New Jersey HIV/AIDS

Epidemiologic Overview, 2017(Data based upon the HIV/AIDS Reporting System

‘eHARS,’ unless otherwise noted.)

New Jersey Department of Health

Division of HIV, STD, TB Services

INTRODUCTION

We will discuss:

Incidence – new cases in 2015

True incidence is estimated to be about 10% greater than cases reported to the NJ Department of Health; the 10% includes unreported as well as undiagnosed cases.

Prevalence – persons living with HIV in 2017.

Diagnosis Trends (2011 to 2015) and comparison to National figures.

HIV data will be examined by demographic status: gender, age, race, and exposure category

Review geographic dispersion of HIV in NJ.

NJ Care Continuum.

All surveillance data is based upon cases entered in the registry by December 31, 2017.

HIV INFECTION IN NEW JERSEY

New Jersey ranked 6th among the 50 states in the rate of adults and

adolescents living with HIV/AIDS in 2015 and 11th in the

rate of adults and adolescents diagnosed with HIV/AIDS in 2015.

Cumulatively, 81,437 cases of HIV/AIDS have been reported in New

Jersey. As of December 31, 2017; 37,411 individuals were known to be

alive and residing in New Jersey. Prevalent cases include 17,973

(48%) persons living with HIV only and 19,438 (52%) persons living

with AIDS.

In 2015, there were 1,170 new diagnoses with HIV/AIDS in New Jersey.

# of HIV/AIDS diagnoses in NJ for three most-affected subpopulation:

1) Hispanic/Latino MSM (not including MSM/IDU): 203.

2) Black MSM (not including MSM/IDU): 190.

3) Black Heterosexual Women: 130.

Between 2011 and 2015, the number of new adult/adolescent HIV/AIDS

diagnoses decreased by 2%.

The percentage of concurrent HIV and AIDS diagnoses

(cases that have already progressed to AIDS at the time of first

diagnosis) has remained consistent over the last decade.

In 2015, a quarter (25%) of new cases were concurrent HIV and AIDS

diagnoses.

Incidence Rates of HIV Infection Among Adults and

Adolescents, 2016 - United Sates Rates per 100,000:

16.8 in the South, 11.2 in the Northeast, 10.2 in the West, and 7.5 in the

Midwest. NJ = 15.2

Number HIV/AIDS Diagnoses by Stage of Disease New Jersey, 2011 - 2015

New Jersey has historically had one of the highest proportions of HIV infections occurring in females, although the proportion of female cases is declining. New Jersey ranked 5th in the number of cumulative HIV diagnoses among females in the U.S. through 2015.

NJ ranked 7th nationally in the rate of new infections; 24.2% of diagnoses in 2015 were among females.

New Jersey ranked 8th nationally in the rate of adult and adolescent females living with HIV infection through 2016. A third (32.4%) of 2017 prevalent cases are among females, compared with a quarter of prevalent cases nationally.

HIV/AIDS and Gender

Number HIV/AIDS Diagnoses by Gender New Jersey, 2011 - 2015

Transgender Cases --New Jersey, December 31, 2017

Gender N %

M to Female 110 97%

F to Male 1 1%

Other gender ID 2 2%

Race/Ethnicity N %

White 6 5%

Black 62 55%

Hispanic 44 39%

Other/Unknown 1 1%

Age at Diagnosis N %

13-24 36 32%

25-34 51 45%

35-44 18 16%

45+ 8 7%

Transmission N %

Sex 98 87%

IDU-Related 3 3%

Unknown 12 11%

Gender N %

M to Female 90 97%

F to Male 1 1%

Other gender ID 2 2%

Race/Ethnicity N %

White 7 8%

Black 52 56%

Hispanic 33 35%

Other/Unknown 1 1%

Age at Diagnosis N %

13-24 30 32%

25-34 41 44%

35-44 16 17%

45+ 6 6%

Transmission N %

Sex 80 86%

IDU-Related 2 2%

Unknown 11 12%

Prevalent Cases (N=93)Cumulative Cases (N=113)

Number Adult/Adolescent HIV/AIDS Diagnoses by Age Group -- New Jersey, 2011 - 2015

While over two-thirds of prevalent cases were 45 or older in 2016; there appears to an increase in the proportion of persons being diagnosed at an earlier age. Between 2008-2014, the number of diagnoses increased among males aged 13 to 34 years, especially those aged 13 to 24. In this latter group, the number of diagnoses rose from 162 in 2008 to 178 in 2014, increasing from 10% of male diagnoses in 2008 to 20% in 2014.

