Wednesday, October 30, 2013

NYC HIV Stats Down 38%, DoH Preps New Epi Profile

What's happening with statistics for new HIV diagnoses in the five boroughs of New York City, according to the Department of Health? The October 2012 semi-annual HIV epi survey's historical chart, above, shows in the light blue line on the lower right that such diagnoses are in a decline.

It's not only new HIV diagnoses that have fallen but also full-blown AIDS cases and deaths are also decreasing. But what is the percentage decline from 2001 to 2011 in new HIV diagnoses?

Since there are no hard numbers behind each yearly blue dot, in the historical chart up top, I don't know the number of new HIV diagnoses in 2001 but I estimate the number was 5,900. Numbers of HIV and AIDS diagnoses are counted in the four-digits, as explained on the far left sideways explanation in red.

Using the 2001 estimate of 5,900 against the 3,400 figure for new HIV diagnoses in 2011, a figure that comes from the NYC DoH's PowerPoint presentation HIV/AIDS in New York City, 2007-2011, above, I guesstimate the drop at 38%.

This chart is from the New York State Department of Health AIDS Institute, from their HIV-STD-Hepatitis C epi report which was published in May, and shows newly diagnoses HIV cases statewide from 2002 - 2010.Here's are the excellent declining developments:

Newly diagnosed HIV cases have fallen steadily over this time period, with over 6,000 cases in 2002, which decline to under 4,000 in 2010. This represented a 37% drop in newly diagnosed cases over this 9-year period.

The statewide drop of 37% I believe bolsters my contention that the decline in NYC stats is 38%, for roughly the same time period.

The state epi profile also contains welcomed news about new HIV cases by racial categories. The orange bars represent black cases, Hispanics with green bars and white cases are the blue bars:

This figure demonstrates that the successes observed in [over all HIV cases] have also been observed among the three most populous racial/ethnic groups in NYS. In fact, the sharpest decline was observed among black persons, with a 42% decrease, followed by Hispanic (35%) and white (26%) persons. The number of newly diagnosed HIV cases among Asian/Pacific Islanders, Native Americans, and Multi-race were too small to provide meaningful trends, therefore are not shown.

Another important decline among a very high-risk population is seen in the state chart for people who inject substances:

The substantial decline in newly diagnosed HIV cases among injecting drug users represents another significant achievement in the history of the AIDS epidemic. The number of newly diagnosed HIV cases attributable to injecting drug use declined by 78% from 2002 to 2010.

I asked NYC DoH spokeswoman Diane Hepps why there is no October 2013 semi-annual epi report, as there have been such reports for the past seven years. Hepps replied:

Note we won’t be releasing a report this October but we will be releasing an annual report by the end of the year. The inaugural annual report will be released by end of year and we will continue to publish mid-year reports. 

Whenever a department of public health is ending publication of any HIV epi reports, I believe there should be a public notice about it on the department's web site. That is not the case with DoH. There is no info on the surveillance page about ending the October semi-annuals and that they are are launching a new annual report. Let's hope DoH soon informs the public about the pending changes.

Finally, here is Hepps' reply to my question about why the NYC stats for new HIV diagnoses are down:

It is likely that the reasons for this decline are multifactorial and include a broad scale-up of routine HIV screening in NYC with prompt linkage to care, support for staying in care and adhering to HIV treatment, as well as widespread availability of sterile syringes and free condoms, among other factors.

When the inaugural annual report is released in December, we'll see if the declines continue.


Peter Staley said...

Great post, Michael. Indeed, NYC and NY State are doing better than the rest of the country, with big declines in new infections. One of the key stats driving this is that more New Yorkers are on treatment, and virally suppressed -- 37% of people with HIV, vs. 25% nationally.

New HIV infections are dropping in all groups, except one -- gay men. Your post failed to mention this. You can see the MSM stats for NYC graphed here:

Michael Petrelis said...

Hi Peter. I followed your link and saw your graph.

