6.2 HIV/AIDS HIV/AIDS Surveillance. Section 6.2. Explanation of the Statistics Presented

Similar documents
Georgia HIV/AIDS Surveillance Summary. Data Through December 31, 2010

WISCONSIN AIDS/HIV PROGRAM NOTES

Estimates of New HIV Infections in the United States

Using HIV Surveillance Data to Calculate Measures for the Continuum of HIV Care

HIV Surveillance Update

4/3/2012. Surveillance. Direct Care. Prevention. Quality Management

HIV Infection Among Those with an Injection Drug Use*-Associated Risk, Florida, 2014

Program Performance Indicators Revised Baseline & Target Setting Form January 1 June 30, 2004 Interim Progress Report

HIV/AIDS In the Houston Area

HIV and AIDS in Bangladesh

EXECUTIVE SUMMARY: INTEGRATED EPIDEMIOLOGIC PROFILE FOR HIV/AIDS PREVENTION AND CARE ELIGIBLE METROPOLITAN AREA PLANNING, PHILADELPHIA

in children less than one year old. It is commonly divided into two categories, neonatal

EPIDEMIOLOGY OF HEPATITIS B IN IRELAND

UNITED NATIONS GENERAL ASSEMBLY SPECIAL SESSION ON HIV/AIDS. Country Progress Report Sweden

HIV prevention and the wider UK population. What HIV prevention work should be directed towards the general population in the UK?

The HIV/AIDS Epidemic in California s Latino Population

2011 STI Annual Report

West Virginia HIV/AIDS Surveillance Report 2009 Update West Virginia HIV/AIDS Program

Injection Drug Users in Miami-Dade: NHBS-IDU2 Cycle Preliminary Results

Understanding the HIV Care Continuum

HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS 11

HIV/AIDS: General Information & Testing in the Emergency Department

HIV/AIDS Tool Kit. B. HIV/AIDS Questionnaire for Health Care Providers and Staff

Minnesota HIV/AIDS Epidemiologic Profile

HIV Epidemiology in New York State

Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General

Q&A on methodology on HIV estimates

GARPR Online Reporting Tool

New Brunswick Health Indicators

Figure 1.1 Percentage of persons without health insurance coverage: all ages, United States,

UNINSURED ADULTS IN MAINE, 2013 AND 2014: RATE STAYS STEADY AND BARRIERS TO HEALTH CARE CONTINUE

HIV& AIDS BASIC FACTS. HIV & Drug Use. You are better off knowing if you have HIV. HIV & Sex. What are HIV & AIDS? HIV & Blood Products

Epidemiologic Profile for HIV/STD Prevention & Care Planning

Integrating Medical Care Coordination Services into HIV Clinic Medical Homes

A Ministry of the Archdiocese of Galveston-Houston A United Way Agency

Hepatitis C Virus Infection: Prevalence Report, 2003 Data Source: Minnesota Department of Health HCV Surveillance System

Kalamazoo County STD Task Force

Educational Attainment in the United States: 2015

STATE OF THE HIV/AIDS EPIDEMIC IN CHARLESTON

Targeted HIV Testing & Enhanced Testing Technologies. HIV Prevention Section Bureau of HIV/AIDS

Bridging the Gaps: Eliminating Disparities in Teen Pregnancy & Sexual Health

HIV/AIDS Tool Kit. D. Answer Key for the HIV/AIDS Questionnaire for Health Care Providers and Staff

What is HPV? Low-risk HPV types. High-risk HPV types

DC Comprehensive HIV Prevention Plan for : Goals and Objectives

MALAWI YOUTH DATA SHEET 2014

Meningococcal Disease Among Men Who Have Sex with Men United States, January June 2015

Texas Diabetes Fact Sheet

Statistics on Women in the Justice System. January, 2014

Health Care Access to Vulnerable Populations

Module 4: Formulating M&E Questions and Indicators

William Atkinson, MD, MPH Hepatitis B Vaccine Issues June 16, 2016

Huron County Community Health Profile

Health Status, Health Insurance, and Medical Services Utilization: 2010 Household Economic Studies

SB 71 Question and Answer Guide, page 1

HIV/AIDS Epidemic Status at-a-glance

Chapter 20: Analysis of Surveillance Data

4/30/2013 HPV VACCINE AND NORTH DAKOTA HPV IMMUNIZATION RATES HUMAN PAPILLOMAVIRUS (HPV) HUMAN PAPILLOMAVIRUS HPV CONTINUED

Denver County Births and Deaths 2013

UNAIDS 2014 LESOTHO HIV EPIDEMIC PROFILE

Hepatitis C Infections in Oregon September 2014

Epidemiology of Hepatitis C Infection. Pablo Barreiro Service of Infectious Diseases Hospital Carlos III, Madrid

HIV/AIDS PAPER OUTLINE. 0.Introduction. -Definitions. 1. AIDS as a stigma. -Factors to the AIDS stigma. 2. Transmission to HIV

