Wisconsin Department of Health Services Wisconsin HIV Surveillance

Wisconsin Department of Health Services Wisconsin HIV Surveillance Annual Review: Slide Set New diagnoses, prevalence, and deaths through December 2016 April, 2017 P-00484

Wisconsin Department of Health Services

Flow of individuals with HIV in and out of Wisconsin Department of Health Services

Wisconsin Department of Health Services

1982 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 2013 2014 2015 2016 Number of Diagnoses Total diagnoses Number of new HIV diagnoses, Wisconsin, 1982 -2016 700 600 500 400 300 200 100 0 Year of Diagnosis Wisconsin Department of Health Services

Total diagnoses Number and rate of new HIV diagnoses, Wisconsin, 2007 -2016 223 4. 4 4. 3 6 Rate 250 246 5. 0 4. 9 200 Number 253 242 250 Number of Diagnoses 283 276 221 227 221 4 4. 3 3. 9 5 3. 8 3. 9 3. 8 150 3 100 2 50 1 0 0 2007 2008 2009 2010 2011 2012 2013 Year of Diagnosis 2014 2015 2016 Wisconsin Department of Health Services Rate per 100, 000 Population 300

HIV diagnosis rates across the U. S. Estimated HIV diagnosis rate by state, 2015 Rate per 100, 000 Population 60 57 50 40 30 20 12. 3 11. 5 10 9. 6 7. 3 5. 2 4. 0 DC LA FL GA MD MS NV TX NY SC NC NJ US CA DE IL VA TN AZ AL IN PA MA AR OK HI OH MO CT KY MI CO NM WA RI MN OR KS NE IA WV WI UT ME AK ND SD WY ID VT MT NH 0 State of Residence at Diagnosis CDC HIV Surveillance Report, 2015, V 27 Wisconsin Department of Health Services

Type of facility of diagnosis Percent of diagnoses by facility of HIV diagnosis, Wisconsin, 2016 Outpatient Clinic 43% CTR Site 23% Inpatient Hospital 9% Emergency Room/Urgent Care 7% Health Department 2% Blood/Plasma Center 5% Family Planning Clinic 5% Jail/Prison 3% Other† 3% 0% 10% †Other includes diagnoses at an HIV clinic, out-of-state facility, military processing center, or mail-in testing facility. 20% 30% Percent of Diagnoses 40% 50% Wisconsin Department of Health Services

Sex and age at diagnosis Number of HIV diagnoses by age and sex, Wisconsin, 2016 60 Female Number of Diagnoses Male 3 50 40 6 30 20 10 3 1 45 32 17 1 6 4 24 14 4 12 17 8 0 15 -19 20 -24 25 -29 30 -34 35 -39 40 -44 45 -49 Age at Diagnosis (Years) 50 -54 4 13 55 -59 7 60+ Wisconsin Department of Health Services

Sex and age at diagnosis HIV diagnosis rate by age at diagnosis and sex, Wisconsin, 2007 -2016 18 16. 1, Male 13 -29 Rate per 100, 000 Population 16 14 13. 0 12 10 12. 0 8 7. 7, Male 30 -59 6 4 2 2. 9 1. 8, Female 13 -29 2. 1 1. 6, Female 30 -59 0 2007 2008 2009 2010 2011 2012 2013 Year of Diagnosis 2014 2015 2016 Wisconsin Department of Health Services

HIV among transgender individuals Number of HIV diagnoses among transgender individuals by age at diagnosis and race/ethnicity, Wisconsin, 2007 -2016 20 30 -59 Years Number of Diagnoses 18 16 13 -29 Years 5 14 12 10 5 8 6 13 4 6 2 1 3 1 1 White Asian Multi. Racial 0 Black Hispanic Race/Ethnicity Wisconsin Department of Health Services

