Monitoring progress toward the end of
the HIV epidemic in New York State:
HIV Epidemiology in NYC
Sarah L. Braunstein, PhD MPH
Director, HIV Epidemiology and Field Services Program
New York City Department of Health and Mental Hygiene
HIV in NYC, 1981-2013
140,000
New AIDS
Diagnoses
12,000
120,000
Reported Persons Living
with HIV (non-AIDS)
10,000
100,000
HIV-Related
Deaths
8,000
80,000
6,000
60,000
New HIV
Diagnoses
Reported
Persons Living
with AIDS
4,000
40,000
2,000
Number of Reported PLWHA
20,000
NYS HIV
HAART
CDC AIDS case
reporting law
introduced
definition (23 OIs)
takes effect
implemented
AIDS case definition
HIV-related cause
NYS expands AIDS
expanded
of death reporting
reporting to
(CD4 <200, 26 OIs)
begins
include HIV
AIDS case reporting
mandated by NYS
• HIV surveillance
expands to
include
all HIV-related
laboratory
reports
*2013
*2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
0
1982
0
1981
Number of New HIV/AIDS Diagnoses and Deaths
14,000
PLWHA=Persons living with HIV/AIDS
*Data on 2012 and 2013 deaths are incomplete.
Data as reported to NYC DOHMH by June 30, 2014.
HIV in NYC, 1981-2013
2013: 2,832 new HIV diagnoses
1,784 new AIDS diagnoses
1,527 deaths among PWH
PLWHA=Persons living with HIV/AIDS
*Data on 2012 and 2013 deaths are incomplete.
Data as reported to NYC DOHMH by June 30, 2014.
HIV Diagnoses, 2001-2013
Data as reported to NYC DOHMH by June 30, 2014.
New HIV Diagnoses and Estimated
Incidence in NYC, 2009-2013
5,000 4500
4000
3599
3584
3141
3,353
2,000
3,225
3146
2927
3,000 2500
2000
3474
3,705
3000
Number
Number of HIV cases
4,000 3500
3936
4256
2,990
2,832
2733
2,597
2,718
2,284
2,230
2076
1,894
1500
1000
1,000
500
0
0
2008
2009
2009
2010
Newdiagnoses
diagnoses
of HIV
New
of HIV
2010
2011
2011
2012
Year
Year of
diagnosis
Estimated
HIV incidence
Estimated
HIV Incidence
2012*
2013*
*2013 incidence data are preliminary.
generated September 2014, 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 that are
contained in the HIV surveillance registry. Unknown risk factor was imputed using the Multiple Imputation procedure in SAS v9.2. Surveillance data
used in these estimates were reported through June 30, 2014.
1Estimates
Geographic Distribution of HIV in NYC, 2013
•
•
•
ZIP codes in the Central Harlem-Morningside
Heights, Chelsea-Clinton, and WilliamsburgBushwick 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 Lower Manhattan, Stapleton-St.
George, and Willowbrook had the highest mortality
among persons with HIV.
Data as reported to NYC DOHMH by June 30, 2014.
HIV diagnoses includes diagnoses of HIV without AIDS and HIV concurrent with AIDS.
¹Diagnosis rates and percentages calculated using the intercensal 2013 NYC population.
²2013 death data are incomplete. ³Death rates are age-adjusted to the NYC Census 2010 population.
HIV Diagnosis Rates1 Among Males and
Females in NYC by Race/Ethnicity2, 2013
The HIV diagnosis rate among black males was
1.5 times higher than the rate among Hispanic males
and over 2 times higher than the rate
among white males.
180
150
The HIV diagnosis rate among black females was
over 2 times higher than the rate among Hispanic
females and over 9 times higher than the rate
among white females.
180
143.7
150
120
120
93.5
90
90
50.8
60
60
26.1
30
42.5
30
18.0
4.3
2.1
White
API
0
0
Black
Hispanic
White
API
Black
Hispanic
Data as reported to NYC DOHMH by June 30, 2014.
