Massachusetts hiv/aids data Fact Sheet Communities of Color November 2012 Introduction



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Massachusetts HIV/AIDS Data Fact Sheet

Communities of Color

November 2012

Introduction



Communities of color have been disproportionately affected by HIV/AIDS in Massachusettsi since the beginning of the epidemic. While only 6% of the Massachusetts population are black (non-Hispanic) and another 8% are Hispanic/Latino, 30% of people living with HIV/AIDS in Massachusetts are black (non-Hispanic), and 25% are Hispanic/Latino. Among individuals diagnosed with HIV infection within the years 2008 to 2010, 33% were black (non-Hispanic) and 25% were Hispanic/Latino. People of color are affected by HIV/AIDS at levels disproportionate to their representation in the population at all disease stages, from detection of HIV infection to an AIDS diagnosis, as well as in mortality.
Evidence of Disparity:

  • Six percent of males in Massachusetts are black (non-Hispanic) compared to 24% of males living with HIV/AIDS, and 26% of those recently diagnosed with HIV infection.

  • Eight percent of all Massachusetts males are Hispanic/Latino compared to 23% of males living with HIV/AIDS, and 24% of those recently diagnosed with HIV infection.

  • Six percent of females in Massachusetts are black (non-Hispanic) compared to 44% of females living with HIV/AIDS, and 52% of those recently diagnosed with HIV infection.

  • Eight percent of females in Massachusetts are Hispanic/Latina compared to 28% of females living with HIV/AIDS, and 27% of those recently diagnosed with HIV infection.



Age-adjusted rates: Age-adjusted rates allow for direct comparison of disease impact among racial/ethnic populations of different sizes and age distribution.ii

  • The age-adjusted prevalence rate of HIV/AIDS among the black (non-Hispanic) population (1,512.2 per 100,000) is 11 times greater, and among the Hispanic/Latino population (1,162.0 per 100,000) is eight times greater than that among the white (non-Hispanic) population (136.9 per 100,000).



  • Similarly, the age-adjusted average annual rate of HIV diagnosis from 2008 to 2010 among the black (non-Hispanic) population (57.7 per 100,000) is 12 times greater, and among the Hispanic/Latino population (35.0 per 100,000) is seven times greater than that among the white (non-Hispanic) population (4.8 per 100,000).

  • Among females, the level of disparity is more pronounced: the age-adjusted prevalence of HIV/AIDS among black (non-Hispanic) females (1,226.1 per 100,000) is 26 times greater, and among Hispanic/Latina females (718.9 per 100,000) is 15 times greater than that among white (non-Hispanic) females (46.9 per 100,000).

  • Similarly, the age-adjusted average annual rate of HIV diagnosis from 2008 to 2010 among black (non-Hispanic) females (48.0 per 100,000) is 40 times greater, and among Hispanic/Latina females (21.0 per 100,000) is 18 times greater than for white (non-Hispanic) females (1.2 per 100,000).

Age-adjusted rates of death: The disparate impact experienced by non-Hispanic black and Hispanic/Latino populations, as evidenced by their age-adjusted HIV/AIDS prevalence and rates of HIV infection diagnosis, is mirrored in the age-adjusted rates of death. However, while persons of color are diagnosed with HIV/AIDS at higher rates in Massachusetts, after diagnosis, the average survival time does not appear to vary with race/ethnicity. This is likely due to widespread availability and utilization of medical care and highly active antiretroviral therapy (HAART) in the Commonwealth.


  • The age-adjusted average annual rate of death within the three-year period 2008 to 2010 among both the black (non-Hispanic) and Hispanic population reported with HIV/AIDS (19.5 per 100,000 and 18.0 per 100,000, respectively) is nine times greater than for the white (non-Hispanic) population (2.1 per 100,000).


Exposure Mode:

  • The predominant mode of exposure among white (non-Hispanic) individuals diagnosed with HIV infection, within the years 2008 to 2010, is male-to-male sex (64%). Among black (non-Hispanic) individuals, the most frequently reported exposure mode is female reporting sex with male of unknown risk and HIV status (presumed heterosexual exposure, 22%),iii followed by heterosexual sex with partners of known risk and/or HIV status (19%) and male-to-male sex (18%). Among Hispanic/Latino individuals, male-to-male sex accounts for 28%, injection drug use 18%, and heterosexual exposure 17% of reported exposures to HIV infection.

  • Exposure mode among people diagnosed with HIV infection within the three-year period 2008 to 2010 varies by race/ethnicity among both males and females.