Maternal Health Services Utilization

Morbidity and Mortality among Adolescents and Young Adults in the United States

HIV/AIDS Epidemiology Report

Mid-year population estimates. Embargoed until: 20 July :30

Patterns and Trends of Drug Abuse in the Baltimore/Maryland/Washington, DC, Metropolitan Area Epidemiology and Trends:

HPTN 073: Black MSM Open-Label PrEP Demonstration Project

The Sexual Health of Youth in the United States

Q and A for PARTNER Studies: Interim analysis results presented at CROI CROI presentation can be found at

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Educational Attainment of Veterans: 2000 to 2009

State Health Assessment Health Priority Status Report Update. June 29, 2015 Presented by UIC SPH and IDPH

EXPANDED HIV TESTING AND LINKAGE TO CARE (X-TLC) IN HEALTHCARE SETTINGS ON THE SOUTH SIDE OF CHICAGO

Maryland HIV Plan

HIV/AIDS in the Houston Area

Meena Abraham, DrPH, MPH Director of Epidemiology Services Baltimore City Health Department

Massachusetts HIV Drug Assistance Program (HDAP) and Comprehensive Health Insurance Initiative (CHII) Application Form

Public Knowledge and Attitudes, 2014

Populations of Color in Minnesota

Hepatitis C. Screening, Diagnosis and Linkage to Care

Impact of Diabetes on Treatment Outcomes among Maryland Tuberculosis Cases, Tania Tang PHASE Symposium May 12, 2007

Malawi Population Data Sheet

Sexual Assault Prevalence in Texas 1

COLLEGE ENROLLMENT AND WORK ACTIVITY OF 2014 HIGH SCHOOL GRADUATES

Volunteering. Volunteering

Understanding the Science of Type 2 Diabetes. Anne Westbrook and April Gardner NABT Dallas, TX November 1, 2012

2004 Update. Sierra Leone

Drug Use and Abuse in San Diego County, California: 2013

Viral Hepatitis Case Report

How To Prevent An Std

TEENAGE PREGNANCY. Arizona, Public Health Services Bureau of Public Health Statistics Health Status and Vital Statistics Section

Understanding public opinion toward HIV/AIDS

APPENDIX C Process Monitoring and Evaluation Tools

Long Term Socio-Economic Impact of HIV/AIDS on Children and Policy Response in Thailand

Condoms, PrEP, and the use of ART to prevent the sexual transmission of HIV: Overview of the science and recommendations for service providers

The Epidemiology of Hepatitis A, B, and C

The Minnesota Chlamydia Strategy: Action Plan to Reduce and Prevent Chlamydia in Minnesota Minnesota Chlamydia Partnership, April 2011

Health Profile for St. Louis City

The State Hospital HIV / AIDS

High Risk Behavior For Acquiring HIV Among Adults Aged 18-64 Years, 2004-2005 Health Provider Talked With About Preventing STDs Through Condom Use in the Past 12 months % 95% C.I.I.

6.2 HIV/AIDS 6.2.1 HIV/AIDS Surveillance Explanation of the Statistics Presented Newly diagnosed HIV/AIDS cases include cases diagnosed in a one-year time period; new diagnoses do not necessarily represent new infections, as newly diagnosed cases may have been infected for many years. Newly diagnosed cases include persons with HIV (who do not have AIDS) and people who are newly diagnosed with AIDS who had not been diagnosed with HIV previously. Prevalent cases include both newly diagnosed cases as well as all cases diagnosed previously that are still living at a specific point in time. Prevalence includes persons with AIDS as well as persons with HIV but not AIDS. Two different views of HIV/AIDS prevalence are included in this report: reported prevalence and estimated prevalence. The reported prevalence includes only cases that have been diagnosed and reported and contain patient name (this does not include positive test results from anonymous testing). The estimated prevalence is calculated based on the following: 1. The number of reported cases who are living with HIV/AIDS 2. The number of known HIV+ cases not yet reported, estimated at 10% of the known living HIV/AIDS cases 3. The number of HIV+ cases that have not yet been tested, estimated at 25% of the total cases living with HIV/AIDS Kalamazoo County HIV/AIDS Statistics Reported HIV/AIDS prevalence in Kalamazoo County (all persons currently living with an HIV or AIDS diagnosis) is 291 persons as of April 1, 2011. Reported AIDS prevalence in Kalamazoo County (all persons currently living with an AIDS diagnosis - a subset of those living with HIV/AIDS) is 145 persons as of April 1, 2011. Estimated HIV prevalence as of April 1, 2011 for Kalamazoo County is 390. The estimated prevalence represents a minimum estimate of the number of persons who are HIV+. This prevalence estimate equates to a prevalence rate of 157.0 per 100,000 population. Although Kalamazoo County s prevalence rate is lower than the prevalence rate in Michigan overall, when compared to all other Michigan local health jurisdictions (43 total in Michigan) it ranked tenth in reported prevalence rates in the state as of January 1, 2010. 1 1 2010 Epidemiologic Profile of HIV/AIDS in Michigan; Michigan Department of Community Health, Bureau of Epidemiology, HIV/STD and Other Bloodborne Infections Surveillance Section. Accessed here 6/2/11: http://www.michigan.gov/mdch/0,1607,7-132-2944_5320_5331-36307--,00.html Revised 6/6/11 1

