HIV Epidemiology
in New York State
and New York City
Lou Smith, MD, MPH
Director, Division of Epidemiology, Evaluation and Research
AIDS Institute, New York State Department of Health
Sarah Braunstein, PhD, MPH
Director, HIV Epidemiology and Field Services Program
New York City Department of Health and Mental Hygiene
Trends in HIV and AIDS Cases*
New York State, 1984 - 2012
16,000
12,000
Number
diagnosed each
year with AIDS
People living with
HIV (non-AIDS) at
the end of each year
120,000
100,000
10,000
80,000
8,000
6,000
4,000
Number of
deaths each
year among
AIDS cases
People living with
AIDS at the end of
each year
2,000
60,000
Number of PLWDHI
Number of AIDS Diagnoses and Deaths
14,000
140,000
40,000
Number of deaths
among HIV & AIDS
cases each year
20,000
0
0
1984 1986 1988 1990 1992 1994 1996 1998 2000^ 2002 2004 2006 2008 2010 2012
*Data as of April 2014
^HIV named reporting began in NYS in 2000;
deaths among HIV and AIDS cases are reported starting in 2000.
NYSDOH/AI/BHAE
New York State Mother-to-Child HIV
Transmission Number and Rate of HIV Infected
Infants by Year of Delivery, 1997* - 2013
Number of HIV Infected Infants
120
12
11.5
10
100
8.7
80
8
6.9
6
60
3.6 3.8
40
4
3.2
2.6 2.3
1.2
20
1.7
1.4
1.3
2.1
0.7
1.3
0.8
0.5
0
0
n=99
2
n=81
n=62
n=28
n=27
n=23
n=8
n=16
n=13
n=10
n=8
n=6
n=11
n=3
n=6
n=3
n=2
Year of Delivery
Number
Rate
*1997 data is February – December
n=Number of infected infants identified
NYSDOH/AI/BHAE
4
Legal Basis for HIV Surveillance
in New York State
• HIV Reporting and Partner Services Law implemented
June 1, 2000, required reporting to New York State
• Medical providers required to report new diagnoses of HIV, AIDS,
and HIV-related illness and known sex or needle-sharing partners
• Laboratories conducting HIV-related tests required to report results
• Changes in the reporting law have broadened the
permissible uses of surveillance data
• 2000 – 2010: HIV epidemiology, partner notification
• 2010 – 2014: deduplication, assess comorbidity, direct health
department program needs
• 2014: sharing with medical providers for linkage and retention
NYSDOH/AI/BHAE
5
New York State HIV Laboratory Reporting
HIV antibody
CD4 lymphocytes
HIV nucleic acid
tests
Resistance and
subtype results
6/2000 to 6/2005
WB or IFA
confirmed (+)
tests
<500 cells/mm3
or <29%
Any detectable
value
Not reportable
6/2005 to present
WB or IFA
confirmed (+)
tests
All values
All values
Genotype
nucleotide
sequence
NYSDOH/AI/BHAE
6
Epidemiology of HIV in New
York State
7
Trends in HIV and AIDS* New York State,
2002-2012
140,000
New HIV diagnoses
6,000
People living
with HIV (nonAIDS)
5,000
4,000
3,000
2,000
120,000
100,000
80,000
Deaths
among
persons
with
HIV/AIDS
1,000
People living
with AIDS
60,000
Number of PLWDHI
Number of HIV Diagnoses and Deaths
7,000
40,000
20,000
0
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
*Data as of April 2014. New HIV diagnoses include those diagnosed concurrently with AIDS.
HIV named reporting began in NYS in 2000.
NYSDOH/AI/BHAE
8
Age Distribution of Newly Diagnosed HIV* Cases
New York State, 2012**
N=3,316
Average=36 yrs
40
Percent of Cases
35
Female
N = 743
30
Male
N = 2,573
25
20
15
10
5
0
12 &
under
13-19
20-29
30-39
40-49
50-59
60+
Age (years) in 2012
*Regardless of subsequent or concurrent AIDS diagnosis
**Data as of April 2014
NYSDOH/AI/BHAE
9
New HIV Diagnoses* by Race/Ethnicity,
New York State, 2012**
% of Total HIV
Diagnoses
Rate per
100,000
Population***
3,316
100%
16.7
Non-Hispanic
White
672
20.3%
6.1
Non-Hispanic
Black
1,393
42.0%
45.4
Hispanic
1,019
30.7%
27.0
Asian/PI
83
2.5%
4.5
Native Am
4
0.1%
5.1
Multi-race
145
4.4%
--
Race/Ethnicity
NYS Total
Number of HIV
Diagnoses
*Regardless of concurrent or subsequent AIDS diagnosis .
