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Wisconsin Department of Health Services HIV/AIDS Surveillance Annual Review

New diagnoses, prevalent cases, and deaths through December 31, 2012
April 2013

BACKGROUND AND OVERVIEW OF HIV CASES IN WISCONSIN

Wisconsin Department of Health Services

Introduction
This annual review relies on HIV and AIDS diagnoses reported to the Wisconsin Department of Health Services HIV/AIDS Surveillance System through 2012. The annual review is intended to assist planners of HIV prevention and care services to better serve those at risk of and living with HIV, to ensure effective use of existing resources, and to seek additional resources where most needed. The tables and technical notes at the end of the PDF version of the annual review provide additional information. http://www.dhs.wisconsin.gov/aids-hiv/Stats/index.htm
Wisconsin Department of Health Services

Methods
Methodological changes that affect 2012 HIV/AIDS Surveillance Summary include: Analyzing data by year of diagnosis rather than year of report. Including a review of the National Death Index, in addition to Wisconsin Death Index.

Wisconsin Department of Health Services

Figure 1: Flow of cases of HIV infection in and out of Wisconsin, 2012


New diagnoses in Wisconsin (n=241) Out of state cases moving into Wisconsin (n=159)

New diagnoses Prevalent cases reported, (n=6,549) Out of state cases Cases already living in Wisconsin

Cases ever reported in Wisconsin but currently residing in another state (n 1,000) Deaths through 2010 (n = 4,466; newly occurring or retrospectively identified)
Wisconsin Department of Health Services

NEW HIV DIAGNOSES


These include cases of HIV diagnosed in Wisconsin in 2012

Wisconsin Department of Health Services

UNITED STATES Figure 2. HIV diagnosis rates per 100,000 population by state, 2011
35 30

Rate per 100,000 population

25

20

IL U.S.
15

10

MI

IN

MN

WI

IA

0
MD LA FL GA NY MS TX MA SC NJ AL NC IL CA US NV TN DE VA PA RI CT AZ OH MO OK AR MI CO WA IN KY NM OR MN HI WV KS WI ME IA NE NH AK UT SD WY ID MT ND VT

Source: CDC HIV Surveillance Report, V 23, Table 19

Wisconsin Department of Health Services

TOTAL CASES Figure 3. Cases of HIV diagnosed in Wisconsin, 1983-2012


600

500

HIV diagnoses

400

300

200

100

* Cases are shown using 3-year rolling averages


Wisconsin Department of Health Services

CASES BY SEX Figure 4. HIV diagnoses per 100,000 population by sex, Wisconsin, 2003-2012
9.0

8.0

Male
7.0

Rate per 100,000 population

6.0

5.0

4.0

3.0

Female
2.0 1.0

0.0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Wisconsin Department of Health Services

SEX AND AGE Figure 5. HIV diagnosis rates per 100,000 population by sex and age group, Wisconsin, 2003-2012
18.0

16.0

Rate per 100,000 population

14.0

12.0

Males 15-29
10.0

8.0

Males 30+

6.0

4.0

Females 15-29

2.0

Females 30+
0.0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Wisconsin Department of Health Services

RACE/ETHNICITY Figure 6. Percent of HIV diagnoses in Whites and racial/ethnic minorities, Wisconsin, 1983-2012
100% 90% 80%

2012 diagnoses (n=241)

Multi-racial Asian

HIV diagnoses

70% 60%

Racial/ethnic minority
Hispanic

50%
40% 30% 20% 10% 0% 1983 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 2009 2010 2011 2012

Black

White
White

Wisconsin Department of Health Services

SEX AND RACE/ETHNICITY: RATES Figure 7. HIV diagnosis rates per 100,000 population by sex and race/ethnicity, Wisconsin, 2008-2012
50.0

