HIV Surveillance Summary Georgia, 2014 HIV/AIDS Epidemiology Section Epidemiology Program Division of Health Protection Georgia Department of Public Health 2014 Georgia HIV Surveillance Summary Page 1 This HIV Surveillance Summary, Georgia 2014 is published by the Georgia Department of Public Health (DPH), HIV/AIDS Epidemiology Section (HAES), 2 Peachtree Street NW, Atlanta, Georgia 30303. Data are presented from known diagnoses and laboratory reports entered into the Georgia Enhanced HIV/AIDS Reporting Sytem (eHARS). All data are provisional. The HIV Surveillance Summary, Georgia 2014 is not copyrighted and may be used and reproduced without permission. Citation of the source is, however, appreciated. SUGGESTED CITATION: Georgia Department of Public Health, HIV/AIDS Epidemiology Section HIV Surveillance Summary, Georgia 2014, https://dph.georgia.gov/data-fact-sheet-summaris, Published March 2016, [Accessed: date] ACKNOWLEDGEMENTS: Publication of this report was made possible with the contributions of the Georgia DPH HAES Core HIV Surveillance staff, HIV Case Report Forms submitted by the Georgia health care facility staff, HIV infection related laboratory test results transmitted by laboratory facilities in Georgia, data matches with other DPH programs, and the ongoing efforts of multiple individuals from public and private sector organizations dedicated to improving surveillance, prevention, testing, and care of persons living with HIV infection. Georgia HIV Core Surveillance Team contributors: Lauren Barrineau, Thelma Fannin, Brian Huyelbroeck, Latosha Johnson, Jane Kelly, Rodriques Lambert, Mildred McGainey, Latoya Moss, Rama Namballa, Doris Pearson, A. Eugene Pennisi, Akilah Spratling, Caroline Stamatakis, Lakecia Vanerson, and Andrenita West. This report was prepared by the following staff of the Georgia Department of Public Health: Victoria N. Davis, MPH; Pascale Wortley, MD, MPH; Cherie Drenzek, DVM, MS. 2014 Georgia HIV Surveillance Summary Page 2 Table of Contents Executive Summary.........................................................................................................................................................................4 Technical Notes.............................................................................................................................................................................. 5 Data Limitations...............................................................................................................................................................................8 Highlights of Analyses.....................................................................................................................................................................9 Table 1. Distribution of the general population by race/ethnicity, Georgia, 2014.................................................................................................................................................................................................13 Table 2. Diagnoses of HIV infection and Stage 3 (AIDS) by sex, age, race/ethnicity, Georgia, 2014................................14 Table 3. Diagnoses of HIV infection and Stage 3, AIDS by transmission category and sex, Georgia 2014........................15 Table 4. Diagnoses of HIV infection and Stage 3 (AIDS) by public health district, Georgia 2014 ....................................16 Table 5. Persons living with HIV infection and Stage 3 (AIDS) by sex, age, race/ethnicity, Georgia, through December 31, 2014...................................................................................................... ................................................................17 Table 6. Persons living with HIV infection and Stage 3 (AIDS) by transmission category and sex, Georgia, through December 31, 2014........................................................................................................................................................18 Table 7. Persons living with HIV infection and Stage 3 (AIDS) by public health district, Georgia, as of December 31, 2014.................................................................................................................................................................................................19 Table 8. Cumulative diagnoses of HIV infection and Stage 3 (AIDS) by sex, age, race/ethnicity, Georgia, as of December 31, 2014.............................................................................................................................................................20 Table 9. Cumulative diagnoses of HIV infection and Stage 3 (AIDS) of HIV infection by transmission category and sex, Georgia, as of December 31, 2014..............................................................................................................................21 Table 10. Cumulative diagnoses of HIV infection and Stage 3 (AIDS) by public health district, Georgia, as of December 31, 2014......................................................................................................................................................................22 