HIV Epidemiology Broward County Revision 110518 Excluding Department

HIV Epidemiology Broward County Revision: 11/05/18 (Excluding Department of Corrections) Presented By: Florida Department of Health HIV/AIDS Section Data as of 6/30/2018 Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 1

Technical Notes HIV diagnoses by year of diagnosis represent persons whose HIV was diagnosed in that year, regardless of AIDS status at time of diagnosis. AIDS and HIV diagnoses by year of diagnosis are not mutually exclusive and cannot be added together. HIV prevalence data represent persons who were living with an HIV diagnosis in the reporting area through the end of the calendar year (regardless of where they were diagnosed). Resident deaths due to HIV represent persons who resided in Florida and whose underlying cause of death was HIV, regardless if their HIV status was reported in Florida or not. Division of Disease Control and Health Protection 2

Technical Notes, Continued Adult diagnoses represent ages 13 and older; pediatric diagnoses are those under the age of 13. For data by year of diagnosis, the age is by age at diagnosis. For living data, the age is by current age at the end of the most recent calendar year, regardless of age at diagnosis Unless otherwise noted, Whites are non-Hispanic, Blacks are non-Hispanic and Other (which may be omitted in some graphs due to small numbers) represents Asian, American Indian, or mixed races For data by year, area and county data will exclude Department of Corrections diagnoses. For living data, Department of Corrections will not be excluded from area and county data. Division of Disease Control and Health Protection 3

Florida’s Plan to Eliminate HIV Transmission and Reduce HIV-related Deaths Implement routine HIV and Sexually Transmitted Infections (STIs) screening in health care settings and priority testing in non-health care settings Provide rapid access to treatment and ensure retention in care (Test and Treat) Improve and promote access to antiretroviral preexposure prophylaxis (Pr. EP) and non-occupational postexposure prophylaxis (n. PEP) Increase HIV awareness and community response through outreach, engagement, and messaging Division of Disease Control and Health Protection 4

Definitions of Mode of Exposure Categories MSM: Men who have sex with men or male-to-male sexual contact. The term MSM indicates a behavior that allows for HIV transmission, it does not indicate how individuals selfidentify in terms of sexuality or gender IDU: Injection drug use MSM/IDU: Men who have sex with men or male-to-male sexual contact & injection drug use Heterosexual: Heterosexual contact with person with HIV or known HIV risk Other Risk: includes hemophilia, transfusion, perinatal and other pediatric risks and other confirmed risks Division of Disease Control and Health Protection 5

The Epidemic in Broward County 2016 2017 Trend 1, 860, 979 1, 884, 545 1. 3% increase Diagnosed HIV cases 738 715 3. 1% decrease Diagnosed AIDS cases 254 262 3. 1% increase Pediatric AIDS cases diagnosed 0 0 Perinatal HIV cases 0 2 20, 499 20, 661 0. 8% increase 126 98 22. 2% decrease Population People diagnosed living with HIV (Prevalence) HIV-related deaths Division of Disease Control and Health Protection 6

Cases by Year of Diagnosis Division of Disease Control and Health Protection 7 7

HIV Cases by Year of Diagnosis, Broward County, 2008– 2017 10 year % change (2008– 2017) = 29% decrease Number of Cases 1, 200 1, 000 800 1, 008 868 791 797 688 655 694 639 738 715 600 400 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year of Diagnosis Division of Disease Control and Health Protection 8 8

AIDS Cases by Year of Diagnosis, Broward County, 2008– 2017 10 year % change (2008– 2017) = 66% decrease 900 Number of Cases 800 700 600 500 400 769 664 530 524 434 408 294 279 300 254 262 200 100 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year of Diagnosis Division of Disease Control and Health Protection 9 9

Adult (Age 13+) HIV Cases, by Sex and Year of Diagnosis, Broward County, 2008– 2017 Male Female Percent of Cases (%) 100 Male to Female Ratio 2008= 2. 6 to 1 2017= 3. 9 to 1 80 60 40 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year of Diagnosis Division of Disease Control and Health Protection 10