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  • Among white (non-Hispanic) males, male-to-male sex is the predominant exposure mode, accounting for 74% of reported cases; for 15%, exposure mode is undetermined.



  • Exposure mode is undetermined in 47% of black (non-Hispanic) males. Male-to-male sex is the most frequently reported risk accounting for 32% of all cases, followed by heterosexual sex at 10% and injection drug use at 7% of reported exposures.

  • Among Hispanic/Latino males, male-to-male sex is the most frequently reported exposure mode accounting for 40% of cases, followed by undetermined exposure mode at 29%, injection drug use at 18% and heterosexual sex at 9% of exposures.




  • Among white (non-Hispanic) females diagnosed with HIV infection, exposure mode is near evenly distributed among the three main exposure modes reported in females: injection drug use accounts for 32%, heterosexual sex (with partners of known risk and/or HIV status) accounts for 31%, and sex with males of unknown risk and HIV status (presumed heterosexual) accounts for 22% of exposures.

  • The predominant exposure mode among black (non-Hispanic) females is sex with males of unknown risk and HIV status (presumed heterosexual exposure) at 50% of exposures.

  • Among Hispanic/Latina females, heterosexual sex (with partners of known risk and/or HIV status) is the most frequently reported exposure mode accounting for 38% of exposures, followed by sex with males of unknown risk and HIV status (presumed heterosexual exposure) at 34% and injection drug use at 17% of exposures.

Geography:

  • The Western Health Service Region (HSR)iv was the residence for the largest proportion of Hispanic/Latino individuals among recent HIV infection diagnoses (42%), followed by the Northeast HSR (32%) and the Central HSR (26%).

  • The Boston HSR was the residence for the largest proportion of black (non-Hispanic) individuals among recent HIV infection diagnoses at 41%, followed by the Central HSR at 37% and the Metro West HSR at 34%.

Among cities with over 20 people diagnosed with HIV infection within the three-year period 2008 to 2010, the following have the highest proportions of black (non-Hispanic) individuals diagnosed with HIV infection [N is the number of black (non-Hispanic) individuals diagnosed]:


Brockton

77.8%

(N=49)

Malden

64.7%

(N=22)

Waltham

48.6%

(N=18)

Worcester

45.4%

(N=44)

Cambridge

44.2%

(N=23)

Quincy

42.9%

(N=9)

Boston

42.4%

(N=227)

Everett

41.7%

(N=10)

Lynn

35.7%

(N=15)

Framingham

34.8%

(N=8)

Among cities with over 20 people diagnosed with HIV infection within the three-year period 2008 to 2010, the following have the highest proportions of Hispanic/Latino individuals diagnosed with HIV infection (N is the number of Hispanic/Latino individuals diagnosed):




Lawrence

88.2%

(N=45)

Holyoke

67.7%

(N=21)

Springfield

53.6%

(N=52)

Framingham

43.5%

(N=10)

Lynn

38.1%

(N=16)

Worcester

30.9%

(N=30)

Lowell

30.5%

(N=18)

Everett

29.2%

(N=7)

Fall River

25.0%

(N=9)

Malden

23.5%

(N=8)


Place of Birth:


  • Fifty-one percent of black (non-Hispanic) individuals diagnosed with HIV infection within the three-year period 2008 to 2010 were born outside the US, compared to 67% of Asian/Pacific Islander individuals, 35% of Hispanic/Latino individuals and 8% of white (non-Hispanic) individuals.

  • The majority of non-US born black (non-Hispanic) individuals diagnosed with HIV infection within the three-year period 2008 to 2010 were from Sub-Saharan Africa and the Caribbean Basin.

  • Combined, the following five countries represent the country of birth for 70% of non-US born black (non-Hispanic) individuals diagnosed with HIV infection in Massachusetts within the three-year period 2008 to 2010 (N is the number of non-US born black (non-Hispanic) individuals diagnosed with HIV infection):



Haiti

37.0%

(N=125)

Uganda

10.1%

(N=34)

Cape Verde

9.8%

(N=33)

Ghana

6.8%

(N=23)

Kenya

5.9%

(N=20)




  • The majority of non-US born Hispanic/Latino individuals recently diagnosed with HIV infection are from Central and South America and the Caribbean Basin.