Black
45.6

45.0

Hispanic

Rate per 100,000 population

40.0 35.0 30.0 25.0 20.0 15.0 10.0

Asian/Pacific Islander
White American Indian

16.8

16.6

6.6
5.0 0.0 Male Female

3.6

2.5

3.7

3.2 0.6 0.8

Wisconsin Department of Health Services

AGE Figure 8. HIV diagnoses by age group, Wisconsin, 2012 n=241


50

46
45 40 35

38
32

HIV diagnoses

31
30

25
25 20 15 10 5

18 16 14

12
8

0
0

1 5-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+

<5

Wisconsin Department of Health Services

DIAGNOSIS BY AGE GROUP Figure 9. HIV diagnosis by age group and demographic characteristics, Wisconsin, 2012
100% 90% 80% 70% 60% 50%

13% 24% 24%

10%

9%

13% 23% 21%

Aged 50+ Aged 30-49 Aged 15-29

36% 48% 47% 59% 59% 45% 51% 55%

40%
30% 20%

54% 39% 29% 31% 17%

42%
27% 24%

10% 0%

* Data have been statistically adjusted to account for unknown risk. See technical notes. ** MSM includes those who have also injected drugs. Wisconsin Department of Health Services

RISK EXPOSURE Figure 10. HIV diagnoses by estimated risk exposure group*, Wisconsin, 2012
(n=241)
Other , 0.4%

Heterosexual , 21%

IDU , 7%

MSM & IDU , 2%

MSM , 68%

* Data have been statistically adjusted to account for unknown risk. See technical notes.

Wisconsin Department of Health Services

RISK EXPOSURE Figure 11. HIV diagnoses by estimated risk exposure group*, Wisconsin, 2003-2012
180 160 140 120

HIV diagnoses (adjusted)

MSM
100 80 60 40 20

Heterosexual

IDU
0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

* Data have been statistically adjusted to account for unknown risk. See technical notes.

Wisconsin Department of Health Services

RISK AND RACE/ETHNICITY Figure 12. HIV diagnoses by estimated risk exposure group* and race/ethnicity Wisconsin, 2012
90 80

77

HIV diagnoses (adjusted)

70

62
60

White Black Hispanic Asian/Pacific Islander Multi-racial

50

40

31
30

26

20

14
10

2
0
MSM (n170)

5
1
Heterosexual (n52)

7 4 1 1
Perinatal (n=1)

IDU (n18)

* Data have been statistically adjusted to account for unknown risk. See technical notes.

Wisconsin Department of Health Services

YOUNG MSM: RACE/ETHNICITY Figure 13. HIV diagnoses in MSM* ages 15-29, by race/ethnicity, Wisconsin, 2003-2012
60

50

HIV diagnoses (adjusted)

Black
40

30

20

White
10

Hispanic
0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

* Data have been statistically adjusted to account for unknown risk. See technical notes. ** Includes Asians, American Indians, and multi-racial individuals. Wisconsin Department of Health Services

AGE AT DIAGNOSIS BY RISK Figure 14: Median age at HIV diagnosis by risk exposure*, and among MSM, by race/ethnicity, Wisconsin, 2012
Median age at HIV diagnosis
Total (n=241) 33

IDU (n=9)

42

Heterosexual (n=20)

41

MSM (including MSM/IDU) (n=127)

30

Black MSM (n=46)

23

MSM

Hispanic MSM (n=22)

31

White MSM (n=54)


0 5 10 15 20 25 30 35 40

43
45 50

* Excludes cases with unknown risk exposure.

Wisconsin Department of Health Services

AGE AT DIAGNOSIS Figure 15. Median age at HIV diagnosis for Black MSM*, 2003-2012, Wisconsin
Circle size and number in circle represent the number of HIV diagnoses among Black MSM that year

30 Median age at HIV diagnoses 29

30

28 27 26
42 22

25 24 23
31

43 52 54 46 42 62

22 21 20 2003 2004 2005 2006 2007 2008 2009

2010

2011

2012

* Excludes cases with unknown risk exposure.

