
  • Mode of transmission
  • HIV/AIDS Diagnosis Data
  • HIV diagnosis date
  • AIDS diagnosis date
  • Proportion of cases diagnosed with AIDS within 6
    months of HIV diagnosis (late detection)

14
15
Data Sources HIV Incidence Surveillance
  • Serologic Testing Algorithm for Recent HIV
    Seroconversion (STARHS)
  • HIV testing and treatment history
  • History of previous negative test results
  • Date of most recent negative test result
  • Time between last negative and first positive
    test

15
16
Methods
  • Rates calculated using
  • Denominators for rates assumed 8.2 of males aged
    18-29 years were MSM
  • California State Department of Finance population
    estimates

Lieb, 2011
16
17
Results 2010 HIV Incidence Estimates
17
18
Rates and 95 CI of new HIV Infection among MSM
by Age Group, LAC 2010
Rate per 1,000
Age Group
18
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
19
Proportion of Estimated HIV Infections in MSM
aged 18-29 years by Race, LAC 2010
19
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
20
Estimated HIV Incidence Rates and 95 CI for YMSM
age 18-29 years by Race, LAC 2010
Rate per 1,000
Race/Ethnicity
20
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
21
Results Combined Year HIV Incidence Estimates
21
22
Rate and 95 CI of new HIV Infection by Age
Group, LAC 2008-2010
Rate per 1,000
Age Group
22
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
23
Rate of New HIV Infection among Young MSM by
Race/Ethnicity and Age Group, 2008-2010

Rate per 1,000
Age Group (years)
Rate for black MSM significantly different from
other MSM.
23
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
24
Rate of new HIV Infection among Young MSM by
Race/Ethnicity and Age Group, 2008-2010

Rate per 1,000
Age Group (years)
Rate for black MSM significantly different from
other MSM.
24
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
25
Key Findings
  • In LAC, the rate of incidence among 13-17 year
    old MSM is low compared with 18-29 year old MSM.
  • HIV incidence estimates confirm that MSM ages
    18-29 years are at the highest risk for new HIV
    infections
  • The magnitude of the racial/ethnic disparity for
    young Black MSM compared with Whites and Latinos
    is largest for 18-24 year olds

25
26
Discussion
26
27
Possible Reasons for Increased Risk Among Black
YMSM
  • Age of sexual debut
  • Increased partner age
  • Most likely to have Black partners
  • Decreased engagement in HIV care
  • Undiagnosed HIV Infection
  • Late Detection
  • Less Retention in Care
  • Less Viral Load Suppression

Millett et al, 2012
27
28
Linkage to Care Among MSM Reported with HIV, by
Race/Ethnicity, LAC 2010
of cases
N454
N743
Age Group
Linked to care lt3 months of diagnosis MSM
diagnosed in 2010. Number of people diagnosed
with HIV from 1/1/2010-12/31/2010
28
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
29
Viral Load Suppression Among MSM Living with HIV
Race/Ethnicity, LAC 2010
of cases
N1,111
N15,638
Age Group
Viral load suppression defined as VL lt200.
Number of people living with HIV at the end of
12/31/2010
29
Source LAC Division of HIV and STD Programs,
reported as of 12/31/2012.
30
Limitations
  • Missing Data
  • Variation by Race/Ethnicity
  • Assumptions of Multiple Imputation Technique
  • Sample Size
  • Assumptions of Incidence Methodology
  • No Change in Testing Behavior

30
31
Conclusions
  • The risk of new HIV infection among YMSM varies
    by both age and race/ethnicity
  • Black MSM are at an increased risk of new HIV
    infection across age groups
  • Black MSM, age 18-24 years, show most dramatic
    disparity in risk compared with Latino and White
    peers

31
32
Conclusions (contd)
  • Research is needed to better understand
    contributing factors.
  • Retention in care
  • Quality of care
  • Adherence to antiretroviral therapy

31
33
Acknowledgements
  • Los Angeles County
  • HIV Incidence Surveillance Team
  • Trista Bingham, PhD
  • Deanna Lewis
  • Randi Kendrick
  • Core HIV Surveillance
  • Douglas Frye, MD
  • Yunyin Hu
  • Long Beach Health Department
  • Pasadena Health Department
  • Centers for Disease Control and Prevention

32
34
Thank You!
  • For more information contact
  • Shoshanna Nakelsky
  • HIV Incidence Surveillance Coordinator
  • snakelsky_at_ph.lacounty.gov
  • 213.351.8154

32
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