HIV/AIDS Resources and Reporting............................................................................................................................................23 2014 Georgia HIV Surveillance Summary Page 3 Executive Summary Human immunodeficiency virus (HIV) damages specific cells of the immune system called CD4 cells. Untreated, HIV eventually overwhelms the immune system, resulting in a chronic lifethreatening condition called acquired immune deficiency syndrome (AIDS). In this report, the term HIV infection refers to HIV diagnoses regardless of stage of disease; that is, HIV infection includes HIV (not AIDS) and AIDS. Based on the CD4 count (cells/ml), HIV infection is defined as Stage 1 (CD4>500), Stage 2 (CD4 200499 cells/ml) and Stage 3 (AIDS) (<200 cells/ml). There is no cure for HIV infection, but with antiretroviral therapy (ART), HIV infection can be controlled. Advances in HIV treatment with ART have led to improved quality of life and prolonged lifespan for people living with HIV. Further, achieving viral suppression with effective ART use reduces HIV transmission due to decreased levels of circulating virus. HIV infection remains an important public health problem in the state of Georgia. In 2014, Georgia was ranked fifth highest in the nation for the total number of new diagnoses of HIV infection among adults and adolescents after Florida, California, Texas, and New York1. There were 2,640 new diagnoses of HIV infection during 2014 in Georgia. The majority of these new diagnoses were among males (80%). The highest percentage of new HIV diagnoses was seen among those aged 30 to 39 years (24%), and the highest percentage of Stage 3 (AIDS) was also seen among those aged 20-29 years (37%). Among all races/ethnicities, Black/non-Hispanics accounted for the majority of the diagnoses (65% of new HIV infections and 67% of Stage 3 (AIDS)). Seventy five percent (1586) of new HIV infections among Georgia males in 2014 were attributed to male to male sexual (MSM) contact. Among women, 81% (407) of new HIV infections were attributed to heterosexual contact (HET). As of December 31, 2014, there were 53,230 persons living with HIV infection in Georgia. Similar to the new diagnoses of HIV infection, the majority of prevalent cases are among Black/Non-Hispanic persons (68%) and males (78%). Seventy-seven percent (30,845) of prevalent HIV cases among males were attributed to the MSM transmission category and 80% (10,352) of cases among females were attributed to heterosexual contact. Monitoring the HIV/AIDS epidemic and understanding the burden of HIV infection in Georgia are essential for meeting the goals stated in the 2010 National HIV/AIDS Strategy to reduce HIV incidence, increase access to care, and optimize health outcomes for persons living with HIV and reduce HIV-related health disparities2. 1 Centers for Disease Control and Prevention. HIV Surveillance Report, 2014; vol.26. http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdchiv-surveillance-report-us.pdf. Published November 2015. Accessed February 2016 2014 Georgia HIV Surveillance Summary 2 The White House Office of National AIDS Policy, National HIV/AIDS Strategy for the United Sates , Washington, DC: The White House, 2010 Page 4 Technical Notes HIV Surveillance Georgia statutes and regulations (O.C.G.A. 3112-2(b))3 require healthcare providers (such as nurses, nurse practitioners, doctors, physician assistants) and laboratories licensed in the state of Georgia to report all cases of HIV infection and/or Stage 3 (AIDS) to the Georgia DPH within seven days of diagnosis. The information is used to monitor the HIV/AIDS epidemic in Georgia and guide program planning and evaluation. The data presented in the accompanying tables are based on confidential case reports collected through the Georgia DPH enhanced HIV/AIDS Reporting System (eHARS). This report includes surveillance data through December 31, 2015 by diagnostic category, for newly diagnosed HIV cases, persons living with and cumulative cases of HIV infection and Stage 3 (AIDS). The data are displayed by date of diagnosis and are not adjusted for reporting delays or incomplete reporting. Persons residing in correctional facilities are included in this report and may inflate rates in certain geographic regions where there are large numbers of HIV-positive inmates. Tables depicting "Persons living with HIV infection and Stage 3 (AIDS)" comprise persons with current residence in the state of Georgia based on current information available for them in the Georgia HIV/AIDS surveillance system regardless of where the persons were diagnosed. Persons represented in the "New Diagnoses" and "Cumulative" tables were diagnosed in the state of Georgia. Due to the difference in residency criteria and the influx of cases to Georgia, the number of persons living with HIV infection in Georgia may be higher in some sub-categories than cumulative HIV infections. HIV infection includes persons with a diagnosis of HIV infection regardless of the stage of disease at diagnosis; i.e., both