HIV, Race and Risk in Atlanta, GA:

Data from Emory University Studies

Patrick Sullivan, DVM, PhD

Emory University

Center for AIDS Research

About AIDSVu

AIDSVu is a compilation of interactive, online maps that allows users to visually explore the HIV epidemic in the U.S. alongside critical resources such as HIV testing and treatment center locations.

AIDSVu’s mission is to make HIV prevalence data widely accessible and locally relevant.

AIDSVu provides users with an intuitive, visual way to connect with complex information about persons living with an HIV diagnosis at national, state and local levels.

Rates of Persons Living with an HIV or AIDS Diagnosis, by ZIP Code, Atlanta, 2011

Notes: Rates include persons living with an HIV or AIDS diagnosis in Clayton, Cobb, Douglas, DeKalb, Fulton, and Gwinnett Counties at the end of 2011 and who were reported as of 12/31/2013. Data have not been adjusted for reporting delays.Data Source: Georgia Department of Public Health, Division of Health Protection, Epidemiology Program, HIV/AIDS Epidemiology Section.

* Data are not shown to protect privacy because of a small number of cases and/or a small population size.

Black Rates White Rates

Rates of Black & White Persons Living with an HIV or AIDS Diagnosis, by ZIP Code, Atlanta, 2011

Notes: Rates include persons living with an HIV or AIDS diagnosis in Clayton, Cobb, Douglas, DeKalb, Fulton, and Gwinnett Counties at the end of 2011 and who were reported as of 12/31/2013. Data have not been adjusted for reporting delays.Data Source: Georgia Department of Public Health, Division of Health Protection, Epidemiology Program, HIV/AIDS Epidemiology Section.

* Data are not shown to protect privacy because of a small number of cases and/or a small population size.

Persons Living with an HIV Diagnosis Poverty Rates

Rates of Persons Living with an HIV Diagnosis & Poverty Rates, by ZIP Code, Atlanta, 2011

Notes: Rates include persons living with an HIV or AIDS diagnosis in Clayton, Cobb, Douglas, DeKalb, Fulton, and Gwinnett Counties at the end of 2011 and who were reported as of 12/31/2013. Data have not been adjusted for reporting delays.Data Sources: Georgia Department of Public Health, Division of Health Protection, Epidemiology Program, HIV/AIDS Epidemiology Section. U.S. Census Bureau, Small Area Income and Poverty Estimates.

* Data are not shown to protect privacy. † Data not available because the data source does not publish these data for this jurisdiction.

When did the study occur?

Analysis and dissemination phase• Preparing data• Statistical analyses• Publishing papers in scientific literature• Dissemination to community and stakeholders

2010 2011 2012 2013 20142009

7/2010 – 12/2012: Recruitment

5/2009 - 7/2010 Planning, focus groups

7/2010 – 3/31/2014: Participant follow-up

1/2013 – 12/2014: Prevalence findings

1/2014 – 12/2014: Incidence findings

“Active” study phase

HIV Prevalence, by Race and Age Sullivan et al – PLoS One 2014

Black MSM: 44% White MSM: 13%

Comparisons of Factors by Race Sullivan et al – PLoS One 2014

•Compared to white MSM, black MSM reported:▫Fewer sexual partners and sex risks▫Less drug use

▫A higher degree of same-race partnering▫Similar ages of partners▫Less pre-sexual discussion of HIV status

▫Lower socioeconomic status(poverty, employment, insurance)

▫Living in more disadvantaged census tracts

Social determinants

Partner pool /

network

Individual risk behaviors

• Driven largely by differences in HIV prevalence.

• However, differences in HIV care continuum will also contribute.

Population Transmission RiskKelley et al – PLoS One 2012

STI IncidenceRosenberg et al – CROI 2014

BMSM WMSM

Rate Ratio Infections

Rate(% / year) Infections

Rate(% / year)

Urethral Chlamydia 17 4.9 14 3.1 1.6

Urethral Gonorrhea 8 2.3 1 0.2 10.3

Rectal Chlamydia 31 10.2 21 5.4 1.9

Rectal Gonorrhea 28 9.0 15 3.8 2.4

Syphilis 22 6.2 0 0.0

HIV IncidenceRosenberg et al – CROI 2014

Black MSM White MSMOverall

Incidence rate 6.6% / year 1.7% / year

New HIV infections 24 8

% HIV-positive at end of study 11.3% 3.6%

Age 18 – 24

Incidence rate 12.1% / year 1.0 % / year

New HIV infections 16 1

% HIV-positive at end of study 16.6% 1.6%

Age 25+

Incidence rate 3.5% / year 1.9% / year

New HIV infections 8 7

% HIV-positive at end of study 6.0% 4.5%

1.7 / 100 PY8 infections

Cum. Inc. (2-yr): 3.6%

6.6 / 100 PY24 infections

Cum. Inc. (2-yr): 11.3%

Log-Rank P = 0.0005

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THANK YOU!

Patrick Sullivan psulli@emory.edu

Eli Rosenberg esrose2@emory.edu