TRANSGENDER INDIVIDUALS Figure 16. HIV diagnoses among transgender individuals by race/ethnicity, Wisconsin, 2003-2012
12

10

1
8

Age 30+ Age <30

HIV diagnoses

3 9
4

1
2

4
2 1

0 Black (n=10) Hispanic (n=7) White (n=3) Multi-racial (n=1)

Wisconsin Department of Health Services

2012 DIAGNOSES BY COUNTY Figure 17. HIV diagnoses by county, Wisconsin, 2012
Burnett

Bayfield Douglas

Ashland

Iron

Vilas Washburn

Sawyer

Florence Oneida

Price

Forest

Polk Barron

Rusk Marinette Lincoln Langlade Taylor

St. Croix Dunn

Chippewa Menominee Marathon Shawano

Oconto Door

Pierce Pepin

Eau Claire

Clark Kewaunee Portage Waupaca Outagamie Brown

Wood Buffalo Jackson Trempealeau

2012 HIV diagnoses (n=241)


0-3 4 - 10

Waushara

Winnebago

Calumet

Manitowoc

La Crosse

Monroe

Juneau

Adams Marquette Fond du Lac Green Lake Sheboygan

Vernon Columbia Richland Crawford Sauk Dodge

Washington Ozaukee

Dane Iowa Grant

Jefferson

Waukesha Milwaukee

11 - 25 128

Racine Lafayette Green Rock Walworth Kenosha

Wisconsin Department of Health Services

DIAGNOSIS BY GEOGRAPHY Figure 18. HIV diagnosis by geography and demographic characteristics, Wisconsin, 2012
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% White Black Hispanic 15-29 30-49 50+

All Other Counties


22% 33% 44% 50% 72%

Milwaukee County

76%

78% 67% 56% 50% 28%

24%

Wisconsin Department of Health Services

Summary of HIV diagnoses in Wisconsin, 2012


2012 diagnoses in Wisconsin: 241 Sex: Males, 78% of new diagnoses Males and females stable rates, 2003-2012 Gender: 21 diagnoses in transgender individuals, 2003-2012 Race/Ethnicity: Males: Rates in Blacks 10 times and Hispanics 5 times higher than in Whites Females: Rates in Blacks 25 times and Hispanics and Asians 5 times higher than in Whites Geography Diagnosis rates in Milwaukee 6 times higher than in Wisconsin excluding Milwaukee County
Wisconsin Department of Health Services

Summary of HIV diagnoses by risk exposure in Wisconsin, 2012


Risk Median age at diagnosis by risk Men who have sex with men, 70% 33 High-risk heterosexual, 21% 42 Injection drug users, 7% 41 MSM by race/ethnicity (all ages) Whites, 45% Blacks, 36% Hispanics, 15% Asians, 2%

Median age by race 43 23 31 --

Black MSM under age 30 58% of 2012 diagnoses (8% of male population, ages 15-29) Diagnoses tripled 2003-2010, declined modestly 2010 2012 Median age at diagnosis, 23
Wisconsin Department of Health Services

PREVALENT CASES
Prevalence is the number of people living with HIV infection at a given point in time

Wisconsin Department of Health Services

AWARE OF HIV INFECTION: UNITED STATES Figure 19. Percent aware of their HIV infection, by demographic group, United States, 2009
Total BY AGE Aged 13-24 years Aged 25-34 years Aged 35-44 years Aged 45-54 years Aged 55-64 years Aged 65 years and over BY SEX Male Female BY RACE/ETHNICITY White only Black or AA only American Indian or AN only Asian only Native Hawaiian or PI only 2 or more races Hispanic or Latino

82% 41% 72% 85% 89% 89% 89% 81% 85%

85% 81% 75% 73% 74% 80% 80%


0% 20% 40% 60% 80% 100%

Health Indictors Warehouse: http://www.healthindicators.gov/Indicators/HIV-infection-status-awarenesspercent_942/Profile/Data

Wisconsin Department of Health Services

NUMBER UNAWARE OF HIV INFECTION Figure 20. Estimated number unaware of their HIV infection, by demographic group, Wisconsin, 2012
BY AGE Aged 13-24 years Aged 25-34 years Aged 35-44 years Aged 45-54 years Aged 55+ years BY SEX Male Female BY RACE/ETHNICITY White Black American Indian Asian Multi-racial Hispanic or Latino
-

438 345 276 303 171 1,228 237 537 599 13 26 18 192
200 400 600 800 1,000 1,200 1,400

Uses estimates from Health Indictors Warehouse: http://www.healthindicators.gov/Indicators/HIVinfection-status-awareness-percent_942/Profile/Data