HIV (not AIDS) and AIDS Name-based AIDS reporting began in the early 1980s, and name-based HIV reporting began in Georgia on December 31, 2003. Electronic lab reporting began in 2011. There are known delays in case reporting, we expect that the number of HIV diagnoses in 2014 will continue to increase as additional case reports are received. The Georgia electronic laboratory reporting (ELR) system makes it possible to use laboratory-based measures (e.g., CD4 count, viral load) to estimate the HIV Care Continuum for persons with a diagnosis of HIV infection in the state of Georgia (https://dph.georgia.gov/hiv-care-continuum). Transmission Categories Persons with a diagnosis of HIV infection with no reported and/or identified exposure to HIV through any of the routes listed in the hierarchy of transmission categories by the Centers for Disease Control and Prevention are classified as either `no risk factor identified or no risk factor reported' (NIR/NRR). In 2014, 44% of new HIV diagnoses infection were reported with 3 Department of Public Health, Rules and regulations 290-5-48.11 (2003); Official Code of Georgia Annotated (O.C.G.A.) 2014 Georgia HIV Surveillance Summary 31-22-9.2 (2011) Page 5 no or insufficient risk information to determine transmission category. Multiple imputation, a statistical approach, was used in this report to replace each missing transmission category with a set of plausible values that represent the uncertainty about the true, but missing, value. The methods were applied to HIV cases among the adult and adolescent population only and not to the pediatric (age less than 13 years) population of Georgia. To identify and reduce HIVrelated disparities in prevention and care, it is necessary to have the best available estimate for the distribution of known transmission categories among the HIVinfected population of Georgia. Multiple imputation is considered by the Centers for Disease Control and Prevention to be the best method for redistribution of missing data in large databases.4 Cases with Incomplete Information Cases missing required fields such as sex and race/ethnicity are not included in the CDC's National HIV Surveillance Report but are included in the Georgia Surveillance Summary in recognition of the importance of providing an estimate closest to the absolute number of HIV infections in the state of Georgia for effective prevention program planning. Work is underway to reduce the number of cases missing required fields. The proportion of cases missing information should be taken into consideration when examining trends by race/ethnicity. Categorization of Cases by Public Health District In the 2013 Georgia HIV Surveillance Summary, there were 250 new diagnosed cases and 4,806 prevalent cases that were not assigned to a Public Health District (unknown Health District) because county of residence had not been reported. In 2014, cases missing county of residence were geocoded based on their address using the Arc GIS Desktop Version 10.2 Software. As a result, only 40 newly diagnosed cases and 572 prevalent cases remained in the unknown Health District category. Health district-specific counts and rates increased between 2013 and 2014 as a result of cases shifting from the "unknown health district" category into the appropriate health district. Gender Categories Persons diagnosed with HIV for whom the current identity box "transgender" was checked are classified as transgender. Because providers often do not complete all case report forms fields, the numbers reported here are most likely an underestimate. Also, because the current identity fields were added to the case report form in 2007, cumulative and prevalent counts of HIV among transgender persons are incomplete. Definitions of Measures NEW DIAGNOSES of HIV infection (Stage 1-3) and/or Stage 3 (AIDS) are cases who were diagnosed between January 01, 2014 and December 31, 2014 and reported to the Georgia DPH. Cases with a diagnosis of Stage 3 4 Harrison KM, Kajese T, Hall HI, Song R. Risk factor redistribution of the national HIV/AIDS surveillance data: an alternative approach. Public Health Rep 2008;123:61827. 2014 Georgia HIV Surveillance Summary Page 6 include two groups: 1) persons newly diagnosed with HIV and found to be Stage 3 (CD4 <200 cells/ml) at diagnosis; and, 2) persons previously diagnosed with HIV who were found to meet the Stage 3 definition in 2014. PERSONS LIVING WITH a diagnosis of HIV infection (Stage 1-3) and /or Stage 3 (AIDS) are cases who were diagnosed and alive as of December 31, 2014. Persons living with a diagnosis of Stage 3 (AIDS) are persons who were alive as of December 31, 2014 and who were ever diagnosed with Stage 3 (AIDS). CUMULATIVE DIAGNOSES of HIV infection (Stage 1-3) and Stage 3 (AIDS) are cases who were reported to the Georgia DPH and diagnosed as of December 31, 2014 and include persons living and deceased. TRANSMISSION CATEGORIES presented in this report follow the standards created by the Centers for Disease Control and Prevention (CDC)5 and have been used for many years. According to the CDC, transmission category is the term