Bronx Community Health Dashboard HIV and AIDS Created

Bronx Community Health Dashboard: HIV and AIDS Created: 5/4/2017 Last Updated: 3/20/2019 See last slide for more information about this project. 1

Overview of HIV/AIDS in the Bronx 2 Disparities exist in early HIV/AIDS detection, but are declining Bronx residents are being diagnosed with HIV at a lower rate and are living with HIV longer Bronx residents with lower incomes and less education are more likely to have had an HIV/AIDS test Bronx residents have the highest likelihood of ever having an HIV/AIDS screening compared to other boroughs Newly diagnosed Bronx residents equally likely to initiate care, but somewhat less likely to have viral suppression, 2017 AIDS diagnoses are highest in the Bronx amongst non-Hispanic black residents and males

Fewer people are being newly diagnosed with HIV and AIDS in the Bronx HIV Diagnosis HIV AIDS Diagnosis AIDS Rate of HIV and AIDS diagnoses per 100, 000 120 109. 1 100 101. 4 65% decrease 80 60 HIV Diagnosis: positive Western blot 40 35. 8 21. 0 test in adults and positive PCR (polymerase chain reaction) test in infants <18 months AIDS Diagnosis: HIV-infected and either 1+ AIDS-defining opportunistic illness or a lab test indicating suppressed CD 4+ cell counts (<200 cells/µL) 20 0 2001 3 81% decrease 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Data source: New York City HIV/AIDS Annual Surveillance Statistics, 2001 -2017. 2014 2015 2016 2017

The percent of Bronx residents living with HIV/AIDS has been steadily increasing over the last 15 years Bronx Percent of population living with HIV/AIDS 2. 50 NYC Excluding Bronx 2. 09 2. 00 1. 50 1. 38 1. 35 1. 00 0. 50 0. 00 2001 4 2002 2003 2004 2005 2006 2007 2008 2009 2010 Data source: New York City HIV/AIDS Annual Surveillance Statistics, 2001 -2017. 2011 2012 2013 2014 2015 2016 2017

New HIV and AIDS diagnoses rates are falling 120 Bronx 120 NYC Excluding Bronx 107. 2 99. 7 3 fold decrease in new HIV diagnoses 80 64. 2 60 40 20 31. 8 Rate of AIDS diagnoses per 100, 000 100 23. 4 5 fold decrease in new AIDS diagnoses 80 61. 6 60 40 21. 0 20 12. 7 0 5 Data source: New York City HIV/AIDS Annual Surveillance Statistics, 2001 -2017. 20 17 20 16 20 15 20 14 20 13 20 12 20 11 20 10 20 09 20 08 20 07 20 06 20 05 20 04 20 03 20 02 20 01 0 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 20 17 Rate of HIV diagnoses per 100, 000 100

The rate of new HIV/AIDS cases is falling but the rate of people living with HIV/AIDS is increasing People Living with HIV/AIDS HIV Diagnosis AIDS Diagnosis 2. 50 Note different axis scales 120 2. 1 2. 00 100 99. 7 80 1. 50 1. 4 60 1. 00 31. 8 0. 50 40 20 21. 0 0. 00 0 2001 6 2002 2003 2004 2005 2006 2007 2008 2009 2010 Data source: New York City HIV/AIDS Annual Surveillance Statistics, 2001 -2017. 2011 2012 2013 2014 2015 2016 2017 Rate of HIV and AIDS diagnoses per 100, 000 Percent of People Living with HIV and AIDS 107. 2

HIV Testing 7

Bronx adult residents are more likely to have ever had an HIV/AIDS test compared to other boroughs 100 89. 6 90 83. 7 64. 2 63. 9 58. 2 60 55. 7 52. 1 50 40 30 20 10 N d ev e rm at ep ar ed /s ow ar rie ed * ed iv D Data source: Community Health Survey, 2017. Age results not age-adjusted. or ce d/ w id M ar rie d/ c Fe ou pl m al e e al M + 65 64 45 - 44 25 - 24 la Is en at St 18 - nd s ue en an ha M Q n tta n ly oo k on x 0 Br 8 79. 1 78. 3 74. 5 71. 8 70 85. 2 82. 5 78. 7 80 Br Age-adjusted percent reporting ever getting HIV/AIDS test Bronx only

