HIV/AIDS in Special Population Groups in Texas

Miranda Fanning, MPHTB/HIV/STD Epidemiology and SurveillanceTexas Department of State Health Services

Women with HIV in TexasWomen with HIV in Texas

Texas Department of State Health Services 2

Outline

Overview

Demographic Makeup

Risk Distribution

Testing Behaviors

Perinatal Surveillance

Future Steps


Overview

Women account for 26% of all adult and adolescent HIV cases in the US*

Nationally, HIV is: 5th leading cause of death in women, 35-44* 6th leading cause of death in women, 25-34*

Biologically, women are more likely to be infected with HIV during sex**

* “CDC HIV/AIDS Facts Sheet” CDC.gov** “HIV/AIDS Policy Facts Sheet” KFF.org


Overview

As of the end of 2008, 13,751 women were living with HIV/AIDS in Texas 11 women per 10,000 are living with HIV 22% of total living HIV cases

980 new female HIV cases diagnosed in 2008


Women with HIV, by year of diagnosis, Diagnosed 2000-2008

Texas Cases Diagnosed 1984-2008

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

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

Year of Diagnosis

Pro

po

rtio

n o

f Dia

gn

ose

d C

ase

s


Demographic Makeup: Women with HIV, by Race/Ethnicity, Diagnosed 2000-2008

Other2%

Black60%

White18%

Hispanic20%


Demographic Makeup: HIV Cases by Race/Ethnicity and Sex, Diagnosed 2000-2008

30%20%

35%60%

34%

18%

1%2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Female Male

Sex

Pro

po

rtio

n o

f D

iag

no

se

d C

as

es

Hispanic Black White Other


Demographic Makeup: Women with HIV, by Age Group, Diagnosed 2000-2008

50+12%

30-3931%

40-4921%

13-196%

20-2930%


Demographic Makeup: Adult HIV Cases, by Age and Sex, Diagnosed 2000-2008

40%

26%21% 20% 24%

60%

74%79% 80% 76%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

13-19 20-29 30-39 40-49 50+

Age At Diagnosis

Pro

po

rtio

n o

f c

as

es

Females Males


Demographic Makeup: Women with HIV, by Age and Race/Ethnicity, Diagnosed 2000-2008

20-2930%

20-2937%

20-2931% 20-29

23%

30-3933%

30-3929%

30-3930% 30-39

31%

40-4918%

40-4918%

40-4920% 40-49

26%

13-19; 5% 13-19; 4% 13-19; 6% 13-19; 5%

50+; 12% 50+; 13%50+; 10% 50+; 11%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Hispanic Other Black White

Race

Pro

po

rtio

n o

f C

as

es


Risk factor information is captured for reported cases

Hierarchical approach used to determine which risk factor was the primary mode of transmission

Only one risk category determined for each individual

Primary mode of transmission for females inlcudes: Intravenous Drug Use Heterosexual sex with

An intravenous drug user A bisexual male A male with other risk factors A male with document HIV infection, risk unspecified

Other Less Common Risk Factors

Collecting Risk Information


Risk Factor Data Limitations

To be categorized in Heterosexual Risk category, women must have a partner with: A documented infection; or Another known risk factor

If a case does not have a risk factor or does not meet the qualifications for Heterosexual Risk category, risk must be imputed

In 2008, 39% of female cases required risk imputation


Risk Distribution of Women with HIV, Diagnosed 2000-2008

Adult injection drug use (IDU)

23%

Adult heterosexual contact

76%

Perinatal exposure1%

Other Risk Factors<1%


Risk Distribution: Women with HIV, by Race/Ethnicity, Diagnosed 2000-2008

16% 19% 20%

39%

83%78% 79%

59%

0% 0% 0% 0%0% 0% 0% 0%1% 1% 1% 1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Hispanic Other Black White

Race/Ethnicity

Pro

po

rtio

n o

f C

as

es

Perinatal exposure

Other Risk Factors

Adult heterosexualcontact

Adult injection druguse (IDU)


Risk Distribution: Women with HIV, by Age, Diagnosed 2000-2008

16% 17%24%

31%24%

83% 83%75%

69%75%

0% 0% 0% 0% 1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

13-19 20-29 30-39 40-49 50+

Age at Diagnosis

Pro

po

rtio

n o

f C

as

es

Other RiskFactors

Adultheterosexualcontact

Adult injectiondrug use(IDU)


Testing Behaviors: Women with HIV, Time between HIV and AIDS Diagnosis, Initial diagnosis 2000-2008

>12 months70%

7-12 months2%

0-6 months28%


Testing Behaviors

Incidence Estimates indicated 50% of women diagnosed in 2008 were long term late testers


Perinatal Surveillance

13,751 HIV+ women living in Texas 8,201 (60%) are women of childbearing age

(15-44 years) 361 (3%) delivered an HIV exposed infant


Perinatally Exposed and Infected Children, Texas, 1999-2008

0

50

100

150

200

250

300

350

400

450

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Year of Birth

No

. of P

eri

na

tal E

xpo

sure

s

0

1

2

3

4

5

6

7

8

Pe

rce

nt I

nfe

cte

d

Exposures Infected


Perinatal Surveillance: Timing of HIV Diagnosis among HIV+ Women Delivering an Exposed Child, 2008

0

100

200

300

Prior to Pregnancy During Pregnancy At Delivery0%

2%

4%

6%

8%

10%

12%

14%

Women (n=361) Infected Children (n=9)

*Note: Excluding 3 women with unknown timing of HIV diagnosis


Conclusions

Sub-populations of women with HIV show unique characteristics that warrant targeted approaches

Primary mode of transmission varies depending on age and race in HIV positive women in Texas

Education on early and routine testing in women would be advantageous

Testing during pregnancy is vital to reducing perinatal HIV transmission


Future Steps- Evaluation and Analysis

Addition of presumed heterosexual category

Evaluate socio-economic characteristics to identify the proportion of HIV positive individuals in low-income communities

Additional research on testing behavior and cues for testing in women


Questions


Acknowledgements

Presentation contributors: Elvia Ledezma, MPH Margaret Hawthorne, MPH

HIV/AIDS in Special Population Groups in Texas

Health & Medicine

Transcript of HIV/AIDS in Special Population Groups in Texas