Epidemiology ofHIV Infection Trends
in Florida Reported through 2013
Florida Department of HealthHIV/AIDS and Hepatitis Section
Division of Disease Control and Health ProtectionAnnual data as of 12/31/2013
To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.
Created: 12/27/13
Revision: 04/18/14
HIV and AIDS Case Data
HIV Infection reporting represents newly reported HIV cases, regardless of AIDS status at time of report.
HIV infection cases classified as Stage 3 (AIDS) became reportable in Florida in 1981.
HIV infection cases (without an AIDS diagnosis) became reportable in Florida on July 1, 1997.
AIDS cases and HIV infection cases by year of report are NOT mutually exclusive and CANNOT be added together.
Frozen databases of year-end data are generated at the end of each calendar year. These are the same data used for Florida CHARTS and all grant-related data where annual data are included.
HIV prevalence data are prepared later in the year, when most of the “expected” death data are complete, usually in July.
HIV and AIDS Case Data (con’t) Adult cases represent ages 13 and older, pediatric cases
are those under the age of 13. For data by year, the age is by age of 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 and blacks are non-Hispanic.
Total statewide data will include Department of Correction Cases (DOC) unless otherwise noted. County data will exclude DOC cases.
HIV “incidence estimates” are approximations of the numbers of people who are newly infected, which include those whose infection has not yet been diagnosed or reported.
Surveillance Case Definition for AIDS in Florida under age 6
Laboratory evidence and/or medical documentation by a physician of a person with a positive confirmatory HIV antibody test and/or positive virologic test (qualitative or quantitative) and
For children under age 6: Has been diagnosed with one or more AIDS-defining illness
(Opportunistic Infections)
Surveillance Case Definition for AIDS in Florida age 6 and older
Laboratory evidence and/or medical documentation by a physician of a person with a positive confirmatory HIV antibody test and/or positive virologic test (qualitative or quantitative) and
For persons 6 years of age or older: Has a CD4 absolute lymphocyte count below 200, or a CD4
of less than 14% total lymphocytes and/or Has been diagnosed with one or more AIDS-defining illness
(i.e., Opportunistic Infections) excluding multiple or recurrent bacterial infections
Surveillance Case Definition for HIV in Florida
Laboratory CriteriaPositive result on a screening test for HIV antibody, followed by a positive result on a confirmatory test for HIV antibody (e.g., Western blot, IFA, multispot, etc)
ORPositive result or report of a detectable quantity of any of the following HIV virologic (non-antibody) tests:
• HIV nucleic acid (DNA or RNA) detection test (e.g., polymerase chain reaction [PCR]) Has a CD4 of less than 14 percent total lymphocytes
• HIV p24 antigen test, (excluding neutralization assay)• HIV isolation (viral culture)
HIV Infection Reporting in Florida
HIV Case Reporting in Florida is based on a positive antibody or antigen test for HIV:
HIV (not AIDS) cases became reportable in Florida on 07/1997, but only via confirmatory Western Blot (antibody) HIV tests. Reporting was NOT retroactive. Previously positive tests required re-testing with a confirmatory test before they could become reportable.
Viral load (antigen) HIV tests became reportable in Florida on 11/20/2006.
As of 2009, all states now have confidential name-based HIV infection reporting.
Private MDs Medical Records Death Certificates Laboratories Medical Examiners Counseling & Testing Sites
Correctional Facilities Hospitals (ICD-9), Billing HIV Patient Care Clinics Registries (e.g., AZT, TB,
Cancer)
Reporting Sources of HIV and AIDS Cases
Surveillance for HIV/AIDS relies on reporting from the above sources. Additionally, local public health professionals are responsible for case finding and/or epidemiologic follow-up, resulting in a very high completeness of reporting and decent classification of exposure (risk) category.
The Epidemic in FloridaPopulation in 2013: 19.2 million
(4th in the nation)Newly diagnosed** HIV infections in 2013: 4,864
(2nd in the nation in 2011)Newly diagnosed** AIDS cases in 2013: 2,532
(3rd in the nation in 2011) Cumulative pediatric AIDS cases reported through 2013: 1,547
(2nd in the nation in 2011)
Persons diagnosed and living***with HIV disease through 2012: 105,627
(3rd in the nation in 2010)HIV prevalence estimate through 2012: 125,000
(11.4% of the U.S. estimate for 2010)
HIV incidence estimates 2010: 3,454(There was a 30% decrease from 2007-2010)
HIV-related deaths in 2012: 923(Down 8.2% from 2011.
The first time to ever be under 1,000 deaths in a given year.)
