2018 regional hiv/aids epidemiologic profile of lawrence ... · web view2019/02/20 · number and...

Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

2018 Massachusetts HIV/AIDS Epidemiologic ProfileRegional HIV/AIDS Epidemiologic Profile of Lawrence, Massachusetts

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Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences. 2018 Massachusetts HIV/AIDS Epidemiologic Profile: Regional HIV/AIDS Epidemiologic Profile of Lawrence, Massachusetts. https://www.mass.gov/lists/hivaids-epidemiologic-profiles Published September 2018. Accessed [date].

Massachusetts Department of Public Health Bureau of Infectious Disease and Laboratory Sciences305 South StreetJamaica Plain, MA 02130

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2018 Regional HIV/AIDS Epidemiologic Profile of Lawrence

Table 1. Total number of individuals reported with HIV infection or AIDS1 by mortality status on January 1, 2018: Lawrence, Massachusetts

N %

Individuals Living with HIV infection2 512 67%Individuals Reported with HIV or AIDS Who Are Deceased3 257 33%Total Number of Individuals Reported with HIV Infection or AIDS 769 100%

1 Does not include individuals diagnosed with HIV infection (non-AIDS) who died prior to January 1, 1999 or who were not in care on January 1, 1999.2 HIV prevalence data include all individuals who were residing in Massachusetts as of 1/1/18, regardless of where they were first diagnosed.3 All-cause HIV/AIDS death data include only individuals who were first diagnosed in Massachusetts.Data Source: MDPH Bureau of Infectious Disease and Laboratory Sciences, data are current as of 1/1/18 and may be subject to change

Table 2. Average annual rate of HIV infection diagnosis1 from 2014 to 2016 and HIV prevalence2 rate on 1/1/18: Lawrence, Massachusetts

Average annual HIV diagnosis rate from 2014–2016 Average rate per 100,000

Average annual number of HIV

diagnosesLawrence, MA 30.1 23Massachusetts Total 9.7 633

HIV prevalence rate on 1/1/18 Rate per 100,000

Number of individuals living with HIV infection

Lawrence, MA 670.4 512Massachusetts Total 337.7 22,112

1 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.2 HIV prevalence data include all individuals who were residing in Massachusetts as of 1/1/18, regardless of where they were first diagnosed.Data Source: MDPH Bureau of Infectious Disease and Laboratory Sciences, data are current as of 1/1/18 and may be subject to change; The denominators for rate calculations are from the MDPH Massachusetts Race Allocated Census 2010 Estimates (MRACE 2010), Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation

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Table 3. Individuals living with HIV infection,1 deaths among individuals reported with HIV/AIDS,2 and newly diagnosed HIV infections3 by year: 2007–2016, Lawrence, Massachusetts

Year HIV Prevalence1 Deaths among those with HIV/AIDS

Diagnosis of HIV Infection

2007 338 11 242008 349 4 162009 361 7 202010 374 5 172011 385 10 202012 393 4 242013 411 5 212014 426 7 182015 436 6 232016 452 2 28

1 Number of individuals living with HIV infection on 12/31 of each year. Residence calculated based on vital status. For those alive as of 1/1/18, residence based on most recent record available. For those deceased with known residence at death, residence at death. For those deceased with unknown residence at death, residence at diagnosis.2 All-cause HIV/AIDS death data include only individuals who were first diagnosed in Massachusetts.3 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.Data source: MDPH Bureau of Infectious Disease and Laboratory Sciences, data are current as of 1/1/18 and may be subject to change

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Table 4. Number and percentage of individuals diagnosed with HIV infection from 2014–20161 and individuals living with HIV infection (ILWH) on 1/1/182 by sex at birth, place of birth, race/ethnicity, exposure mode, and age: Lawrence, Massachusetts

HIV Infection Diagnoses ILWHSex at Birth: N % N %Male 44 64% 300 59%Female 25 36% 212 41%Place of Birth: N % N %US 33 48% 150 29%Puerto Rico/US Dependency3 10 14% 176 34%Non-US 26 38% 186 36%Race/Ethnicity: N % N %White (non-Hispanic) 15 22% 64 13%Black (non-Hispanic) <5 N/A 40 8%Hispanic/Latino 52 75% 404 79%Asian/Pacific Islander <5 N/A <5 N/AOther/Undetermined 0 0% <5 N/AExposure Mode: N % N %Male-to-male sex (MSM) 21 30% 84 16%Injection Drug Use (IDU) 15 22% 121 24%MSM/IDU <5 N/A 6 1%Heterosexual Sex 9 13% 126 25%Other4 <5 N/A 10 2%Total No Identified Risk (NIR) 23 33% 165 32% Presumed Heterosexual Sex5 <5 N/A 60 12% NIR6 ≥57 N/A 105 21%Age: N % N %