for the classification of cases that summarizes a person's possible HIV risk factors. The summary classification results from selecting, from the presumed hierarchical order of probability, the one risk factor most likely to have been responsible for HIV transmission. For surveillance purposes, HIV and AIDS cases are counted only once in the hierarchy of transmission categories. Persons with more than one reported risk factor for HIV infection are classified in the transmission category according to the behavior that is most likely to have resulted in transmission. The exception is men who report sexual contact with other men and injection drug use; this group makes up a separate transmission category. Persons whose transmission category is classified as heterosexual contact are persons who report heterosexual contact specifically with a person known to have, or be at high risk for, HIV infection (e.g., an injection drug user/IDU). The term high risk is not included in the transmission category label for heterosexual contact in the tables because heterosexual contact itself is the risk factor most likely to have been responsible for transmission. However, the Table 3 footnote regarding this category clarifies how the data are defined: "heterosexual contact with a person known to have, or to be at high risk for, HIV infection". Cases among persons with no reported exposure to HIV through any of the routes listed in the hierarchy of transmission categories are classified as either no risk factor identified or reported (NIR/NRR)1 CURRENT RESIDENCE is used to determine the number of persons living with HIV infection in Georgia. Current address is determined using the date of the most recentlyentered residential address into the Georgia eHARS. VITAL STATUS: Persons are assumed to be alive unless otherwise documented or reported. The Georgia DPH performs an annual match of the eHARS database with Georgia Vital Records death data, the National Death Index and the Social Security Death Index to ascertain vital status and identify any cases deceased from an HIV-related cause yet not otherwise reported. RATES: Denominators for population rates are based on the 2014 estimates of the resident population retrieved from the Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP). Rates are per 5 Centers for Disease Control and Prevention. HIV Surveillance Report, 2011; vol.23. http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv- 2014 Georgia HIV Surveillance Summary surveillance-report-us.pdf. Published November 2015. Accessed February, 2016 Page 7 100,000 population. Rates based on estimated case numbers less than 12 should be interpreted with caution because these rates have relative standard errors greater than 30% and are considered unreliable. REPORTING PERIOD: Case numbers are based on data entered through December 2015, and are not adjusted for reporting delays. PERCENTAGES: Total percentages may not add up to 100% due to rounding and represent the percentage of the total. Data Limitations Complete and timely reporting of HIV infections to the Georgia DPH is critical for monitoring the HIV epidemic. Delays and incomplete reporting lead to underestimation of the impact of HIV in Georgia. Data in this report are not adjusted for reporting delays. Although multiple imputation methods were used to assign a known risk category to cases with missing information, a proportion of cases remain without any identified and /or reported risk factor. In addition, populations for which data are missing (e.g. birth sex, race, transmission category, geographic location) may be fundamentally different. All registered laboratories are also mandated by state law to report laboratory results on any HIV-related laboratory test to the Georgia DPH. However, some facilities may not comply or send only some test results and not others. Missing laboratory data may limit accurate estimation of unmet need for the state of Georgia and the Atlanta EMA. Population Highlights of Analyses Table 1: Estimates and distribution of the general population by race/ethnicity, Georgia, 2014 There were an estimated 10 million persons living in Georgia during 2014 Of these individuals, the majority were White, Non-Hispanic (54%) The largest minority group in the state was Black, Non-Hispanic (31%) Individuals who were Hispanic/Latino comprised 9% of the state's population. The smallest racial/ethnic groups in the state were Asian, Non-Hispanic (4%); American Indian/Alaskan Native, Non-Hispanic (<1%); Native Hawaiian/Pacific Islander, Non-Hispanic (<1%); and Multiracial/Other, Non-Hispanic (2%). New Diagnoses Tables 2 to 4: New diagnoses of HIV infection, Georgia, January 01, 2014 to December 31, 2014 There were 2,640 persons with a new diagnoses of HIV infection in Georgia during 2014. The majority of the new HIV diagnoses were among males (80%). Persons aged 20-29 years at the time of diagnosis represented the largest age group (37%) for new diagnoses of HIV infection in Georgia during 2014. There were racial/ethnic disparities among persons with new diagnoses of HIV infection in Georgia in 2014. o Black/Non-Hispanics accounted for 65% of new HIV infection diagnoses and comprised 31% of Georgia's population. 