**Data as of March 2014
*** Age-standardized
NYSDOH/AI/BHAE
10
Newly Diagnosed HIV Cases by Transmission Risk
New York State, 2002-2012*
6000
5000
4000
3000
2000
1000
0
2002
*December 2013
2004
2006
2008
2010
MSM
Fem. Pres. Het.
Heterosexual
Unknown
IDU
MSM/IDU
Pediatric
Blood Prod.
2012
NYSDOH/AI/BHAE
Newly diagnosed HIV cases by county, 2012
Total # of newly diagnosed cases in
NYS, 2012: 697
(excluding inmates and NYC)
Total # of newly diagnosed cases in
NYS, 2012: 726
(including inmates, excludes NYC)
11
NYSDOH/AI/BHAE & NY LINKS
12
Median Initial* CD4 Count of Persons Newly
Diagnosed with HIV: New York State 2006-2012
400
372
350
317
320
300
331
353
372
352
CD4 lymphocytes (cells/mm3)
250
200
150
100
50
0
2006
2007
2008
2009
2010
2011
2012
Year of HIV Diagnosis
*Includes only cases with CD4 count within 3 months of diagnosis. Cases that developed AIDS with 30 days of HIV diagnosis are included.
Case data as of September 2013 with laboratory data as of November 2013.
NYSDOH/AI/BHAE
13
Linkage to Care within 3 Months of HIV
Diagnosis by Region: New York State - 2012
% linked
NHAS 2015
Goal 85%
New York State
Albany
Binghamton*
Buffalo
L. Hudson
M. Hudson
Nassau Suffolk
New York City
Rochester
Syracuse
0%
10%
*Based on less than 20 persons.
20%
30%
40%
50%
60%
70%
80%
90%
100%
NYSDOH/AI/BHAE
14
Age Distribution of Persons Living with Diagnosed HIV
Infection: New York State, December 2012*
35%
N=132,174
Average= 47.9 yrs
Percent of Cases
30%
25%
20%
15%
10%
5%
0%
<13
*Data as of April 2014
13-19
20-24 25-29 30-39 40-49
Age (years) in 2012
50-59
60+
NYSDOH/AI/BHAE
15
Time to AIDS Diagnosis for New HIV Cases that Were
Not Concurrent HIV/AIDS Diagnoses, NYS
by Year of HIV Diagnosis
2002
2003
Cumulative Percent
w/AIDS Diagnosis
40%
20% of persons diagnosed with
HIV (not AIDS) in 2002 had
developed AIDS within 2 years.
2004
2005
2006
30%
2007
2008
20%
2009
2010
2011
10%
10% of persons diagnosed with
HIV (not AIDS) in 2011 had
developed AIDS within 2 years.
0%
0
1
2
3
4
5
6
7
8
Years after HIV Diagnosis
9
10
11
NYSDOH/AI/BHAE
16
Cascade of HIV Care
New York State, 2012
0
50,000
100,000
150,000
Estimated HIV Infected
Persons
154,000
Persons Living w/ Diagnosed
HIV Infection
Cases w/any HIV Care during
the year*
Cases w/continuous care
during the year**
Virally suppressed ( n.d. or
≤200/ml) at test closest to
end-of-year
* Any VL or CD4 test during the year
** At least 2 tests, at least 3 months apart
132,000
86% of infected
86,000
56% of infected
65% of PLWDHI
75,000
48% of infected
56% of PLWDHI
68,000
44% of infected
51% of PLWDHI
79% of cases w/any care
17
Viral Suppression among Persons Living with Diagnosed HIV
Infection by Risk and Race/Ethnicity: New York State, 2012
% viral suppression
Race/ethnicity
NYS average 51%
White nonHispanic
Black nonHispanic
Hispanic
Asian/PI
Native Amer.*
Multirace**
Risk
MSM
IDU
MSM-IDU
Heterosexual
Female Pres. Het.
Blood Products
Pediatric Risk
Unknown
0%
10%
20%
30%
40%
*Based on a small number of persons (n=100).