  • Combined, the following five countries represent the country of birth for 78% of non-US-born Hispanic/Latino individuals diagnosed with HIV infection in Massachusetts within the three-year period 2008 to 2010 (N is the number of non-US born Hispanic/Latino individuals diagnosed with HIV infection):




Dominican Republic

30.1%

(N=52)

Brazil

19.7%

(N=34)

El Salvador

11.6%

(N=20)

Guatemala

8.7%

(N=15)

Honduras

8.1%

(N=14)


Youth Diagnosed with HIV Infection:

  • Although black (non-Hispanic) youth represent only 8% of people under the age of 25 in Massachusetts, they accounted for 36% of HIV infection diagnoses among this age group within the three-year period 2008 to 2010.

  • Although Hispanic/Latino youth represent only 11% of people under the age of 25 in Massachusetts, they accounted for 29% of HIV infection diagnoses among this age group within the three-year period 2008 to 2010.


Behavioral Risk for HIV Infection:

The Behavioral Risk Factor Surveillance System (BRFSS) tracks patterns of condom use among sexually active adults in Massachusetts.



  • Of 4,679 sexually active respondents to the 2009 and 2010 BRFSS, aged 18-64 years, 22% reported using a condom during their last sexual encounter. A greater proportion of black (non-Hispanic) respondents (39%) and Hispanic/Latino respondents (24%) reported condom use at last sexual encounter, compared to white (non-Hispanic) respondents (20%).

Data Sources:

All HIV/AIDS Case Data: Massachusetts Department of Public Health (MDPH) HIV/AIDS Surveillance Program, Data as of January 1, 2012


BRFSS Data: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research and Evaluation, Behavioral Risk Factor Surveillance System

i Effective January 1, 2011, the Massachusetts Department of Public Health (MDPH), Bureau of Infectious Diseases, HIV/AIDS fact sheets, epidemiologic reports and other HIV data presentations have been updated to remove all HIV/AIDS cases who were first diagnosed in another state before being reported in Massachusetts. As of January 1, 2012, this resulted in the removal of 2,924 HIV/AIDS cases, of which 808 have died and 2,116 were living. These persons living with HIV/AIDS may still continue to reside and receive care in the Commonwealth. The total number of persons living with HIV/AIDS, irrespective of location of diagnosis, is the basis for MDPH service planning. This change is partially a result of increased activities required by the Centers for Disease Control and Prevention (CDC) for de-duplication among states in an effort to identify cases that are counted multiple times in the National HIV/AIDS surveillance system. The cases are assigned to the state that reports the earliest date of AIDS diagnosis if available. If the case has not progressed to AIDS, the case is assigned to the state with the earliest HIV diagnosis date. Please note that all previous HIV/AIDS fact sheets, data reports and presentations include cases that may have been first diagnosed in another state.

ii Age-adjusted relative rate comparisons are lower than in previous years due to the use of updated population denominators (MDPH Modified Age, Race/Ethnicity, & Sex Estimates 2005).

iii Effective January 1, 2011, the Massachusetts Department of Public Health (MDPH) HIV/AIDS fact sheets, epidemiologic reports, and other data presentations have been updated to eliminate the presumed heterosexual exposure mode category for males; those cases have been reassigned to the no identified risk (NIR) exposure mode category. The presumed heterosexual exposure mode category was used with the intention of identifying HIV exposure mode for females when sex with males is the only reported risk factor, there is no evidence of current or past injection drug use (IDU), and behavioral risk and HIV status information about male sexual partners are unknown. Twenty-seven percent of females living with HIV/AIDS and 40% of recent female HIV diagnoses are reported in the presumed heterosexual exposure mode category. The application of the presumed heterosexual exposure mode category to males is overly inclusive in that female to male HIV transmission is biologically less probable, and there are alternate exposure modes that are possible for males, including sex with other men (MSM) or IDU. The CDC reports males diagnosed with HIV/AIDS who report sex with females as their only risk factor, without corresponding partner risk or HIV status information, in the NIR exposure mode category. This revision to report presumed heterosexual male HIV/AIDS cases as NIR will bring Massachusetts HIV/AIDS case reporting for males in alignment with CDC standards. The MDPH will maintain presumed heterosexual and heterosexual exposure mode categories for females.

iv HSRs are regions defined geographically to facilitate targeted health service planning. See Epidemiologic Profile General Appendices, Health Service Region Maps, available at http://www.mass.gov/eohhs/docs/dph/aids/2006-profiles/app-hrs-maps.pdf for configuration of health service regions. Reflects the health service region of a person’s residence at the time of report (not necessarily current residence).

For detailed data tables and technical notes see Appendix

Massachusetts Department of Public Health Office of HIV/AIDS 250 Washington St. 3rd Floor Boston, MA 02108

617.624.5300 FAX 617.624.5399 www.mass.gov/dph/aids




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