At Diagnosis On January 1, 2018Under 13 0 0% <5 N/A13 to 19 8 12% <5 N/A20 to 24 10 14% 13 3%25 to 29 10 14% 16 3%30 to 34 6 9% 25 5%35 to 39 8 12% 42 8%40 to 44 <5 N/A 53 10%45 to 49 13 19% 62 12%50 to 54 <5 N/A 90 18%55 to 59 5 7% 81 16%60 to 64 <5 N/A 66 13%65 to 69 <5 N/A 38 7%70+ 0 0% 24 5%Total8 69 100% 512 100%1 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.2 HIV prevalence data include all individuals who were residing in Massachusetts as of 1/1/18, regardless of where they were first diagnosed.3 All individuals diagnosed with HIV infection from 2014–2016 who were born in a US dependency were born in Puerto Rico; 99% of individuals living with HIV infection in MA who were born in a US dependency were born in Puerto Rico,1% were born in US minor outlying areas, <1% were born in the US Virgin Islands, and <1% were born in Guam.4 Includes pediatric and blood/blood products exposure modes5 Includes a woman having sex with a man of unknown HIV status or risk. This category is limited to women only.6 Includes a man having sex with a woman of unknown HIV status or risk, those still being followed up for risk information, those who have died with no determined risk, and those lost to follow-up.7 Value >5 suppressed to protect privacy, N/A=Not Applicable8 Total includes numbers suppressed to protect privacyData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 5. Number and percentage of individuals living with HIV infection on January 1, 2018 by sex at birth1 and race/ethnicity: Lawrence, Massachusetts2

Men WomenRace/Ethnicity: N % N %

White (non-Hispanic) 48 16% 16 8%Black (non-Hispanic) 19 6% 21 10%Hispanic/Latino 231 77% 173 82%Asian/Pacific Islander <5 N/A <5 N/ATotal3 300 100% 212 100%

1 Data reflect sex at birth not gender identity or gender expression of transgender individuals (N=107 transgender individuals living with HIV infection in MA). Please note “women” and “men” are used for stylistic reasons to describe female and male populations diagnosed with HIV infection that include a small number of girls and boys (N=24 children living with HIV infection under age 13 as of 1/1/18). 2 HIV prevalence data include all individuals who were residing in Massachusetts as of 1/1/18, regardless of where they were first diagnosed.3 Total includes American Indian/Alaska Native, other and unspecified race/ethnicity4 Value >5 suppressed to protect privacy, N/A=Not ApplicableData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

Table 6. Number and percentage of individuals living with HIV infection on January 1, 2018 by sex at birth1 and exposure mode: Lawrence, Massachusetts2

Men WomenExposure Mode: N % N %

Male-to-male sex (MSM) 84 28% N/A N/AInjection drug use (IDU) 92 31% 29 14%MSM/IDU 6 2% N/A N/AHeterosexual sex 33 11% 93 44%Total No Identified Risk (NIR) 78 26% 87 41%

Presumed heterosexual sex3 N/A N/A 60 28% NIR4 78 26% 27 13%

Total5 300 100% 212 100%

1 Data reflect sex at birth not gender identity or gender expression of transgender individuals (N=107 transgender individuals living with HIV infection in MA). Please note “women” and “men” are used for stylistic reasons to describe female and male populations diagnosed with HIV infection that include a small number of girls and boys (N=24 children living with HIV infection under age 13 as of 1/1/18).2 HIV prevalence data include all individuals who were residing in Massachusetts as of 1/1/18, regardless of where they were first diagnosed.3 Includes a woman having sex with a man of unknown HIV status or risk. This category is limited to women only.4 Includes a man having sex with a woman of unknown HIV status or risk, those still being followed up for risk information, those who have died with no determined risk, and those lost to follow-up.5 Total includes pediatric and blood/blood products exposure modes and numbers suppressed to protect privacy, N/A=Not ApplicableData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 7. Number and percentage of individuals diagnosed with HIV infection from 2014–20161 by sex at birth2 and race/ethnicity: Lawrence, Massachusetts3

Men WomenRace/Ethnicity: N % N %

White (non-Hispanic) 7 16% 8 32%Black (non-Hispanic) <5 N/A 0 0%Hispanic/Latino 35 80% 17 68%Asian/Pacific Islander <5 N/A 0 0%Total4 44 100% 25 100%