57% White15% Black23% Hispanic 4% Other*
*Other = Asian/Pacific Islanders; American Indians/Alaskan Natives; multi-racial. **Data by year of diagnosis for 2013 are incomplete and should be interpreted with care *** Living (prevalence) data as of 06/30/2013
29% White49% Black20% Hispanic 2% Other*
Pediatric HIV Infection Cases N=2,576
Population Estimates N= 2,870,836
Pediatric* HIV Infection Cases and State Population**
in Children <13 years of age, by Race/Ethnicity, Reported* through 2013, Florida
10%
74%
14% 2%
WhiteBlackHispanicOther
43%
21%
29%
6%
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 130
20
40
60
80
100
120 Aged < 2 years at AIDS diagnosis
Aged >= 2 years at AIDS diagnosis
Year of Diagnosis
Nu
mb
er o
f C
ases
Pediatric AIDS Cases by Age Group at Diagnosis and Year of
Diagnosis, 1990-2013, Florida
These data represent an 90% decline in pediatric AIDS cases by year of diagnosis from 1992 (N=178) to 2013 (N=17). Due to reporting lags, 2013 data by year of diagnosis are provisional. Data as of 03/31/2014.
N=1,545
Perinatally Acquired HIV Infected Cases,Born in Florida,
by Year of Birth, 1979-2013
Birth # % change
2001 382002 21 -45%2003 20 -5%2004 13 -35%2005 14 8%2006 19 36%2007 17 -11%2008 11 -35%2009 9 -18%2010 6 -33%2011 3 -50%2012 8 167%2013 9 13%
Note: These data represent a 92% decline in HIV-perinatally infected births from 1993 (N=110) to 2013 (N=9). These data include ALL perinatally acquired HIV Infection cases BORN in Florida.2013 data are provisional. None of the babies born since 2010 have developed AIDS.Data as of 03/31/2014.
79 81 83 85 87 89 91 93 95 97 99 01 03 05 07 09 11 130
20
40
60
80
100
120
Year of Report
Nu
mb
er o
f C
ases
HIV Infection Case Rates* by County of Residence,**Reported in 2013, Florida
*Population data were provided by Florida CHARTS as of 01/06/2014.**County totals exclude Department of Corrections cases (N=108). Numbers on counties are cases reported.
Statewide Data:N= 5,938
State Rate = 30.9Rate per 100,000 population
0 0.1 to 15.015.1 to 30.0> 30.0
0
1044
0
0
0
0
0
9
5
1
5
5
42
4
7
2
3
2
1
9
1
1
151
18
49
1
1125
19
1
12
13
12
7
6
46
111
4
3
8
3
99
40
72
52 12
46
25
42
71
52
49
161
25
63
210
42
86
414
143625
403
470
341
14
6
110
AIDS Case Rates* by County of Residence,**Reported in 2013, Florida
0 0.1 to 15.015.1 to 30.0> 30.0
Statewide Data:N=3,282
State Rate = 17.1Rate per 100,000 Population
*Population data provided by Florida CHARTS as of 01/06/2014.**County totals exclude Department of Corrections cases (N=66). Numbers on counties are cases reported.
0
0 0
0
0
0
0
0
5
1
5
43
27
79
1
6
4
1
44
8
1
36
2
6
6
1
4
11
60
4
2
6 30
8
37
7
35
10
27
30
83
17
1640
11
151
25
10
38
125
16 4
226
4
7
70911
498
231
310
49
199
70
10
5
Florida Areas
Area 5
Pasco
Pinellas
Area 4
BakerClay
DuvalNassau
St Johns
Area 3
Alachua Bradford Columbia
Dixie Gilchrest Hamilton
Lafayette Levy Putnam
Suwannee Union
Area 10
Broward
Area 8
Charlotte DeSoto
Glades Sarasota
Hendry Collier
Lee
Area 6
Hernando
Hillsborough
Manatee
Area 2a
Bay Calhoun
Gulf Holmes Jackson
Washington
Area 11a
Dade
Area 1
Escambia
Okaloosa
Santa Rosa
Walton
Area 9
Palm Beach
Area 7
Brevard
Orange
Osceola
Seminole
Area 14
Hardee
Highlands
Polk
Area 15
Indian RiverMartin
OkeechobeeSt Lucie
Area 12
Flagler
Volusia
Area 13
CitrusLake
MarionSumter
Area 11b
Monroe
Area 2b
Franklin Gadsden Jackson
Jefferson Leon Liberty
Madison Taylor Wakulla
ES
CA
MB
IA
SA
NTA
RO
SA
OK
ALO
OS
A
WA
LTO
N HOLMES
WS
BAY
JACKSON
CN
GF
LIB
ER
TY
FK
GD
LEON
WK
JF
TAYLOR
MD
SW
LF
DIXIE
LEVY
CB
NASSAU
MARION
PASCO
PT
CLAY
BK DUVAL
ST
JO
HN
S
VL
ORANGE
BR
EV
AR
D
OSCEOLA
POLKHBPN
DESOTO
LEEHENDRY
COLLIER
MARTIN
ST LUCIE
OBHG
10
9
15
7
12
4
3
2
1
13
6
8
14
SS
FG
MONROE DADE
PALM BEACH
GLADESCHARLOTTE
IRHR
SMHN
CTST
LAKE
GC AL
BF
HM
5
11
BROWARD
MA
*Source: Population estimates are provided by FloridaCHARTS
Adult HIV Infection Cases and Population*
by Area, Reported in 2013, Florida
1 2a 2b 3 4 5 6 7 8 9 10 11a 11b 12 13 14 150
5
10
15
20
25
30
% HIV Cases % of Floridas Population
Area
Per
cen
t b
y A
rea
Adult AIDS Cases and Population* by Area, Reported in 2013, Florida
*Source: Population estimates are provided by FloridaCHARTS
1 2a 2b 3 4 5 6 7 8 9 10 11a 11b 12 13 14 150
5
10
15
20
25
% HIV Cases % of Floridas Population
Area
Per
cen
t b
y A
rea
HIV Infection Cases and Rates*,by Year of Report, 2004-2013, Florida
Note: Enhanced laboratory reporting (ELR) laws in 2006 and the expansion of ELR in 2007 led to an artificial peak in newly reported cases of HIV infection in 2008. This was followed by a general decline in reported cases through 2012. Another surge in the expansion of ELR in 2012 was followed by another increase in newly reported cases of HIV infection in 2013. These trends were observed across most race/sex/risk groups throughout the state.*Source: Population estimates are provided by Florida CHARTS as of 01/06/2014.