Among women, the absolute number of diagnoses decreased in all age groups. However, the proportion of cases among females ages 13 to 24, increased from 9% of diagnoses in 2008 to12% of diagnoses in 2014.

.

HIV/AIDS and Age

Number HIV/AIDS Diagnoses by Race/Ethnicity

-- New Jersey, 2011 - 2015

Number of persons Living with HIV/AIDS, 2017 by Gender and Race in New Jersey

NUMBER AND PERCENTAGE OF HIV/AIDS DIAGNOSED IN 2015 BY RACE/ETHNICITY AND SEX – NEW JERSEY

NJ Females diagnosed

HIV/AIDS

2015, N=283

NJ males diagnosed

HIV/AIDS

2015, N=887

NJ eHARS as of 12/31/ 2017.

POPULATION (2016) AND PLWHA (2017) BY RACE/ETHNICITY –NEW JERSEY

Persons Living with

HIV/AIDS

New Jersey, 2017, N=37,411

New Jersey Population

2016, N=8,944,469

July 2017 Bridged-Race estimates for 2016 population NJ eHARS as of 12/31/ 2017.

PERCENT FOR ADULT/ADOLESCENT HIV/AIDS DIAGNOSES BY AGE GROUP AND SEX -- NJ, 2015

Men (aged 13+,N=885) Women (aged13+,N=280)

50%

White

Number Adult/Adolescent HIV/AIDS Diagnoses by

Race/Ethnicity and Age Group -- New Jersey, 2015Hispanic

Black

The number and percentage of new HIV/AIDS diagnoses due to IDU transmission in NJ diminished in recent years. In 2015, only 3.4% of men diagnosed with HIV/AIDS were IDU, this figure was 5.0% for women. Currently, 17% of persons living with HIV/AIDS in is attributed to IDU exposure.

MSM has become the highest HIV/AIDS risk in NJ population. 57.5% of NJ men diagnosed with HIV/AIDS in 2015 were MSM. 55% of Black men diagnosed HIV/AIDS in 2015 were MSM and 64% of Hispanics men were MSM. The disparity of new cases in

minorities is particularly pronounced for young MSM.

HIV/AIDS and Mode of Transmission

Number of Women Diagnosed HIV/AIDS by Exposure

Category -- New Jersey, 2011 - 2015

Number of Men Diagnosed HIV/AIDS by Exposure

Category -- New Jersey, 2011 - 2015

NEW HIV/AIDS CASES DIAGNOSED BYEXPOSURE CATEGORY, 2015 – NEW JERSEY

Females Diagnosed HIV/AIDS

2015, N=283

Males diagnosed with HIV/AIDS

2015, N=887

PLWHA BY EXPOSURE CATEGORY –NEW JERSEYEHARS DATA AS OF 12/31/2017

Females Living with HIV/AIDS

2017, N=12,103

Males Living with HIV/AIDS

2017, N=25,308

2

7

9

8

5

6

3

1

HIV/AIDS Cases Diagnosed in 2015 by Planning Area

5.0 – 8.9

9.0 – 13.9

14.0 – 22.9

23.0 +

New HIV/AIDS Cases

Diagnosed in CY2015 per 100,000

2015 population, by Planning Area

Statewide rate= 13.1 per 100,000

Planning Area: 2015 New Cases Rate

1 Jersey City TGA 23.5

2 Newark EMA 20.3

3 Mercer 14.5

4 Atlantic-Cape May TGA 13.6

5 Cumberland 10.3

6 Bergen-Passaic TGA 9.7

7 NJ Portion of Philadelphia EMA 9.3

8 Middlesex-Somerset-Hunterdon 7.6

9 Monmouth-Ocean 5.2 eHARS Data as of 12/31/2017,

2015 population from 2017 estimated

Counties: N (Rates)