API=Asian/Pacific Islander
1Includes diagnoses of HIV without AIDS and HIV concurrent with AIDS.
2Native American and multiracial groups not shown because of small numbers.
New HIV Diagnoses Among MSM
in NYC, 2009-2013
New HIV (non-AIDS) diagnoses (N)
Overall: 4.3% decline
Younger MSM: Stable
Older MSM: 8.8% decline
1,200
13-29 years
30+ years
1,000
844
879
845 857
839 868
852 824
800
847
802
600
400
200
0
2009
2010
2011
Year of Diagnosis
2012
2013
Since 2012, the number of new HIV diagnoses is higher among MSM under age 30 than among those in older age groups
Data as reported to NYC DOHMH by June 30, 2014.
MSM risk category includes men who have sex with men and inject drugs (MSM-IDU).
Estimated HIV Incidence Among MSM in
NYC, 2009-2013
Estimated HIV Incidence among MSM Overall
Estimated HIV Incidence among MSM <30
Estimated HIV Incidence among MSM ≥30
2,000
1,584
1,487
Number of HIV cases
1,500
1,406
1,321
1,246
1,000
816
796
684
775
648
767
500
691
637
631
597
0
2009
2010
2011
2012
2013*
Year of diagnosis
*2013 incidence data are preliminary.
generated September 2014, 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 that are contained in the HIV
surveillance registry. Unknown risk factor was imputed using the Multiple Imputation procedure in SAS v9.2. Surveillance data used in these estimates were
reported through June 30, 2014.
2MSM includes persons reporting both MSM and injection drug use history.
1Estimates
New HIV Diagnoses Among MSM
by Race/Ethnicity* in NYC, 2009-2013
700
Number of new HIV diagnoses
600
500
400
Black MSM
Hispanic MSM
White MSM
300
Asian/Pacific
API
MSM
Islander
200
100
0
2009
2010
2011
2012
2013
Year of diagnosis
Data as reported to NYC DOHMH by June 30, 2014.
American and multiracial groups not shown due to small numbers.
MSM risk category includes men who have sex with men and inject drugs (MSM-IDU).
*Native
Age-adjusted Death Rates Among Persons
with HIV in NYC, 2000-2013
Age-adjusted¹ death rates per 1,000 mid-year PLWHA
40
35
HIV-related
30
Non-HIV-related
All-cause 3
25
20
15
10
5
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year of death
2009
2010
2011
2012
2013 2
Data as reported to NYC DOHMH by March 31, 2015.
¹Age-adjusted to the NYC Census 2010 population.
²2013 deaths outside NYC are incomplete.
³Includes persons with unknown cause of death.
Age-adjusted HIV-related Death Rates in NYC by
Race/Ethnicity, 2000-2013
Age-adjusted¹ death rates per 1,000 mid-year PLWHA
40
35
Hispanic
Asian/Pacific Islander
30
Black
White
25
20
15
10
5
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year of death
2009
2010
2011
2012
2
2013
Data as reported to NYC DOHMH by March 31, 2015.
¹Age-adjusted to the NYC Census 2010 population.
²2013 deaths outside NYC are incomplete.
Age-adjusted HIV-related Death Rates in NYC by
Transmission Risk Category, 2000-2013
Age-adjusted¹ death rates per 1,000 mid-year PLWHA
35
30
MSM
IDU
25
Heterosexual
20
15
10
5
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year of death
2009
2010
2011
2012
2013 2
Data as reported to NYC DOHMH by March 31, 2015.
¹Age-adjusted to the NYC Census 2010 population.
²2013 deaths outside NYC are incomplete.
HIV-related Death Rates in NYC by
Age Group, 2000-2013
60.0
Death rates per 1,000 mid-year PLWHA
50.0
40.0
0 - 12
13 - 19
20 - 29
40 - 49
50 - 59
60+
30 - 39
30.0
20.0
10.0
0.0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013¹
Year of death
Data as reported to NYC DOHMH by March 31, 2015.
