HIV/AIDS in Baltimore City:
An Epidemiological Profile
Colin Flynn, Chief
Center for HIV Surveillance & Epidemiology
Infectious Disease & Environmental Health Admin.
Maryland Department of Health & Mental Hygiene
May 24, 2012
IDEHA Mission

To improve the health of Marylanders by reducing the
transmission of infectious diseases, helping impacted
persons live longer, healthier lives, and protecting
individuals and communities from environmental health
hazards

We work in partnership with local health departments,
providers, community based organizations, and public
and private sector agencies to provide public health
leadership in the prevention, control, monitoring, and
treatment of infectious diseases and environmental health
hazards.
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
2
U.S. HIV/AIDS Prevalence

At the end of 2009, an estimated 1.2
million Americans were infected with HIV

It is also estimated that 20% of the
infected were undiagnosed
– CDC. HIV in the United States. Fact Sheet, Nov.
2011. Atlanta.
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
3
2010 Estimated HIV
Diagnoses, Ranked by Rates
STATE/TERRITORY
1. District of Columbia*
2. Virgin Islands
3. Florida
4. Maryland*
5. Louisiana
6. Puerto Rico
7. New York
8. Georgia
9. New Jersey
10. South Carolina
Cases
939
47
5,782
1,708
1,279
1,118
5,321
2,581
2,207
914
United States**
48,298
CDC. HIV Surveillance Report, 2010. Vol. 22. Table 19.
* Maryland DHMH estimates from CDC data.
** Based on 46 states and 5 territories.
Rate per 100,000
156.7
42.8
31.2
30.0
28.5
28.2
27.2
26.3
25.3
20.0
16.3
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
4
2009 Estimated Adults Living
with HIV, Ranked by Rates
STATE/TERRITORY
1. District of Columbia*
2. New York
3. Virgin Islands
4. Florida
5. Puerto Rico
6. Maryland*
7. New Jersey
8. Georgia
9. Louisiana
10. Delaware
Cases
13,973
130,608
573
92,874
18,350
29,282
36,041
35,129
16,211
2,913
United States**
800,784
CDC. HIV Surveillance Report, 2010. Vol. 22. Table 21.
* Maryland DHMH estimates from CDC data.
** Based on 46 states and 5 territories.
Rate per 100,000
2,330.2
795.9
632.7
594.8
555.7
513.8
497.1
442.6
440.4
395.8
327.6
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
5
2010 Estimated HIV
Diagnoses, Ranked by Rates
METROPOLITAN AREA
1. Miami, FL
2. Baton Rouge, LA
3. New Orleans-Metairie-Kenner, LA
4. Washington, DC-VA-MD-WV*
5. Baltimore-Towson, MD*
6. Jackson, MS
7. Memphis, TN-MS-AR
8. Orlando, FL
9. New York, NY-NJ-PA
10. Columbia, SC
United States**
CDC. HIV Surveillance Report, 2010. Vol. 22. Table 24.
* Maryland DHMH estimates from CDC data.
** Based on 46 states and 5 territories.
Cases Rate per 100,000
2,757
49.7
339
43.0
439
36.9
1,995
36.4
951
35.4
184
34.0
440
33.7
686
32.9
6,160
32.3
230
30.9
47,692
16.3
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
6
2009 Estimated Adults Living
with HIV, Ranked by Rates
METROPOLITAN AREA
Cases Rate per 100,000
1. Miami, FL
48,177
868.5
2. New York, NY-NJ-PA
140,988
739.3
3. Baltimore-Towson, MD*
18,116
673.3
4. New Orleans-Metairie-Kenner, LA
7,380
620.2
5. Jackson, MS
2,952
545.8
6. San Francisco, CA
23,101
535.0
7. Washington, DC-VA-MD-WV*
29,163
532.5
8. Memphis, TN-MS-AR
6,891
528.1
9. Baton Rouge-LA
3,779
480.2
10. San Juan-Caguas-Guaynabo, PR 12,505
477.8
United States**
CDC. HIV Surveillance Report, 2010. Vol. 22. Table 24.
* Maryland DHMH estimates from CDC data.
** Based on 46 states and 5 territories.
793,935
271.4
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
7
Maryland Living
Adult/Adolescent HIV
Cases by Region, 12/31/10
N = 29,642
Suburban
Washington
29%
Suburban
Baltimore
15%
Corrections
5%
Western
2%
Eastern
3%
Baltimore City
44%
Using data as reported through 12/31/2011
Southern
2%
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
8
HIV/AIDS Trends
Baltimore City
Number of Events
1,600
1,400
2001-2008 HIV high,
due to reporting transition
1,200
1,000
800
600
400
200
0
Year of Diagnosis or Death
Reported HIV Diagnoses
Reported AIDS Diagnoses
Using data as reported through 12/31/2011
Reported AIDS Deaths
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
9
Baltimore City
Living HIV Cases
+20% Undiagnosed?
Number of Cases
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
Year
Living HIV Cases without AIDS
Using data as reported through 12/31/2011
Living HIV Cases with AIDS
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
10
Behavioral Surveillance
Baltimore-Towson MSA
N
HIV Positive (%)
Unrecognized
Infection (%)
MSM-2 (2008)
448
37.5%
78.4%
IDU-2 (2009)
507
16.2%
48.0%
HET-2 (2010)
338
6.3%
62.5%
http://ideha.dhmh.maryland.gov/OIDEOR/CHSE/SitePages/behavioral-surveillance.aspx
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
11
Baltimore City
Adult/Adolescent HIV/AIDS
Statistics
Reported Diagnoses (during 2010)
HIV
AIDS
Living Cases (on 12/31/10)
HIV without AIDS
HIV with AIDS
Total HIV
No.
406
303
No.
5,618
7,446
13,064
Using data as reported through 12/31/2011
per 100,000
77.6
57.9
per 100,000 1 in X
1,073.2
1,422.4
2,495.7
40
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
12
Adult/Adolescent Population and
Living HIV Cases by Sex at Birth,
Baltimore City
100%
80%
53.6
37.1
60%
Female
Male
40%
20%
46.4
62.9
0%
Population
Population on 4/1/10, Cases on 12/31/10
as reported through 12/31/11
Living HIV Cases
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
13
Reported Adult/Adolescent HIV
Diagnosis Trends by Sex at
Birth, Baltimore City
Percent
100
80
60
40
20
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year of HIV Diagnosis
Male
Using data as reported through 12/31/2011
Female
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
14
Adult/Adolescent Population and
Living HIV Cases by Race/
Ethnicity, Baltimore City
1.8
2.5
100%
2.4
0.2
80%
60%
Other
61.6
NH-Asian
85.1
NH-Black
40%
Hispanic
3.9
20%
NH-White
30.2
10.4
0%
Population
Population on 4/1/10, Cases on 12/31/10
as reported through 12/31/11
1.9
Living HIV Cases
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
15
Reported Adult/Adolescent HIV
Diagnosis Trends by
Race/Ethnicity, Baltimore City
Percent
100
80
60
40
20
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year of HIV Diagnosis
Hispanic
NH-Asian
NH-Black
Using data as reported through 12/31/2011
NH-White
NH-Other
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
16
Population and Living HIV Cases
by Age, Baltimore City
100%
80%
60%
40%
20%
11.9
16.7
13.2
13.3
13.4
32.9
18.4
33.6
60+
50-59
40-49
30-39
20-29
<20
25.0
12.9
Population
Living HIV Cases
0%
Population on 4/1/10, Cases on 12/31/10
as reported through 12/31/11
7.4
1.3
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
17
Reported Adult/Adolescent HIV
Diagnosis Trends by Age at
Diagnosis, Baltimore City
Percent
40
30
20
10
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year of HIV Diagnosis
13-19
20-29
30-39
Using data as reported through 12/31/2011
40-49
50-59
60+
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
18
Exposure Categories
MSM: Men who have Sex with Men
IDU: Injection Drug Use
MSM/IDU: Men who have Sex with
Men AND Inject Drugs
HetSex: Heterosexual Contact with a
Person that has or is at Risk for
HIV Infection
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
19
Living Adult/Adolescent HIV
Cases 12/31/10 by Exposure
Category, Baltimore City
N (with Risk) = 10,523 (81% of Total)
MSM
22%
MSM/IDU
4%
Other
<1%
HetSex
26%
Using data as reported through 12/31/2011
IDU
48%
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
20
Living Adult/Adolescent HIV
Cases 12/31/10 by Exposure
Category and Sex at Birth
Baltimore City
Cases
7,000
6,000
5,000
MSM
MSM/IDU
IDU
HetSex
Other
4,000
3,000
2,000
1,000
0
Male
Using data as reported through 12/31/2011
Female
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
21
Reported Adult/Adolescent HIV
Diagnoses, Exposure Category
Trends, Baltimore City
Percent
70
60
50
40
30
20
10
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year of HIV Diagnosis
MSM
IDU
HetSex
Using data as reported through 12/31/2011
MSM/IDU
Other
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
22
2010 Reported Adult/Adolescent
HIV Diagnoses (N=406)
Baltimore City

