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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

2018 Massachusetts HIV/AIDS Epidemiologic ProfileRegional HIV/AIDS Epidemiologic Profile of

Worcester County, Massachusetts

Suggested citation:

Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences. 2018 Massachusetts HIV/AIDS Epidemiologic Profile: Regional HIV/AIDS Epidemiologic Profile of Worcester County, Massachusetts. https://www.mass.gov/lists/hivaids-epidemiologic-profiles Published September 2018. Accessed [date].

Massachusetts Department of Public Health Bureau of Infectious Disease and Laboratory Sciences305 South StreetJamaica Plain, MA 02130

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2018 Regional HIV/AIDS Epidemiologic Profile of Worcester County

Table 1. Total number of individuals reported with HIV infection or AIDS1 by mortality status on January 1, 2018: Worcester County, Massachusetts

N %

Individuals Living with HIV infection2 1,933 63%Individuals Reported with HIV or AIDS Who Are Deceased3 1,155 37%Total Number of Individuals Reported with HIV Infection or AIDS 3,088 100%

1 Does not include individuals diagnosed with HIV infection (non-AIDS) who died prior to January 1, 1999 or who were not in care on January 1, 1999.2 HIV prevalence data include all individuals who were residing in Massachusetts as of 1/1/18, regardless of where they were first diagnosed.3 All-cause HIV/AIDS death data include only individuals who were first diagnosed in Massachusetts.Data Source: MDPH Bureau of Infectious Disease and Laboratory Sciences, data are current as of 1/1/18 and may be subject to change

Table 2. Average annual rate of HIV infection diagnosis1 from 2014 to 2016 and HIV prevalence2 rate on 1/1/18: Worcester County, Massachusetts

Average annual HIV diagnosis rate from 2014–2016 Average rate per 100,000

Average annual number of HIV

diagnosesWorcester County, MA 6.6 52.7Massachusetts Total 9.7 633

HIV prevalence rate on 1/1/18 Rate per 100,000

Number of individuals living with HIV infection

Worcester County, MA 242.1 1,933Massachusetts Total 337.7 22,112

1 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.2 HIV prevalence data include all individuals who were residing in Massachusetts as of 1/1/18, regardless of where they were first diagnosed.Data Source: MDPH Bureau of Infectious Disease and Laboratory Sciences, data are current as of 1/1/18 and may be subject to change; The denominators for rate calculations are from the MDPH Massachusetts Race Allocated Census 2010 Estimates (MRACE 2010), Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation

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Table 3. Individuals living with HIV infection,1 deaths among individuals reported with HIV/AIDS,2 and newly diagnosed HIV infections3 by year: 2007–2016, Worcester County, Massachusetts

Year HIV Prevalence1 Deaths among those with HIV/AIDS

Diagnosis of HIV Infection

2007 1,321 28 642008 1,349 28 582009 1,370 27 572010 1,395 23 642011 1,429 15 562012 1,470 26 492013 1,489 23 472014 1,512 20 462015 1,531 26 452016 1,547 20 67

1 Number of individuals living with HIV infection on 12/31 of each year. Residence calculated based on vital status. For those alive as of 1/1/18, residence based on most recent record available. For those deceased with known residence at death, residence at death. For those deceased with unknown residence at death, residence at diagnosis.2 All-cause HIV/AIDS death data include only individuals who were first diagnosed in Massachusetts.3 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.Data source: MDPH Bureau of Infectious Disease and Laboratory Sciences, data are current as of 1/1/18 and may be subject to change

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Table 4. Number and percentage of individuals diagnosed with HIV infection from 2014–20161 and individuals living with HIV infection (ILWH) on 1/1/182 by sex at birth, gender, place of birth, race/ethnicity, exposure mode, and age: Worcester County, Massachusetts

