HIV/AIDS Epidemic in Santa Clara County 2012

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1 HIV/AIDS Epidemic in Santa Clara County 2012

2 Contents Summary of key findings... 2 Technical notes... 3 Overview of HIV/AIDS in Santa Clara County... 4 People living with HIV/AIDS... 6 Trends in HIV/AIDS diagnosis... 7 Age at diagnosis... 7 Race/ethnicity... 8 Transmission mode... 9 Late testing AIDS diagnosis HIV/AIDS survival HIV infection among men who have sex with men HIV infection and nativity HIV infection among older adults HIV infection among adolescents and young adults

3 Summary of key findings As of 2012, a total number of 5,641 individuals with HIV/AIDS had been reported in Santa Clara County. Among these individuals, 41% had died by the end of 2012 and 59% were presumably living with HIV/AIDS. Whites constituted half of cumulative HIV/AIDS cases and one-third of cases were Latino. One in ten HIV/AIDS cases were African American. Nearly three quarters (73%) of HIV/AIDS cases were men who have sex with men (MSM). From 2006 to2012, the annual number and annual rate of diagnosis of new HIV/AIDS cases consistently declined in Santa Clara County. The overall rate per 100,000 people decreased by 46% from 14.7 to 7.9. A similar declining trend was evident for both males and females. The rate among people ages 20 to 49 decreased by approximately 5 from 2006 to 2012, whereas the rate among those ages 50 and older remained stable. In the same time period, African Americans had the highest rate of new HIV/AIDS diagnosis, followed by Latinos and Whites. Asian/Pacific Islanders had the lowest rate of new HIV/AIDS diagnosis. The rate among African Americans per 100,000 people decreased by over 6 from 68.6 in 2006 to 27.5 in 2012, and the rate among Latinos declined from 27.2 to The rate among Whites and Asian/Pacific Islanders remained stable from 2006 to Of HIV/AIDS cases newly diagnosed from 2000 to 2011, 44% were diagnosed late in the course of their HIV infection (i.e., diagnosed with AIDS within 3 months after initial diagnosis of HIV infection). However, this percentage is declining; 55% were diagnosed late in 2000 compared to 39% in People ages 40 and older, Latinos and African Americans, and people born in countries outside the US were more likely to be diagnosed late in the course of their infection. The number of MSM diagnosed with HIV/AIDS decreased from 1986 to 2000, and then remained stable. After 2000, there was an increase in the number of Latino MSM diagnosed with HIV/AIDS. The proportion of MSM cases that were born outside the US has increased gradually over time. Foreign-born HIV/AIDS cases were diagnosed at a younger age than their US-born counterparts. From 2000 to 2011, the HIV-related death rate per year was lower than the Healthy People 2020 target of 3.3 deaths per 100,000 people. The death rate in Santa Clara County was 1.4 deaths per 100,000 people in Of AIDS patients diagnosed from 2000 to 2009, 9 survived for at least three years after being diagnosed with AIDS. 2

4 Technical notes This report includes information reported to the Santa Clara County Public Health Department (SCCPHD) through December 31, As such, the data may not represent HIV-infected residents who have not been tested or who were tested at a time when the infection could not be detected. Consistent with national reporting standards, individuals diagnosed with HIV/AIDS are defined as people with HIV infection regardless of the stage of infection. The data are presented in eight sections. The first four sections describe the overall picture of the epidemic in Santa Clara County with a focus on the characteristics of people diagnosed with HIV/AIDS and those who were living with HIV/AIDS by the end of 2012, the trend in new HIV/AIDS diagnoses from 2006 to 2012, and the trend in survival of HIV/AIDS cases. The last four sections demonstrate the key features of HIV infections among MSM, foreign-born persons, and individuals ages 50 and older as well as adolescents and young adults diagnosed at ages 13 to 24. The analysis presented in the section on HIV infection among MSM includes cases of men who contracted the virus through having sex with men, as well as cases contracted through intravenous drug use among MSM (MSM/IDU). The data for recent years should be interpreted with caution due to reporting delay, particularly for Reporting delay occurs when HIV/AIDS diagnoses or deaths are not reported to SCCPHD in a timely manner. Analysis of HIV/AIDS deaths was restricted to those diagnosed through 2011 to allow at least 12 months for deaths to be reported to SCCPHD. For three-year survival of AIDS cases, the analysis was limited to people diagnosed with AIDS through Rates per 100,000 people were calculated for (1) the number of HIV/AIDS diagnoses, (2) the number of deaths of people diagnosed with HIV/AIDS, and (3) the number of people living with HIV/AIDS. Due to instability, caution should be used when interpreting rates, proportions, and trends that are based on numbers less than 20. Population denominators for calculating rates were based on Race/Ethnic Population with Age and Sex Detail, (for data from ) and State and County Population Projections by Race/Ethnicity and Age, (for data from ) from the California Department of Finance except for the rates among the US-born and foreign-born. For the USborn and foreign-born, population denominators were from the US Census Bureau, American Community Survey 1-Year Estimates from 2006 to

