October 15, 2012 Geographic Differences in HIV Infection Among ...

Morbidity and Mortality Weekly Report Weekly / Vol. 61 / No. 40

October 12, 2012

Geographic Differences in HIV Infection Among Hispanics or Latinos — 46 States and Puerto Rico, 2010

National Latino AIDS Awareness Day — October 15, 2012 National Latino AIDS Awareness Day is observed each year to increase awareness of the disproportionate impact of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) on the Hispanic or Latino population in the United States. In 2009, the estimated percentage of persons in the United States with HIV infection who did not know they were infected was 19.7% among Hispanics or Latinos, compared with 14.8% among nonHispanic whites (1). National Latino AIDS Awareness Day, October 15, 2012, is an opportunity to encourage increased HIV prevention activities, such as HIV testing and linkage to care and treatment, for Hispanics or Latinos. Two of the goals of the National HIV/AIDS Strategy are to reduce HIV incidence and to reduce HIV-related disparities (2). For 2009, estimates of HIV incidence indicated that Hispanics or Latinos had a rate of 26.4 per 100,000 population, compared with 9.1 for non-Hispanic whites (3). CDC supports testing, access to care and treatment, and a range of other efforts to reduce HIV infection among Hispanics or Latinos. Additional information about CDC activities for National Latino AIDS Awareness Day and HIV resources is available at http://www.cdc.gov/hiv/latinos/index.htm. References 1. CDC. Monitoring selected national HIV prevention and care objectives using HIV surveillance data—United States and 6 U.S. dependent areas—2010. HIV surveillance supplemental report 2012;17(No. 3, part A). Available at http://www.cdc.gov/hiv/ surveillance/resources/reports/2010supp_vol17no3/index.htm. Accessed October 4, 2012. 2. Office of National AIDS Policy. The National HIV/AIDS strategy for the United States and the National HIV/AIDS strategy: federal implementation plan. Washington, DC: Office of National AIDS Policy; 2010. Available at http://www.whitehouse.gov/onap/nhas. Accessed October 10, 2012. 3. Prejean J, Song R, Hernandez A, et al. Estimated HIV incidence in the United States, 2006–2009. PLoS ONE 2011;6:e17502.

In the United States, Hispanics or Latinos are disproportionately affected by infection with human immunodeficiency virus (HIV). In 2010, new diagnoses of HIV infection among Hispanics or Latinos occurred at an annual rate that was 2.8 times that of non-Hispanic whites (20.4 versus 7.3 per 100,000 persons) (1). To further assess HIV infection among Hispanics or Latinos in the United States, CDC analyzed the geographic distribution of new diagnoses in 2010 in 46 states and Puerto Rico and the characteristics of those diagnosed. The results of this analysis determined that a lower percentage of infections were attributed to male-to-male sexual contact in Puerto Rico than in the 46 states (36.1% versus 66.5%) and a higher percentage were attributed to heterosexual contact (40.7% versus 22.0%) or injection-drug use (IDU) (20.4% versus 8.6%). In the 46 states, the rate of new diagnoses of HIV infection among Hispanics or Latinos in the Northeast Census region in 2010 (55.0 per 100,000 persons) was more

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Morbidity and Mortality Weekly Report

than twice as high as in other regions, and a higher percentage of those with a new HIV diagnosis were born in Puerto Rico or had their HIV infection attributed to IDU, compared with other regions. Geographic differences in HIV infection among Hispanics or Latinos should be addressed with HIV testing, prevention, and treatment efforts tailored to specific communities. Data were analyzed for Hispanics or Latinos* with newly diagnosed HIV infection in 2010 who were aged ≥13 years at HIV diagnosis and for those living with a diagnosis of HIV infection who were aged ≥13 years at the end of 2009. The data were reported to CDC through June 2011 by Puerto Rico, which represented 98.1% of Hispanics or Latinos diagnosed with HIV infection in five U.S. dependent areas† in 2010, and the 46 states. All of these reporting areas have had confidential, name-based HIV infection reporting since at least January 2007. The numbers and percentages of HIV diagnoses in 2010 among Hispanic or Latino adolescents and adults in each U.S. Census region§ and Puerto Rico were calculated by sex, age group, transmission category, residence at diagnosis, and place of birth. The * Hispanics or Latinos might be of any race. † The five U.S. dependent areas are American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands. § Northeast: Connecticut, Maine, New Hampshire, New Jersey, New York, Pennsylvania, and Rhode Island; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.

number of diagnoses of HIV infection was adjusted for reporting delay but not for incomplete reporting. Multiple imputation was used to assign a transmission category to those cases missing risk information (2,3). The number of persons living with a diagnosis of HIV infection (prevalence of diagnosed HIV infection) was further adjusted to account for the delay in reporting of deaths among persons with HIV. Where possible, rates per 100,000 persons were calculated based on postcensal estimates of Hispanic populations from the U.S. Census Bureau (4).