HIV Infection Diagnoses ILWHSex at Birth: N % N %Male 113 72% 1,212 63%Female 45 28% 721 37%Gender N % N %Cisgender3 ≥58 N/A 1,922 99%Transgender <5 N/A 11 1%Place of Birth: N % N %US 82 52% 1,109 57%Puerto Rico/US Dependency4 11 7% 333 17%Non-US 65 41% 491 25%Race/Ethnicity: N % N %White (non-Hispanic) 54 34% 758 39%Black (non-Hispanic) 58 37% 521 27%Hispanic/Latino 40 25% 601 31%Asian/Pacific Islander <5 N/A 35 2%Other/Undetermined <5 N/A 18 1%Exposure Mode: N % N %Male-to-male sex (MSM) 68 43% 570 29%Injection Drug Use (IDU) 10 6% 417 22%MSM/IDU <5 N/A 70 4%Heterosexual Sex 10 6% 362 19%Other5 <5 N/A 56 3%Total No Identified Risk (NIR) 66 42% 458 24% Presumed Heterosexual Sex6 27 17% 229 12% NIR7 39 25% 229 12%Age: N % N %

At Diagnosis On January 1, 2018Under 13 <5 N/A <5 N/A13 to 19 5 3% ≥58 N/A20 to 24 15 9% 29 2%25 to 29 25 16% 78 4%30 to 34 23 15% 93 5%35 to 39 22 14% 130 7%40 to 44 16 10% 168 9%45 to 49 20 13% 251 13%50 to 54 19 12% 308 16%55 to 59 7 4% 372 19%60 to 64 <5 N/A 266 14%65 to 69 <5 N/A 153 8%70+ 0 0% 75 4%Total9 158 100% 1,933 100%1 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.2 HIV prevalence data include all individuals who were residing in Massachusetts as of 1/1/18, regardless of where they were first diagnosed.3 Persons whose current gender identity corresponds with their sex assigned at birth.4 All individuals diagnosed with HIV infection from 2014–2016 who were born in a US dependency were born in Puerto Rico; 99% of individuals living with HIV infection in MA who were born in a US dependency were born in Puerto Rico,1% were born in US minor outlying areas, <1% were born in the US Virgin Islands, and <1% were born in Guam.5 Includes pediatric and blood/blood products exposure modes6 Includes a woman having sex with a man of unknown HIV status or risk. This category is limited to women only.7 Includes a man having sex with a woman of unknown HIV status or risk, those still being followed up for risk information, those who have died with no determined risk, and those lost to follow-up.8 Value >5 suppressed to protect privacy, N/A=Not Applicable9 Total includes numbers suppressed to protect privacyData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 5. Number and percentage of individuals living with HIV infection on January 1, 2018 by sex at birth1 and race/ethnicity: Worcester County, Massachusetts2

Men WomenRace/Ethnicity: N % N %

White (non-Hispanic) 588 49% 170 24%Black (non-Hispanic) 231 19% 290 40%Hispanic/Latino 357 29% 244 34%Asian/Pacific Islander 26 2% 9 1%Total3 1,212 100% 721 100%

1 Data reflect sex at birth not gender identity or gender expression of transgender individuals (N=107 transgender individuals living with HIV infection in MA). Please note “women” and “men” are used for stylistic reasons to describe female and male populations diagnosed with HIV infection that include a small number of girls and boys (N=24 children living with HIV infection under age 13 as of 1/1/18). 2 HIV prevalence data include all individuals who were residing in Massachusetts as of 1/1/18, regardless of where they were first diagnosed.3 Total includes American Indian/Alaska Native, other and unspecified race/ethnicityData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

Table 6. Number and percentage of individuals living with HIV infection on January 1, 2018 by sex at birth1 and exposure mode: Worcester County, Massachusetts2

Men WomenExposure Mode: N % N %

Male-to-male sex (MSM) 570 47% N/A N/AInjection drug use (IDU) 253 21% 164 23%MSM/IDU 70 6% N/A N/AHeterosexual sex 95 8% 267 37%Other3 33 3% 23 3%Total No Identified Risk (NIR) 191 16% 267 37%

Presumed heterosexual sex4 N/A N/A 229 32% NIR5 191 16% 38 5%

Total 1,212 100% 721 100%

1 Data reflect sex at birth not gender identity or gender expression of transgender individuals (N=107 transgender individuals living with HIV infection in MA). Please note “women” and “men” are used for stylistic reasons to describe female and male populations diagnosed with HIV infection that include a small number of girls and boys (N=24 children living with HIV infection under age 13 as of 1/1/18).2 HIV prevalence data include all individuals who were residing in Massachusetts as of 1/1/18, regardless of where they were first diagnosed.3 Includes pediatric and blood/blood products exposure modes4 Includes a woman having sex with a man of unknown HIV status or risk. This category is limited to women only.5 Includes a man having sex with a woman of unknown HIV status or risk, those still being followed up for risk information, those who have died with no determined risk, and those lost to follow-up.Data Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 7. Number and percentage of individuals diagnosed with HIV infection from 2014–20161 by sex at birth2 and race/ethnicity: Worcester County, Massachusetts3