5 Overview of HIV/AIDS in Santa Clara County As of December 31, 2012, a total number of 5,641 individuals diagnosed with HIV/AIDS had been reported to Santa Clara County since reporting began in 1983 (Figure 1.1). Of these, 4,675 (83%) were diagnosed with AIDS. A cumulative number of 2,299 (41%) HIV/AIDS cases had died. Among deceased cases, 2,273 were AIDS cases. Figure 1.1 HIV/AIDS cases, deaths, and prevalence, , ,000 2,500 2,000 1,500 1, Year of diagnosis/death HIV/AIDS new diagnosis Deceased HIV/AIDS cases PLWHA Nearly 9 in 10 of the cumulative cases were male and diagnosed at ages 20 to 40. Half of the cases were White, 31% were Latino and 11% were African American. Nearly three quarters (73%) of the cases were either MSM or MSM who injected drugs (MSM&IDU). Approximately 1 in 5 cases was foreign-born (Table 1.1). The demographic characteristics and transmission mode of HIV/AIDS cases diagnosed in 2012 were different than those of cumulative HIV/AIDS cases. Among recently diagnosed HIV/AIDS cases, a higher proportion were people ages 40 and older, Latinos and Asian/Pacific Islanders, and foreign-born. One third (33%) of cases diagnosed in 2012 did not have a specified transmission mode, compared to only 8% of cumulative cases (Table 1.1). 4

6 Table 1.1 Characteristics of cumulative and new HIV/AIDS cases in Santa Clara County Cumulative HIV/AIDS cases New HIV/AIDS cases 2012 (n=5,641) (n=120) Number % * Number % * Gender Female Male 5, Age at diagnosis < , , , >= Race/ethnicity White 2, Latino 1, Asian/Pacific Islander African American Other Transmission mode MSM 3, IDU (male) IDU (female) MSM & IDU Heterosexual (male) Heterosexual (female) Perinatal Other Unknown Nativity US-born 4, Foreign-born 1, Unknown *s for some categories may not sum to 100 due to rounding 5

7 People living with HIV/AIDS As of December 31, 2012, a total of 3,342 people were living with HIV/AIDS (PLWHA) with a prevalence rate of cases per 100,000 people (Table 2.1). Among these, 2,402 were living with AIDS. Across all age groups, people ages 40 to 59 had the highest burden of HIV/AIDS with a prevalence rate of over 400 cases per 100,000 people. African Americans had more than three times the prevalence rate of Latinos and Whites. Table 2.1 Characteristics of people living with HIV/AIDS Number % * Rate Sex Female Male 2, Current age < , >= Race/ethnicity White 1, Latino 1, Asian/Pacific Islander African American Other Transmission mode MSM 2, IDU (male) IDU (female) MSM & IDU Heterosexual (male) Heterosexual (female) Pediatric Other Unknown