Residents with lower incomes and less education more likely to have ever had an HIV/AIDS test Age-adjusted percent reporting ever getting HIV/AIDS test 90 84. 9 84. 7 78. 9 80 81. 9 81. 8 74. 6 79. 9 77. 4 73. 4 71. 8 70 63. 2 62. 6 60 50 40 30 20 10 0 Hispanic 9 Non. Hispanic black Non. Hispanic white* Data source: Community Health Survey, 2017. Highest poverty High poverty Medium poverty Lowest poverty* <HS High school Some college College

Age-adjusted percent reporting ever getting HIV/AIDS test Since 2004, the Bronx has had the highest percentage of people ever getting an HIV/AIDS test Bronx 80 Brooklyn Manhattan Queens Staten Island 78. 7 71. 8 64. 2 60 54. 3 58. 2 51. 0 52. 1 44. 7 40 41. 7 36. 2 20 0 2004 10 2005 2006 2007 2008 Data source: Community Health Survey, 2004 -2017. Comparable data not collected in 2006. 2009 2010 2011 2012 2013 2014 2015 2016 2017

HIV Diagnoses in the Bronx 11

HIV diagnosis rates have decreased in all groups, but disparities remain Hispanic 180 Non-Hispanic Black Non-Hispanic White Asian 161. 5 HIV diagnosis rate per 100, 000 160 Non-Hispanic black population’s HIV diagnosis rate has fallen over 3 fold since 2001 but remains highest of all race/ethnicities in the Bronx 140 120 100 88. 0 80 60 51. 9 40 27. 3 24. 7 13. 1 20 0 13. 4 2001 12 3. 8 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Data source: New York City HIV/AIDS Annual Surveillance Statistics, 2001 -2017. 2002 -2004 data for the Asian population is unstable. For 2016 and 2017, denominators are from the American Community Survey. For all other years, denominators are DOHMH population estimates. 2017

Males in the Bronx have higher rates of HIV diagnoses 100 Male Female 0 -19 87. 3 90 30 -39 40 -49 50 -59 60+ 140 127. 8 70 60 47. 0 50 48. 6 40 30 HIV diagnosis rate per 100, 000 80 HIV diagnosis rate per 100, 000 20 -29 120 122. 7 100 103. 8 80 76. 1 60 66. 6 60. 8 40 40. 2 17. 0 20 32. 3 20 10 17. 4 9. 9 11. 2 6. 1 0 0 2006 13 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2006 2007 2008 2009 2010 2011 Data source: New York City HIV/AIDS Annual Surveillance Statistics, 2006 -2017. For 2016 and 2017, denominators are from American Community Survey. For all other years, denominators are DOHMH population estimates. 2012 2013 2014 2015 2016 2017

HIV Diagnosis Rate Per 100, 000 4 of 10 community districts with highest rates of new HIV diagnoses are in the Bronx 212 207 210 Bronx 35. 7 40 30 20 NYC 24. 0 10 201 202 HIV Diagnosis Rate per 100, 000 0 201 Mott Haven & Melrose 202 Hunts Point & Longwood 203 Morrisania & Crotona 204 Highbridge & Concourse 205 Fordham & University Heights 206 Belmont & East Tremont 207 Kingsbridge Heights & Bedford 208 Riverdale & Fieldston 70 58. 8 60 49. 2 50 40 32. 4 10 es (2 Be 12 te am df r& ) o sb rd So rid (2 un ge 02 dv H ) & ig i ew hb Ba rid (2 yc 04 ge he Be ) st & lm er C on on (2 t& 07 co ) u Ea rs M e ot st Fo (2 t. H Tr rd 11 em ha av ) en m on & t( & U 20 M ni el 5) ve r os rs M e ity or (2 ris H 06 ei H a ) gh ni un a ts ts & (2 Po C 09 ro in ) to t& na Lo (2 ng 10 w ) oo d (2 03 ) on (2 08 ei gh t s & & Fi ch illi Pa rk W on xd da le er iv ng sb R Ki ris M or Th ro gs N ec k Pa rk & & C Br o- op 212 Williamsbridge & Baychester el ds t 01 ) (2 C ity 211 Morris Park & Bronxdale ) 0 210 Throgs Neck & Co-op City Data source: NYC Community Health Profiles, 2018. 39. 8 43. 7 18. 5 18. 1 15. 6 20 209 Parkchester & Soundview 14 33. 1 34. 5 43. 4 51. 3 30 H 209 50 ge 204 203 211 60 al e 205 206 70 rid 208 Highest: Central Harlem and Brownsville 80

In the Bronx, HIV diagnoses are highest for men who have sex with men MSM 800 IDU MSM-IDU Heterosexual Transgender Perinatal Unknown Male HIV Diagnosis 764 Number of male HIV diagnoses IDU MSM-IDU 600 Heterosexual 8% 500 2% 1% 400 333 64% Transgender Perinatal Unknown *numbers from 2017 data 300 200 Abbreviations MSM=men who have sex with men IDU=people who inject drugs MSM-IDU=men who have sex with men and inject drugs 100 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 15 MSM 25% 700 Data source: New York City HIV/AIDS Annual Surveillance Statistics, 2001 -2017.