Year Rate04 44.205 38.906 36.607 37.108 42.109 29.710 26.111 26.612 23.813 30.9
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
1,0002,0003,0004,0005,0006,0007,0008,0009,000
7,7196,954 6,684 6,867
7,853
5,5574,913 5,044 4,531
5,938
Year of Report
Nu
mb
er o
f C
ases
Note: Enhanced laboratory reporting (ELR) laws in 2006 and the expansion of ELR in 2007 led to an artificial peak in newly reported cases of AIDS in 2008. This was followed by a general decline in reported cases through 2012. Another surge in the expansion of ELR in 2012 was followed by another increase in newly reported cases of AIDS in 2013. These trends were observed across most race/sex/risk groups throughout the state.*Source: Population estimates are provided by Florida CHARTS as of 01/06/2014.
AIDS Cases and Rates*,by Year of Report, 2004-2013, Florida
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
1,000
2,000
3,000
4,000
5,000
6,0005,356
4,633 4,829
3,6684,616
4,038
3,173 3,2952,652
3,282
Year of Report
Nu
mb
er o
f C
ases
Year Rate04 30.605 25.906 26.507 19.808 24.809 21.610 16.911 17.412 13.913 17.1
Proportion of Adult HIV Infection Cases, by Sex and
Year of Report, 2004-2013, Florida
Note: In 2013, 77% of the adult HIV infection cases were male, compared to only 70% in 2004. Over the past ten years, the proportion of HIV infection cases among men has increased while the proportion among women has decreased. The result is an increase in the male-to-female ratio, from 2.3:1 in 2004 to 3.3:1 in 2013. The relative increase in male HIV cases might be attributed to proportional increases in HIV transmission among men who have sex with men (MSM).
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
20
40
60
80
100
Year of Report
Pro
po
rtio
n o
f C
ases
M:F Ratio
2004 2.3:1
2013 3.3:1
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
20
40
60
80
Year of Report
Proportion of Adult AIDS Cases, by Sex and
Year of Report, 2004-2013, Florida
Note: Although the proportion of adult AIDS cases among men and women has remained fairly level, the proportion of male AIDS cases increased from 69% in 2004 to 71% in 2013. As the proportion of males increase, the ratio of males-to-females increases as well, thus the male-to-female ratio inclined slightly from 2.3:1 in 2004 to 2.5:1 in 2013.
Pro
po
rtio
n o
f C
ases
M:F Ratio
2004 2.3:1
2013 2.5:1
U.S., 2011N=49,273
Note: Florida has a higher proportion of female cases reported in the most recent year, compared to the U.S.*Source: U.S. data, CDC HIV surveillance report, Vol. 23, Table 1a, 2012 data not available. HIV cases are estimated reports for all 50 states with confidential HIV reporting.
Adult HIV Infection Cases, by Sex,Reported in the United States* and Florida
Florida, 2013N=5,916
77%
23%
79%
21%
MaleFemale
U.S., 2011N=32,052
Note: Florida has a higher proportion of female cases reported in the most recent year, compared to the U.S.*Source: U.S. data, CDC HIV surveillance report, Vol. 23, Table 2a, 2012 data not available.
Adult AIDS Cases by Sex,Reported in the United States* and Florida
Florida, 2013N=3,279
71%
29%
75%
25%
MaleFemale
Note: In 2013, a larger proportion of AIDS cases were reported among women compared to the proportion of HIV infection reported among women.
HIV InfectionN=5,916
AIDSN=3,279
Adult HIV Infection and AIDS Cases, by Sex, Reported in 2013, Florida
77%
23%
MaleFemale
71%
29%
- Amount of HIV already in the community- Late diagnosis of HIV or AIDS*
- Access to/acceptance of care*
- Stigma, denial*,
- Discrimination, homophobia*
- HIV/AIDS complacency*
- Poverty and unemployment
*Factors that HIV/AIDS initiatives can impact.