1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 YTD Total persons diagnosed Rate per 100,000 population Section 6.2 250 200 150 100 50 0 Estimated HIV Prevalence Rate for Michigan and Kalamazoo County, April 1, 2011 157.0 Kzoo 195.6 MI The number of new cases of HIV diagnosed increased in both 2003 and 2004 after declining for several years, but again decreased in each year in 2005, 2006 and 2007. In 2008 and 2009 the number of new diagnoses increased again, but declined in 2010. The number of reported HIV new diagnoses may be influenced by increases in HIV testing due to improved public awareness; additionally, HIV may not be diagnosed in the same year that a person becomes infected. Therefore, interpretation of trends must take these limitations into consideration. Reported Number of Kalamazoo County Residents Diagnosed with HIV or AIDS per Year, 1983-2011 YTD 45 40 35 30 25 20 15 10 5 0 New HIV/AIDS Diagnoses New AIDS Diagnoses Year The reported prevalence of HIV/AIDS cases has continued to increase over time. This is because the number of new cases diagnosed and reported each year exceeds the number of HIV/AIDS cases who die each year. Revised 6/6/11 2

1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 YTD Total persons diagnosed Section 6.2 350 300 250 200 150 100 50 0 Reported Number of Kalamazoo County Residents Living with HIV/AIDS and AIDS (Prevalence), 1983-2011 YTD HIV/AIDS Prevalence AIDS Prevalence Year Kalamazoo County Reported Cases of HIV/AIDS, New Diagnoses and Prevalence 1983-2011 Year New HIV Diagnoses New AIDS Diagnoses HIV/AIDS Prevalence AIDS Prevalence 1983 1 1 1 1 1984 2 0 3 1 1985 8 3 9 2 1986 9 1 17 2 1987 16 7 29 5 1988 14 10 39 11 1989 23 7 58 14 1990 39 21 87 25 1991 24 10 103 27 1992 21 14 117 34 1993 20 25 125 48 1994 20 22 131 57 1995 21 28 138 72 1996 26 21 152 81 1997 18 21 155 89 1998 15 12 167 99 1999 16 5 178 99 2000 10 9 180 100 2001 11 6 186 101 2002 9 1 191 98 2003 13 5 199 98 2004 25 7 222 104 2005 18 14 235 115 2006 13 7 245 120 2007 10 9 248 123 2008 16 11 261 131 2009 22 9 277 135 2010 15 10 290 143 2011 YTD 1 2 291 145 Revised 6/6/11 3

Rate per 100,000 population Section 6.2 Age at HIV/AIDS Diagnosis Among Reported Cases Currently Living in Kalamazoo County, April 1, 2011 0-12 years 13-19 years 20-24 years 25-29 years 30-39 years 40-49 years 50-59 years 60+ years <1.7% 1.7% 6.5% 5.5% 12.7% 19.2% 19.2% 34.0% % 1% 2% 3% 4% As of April 1, 2011, among the 291 reported cases living in Kalamazoo County, the largest percentage of cases were diagnosed between the ages of 30 and 39 years old (34.0% of cases). Among all reported cases, 6.5% (19 cases) were diagnosed when they were between the ages of 13 to 19 years old. Cases could have been diagnosed in any year and currently be any age; this statistic does not mean that there are currently 19 teens who have been reported as HIV positive. Cases diagnosed as teens may now be in an older age group; likewise cases diagnosed when they were younger than 13 years may have aged into the teen age group. The estimated prevalence rate of HIV among Kalamazoo County males is 4.1 times higher than the rate among females. This is similar to the disparity by sex in Michigan overall (male rate is 3.5 times higher than female rate). Estimated HIV Prevalence Rate for Michigan and Kalamazoo County by Sex, April 1, 2011 350 300 250 200 150 100 50 0 257.5 Kzoo 62.5 307.8 MI 87.0 Males Females Revised 6/6/11 4

Rate per 100,000 population Section 6.2 In Kalamazoo County, the estimated prevalence of HIV/AIDS among the black, non- Hispanic/Latino population is 5.6 times as high as the rate among white, non-hispanic/latinos. The disparity in Michigan overall is even greater; the estimated prevalence among blacks is 9.2 times as high as the rate among whites. The estimated prevalence among Hispanics/Latinos is similar to the rate among whites in Kalamazoo (1.1 times greater among Hispanics/Latinos). In Michigan overall, the prevalence among Hispanics is 2.2 times higher than it is among whites. Estimated HIV Prevalence Rate for Michigan and Kalamazoo County by Race and Ethnicity, April 1, 2011 900 800 700 600 500 400 300 200 100 0 601.7 107.1 112.7 86.6 Kzoo 794.0 MI 194.7 White, non-hispanic/latino Black, non-hispanic/latino Hispanic/Latino Revised 6/6/11 5

