hiv/aids in special population groups in texas
TRANSCRIPT
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
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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
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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
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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
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Demographic Makeup: Women with HIV, by Race/Ethnicity, Diagnosed 2000-2008
Other2%
Black60%
White18%
Hispanic20%
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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
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Demographic Makeup: Women with HIV, by Age Group, Diagnosed 2000-2008
50+12%
30-3931%
40-4921%
13-196%
20-2930%
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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
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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
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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
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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
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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%
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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)
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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)
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Testing Behaviors: Women with HIV, Time between HIV and AIDS Diagnosis, Initial diagnosis 2000-2008
>12 months70%
7-12 months2%
0-6 months28%
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Testing Behaviors
Incidence Estimates indicated 50% of women diagnosed in 2008 were long term late testers
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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
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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
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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
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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
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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
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Questions
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Acknowledgements
Presentation contributors: Elvia Ledezma, MPH Margaret Hawthorne, MPH