Race/ethnicity Percentage of new HIV diagnoses among Whites and persons of color, Wisconsin, 1982 -2016 100% 90% % White % People of Color 80% 65% 60% 50% 40% 35% 30% 20% 10% 0% 1982 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 2013 2014 2015 2016 Percent 70% Year of Diagnosis Wisconsin Department of Health Services

Sex and race/ethnicity: rates HIV diagnosis rate by sex and race/ethnicity, Wisconsin, 2012 -2016 Rate per 100, 000 Population 45 41. 3 Black 40 Hispanic Asian ----- All males: 7. 3 35 American Indian White All females: 1. 1 30 25 20 15. 8 15 10 5 9. 5 5. 7 5. 1‡ 3. 1 2. 5 0 Male †Rates based on counts less than five have been suppressed. ‡Rates are statistically unreliable due to count <12. Sex † † 0. 4 Female Wisconsin Department of Health Services

Age by reported transmission category Median age at HIV diagnosis by transmission category based on reported risk, and among men with diagnoses attributed to male-male sexual contact by race/ethnicity, Wisconsin, 2016 Total (n=221) 31 Heterosexual Contact (n=12) 37 Injection Drug Use (n=8) 43 Male-Male Sexual Contact† (n=138) Male-Male Sexual Contact† 29 Black (n=66) 23 Hispanic (n=15) 34 White (n=52) 41 0 †Also includes diagnoses attributed to both male-male sexual contact and injection drug use. 10 20 30 40 Median Age at Diagnosis (Years) 50 Wisconsin Department of Health Services

Estimated transmission category Percentage of HIV diagnoses by sex and estimated transmission category†, Wisconsin, 2016 Percent of New Diagnoses Within Each Category Male-Male Sexual Contact‡ 80% ‡Also 86% 80% 70% 60% 50% 40% 30% 20% 14% 10% 0% Total †Data Injection Drug Use 94% 100% 90% Heterosexual Contact 6% 14% 2% Male 4% 0% Female have been statistically adjusted to account for those with unknown transmission category. includes diagnoses attributed to both male-male sexual contact and injection drug use. Wisconsin Department of Health Services

Estimated transmission category HIV diagnoses by estimated transmission category†, Wisconsin, 2007 -2016 Estimated Number of Diagnoses 250 Male-Male Sexual Contact‡ Heterosexual Contact Injection Drug Use 200 150 100 50 0 2007 †Data ‡Also 2008 2009 2010 2011 2012 Year of Diagnosis 2013 2014 2015 2016 have been statistically adjusted to account for those with unknown transmission category. includes diagnoses attributed to both male-male sexual contact and injection drug use. Wisconsin Department of Health Services

Young men by race/ethnicity HIV diagnoses attributed† to male-male sexual contact†, ages 13 -29, by race/ethnicity, Wisconsin, 2007 -2016 Estimated Number of Diagnoses 70 Black 60 50 40 30 20 White 10 Hispanic 0 2007 †Data ‡Also 2008 2009 2010 2011 2012 Year of Diagnosis 2013 2014 2015 2016 have been statistically adjusted to account for those with unknown transmission category. includes diagnoses attributed to both male-male sexual contact and injection drug use. Wisconsin Department of Health Services

Pediatric HIV and perinatal exposure Diagnostic status of HIV-exposed infants born in Wisconsin or with undocumented state of birth, 2007 -2016 35 Living with HIV (n=5) Number of Births 30 HIV Negative (n=207) 25 20 15 10 5 0 2007 2008 2009 2010 2011 2012 Birth Year 2013 2014 2015 2016 Wisconsin Department of Health Services

Geography Number of HIV diagnoses by county of residence† at diagnosis, Wisconsin, 2016 †Excludes 4 individuals diagnosed in the Department of Corrections. Wisconsin Department of Health Services