Of all Kalamazoo County residents living with HIV or AIDS as of April 1, 2011, approximately 80% of cases reported had a known mode of transmission. Men who have sex with men (MSM) comprise the largest percentage of cases (51%). Injecting drug use (IDU) is the reported mode of transmission for 8% of cases, and an additional 5% of cases reported both MSM and IDU as potential modes of transmission. Ten percent of cases were high-risk heterosexuals (their partners are known to be HIV infected or at high risk for HIV). An additional 3% of cases were among females whose only reported risk was heterosexual contact, and 6% of cases were among men who were presumed to have only heterosexual contact. For 15% of cases, the likely mode of transmission was unknown. Mode of HIV Transmission Among Reported Cases Currently Living in Kalamazoo County, April 1, 2011 Injecting Drug Use 8% Male-Male sex/ Injecting Drug Use 5% High-Risk Heterosexual* 10% Male-Male sex 51% Undetermined: Unknown 15% Blood Products <1.7% Perinatal <1.7% Presumed Heterosexual - Female** 3% Undetermined: Presumed Heterosexual - Male*** 6% *High Risk Heterosexual: males and females whose sexual partners are known to be HIV-infected or at high risk for HIV. The partners meet one of the following criteria: a history of sexual contact with bi-sexual males (for females), injection drug users, hemophiliacs, HIV+ transfusion recipients or other HIV+ persons of unknown risk. **Presumed Heterosexual Female: Females who are not injection drug users and whose only reported risk is heterosexual contact, but their male partners risk and HIV status are unknown. ***Presumed Heterosexual Male: Males whose only reported risk is heterosexual contact, and their female partners risk and HIV status are unknown. HIV Data Source: Michigan Department of Community Health, Bureau of Epidemiology, HIV/AIDS Surveillance Section; April 2011 Quarterly HIV/AIDS Analysis. Population Data Source: National Center for Health Statistics. Postcensal estimates of the resident population of the United States for July 1, 2000-July 1, 2009, by year, county, age, bridged race, Hispanic origin, and sex (Vintage 2009). Prepared under a collaborative arrangement with the U.S. Census Bureau; released June 20, 2010. Available on the Internet from: http://www.cdc.gov/nchs/nvss/bridged_race.htm as of July 23, 2010. Revised 6/6/11 6

6.2.2 HIV Testing and Risk Behaviors In Kalamazoo County in 2009-2010, 35.2% of adults aged 18-64 years had ever been tested for HIV. This was similar to the proportion in Michigan in 2010 of 38.0%. Adults between the ages of 25 and 44 years of age in Kalamazoo County (and in Michigan) were more likely to have ever been tested than younger or older adults. African American adults were twice as likely to have been tested as white adults (62.9% of African American adults have been tested compared to 30.3% of white adults in Kalamazoo County). Percentage of Adults 18-64 Years Old in Kalamazoo County Ever Tested for HIV by Age Group, 2009-2010 8 6 4 2 61.3 56.9 37.9 14.5 22.1 18-24 years 25-34 years 35-44 years 45-54 years 55-64 years 6 4 Percentage of Adults 18-64 Years Old in Kalamazoo County Ever Tested for HIV by Income, 2009-2010 52.5 44.9 37.2 35.8 30.9 2 LT $20,000 $20,000-34,999 $35,000-49,999 $50,000-74,999 $75,000+ Revised 6/6/11 7

Among adults 18 to 64 years old, 10.7% reported having had an HIV test in the past 12 months. A greater percentage of males (13.5%) compared with females (8.1%) and more blacks (38.9%) than whites (6.2%) reported recent HIV testing. The percentage of adults with recent testing was highest among those aged 25-34 years and those with less education and lower income. 2 Percentage of Adults 18-64 Years Old in Kalamazoo County Tested for HIV in the Past 12 Months by Age Group, 2009-2010 17.9 15.0 1 5.0 8.0 12.4 11.4 6.0 18-24 years 25-34 years 35-44 years 45-54 years 55-64 years 3 25.0 2 15.0 1 5.0 Percentage of Adults 18-64 Years Old in Kalamazoo County Tested for HIV in the Past 12 Months by Income, 2009-2010 26.8 21.1 5.9 LT $20,000 $20,000-34,999 $35,000-49,999 $50,000-74,999 $75,000+ 8.3 5.4 Percentage of Adults 18-64 Years Old in Kalamazoo County Tested for HIV in the Past 12 Months by Education, 2009-2010 3 2 1 19.8 8.8 8.4 10.9 Less than HS HS graduate Some college College graduate Revised 6/6/11 8