New Diagnoses of HIV Infection In 2010, an estimated total of 10,731 Hispanics or Latinos were newly diagnosed with HIV infection in 46 states (9,620 [89.6%]) and Puerto Rico (1,111 [10.4%]) (Table 1). By category, 83.2% were males, 63.4% were men who had sex with men, and 86.4% were urban residents; infection was most common (32.4%) among persons aged 25–34 years. Among the 8,966 (83.6%) cases with birthplace data available, 54.4% of new diagnoses were in persons born outside of the 50 states and the District of Columbia; the highest percentages were from Mexico (19.4%) and Puerto Rico (15.8%). Compared with new diagnoses of HIV infection among Hispanics or Latinos in the 46 states, lower percentages of diagnoses in Hispanics or Latinos in Puerto Rico were among males (75.3% versus 84.1%), men who had sex with men (36.1% versus 66.5%), and urban residents¶ (69.8% versus 88.3%); higher percentages were among ¶ Residents

of metropolitan areas with ≥500,000 population.

The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. Suggested citation: Centers for Disease Control and Prevention. [Article title]. MMWR 2012;61:[inclusive page numbers].

Centers for Disease Control and Prevention

Thomas R. Frieden, MD, MPH, Director Harold W. Jaffe, MD, MA, Associate Director for Science James W. Stephens, PhD, Director, Office of Science Quality Stephen B. Thacker, MD, MSc, Deputy Director for Surveillance, Epidemiology, and Laboratory Services Stephanie Zaza, MD, MPH, Director, Epidemiology and Analysis Program Office

MMWR Editorial and Production Staff

Ronald L. Moolenaar, MD, MPH, Editor, MMWR Series Maureen A. Leahy, Julia C. Martinroe, John S. Moran, MD, MPH, Deputy Editor, MMWR Series Teresa F. Rutledge, Managing Editor, MMWR Series Stephen R. Spriggs, Terraye M. Starr Douglas W. Weatherwax, Lead Technical Writer-Editor Visual Information Specialists Donald G. Meadows, MA, Jude C. Rutledge, Writer-Editors Quang M. Doan, MBA, Phyllis H. King Martha F. Boyd, Lead Visual Information Specialist Information Technology Specialists

MMWR Editorial Board

William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Matthew L. Boulton, MD, MPH, Ann Arbor, MI Dennis G. Maki, MD, Madison, WI Virginia A. Caine, MD, Indianapolis, IN Patricia Quinlisk, MD, MPH, Des Moines, IA Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA Patrick L. Remington, MD, MPH, Madison, WI David W. Fleming, MD, Seattle, WA John V. Rullan, MD, MPH, San Juan, PR William E. Halperin, MD, DrPH, MPH, Newark, NJ William Schaffner, MD, Nashville, TN King K. Holmes, MD, PhD, Seattle, WA Dixie E. Snider, MD, MPH, Atlanta, GA Deborah Holtzman, PhD, Atlanta, GA John W. Ward, MD, Atlanta, GA Timothy F. Jones, MD, Nashville, TN

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MMWR / October 12, 2012 / Vol. 61 / No. 40

Morbidity and Mortality Weekly Report

TABLE 1. Estimated number* and percentage of new diagnoses of HIV infection among Hispanics or Latinos† aged ≥13 years, by U.S. Census region§ and selected characteristics — 46 states and Puerto Rico, 2010 Northeast Characteristic Sex Male Female Age group at diagnosis (yrs) 13–24 25–34 35–44 45–54 ≥55 Transmission category Males Male-to-male sexual contact Injection-drug use Male-to-male sexual contact and injection-drug use Heterosexual contact¶ Other** Females Injection-drug use Heterosexual contact¶ Other** Residence area at diagnosis Urban†† Suburban§§ Rural¶¶ Unknown Place of birth 50 states and DC Central America Cuba Mexico Puerto Rico South America Other Overall***

Midwest

No.