Wisconsin Department of Health Services

Late diagnosis Percentage of people first diagnosed with HIV during Stage 3 or who progressed to Stage 3 within one year of HIV diagnosis, by year of HIV diagnosis, Wisconsin, 2012 -2016 Progressed to Stage 3 within one year of HIV diganosis† 45% Stage 3 at the time of HIV diagnosis Percent of Diagnoses 40% 35% 8% 4% 30% 4% 25% 6% 20% 15% 31% 29% 10% 25% 5% 17% 19% 2015 2016 0% 2012 2013 2014 Year of Diagnosis †Those diagnosed with HIV during 2016 have not had one full year to evaluate progression to Stage 3 and therefore this category is excluded. Wisconsin Department of Health Services

Late diagnosis by demographic group 70% 60% 50% 40% 30% 20% 31% Overall Ages 30 and Older 17% 41% Ages 13 -29 Unknown Risk Heterosexual Contact Injection Drug Use 28% 39% 33% 38% Male-Male Sexual Contact† Asian Hispanic 33% 26% 37% 40% Black 32% 31% White 0% Male 10% Female Percentage of New Diagnoses Percentage of people first diagnosed with HIV during Stage 3 or who progressed to Stage 3 within one year of HIV diagnosis, by demographic group, Wisconsin, 2012 -2015 †Also includes diagnoses attributed to both male-male sexual contact and injection drug use. Wisconsin Department of Health Services

HIV Stage at Diagnosis HIV stage at diagnosis, Wisconsin, 2016 19% late diagnosis Stage 3 defining condition (low CD 4 count, opportunistic infection) at time of diagnosis or within 30 days after Stage 3 Acute Recent 25% early diagnosis (Stage 1) • Antigen positive • High first viral load • Reported recent negative test Latent (Stage 2) 56% of diagnoses Wisconsin Department of Health Services

Wisconsin Department of Health Services

Prevalence: In-migration Number of people previously diagnosed with HIV moving into Wisconsin, 2007 -2016 250 220 Number of People 200 150 143 100 50 0 2007 2008 2009 2010 2011 2012 Year of Report 2013 2014 2015 2016 Wisconsin Department of Health Services

Unaware of HIV status: United States Estimated percentage of those with HIV who are unaware of their status, by demographic group, United States, 2013 13. 0% TOTAL BY AGE 13 -24 years 25 -34 years 35 - 44 years 45 -54 years 55 -64 years 65+ 7. 4% 5. 4% 1. 8% BY RACE/ETHNICITY Black White Hispanic or Latino Asian Multi-racial American Indian BY RISK EXPOSURE Male-Male Sexual Contact Heterosexual Contact-Male Heterosexual Contact-Female Injection Drug Use-Male Injection Drug Use-Female 14. 3% 13. 3% 10. 8% 15. 3% 12. 1% 5. 0% 51. 4% 26. 7% 21. 6% 17. 5% 15. 3% 17. 3% 12. 5% Percent Unaware Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data— United States and 6 dependent areas— 2014. HIV Surveillance Supplemental Report 2016; 2 (No. 4). https: //www. cdc. gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-21 -4. pdf. Published July 2016. Accessed February 2017. Wisconsin Department of Health Services

Unaware of HIV status: Wisconsin Estimated number unaware of their HIV, using CDC national estimates, by demographic group, Wisconsin, 2016 TOTAL BY AGE 13 -24 years 25 -34 years 35 - 44 years 45 -54 years 55 -64 years 65+ BY RACE/ETHNICITY Black White Hispanic or Latino Asian Multi-racial American Indian BY RISK EXPOSURE Male-Male Sexual Contact Heterosexual Contact-Male Heterosexual Contact-Female Injection Drug Use-Male Injection Drug Use-Female 1034 262 7 95 161 26 17 8 73 24 15 217 178 376 Wisconsin known prevalence: 6, 923 402 382 Estimated number of people living with HIV in Wisconsin who are unaware of their HIV: ~1, 000 851 143 Number Unaware Wisconsin Department of Health Services