HIV diagnoses are highest for females with heterosexual contact in the Bronx 600 582 IDU Heterosexual Transgender Perinatal Unknown Female HIV Diagnosis 3% 9% Number of female HIV diagnoses 500 7% Heterosexual 400 Transgender Perinatal Unknown 300 81% 200 131 100 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 16 IDU Data source: New York City HIV/AIDS Annual Surveillance Statistics, 2001 -2017. *numbers from 2017 data

AIDS Diagnoses in the Bronx AIDS diagnosis is defined as: 1) Those diagnosed concurrent with HIV 2) Those who transitioned from HIV to AIDS 17

AIDS diagnoses rates are highest among the non-Hispanic black population in the Bronx 180 AIDS diagnosis rate per 100, 000 160 Hispanic 157. 2 140 Non-Hispanic Black Non-Hispanic White Asian AIDS Diagnosis: HIV-infected and either ≥ 1 AIDS-defining opportunistic illness or a lab test indicating suppressed CD 4+ cell counts (<200 cells/µL) 120 103. 4 100 80 60 40 39. 5 36. 0 15. 2 20 8. 5 0 3. 8 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 18 Data source: New York City HIV/AIDS Annual Surveillance Statistics, 2001 -2017. 2001 -2004 data for Asian population is unstable. For 2016 and 2017, denominators are from American Community Survey. For all other years, denominators are DOHMH population estimates.

Males in the Bronx have higher rates of AIDS diagnoses 90 85. 6 Male 0 -19 Female 20 -29 30 -39 40 -49 50 -59 60+ 180 80 160 70 140 60 50. 5 50 40 31. 2 30 20 AIDS diagnosis rate per 100, 000 163. 6 125. 2 120 114. 1 100 80 60 40 11. 9 49. 7 29. 5 20 10 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 19 31. 5 18. 9 4. 8 0 46. 5 0. 7 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Data source: New York City HIV/AIDS Annual Surveillance Statistics, 2001 -2017. AIDS diagnosis rates pre-2006 are unavailable. For 2016 and 2017, denominators are from American Community Survey. For all other years, denominators are DOHMH population estimates.

In the Bronx, AIDS diagnoses are highest for men who have sex with men MSM 900 IDU MSM-IDU Heterosexual Transgender Perinatal Unknown AIDS Diagnosis 875 Number of male AIDS diagnoses MSM 40% 600 MSM-IDU Heterosexual Transgender 2% Perinatal 11% 6% 300 214 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 20 IDU 31% Data source: New York City HIV/AIDS Annual Surveillance Statistics, 2001 -2017. MSM-IDU category was not created until 2009; Transgender category was not created until 2011. 9% Unknown *numbers from 2017 data Abbreviations MSM=men who have sex with men IDU=people who inject drugs MSM-IDU=men who have sex with men and inject drugs

In the Bronx, AIDS diagnoses are highest for females with heterosexual contact IDU Number of female AIDS diagnoses 600 Heterosexual Transgender Perinatal Unknown AIDS Diagnosis 573 500 17% 2% 400 IDU Heterosexual 5% Transgender Perinatal 300 64% Unknown *numbers from 2017 data 200 92 100 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 21 11% Data source: New York City HIV/AIDS Annual Surveillance Statistics, 2001 -2017. MSM-IDU category was not created until 2009; Transgender category was not created until 2011.

HIV/AIDS Related Care in the Bronx 22

Timely initiation of care among those newly diagnosed with HIV slightly increased in the Bronx between 2013 and 2017 Bronx Timely initiation of care, percent 100 76 75 NYC 79 81 84 74 65 69 72 76 80 Timely initiation of care is defined as first CD 4 or VL drawn within 30 days of HIV diagnosis 50 25 0 2013 23 2014 2015 2016 Data source: HIV/AIDS in the Bronx, New York City, 2017. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 2017