Adult (Age 13+) AIDS Cases, by Sex and Year of Diagnosis, Broward County, 2008– 2017 Male Female Percent of Cases (%) 80 60 Male to Female Ratio 40 2008= 1. 7 to 1 2017= 2. 4 to 1 20 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year of Diagnosis Division of Disease Control and Health Protection 11

Adult (Age 13+) HIV and AIDS Cases by Sex, Broward County, Diagnosed in 2017 HIV N=713 AIDS N=262 20% 29% 71% 80% Male Female Division of Disease Control and Health Protection 12

Adult (Age 13+) HIV Cases by Race/Ethnicity and Year of Diagnosis, Broward County, 2008– 2017 White Black Hispanic Other Number of Cases 600 500 400 300 200 100 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year of Diagnosis Division of Disease Control and Health Protection 1 Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial. 13

Adult (Age 13+) Male HIV Cases by Race/Ethnicity and Year of Diagnosis, Broward County, 2008– 2017 Number of Cases 350 White Black Hispanic Other 300 250 200 150 100 50 0 2008 2009 2010 2011 2012 2013 Year of Diagnosis 2014 2015 2016 2017 Division of Disease Control and Health Protection 1 Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial. 14

Adult (Age 13+) Female HIV Cases by Race/Ethnicity and Year of Diagnosis, Broward County, 2008– 2017 Number of Cases 250 White Black Hispanic Other 200 150 100 50 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year of Diagnosis Division of Disease Control and Health Protection 1 Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial. 15

Adult (Age 13+) HIV Cases, by Age Group at Diagnosis, and Year of Diagnosis, Broward County, 2008– 2017 13– 19 20– 29 30– 39 40– 49 50+ Number of Cases 350 300 250 200 150 100 50 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year of Diagnosis Division of Disease Control and Health Protection 16

Percentage of Adult (Age 13+) HIV and AIDS Cases Diagnosed in 2017 and Population, by Race/Ethnicity, Broward County 27% Black 45% White 25% 26% Hispanic Other 15% 55% HIV N=713 40% Broward Adult Population Estimates N=1, 884, 545 28% 26% AIDS N=262 5% 5% 3% 0% 20% Population 40% AIDS 60% HIV Division of Disease Control and Health Protection 1 Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial. 17

Rate per 100, 000 Population Adult (Age 13+) HIV Case Rates 1 by Sex and Race/Ethnicity, Broward County, Diagnosed in 2017 120. 0 White Black 113. 2 Hispanic Ratios: Males Black to White, 2. 1 to 1 Hispanic to White, 1. 5 to 1 100. 0 79. 3 80. 0 60. 0 52. 5 45. 0 Females Black to White, 8. 9 to 1 Hispanic to White, 1. 5 to 1 40. 0 20. 0 7. 7 5. 0 0. 0 Male Female Division of Disease Control and Health Protection 1 Source: Population estimates are provided by Florida CHARTS as of 6/20/2017. 18

Adult (Age 13+) AIDS Case Rates 1 by Sex and Race/Ethnicity, Broward County, Diagnosed in 2017 Rate per 100, 000 Population White 50. 0 45. 0 40. 0 35. 0 30. 0 25. 0 20. 0 15. 0 10. 0 5. 0 0. 0 Black Hispanic 45. 1 Ratios: Males Black to White, 2. 6 to 1 Hispanic to White, 0. 9 to 1 25. 1 17. 4 16. 4 3. 1 Male Females Black to White, 7. 9 to 1 Hispanic to White, 0. 6 to 1 2. 1 Female Division of Disease Control and Health Protection 1 Source: Population estimates are provided by Florida CHARTS as of 6/20/2017. 19