2014 Georgia HIV Surveillance Summary Page 8 o White/Non-Hispanics accounted for 13% of new HIV infection diagnoses and comprised 54% of Georgia's population. o Hispanics/Latinos of all races accounted for 5% of new diagnoses of HIV infection and comprised 9% of Georgia's population. The number of cases and proportions stratified by transmission category are shown by both unadjusted and adjusted after multiple imputation. Using multiple imputation, 75% of HIV infections diagnosed among males in Georgia in 2014 were attributed to the MSM transmission category. Among women, 81% of HIV infections diagnosed in 2014 were attributed to heterosexual contact. The overall state rate for new diagnoses of HIV infection in 2014 was 26 cases per 100,000 population. In 2014, several Public Health Districts had newly diagnosed HIV infection rates that exceeded the overall state rate: Fulton (77 per 100,000), DeKalb (61 per 100,000) and Clayton (44 per 100,000). Tables 2 to 4: New diagnoses of Stage 3 (AIDS), Georgia, January 01, 2014 to December 31, 2014 There were 1,320 persons with new diagnoses of Stage 3 (AIDS) in Georgia during 2014. The majority of the new diagnoses with Stage 3 (AIDS) were among males (76%). Persons aged 30-39 years at the time of diagnosis represented the largest age group (26%) for new diagnoses of Stage 3 (AIDS) in Georgia during 2014. There were racial/ethnic disparities among persons with new diagnoses of Stage 3 (AIDS) in Georgia in 2014. o Black/Non-Hispanics accounted for 70% of new Stage 3 (AIDS) diagnoses and comprised 31% of Georgia's population. o White/Non-Hispanics accounted for 13% of new Stage 3 (AIDS) diagnoses and comprised 54% of Georgia's population. o Hispanics/Latinos of all races accounted for 6% of new diagnoses of Stage 3 (AIDS) and comprised 9% of Georgia's population. Among males, 76% of new Stage 3 (AIDS) diagnoses were attributed to the MSM transmission category. Among females, 82% of new Stage 3 (AIDS) diagnoses were attributed to the heterosexual contact transmission category. Persons Living with HIV/AIDS Infection Tables 5 to 7: Persons Living with HIV infection, Georgia, as of December 31, 2014 There were 53,230 persons living with HIV infection in Georgia as of December 31, 2014. The majority of persons living with HIV infection were male (75%). The largest age category for persons living with HIV in Georgia was 40-49 years (29%). There were racial/ethnic disparities among persons living with HIV infection in Georgia in 2014. o Black/Non-Hispanics accounted for 66% of persons living with HIV infection and comprised 31% of Georgia's population. 2014 Georgia HIV Surveillance Summary Page 9 o White/Non-Hispanics accounted for 20% of persons living with HIV infection and comprised 54% of Georgia's population. o Hispanic/Latinos of all races accounted for 6% of persons living with HIV infection and comprised 9% of Georgia's population. Among males living with HIV infection in Georgia, 77% of cases were attributed to the MSM transmission category. Among females living with HIV infection in Georgia, 80% of cases were attributed to the heterosexual contact transmission category. The overall state prevalence rate for HIV infection in 2014 was 527 cases per 100,000 population. Three Public Health Districts had HIV prevalence rates that exceeded the overall state rate in 2014: Fulton (1602 per 100,000), DeKalb (1252 per 100,000) and Clayton (824 per 100,000). Tables 5 to 7: Persons Living with Stage 3 (AIDS), Georgia, as of December 31, 2014 There were 28,284 persons living with Stage 3 (AIDS) in Georgia as of December 31, 2014. The majority of persons living with Stage 3 (AIDS) were male (76%). The largest age category of persons living with Stage 3 (AIDS) in Georgia was 50-59 years (32%). There were racial/ethnic disparities among persons living with Stage 3 (AIDS) in Georgia in 2014 o Black/Non-Hispanics accounted for 68% of persons living with Stage 3 (AIDS) and comprised 31% of Georgia's population. o White/Non-Hispanics accounted for 20% of persons living with Stage 3 (AIDS) and comprised 54% of Georgia's population.2 o Hispanic/Latinos of all races accounted for 6% of persons living with Stage 3 (AIDS) and comprised 9% of Georgia's population. Among males living with Stage 3 (AIDS), 75% of cases were attributed to the MSM transmission category. Among females living with Stage 3 (AIDS), 80% of cases were attributed to the heterosexual contact transmission category. The overall state prevalence rate for Stage 3 (AIDS) in 2014 was 280 cases per 100,000 population. Three Public Health Districts had AIDS prevalence rates that exceeded the overall state rate in 2014: Fulton (855 per 100,000), DeKalb (675 per 100,000) and Clayton (432 per 100,000). Cumulative Diagnoses Table 8 to 10: Cumulative diagnoses of HIV infection, Georgia, as of December 31, 2014 There were 70,813 cumulative diagnoses of HIV infection in Georgia as of December 31, 2014. The majority (77%) of cumulative HIV cases were male. The