Among Bronx residents newly diagnosed with HIV in 2017, Hispanic residents were most likely to have timely initiation of care Timely initiation of care is defined as first CD 4 or VL drawn within 30 days of HIV diagnosis Percent of newly diagnosed Bronx residents with timely initiation of care 100 83 85 78 75 50 25 0 Black (n=222) 24 Latino/Hispanic (n=219) Data source: HIV/AIDS in the Bronx, New York City, 2017. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. White (n=18)

Among Bronx residents newly diagnosed with HIV in 2017, MSM-IDU were most likely to have timely initiation of care 100 Timely initiation of care is defined as first CD 4 or VL drawn within 30 days of HIV diagnosis. Percent of newly diagnosed Bronx residents with timely initiation of care 100 86 89 83 75 67 50 Abbreviations MSM=men who have sex with men IDU=people who inject drugs MSM-IDU=men who have sex with men and inject drugs TG-SC=transgender sexual contact 25 0 MSM 25 IDU MSM-IDU Heterosexual Data source: HIV/AIDS in the Bronx, New York City, 2017. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. TG-SC

Newly diagnosed Bronx residents are equally likely to initiate care, but somewhat less likely to have viral suppression, 2017 Timely Initiation of Care Among Newly Diagnosed, 2017 100 90 84 82 Viral Suppression* within 6 Months of HIV Diagnosis, 2017 85 80 80 80 79 84 84 83 M Q SI 75 67 70 66 68 61 58 60 Percent Viral Suppression* Among PLWHA, 2017 50 40 30 20 10 0 BX BK M Q SI Timely initiation: First CD 4 or viral load drawn within 30 days of diagnosis 26 BX BK M Q SI BX BK *Viral suppression: Viral load ≤ 200 copies/m. L; PLWHA: People Living with HIV/AIDS Data source: HIV/AIDS in the Bronx, New York City, 2017. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

HIV/AIDS related care by risk category for all of New York City, 2017 Timely Initiation of Care Among Newly Diagnosed, 2017 100 90 84 83 Viral Suppression* within 6 Months of HIV Diagnosis, 2017 84 81 77 80 78 76 69 70 65 60 60 78 75 79 76 63 61 56 50 40 30 20 10 27 w n al r/U nk no in at Pe r -S C th e et er os ex -ID H SM M TG ua l U U ID SM M C -S ex TG ua l U er os et H M SM -ID ID SM U O Timely initiation: First CD 4 or viral load drawn within 30 days of diagnosis M C -S H et er os -ID SM M TG ex ua l U U ID SM 0 M Percent Viral Suppression* Among PLWHA, 2017 *Viral suppression: Viral load ≤ 200 copies/m. L; PLWHA: People Living with HIV/AIDS Data source: HIV/AIDS in the Bronx, New York City, 2017. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

Among Bronx residents newly diagnosed with HIV, 41% achieved viral suppression within 3 months and 61% within 6 months Bronx 70 NYC Percent of newly diagnosed achieving viral suppression in the Bronx 64 61 60 50 45 41 40 30 20 10 0 3 Months 28 6 Months Data source: HIV/AIDS in the Bronx, New York City, 2017. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. Viral suppression is defined as viral load ≤ 200 copies/m. L

Among people newly diagnosed with HIV in the Bronx, MSM were most likely to achieve viral suppression within 6 months Percent of newly diagnosed achieving viral suppression within 6 months of diagnosis in the Bronx 80 71 70 65 67 60 50 38 40 38 30 Abbreviations MSM=men who have sex with men IDU=people who inject drugs MSM-IDU=men who have sex with men and inject drugs TG-SC=transgender sexual contact 20 10 0 MSM 29 Viral suppression is defined as viral load ≤ 200 copies/m. L IDU MSM-IDU Heterosexual Contact Data source: NYC HIV Surveillance Registry, 2016. Data not available for 2017. TG-SC

Among diagnosed PLWHA in the Bronx, non-Hispanic black residents had the lowest viral suppression proportion Percent of newly diagnosed achieving viral suppression in the Bronx 90 80 80 83 76 76 79 72 70 60 50 40 30 20 10 0 Black 30 Latino/Hispanic White Asian/Pacific Islander Native American Data source: HIV/AIDS in the Bronx, New York City, 2017. PLWHA = People Living with HIV/AIDS. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. Other Viral suppression is defined as viral load ≤ 200 copies/m. L