It looks like HIV is statistically stable for MSM and that proportionally, the number of MSM diagnoses grows larger while other transmission categories, such as IVDU cases, go down.

You're one of the few agreeing with me, and the NYC/NYS stats, that new infections are dropping.

We'll all have data to scrutinize and analyze in December when NYC DOH releases its inaugural HIV epi profile.

Peter Staley said...

Yup, and even more sadly, there's been a large rise in new HIV infections among young MSM over the 10 years. We're seeing this through-out the world, with a few exceptions -- notably SF and DC.

Simon Forbes said...

We do have to look at these figures very carefully. Overall in the UK new HIV infections are going down. However, if we look closely there has been a steady rise in infections among men who have sex with men in the past 10 years. See below esp pp 13-14 and the tables in appendices 2 and 3.

The highest rate is not among the under 25s but those in their late 20s (25-34 generally according the above report)

I think there is too much finger pointing at young gay guys aged under 25. This is a stereotype and based on a lot of self deception IMHO - the idea that barebacking happens because of lack of education etc etc. In fact it is often the older "more educated" ones say late 20s and 30s who are more at risk of infection. According to this article in Michael's home town it is MSM in their 30s who are most at risk.

I would draw your attention to this article on barebacking from GMFA a London based organisation I used to do a lot of work for. It is one of the more balanced pieces on the subject I have read:

The good news though is that the rate of new AIDS cases and deaths is steady if not falling in the UK and elsewhere I believe. In the vast majority of cases the fatalities are due to late diagnosis when the CD4 count has dropped below 350 or even 200. This highlights the importance of testing IMHO esp if they are taking risks so people can get started on treatments early rather than when it is too late.

Peter Staley said...

Thanks for this, Simon. Fascinating take on the age breakdowns in the U.K. But they don't match the U.S. While HIV infection rates among MSM are rising (often only slightly) in all age groups), the fastest for us is in the 20-25 year-olds. Most of this is in young African-American MSM. Blacks make-up 13% of our population, and only 3% in the U.K., so maybe this accounts for some of the difference?

Worth noting are the many studies showing very few differences in safe-sex practices between ethnic groups in the U.S. In fact, Black MSM have been shown to wear condoms and have fewer sex partners than White MSM. Their higher HIV infection rates are primarily pegged to much higher underlying prevalence, and higher rates of STDs.

For reference, see bullet #4 under the "By Risk Group" section of this CDC webpage:

"The estimated number of new HIV infections was greatest among MSM in the youngest age group. In 2010, the greatest number of new HIV infections (4,800) among MSM occurred in young black/African American MSM aged 13–24. Young black MSM accounted for 45% of new HIV infections among black MSM and 55% of new HIV infections among young MSM overall."

Simon Forbes said...

Thanks Peter. I had a close look at the US CDC stats and among whites those with new infections tend to be significantly older than among non-white groups so I think the ethnic make up of the UK does have something to do with it and there could well be a transnational pattern here.

Interesting you should say that condom use is not less in black MSMs as that is true of figures I have seen in the UK too. On other STIs significantly increasing risk of transmission of HIV I think that is absolutely right and I don't think anyone informed person would dispute that.

Another interesting international comparison is Toronto see pp 1.16-1.20

Again males (80% MSMs) more likely to be infected at 25-34 with a peak in the early 30s.

Some interesting stats too on risk factors - pity not more comprehensive. Another shock horror stereotype with respect to barebacking peddled by gay press hacks is the internet, but meeting contacts in bath houses are much higher than that and dark rooms are not even listed. The fact that it is more open and "up front" on the internet is neither here nor there IMHO. Serosorting (also strongly disapproved of in certain quarters) did not also yield a large number of infections - fewer than condom breakage in fact.

Of course we need to be careful with such stats and recognise that the full truth is not always told to clinics in such circumstances - for instance I have heard too many "just one time" stories to automatically believe everyone that says that.