hiv/aids in special population groups in texas

Douglas A. ShehanUniversity of Texas Southwestern Medical Center-In collaboration with Texas Department of State Health Services-

17th Texas HIV/STD Conference, May 2010

Our Emerging Challenge: HIV Testing and Treatment Among Hispanics in TexasOur Emerging Challenge: HIV Testing and Treatment Among Hispanics in Texas

Texas Department of State Health Services 2

Outline: HIV Testing & Treatment Among Hispanics

Overview: The Hispanic population in Texas and our emerging HIV challenge

Exploring the Data Data Sources Emerging Patterns

Summary


Growing Hispanic Population in Texas

Hispanics are the largest and fastest-growing minority in Texas

From 2000 to 2007 this population grew by 12% In 2007 Hispanics represented 37% of Texans

By 2020, the Hispanic population is expected to outnumber the White population in Texas.

Source: The Texas Data Center and the Office of the State Demographer


Growing Hispanic Population in Texas

Race/Ethnicity

Population by Year1980 Population

millions(% of the population)

2040 Projected Population

millions(% of the population)

Hispanic3.0

(21%)18.8

(53%)

Black1.7

(12%)3.4

(10%)

White9.4

(66%)11.5

(32%)

Projected Texas Population by Specified Race/Ethnicity 1980 to 2040

Source: The Texas Data Center and the Office of the State Demographer


Emerging Challenge: HIV/AIDS Among Hispanic Persons in TX

Advances in HIV treatments have slowed the progression of HIV infection to AIDS and have led to dramatic decreases in deaths among persons with AIDS, yet the HIV/AIDS epidemic is a increasing problem among Hispanics in Texas.

In 2007: Over 1,200 Hispanics were newly diagnosed with

HIV/AIDS Approximately 15,000 Hispanics were known to be

living with HIV Over 800 Hispanics were diagnosed with AIDS


Emerging Challenge: HIV/AIDS Among Hispanic Persons in TX

Hispanics living with HIV/AIDS in Texas 2007


Increasing Proportion of AIDS Cases among Hispanics in TX

Number and Proportion of AIDS Cases Among Hispanics in Texas, 1990-2007

0

200

400

600

800

1000

1200

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year of Diagnosis

No.

of Cas

es

0%

5%

10%

15%

20%

25%

30%

35%

Ca

se

s, %


Increasing Proportion of AIDS Cases among Hispanics in TX

Proportion of AIDS Cases by Race/Ethnicity Texas, 1990-2007

0

10

20

30

40

50

60

90 91 92 93 94 95 96 97 98 99 '00 '01 02 03 04 05 06 07

Year of Diagnosis

% C

ases

Black

Hispanic

White

Other


Emerging Challenge: Increasing Proportion of AIDS Cases

Reasons the proportion of AIDS cases may be increasing among Hispanics in Texas Not testing or testing less frequently Getting into care later

Consequences May unknowingly infect others May unknowingly become co-infected with other STIs

and/or drug-resistant strains of HIV Quicker progression to AIDS Could lead to poor health outcomes including death


Exploring our Data: Data Sources

Examined and compared available Texas surveillance data to assess HIV testing and treatment among Hispanic persons in Texas

Descriptive analyses of data from: Behavioral Risk Factor Surveillance System (BRFSS) Texas HIV/AIDS surveillance Enhanced Perinatal Surveillance (EPS) HIV Incidence Surveillance (HIS) Medical Monitoring Project (MMP) Texas’ Response: Hispanic Male Community

Assessment


Behavioral Risk Factor Surveillance System (BRFSS)

Annual random-digit-dialed telephone survey

Administered in collaboration with the Centers for Disease Control and Prevention (CDC)

The 2007 Texas BRFSS administered questions about HIV testing history to 12,261 persons aged 18 to 64

Survey data were weighted: by demographic characteristics to account for differences in selection probabilities


BRFSS: HIV Testing Behavior

Race/Ethnicity

HIV Testing HistoryEver Tested Tested in Past Year

Hispanic 41% 15%

Black 64% 28%

White 41% 10%

Ever Tested for HIV among persons aged 18-64 years, Texas, 2007


BRFSS: Testing Facility

Type of Facility where Last HIV Test was Received, Texas, 2007

0

10

20

30

40

50

60

PrivateDr/HMO

Hospital Clinic Counselingand Testing

% C

ases

Hispanic Black White


Texas HIV/AIDS Surveillance

In Texas, AIDS has been a reportable condition since 1983, and HIV became reportable by name in 1999

Key HIV/AIDS surveillance data collected include:

Demographic characteristics (sex, race/ethnicity, age, locality)

Mode of transmission

Opportunistic infections

Virologic and immunologic status

Enhanced perinatal surveillance data elements

Evaluated HIV/AIDS surveillance data of cases diagnosed through 2007 and reported as of May 2009


