Profile of Charlotte-Gastonia-Concord TGA

Profile of Charlotte-Gastonia-Concord TGA Profile of Charlotte-Gastonia-Concord TGA Figure 1. Charlotte-Gastonia-Concord TGA Definition North Carolina Anson County Cabarrus County Gaston County Mecklenburg County Union County South Carolina York County Charlotte-Gastonia-Concord TGA 2005 Population: 1,491,330 Data Source: US Census Bureau 2000 MSA: North Carolina GIS Map 2005 American Community Survey Population Data The Charlotte-Gastonia-Concord TGA includes six counties located in two states (Figure 1). According to estimates from the US Census Bureau, the 2005 household population of the region is 1,491,330. Between 2000 and 2005, the population of the region increased by 11%. Unless otherwise stated, the following statements reflect data from the 2005 American Community Survey. Fifty-one percent of the population, or 759,878 persons are female and 49% are male (731,452 persons). Non- Hispanic Whites account for the majority of the population (66%). Non-Hispanic African- Americans are the largest minority group, representing 23% of the total population, followed by Hispanics (8%), Asians (2%) and Persons of Other Races (1%). The median age of the population is 34.9. The proportion of individuals receiving a bachelor s degree or more is higher in the TGA than North Carolina and South Carolina. Figure 2. Selected Demographic Information: Charlotte-Gastonia-Concord TGA, North Carolina and South Carolina Charlotte- Gastonia- North Carolina South Carolina Concord TGA Total Population 1,491,330 8,411,041 4,113,961 Median Age 34.9 36.2 37.1 Racial/Ethnic Distribution White* 66% 68% 66% Black or African American* 23% 21% 28% American Indian and Alaska Native* >1% 1% >1% Asian* 2% 2% 1% Hispanic 8% 6% 3% Pacific Islander* >1% >1% >1% Some other race* 1% 1% 1% Educational Attainment High School Graduate or higher 86% 82% 82% Bachelor's degree or higher 30% 25% 23% * Not Hispanic Data Source: US Census 2005 American Community Survey February 2007 1

HIV/AIDS EPIDEMIOLOGY in the CHARLOTTE-GASTONIA-CONCORD TGA The Charlotte-Gastonia-Concord NC-SC TGA includes six counties (five in North Carolina and one in South Carolina) and has an estimated population of approximately 1.5 million residents. Each year an average number of 418 new cases of HIV/AIDS are reported in the TGA. The majority of these cases occur among males, person s ages 20 44 years and minority populations. The following section summarizes the impact of HIV/AIDS in this geographic area. As the TGA includes portions of two states, HIV/AIDS data reflects data collection from both the North Carolina and South Carolina public health surveillance systems. HIV Disease Case Reporting HIV disease refers to the entire spectrum of disease and includes HIV infection (not AIDS), previously reported HIV infections that have progressed to AIDS and concurrent diagnoses of HIV and AIDS. Overall Trends in HIV Disease Reporting Between 2001 and 2003, the rate of reported HIV disease in the Charlotte- Gastonia-Concord TGA increased by 59%, from 23.6 cases per 100,000 population in 2001 to 37.5 in 2003. It is important to note that during 2003 the state of North Carolina enhanced their surveillance activities resulting in the addition of older prevalent cases to the system. This addition partially contributed to the 2003 spike noted for the state and for the TGA. HIV disease case reports for 2004 and 2005, although lower than 2003, are approximately 27% higher than the number of cases reported in 2001. The annual case rates for the Charlotte- Gastonia-Concord TGA remains higher than rates for North Carolina and South Carolina, indicating an increased burden of disease in the area. Figure 1. Trends in HIV Disease Cases and Annual Rates RAte per 100,000 population HIV Disease Case Reports in Charlotte-Gastonia-Concord MSA Years: 2001-2005 Trends in HIV Disease Reporting: Charlotte-Gastonia-Concord, MSA, North Carolina and South Carolina Calender Years: 2001-2005 40 35 30 25 20 15 10 5 0 Number of Reported Cases 600 500 400 300 200 100 0 23.6 325 28.4 400 540 37.5 411 414 2001 2002 2003 2004 2005 Years 27.9 27.8 Charlotte-Gastonia-Concord MSA North Carolina South Carolina 2001 2002 2003 2004 2005 NC DHHS, HIV/STD Prevention and Care Branch. SCDHEC, STD/HIV Division HIV/STD Surveillance Reports US Census Bureau, Population Division. Annual Estimates of the Population of Metropolitan/Micropolitan Statistical Areas Prepared by: Mecklenburg County Health Department, Epidemiology Program 02/2007