Among diagnosed PLWHA in NYC, people with perinatal transmission risk had the lowest viral suppression proportion Viral Suppression among diagnosed PLWHA by transmission risk in the Bronx, 2017 80 76 74 74 70 75 73 70 58 60 50 40 Abbreviations MSM=men who have sex with men IDU=people who inject drugs MSM-IDU=men who have sex with men and inject drugs TG-SC=transgender sexual contact 30 20 10 0 MSM 31 Viral suppression is defined as viral load ≤ 200 copies/m. L IDU MSM-IDU Heterosexual Contact TG-SC Perinatal Data source: HIV/AIDS in the Bronx, New York City, 2017. PLWHA = People Living with HIV/AIDS. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. Other/Unknown

Of approximately 25, 300 PLWHA in the Bronx in 2017, 69% had a suppressed viral load 100 90 80 80 % of PLWHA who are… Viral suppression is defined as viral load ≤ 200 copies/m. L 86 69 70 60 50 40 30 20 10 0 Retained in Care (defined as ≥ 1 viral load/CD 4 measurement) 32 Prescribed anti-retroviral therapy Virally Suppressed Data source: HIV/AIDS in the Bronx, New York City, 2017. PLWHA = People Living with HIV/AIDS. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

HIV/AIDS Mortality in the Bronx 33

HIV mortality rates have fallen over 4 -fold since 2000 Bronx -- 2000: 3 rd leading cause of death | 2017: 12 th leading cause of death Bronx 70 Rest of NYC 40 Bronx 35 NYC Excluding Bronx 30 25 81% decrease 16. 8 15 10 7. 1 3. 2 5 34 Miami-Dade County DC Baltimore City 52. 5 These areas chosen for comparison due to similar demographics and high HIV/AIDS burden 50 44. 6 40 42. 6 30 21. 4 20 13. 6 10 9. 3 7. 1 5. 2 Data source: Underlying Cause of Death, 2000 -2017. 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 20 17 01 20 00 20 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 20 17 0 00 0 Bronx 60 20 20 83% decrease Age-adjusted HIV/AIDS mortality rate per 100, 000 42. 6 20 Age-adjusted HIV/AIDS mortality rate per 100, 000 45

Males and 45 -64 year olds have highest rates of HIV mortality in the Bronx Female 140 Male 50 40 30 27. 8 20 11. 2 10 35 -44 45 -54 55 -64 65 -74 120 HIV/AIDS mortality rate per 100, 000 60 25 -34 128. 4 61. 0 100 89. 4 80 60 40 50. 8 29. 7 23. 1 20 14. 4 21. 2 3. 7 Data Suppressed 9. 8 0 35 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 20 17 01 200020012002200320042005200620072008200920102011201220132014201520162017 20 20 00 0 20 Age-adjusted HIV mortality rate per 100, 000 70 Data source: Underlying Cause of Death, 2000 -2017. Age-specific rates are not age-adjusted. 25 -34 year data unstable after 2006. 35 -44 unstable after 2016.

HIV/AIDS mortality rates are highest for the non-Hispanic black population in the Bronx Hispanic Age-adjusted HIV/AIDS mortality rate per 100, 000 60 Non-Hispanic Black Non-Hispanic White 55. 6 50 40 30 37. 7 25. 6 20 16. 9 12. 5 Data Suppressed 10 8. 2 0 2000 36 2001 2002 2003 2004 2005 2006 2007 2008 Data source: Underlying Cause of Death, 2000 -2017. Data on non-Hispanic white respondents statistically unstable 2008 -2017. 2009 2010 2011 2012 2013 2014 2015

There are dramatic disparities in all-cause mortality among people living HIV/AIDS in the Bronx Note: Different analysis approach from previous slides. Males, including transgender men Estimated deaths among people with HIV/AIDS per 1, 000 PLWHA 35 Female, including transgender women 30. 7 30 25 21. 2 20 Abbreviations MSM=men who have sex with men IDU=people who inject drugs MSM-IDU=men who have sex with men and inject drugs 26. 3 15 11. 4 10 8. 8 8. 0 5 0 MSM 37 IDU MSM-IDU Heterosexual Data source: Calculated from NYC HIV/AIDS Annual Surveillance Statistics, 2016 -17. All-cause mortality can include any cause of death, not necessarily HIV/AIDS. IDU Heterosexual

About the Community Health Dashboard Project § The goal of the project is to provide Bronx-specific data on risk factors and health outcomes with an emphasis on presenting data on trends, socio-demographic differences (e. g. , by age, sex, race/ethnicity, etc. ) and sub-county/neighborhood level data § Data will be periodically updated as new data becomes available. § Produced by Montefiore’s Office of Community & Population Health using publicly-available data sources § For more information please contact us at OCPHDept@montefiore. org 38