Underlying Factors Affecting HIV/AIDS Disparities
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
500
1000
1500
2000
2500
3000
3500
Year of Report
Adult HIV Infection Cases, by Race/Ethnicity, and Year of Report, 2004–2013, Florida
Note: Over the past ten years, HIV infection cases decreased among blacks by 32% and among whites by 21%. There was a 1% overall increase among Hispanics for this same period. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.
Num
ber o
f Cas
es
Black
White
Hispanic
Other*
Proportion of Adult HIV Infection Cases, by Race/Ethnicity, and Year of Report, 2004-2013, Florida
Note: From 2004 to 2013, the proportion of adult HIV cases among blacks decreased by 6 percentage points. In contrast, increases were observed among both whites (1 percentage point) and Hispanics (6 percentage points) over this same time period.
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
10
20
30
40
50
60
Year of Report
Prop
ortio
n of
Cas
es
Black
White
Hispanic
Other*
Adult Male HIV Infection Cases, by Race/Ethnicity, and Year of Report, 2004–2013, Florida
Note: Over the past ten years, black men represented the highest proportion (> 35%) of male HIV infection cases by race/ethnicity. From 2004 to 2013, the percentage of male HIV cases increased among Hispanics by 7 percentage points. In contrast, the HIV cases decreased by 1 percentage point among whites and 5 percentage points among blacks over the same time period. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.
2004 2005 2006 2007 2008 2009 2010 2011 2012 201305
101520253035404550
Year of Report
Per
cen
t o
f C
ases
Black
White
HispanicOther*
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
10
20
30
40
50
60
70
80
Year of Report
Adult Female HIV Infection Cases, by Race/Ethnicity, and Year of Report, 2004–2013, Florida
Note: HIV case disparities are more evident among women than men. For the past ten years, black women represented over 63% of the cases each year. From 2004 to 2013, the proportion of cases by race/ethnicity among women remained fairly stable. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.
Black
White
Hispanic
Other*
Per
cen
t o
f C
ases
Adult AIDS Cases, by Race/Ethnicity, and Year of Report, 1990–2013, Florida
Note: This 22 year trend shows the change in the epidemic over time. The peak in AIDS cases in 1993 can be associated with the expansion of the AIDS surveillance case definition. The overall declines in new AIDS cases among all race/ethnic groups are due in part to the success of highly active antiretroviral therapies, introduced in 1996. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 130
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
Year of Report
Nu
mb
er o
f C
ases Black
White
Hispanic
Other*
04 05 06 07 08 09 10 11 12 130
500
1,000
1,500
2,000
2,500
3,000
Year of Report
Adult AIDS Cases, by Race/Ethnicity, and Year of Report, 2004–2013, Florida
Note: The overall declines in new AIDS cases among all race/ethnic groups are due in part to the success of highly active antiretroviral therapies, introduced in 1996. From 2004 to 2013, the proportion of adult AIDS cases decreased by 42% among whites, 41% among blacks and 26% among Hispanics. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.
Nu
mb
er o
f C
ases
Black
White Hispanic
Other*
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
10
20
30
40
50
60
Year of Report
Proportion of Adult AIDS Cases, by Race/Ethnicity, and Year of Report, 2004–2013, Florida
Note: Historically, blacks account for over 50% of the reported AIDS cases each year. Of the adult AIDS cases reported in 2013, 26% were white, compared to 51% black and 21% Hispanic. Over the past 10 years, the proportion of AIDS cases has remained fairly level among all race/ethnic groups. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.
Pro
po
rtio
n o
f C
ases
Black
White Hispanic
Other*
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
10
20
30
40
50
60
Year of Report
Proportion of Adult Male AIDS Cases, by Race/Ethnicity, and Year of Report, 2004-2013, Florida
Note: For most of the past 10 years, black males accounted for nearly 50% of all AIDS cases among men. Over the past ten years, the proportion of adult male AIDS cases decreased among whites (2 percentage points) and blacks (1 percentage point), yet increased among Hispanics (4 percentage points). From 2004 to 2013, the proportion of adult male AIDS cases remained fairly level among the other race/ethnicity group.*Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.
Black
WhiteHispanic
Other*
Pro
po
rtio
n o
f C
ases
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
10
20
30
40
50
60
70
80
Year of Report
Proportion of Adult Female AIDS Cases, by Race/Ethnicity, and Year of Report, 2004–2013, Florida
Note: AIDS case disparities are more evident among women than men. From 2004 to 2013, black women represented 70% or more of the female AIDS cases for most of the years. *Other includes American Indian/Alaska Native, Asian/Pacific Islander, and multi-racial.
Black
White
Hispanic
Other*
AIDSN=32,052
2011 U.S.Population Data
N=311,587,816
HIV**N=49,273
Total HIV and AIDS Cases Diagnosed in 2011 and Population, by Race/Ethnicity, United States*
Note: In 2011, blacks are over-represented among the HIV and AIDS cases, accounting for 47% of HIV cases and 50% of AIDS cases, but only 13% of the population. Similarly, Hispanics represent 17% of the population and account for 21% of the HIV cases and 20% of the AIDS cases. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. *Source: U.S. data, CDC HIV surveillance report, Vol. 23, Tables 1a & 2a, 2012 data not available, **HIV infection data are estimated reports from all 50 states with confidential name-based HIV infection reporting.***Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races.