Among adults in Kalamazoo County aged 18 to 64 years, 4.1% reported having at least one risk factor in the previous year that is associated with a high risk of acquiring HIV. High risk factors include having used intravenous drugs, having been treated for a sexually transmitted infection, having given or received money or drugs in exchange for sex, and having anal sex without a condom. Although differences among groups were not significant in Kalamazoo County, the proportion of adults with at least one of these risk factors appears to be higher among younger adults, and adults with less education. Percentage of Adults 18-64 Years Old in Kalamazoo County Reporting High- Risk Behavior (for Acquiring HIV) in the Past Year by Age Group, 2009-2010 12.0 1 8.0 6.0 4.0 2.0 9.7 1.9 2.5 1.6 18-24 years 25-34 years 35-44 years 45-54 years 55-64 years 8.0 6.0 4.0 2.0 Percentage of Adults 18-64 Years Old in Kalamazoo County Reporting High- Risk Behavior (for Acquiring HIV) in the Past Year by Education, 2009-2010 7.3 5.6 Less than HS HS graduate Some college College graduate 3.5 2.0 Revised 6/6/11 9

HIV Testing and High Risk Behavior For Acquiring HIV Among Adults Aged 18-64 Years, 2009-2010 Had an HIV Test in Ever Tested for HIV a the Past 12 Months b High-Risk Behavior for Acquiring HIV c % 95% C.I. % 95% C.I. % 95% C.I. Total 35.2 (28.1-43.0) 10.7 (6.9-16.1) 4.1 (2.0-8.4) Age 18-24 years 14.5 (5.7-32.1) 8.0 (2.1-26.6) 9.7 (3.4-24.8) 25-34 years 61.3 (44.5-75.8) 17.9 (9.0-32.3) 1.9 (0.5-7.2) 35-44 years 56.9 (45.9-67.3) 12.4 (5.8-24.4) 2.5 (0.7-8.7) 45-54 years 37.9 (28.7-48.2) 11.4 (5.6-21.8) 1.6 (0.5-5.2) 55-64 years 22.1 (14.2-32.7) 6.0 (2.4-14.1) ( - 0.3) Gender Male 34.5 (24.4-46.2) 13.5 (7.3-23.6) 3.0 (1.0-8.5) Female 35.8 (26.3-46.6) 8.1 (4.5-14.3) 5.1 (1.9-12.8) Race White non-hispanic 30.3 (23.3-38.2) 6.2 (3.6-10.5) 2.6 (1.0-6.6) Black non-hispanic 62.9 (36.3-83.4) 38.9 (18.5-64.1) 0.6 (0.2-1.9) Education Less than HS 31.5 (9.5-66.9) 19.8 (4.7-55.2) 7.3 (1.1-36.3) HS graduate 30.8 (20.8-42.9) 8.8 (3.8-19.2) 5.6 (1.7-17.0) Some college 29.0 (19.3-41.0) 8.4 (4.2-15.8) 3.5 (0.9-13.4) College graduate 50.8 (42.2-59.4) 10.9 (5.9-19.3) 2.0 (0.8-4.6) Income LT $20,000 52.5 (35.9-68.6) 26.8 (12.4-48.8) 0.8 (0.2-2.8) $20,000-34,999 44.9 (29.4-61.5) 21.1 (9.5-40.8) 6.7 (1.4-26.4) $35,000-49,999 37.2 (19.6-58.9) 5.9 (1.8-17.2) 3.1 (0.4-19.4) $50,000-74,999 35.8 (22.6-51.5) 8.3 (2.9-21.7) 0.4 (0.1-2.2) $75,000+ 30.9 (19.5-45.3) 5.4 (2.2-12.8) 6.3 (2.0-18.1) City/Out-County City of Kalamazoo 53.3 (41.0-65.3) 21.8 (12.3-35.7) 4.4 (1.3-14.3) Rest of County 27.4 (18.8-38.0) 8.0 (4.4-14.3) 4.1 (1.4-11.3) Within City of Kalamazoo White in City 39.8 (27.0-54.3) 10.6 (4.4-23.5) 5.7 (1.3-21.8) Black in City 75.5 (57.1-87.7) 45.0 (22.7-69.5) 0.5 (0.1-1.6) a Among those aged 18-64 years, the proportion who reported that they ever had been tested for HIV, not including tests that were part of a blood donation. Don't know was considered a valid response to this question. b Among those aged 18-64 years, the proportion who reported that they had been tested for HIV in the past 12 months, not including tests that were part of a blood donation. Don't know was considered a valid response to this question. c Among those aged 18-64 years, the proportion who reported that they had done at least one of the following in the past year: - Used intravenous drugs. - Been treated for a sexually transmitted or venereal disease. - Given or received money or drugs in exchange for sex. - Had anal sex without a condom. Revised 6/6/11 10