**Multirace care measures are likely less reliable due to the method used to calculate multirace status.
50%
60%
70%
NYSDOH/AI/BHAE
18
Newly Diagnosed HIV Cases
New York State, 2002-2012
6,000
5,000
4,000
NYS
3,000
NYC
2,000
NYS
excl
NYC
1,000
0
2002
*Data as of April 2014
2004
2006
2008
2010
2012
NYSDOH/AI/BHAE
Monitoring Progress Toward the End of
the HIV Epidemic in New York State:
The view from NYC
Sarah L. Braunstein, PhD MPH
Director, HIV Epidemiology and Field Services Program,
NYC Department of Health and Mental Hygiene
HIV in New York City, 1981-2012
Data reported to NYC DOHMH through June 30, 2013.
HIV in New York City, 1981-2012
2012: 3,141 new HIV diagnoses
1,889 new AIDS diagnoses
1,578 deaths among PWH
(607 HIV-related)
Data reported to NYC DOHMH through June 30, 2013.
New Diagnoses and Estimated Incidence
in NYC, 2008-2012
4500
4000
4256
3500
3584
3936
3599
3141
3000
Number
3474
3146
2927
2500
2733
2000
2076
1500
1000
500
0
2008
2009
2010
2011
2012*
Year
New diagnoses of HIV
Estimated HIV incidence
*2012 incidence data are preliminary.
Estimates generated September 2013, by the CDC Stratified Extrapolation Approach (SEA). SEA combines results from the Serologic Testing
Algorithm for Recent Seroconversion (STARHS) with data on demographic characteristics, risk factor, initial diagnosis date, testing and
treatment history from the HIV surveillance registry. Unknown risk factor was imputed using the Multiple Imputation procedure in SAS v9.2.
Geographic Distribution of HIV in NYC, 2012
•
•
•
ZIP codes in the Chelsea-Clinton, Central HarlemMorningside Heights and Washington HeightsInwood neighborhoods had the highest HIV
diagnosis rates.
ZIP codes in Chelsea-Clinton, West Queens and
East Harlem had the highest HIV prevalence
ZIP codes in Bayside-Little Neck, Port Richmond
and Canarsie-Flatlands had the highest mortality
among persons with HIV.
Data as reported to NYC DOHMH by June 30, 2013.
HIV diagnoses includes diagnoses of HIV without AIDS and HIV concurrent with AIDS.
Death rates are age-adjusted to the citywide population of PWHA in 2012. 2012 death data are incomplete.
Age-adjusted Death Rates Among Persons
with HIV in NYC, 2001-2012
Age-adjusted death rates per 1,000 mid-year PLWHA
35
30
All-cause
25
20
HIV-related
15
10
Non-HIV-related
5
0
2001
2002
2003
2004
2005
2006
2007
2008
Year of death
2009
2010
2011
2012*
Data reported to NYC DOHMH by June 30, 2014.
*2012 Deaths are incomplete – deaths among persons with HIV occurring outside NYC are not included.
HIV Diagnosis Rates Among Males and
Females by Race/ethnicity in NYC, 2012
The HIV diagnosis rate among black males was over
1.5 times higher than the rate among Hispanic
males and over 2 times higher than the rate
among white males.
180
The HIV diagnosis rate among black females
was over 3 times higher than the rate among
Hispanic females and over 12 times higher
than the rate among white females.
180
162.9
150
150
120
120
104.1
90
90
62.0
60
60
25.9
30
0
Black
Hispanic
White
API
56.4
30
19.4
0
Black
Hispanic
4.6
2.6
White
API
Data as reported to NYC DOHMH by June 30, 2013.
API=Asian/Pacific Islander
New HIV Diagnoses Among Women
in NYC, 2012
35.8% decline overall
800
700
600
Heterosexual
Number
500
400
300
Unknown risk
200
100
Injection drug use
0
2008
2009
2010
2011
2012
Year of diagnosis
Data reported to NYC DOHMH through June 30, 2013.
New HIV Diagnoses Among MSM
in NYC, 2008-2012
2000
10.6% decline
1923
1800
1803
1794
1802
2009
2010
2011
1719
1600
Number
1400
1200
1000
800
600
400
200
0
2008
2012
Year of diagnosis
Data reported to NYC DOHMH through June 30, 2013.