largest age category at diagnosis for cumulative cases of HIV infection in Georgia was 30-39 years (34%). There were racial/ethnic disparities among cumulative HIV infections in Georgia in 2014. o Black/Non-Hispanics accounted for 66% of cumulative HIV infections 2014 Georgia HIV Surveillance Summary Page 10 o White/Non-Hispanics accounted for 23% of cumulative HIV infections o Hispanic/Latinos of all races accounted for 4% of cumulative HIV infections Among male adults/adolescents, 73% of cumulative cases were attributed to the MSM transmission category. Among female adults/adolescents, 78% of cases were attributed to the heterosexual contact transmission category. The highest cumulative number of diagnoses of HIV infection in Georgia were in the Fulton (22,723) and DeKalb (11,876) Public Health Districts. Table 8 to 10: Cumulative diagnoses of Stage 3 (AIDS), Georgia, as of December 31, 2014 There were 44,612 cumulative diagnoses of stage 3 (AIDS) in Georgia as of December 31, 2014. The majority of these cumulative Stage 3 (AIDS) cases were male (78%) The largest age category at diagnosis for cumulative cases of Stage 3 (AIDS) in Georgia was 30-39 years (39%). There were racial/ethnic disparities among cumulative Stage 3 (AIDS) cases in Georgia in 2014. o Black/Non-Hispanics accounted for 66% of cumulative Stage 3 (AIDS) cases o White/Non-Hispanics accounted for 26% were of cumulative Stage 3 (AIDS) cases o Hispanic/Latinos of all races accounted for 4% of all Stage 3 (AIDS) cases Among male adult/adolescents, 70% of cumulative stage 3 (AIDS) cases were attributed to the MSM transmission category. 2014 Georgia HIV Surveillance Summary Among female adults/adolescents, 76% of cumulative Stage 3 (AIDS) cases were attributed to the heterosexual contact transmission category. The highest cumulative numbers of diagnoses of Stage 3 (AIDS) in Georgia were in the Fulton (16,234) and DeKalb (7,216) Public Health Districts. Page 11 Table 1: Distribution of the General Population by Race/Ethnicity, Georgia, 2014 Race/Ethnicity White, Non-Hispanic Black, Non-Hispanic Hispanic/Latino, Any Race Asian, Non-Hispanic American Indian /Alaskan Native, Non-Hispanic Native Hawaiian/Pacific Islander, Non-Hispanic Multiracial/Other, Non-Hispanic Total Number1 (%) 5,487,103 (54) 3,098,214 (31) 935,279 (9) 378,945 (4) 23,286 (<1) 6,331 (<1) 168,185 (2) 10,097,343 1 Population estimates are based on data obtained from Georgia Department of Public Health, Office of Health Indicators for Planning(OHIP) 2014 Georgia HIV Surveillance Summary Page 12 Table 2: Diagnoses of HIV infection and Stage 3 (AIDS) by sex, age and race/ethnicity, Georgia, January 01, 2014 to December 31, 2014 HIV infection Stage 3 (AIDS)2 Sex Male Female Transgender Unknown Count 2,102 521 9 8 Percent1 80% 20% <1% <1% Count 999 317 3 4 Percent 76% 24% <1% <1% Age at Diagnosis (years) <13 13-19 20-24 25-29 30-39 40-49 50-59 60+ Count 9 101 500 468 636 469 335 122 Percent <1% 4% 19% 18% 24% 18% 13% 5% Count 4 12 114 189 337 335 250 79 Percent <1% <1% 9% 14% 26% 25% 19% 6% Race/Ethnicity Black/Non-Hispanic White/Non-Hispanic Hispanic/Latino, Any Race American Indian/Alaska Native Asian/Native Hawaiian/Pacific Islander Multiple races Unknown Total Count 1,719 356 139 4 17 45 360 2,640 Percent 65% 13% 5% <1% <1% 2% 14% Count 919 173 76 2 10 31 109 1,320 Percent 70% 13% 6% <1% <1% 2% 8% 1 Total percentages may not add up to 100% due to rounding and represent the percentage of the subtotal 2014 Georgia HIV Surveillance Summary 2 This group includes newly diagnosed persons with Stage 3 HIV (AIDS) at initial diagnosis and previously diagnosed persons who first met the Stage 3 definition in 2014. Page 13 Table 3: Diagnoses1 of HIV Infection and Stage 3 (AIDS) by sex and transmission category3, Georgia, January 01, 2014 to December 31, 2014 Male adult or adolescent MSM5 IDU6 MSM & IDU7 Heterosexual8 Other9 Subtotal HIV infection1 Unadjusted Estimates Adjusted3 Estimates Count Percent4 Count Percent 1,105 52% 1,586 75% 26 1% 59 3% 21 1% 42 2% 103 5% 147 7% 854 40% 275 13% 2,109 2,109 Stage 3 (AIDS)2 Unadjusted Estimates Adjusted Estimates Count Percent Count Percent 550 55% 760 76% 20 2% 40 4% 18 2% 28 3% 59 6% 88 9% 350 35% 81 8% 997 997 Female adult or adolescent IDU Heterosexual Other9 Subtotal Count 7 213 294 514 Percent 1% 41% 57% Count 31 407 76 514 Percent 7% 81% 11% Count 10 132 169 311 Percent 3% 42% 54% Count 28 255 28 311 Percent 9% 82% 9% Child (<13 years at diagnosis) Perinatal10 Other11 Subtotal Total Count 5 4 9 2,632 Percent 55% 45% Count 7 1 8 1,316 Percent 88% 12% 1 HIV stage 1-3 2 Includes newly diagnosed persons with Stage 3 HIV (AIDS) at initial diagnosis and previously diagnosed persons who first met the Stage 3 definition on 2014. 3 Adjusted for missing risk using multiple imputation methods 4 Total percentages may not add up to 100% due to rounding and represent the percentage of the subtotal. 