8 Nativity US-born 2, Foreign-born 1, Unknown Total 3, * s for some categories may not sum to 100 due to rounding Rates are not provided for categories with small numbers of cases or where population size was unavailable Trends in HIV/AIDS diagnosis Between 2006 and 2012, there was a steady reduction in the number of cases newly diagnosed with HIV/AIDS (Figure 3.1). In recent years, the number of cases was lower for diagnosed cases due to reporting delay, particularly for The overall annual rate of new diagnoses declined by 46% from 14.7 cases per 100,000 people in 2006 to 7.9 cases per 100,000 people in Similar declines occurred among both males and females. Figure 3.1 Number and annual rate of new HIV/AIDS diagnosis among adults and adolescents by gender, Number of cases Rate per 100, Year of diagnosis Female counts Male counts Female rates Male rates SCC total rates Age at diagnosis Overall, the annual rate of new HIV/AIDS diagnosis was higher among people ages 20 to 49 than for people ages 50 and older (Figure 3.2). From 2006 to 2012, there was a declining trend in new HIV/AIDS diagnosis for younger age groups. For people ages 20 to 29, the rate of new HIV/AIDS diagnosis per 100,000 people reduced by nearly 5 from 20.1 cases in 2006 to 10.3 cases in 2012, despite a slight increase to 23.8 cases in For people ages 30 to 39 and ages 40 to 49, the rate reduced by 47% and 39%, respectively, in the same time period. The 7

9 rate of newly diagnosed HIV/AIDS cases among people ages 50 to 59 declined between 2006 and 2008, then increased in 2009 and remained relatively stable thereafter. There was no significant reduction in rates for people ages 60 to 64 after Figure 3.2 Annual rate of new HIV/AIDS diagnosis by age group, Rate per 100, Year of diagnosis Race/ethnicity Between 2006 and 2012, Latinos had the highest number of new HIV/AIDS cases among all racial/ethnic groups. The number of Latino and African American cases declined gradually after 2006, while the number of new HIV/AIDS cases among Whites and Asian/Pacific Islanders remained relatively stable during the same time period (Figure 3.3). Figure 3.3 Number of new HIV/AIDS diagnosis among adults and adolescents by race/ethnicity, Number of cases Year of diagnosis Latino White Asian/Pacific Islander African American 8

10 From 2006 to 2012, annual HIV/AIDS rates were higher among African Americans than other racial/ethnic groups; Asian/Pacific Islanders had the lowest rates. Although the rate for African Americans increased slightly from 2006 to 2007, rates declined from 70.8 cases per 100,000 people in 2007 to 27.5 cases per 100,000 people in Similarly, rates declined among Latinos, from 27.2 to 12.6 cases per 100,000 people. The rates for Whites and Asian/Pacific Islanders remained fairly stable. In 2012, the rate of new HIV/AIDS cases per 100,000 people was 6.4 for Whites and 4.6 for Asian/Pacific Islanders (Figure 3.4). Figure 3.4 Annual rate of new HIV/AIDS diagnosis among adults and adolescents by race/ethnicity, , Rate per 100, Year of diagnosis Latino Asian/Pacific Islander African American White Transmission mode From 2006 to 2012, the majority of male adults and adolescents newly diagnosed with HIV/AIDS became infected through male-to-male sexual contact. The number of MSM cases remained stable from 2006 to 2009, and then decreased slightly from 2009 to The lower observed number of MSM cases in 2012 could be the result of delayed reporting (Figure 3.5). Overall, a larger proportion of female cases contracted HIV infection through heterosexual contact than through IDU (Figure 3.6). However, there were a significant number of female cases whose transmission mode remained unknown. 9

11 Figure 3.5 Number of male adults and adolescents newly diagnosed with HIV/AIDS by transmission mode, Number of cases Year of diagnosis MSM IDU MSM & IDU Heterosexual Unknown Figure 3.6 Number of female adults and adolescents newly diagnosed with HIV/AIDS by transmission mode, Number of cases Year of diagnosis IDU Heterosexual Unknown Late testing Between 2000 to 2009, an average of44% of people newly diagnosed with HIV/AIDS from 2000 to 2011 were diagnosed late in the course of their infection, which was defined as being diagnosed with AIDS within 3 months of initial diagnosis. However, there was a clear declining trend from 2000 to 2009 in the proportion of late diagnoses, with the exception of an increase from 34% in 2009 to 44% in Overall, the proportion of HIV/AIDS cases diagnosed late decreased by 29% from 2000 (55%) to 2011 (39%) (Figure 3.7). 10