Men WomenRace/Ethnicity: N % N %

White (non-Hispanic) 49 43% 5 11%Black (non-Hispanic) 27 24% 31 69%Hispanic/Latino 32 28% 8 18%Total4 113 100% 45 100%

1 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available three-year period after the implementation of HIV infection reporting in 1999.2 Data reflect sex at birth not gender identity or gender expression of transgender individuals (N=107 transgender individuals living with HIV infection in MA). Please note “women” and “men” are used for stylistic reasons to describe female and male populations diagnosed with HIV infection that include a small number of girls and boys (N=24 children living with HIV infection under age 13 as of 1/1/18).3 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.4 Total includes Asian/Pacific Islander, American Indian/Alaska Native, other and unspecified race/ethnicity.Data Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 8. Number and percentage of individuals diagnosed with HIV infection from 2014–20161 by sex at birth2 and exposure mode: Worcester County, Massachusetts3

Men WomenExposure Mode: N % N %

Male-to-male sex (MSM) 68 60% N/A N/AInjection drug use (IDU) 8 7% <5 N/AMSM/IDU <5 N/A N/A N/AHeterosexual sex <5 N/A 7 16%Other4 <5 N/A <5 N/ATotal No Identified Risk (NIR) 30 27% 36 80%

Presumed heterosexual sex5 N/A N/A 27 60% NIR6 30 27% 9 20%

Total7 113 100% 45 100%

1 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available three-year period after the implementation of HIV infection reporting in 1999.2 Data reflect sex at birth not gender identity or gender expression of transgender individuals (N=107 transgender individuals living with HIV infection in MA). Please note “women” and “men” are used for stylistic reasons to describe female and male populations diagnosed with HIV infection that include a small number of girls and boys (N=24 children living with HIV infection under age 13 as of 1/1/18).3 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.4 Includes pediatric and blood/blood products exposure modes5 Includes a woman having sex with a man of unknown HIV status or risk. This category is limited to women only.6 Includes a man having sex with a woman of unknown HIV status or risk, those still being followed up for risk information, those who have died with no determined risk, and those lost to follow-up.7 Total includes numbers suppressed to protect privacy.N/A=Not ApplicableData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 9. Number and percentage of individuals diagnosed with HIV infection by sex at birth1 and year of diagnosis: Worcester County, Massachusetts,2 2007–20163

Men Women TotalN % N % N

2007 39 61% 25 39% 642008 33 57% 25 43% 582009 40 70% 17 30% 572010 34 53% 30 47% 642011 37 66% 19 34% 562012 32 65% 17 35% 492013 31 66% 16 34% 472014 33 72% 13 28% 462015 35 78% 10 22% 452016 45 67% 22 33% 67

1 Data reflect sex at birth not gender identity or gender expression of transgender individuals (N=107 transgender individuals living with HIV infection in MA). Please note “women” and “men” are used for stylistic reasons to describe female and male populations diagnosed with HIV infection that include a small number of girls and boys (N=24 children living with HIV infection under age 13 as of 1/1/18).2 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.3 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available ten-year period after the implementation of HIV infection reporting in 1999.Data Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 10. Number and percentage of individuals diagnosed with HIV infection by race/ethnicity and year of diagnosis: Worcester County, Massachusetts1, 2007–20162

White Non-Hispanic Black Non-Hispanic Hispanic/Latino Total3

N % N % N % N

2007 25 39% 24 38% 13 20% 642008 24 41% 15 26% 17 29% 582009 19 33% 20 35% 16 28% 572010 21 33% 29 45% 12 19% 642011 18 32% 17 30% 17 30% 562012 19 39% 17 35% 10 20% 492013 17 36% 20 43% 9 19% 472014 14 30% 20 43% 9 20% 462015 14 31% 16 36% 14 31% 452016 26 39% 22 33% 17 25% 67