1 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available three-year period after the implementation of HIV infection reporting in 1999.2 Data reflect sex at birth not gender identity or gender expression of transgender individuals (N=107 transgender individuals living with HIV infection in MA). Please note “women” and “men” are used for stylistic reasons to describe female and male populations diagnosed with HIV infection that include a small number of girls and boys (N=24 children living with HIV infection under age 13 as of 1/1/18).3 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.4 Total includes American Indian/Alaska Native, other and unspecified race/ethnicity and numbers suppressed to protect privacy.N/A=Not ApplicableData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 8. Number and percentage of individuals diagnosed with HIV infection from 2014–20161 by sex at birth2 and exposure mode: Lawrence, Massachusetts3

Men WomenExposure Mode: N % N %

Male-to-male sex (MSM) 21 48% N/A N/AInjection drug use (IDU) 7 16% 8 32%MSM/IDU <5 N/A N/A N/AHeterosexual sex <5 N/A 6 24%Other4 0 0% 0 0%Total No Identified Risk (NIR) 12 27% 11 44%

Presumed heterosexual sex5 N/A N/A <5 N/A NIR6 12 27% ≥57 N/A

Total8 44 100% 25 100%

1 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available three-year period after the implementation of HIV infection reporting in 1999.2 Data reflect sex at birth not gender identity or gender expression of transgender individuals (N=107 transgender individuals living with HIV infection in MA). Please note “women” and “men” are used for stylistic reasons to describe female and male populations diagnosed with HIV infection that include a small number of girls and boys (N=24 children living with HIV infection under age 13 as of 1/1/18).3 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.4 Includes pediatric and blood/blood products exposure modes5 Includes a woman having sex with a man of unknown HIV status or risk. This category is limited to women only.6 Includes a man having sex with a woman of unknown HIV status or risk, those still being followed up for risk information, those who have died with no determined risk, and those lost to follow-up.7 Value >5 suppressed to protect privacy, N/A=Not Applicable8 Total includes numbers suppressed to protect privacy.N/A=Not ApplicableData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 9. Number and percentage of individuals diagnosed with HIV infection by sex at birth1 and year of diagnosis: Lawrence, Massachusetts,2 2007–20163

Men Women TotalN % N % N

2007 13 54% 11 46% 242008 10 63% 6 38% 162009 10 50% 10 50% 202010 8 47% 9 53% 172011 11 55% 9 45% 202012 16 67% 8 33% 242013 15 71% 6 29% 212014 11 61% 7 39% 182015 17 74% 6 26% 232016 16 57% 12 43% 28

1 Data reflect sex at birth not gender identity or gender expression of transgender individuals (N=107 transgender individuals living with HIV infection in MA). Please note “women” and “men” are used for stylistic reasons to describe female and male populations diagnosed with HIV infection that include a small number of girls and boys (N=24 children living with HIV infection under age 13 as of 1/1/18).2 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.3 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available ten-year period after the implementation of HIV infection reporting in 1999.Data Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 10. Number and percentage of individuals diagnosed with HIV infection by race/ethnicity and year of diagnosis: Lawrence, Massachusetts1, 2007–20162

White Non-Hispanic Black Non-Hispanic Hispanic/Latino Total3

N % N % N % N

2007 <5 N/A <5 N/A 18 75% 242008 <5 N/A <5 N/A 14 88% 162009 <5 N/A <5 N/A 16 80% 202010 <5 N/A <5 N/A 15 88% 172011 <5 N/A <5 N/A 15 75% 202012 <5 N/A <5 N/A 19 79% 242013 <5 N/A <5 N/A 16 76% 212014 <5 N/A <5 N/A 14 78% 182015 <5 N/A <5 N/A 18 78% 232016 >54 N/A <5 N/A 20 71% 28

1 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.2 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available ten-year period after the implementation of HIV infection reporting in 1999.3 Totals include Asian/Pacific Islander, American Indian/Alaskan Native individuals, those of other or undetermined race/ethnicity, and numbers suppressed to protect privacy.4 Value >5 suppressed to protect privacy, N/A=Not ApplicableData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 11. Number and percentage of individuals diagnosed with HIV infection by place of birth and year of diagnosis: Lawrence, Massachusetts1, 2007–20162