5 MSM Male-to-male sexual contact 6 IDU Injection drug use 7 MSM&IDU Male-to-male sexual contact and injection drug use 8 Defined as sexual contact with someone of the opposite sex with known risk such as injection drug use, bisexual male (applies to females only), person with hemophilia/coagulation disorder, transfusion recipient with HIV documentation, and or person with AIDS or documented HIV. 9 Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported (the latter account for great majority). 10 Cases born to HIV-infected mother 11 Includes hemophilia, blood transfusion, and risk factor not reported (the latter account for great majority). 2014 Georgia HIV Surveillance Summary Page 14 Table 4: Diagnoses of HIV infection and Stage 3 (AIDS) by Public Health District of residence at diagnosis, Georgia, January 01, 2014 to December 31, 2014 Public Health Districts Count HIV infection Rate1 1-1 Northwest (Rome) 34 5 1-2 North Georgia (Dalton) 20 4 2 North (Gainesville) 38 6 3-1 Cobb-Douglas 205 24 3-2 Fulton 771 77 3-3 Clayton (Jonesboro) 118 44 3-4 East Metro (Lawrenceville) 205 19 3-5 DeKalb 443 61 4 LaGrange 119 14 5-1 South Central (Dublin) 30 20 5-2 North Central (Macon) 112 21 6 East Central (Augusta) 96 20 7 West Central (Columbus) 70 19 8-1 South (Valdosta) 46 18 8-2 Southwest (Albany) 76 22 9-1 Coastal (Savannah) 122 20 9-2 Southeast (Waycross) 55 15 10 Northeast (Athens) 40 8 Unknown Health District 40 -- Total 2,640 26 Note: AIDS diagnoses by Public Health District cannot be tabulated at this time. An updated reported will be posted once this technical issue is resolved. 1 Crude rates are per 100,000 population and are not adjusted for significant factors such as age, sex, and race/ethnicity which might influence the rate. Population denominators used to calculate the rates were retrieved from Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP) 2014 Georgia HIV Surveillance Summary Page 15 Table 5: Persons living with diagnosed HIV infection and Stage 3 (AIDS) by sex, age and race/ethnicity, Georgia through December 31, 2014 Sex Male Female Transgender Unknown HIV infection1 Count 40,033 12,947 148 102 Percent 75% 24% <1% <1% Stage 3 (AIDS) Count 21,453 6,715 89 27 Percent 76% 24% <1% <1% Current Age (years) <13 13-19 20-24 25-29 30-39 40-49 50-59 60+ Missing Count 171 329 2,142 4,720 10,969 15,260 14,190 5,435 14 Percent <1% <1% 4% 9% 21% 29% 27% 10% <1% Count 19 84 522 1,475 4,864 8,849 8,999 3,471 1 Percent <1% <1% 2% 5% 17% 31% 32% 12% <1% Race/Ethnicity Black/Non-Hispanic White/Non-Hispanic Hispanic/Latino, Any Race American Indian/Alaska Native Asian/Native Hawaiian/Pacific Islander Multiple races Unknown Count 35,352 10,380 3,043 29 218 1,804 2,404 Percent 66% 20% 6% <1% <1% 3% 5% Count 19,149 5,602 1,717 11 100 1,109 596 Percent 68% 20% 6% <1% <1% 4% 2% Total 53,230 28,284 _________________________________________________________________ 1 HIV Stage 1-3 2014 Georgia HIV Surveillance Summary Page 16 Table 6: Persons living1 with a diagnosis of HIV Infection and Stage 3 (AIDS) by sex and transmission category, Georgia, through December 31, 2014 Male adult or adolescent MSM IDU MSM & IDU Heterosexual Other4 Subtotal HIV infection Unadjusted Estimates Adjusted2 Estimates Stage 3 (AIDS) Adjusted Unadjusted Estimates Estimates Count 23,123 1,506 1,829 1,777 11,828 40,063 Percent3 58% 4% 5% 4% 30% Count 30,845 2,217 2,331 2,649 2,021 40,063 Percent 77% 6% 6% 7% 5% Count 12,757 1,114 1,241 1,200 5,206 21,518 Percent 59% 5% 6% 6% 24% Count 16,190 1,511 1,498 1,723 597 21,518 Percent 75% 7% 7% 8% 3% Female adult or adolescent IDU Heterosexual Other4 Subtotal Count 1,058 5,778 6,044 12,880 Percent 8% 45% 47% Count 1,751 10,352 777 12,880 Percent 14% 80% 6% Count 715 3,331 2,673 6,719 Percent Count Percent 11% 50% 40% 1,076 5,381 263 6,719 16% 80% 4% Child (<13 years at end of year) Perinatal Other5 Subtotal Total Count 104 67 171 53,114 Percent 61% 39% Count Percent Count 16 3 19 28,256 Percent Count Percent 84% 16% 1 Persons living with HIV infection and Stage 3 (AIDS) with no information on birth sex and date of birth were excluded from the table; subtotals may not add up to the totals 2 Adjusted for missing risk using multiple imputation methods 3Total percentages may not add up to 100% due to rounding and represent the percentage of the subtotal. 4Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported (the latter account for great majority). 5Includes hemophilia, blood transfusion, and risk factor not reported (the latter account for great majority). 2014 Georgia HIV Surveillance Summary Page 17 Table 7: Persons living with a diagnoses of HIV infection and Stage 3 (AIDS) by Public Health District of residence at diagnosis, Georgia, through December 31, 2014 Public Health Districts 1-1 Northwest (Rome) 1-2 North Georgia (Dalton) 2 North (Gainesville) 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton (Jonesboro) 3-4 East Metro (Lawrenceville) 3-5 DeKalb 4 LaGrange 5-1 South Central (Dublin) 5-2 North Central (Macon) 6 East Central (Augusta) 7 West Central (Columbus) 8-1 South (Valdosta) 8-2 Southwest (Albany) 9-1 Coastal (Savannah) 9-2 Southeast (Waycross) 10 Northeast (Athens) Unknown Health District Total HIV infection Count Rate1 1,000 154 610 134 737 111 3,527 406 15,958 1602 2,205 824 3,582 335 9,039 1252 1,807 219 763 502 