1 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.2 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available ten-year period after the implementation of HIV infection reporting in 1999.3 Totals include Asian/Pacific Islander, American Indian/Alaskan Native individuals, those of other or undetermined race/ethnicity, and suppressed numbers.Data Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 11. Number and percentage of individuals diagnosed with HIV infection by place of birth and year of diagnosis: Worcester County, Massachusetts1, 2007–20162

USPuerto Rico/

US Dependency3 Non-US Total4

N % N % N % N

2007 34 53% 6 9% 24 38% 642008 30 52% 13 22% 15 26% 582009 31 54% 10 18% 16 28% 572010 30 47% 5 8% 29 45% 642011 32 57% 6 11% 18 32% 562012 ≥55 N/A <5 N/A 20 41% 492013 ≥55 N/A <5 N/A 21 45% 472014 ≥55 N/A <5 N/A 20 43% 462015 20 44% 6 13% 19 42% 452016 ≥55 N/A <5 N/A 26 39% 671 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.2 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available ten-year period after the implementation of HIV infection reporting in 1999.3 Ninety-nine percent of individuals diagnosed with HIV infection from 2007–2016 who were born in a US dependency were born in Puerto Rico, 1% were born in US minor outlying areas, <1% were born in the US Virgin Islands, and <1% were born in Guam.4 Total includes numbers suppressed to protect privacy.5 Value >5 suppressed to protect privacy, N/A=Not ApplicableData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 12. Number and percentage of individuals diagnosed with HIV infection by exposure mode and year of diagnosis: Worcester County, Massachusetts1, 2007–20162

MSM IDUMSM/IDU HTSX Other3

Pres.HTSX4 NIR5 Total6

N % N % N % N % N % N % N % N

2007 22 34% 8 13% <5 N/A 8 13% <5 N/A 12 19% 13 20% 642008 15 26% 13 22% <5 N/A 13 22% <5 N/A 8 14% 8 14% 582009 23 40% <5 N/A <5 N/A 11 19% <5 N/A <5 N/A 9 16% 572010 18 28% 6 9% <5 N/A 13 20% <5 N/A 15 23% 10 16% 642011 17 30% 7 13% <5 N/A 11 20% <5 N/A 6 11% 14 25% 562012 20 41% <5 N/A <5 N/A <5 N/A 0 0% 12 24% 9 18% 492013 19 40% <5 N/A 0 0% <5 N/A <5 N/A 8 17% 13 28% 472014 20 43% <5 N/A <5 N/A <5 N/A 0 0% 11 24% 12 26% 462015 20 44% <5 N/A <5 N/A <5 N/A 0 0% 6 13% 12 27% 452016 28 42% 6 9% <5 N/A 6 9% <5 N/A 10 15% 15 22% 671 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.2 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available ten-year period after the implementation of HIV infection reporting in 1999.3 Includes pediatric and blood/blood products exposure modes4 Includes a woman having sex with a man of unknown HIV status or risk. This category is limited to women only.5 Includes a man having sex with a woman of unknown HIV status or risk, those still being followed up for risk information, those who have died with no determined risk, and those lost to follow-up.6 Total includes numbers suppressed to protect privacy.HTSX = Heterosexual Sex; IDU = Injection Drug Use; MSM = Male-to-Male Sex; MSM/IDU = Male-to-Male Sex and Injection Drug Use; N/A=Not Applicable; NIR = No Identified Risk Pres. HTSX = Presumed Heterosexual SexData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 13. Number and percentage of individuals diagnosed with AIDS by sex at birth1 and year of diagnosis: Worcester County, Massachusetts,2 2007–2016

Men Women TotalN % N % N

2007 28 58% 20 42% 482008 28 65% 15 35% 432009 21 55% 17 45% 382010 26 62% 16 38% 422011 22 61% 14 39% 362012 18 55% 15 45% 332013 25 71% 10 29% 352014 21 78% 6 22% 272015 21 64% 12 36% 332016 10 45% 12 55% 22

1 Data reflect sex at birth and therefore not gender identity or gender expression of transgender individuals (N=107 transgender individuals living with HIV infection). Please note “women” and “men” are used for stylistic reasons to describe female and male populations diagnosed with HIV infection that include a small number of girls and boys (N=24 children living with HIV infection under age 13 as of 1/1/18). 2 AIDS diagnoses include only individuals who were first diagnosed in Massachusetts.Data Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 14. Number and percentage of individuals diagnosed with AIDS by race/ethnicity and year of diagnosis: Worcester County, Massachusetts,1 2007–2016