USPuerto Rico/

US Dependency3 Non-US Total4

N % N % N % N

2007 7 29% 9 38% 8 33% 242008 <5 N/A <5 N/A 8 50% 162009 5 25% 5 25% 10 50% 202010 <5 N/A ≥55 N/A 8 47% 172011 ≥55 N/A <5 N/A 10 50% 202012 8 33% 7 29% 9 38% 242013 7 33% 5 24% 9 43% 212014 ≥55 N/A <5 N/A 6 33% 182015 ≥55 N/A <5 N/A 8 35% 232016 ≥55 N/A <5 N/A 12 43% 281 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.2 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available ten-year period after the implementation of HIV infection reporting in 1999.3 Ninety-nine percent of individuals diagnosed with HIV infection from 2007–2016 who were born in a US dependency were born in Puerto Rico, 1% were born in US minor outlying areas, <1% were born in the US Virgin Islands, and <1% were born in Guam.4 Total includes numbers suppressed to protect privacy.5 Value >5 suppressed to protect privacy, N/A=Not ApplicableData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 12. Number and percentage of individuals diagnosed with HIV infection by exposure mode and year of diagnosis: Lawrence, Massachusetts1, 2007–20162

MSM IDUMSM/IDU HTSX Other3

Pres.HTSX4 NIR5 Total6

N % N % N % N % N % N % N % N

2007 5 21% 6 25% 0 0% <5 N/A <5 N/A <5 N/A 7 29% 242008 <5 N/A <5 N/A 0 0% <5 N/A 0 0% <5 N/A 5 31% 162009 <5 N/A <5 N/A 0 0% 6 30% <5 N/A <5 N/A 5 25% 202010 0 0% <5 N/A 0 0% 9 53% 0 0% 0 0% <5 N/A 172011 <5 N/A <5 N/A 0 0% 5 25% 0 0% <5 N/A 7 35% 202012 7 29% 5 21% 0 0% 6 25% <5 N/A <5 N/A <5 N/A 242013 <5 N/A <5 N/A 0 0% <5 N/A 0 0% <5 N/A 6 29% 212014 7 39% <5 N/A <5 N/A <5 N/A 0 0% 0 0% <5 N/A 182015 9 39% 5 22% 0 0% 0 0% <5 N/A <5 N/A 7 30% 232016 5 18% 7 25% 0 0% 6 21% <5 N/A <5 N/A 8 29% 281 New HIV diagnoses include only individuals who were first diagnosed in Massachusetts.2 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available ten-year period after the implementation of HIV infection reporting in 1999.3 Includes pediatric and blood/blood products exposure modes4 Includes a woman having sex with a man of unknown HIV status or risk. This category is limited to women only.5 Includes a man having sex with a woman of unknown HIV status or risk, those still being followed up for risk information, those who have died with no determined risk, and those lost to follow-up.6 Total includes numbers suppressed to protect privacy.HTSX = Heterosexual Sex; IDU = Injection Drug Use; MSM = Male-to-Male Sex; MSM/IDU = Male-to-Male Sex and Injection Drug Use; N/A=Not Applicable; NIR = No Identified Risk Pres. HTSX = Presumed Heterosexual SexData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 13. Number and percentage of individuals diagnosed with AIDS by sex at birth1 and year of diagnosis: Lawrence, Massachusetts,2 2007–2016

Men Women Total4

N % N % N

2007 8 47% 9 53% 172008 5 50% 5 50% 102009 ≥53 N/A <5 N/A 122010 <5 N/A ≥53 N/A 92011 11 58% 8 42% 192012 8 53% 7 47% 152013 12 67% 6 33% 182014 5 45% 6 55% 112015 6 55% 5 45% 112016 ≥53 N/A <5 N/A 8

1 Data reflect sex at birth and therefore not gender identity or gender expression of transgender individuals (N=107 transgender individuals living with HIV infection). Please note “women” and “men” are used for stylistic reasons to describe female and male populations diagnosed with HIV infection that include a small number of girls and boys (N=24 children living with HIV infection under age 13 as of 1/1/18). 2 AIDS diagnoses include only individuals who were first diagnosed in Massachusetts.3 Value >5 suppressed to protect privacy, N/A=Not Applicable4 Total includes numbers suppressed to protect privacy.Data Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 14. Number and percentage of individuals diagnosed with AIDS by race/ethnicity and year of diagnosis: Lawrence, Massachusetts,1 2007–2016