%

No.

%

1,943 591

76.7 23.3

501 95

84.2 16.0

457 748 680 422 226

18.0 29.5 26.8 16.7 8.9

118 219 165 62 31

1,331 305 55

52.5 12.0 2.2

251 1

South No.

West

Subtotal

Puerto Rico

Total

%

No.

%

No.

%

No.

%

No.

%

2,858 546

84.0 16.0

2,785 302

90.2 9.8

8,087 1,534

84.1 15.9

837 274

75.3 24.7

8,924 1,807

83.2 16.8

19.8 36.8 27.7 10.4 5.2

628 1,104 904 555 213

18.4 32.4 26.6 16.3 6.3

576 1,113 798 429 170

18.7 36.1 25.9 13.9 5.5

1,779 3,184 2,547 1,468 640

18.5 33.1 26.5 15.3 6.7

136 298 283 250 144

12.2 26.8 25.5 22.5 13.0

1,916 3,482 2,831 1,718 785

17.9 32.4 26.4 16.0 7.3

397 39 16

66.7 6.6 2.7

2,297 144 82

67.5 4.2 2.4

2,374 144 126

76.9 4.7 4.1

6,399 632 279

66.5 6.6 2.9

401 200 31

36.1 18.0 2.8

6,800 833 310

63.4 7.8 2.9

9.9 0.0

48 1

8.1 0.2

333 2

9.8 0.1

139 2

4.5 0.1

771 6

8.0 0.1

205 —

18.5 —

975 5

9.1 0.0

96 495 1

3.8 19.5 0.0

13 82 0

2.2 13.8 0.0

50 496 1

1.5 14.6 0.0

32 270 1

1.0 8.7 0.0

191 1,343 3

2.0 14.0 0.0

27 247 —

2.4 22.2 —

217 1,588 2

2.0 14.8 0.0

2,362 115 33 25

93.2 4.5 1.3 1.0

473 60 33 29

79.5 10.1 5.5 4.9

2,831 340 205 28

83.2 10.0 6.0 0.8

2,829 204 46 8

91.6 6.6 1.5 0.3

8,495 719 317 90

88.3 7.5 3.3 0.9

775 233 29 74

69.8 21.0 2.6 6.7

9,270 952 346 164

86.4 8.9 3.2 1.5

1,178 140 28 153 224 163 229 2,534

55.7 6.6 1.3 7.2 10.6 7.7 10.8 100.0

178 41 2 136 21 17 9 595

44.1 10.1 0.5 33.7 5.2 4.2 2.2 100.0

1,407 295 200 517 145 157 65 3,404

50.5 10.6 7.2 18.6 5.2 5.6 2.3 100.0

1,296 230 17 932 16 52 33 3,087

50.3 8.9 0.7 36.2 0.6 2.0 1.3 100.0

4,059 706 247 1,738 406 389 336 9,620

51.5 9.0 3.1 22.1 5.2 4.9 4.3 100.0

32 3 — 2 1,009 6 34 1,111

2.9 0.3 — 0.2 90.8 0.5 3.1 100.0

4,090 709 247 1,740 1,416 395 369 10,731

45.6 7.9 2.8 19.4 15.8 4.4 4.1 100.0

* Estimates resulted from statistical adjustment that accounted for reporting delays and missing risk-factor information, but not for incomplete reporting. † Hispanics or Latinos might be of any race. § Northeast: Connecticut, Maine, New Hampshire, New Jersey, New York, Pennsylvania, and Rhode Island; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. ¶ Heterosexual contact with a person known to have, or to be at high risk for HIV infection. ** Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified. †† Metropolitan area of ≥500,000 population. §§ Metropolitan area of 50,000–499,999 population. ¶¶ Nonmetropolitan area of 132,000 persons with arthritis. Additional information on World Arthritis Day is available at http://www. worldarthritisday.org.

The fifth annual Global Handwashing Day will be observed on October 15, 2012. This observance increases awareness and understanding of handwashing with soap as an effective and affordable method of preventing disease around the world. Handwashing with soap has an important role to play in child survival and health. About 2.2 million children aged