Hiv Aids Epidemic In Usa Ppt Kates

Source: Kaiser Family Foundation, State Health Facts CDC, Special Data Request, November 2005... Rate = 9.5 Source: Kaiser Family Foundation, State Health Facts CDC, Special Data Request

The HIV/AIDS Epidemic in the

United States

Jennifer Kates, M.A., M.P.A.

Vice President and Director,

HIV Policy Kaiser Family Foundation

KaiserEDU.org Tutorial

February 2006

New infections each year 40,000 People living with

HIV/AIDS 1,039,000 – 1,185,000 People with

HIV/AIDS not in care

42 – 59%

People with HIV who don’t know they’re infected

24 – 27%

The U.S Epidemic: Snapshot of Key Data

Note: Data are estimates

Sources: CDC, 2005; Glynn, K et al., CDC, "Estimated HIV prevalence in the United States at the end

of 2003", Presentation at the National HIV Prevention Conference, 2005; Fleming, P., et al., “HIV

Prevalence in the United States 2000”, 9th Conference on Retroviruses and Opportunistic Infections, 2002

0 17,000

420,000 New AIDS

Cases

People Living with AIDS

New AIDS Cases, Deaths, and People Living with

AIDS, 1985-2004

Deaths among People with AIDS

Note: Data are estimates

Source: CDC, Data Request, 2006

Proportion of AIDS Cases,

Alaska Native

Percent of

AIDS Diagnoses

Note: Data are estimates

Source: CDC, Data Request, 2006

Figure 3

2004

Notes: U.S Population estimates do not include U.S dependencies, possessions, and associated nations; persons who reported more than one race were included in multiple categories May not total 100% due to rounding Total AIDS diagnoses in 2004 include persons of unknown race or multiple races AI/AN = American Indian/Alaskan Native

Sources: CDC, HIV/AIDS Surveillance Report, Vol 16, 2005; U.S Census Bureau, Population Estimates Program,

AI/AN

AIDS Cases 42,514

U.S Population 293,655,404

Impact on Women

Women as a Share of New AIDS Diagnoses

Note: Data are estimates

Sources: CDC, Data Request, 2006

New AIDS Diagnoses by Race/Ethnicity

and Sex, 2004

33%

White 15%

Note: Data are estimates for adults/adolescents and do not include cases from the U.S

dependencies, possessions, and associated nations, and cases of unknown residence

Source: CDC, HIV/AIDS Surveillance Report, Vol 16, 2005.

Figure 6

Reported HIV Cases Among Teen Girls and

HIV Spread Primarily Through Sex,

Other

Notes: Data are estimates May not total 100% due to rounding

Sources: CDC, Presentation by Dr Harold Jaffe, “HIV/AIDS in America Today”, National HIV

Prevention Conference, 2003; CDC, HIV/AIDS Surveillance Report, Vol 16, 2005

Figure 8

Heterosexual

Impact

AIDS Case Rate per 100,000 Population

by Region, 2004

20.4 18.7 9.0

6.8

Midwest West South Northeast

Notes: Case rates calculated by KFF; data do not include U.S territories and possessions Sources:

CDC, HIV/AIDS Surveillance Report, Vol 16, 2005; U.S Census Bureau, Population Estimates

Program, 2004 Population Estimates

Figure 9

Top 10 States by AIDS Case Rate per 100,000 Population, 2004

U.S Rate = 15.0

Source: CDC, HIV/AIDS Surveillance Report, Vol 16, 2005.

179.2 39.7

33.5 26.1 23.4 22.4 21.2 18.9 18.4 18.6

District of Columbia

New York Florida Maryland Puerto Rico Louisiana New Jersey Delaware Georgia Connecticut & Virgin Is.

335.1 158.7

148.7 131.1 114.7 110.2 92.6 86.9 77.1 84.6

District of Columbia

New York Florida North Dakota New Hampshire

New Jersey Maryland Rhode Island Pennsylvania

Delaware

Top 10 States by AIDS Case Rate per 100,000 African Americans, 2004

U.S Rate = 73.9

Note: Data not available for U.S dependencies, possessions, and independent nations in free

association with the United States

Source: Kaiser Family Foundation, State Health Facts (CDC, Special Data Request, November

2005)

Figure 11

113.3 29.3

23.1 22.5 17.8 16.8 16.3 16.2

13.4 15.7

District of Columbia

New York Florida Maryland Delaware New Jersey Louisiana Connecticut Puerto Rico Virgin Islands

Top 10 States by AIDS Case Rate per 100,000 Among Women, 2004

U.S Rate = 9.5

Source: Kaiser Family Foundation, State Health Facts (CDC, Special Data Request, November

2005)

Top 10 MSAs by AIDS Case Rate per 100,000 Population, 2004

29.9 30.0 31.2 31.3 31.9 32.8 35.0 35.0 41.9

53.8

Jacksonville, FL

Jackson, MS Orlando, FL Poughkeepsie, NY New Orleans, LA Baltimore, MD Washington DC-MD-VA-WV

Baton Rouge, LA New York, NY

Miami, FL

U.S Rate = 15.0

Note: MSAs with 500,000 or more population

Source: CDC, HIV/AIDS Surveillance Report, Vol 16, 2005.