Linkage to Care: 64% had a CD4 or VL test
within 3 months of HIV diagnosis

CD4 at Diagnosis: 66% had a CD4 test within 12
months of HIV diagnosis, and the median value
was 334 cells/microliter

Late HIV Diagnosis: 26% had an AIDS diagnosis
within 12 months of their HIV diagnosis
Using data as reported through 12/31/2011
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
23
2010 Reported Adult/Adolescent
AIDS Diagnoses (N=303)
Baltimore City

Progression: The average time from HIV
diagnosis to AIDS diagnosis was 4.8 years

Late HIV Diagnosis: 35% were diagnosed with
AIDS within 12 months of their HIV diagnosis
Using data as reported through 12/31/2011
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
24
National HIV/AIDS Strategy
Goals:
 Reducing HIV incidence
 Increasing access to care and
optimizing health outcomes
 Reducing HIV-related health disparities
 Achieving a more coordinated national
response
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
25
Continuum of Care
Estimated number and percentage of HIV infected adults
engaged in selected stages of the continuum of care,
Baltimore City, Maryland 2010
100
16000
13,064
80
Percentage
18000
16,330
14000
12000
60
10000
8,295
8000
6,396
40
6000
4,368
20
2,340
4000
2000
0
0
HIV Infected
HIV
Linked to HIV Retained in
Diagnosed
Care
HIV Care
Engagement in HIV Care
On ART
Suppressed
VL
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
26
Undetectable HIV Viral Load Levels
Baltimore City, 12/31/2010
By ZIP code of
residence at
diagnosis
13,064 cases
5,414 with VL
Total living HIV cases, age 13+
at diagnosis, alive on 12/31/2009
Percent with a reported HIV viral load
that was undetectable
<42.6%
42.6 – 47.5%
>47.5%
Population <1,000 or <5 viral load tests
Using data as reported through 12/31/2011
City rate = 45.0%
undetectable
Maryland Infectious Disease and
Environmental Health Administration
May 24, 2012
27
Maryland
Infectious Disease and
Environmental Health
Administration
http://ideha.dhmh.maryland.gov/oideor/chse