1 Essex 9601 (1205)

2 Hudson 5098 (752)

3 Union 2883 (519)

4 Atlantic 1371 (506)

5 Passaic 2460 (484)

6 Mercer 1539 (415)

7 Cumberland 620 (403)

8 Camden 1909 (374)

9 Monmouth 1902 (304)

10 Middlesex 2160 (258)

11 Salem 155 (244)

12 Cape May 219 (232)

13 Burlington 888 (198)

14 Somerset 638 (191)

15 Bergen 1793 (191)

16 Warren 198 (186)

17 Morris 872 (175)

18 Gloucester 470 (161)

19 Ocean 818 (138)

20 Hunterdon 161 (129)

21 Sussex 174 (122)

Persons Living with HIV/AIDS in 2017 by County

0.0 - 199

200 - 420

421 - 599

600 +

Prevalence Rate: Persons Living with

HIV/AIDS as of 12/31/2017 per 100,000

population (Bridged Race Estimates

for July 1, 2016)

Statewide rate= 418 per 100,000

Data as of 12/31/2017

2

9

14

5

1

4

3

6

7

8

11

10

12

1517

13

18

20

16

21

19

The percentage of New Jersey’s population living in poverty is lower than the nation as a whole. More than ten percent (10.4%) of New Jersey’s residents had incomes below the poverty level in 2016 compared to 15.1% nationally (Source:2012-2016 American Community Survey 5-Year estimates).

Counties with the lowest percentage of residents living below the poverty level (richest counties) are Hunterdon, Morris and Somerset. The richer counties tend to have lower HIV prevalence.

Conversely, counties with the highest percentage of residents living below the poverty level (poorest counties) tend to have higher HIV incidence and prevalence.

Essex, Hudson, Atlantic, Passaic, Mercer, Cumberland and Camden counties had the highest HIV/AIDS prevalence rates in 2017 and the highest poverty rates in 2016.

Socio-economic Status in New Jersey

Counties: Poverty Rates

1 Cumberland 18.4%

2 Passaic 17.2%

3 Essex 16.3%

4 Hudson 15.6%

5 Atlantic 14.2%

6 Salem 12.6%

7 Camden 12.0%

8 Cape May 11.9%

9 Mercer 11.1%

10 Ocean 11.0%

11 Union 10.6%

12 Middlesex 8.6%

13 Warren 8.3%

14 Gloucester 7.8%

15 Monmouth 7.1%

16 Bergen 6.9%

17 Burlington 6.2%

18 Sussex 6.0%

19 Morris 5.4%

20 Somerset 5.2%

21 Hunterdon 4.5%

Living with HIV/AIDS, 2017 Poverty Rates in 2016

by County 4.5 – 6.2 (17-21)6.9 – 10.6 (11-16)

10.8 – 12.0 (7-10)

12.6 + (1-6)

Statewide rate = 10.4%

Data as of 12/31/2017

4

15

20

2

3

5

11

9

1

7

6

12

8

19

17

14

21

13

18

10

16

Counties: N (Rates)

1 Essex 9601 (1205)

2 Hudson 5098 (752)

3 Union 2883 (519)

4 Atlantic 1371 (506)

5 Passaic 2460 (484)

6 Mercer 1539 (415)

7 Cumberland 620 (403)

8 Camden 1909 (374)

9 Monmouth 1902 (304)

10 Middlesex 2160 (258)

11 Salem 155 (244)

12 Cape May 219 (232)

13 Burlington 888 (198)

14 Somerset 638 (191)

15 Bergen 1793 (191)

16 Warren 198 (186)

17 Morris 872 (175)

18 Gloucester 470 (161)

19 Ocean 818 (138)

20 Hunterdon 161 (129)

21 Sussex 174 (122)

MSM ONLY, NUMBER AND PERCENT OF PERSONS DIAGNOSED WITH HIV/AIDS, 2011-2015

BY AGE GROUP – NJ

By Age Groups (for age 13+, N=2,122 )