Adult (Age 13+) HIV Cases, by Sex and Age Group at Diagnosis, Broward County, Diagnosed in 2017 13– 19 Percent of Cases (%) 35 30 30 20– 29 30– 39 40– 49 30 50+ 29 28 25 25 20 20 16 13 15 10 5 4 4 0 Males N=569 Females N=144 Division of Disease Control and Health Protection 20

Adult (Age 13+) Male HIV Cases by Race/Ethnicity and Age at Diagnosis, Diagnosed in 2017, Broward County White Black Hispanic Other 80 70 Percent of Cases (%) 60 50 40 30 20 10 0 13– 19 20– 29 30– 39 Age 40– 49 Division of Disease Control and Health Protection 1 Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial. 50+ 21

Adult (Age 13+) Female HIV Cases by Race/Ethnicity and Age at Diagnosis, Diagnosed in 2017, Broward County White Black Hispanic Other 80 70 Percent of Cases (%) 60 50 40 30 20 10 0 13– 19 20– 29 30– 39 40– 49 50+ Age Division of Disease Control and Health Protection 1 Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial. 22

Adult (Age 13+) Male HIV Cases, by Mode of Exposure and Year of Diagnosis, Broward County, 2008– 2017 MSM IDU MSM/IDU Heterosexual Number of Cases 600 500 400 300 200 100 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year of Diagnosis Division of Disease Control and Health Protection 23

Adult (Age 13+) Female HIV Cases by Exposure Category and Year of Diagnosis, Broward County, 2008– 2017 IDU Heterosexual Number of Cases 300 250 200 150 100 50 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year of Diagnosis Division of Disease Control and Health Protection 24

Adult (Age 13+) HIV Cases for Males and Females, by Mode of Exposure, Broward County, 2017 Male N=569 1%2% Female N=144 18% <1% 4% <1% 95% 78% MSM IDU MSM/IDU Heterosexual Other Division of Disease Control and Health Protection 1 Other Risk includes hemophilia, transfusion, perinatal and other pediatric risks as well as other confirmed risks. 25

Adult (Age 13+) Male HIV Cases by Race/Ethnicity and Mode of Exposure, Diagnosed in 2017, Broward County 160 140 Number of Cases 120 100 80 60 40 20 0 White N = 166 MSM 1 Other Black N = 218 Hispanic N = 169 Heterosexual IDU MSM/IDU Other N = 16 Other Division of Disease Control and Health Protection includes Asian/Pacific Islander, Native Alaskan/American Indian and Multi-racial individuals. 2 Other Risk includes hemophilia, transfusion, perinatal and other pediatric risks as well as other confirmed risks. 26

Adult (Age 13+) Female HIV Cases by Race/Ethnicity and Mode of Exposure, Diagnosed in 2017, Broward County Number of Cases 120 100 80 60 40 20 0 White N = 16 Black N = 104 Hispanic N = 18 Heterosexual IDU Other N = 6 Other Division of Disease Control and Health Protection includes Asian/Pacific Islander, Native Alaskan/American Indian and Multi-racial individuals. 2 Other Risk includes hemophilia, transfusion, perinatal and other pediatric risks as well as other confirmed risks. 1 Other 27

Co-Morbidity Data Division of Disease Control and Health Protection 28 28

Adult (Age 13+) Early Syphilis Case Rates 1 by Sex and Year of Diagnosis, 2013– 2017 Rate per 100, 000 Population Male Female 900 800 700 600 500 400 300 200 100 0 2013 Male to Female Ratio 2013 = 10. 8: 1 2017 = 14. 8: 1 2014 2015 2016 2017 Year of Diagnosis Division of Disease Control and Health Protection 1 Source: Population data are provided by Florida CHARTS as of 6/30/2018. 29

Adult (Age 13+) HIV Diagnoses with STD 1 by Type and Year of STD Report, 2 2013– 2017, Area 10 Years of STD Report 2013 2014 2015 2016 2017 Syphilis Chlamydia Gonorrhea 380 429 465 410 463 274 336 364 396 546 313 335 489 508 Division of Disease Control and Health Protection 1 Sexually 2 Source: transmitted disease (STD) PRISM, STD Section as of 6/30/2018 30