Although data is not available for 2009-2010 for Kalamazoo County, in 2004-2005 some of the groups in which the risk factors for acquiring HIV appeared to be more common were also groups who were more likely to have had a health provider talk with them about preventing sexually transmitted infections through condom use in the past twelve months (younger adults and adults with less education). Additional groups that reported a provider talked with them about prevention more commonly were females, blacks, and adults with lower incomes. Overall, 13.1% of adults in Kalamazoo County had a health provider talk with them about condom use to prevent sexually transmitted infections. This was similar to the percentage of adults in Michigan (12.0%) who reported a health provider talked with them about condom use. 4 35.0 3 25.0 2 15.0 1 5.0 34.1 Percentage of Adults 18-64 Years Old in Kalamazoo County Reporting a Health Provider Talked With Them About Preventing STDs and HIV Through Condom Use in the Past 12 Months by Age, Sex, Race, Education and Income, 2004-2005 16.0 9.3 3.0 2.6 6.8 19.2 10.9 27.4 23.6 22.9 19.8 14.3 12.3 9.7 9.3 7.5 6.2 Source: Kalamazoo County 2004-2005 Behavioral Risk Factor Survey Revised 6/6/11 11

High Risk Behavior For Acquiring HIV Among Adults Aged 18-64 Years, 2004-2005 Health Provider Talked With About Preventing STDs Through Condom Use in the Past 12 Months % 95% C.I. Total 13.1 (10.2-15.9) Age 18-24 years 34.1 (23.4-44.8) 25-34 years 16.0 (9.5-22.6) 35-44 years 9.3 (4.6-14.0) 45-54 years 3.0 (0.8-5.3) 55-64 years 2.6 (0.1-5.2) Gender Male 6.8 (3.4-10.1) Female 19.2 (14.8-23.6) Race White 10.9 (8.1-13.8) Black 27.4 (15.9-38.8) Education Less than HS 23.6 (10.4-36.9) HS graduate 14.3 (8.0-20.6) Some college 12.3 (7.8-16.7) College graduate 9.7 (5.7-13.7) Income LT $20,000 19.8 (11.5-28.1) $20,000-34,999 22.9 (14.3-31.6) $35,000-49,999 9.3 (2.7-15.9) $50,000-74,999 7.5 (2.8-12.2) $75,000+ 6.2 (2.4-9.9) City/Out-County City of Kalamazoo 21.4 (16.0-26.8) Rest of County 7.4 (4.5-10.3) Within City of Kalamazoo White in City 17.1 (11.3-22.9) Black in City 33.2 (20.2-46.1) Source: Kalamazoo County 2004-2005 Behavioral Risk Factor Survey Revised 6/6/11 12

Percent tested in past 12 months Section 6.2 Number of partners in the past year was not collected in the most recent BRFS survey, so estimates of recent HIV testing among adults who were sexually active or who had a new partner during the past 12 months are not available for 2009-2010. From the 2004-2005 survey, among adults in Kalamazoo County who had at least one sex partner in the previous twelve months, 17.1% reported also having had an HIV test in the past twelve months. This percentage increased among adults who reported having at least one new sex partner in the past twelve months; 23.2% of these adults also reported having had an HIV test in this time period. Although younger adults who were sexually active were more likely to have had an HIV test in the past year than older adults, when only adults with new sex partners in the previous year were compared, adults between the ages of 35 and 44 years were the most likely to have had an HIV test in the past year than younger or older adults. Sexually active males and females were equally likely to have had an HIV test in the previous year, but females who had a new partner in the past year were more likely to have been tested for HIV than males who had a new partner in the past year. 35.0 3 25.0 2 15.0 1 5.0 HIV Testing and Sexual Activity by Age Among Adults Aged 18 to 49 Years in Kalamazoo County, 2004-2005 25.1% 23.4% 12.9% 2.8% 18.5% 26.9% 32.6% 11.8% Had an HIV test in the past 12 months among Had an HIV test in the past 12 months among those who were sexually active in past 12 months those with at least one NEW sex partner in past 12 months 18-24 years 25-34 years 35-44 years 45-49 years Source: Kalamazoo County 2004-2005 Behavioral Risk Factor Survey Revised 6/6/11 13