Prevalence: age People living with HIV by current age as of December 31, 2016, and people diagnosed during 2016 by age at diagnosis, Wisconsin 25% Current Age at Diagnosis Percent of People 20% 15% 10% 5% 0% <15 15 -19 20 -24 25 -29 30 -34 35 -39 40 -44 Age (Years) 45 -49 50 -54 55 -59 60+ Wisconsin Department of Health Services

Prevalence: selected demographic groups Estimated prevalence of HIV in selected demographic groups, ages 15 -59, Wisconsin, 2016 Estimated HIV Prevalence Within Demographic Group 35% 32. 8% Black 30% Hispanic 25% White 20% 15% 10% 5% 9. 3% 3. 6% 0. 4% 0% Gay and Bisexual Males 0. 2% Heterosexual Males Estimates generated from surveillance data and state-specific estimates of MSM populations in: Lieb S. , et al. Statewide estimation of populations of MSM in the United States. Public Health Reports 2011; 126(1): 60 -72 and CDC’s estimate that overall 12. 8% of people living with HIV are unaware of their HIV infection, with variations by race/ethnicity. Imputed risk calculations were also used for individuals with missing risk information. 1. 2% 0. 4% Females Wisconsin Department of Health Services

Prevalence: county Prevalence of HIV by county†, Wisconsin, 2016 †Excludes 211 people whose last known address was within the Department of Corrections. Wisconsin Department of Health Services

Wisconsin Department of Health Services

Deaths Number of deaths†, by cause of death, among people living with HIV in Wisconsin, 1982 -2016 300 Other Cause Number of Deaths 250 HIV 200 150 100 50 1982 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 2013 2014 2015 0 Year of Death †Excludes 77 individuals with an unknown cause of death and 84 individuals with a missing state of death. Wisconsin Department of Health Services

Deaths Median age at death, by cause of death†, among people living with HIV in Wisconsin, 1982 -2015 Median Age at Death 60 56 53 50 40 30 20 Other Cause 10 HIV 1982 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 2013 2014 2015 0 Year of Death †Excludes 77 individuals with an unknown cause of death and 84 individuals with a missing state of death. Wisconsin Department of Health Services

Deaths Number of deaths, by race/ethnicity, among people living with HIV in Wisconsin, 2006 -2015 60 Number of Deaths 50 40 White Black 30 20 10 Hispanic 0 2006 †Excludes 2007 2008 2009 2010 2011 Year of Death 2012 2013 2014 2015 84 individuals with a missing state of death. Wisconsin Department of Health Services

Wisconsin Department of Health Services

HIV care continuum†, Wisconsin, 2016 Estimated 100% At High Risk Living with Diagnosed for HIV and Living with HIV 88% Linked within 3 Months of Diagnosis †Reflects laboratory data received through March 27, 2017. 71% In Care 54% Based on Surveillance Data 64% 91% Retained in Virally Care Suppressed among Those Tested Wisconsin Department of Health Services

Wisconsin Department of Health Services

Sexually Transmitted Infections (STI) Sexually transmitted infections† among people living with HIV, by timing of STI diagnosis, Wisconsin, 2016 Same time as HIV diagnosis 13% >1 year after HIV diagnosis 77% †Number of unique diagnoses; individuals may be duplicated if they received more than one STI diagnosis during the year. n=141 syphilis diagnoses n=220 gonorrhea diagnoses n=184 chlamydia diagnoses >1 month-1 year after HIV diagnosis 10% Wisconsin Department of Health Services

Full reports • For additional information and methodology, visit the HIV Program website: https: //www. dhs. wisconsin. gov/aidshiv/data. htm – Statewide report: summary https: //www. dhs. wisconsin. gov/publications/p 00792 -17 -june. pdf – Statewide report: comprehensive report https: //www. dhs. wisconsin. gov/publications/p 00484. pdf – City of Milwaukee report https: //www. dhs. wisconsin. gov/publications/p 00484 a. pdf