Wisconsin Department of Health Services

PREVALENCE: STATE OF DIAGNOSIS Figure 21. Prevalent cases of HIV infection by state of initial HIV diagnosis, Wisconsin, as of December 31, 2012 n = 6,549

Non-Wisconsin diagnoses, 24%

Wisconsin diagnoses, 76%

Wisconsin Department of Health Services

PREVALENCE: AGE Figure 22. Prevalent cases of HIV infection by current age as of 12/31/2012 and cases reported during 2012 by age at diagnosis, Wisconsin
Current age of prevalent cases (n=6,549)

Age at diagnosis, cases diagnosed in 2012 (n=241)


25%

20%

Percent

15%

10%

5%

0% <5 5-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+

Wisconsin Department of Health Services

ESTIMATED PREVALENCE* BY DEMOGRAPHIC GROUP Figure 23. Impact of HIV on selected demographic groups, ages 15-59 years, Wisconsin, as of December 31, 2012
30%

Estimated HIV prevalence within demographic group

27%
25% 20%

Black Hispanic White

15%
10%

Less than 1.5% 7%

5% 0% MSM

3% 1.2% 0.4% 0.2%


Non-MSM males

0.7% 0.2% 0.0%


Females

Demographic Group
* The estimated prevalence is adjusted to account for the CDCs estimate that 18% of HIV-infected persons are unaware of their infection and therefore not reported. The percent of males that are MSM was calculated using published estimates (Lieb, 2011).
Wisconsin Department of Health Services

PREVALENCE: GEOGRAPHY
Figure 24. Reported cases of HIV infection presumed to be alive by county, Wisconsin, as of December 31, 2012
Burnett

Bayfield Douglas

Ashland

Iron

Vilas Washburn

Sawyer

Florence Oneida

Price

Forest

Polk Barron

Rusk Marinette Lincoln Langlade Taylor

St. Croix Dunn

Chippewa Menominee Marathon Shawano

Oconto Door

Pierce Pepin

Eau Claire

Clark Kewaunee Portage Waupaca Outagamie Brown

Wood Buffalo Jackson Trempealeau

Waushara

Winnebago

Calumet

Manitowoc

Persons reported and living with HIV in Wisconsin, 2012 (n=6,035*)


0 - 20 21 - 40

La Crosse

Monroe

Juneau

Adams Marquette Fond du Lac Green Lake Sheboygan

Vernon Columbia Richland Crawford Sauk Dodge

Washington Ozaukee

41 - 100
Iowa

Dane

Jefferson

Waukesha Milwaukee

101 - 200 201 - 3014

Grant Racine Lafayette Green Rock Walworth Kenosha

*Excludes 228 cases with the Wisconsin Department of Corrections as the last known address and 285 cases where county of residence is unknown.

Wisconsin Department of Health Services

DEATHS
Deaths are the number of people with HIV infection who died in a given year, irrespective of cause of death

Wisconsin Department of Health Services

DEATHS Figure 25. Deaths due to any cause among persons reported with HIV infection by year of death, Wisconsin, 1990-2010
400

350

Number of deaths

300

250

200

150

100

50

0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Wisconsin Department of Health Services

DEATHS: AGE Figure 26. Deaths due to any cause among persons reported with HIV infection, by median age at death, Wisconsin, 2001-2010 n=1,251
60

50
50

50

43
40

45 42 42 39.5 40

47

47

30

20

10

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

Wisconsin Department of Health Services

Summary of HIV Prevalence and Deaths as of 12/31/2012


PREVALENT CASES Wisconsin, one-third rate of U.S. states 6,549 reported + 1,500 estimated unaware of HIV infection 8,000 Age 40% are age 50 or older

Estimated HIV positive by risk and race General population: 2 in 1,000 Blacks: Non-MSM males, 1.2%; females, 0.7% MSM: Black, 27%; Hispanic, 7%; White, 3% Geography: Milwaukee County: 48%; Dane County, 12%; all other 4% or less

DEATHS
89 in HIV-infected individuals in 2010
Wisconsin Department of Health Services