Adult (Age 13+) Chlamydia and Gonorrhea 1 Cases, Broward County, Diagnosed 2013– 2017 Chlamydia Gonorrhea Number of Cases 12, 000 10, 000 8, 000 6, 000 4, 000 2, 000 0 2013 2014 2015 Year of Diagnosis 2016 Division of Disease Control and Health Protection 1 Source: STD data provided by the Sexually Transmitted Disease & Viral Hepatitis Section. 2017 31

Adult (Age 13+) AIDS Diagnoses with TB by Year of TB Report 1, Broward County, 2013– 2017 Years of TB Report HIV/TB 2013 2014 2015 2016 2017 8 6 3 11 10 Division of Disease Control and Health Protection 1 Source: TB Section. Data as of 7/24/2018 32

Persons Living with HIV Division of Disease Control and Health Protection 33 33

Adults (Age 13+) Living with HIV By ZIP, Broward County, Year-end 2017 Division of Disease Control and Health Protection 1 Excludes DOC, homeless, and cases with unknown zips. Data as of 6/30/2017 34

MSM 1 Living with HIV By ZIP, Broward County, Year-end 2017 1 Includes Division of Disease Control and Health Protection MSM/IDU cases. Excludes DOC, homeless, and cases with unknown zips. Data as of 6/30/2017 35

IDUs 1 Living with HIV By ZIP, Broward County, Year-end 2017 Division of Disease Control and Health Protection 1 Includes MSM/IDU cases. Excludes DOC, homeless, and cases with unknown zips. Data as of 6/30/2017 36

Adult (Age 13+) Heterosexuals Living with HIV By ZIP, Broward County, Year-end 2017 Division of Disease Control and Health Protection Excludes DOC, homeless, and cases with unknown zips. Data as of 6/30/2017 37

One-In-Statements for Adults (Age 13+) Living with HIV in Broward County, Year-end 2017 One in 77 adults in Broward County were known to be living with HIV One in 93 Whites were living with HIV One in 44 Blacks were living with HIV One in 123 Hispanics were living with HIV Division of Disease Control and Health Protection 38

Adults (Age 13+) Living with HIV, Year-end 2017, Area Male(#) Female(#) (%) 10 (%) 1 Race/Ethnicity White 6, 404 41. 9% 480 9. 0% Black 5, 394 35. 3% 4, 236 79. 3% Hispanic 3, 133 20. 5% 505 9. 5% 370 2. 4% 118 2. 2% Other Age Group 13 -19 52 0. 3% 43 0. 8% 20 -29 1, 059 6. 9% 340 6. 4% 30 -39 2, 077 13. 6% 943 17. 7% 40 -49 3, 213 21. 0% 1, 425 26. 7% 50+ 8, 900 58. 2% 2, 588 48. 5% Mode of Exposure MSM 10, 970 71. 7% 0 0. 0% IDU 639 4. 2% 508 9. 5% MSM/IDU 639 4. 2% 0 0. 0% 2, 949 19. 3% 4, 668 87. 4% 104 0. 7% 163 3. 1% 100. 0% 5, 339 100. 0% Heterosexual Other risk Total 15, 301

Broward County’s Top-Nine Priority Populations 1 for Primary 2 HIV Prevention, 2017 27. 8% Black Heterosexual White MSM 20. 5% Hispanic MSM 20. 3% Black MSM 18. 5% Hispanic Heterosexual White IDU Black IDU Hispanic IDU 5. 1% 3. 2% 2. 6% 1. 5% 0. 6% Division of Disease Control and Health Protection 1 MSM=(MSM and MSM/IDU Diagnoses) and IDU=(IDU and MSM/IDU Diagnoses), therefore the data are not mutually exclusive. 40