Recent Increases in AIDS Case Reports Within the last four years, the number of AIDS cases reported in the region has grown, placing an increased burden on the public health infrastructure for the region. Between 2004 and 2005, there were 508 new reports of AIDS cases in the TGA. Reports during this time period were nearly 13% higher than case reports for 2002/2003 (2002-2003 AIDS cases = 450). Factors contributing to the increased reports of AIDS cases in the area include: increased testing, sub-optimal antiretroviral treatment response and failure to diagnose HIV infection until AIDS-related symptoms occur (late diagnosis). Reports from the North Carolina HIV/STD Prevention and Care Branch suggest that roughly 30% of individuals diagnosed with HIV disease each year in North Carolina are concurrently diagnosed with AIDS. The recent growth in infection for the TGA along with a rising number of persons living longer with HIV point to a need for increased testing and better access to care. Prevalence of HIV/AIDS Based upon 2005 cumulative reports, over 6,700 cases of HIV/AIDS have been reported in the TGA. However, after accounting for deaths and persons with an unknown vital status, 4,364 persons are reported to be living with HIV/AIDS. This estimate only reflects those individuals who have been diagnosed with HIV and reported within the two public health surveillance systems and does not include individuals who are, as yet, unaware of their HIV status. The Centers for Disease Control estimates that as many as 25% of persons infected with HIV are unaware of their status. Applying this statistic to the current surveillance of HIV/AIDS in the TGA would result in an additional 1,091 PLWHA in the region and would increase the overall prevalence of persons living with HIV/AIDS to over 5,450. Demographic Profile of People Living with HIV/AIDS (PLWHA) Of the 4,364 persons reported to be living with HIV/AIDS, an estimated 2,888 persons have been diagnosed as HIV (non-aids). While the majority of PLWHA in the region are HIV (non-aids), 34%, or 1,476 persons, are living with AIDS (PLWA). Important changes in the HIV epidemic have been noted over time. Increased reports have been noted for females, young adults, heterosexual contact and racial minorities. Figure 2. Distribution of Reported HIV/AIDS Prevalence Cases in Charlotte-Gastonia-Concord TGA: PLWHA as of 12/31/2005 AIDS HIV(non- AIDS) 34% 0% 10% 20% 30% 40% 50% 60% 70% NC DHHS, HIV/STD Prevention and Care Branch. SCDHEC, STD/HIV Division HIV/STD Surveillance Reports 66% Prepared by: Mecklenburg County Health Department, Epidemiology Program 02/2007

Similar trends can be observed among PLWHA in the Charlotte- Gastonia-Concord TGA (see Figure 2.). When comparing the demographic profile of HIV (non-aids) and AIDS cases in the region, the following can be observed for people living with HIV (non-aids) or PLWH: o A larger proportion of women have been reported, o The population is younger with more people reported between the ages of 20 44 years, and o A higher proportion of minorities have been reported. Figure 2. Distribution of Selected Demographics: PLWH vs. PLWHA HIV (non-aids) AIDS By Age 45 years+ 36% 44% 45 years+ 20-44 years 63% Females 65% ales Males 55% 20-44 years By Gender 35% 23% Females 77% Males By Race/Ethnicity Hispanics 3% 2% Hispanics Black 74% 70% Black Whites 23% 23% 26% 26% Whites Profile of Exposure Categories among PLWHA Special Note: Unless otherwise stated, the following statements refer to the 4,364 persons living with HIV/AIDS in the Charlotte-Gastonia-Concord TGA. The three most frequently reported risks among PLHWA in the region include: men who have sex with men (MSM), heterosexual contact and intravenous drug use (IDU). Each year over one third of cases are reported without an identified risk for HIV infection. These cases include persons who are currently being followed by the health department, patients who are loss to follow-up and persons who have declined an interview. Figure 3. Distribution of HIV/AIDS Exposure Categories Among Persons Living with HIV/AIDS in the Charlotte-Gastonia-Concord TGA: (Based upon 4,364 persons living with HIV/AIDS) Pediatric, 1% Other/ Unknown, 36% Blood Products, 1% Heterosexual, 19% MSM, 28% MSM/IDU, 3% IDU, 12% Additional statistics for HIV/AIDS demographics and risk categories can be found in the HIV/AIDS Prevalence and Incidence table for Charlotte-Gastonia-Concord TGA. Prepared by: Mecklenburg County Health Department, Epidemiology Program 02/2007