28%
47%
21%
4%
26%
50%
20%
4%
63%
13%
17%
7%
White Black Hispanic Other*
AIDSN=3,279
2013 Florida* Population Estimates
N=16,344,612
HIVN=5,916
Note: Blacks comprise only 15% of the adult population in Florida, but represent 43% of adult HIV infection cases and 51% of adult AIDS cases reported in 2013. Hispanics comprise 22% of Florida’s adult population, yet account for 26% of the HIV infection cases and 21% of the AIDS cases.*Source: Population estimates are provided by Florida CHARTS as of 02/05/2014.**Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races.
Adult HIV Infection and AIDS Cases Reported in 2013 and Population,
by Race/Ethnicity, Florida
30%
43%
26%
2%
26%
51%
21%
2%
59%
14%
22%
4%
White Black Hispanic Other*
Note: In this snapshot of 2013, HIV cases by race/ethnicity among males is more evenly split compared to HIV cases among females where blacks are over-represented, accounting for 66% of adult cases among women. *Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races
Adult HIV Infection Cases, by Sex and Race/Ethnicity,
Reported in 2013, FloridaMales
N=4,542FemalesN=1,374
34%
36%
29%2%
17%
66%
16% 1%
White Black Hispanic Other*
Adult AIDS Cases, by Sex and Race/Ethnicity,
Reported in 2013, Florida
MalesN=2,336
FemalesN=943
Note: In this snapshot of 2013, blacks are over-represented among the AIDS cases, accounting for 44% of adult cases among men and 69% of the adult cases among women. *Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races
30%
44%
24%2%
14%
69%
14% 3%
White Black Hispanic Other*
THE FORMULA USED FOR CALCULATING THE RATE
IS:
– A specific example, using Florida AIDS data:
Number of AIDS Cases Reported in 1996 X 100,000 = 7,300 X 100,000 Estimated Population of Florida in 1996 14,000,000
= 52.1 per 100,000 population(This is the same rate as 5.21 per 10,000 population or 0.521 per 1,000 or0.0521 percent.)
Rates allow direct comparison of the burden of disease on various communities, by taking the population size into account.
RATE = Number of cases in a specified time X 100,000Population at that time
HIV Infection and AIDS Cases and Rates*
Among Adult Males by Race/EthnicityReported in 2013, Florida
AIDS rate ratios: Black-to-White – 6.1:1 Hispanic-to-White – 2.1:1
HIV AIDSRace/Ethnicity Cases Rate Cases RateWhite 1,537 32.6 706 15.0Black 1,629 145.0 1,024 91.2Hispanic 1,297 72.4 562 31.4Other 79 26.3 44 14.6
Total 4,542 57.3 2,336 29.5
HIV rate ratios: Black-to-White – 4.4:1 Hispanic-to-White – 2.2:1
*Source: Population estimates are provided by Florida CHARTS as of 02/05/2014.
AIDS rate ratios: Black-to-White – 19.4:1 Hispanic-to-White – 2.6:1
HIV AIDSRace/Ethnicity Cases Rate Cases RateWhite 231 4.7 132 2.7Black 901 72.3 654 52.5Hispanic 224 12.1 132 7.1Other 18 5.2 25 7.2
Total 1,374 16.3 943 11.2
HIV rate ratios: Black-to-White – 15.4:1 Hispanic-to-White – 2.6:1
HIV Infection and AIDS Cases and Rates* Among Adult Females by Race/Ethnicity
Reported in 2013, Florida
*Source: Population estimates are provided by Florida CHARTS as of 02/05/2014.
Note: Similar to AIDS, black men and, to an even greater extent, black women are over-represented in the HIV epidemic. The HIV case rate for 2013 is nearly 5 times higher among black men than the rate among white men. Among black women, the HIV case rate is 15-fold greater than the rate among white women. Hispanic male and female HIV case rate is higher than the rate among their white counterparts. *Source: Population estimates are provided by Florida CHARTS as of 02/05/2014.
Adult HIV Infection Case Rates* by Sex and Race/Ethnicity, Reported in 2013, Florida
Rate Ratios:MALES Black:White, 4.4:1 Hispanic:White, 2.2:1
FEMALES Black:White, 15.4:1 Hispanic:White, 2.6:1
Male Female0
20
40
60
80
100
120
140
160
32.6
4.7
145
72.372.4
12.1
White Black Hispanic
Rat
e p
er 1
00,0
00
Adult AIDS Case Rates* by Sex and Race/Ethnicity, Reported in 2013, Florida
Note: Black men are over-represented in the HIV epidemic. In 2013, the AIDS case rate among black males is 6 times higher than the rate among white males. Among black females, the AIDS case rate is 19-fold greater than the rate among white females. Both Hispanic male and female case rate is higher than the rate among their white counterparts. *Source: Population estimates are provided by Florida CHARTS as of 02/05/2014.