2,136 406 2,138 450 1,722 456 1,041 409 1,719 487 2,588 429 1,229 337 857 180 572 - 53,230 527 Stage 3 (AIDS) Count Rate1 565 87 329 72 397 60 1,820 209 8,521 855 1,156 432 1,864 174 4,873 675 974 118 391 257 1,136 216 1,164 245 872 231 551 216 962 273 1,434 238 648 178 477 100 150 - 28,284 280 1 Crude rates are per 100,000 population and are not adjusted for significant factors such as age, sex, and race/ethnicity which might influence the rate. Population denominators used to calculate the rates were retrieved from Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP) 2014 Georgia HIV Surveillance Summary Page 18 Table 8: Cumulative cases of diagnosed HIV Infection and Stage 3 (AIDS), Georgia as of December 31, 2014 Sex Male Female Transgender Unknown Age at Diagnosis (years) <13 13-19 20-24 25-29 30-39 40-49 50-59 60+ Missing Race/Ethnicity Black/Non-Hispanic White/Non-Hispanic Hispanic/Latino, Any Race American Indian/Alaska Native Asian/Native Hawaiian/Pacific Islander Multiple races Unknown Total HIV Infection Count Percent1 54,230 77% 16,341 23% 156 <1 86 <1% Count Percent 616 <1% 2,318 3% 8,346 12% 11,313 16% 24,137 34% 15,858 22% 6,247 9% 1,967 3% 11 <1% Count Percent 46,847 66% 16,563 23% 3,060 4% 35 <1% 228 <1% 1,819 3% 2,261 3% 70,813 Stage 3 (AIDS) Count Percent 34,970 78% 9,622 22% 96 <1% 20 <1% Count Percent 247 <1% 473 1% 2,532 6% 6,023 14% 17,336 39% 12,114 27% 4,462 10% 1,424 3% 1 <1% Count Percent 29,587 66% 11,565 26% 1,785 4% 19 <1% 121 <1% 1,091 2% 444 1% 44,612 1 Total percentages may not add up to 100% due to rounding and represent the percentage of the subtotal 2014 Georgia HIV Surveillance Summary Page 19 Table 9: Cumulative1 diagnoses of HIV Infection and Stage 3 (AIDS) of HIV infection by sex and transmission category, Georgia, as of December 31, 2014 Male adult or adolescent MSM IDU MSM & IDU Heterosexual Other4 Subtotal HIV infection Unadjusted Estimates Adjusted2 Estimates Count Percent3 Count Percent 29,728 55% 39,215 73% 4,161 8% 5,384 10% 2,758 5% 3,424 6% 2,792 5% 4,133 8% 14,607 27% 1889 3% Stage 3 (AIDS) Unadjusted Estimates Adjusted Estimates Count Percent Count Percent 19,647 56% 24,252 70% 3,651 10% 4,453 13% 2,163 6% 2,541 7% 2,165 6% 3,038 9% 7,227 21% 570 2% 54,046 54,045 34,853 34,854 Female adult or adolescent IDU Heterosexual Other4 Subtotal Count 1,907 6,927 7,223 16,057 Percent 12% 42% 45% Count 2,918 12,560 579 16,057 Percent 19% 78% 4% Count 1,511 4,517 3,463 9,491 Percent 16% 48% 36% Count 2,107 7,180 204 9,491 Percent 22% 76% 2% Child (<13 years at diagnosis) Perinatal Other5 Subtotal Total Count 469 144 613 70,721 Percent 77% 23% Count 231 19 247 44,591 Percent 93% 77% 1 Cumulative numbers of HIV infection and Stage 3 (AIDS) with no information on birth sex and date of birth were excluded from the table; subtotals may not add up to the totals 2 Adjusted for missing risk using multiple imputation methods 3Total percentages may not add up to 100% due to rounding and represent the percentage of the subtotal. 4Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported (the latter account for great majority). 5Includes hemophilia, blood transfusion, and risk factor not reported (the latter account for great majority). 2014 Georgia HIV Surveillance Summary Page 20 Table 10: Cumulative cases diagnosed with HIV Infection and Stage 3 (AIDS) by Public Health District of residence at diagnosis, Georgia, through December 31, 2014 Public Health Districts 1-1 Northwest (Rome) 1-2 North Georgia (Dalton) 2 North (Gainesville) 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton (Jonesboro) 3-4 East Metro (Lawrenceville) 3-5 DeKalb 4 LaGrange 5-1 South Central (Dublin) 5-2 North Central (Macon) 6 East Central (Augusta) 7 West Central (Columbus) 8-1 South (Valdosta) 8-2 Southwest (Albany) 9-1 Coastal (Savannah) 9-2 Southeast (Waycross) 10 Northeast (Athens) Unknown Health District Total HIV Infection Count 1,059 727 767 3,678 22,723 2,852 2,957 11,876 2,417 810 2,977 3,257 2,485 1,427 2,440 3,846 1,503 1,124 1,888 70,813 Stage 3 (AIDS) Count 639 421 482 2,173 16,234 1,595 1,699 7,216 1,407 423 1,816 2,158 1,486 802 1,598 2,475 905 743 348 44,620 2014 Georgia HIV Surveillance Summary Page 21 HIV/AIDS Resources: Georgia Department of Public Health http://dph.georgia.gov/what-hiv-and-aids Centers for Disease Control and Prevention http://www.cdc.gov/hiv/ AIDSVu http://aidsvu.org/ Reporting All health care providers diagnosing and/or providing care to a patient with HIV are required by Georgia law (O.C.G.A. 31-12-1) to report HIV infection using the HIV/AIDS Case Report Form. Case report forms should be completed within seven (7) days of diagnosing a patient with HIV and/or AIDS or within seven (7) days of assuming care of an HIV positive patient who is new to the provider, regardless of whether the patient has previously received care elsewhere. Adult and Pediatric case report forms are available at http://dph.georgia.gov/reporting-forms-data-requests 2014 Georgia HIV Surveillance Summary Page 22 For more questions on HIV case reporting in Georgia please contact the HIV Surveillance Coordinator at 1- 800-827-9769