AIDS INCIDENCE, AIDS PREVALENCE AND HIV (NOT AIDS) PREVALENCE BY DEMOGRAPHIC GROUP AND EXPOSURE CATEGORY Demographic Group/ Exposure Category CHARLOTTE-GASTONIA-CONCORD TGA AIDS INCIDENCE: AIDS PREVALENCE ESTIMATES 01/01/04 TO 12/31/05 AIDS incidence is defined as the number of new AIDS cases diagnosed during the period specified. AIDS Prevalence is defined as the number of people living with AIDS as of the date specified. HIV (NOT AIDS) PREVALENCE HIV Prevalence is defined as the estimated number of diagnosed people living with HIV (not AIDS) as of the date specified. Race/Ethnicity Cases % of Total* Cases % of Total* Cases % of Total* White, not Hispanic 134 26 389 26 670 23 Black, not Hispanic 356 70 1038 70 2125 74 Hispanic 15 3 34 2 73 3 Other, not Hispanic *** >1 7 1 17 >1 Not Specified/Other *** >1 8 >1 3 >1 Total 507 1476 2888 Gender # % of Total # % of Total # % of Total Male 376 74 1126 77.0 1863 65 Female 131 26 350 23.0 1025 35 Total 507 1476 2888 Age at Diagnosis (Incidence)/ Current Age (Prevalence) # % of Total # % of Total # % of Total <13 years 0 0 5 >1 9 >1 13 19 years 4 1 7 >1 37 1 20 44 years 347 68 817 55 1806 63 45+ years 156 31 646 44 1033 36 Not Specified/Unknown 0 0 *** >1 3 >1 Total 507 1476 2888 * Percents may not total 100 due to rounding *** Numbers less than three are not included in adherence to confidentiality statutes. North Carolina DHHS, HIV/STD Prevention and Care Unit, Special Data Request: HIV Disease Prevalence in Anson, Cabarrus, Gaston, Mecklenburg and Union Counties SC Department of Health and Environmental Control, Special Data Request: HIV Disease Prevalence in York County Prepared by Mecklenburg County Health Department, Epidemiology Program 02/2007

AIDS INCIDENCE, AIDS PREVALENCE AND HIV (NOT AIDS) PREVALENCE BY DEMOGRAPHIC GROUP AND EXPOSURE CATEGORY CHARLOTTE-GASTONIA-CONCORD, NC-SC MSA CONTINUED Demographic Group/ Exposure Category AIDS INCIDENCE: 01/01/04 TO 12/31/05 AIDS incidence is defined as the number of new AIDS cases diagnosed during the period specified. AIDS PREVALENCE AIDS Prevalence is defined as the number of people living with AIDS as of the date specified. HIV (NOT AIDS) PREVALENCE HIV Prevalence is defined as the estimated number of diagnosed people living with HIV (not AIDS) as of the date specified. Adult/Adolescent AIDS Exposure Category Cases % of Total* Cases % of Total* Cases % of Total* Men who have sex with men 169 33 456 31 743 26 Injection drug users 40 8 217 15 317 11 Men who have sex with men and inject drugs 11 2 50 3 82 3 Heterosexuals** 110 22 353 24 776 27 Other/Hemophilia/blood transfusion 6 1 30 2 32 1 Risk not reported or identified 171 33 361 25 915 32 Total 507 1467 2865 Pediatric AIDS Exposure Categories Cases % of Total Cases % of Total Cases % of Total Mother with/at risk for HIV infection 0 0 9 100 23 100 Other/Hemophilia/blood transfusion 0 0 0 0 0 0 Risk not Reported or identified 0 0 0 0 0 0 Total 0 9 23 ** Heterosexual cases include cases that meet the CDC definition for Heterosexual exposure and cases that are presumed heterosexual based upon follow-up interviews with newly diagnosed persons. North Carolina DHHS, HIV/STD Prevention and Care Unit, Special Data Request: HIV Disease Prevalence in Anson, Cabarrus, Gaston, Mecklenburg and Union Counties SC Department of Health and Environmental Control, Special Data Request: HIV Disease Prevalence in York County Prepared by Mecklenburg County Health Department, Epidemiology Program 02/2007