¹2013 deaths outside NYC are incomplete.
Number and Proportion of Persons with HIV in
New York City Engaged in Selected Stages of the
Continuum of HIV Care in 2013
100%
100%
64% Suppressed
86%
80%
Percentage
79%
74%
64%
60%
40%
20%
0%
HIV-infected
Diagnosed
Retained in care
Prescribed ART
Virally suppressed
N=94,912
N=81,625
N=74,590
N=70,488
N=60,547
Xia Q, Kersanske LS, Wiewel EW, Braunstein SL, Shepard CW,
Torian LV. Proportions of patients with HIV retained in care and
virally suppressed in New York City and the United States. J Acquir
Immune Defic Syndr. 2015;68(3):351-358.
Includes patients receiving care in NYC but living outside of NYC (N=4,794).
14% of PLWH undiagnosed.
Retained in care: ≥1 care visit in 2013.
94.5% of patients who were retained in care prescribed ART (source: MMP 2012).
Viral suppression defined as VL ≤200 cc/mL.
Data as reported to NYC DOHMH by June 30, 2014.
Number and Proportion of Persons with HIV in
New York City Engaged in Selected Stages of the
Continuum of HIV Care in 2013 by Borough
Virally suppressed
100%
Bronx: 61%
Queens: 64%
Brooklyn: 63%
Staten Island: 59%
Manhattan: 68%
Percentage
80%
60%
Bronx
Brooklyn
Manhattan
40%
Queens
Staten Island
20%
0%
HIV-infected
Diagnosed
Retained in care
Xia Q, Kersanske LS, Wiewel EW, Braunstein SL, Shepard CW,
Torian LV. Proportions of patients with HIV retained in care and
virally suppressed in New York City and the United States. J Acquir
Immune Defic Syndr. 2015;68(3):351-358.
Prescribed ART
Virally suppressed
14% of PLWH undiagnosed.
Retained in care: ≥1 care visit in 2013.
94.5% of patients who were retained in care were prescribed ART (source: MMP 2012).
Viral suppression defined as VL ≤200 cc/mL.
Data as reported to NYC DOHMH by June 30, 2014.
Number and Proportion of Persons Newly Diagnosed with
HIV in New York City in 2012 Engaged in Selected
Stages of the Continuum of HIV Care
100%
100%
80%
66% Suppressed
84%
69%
(≤3 mos)
60%
73%
66%
40%
20%
0%
Newly diagnosed
Linked to care
Established in care
Virally suppressed
N=2,990
N=2,521
N=2,188
N=1,961
Wiewel EW, Braunstein SL, Xia Q, Shepard CW, Torian LV.
Monitoring outcomes for newly diagnosed and prevalent HIV cases
using a care continuum created with New York City surveillance
data. J Acquir Immune Defic Syndr. 2015;68(2):217-226.
Linked to care: ≥1 lab after a 7-day lag within 18 months of diagnosis.
Established in care: ≥2 labs ≥3 months apart within 18 months of diagnosis.
Virally suppressed: ever achieved viral suppression (≤200 cc/mL) within 18 months of diagnosis.
Data as reported to NYC DOHMH by June 30, 2014.
Viral suppression* at 6 and 12 months
after HIV diagnosis, NYC, 2008-2013
70%
64.0%
57.8%
60%
53.4%
% Virally suppressed
50%
46.6%
45.6%
40.4%
40%
39.6%
36.3%
35.2%
29.5%
30%
25.7%
23.8%
20%
10%
0%
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
By 6
months
By 12
months
2013
Data as reported to NYC DOHMH by March 31, 2015.
*Viral suppression is defined as an HIV RNA level ≤200 copies/mL following HIV diagnosis.
Thank you
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