White Non-Hispanic Black Non-Hispanic Hispanic/Latino Total2

N % N % N % N

2007 16 33% 17 35% 13 27% 482008 17 40% 14 33% 10 23% 432009 14 37% 10 26% 13 34% 382010 11 26% 18 43% 12 29% 422011 12 33% 12 33% 11 31% 362012 9 27% 8 24% 12 36% 332013 13 37% 12 34% 8 23% 352014 12 44% 8 30% 7 26% 272015 9 27% 12 36% 12 36% 332016 5 23% 11 50% 5 23% 22

1 AIDS diagnoses include only individuals who were first diagnosed in Massachusetts.2 Totals include Asian/Pacific Islander, American Indian/Alaskan Native individuals, and those of other or undetermined race/ethnicity.Data Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 15. Number and percentage of individuals diagnosed with AIDS by exposure mode and year of diagnosis: Worcester County, Massachusetts,1 2007–2016

MSM IDUMSM/IDU HTSX Other2

Pres.HTSX3 NIR4 Total6

N % N % N % N % N % N % N % N

2007 13 27% 10 21% <5 N/A 9 19% <5 N/A 8 17% 7 15% 482008 10 23% 9 21% <5 N/A 10 23% 0 0% <5 N/A 9 21% 432009 8 21% 8 21% <5 N/A 8 21% <5 N/A 6 16% 7 18% 382010 8 19% 14 33% 0 0% 5 12% 0 0% 8 19% 7 17% 422011 7 19% 8 22% 0 0% 6 17% <5 N/A <5 N/A 12 33% 362012 11 33% 6 18% 0 0% 5 15% <5 N/A 7 21% <5 N/A 332013 12 34% 6 17% <5 N/A <5 N/A 0 0% 5 14% 8 23% 352014 10 37% 6 22% <5 N/A <5 N/A 0 0% <5 N/A 5 19% 272015 8 24% <5 N/A 0 0% <5 N/A <5 N/A 5 15% 11 33% 332016 <5 N/A 0 0% 0 0% 7 32% <5 N/A 5 23% 8 36% 221 AIDS diagnoses include only individuals who were first diagnosed in Massachusetts.2 Includes pediatric and blood/blood products exposure modes3 Includes a woman having sex with a man of unknown HIV status or risk. This category is limited to women only.4 Includes a man having sex with a woman of unknown HIV status or risk, those still being followed up for risk information, those who have died with no determined risk, and those lost to follow-up.5 Value >5 suppressed to protect privacy6 Total includes numbers suppressed to protect privacy.HTSX = Heterosexual Sex; IDU = Injection Drug Use; MSM = Male-to-Male Sex; MSM/IDU = Male-to-Male Sex and Injection Drug Use; N/A=Not Applicable; NIR = No Identified Risk Pres. HTSX = Presumed Heterosexual SexData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Technical Notes:

Configuration of Massachusetts Cities/Towns and Counties

Individuals living with HIV infection by current residence:

As of January 1, 2018, the Massachusetts Department of Public Health (MDPH), Bureau of Infectious Disease and Laboratory Sciences (BIDLS), HIV/AIDS fact sheets, epidemiologic reports, and other HIV data presentations include all individuals living with HIV infection who are currently residing in Massachusetts. These prevalent cases include those who may have been first diagnosed in another state. Reports of incidence or new diagnoses will continue to include only individuals who are first diagnosed in Massachusetts. Please note that HIV/AIDS fact sheets, data reports, and presentations published from 2011 to 2017 include only cases that were first diagnosed in Massachusetts.

Presumed heterosexual:

The presumed heterosexual risk category is used exclusively for women to identify HIV exposure mode when sex with men was the only reported risk factor, there was no evidence of current or past injection drug use (IDU), and behavioral risk and HIV status information about male sexual partners were unknown. The rationale for the application of the presumed heterosexual risk category to women only has been addressed in the MDPH Office of HIV/AIDS report “Intersecting Risks: HIV Infection among Heterosexual Women and Men in Massachusetts.” (2010) http://www.mass.gov/Eeohhs2/docs/dph/aids/intersecting_risks.pdf.

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http://www.mass.gov/Eeohhs2/docs/dph/aids/intersecting_risks.pdf

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