Rate Ratios: MALES Black:White, 6.1:1 Hispanic:White, 2.1:1
FEMALES Black:White, 19.4:1 Hispanic:White, 2.7:1
Male Female0
10
20
30
40
50
60
70
80
90
100
15
2.7
91.2
52.5
31.4
7.1
White Black Hispanic
Rat
e p
er 1
00,0
00
*Source: CDC HIV surveillance report, Vol. 23, Tables 1a & 2a, 2012 data not available.**HIV cases are for all 50 states with confidential HIV reporting.Note: All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting.
Adult Cases, by Age Group at Diagnosis, Diagnosed in 2011, United States*
AIDSN=32,037
HIV Infection**N=49,081
13-19 20-29 30-39 40-49 50+0
5
10
15
20
25
30
35
5
32
23 23
17
Pe
rce
nt
of
Ca
se
s
13-19 20-29 30-39 40-49 50+0
5
10
15
20
25
30
35
2
18
25
31
24
Pe
rce
nt
of
Ca
se
s
Note: HIV cases tend to be younger than AIDS cases. The greatest proportion of HIV infection cases reported in 2013 were among those aged 20-29 (26%), followed by those aged 40-49 (25%). Conversely, the largest proportion of AIDS cases reported in 2013 was among persons aged 40-49 (30%), followed by those in the 50 and older age group with 29%.
Age Distribution of Adult HIV Infection CasesCompared with the Age Distribution of
Adult AIDS Cases, Reported in 2013, Florida
AIDSN=3,279
HIV InfectionN=5,916
13-19 20-29 30-39 40-49 50+0
5
10
15
20
25
30
35
3
2623
2523
Pe
rce
nt
of
Ca
se
s
13-19 20-29 30-39 40-49 50+0
5
10
15
20
25
30
35
1
15
24
30 29
Pe
rce
nt
of
Ca
se
s
Note: HIV cases tend to reflect more recent transmission than AIDS cases, and thus present a more current picture of the epidemic. With regard to the age group with the highest percent of HIV infection cases, recent estimates show that among males, 28% of HIV infection cases occur among those in the 20-29 age group, whereas among females, 27% of HIV infection cases occur among those in the 50 and older age group.
Adult HIV Infection Cases, by Sex and Age Group at Diagnosis, Reported in 2013, Florida
MalesN=4,542
FemalesN=1,374
13-19 20-29 30-39 40-49 50+0
5
10
15
20
25
30
3
28
23 2422
Pe
rce
nt
of
Ca
se
s
13-19 20-29 30-39 40-49 50+0
5
10
15
20
25
30
4
20
23
26 27
Pe
rce
nt
of
Ca
se
s
Note: In 2012, recent estimates show that among males, 30% of HIV infection cases occur among those aged 40-49 and 50+ (respectively for both), whereas among females, 30% of HIV Infection Cases occur among those in the 50+ age group.
Adult AIDS Cases, by Sex and Age Group at Diagnosis, Reported in 2013, Florida
MalesN=2,336
FemalesN=943
13-19 20-29 30-39 40-49 50+0
5
10
15
20
25
30
35
1
17
24
29 29
Pe
rce
nt
of
Ca
se
s
13-19 20-29 30-39 40-49 50+0
5
10
15
20
25
30
35
1
11
25
33
29
Pe
rce
nt
of
Ca
se
s
Over the past ten years, the proportion of newly reported adult HIV cases has shown increases for both the 20-29 (7 percentage points) and 50+ (7 percentage points) age groups. In contrast, the proportion of newly reported adult HIV cases among those in the 30-39 and 40-49 age groups decreased by 10 and 4 percentage points respectively, over the same time period.
Adult HIV Infection Cases, by Age Group at Diagnosis, and Year of Report, 2004–2013, Florida
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
5
10
15
20
25
30
35
13-19 20-29 30-39 40-49 50 +
Year of Report
Pro
po
rtio
n o
f C
ases
Adult AIDS Cases, by Age Group at Diagnosis, and Year of Report, 2004–2013, Florida
Over the past ten years, the proportion of newly reported cases has shown increases for both the 20-29 and 50+ age groups. The 20-29 age group increased by 4 percentage points and the 50+ age group increased by 8 percentage points over the past ten years. In contrast, the 30-39 age group decreased by 8 percentage points and the 40-49 age group decreased by 5 percentage points over the past ten years. The 13-19 age group remained relatively level throughout the years.
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
5
10
15
20
25
30
35
40
13-19 20-29 30-39 40-49 50 +
Year of Report
Pro
po
rtio
n o
f C
ases
Definitions of Mode of Exposure Categories
MSM = Men who have sex with men
IDU = Injection Drug Use
MSM/IDU = Men who have sex with men & Injection Drug Use
Heterosexual = Heterosexual contact with person with HIV/AIDS or known HIV risk
OTHER = includes hemophilia, transfusion, perinatal and other pediatric risks and other confirmed risks.