HIV Testing and Sexual Activity Among Adults Aged 18-49 Years in Kalamazoo County, 2004-2005 Demographic Characteristics Had an HIV test in the past 12 months among those who were sexually active in past 12 months Had an HIV test in the past 12 months among those with at least one NEW sex partner in past 12 months % 95% C.I. % 95% C.I. Total 17.1 (12.6-21.6) 23.2 (13.8-32.6) Age Gender Race Education Income 18-24 years 25.1 (12.2-37.9) 18.5 (4.2-32.9) 25-34 years 23.4 (14.9-31.9) 26.9 (10.4-43.4) 35-44 years 12.9 (6.1-19.7) 32.6 (10.9-54.3) 45-49 years 2.8 * 11.8 * Male 16.6 (9.7-23.6) 16.8 (5.4-28.2) Female 17.6 (11.9-23.3) 33.6 (18.4-48.8) White 11.1 (7.4-14.8) 22.2 (11.5-32.8) African American 50.6 (33.9-67.3) 36.2 (10.5-61.9) Less than HS 28.9 (11.3-46.4) 29.5 (1.4-57.5) HS graduate 19.2 (8.8-29.6) 30.3 (8.1-52.5) Some college 13.7 (6.3-21.2) 17.9 (5.3-30.5) College graduate 14.7 (8.7-20.8) 20.3 (2.4-38.2) Less than $35K 29.2 (2-38.5) 30.5 (15.8-45.2) $35K+ 10.9 (5.8-15.9) 21.2 (5.1-37.3) *Confidence interval exceeds possible limits Source: Kalamazoo County 2004-2005 Behavioral Risk Factor Survey For additional analyses and information on sexual risk behaviors among adults and youth including condom use, please refer to Section 6.3: Sexually Transmitted Infections of the Kalamazoo County Health Surveillance Data Book. Revised 6/6/11 14

More than one-third of adults in Kalamazoo County who had ever had an HIV test reported that their most recent test was done at their private doctor s office or HMO. The percentage reporting testing at their provider s office or HMO increased from the 2004-2005 survey to the 2009-2010 (35.4% in 2004-2005, 50.6% in 2009-2010). Clinics and hospitals were the sites next most commonly reported. Testing Location for Most Recent HIV Test Among Adults Aged 18 64 Years in Kalamazoo County, 2009-2010 % 95% C.I. Private doctor or HMO 50.6 (40.8-60.3) Clinic 22.4 (14.2-33.5) Hospital 18.0 (12.2-25.9) Home 3.8 (1.6-8.6) Somewhere else 3.4 (1.8-6.4) Counseling and testing site 1.6 (0.8-3.3) Drug treatment facility 0.2 ( - 0.7) Jail or prison ( - 0.1) Type of clinic where testing was done was not asked in 2009-2010, but in the 2004-2005 survey the most commonly reported type of clinic for HIV testing was a public health clinic. Type of Clinic Where Had Last HIV Test Among Adults Aged 18-64 Years Whose Most Recent HIV Test was at a Clinic, 2004-2005 % 95% C.I. Public health clinic 48.1 (32.7-63.5) Community health clinic 16.9 (7.3-26.4) Family planning clinic 14.9 (5.9-24.0) Prenatal clinic 5.3 * STD clinic 3.5 * *Confidence interval exceeds possible limits Source: Kalamazoo County 2004-2005 Behavioral Risk Factor Survey As reported in 2004-2005, the most common reasons for having been tested for HIV most recently by adults were pregnancy, routine medical check-up, and that testing was required. For 17.4% of adults, the reason they were tested most recently was that they just wanted to find out if they had HIV. (This question was not asked in the 2009-2010 survey.) Reason for Last HIV Test Among Adults Aged 18-64 Years Old, 2004-2005 % 95% C.I. You were pregnant (females only) a 33.1 (24.9-41.3) It was part of a routine medical check-up 25.4 (20.2-30.7) It was required 19.3 (14.0-24.7) Just wanted to find out whether or not had HIV 17.4 (12.5-22.3) Thought you might have gotten HIV through sex or drug use 1.8 (0.6-3.1) You were worried that you could give HIV to someone else 1.7 (0.2-3.1) Someone suggested you should be tested 1.3 (0.2-2.4) Some other reason 15.3 (11.0-19.7) a Proportion of females only who gave this as the main reason they were tested last Source: Kalamazoo County 2004-2005 Behavioral Risk Factor Survey Revised 6/6/11 15