12 Figure 3.7 of cases diagnosed with AIDS within 3 months of initial HIV diagnosis, * Year of diagnosis * Excludes two cases with incomplete month of HIV/AIDS diagnosis. Includes HIV infected people who haven t yet been diagnosed with AIDS Compared to those who were not diagnosed late, people diagnosed late were more likely to be diagnosed at ages 40 and older, be Latino or African American, or be foreign-born (Table 3.1). Table 3.1 Characteristics of HIV/AIDS cases by AIDS diagnosis status, * Diagnosed with AIDS after three months from initial diagnosis AIDS diagnosed within three months of initial diagnosis Number % Number % Gender Female Male Age at diagnosis < >= Race/ethnicity White Latino

13 Asian/Pacific Islander African American Other Transmission mode MSM IDU MSM & IDU Heterosexual Perinatal Other Unknown Nativity US-born Foreign-born Unknown Total * Excludes two cases with incomplete month of HIV/AIDS diagnosis s for some categories may not sum up to 100 due to rounding Includes HIV infected people who haven t yet been diagnosed with AIDS AIDS diagnosis Among people diagnosed with AIDS from 2000 to 2011, the proportion of converted AIDS cases, defined as those who had been diagnosed with HIV prior to the year of AIDS diagnosis, increased consistently (Figure 3.8). Figure 3.8 of converted AIDS cases, Year of AIDS diagnosis Converted AIDS New AIDS 12

14 HIV/AIDS survival For each year since 2000, Santa Clara County has achieved the Healthy People 2020 (HP2020) goal of reducing the HIV-related death rate to 3.3 deaths per 100,000 people (Figure 4.1). The death rate for recent years is likely to be underestimated due to delay in death reporting. Figure 4.1 HIV/AIDS death rates per 100,000 people, Rate per 100, Year of death Among all patients diagnosed with AIDS from 2000 to 2009, 9 survived for at least three years after AIDS diagnosis. The three-year survival rate peaked at 96% in 2004, followed with a slight decrease (Figure 4.2). African Americans had the lowest survival rate of any racial/ethnic group (Figure 4.3); however there was no statistically significant difference in survival across the racial/ethnic groups. Figure 4.2 of people diagnosed with AIDS who survived for at least three years after AIDS diagnosis, Year of AIDS diagnosis 13

15 Figure 4.3 of people diagnosed with AIDS who survived for at least three years after AIDS diagnosis by race/ethnicity, % 91% 9 89% 89% African American (n=177) Asian/Pacific Islander (n=129) Latino (n=523) White (n=441) SCC (n=1,291) HIV infection among men who have sex with men Cumulatively, 73% (4,131/5,641) of HIV-infected people in Santa Clara County contracted the virus through male-to-male sexual contact, including MSM who reported transmission through injection drug use. Four in ten cases were diagnosed at ages 30 to 39, 56% were White, 3 were Latino and nearly one in five were foreign-born (Table 5.1). Table 5.1 Characteristics of cumulative MSM HIV/AIDS cases, Number % Age at diagnosis , , >= Race/ethnicity White 2, Latino 1, Asian/Pacific Islander African American

16 Other 36 1 Nativity US-born 3, Foreign-born Unknown 56 1 Total 4, The number of MSM newly diagnosed with HIV/AIDS decreased from 1986 to 2000 and then stabilized. The percentage of MSM cases that were Latino increased over time. Latinos constituted the largest number of cases from 2006 to 2010 (Figure 5.1). The percentage of MSM cases that were Asian/Pacific Islander also gradually increased over time. Figure 5.1 Number and percentage of MSM cases by race/ethnicity, ,200 9 Number of cases 1, Before After 2010 MSM counts % Latino % Other % Asian/Pacific Islander % African American % White The percentage of MSM cases that were diagnosed at ages 15 to 29 decreased from 1983 to 1995, followed by a slight increase. The percentage diagnosed at ages 30 to 39 decreased after 2000 (Figure 5.2). 15

17 Figure 5.2 of MSM cases by age group, Before After Among MSM cases diagnosed from 2006 to 2012, African Americans were most likely to be diagnosed at ages 15 to 29 while Asian/Pacific Islanders were most likely to be diagnosed at ages 30 to 39. A higher proportion of White MSM cases were diagnosed at ages 50 and older compared to other racial/ethnic groups (Figure 5.3). Figure 5.3 of MSM HIV/AIDS cases by age group and race/ethnicity, African American (n=53) Asian/Pacific Islander (n=89) Latino (n=306) White (n=262) SCC (n=718) Cumulatively, nearly one in five (18.9%) MSM cases were foreign-born. The proportion of foreign-born MSM cases gradually increased over time (Figure 5.4). Compared to US-born 16