NIR = Cases reported with No Identified Risk
Redistribution of NIRs = This illustrates the effect of statistically assigning (redistributing) the NIRs to recognized exposure (risk) categories by applying the proportions of historically reclassified NIRs to the unresolved NIRs.
U.S. (2011)N=49,081
Florida (2013)N=5,916
Adult HIV Infection Cases by Mode of Exposure,Reported in the United States* and Florida
Note: NIRs redistributed. Similar to the AIDS data, the estimated proportion of reported MSM cases for the US is higher than that of Florida (62% vs. 59% respectively). Also, the proportion of IDU cases are higher in the U.S. (8% vs. 5%) and heterosexual cases are lower (27% vs. 34%) when compared to HIV Infection cases reported in Florida. *Source: US data, CDC HIV surveillance report, Vol. 23, Table 1a, (from all 50 states) 2012 data not available.
62%
7%
3%
27%
<1% MSM
IDU
MSM/IDU
Heterosexual
Other59%
5%
2%
34%
<1%
U.S. (2011)N=32,037
Florida (2013)N=3,279
Adult AIDS Cases by Mode of Exposure,Reported in the United States* and Florida
Note: NIRs redistributed. The proportion of MSM cases for the US is much higher than that of Florida (52% vs. 45% respectively). Additionally, the proportion of IDU cases are higher in the US (12% vs. 8%). The proportion of heterosexual cases are much lower for the US than that of Florida (31% vs. 43%). *Source: US data, CDC HIV surveillance report, Vol. 23, Table 2a, from all 50 states, 2012 data not available.
52%
12%
4%
30%1% MSM
IDU
MSM/IDU
Heterosexual
Other45%
8%
3%
43%
1%
45%
8%
3%
43%
1%
AIDSN=3,27
9
HIV InfectionN=5,916
Adult HIV Infection and AIDS Cases, by Mode of Exposure,
Reported in 2013, Florida
Note: NIRs redistributed. In 2013, men who have sex with men (MSM) exposure (59%) was the highest risk for newly reported HIV cases followed by heterosexual sex (34%). Similarly, MSM exposure (45%) was the highest risk for newly reported AIDS cases, followed by heterosexual sex (43%). The higher proportion of MSM among HIV cases compared to AIDS cases, is indicative of a possible resurgence of HIV among MSM, as HIV cases represent a more recent picture of the epidemic.
59%
5%
2%
34%
0% MSM
IDU
MSM/IDU
Heterosexual
Other
Note: NIRs redistributed. For HIV infection and AIDS cases in men reported in 2013, men who have sex with men (MSM) was the most common risk factor (77% and 64% respectively) followed by cases with a heterosexual risk (17% for HIV and 26% for AIDS). HIV cases tend to represent a more recent picture of the epidemic.
AIDSN=2,336
HIV Infection N=4,542
Adult Male HIV Infection and AIDS Cases, by Mode of Exposure,
Reported in 2013, Florida
77%
4% 2% 16%
<1%
MSM
IDU
MSM/IDU
Heterosexual
Other
64%
7%
4%
26%<1%
12%
87%
1%
Note: NIRs redistributed. Among the female HIV and AIDS cases reported for 2013, heterosexual contact was the highest risk (91% and 87% respectively).
AIDSN=943
HIV InfectionN=1,374
Adult Female HIV Infection and AIDS Cases, by Mode of Exposure,
Reported in 2013, Florida
8%
91%
1%
IDUHeterosexualOther
Note: NIRs redistributed. Men who have sex with men (MSM) remains as the primary mode of exposure among male HIV cases in Florida, followed by heterosexual contact.
Adult Male HIV Infection Cases, by Mode of Exposure and
Year of Report, 2004–2013, Florida
04 05 06 07 08 09 10 11 12 130
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
MSM IDU MSM/IDU Heterosexual
Year of Report
Cas
es
Note: NIRs redistributed. The heterosexual risk continues to be the dominant mode of exposure among females.
Adult Female HIV Infection Cases, by Mode of Exposure and
Year of Report, 2004–2013, Florida
04 05 06 07 08 09 10 11 12 130
500
1,000
1,500
2,000
2,500IDU Heterosexual
Year of Report
Cas
es
Note: NIRs redistributed. Men who have sex with men (MSM) remains as the primary mode of exposure among male HIV cases in Florida, followed by heterosexual contact.
Adult Male AIDS Cases, by Mode of Exposure and
Year of Report, 2004–2013, Florida
04 05 06 07 08 09 10 11 12 130
500
1,000
1,500
2,000
2,500
MSM IDU MSM/IDU Heterosexual
Year of Report
Cas
es
Note: NIRs redistributed. The heterosexual risk continues to be the dominant mode of exposure among females with AIDS.
Adult Female AIDS Cases, by Mode of Exposure and
Year of Report, 2004–2013, Florida
04 05 06 07 08 09 10 11 12 130
200
400
600
800
1,000
1,200
1,400
IDU Heterosexual
Year of Report
Cas
es
85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 130
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%No. Tested % Positive
Year of HIV Test
No.