6.2.3 HIV Treatment Perceptions When surveyed in 2004-2005, about half of adults in Kalamazoo County knew that pregnant women could get treatment to reduce the risk of transmitting HIV to her baby, and almost a third did not know whether or not this was true. In Michigan, a similar percentage of adults knew that this was true (49.6% answered correctly). Age, gender, race, education and income groups did not differ in knowledge about this potentially protective treatment for babies of HIV positive mothers. Response to Statement A Pregnant Woman With HIV Can Get Treatment to Help Reduce the Chances That She will Pass the Virus to Her Baby Among Adults Aged 18 64 Years in Kalamazoo County, 2004-2005 Demographic Characteristics TRUE FALSE DON'T KNOW % 95% C.I. % 95% C.I. % 95% C.I. Total 53.8 (49.8 57.8) 19.0 (15.7-22.2) 27.3 (23.8-30.7) Age 18-24 years 56.1 (44.7 67.5) 20.4 (11.6-29.2) 23.5 (13.7-33.2) 25-34 years 57.9 (49.0 66.8) 16.7 (9.8-23.6) 25.4 (17.5-33.3) 35-44 years 52.3 (44.6 6) 21.7 (15.0-28.5) 26.0 (19.5-32.5) 45-54 years 51.1 (43.4 58.8) 21.3 (14.3-28.3) 27.6 (20.9-34.3) 55-64 years 52.0 (43.8 60.1) 11.4 (6.2-16.6) 36.7 (28.7-44.6) Gender Male 52.4 (46.3 58.6) 21.0 (15.9-26.1) 26.6 (21.2-31.9) Female 55.1 (5 60.2) 17.0 (12.8-21.1) 27.9 (23.4-32.5) Race White 53.5 (49.2 57.8) 18.3 (14.8-21.8) 28.2 (24.4-32.0) African American 60.4 (48.1 72.6) 17.3 (7.5-27.1) 22.3 (12.5-32.1) Education Less than HS 53.7 (38.7 68.7) 16.9 (6.1-27.6) 29.4 (15.8-43.1) HS graduate 46.1 (37.6 54.6) 24.7 (17.1-32.4) 29.2 (21.7-36.6) Some college 51.2 (44.1 58.4) 17.5 (11.9-23.1) 31.3 (24.8-37.7) College graduate 63.6 (58.1 69.2) 16.4 (12.0-20.8) 2 (15.5-24.4) Income LT $20K 56.4 (45.9 66.9) 13.8 (6.1-21.6) 29.7 (20.2-39.3) $20-34,999K 51.4 (41.9 60.9) 22.9 (14.2-31.6) 25.8 (17.9-33.6) $35-49,999K 55.8 (45.0 66.5) 15.9 (7.6-24.2) 28.4 (19.1-37.6) $50-74,999K 51.0 (41.8 60.2) 19.3 (12.0-26.5) 29.8 (21.4-38.1) $75K+ 56.2 (48.3 64.1) 22.0 (15.0-29.0) 21.8 (15.6-28.1) Source: Kalamazoo County 2004-2005 Behavioral Risk Factor Survey Revised 6/6/11 16

When respondents in Kalamazoo County were asked in 2004-2005 whether or not it was true that medical treatments were available that were intended to help a person with HIV live longer, almost all knew that this was true (91.0%). Similarly, 89.9% of Michigan respondents answered this correctly. In Kalamazoo County as well as in Michigan overall, a higher proportion of white respondents answered this correctly than African American respondents, and respondents with more education and higher incomes were more likely to answer this correctly than their counterparts. Response to Statement There Are Medical Treatments Available That Are Intended to Help a Person Who is Infected With HIV to Live Longer Among Adults Aged 18 64 Years in Kalamazoo County, 2004-2005 Demographic Characteristics TRUE FALSE DON'T KNOW % 95% C.I. % 95% C.I. % 95% C.I. Total 91.0 (88.6-93.4) 3.0 (1.5-4.5) 6.1 (4.1-8.0) Age 18-24 years 85.9 (77.7-94.0) 5.1 (0.1-10.1) 9.0 (2.2-15.9) 25-34 years 92.9 (88.5-97.3) 1.7 * 5.4 (1.4-9.4) 35-44 years 90.8 (85.9-95.7) 5.3 (0.9-9.6) 4.0 (1.3-6.6) 45-54 years 93.7 (90.1-97.3) 2.0 ( - 3.9) 4.3 (1.2-7.4) 55-64 years 90.8 (85.9-95.7) 0.2 ( - 0.4) 9.0 (4.1-13.9) Gender Male 92.2 (88.8-95.5) 3.2 (0.9-5.4) 4.7 (2.1-7.2) Female 89.8 (86.4-93.2) 2.8 (0.9-4.7) 7.4 (4.5-10.3) Race White 92.9 (90.5-95.2) 2.3 (0.9-3.7) 4.9 (2.9-6.8) African American 84.4 (75.5-93.3) 5.4 * 10.3 (2.9-17.6) Education Less than HS 84.9 (73.6-96.2) 2.9 * 12.3 (1.2-23.3) HS graduate 87.0 (81.2-92.7) 5.9 (1.7-1) 7.2 (2.9-11.5) Some college 91.8 (87.9-95.7) 2.4 * 5.9 (2.8-8.9) College graduate 95.3 (92.9-97.7) 1.3 ( - 2.5) 3.4 (1.3-5.5) Income LT $20K 90.3 (84.9-95.7) 5.4 (0.9-9.9) 4.3 (1.2-7.3) $20-34,999K 86.6 (79.1-94.1) 4.0 * 9.4 (2.9-16.0) $35-49,999K 90.7 (84.3-97.1) 3.8 * 5.5 (1.4-9.5) $50-74,999K 91.4 (85.8-97.0) 2.2 * 6.4 (2.0-10.8) $75K+ 97.4 (95.3-99.4) 0.9 * 1.7 ( - 3.3) *Confidence interval exceeds possible limits Source: Kalamazoo County 2004-2005 Behavioral Risk Factor Survey Revised 6/6/11 17