18 MSM, foreign-born MSM cases were more likely to be diagnosed before age 40, particularly at ages 30 to 39 (Figure 5.5). Figure 5.4 of MSM HIV/AIDS cases by country of birth, * Before After 2010 US-born * Excludes 56 cases whose country of birth was unknown Foreign-born Figure 5.5 of MSM cases by country of birth and age group, * US-born (n=478) Foreign-born (n=220) * Excludes 20 cases for which country of birth was unknown 17

19 HIV infection and nativity Of people newly diagnosed with HIV/AIDS from 1983 to 2012, 23% were born outside the US. The proportion of foreign-born HIV/AIDS cases has gradually increased since 1986 (Figure 6.1) except for a slight decrease for those diagnosed after This is likely due to reporting delay. From 2006 to 2011, rates of new HIV/AIDS diagnosis declined regardless of country of birth (Figure 6.2). Figure 6.1 Number and percentage of people diagnosed with HIV/AIDS by nativity, Number of cases 1,600 1,400 1,200 1, Before After 2010 US-born Foreign-born Unknown % Foreign-born Figure 6.2 Annual rate of new HIV/AIDS diagnosis by country of birth, Rate per 100, US-born Foreign-born Year of diagnosis 18

20 Compared to US-born adult and adolescent cases, foreign-born cases were more likely to be female, ages 20 to 29, Latino or Asian/Pacific Islander, and to have a transmission mode of heterosexual contact (Table 6.1). From 2006 to 2011, the HIV/AIDS death rate for the foreignborn population was lower than that for the US-born population (Figure 6.3). Table 6.1 Characteristics of adult and adolescent HIV/AIDS cases by country of birth, , US-born Foreign-born Number % * Number % * Gender Female Male 3, , Age at diagnosis , , , >= Race/ethnicity White 2, Latino Asian/Pacific Islander African American Other Transmission mode MSM 2, IDU MSM & IDU Heterosexual Other Unknown Total 4, , * s for some categories may not sum to 100 due to rounding 19

21 Figure 6.3 HIV/AIDS death rate by nativity, Rate per 100, Year of death US-born Foreign-born HIV infection among older adults The proportion of HIV/AIDS cases ages 50 and older at diagnosis has increased since 2007 but has stabilized in the past few years (Figure 7.1). Among these cases, a higher proportion were female, White, and acquired HIV through IDU and heterosexual contact (Table7.1). Figure 7.1 Number and percentage of people diagnosed with HIV/AIDS at ages 50 years and older, Number of cases % 2 15% 1 5% case count for younger than 50 yrs case count for 50+ yrs % 50+ yrs Table 7.1 Characteristics of people diagnosed with HIV/AIDS at ages 50 years and older, Ages <50 at diagnosis 20 Ages >=50 at diagnosis Number % Number % Gender Female Male Race/ethnicity

22 White Latino Asian/Pacific Islander African American Other Transmission mode MSM IDU MSM & IDU Heterosexual Unknown Total HIV infection among adolescents and young adults Among adults and adolescents newly diagnosed with HIV/AIDS from 2006 to 2012, the number and the proportion of those ages 13 to 24 at diagnosis remained stable (Figure 8.1). A higher proportion of cases diagnosed at ages 13 to 24 (Table 8.1) were among African American, Latino, and MSM and MSM &IDU than among those diagnosed at older ages (Table 8.1). Figure 8.1 Number and percentage of people diagnosed with HIV/AIDS at ages 13 to 24, Number of cases % 2 15% 1 5% case counts for 25+ yrs case count for yrs % yrs 21

23 Table 8.1 Characteristics of people diagnosed with HIV/AIDS by age at diagnosis, Ages Ages Number % Number % Gender Female Male Race/ethnicity Latino White Asian/Pacific Islander African American Other Transmission mode MSM IDU MSM & IDU Heterosexual Unknown Total

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