Figure 13

Prevention Services for HIV/AIDS

Federal Funding for HIV/AIDS

*Not including international research which is counted in the research and prevention categories

Sources: Kaiser Family Foundation, Federal Funding for HIV/AIDS: The FY 2006 Budget Request,

2/05; DHHS, Office of Budget/ASBTF, 2/05; SSA, Office of the Actuary, 4/05; CMS, Office of the Actuary, 2/05; State Department, Office of the Global AIDS Coordinator; U.S Congress, FY 2005 Consolidated Appropriations Bill and Conference Report

US$ Billions

Total: $19.7 billion

Figure 14

Major Federal Sources of Funding for

HIV/AIDS Care

• Medicaid

• Medicare

• Ryan White CARE Act

• Others include: Department of Veterans

Affairs; SAMHSA; Community and Migrant Health Centers

Sources: Kaiser Family Foundation, Financing HIV/AIDS Care: A Quilt with Many Holes, May 2004;

DHHS, Office of Budget/ASBTF, 4/05

• Provides health & long-term care coverage for more than 52 M low- income people

• Largest source of coverage for people with HIV/AIDS

beneficiaries with HIV/AIDS

low-income populations

• Many with HIV/AIDS qualify through disability-related pathway

• Mandatory and Optional Services

Medicare

Medicaid’s Role in HIV/AIDS Care

Figure 16

Federal Medicaid Spending on

HIV/AIDS Care as Percent of Federal

Spending on HIV/AIDS Care FY 2005

Medicaid 49%

($5.7B) 51% ($6.0B) All Other

Total: $11.7 B

Sources: Kaiser Family Foundation, Medicare and HIV/AIDS, 9/05; KCMU, The Medicaid Program at

a Glance, 1/05 Medicaid HIV/AIDS spending estimate from CMS, Office of the Actuary, 2005, and

HHS Office of the Budget, 2005

• Covers nearly 42 M seniors and persons with disabilities

• Second largest source of HIV/AIDS coverage

 ≈100,000 Medicare beneficiaries with HIV/AIDS,

 Many have supplemental assistance, including Medicaid and ADAP to pay for drugs

• New Medicare Part D Drug Coverage

 Concerns about adequacy of formularies and transition of Dual Eligibles (ARVs yes, other Rx?)

 Effect on ADAP?

Medicaid Medicare’s Role in HIV/AIDS Care

Sources: Kaiser Family Foundation, Medicare and HIV/AIDS, 9/05; Kaiser Family Foundation,

Medicare at a Glance, 9/05 Medicare HIV/AIDS spending estimate from CMS, Office of the Actuary,

2005, and HHS Office of the Budget, 2005

Medicare Spending on HIV/AIDS

Care as Percent of Federal

Spending on HIV/AIDS Care FY 2005

Total: $11.7 B

Medicare 25% ($2.9B)

All Other 75%($8.8B)

The Ryan White CARE Act

• Original intent: relief to safety net (public hospitals)

• Important safety-net for uninsured and low-income

individuals

• Discretionary program, not entitlement

• Only disease-specific discretionary grant program for

care for people with HIV/AIDS

• Builds on Medicaid

 Gap filler in terms of eligibility AND services

• Services provided include: comprehensive primary care

support services, medications

• What you get depends on where you live

• $2.1 B in FY 2005

Figure 18

Components of the CARE Act

• Title I: Eligible Metropolitan Areas (Cities)

• Title II: Funding to States

Assistance Program (ADAP)

• Title III: Funds early intervention services, capacity building,

HIV Prevention

• Centers for Disease Control and Prevention (CDC)

cities; community based organizations; other

Sources: CDC, Personal Communication, 2006; CDC, HIV Prevention

Strategic Plan Through 2005

CDC’s “Advancing HIV Prevention: New Strategies for A Changing Epidemic”

• Announced in 2003

• Aims to:

 reduce barriers to early diagnosis of HIV

 increase access to quality medical care, treatment, and ongoing prevention services for with HIV.

• Four Main Strategies

 Incorporate HIV testing as a routine part of care in traditional medical settings

 Implement new models for diagnosing HIV infections outside medical settings (e.g., rapid testing)

 Prevent new infections by working with people diagnosed with HIV and their partners

 Further decrease mother-to-child HIV transmission

Sources: CDC, Advancing HIV prevention: New strategies for a changing epidemic MMWR

2003;52:329-332; CDC, AHP: http://www.cdc.gov/hiv/prev_prog/AHP/default.htm

Key Summary Points about the

Domestic Epidemic

• Approaching 25 years of AIDS

• Tremendous successes in the U.S including

 significant reduction in new infections since the 1980s

 antiretroviral treatment and people living longer

 reduction in mother to child transmission

• But the U.S epidemic is not over - troubling signs,

potential increases among some populations

• Impact varies across country – complex & “local”

 Minority Americans, particularly African Americans, women, young people, men who have sex with men

• Many challenges remain for prevention, care,

treatment, and research

Figure 22