Broward County’s Top-Nine Priority Populations 1 Prevention for Positives Black Heterosexual 30. 2% White MSM 30. 0% Hispanic MSM 12. 8% Black MSM 11. 9% Black IDU 4. 3% Hispanic Heterosexual 3. 8% White IDU 2. 9% White Heterosexual 2. 9% Hispanic IDU 1. 3% Division of Disease Control and Health Protection 1 MSM=(MSM and MSM/IDU Diagnoses) and IDU=(IDU and MSM/IDU Diagnoses), therefore the data are not mutually exclusive. 41

HIV Care Continuum Definitions HIV Diagnosed: The number of persons known to be diagnosed and living in Florida with HIV (PLWH) at the end of 2016, from data as of 6/30/2017 Ever in Care: PLWH with at least one documented Viral Load (VL) or CD 4 lab, medical visit, or prescription from HIV diagnosis through 3/31/2017 Currently in Care: PLWH with at least one documented VL or CD 4 lab, medical visit, or prescription from 1/1/2016 through 3/31/2017 Retained in Care: PLWH with two or more documented VL or CD 4 labs, medical visits, or prescriptions at least three months apart from 1/1/2016 through 6/30/2017 Suppressed Viral Load: PLWH with a suppressed VL (<200 copies/m. L) on the last VL from 1/1/2016 through 3/31/2017 Division of Disease Control and Health Protection 42

Persons Living with HIV (PLWH) in Broward County along the HIV Care Continuum in 2017 20, 661 100% Percent of PLWH (%) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 19, 386 94% 15, 779 76% PLWH Ever in Care In Care 14, 486 70% Retained in Care 13, 308 64% Suppressed Viral Load Division of Disease Control and Health Protection 43

Resident HIV Deaths by Year of Death Division of Disease Control and Health Protection 44 44

Resident Deaths Due to HIV by Year of Death, Broward County, 2008– 2017 10 year % change (2008– 2017) = 52% decrease 300 Number of Deaths 250 224 200 193 174 150 137 139 122 138 113 126 98 14 15 16 100 50 0 08 09 10 11 12 13 Year of Death Division of Disease Control and Health Protection 17 45 45

Some Useful Links Department. of Health, HIV Section Website http: //www. floridahealth. gov/diseases-and-conditions/aids/surveillance/index. html CDC HIV Surveillance Reports (State and Metro Data): http: //www. cdc. gov/hiv/stats/hasrlink. htm MMWR (Special Articles on Diseases, Including HIV): http: //www. cdc. gov/mmwr/ U. S. Census Data (Available by State, County): http: //www. census. gov Division of Disease Control and Health Protection 46

Surveillance Contacts: Department of Health in Broward County Evariste Akpele, HSPD Phone: 954 -467 -4700 ext. 5567 Email: Evariste. Akpele@flhealth. gov Patrick Jenkins, MPH Phone: 954 -467 -4700 ext 5575 Email: Patrick. Jenkins@flhealth. gov Division of Disease Control and Health Protection 47

Florida HIV/AIDS Surveillance Data Contacts Lorene Maddox, MPH, Surveillance Data Analysis Manager Florida Department of Health Phone: 850 -901 -6968 Email: Lorene. Maddox@flhealth. gov Emma Spencer, MPH, Ph. D Surveillance Program Manager Florida Department of Health Phone: 850 -245 -4432 Email: Emma. Spencer@flhealth. gov Danielle Curatolo, MPH Research Analyst Florida Department of Health Phone: 850 -901 -6983 Email: Danielle. Curatolo@flhealth. gov Ashleigh Tiller Data Reports Coordinator Florida Department of Health Phone: 850 -901 -6984 Email: Ashleigh. Tiller@flhealth. gov HIV/AIDS surveillance data is frozen on June 30, following the end of each calendar year. These are the same data used for Florida CHARTS and all grant-related data. www. floridacharts. com/charts/Communicable. Diseases/default. aspx Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 48