Surveillance: Progression to AIDS w/in 1 Year of Dx, 2007

Progression to AIDS within 1 Year of HIV Diagnosis, Texas 2007

40%

28%30%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%



49%

56%

0%

10%

20%

30%

40%

50%

60%

70%

Foreign Born Born in US

Surveillance: Progression to AIDS w/in 1 Year of Dx, 2007

Progression to AIDS within 1 Year of HIV Diagnosis Among Hispanic Persons,by Country of Origin, Texas 2007

Country of Origin* Persons with unknown country of birth were excluded from analysis


EPS: HIV+ Women Delivering, Texas 1999-2008

Proportion of HIV+ Women Delivering by Race/Ethnicity, Texas, 1999-2008

0

10

20

30

40

50

60

70

99 00 01 02 03 04 05 06 07 08

Year of Delivery

% C

ases

Black

Hispanic

White

Unknown/Other


EPS: HIV+ Women Delivering, Texas 2007

Proportion of HIV+ Women Delivering an infected infant by Race/Ethnicity, Texas, 2007

36%

27% 27%

0%

5%

10%

15%

20%

25%

30%

35%

40%


% C

ases

HIV+ Women Delivering an Infected Infant


EPS: HIV+ Women Delivering an Infected Infant, 2003-2007

38% of Hispanic women were diagnosed at or after delivery 25% of Black women and 38% of White women were

diagnosed at or after delivery

29% of Hispanic women received antiretroviral (ARV) therapy at the three recommended intervals 52% of Black women and 50% of White women

received ARV therapy at the three recommended intervals


HIV Incidence Surveillance (HIS)

HIS provides estimates of the number of newly acquired HIV infections

The HIV incidence estimate is generated using: STARHS (Serologic Testing Algorithm for Recent HIV

Seroconversion) tests results A test that distinguishes between recent and long-

standing HIV infection on a population level HIV testing history data

Evaluated HIV incidence data on cases diagnosed in 2008 and reported by early 2010


Based on the HIS data the Texas Department of State Health Services estimates that there were over 5,000 newly acquired HIV infections in Texas in 2008

The Hispanic population accounted for 30% of these newly acquired HIV infections The Black population accounted for 38% The White/Other population accounted for 32%

Incidence Surveillance: 2008 Incidence Estimate


Race/Ethnicity Estimated Percentages

Newly infected in 2008 and not diagnosed in 2008

Hispanic 58%

Black 52%

White/Other 47%

Overall 52%

Incidence Surveillance: 2008 Incidence Estimate


Texas Medical Monitoring Project (MMP)

Texas MMP collects information about people living with HIV receiving medical care in Texas

Data acquired from 232 patient interviews and medical record abstractions

2005 and 2007 Texas MMP data were used to evaluate delay in starting care (excludes Houston data)


MMP: Delay in Starting Care, 2005 & 2007

13%

8%

21%

0%

5%

10%

15%

20%

25%


Percentage of persons starting care more than 3 months after diagnosis


MMP: Reason Hispanic Persons Start Care Later

Top reasons cited for not starting care:

Didn’t want to think about being HIV positive

Felt good/didn’t want to go

Was unable to get an earlier appointment


Texas’ Response: Hispanic Male Community Assessment

Qualitative study to identify barriers to testing and care

Conducted between June and September 2008

Assessment involved key informant interviews and focus groups in East Texas, El Paso, the Valley and San Antonio Eight focus groups Three key informant interviews


Findings: Hispanic Male Community Assessment

Barriers to testing and care: Location/business hours of testing sites Little advertisement of available services Stigma associated with HIV and other STIs Cost of healthcare

Other social/cultural barriers to testing and treatment: Machismo (too “manly” to get sick) Discussion of sexual topics taboo in the Latino

community


Summary

Hispanics are the largest and fastest growing minority in Texas

The HIV/AIDS epidemic is a growing among Hispanics in Texas with an increasing proportion of AIDS cases among Hispanics

When compared to other racial/ethnic populations in Texas, the Hispanic population is: More likely to be unaware of their HIV status Less likely to have reported testing in the last year or ever

tested More likely to delay starting care after diagnosis More likely to progress to AIDS within 1 year of HIV diagnosis

Effective measures need to be implemented to increase HIV testing and earlier access to treatment among Hispanics in Texas


Acknowledgments

Presentation co-authors/contributors: Texas Department of State Health Services

Elvia Ledezma, MPH Jennifer Chase, MSPH Jonathon Poe, MSSW Margaret Hawthorne, MPH Miranda Leathers Fanning, MPH Nita Ngo, MPH Sharon Riley, MA Tammy Sajak, MPH

University of Texas Southwestern Medical Center Douglas A. Shehan


Questions?

Contact Information: [email protected]

hiv/aids in special population groups in texas

Health & Medicine