Number and Percent of MSM only Diagnoses HIV/AIDS by Age Group in NJ, 2011 - 2015

MSM ONLY, NUMBER AND PERCENT OF PERSONS DIAGNOSED WITH HIV/AIDS, 2011-2015

BY RACE/ETHNICITY – NEW JERSEY

NJ MSM’s diagnosed HIV/AIDS

2013-2017, N=2,122

NJ eHARS as of 12/31/ 2017.

MSM Only Diagnosed HIV/AIDS by Race/Ethnicity—

New Jersey, 2011-2015

Counties: N

1 Essex 447

2 Hudson 376

3 Union 167

4 Passaic 147

5 Camden 138

6 Bergen 135

7 Middlesex 126

8 Monmouth 109

9 Mercer 87

10 Atlantic 61

11 Morris 52

12 Ocean 52

13 Somerset 50

14 Burlington 49

15 Cumberland 33

16 Gloucester 28

17 Salem 12

18 Warren 8

19 Cape May 6

20 Hunterdon 6

21 Sussex 6

MSM Diagnosed HIV/AIDS 2011-2015 by County for NJ

6 - 52

60 - 129

135 - 199

300 +

MSM Only (not including MSM/IDU)

Statewide new HIV ifections among

MSM 2011-2015 = 2,122

Data as of 12/31/2017

2

8

13

4

1

10

3

9

15

5

17

7

19

611

14

16

20

18

21

12

Counties: #

1 Hudson 2027

2 Essex 2022

3 Union 757

4 Camden 689

5 Bergen 673

6 Middlesex 618

7 Monmouth 614

8 Passaic 558

9 Mercer 441

10 Atlantic 394

11 Burlington 325

12 Morris 313

13 Ocean 253

14 Somerset 216

15 Gloucester 188

16 Cumberland 154

17 Hunterdon 76

18 Cape May 70

19 Warren 54

20 Sussex 51

21 Salem 35

MSM Living with HIV/AIDS through 2017 by County in NJ

35 - 190

200 - 445

500 - 799

2,000+

MSM only (not include MSM/IDU)

Persons Living with HIV/AIDS

through 2017

Statewide number = 10,672

New Jersey eHARS

Data as of 12/31/2017

1

7

14

8

2

10

3

9

16

4

21

6

18

512

11

15

17

19

20

13

In comparison to the overall state VL suppression rate of 52%:

Gender – No difference in percentage of viral load suppression from overall population

Race/Ethnicity – White - 58%Black - 49%

Mode of Exposure – MSM – 54%Unknown – 48%

Age at Diagnosis – 55+ – 55%13-24 – 41%

NJ HIV Care Continuum by

Demographic Factors

KEY POINTS New HIV infections are down overall; between 2011 and 2015

there was a 2% decline in new infections: 17% among white, 7% among Black, but 17% increase among Hispanics.

The only demographic group experiencing a growth in new infections is MSM, particularly for Hispanic men.

MSM has become the highest risk factor for HIV/AIDS in NJ. 57.5% of new HIV/AIDS cases in 2015 was among MSM, particularly YMSM between the ages of 19 to 29.

Racial ethnic disparities still exist. Seventy nine percent (79%) of persons living with HIV in 2017 were minority.

A quarter (25%) of infections are diagnosed at a late stage; these cases are diagnosed concurrently with HIV and AIDS.

70% of persons known to be infected and still residing in NJ were retained in care in 2015, 52% of whom were virally suppressed.

QUESTIONS / INFORMATION CONTACT:

BARBARA J. BOLDEN, PHD

DIVISION OF HIV, STD AND TB SERVICES

DIRECTOR, EPIDEMIOLOGIC SERVICES

barbara.bolden@doh.nj.gov

(609) 984-5940