1 State of the State: HIV/STD in Texas Ann Robbins Texas Department of State Health Services June 2009.

1

State of the State:HIV/STD in Texas

Ann RobbinsTexas Department of State Health

ServicesJune 2009

2

In 2007, there were 122,717 reported

diagnoses of sexually transmitted diseases.

3

Chlamydia Cases, 2000-2008

0

20,000

40,000

60,000

80,000

100,000

120,000

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Cas

es

Females, Age 15-24 Females, Other Ages Males, All Ages

4

Chlamydia Case Rates by County 2007

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Gonorrhea Cases, 2000-2008

31,56931,76130,270

26,01624,33924,326

27,114

32,895

30,116

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Cas

es

6

Gonorrhea Case Rates by County 2007

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Primary and Secondary Syphilis Cases by Year of Report, 2000-2008

1,066

879

1,405

1,172

398

833

650591

479

0

200

400

600

800

1,000

1,200

1,400

1,600

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Cas

es

8

P&S Syphilis Case Rates by County -Texas, 2008

Rates 0.0 Cases/100,000

0.1 to 3.9 Cases/100,000

4.0 to 9.9 Cases/100,000

10 or More Cases/100,000

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PLWHA

Deaths

New Cases

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

2003 2004 2005 2006 2007

Year

Nu

mb

er:

PL

WH

A

0

1,000

2,000

3,000

4,000

5,000

6,000

Nu

mb

er:

New

Cas

es a

nd

D

eath

s

Persons Living with HIV/AIDS, New Diagnoses of HIV/AIDS, and Deaths among those with HIV/AIDS

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Texas Persons Living with HIV/AIDS (PLWHA) by County 2006

PLWHA 2006No cases

1-99

100-499

500-1,499

1,500-4,999

5,000-18,500

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Burden of STD in Texas disproportionately borne

by racial/ethic minorities.

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Chlamydia Case Rates by Year of Report and Race/Ethnicity - Texas, 2000-2008

0

200

400

600

800

1,000

1,200

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Cas

es p

er 1

00,0

00

White Af. American Hispanic

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Gonorrhea Case Rates by Race/Ethnicity 2000-2008

0

100

200

300

400

500

600

700

800

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Cas

es p

er 1

00,0

00

White Af. American Hispanic

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P&S Syphilis Case Rates by Year of Report and Race/Ethnicity - Texas,

2000-2008

0

5

10

15

20

25

30

35

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Cas

es p

er 1

00,0

00

White Af. American Hispanic

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The rate of living HIV cases among Blacks in Texas is 3 to 4

times higher than the rate in Whites or Latinos.

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Number and Rate of PLWHA by Race/Ethnicity, 2003-2007

18,604 22,712

23,802

18,113

11,089

15,532

0

5,000

10,000

15,000

20,000

25,000

2003 2004 2005 2006 2007

White Black Hispanic

200.9165.9

713.7

891.1

177.0146.7

0

200

400

600

800

1,000

2003 2004 2005 2006 2007

White Black Hispanic

The number of black persons living with HIV/AIDS surpassed that of whites in 2005. The rate in 2007 was 4-5 times higher for blacks than for others.

Number Rate

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Rate of new HIV/AIDS diagnoses in Black women is 8 times higher than rate in

Latinas, 20 times higher than rate in White women.

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New Diagnoses, Number and Rate, by Sex and Race/Ethnicity, 2006

1,157

1,366

1,011

220

658

145

0

200

400

600

800

1,000

1,200

1,400

1,600

White Black Hispanic

Male Female

20.5

105.7

23.3

5.3

48.0

2.5

0

20

40

60

80

100

120

White Black Hispanic

Male Female

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• Over 5,000 newly acquired HIV infections in Texas in 2007– Blacks accounted for 39%– Latinos accounted for 30% – Whites/Others accounted for 31%

2007 Incidence Estimate

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One in…are Living with HIV/AIDS

One in 378 of all Texans

One in 498 of White Texans

One in 565 of Hispanic Texans

One in 112 of Black Texans

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In Texas, heterosexual transmissions account for

a growing number of newly diagnosed HIV

cases, but MSM still make up the majority of new HIV diagnoses and an increased number of syphilis diagnoses.

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P&S Syphilis Cases by Year of Report by Sex and MSM Risk, 2000-2008

0

200

400

600

800

1,000

1,200

1,400

1,600

2001 2002 2003 2004 2005 2006 2007 2008

Year

Cas

es

MSM P&S Male P&S Female P&S

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Mode of transmission in new and living cases of HIV in Texas, 2007

Newly Diagnosed

MSM52.5%

MSM/IDU3.9%

IDU13.0%

Het.29.8%

Other0.8%

Living Cases

MSM51.6%

MSM/IDU7.2%

IDU15.9%

Het.23.6%

Other1.6%

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1 in 3 Texans with HIV was diagnosed with AIDS within 1

year of first HIV + test

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% of Texans with HIV and AIDS Diagnoses within 1 Month and 1 Year

w/i 1 month

w/i 1 month

w/i 1 month

w/i 1 month

w/i 1 month

w/i 1 month

w/i 1 year

w/i 1 year

w/i 1 year

w/i 1 year

w/i 1 year

w/i 1 year

0.0 10.0 20.0 30.0 40.0 50.0

Hispanic

Black

White

Male

Female

Total

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BRFSS: HIV Testing Behavior

HIV Testing HistoryEver In Past Year

Hispanic 41% 15%

Black 64% 28%

White 41% 10%

Ever Tested for HIV among persons aged 18-64 years, Texas, 2007

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Estimated Percentages

Newly infected in 2007 and unaware of their status

Hispanic 64%

55%

58%

59%

Black

White/Other

Overall

Incidence Surveillance: 2007 Incidence Estimate

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Complexity

• Intersecting and Accelerating Epidemics– Psychiatric involvement

• Major depression• Substance use and abuse

• Need to address structural factors – Constrict or eliminate choices– Physically, socially, psychologically

separate and isolate

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Texas Hospital Discharge Data: Cost of HIV/AIDS and Hepatitis Admissions, 2005

HIV/AIDS

Principle Diagnosis CodeTotal

AdmissionsTotal

ChargesAverage Cost per Admission

AIDS 5153 $237,193,846 $46,030HIV 10 $85,295 $8,529

Total HIV/AIDS $237,279,141

Hepatitis

Principle Diagnosis CodeTotal

AdmissionsTotal

ChargesAverage Cost per Admission

Viral Hepatitic Delta 3 $134,833 $44,944Viral Hepatitis A 145 $2,368,533 $16,335Viral Hepatitis B 404 $9,270,562 $22,947Viral Hepatitis C 1185 $38,950,477 $32,870Viral Hepatitis E 5 $116,552 $23,310Viral Hepatitis Unspecified 159 $2,517,290 $15,832

Total Hepatitis $53,358,247