New HIV Diagnoses Among MSM
by Race/Ethnicity in NYC, 2008-2012
800
700
Black
600
Number
500
Hispanic
White
400
300
200
Asian/Pacific Islander
100
0
2008
2009
2012
2011
2012
Year of diagnosis
Data reported to NYC DOHMH through June 30, 2013.
New HIV Diagnoses Among MSM <30
in NYC, 2008-2012
500
0.9% decline overall
450
400
Black
Number
350
Hispanic
300
250
200
White
150
100
Asian/Pacific Islander
50
0
2008
2009
2012
2011
2012
Year of diagnosis
Data reported to NYC DOHMH through June 30, 2013.
New HIV Diagnoses Among MSM >30
in NYC, 2008-2012
400
19.1% decline overall
350
White
Hispanic
Number
300
250
Black
200
150
100
Asian/Pacific Islander
50
0
2008
2009
2012
2011
2012
Year of diagnosis
Data reported to NYC DOHMH through June 30, 2013.
Estimated HIV Incidence Among MSM
in NYC, 2008-2012
2500
2000
1748
1883
1604
Number
1500
1664
1248
1000
1008
866
913
744
500
830
776
909
843
708
514
0
2008
2009
Estimated HIV incidence among MSM overall
2010
Year
2011
2012*
Estimated HIV incidence among MSM <30
Estimated HIV incidence among MSM ≥30
*2012 incidence data are preliminary.
generated September 2013, by the CDC Stratified Extrapolation Approach (SEA). SEA combines results from the Serologic Testing
Algorithm for Recent Seroconversion (STARHS) with data on demographic characteristics, risk factor, initial diagnosis date, testing and
treatment history from the HIV surveillance registry. Unknown risk factor was imputed using the Multiple Imputation procedure in SAS v9.2.
1Estimates
Acute HIV Infection by HIV Transmission
Risk in NYC, 2008-2012
MSM
180
IDU
Heterosexual
Unknown
160
140
Number
120
100
80
60
40
20
0
2008
2009
2010
2011
2012
Year of diagnosis
Data reported to NYC DOHMH through June 30, 2013.
Acute HIV Infection Among MSM by Age
and Race/ethnicity in NYC, 2012
13-19
35
20-24
25-29
30+
30
Number
25
20
15
10
5
0
Black
Hispanic
White
API
Race/ethnicity
Data reported to NYC DOHMH through June 30, 2013.
HIV Care Continuum for NYC, 2012
100%
73% Linked
133,635
55% Retained
114,926
80%
Largest gap:
Linkage Retention
100%
41% Suppressed
97,940
Percentage
86% of
infected
73% of
infected
60%
85% of
diagnosed
40%
55% of
infected
74% of
linked to
care
20%
0%
72,918
Estimated HIVinfected
Ever HIVdiagnosed
67,624
51% of
infected
93% of
retained in
care
55,453
41% of
infected
82% of
started on
ART
Ever linked to Retained in HIV Presumed ever Suppressed viral
HIV care
care in 2012 started on ART
load (≤200
copies/mL) in
2012
Data reported to NYC DOHMH through June 30, 2013.
Initiation of Care Within 3 Months of HIV
Diagnosis in NYC, 2008–2012
100%
90%
Timely initiation of care (%)
80%
70%
60%
59%
60%
62%
2008
2009
2010
68%
69%
2011
2012
50%
40%
30%
20%
10%
0%
Year of HIV diagnosis
Timely initiation of care is defined as first CD4 or VL drawn within 3 months (91 days) of HIV diagnosis, following a 7-day lag.
Data reported to NYC DOHMH by June 30, 2013.
Viral Suppression at 6 and 12 Months
After HIV Diagnosis in NYC, 2007-2012
70.0%
60.0%
48.4%
50.0%
% Virally suppressed
60.3%
57.7%
43.2%
39.5%
40.0%
34.1%
34.1%
30.0%
44.0%
41.1%
30.0%
27.7%
23.4%
20.0%
10.0%
0.0%
By 6
months
By 12
months
2007
By 6
months
By 12
months
2008
By 6
months
By 12
months
2009
By 6
months
By 12
months
2010
By 6
months
By 12
months
2011
By 6
months
By 12
months
2012
As reported to NYC DOHMH by December 31, 2013.
Thank you
HIV Epidemiology and Field Services Program, NYC DOHMH
http://www.nyc.gov/html/doh/html/data/hivepi.shtml