Tes
ted
% P
ositi
ve
HIV Tests Conducted in Florida and Seropositivity Rates*, 1986-2013
*Seropositivity rates are defined as the percent of positive over the number of tests conducted each year.
AIDS-Defining Conditions* Most Commonly Reported Among Adults,
Reported in 2013, Florida
AIDS Defining Condition # Cases % Cases
No Disease (Immune suppressed only)** 2,764 86%
Pneumocystis carinii pneumonia 148 5%
Wasting Syndrome 69 2%
Candidiasis, esophageal 128 4%
Toxoplasmosis of brain 28 1%
Pneumonia, recurrent 15 0%
Pulmonary Tuberculosis 28 1%
Herpes simplex virus 15 0%
HIV encephalopathy 15 0%
Kaposi's sarcoma 18 1%
Lymphomas (brain, Burkitt's or immunoblastic) 15 0%
Cytomegalovirus (CMV) disease 15 0%
Candidiasis, lung 8 0%
Cryptococcosis, extrapulmonary 8 0%
Total Cases 3,226
*Note: data are NOT mutually exclusive, many cases have more than one disease.**Immune suppressed: CD4 count <200ul or CD4 percent <14%.
Impact of STDs on HIV Infection
Early detection and treatment of Sexually Transmitted Diseases (STDs) has a major impact on sexual transmission of HIV.
Much of heterosexually transmitted HIV infections can be prevented by reducing other underlying STDs.
STDs increase HIV infectivity and susceptibility.
Chlamydia Cases, by Sex and Race/Ethnicity,Reported in 2013, Florida
MalesN=23,518
FemalesN=56,783
Note: 26% of these cases are among adolescents, ages 13-19.*Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races.
22%
42%
11%
25%
WhiteBlackHispanicOther
25%
38%
11%
26%
Gonorrhea Cases, by Sex and Race/Ethnicity, Reported in 2013, Florida
MalesN=11,178
FemalesN=9,712
Note: 19% of these cases are among adolescents, ages 13-19.*Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races.
19%
53%
10%
19%WhiteBlackHispanicOther
22%
55%
6% 17%
Primary and Secondary Syphilis Cases,by Sex and Race/Ethnicity,Reported in 2013, Florida
MalesN=1,383
FemalesN=133
Note: 6% of these cases are among adolescents, ages 13-19.*Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races.
33%
33%
27% 8% White
BlackHispanicOther 14%
71%
5%11%
Chlamydia*, Gonorrhea, Syphilis** and HIV Rates, Reported 1989-2013, Florida
* Note: Chlamydia data available starting 1994.** Note: Syphilis data include both Primary and Secondary Syphilis. Source: Data from 1988 to 2012 have been validated using Florida CHARTS as of 4/18/2014. FloridaCHARTS.com is provided by the Florida Department of Health, Division of Public Health Statistics and Performance Management. 2013 data is provisional as of 4/15/2014.
89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 130
100
200
300
400
500
600Chlamyda Gonorrhea Syphilis HIV
Year of Report
Rat
e p
er 1
00,0
00
Chlamydia, Gonorrhea, Syphilis* and HIV Cases, Reported 2004-2013, Florida
* Note: Syphilis data include both Primary and Secondary Syphilis. Source: STD data validated through Florida CHARTS as of 4/18/2014. FloridaCHARTS.com is provided by the Florida Department of Health, Division of Public Health Statistics and Performance Management. 2013 data is provisional as of 4/15/2014.
04 05 06 07 08 09 10 11 12 130
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000Chlamyda Gonorrhea Syphilis HIV
Year of Report
Cas
es
Florida’s Top-9 Priority Populations in 2013for Primary and Secondary HIV Prevention
Based on HIV Infection Cases, Reported 2011-2013
1. Black Heterosexual men and women2. White Men who have sex with Men3. Black Men who have sex with Men4. Hispanic Men who have sex with Men5. Hispanic Heterosexual men and women6. White Heterosexual men and women7. Black Injection Drug User 8. White Injection Drug User9. Hispanic Injection Drug User
Note: Florida’s top-9 priorities have remained the same since 2010.
“The reason for collecting, analyzing and
disseminating information on a disease is to control that disease. Collection
and analysis should not be allowed to consume
resources if action does not follow.”
--Foege WH et al. Int. J of Epidemiology 1976; 5:29-37
For Florida HIV/AIDS Surveillance DataContact: (850) 245-4444
Lorene Maddox, MPH Ext. 2613 Tracina Bush, BSW Ext. 2612 Madgene Moise, MPH Ext. 2373
Visit Florida’s internet site for:Monthly Surveillance Reports
Slide Sets and Fact SheetsAnnual Reports and Epi Profiles
http://www.doh.state.fl.us/disease_ctrl/aids/trends/trends.html
Visit CDC’s HIV/AIDS internet site for:Surveillance Reports, fact sheets and slide sets
http://www.cdc.gov/hiv/topics/surveillance/resources/reports/index.htm