White Non-Hispanic Black Non-Hispanic Hispanic/Latino Total2

N % N % N % N

2007 <5 N/A <5 N/A 12 71% 172008 0 0% 0 0% 10 100% 102009 0 0% 0 0% 12 100% 122010 <5 N/A <5 N/A 8 89% 92011 <5 N/A <5 N/A 16 84% 192012 <5 N/A <5 N/A 11 73% 152013 <5 N/A <5 N/A 13 72% 182014 <5 N/A <5 N/A 10 91% 112015 <5 N/A <5 N/A 6 55% 112016 0 0% 0 0% 8 100% 8

1 AIDS diagnoses include only individuals who were first diagnosed in Massachusetts.2 Totals include Asian/Pacific Islander, American Indian/Alaskan Native individuals, those of other or undetermined race/ethnicity, and numbers suppressed to protect privacy.3 Value >5 suppressed to protect privacy, N/A=Not ApplicableData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Table 15. Number and percentage of individuals diagnosed with AIDS by exposure mode and year of diagnosis: Lawrence, Massachusetts,1 2007–2016

MSM IDUMSM/IDU HTSX Other2

Pres.HTSX3 NIR4 Total5

N % N % N % N % N % N % N % N

2007 0 0% 6 35% <5 N/A <5 N/A <5 N/A <5 N/A 6 35% 172008 0 0% <5 N/A <5 N/A <5 N/A 0 0% <5 N/A <5 N/A 102009 <5 N/A <5 N/A <5 N/A <5 N/A <5 N/A 0 0% <5 N/A 122010 0 0% <5 N/A <5 N/A <5 N/A 0 0% <5 N/A <5 N/A 92011 <5 N/A <5 N/A 6 32% 6 32% 0 0% <5 N/A 5 26% 192012 5 33% <5 N/A <5 N/A <5 N/A 0 0% <5 N/A <5 N/A 152013 <5 N/A 5 28% <5 N/A <5 N/A 0 0% <5 N/A <5 N/A 182014 0 0% <5 N/A <5 N/A <5 N/A 0 0% 0 0% <5 N/A 112015 <5 N/A 6 55% 0 0% 0 0% 0 0% <5 N/A <5 N/A 112016 0 0% 0 0% <5 N/A <5 N/A <5 N/A <5 N/A <5 N/A 81 AIDS diagnoses include only individuals who were first diagnosed in Massachusetts.2 Includes pediatric and blood/blood products exposure modes3 Includes a woman having sex with a man of unknown HIV status or risk. This category is limited to women only.4 Includes a man having sex with a woman of unknown HIV status or risk, those still being followed up for risk information, those who have died with no determined risk, and those lost to follow-up.5 Total includes numbers suppressed to protect privacy.HTSX = Heterosexual Sex; IDU = Injection Drug Use; MSM = Male-to-Male Sex; MSM/IDU = Male-to-Male Sex and Injection Drug Use; N/A=Not Applicable; NIR = No Identified Risk Pres. HTSX = Presumed Heterosexual SexData Source: MDPH Bureau of Infectious Disease and Laboratory Sciences (percentages may not add up to 100% due to rounding), data are current as of 1/1/18 and may be subject to change

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Technical Notes:

Configuration of Massachusetts Cities/Towns and Counties

Individuals living with HIV infection by current residence:

As of January 1, 2018, the Massachusetts Department of Public Health (MDPH), Bureau of Infectious Disease and Laboratory Sciences (BIDLS), HIV/AIDS fact sheets, epidemiologic reports, and other HIV data presentations include all individuals living with HIV infection who are currently residing in Massachusetts. These prevalent cases include those who may have been first diagnosed in another state. Reports of incidence or new diagnoses will continue to include only individuals who are first diagnosed in Massachusetts. Please note that HIV/AIDS fact sheets, data reports, and presentations published from 2011 to 2017 include only cases that were first diagnosed in Massachusetts.

Presumed heterosexual:

The presumed heterosexual risk category is used exclusively for women to identify HIV exposure mode when sex with men was the only reported risk factor, there was no evidence of current or past injection drug use (IDU), and behavioral risk and HIV status information about male sexual partners were unknown. The rationale for the application of the presumed heterosexual risk category to women only has been addressed in the MDPH Office of HIV/AIDS report “Intersecting Risks: HIV Infection among Heterosexual Women and Men in Massachusetts.” (2010) http://www.mass.gov/Eeohhs2/docs/dph/aids/intersecting_risks.pdf .

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http://www.mass.gov/Eeohhs2/docs/dph/aids/intersecting_risks.pdf

2018 regional hiv/aids epidemiologic profile of lawrence ... · web view2019/02/20 · number and...

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