BURDEN OF HIV/AIDS IN BEXAR COUNTY

San Antonio Metropolitan Health District

October 11, 2017
 New HIV Diagnoses Rates, 2008-2016

25
HIV Infections per 100,000 population

20 18.7

15 16.1

10 12.2

0
'08 '09 '10 '11 '12 '13 '14 '15 16
Year
Bexar County Texas US
Source: 2016 Annual Report: Texas HIV Surveillance Report
US estimated based on CDC number and US population
 New HIV Diagnoses, Bexar County, 2005-2016

400

350
Number of Cases

300

250

200
380 363 360
316 318 334 341 329
150 285 306
271
234
100

50

0
2005 '06 '07 '08 '09 '10 '11 '12 '13 14 '15 16
Year
Source: Texas HARS database
 New HIV Diagnoses by Age Group
Bexar County, 2011-2016
60

50
47.3
40
35.8
32.9
30 29.5
26.4 25.3
20
14.6
10 9.9

0.3 0.2
0
2011 2012 2013 2014 2015 2016
0-14 15-24 25-34 35-44 45+

Source: Texas HARS database, 2016 File

 New HIV Diagnoses by Race/Ethnicity
Bexar County, 2011-2016

45.0
Rate per 100,000 population

40.0
36.9 34.8
35.0
30.0
25.0 20.4
20.0 20.7
15.0 10.7
10.0 10.0
10.6
5.0
3.7
0.0
2011 2012 2013 2014 2015 2016
Year

White Black Hispanic Other

Source: Texas HARS database, 2016 File

 Percent of New HIV Diagnoses by Gender,
Bexar County, 2016

Bexar County Texas

11%
17%

89% 83%

Source: Texas HARS database, 2016 File

 Percent of New HIV Diagnoses by Risk Factor,
Bexar County & Texas, 2016
Bexar County Texas

2% 11%
20%
6%
2%
6%

72%
80%

MSM IDU MSM/IDU Heterosexual

Source: Texas HARS database, 2016 File
Persons Living with HIV , Bexar County, 2016

• ~ 6,000 in Bexar County

• Majority are 45+ years of age (52.4%)
• 85% males
• Race/ethnicity
– 63% Hispanic
– 19% White, non-Hispanic
– 16% Black, non-Hispanic
HIV Mortality Rates, Bexar County, 2011-2015

70 4
3.4
60 3.5
3.1 3
2.9 2.8 3
50
2.5
40
2
30 51 56 50 64 56
1.5
20
1
10 0.5
0 0
2011 2012 2013 2014 2015
Number Rate

Source: CDC Wonder

 New AIDS Diagnoses by Age Group
San Antonio Transitional Grant Area, 2014-2016

16.0
14.8
14.0 13.8
12.0 11.5 11.7
10.0
8.0
6.0 6.5
5.8
5.3
4.0
3.1
2.0
0.2 0.0
0.0
2014 2015 2016
0-12 13-24 25-34 35-44 45+

Source: DSHS, ARIES

 New AIDS Diagnoses by Race/Ethnicity
San Antonio Transitional Grant Area, 2014-2016

25.0
Rate per 100,000 population

20.0
15.4
15.0

10.0 8.5 7.9

5.3
5.0 3.5
2.8
0.0 0.0
0.0
2014 2015 2016
Year
White Black Hispanic Other

Source: DSHS, ARIES

Percent of New AIDS Diagnosis by Gender,
San Antonio TGA, 2016

16%

84%

Male Female

Source: DSHS, ARIES

 Percent of New AIDS Diagnoses by Risk Factor,
San Antonio TGA & Texas, 2016

San Antonio TGA Texas

1.0%

12.3%

7.5% 26.3%

10.8%

4.2% 59.9%
69.4%
8.8%

MSM IDU MSM/IDU Heterosexual Pediatric

Source: DSHS, ARIES

 HIV/AIDS Burden by Five Most Populous
Texas Counties, 2016

County HIV Diagnoses AIDS People Living with HIV

Bexar 18.7 7.6 310.4

Dallas 31.7 16.2 673.1

Harris 26.3 13.1 538.1

Tarrant 15.0 6.1 266.3

Travis 20.2 6.7 393.2

Source: 2016 Annual Report: Texas HIV Surveillance Report

HIV CLUSTER INVESTIGATON
BEXAR COUNTY, 2017
HIV Clusters in Bexar County
 Cluster Analyses Findings - Texas

• 16 Clusters in Texas
– Molecular Clusters range from 5-34 cases in Texas
– Several Clusters have cases linked in other states

• Five clusters in San Antonio*

– Cluster 51 (27 persons)
– Cluster 62 (17 persons)
– Cluster 151 (16 persons)
– Cluster 911 (11 persons)
– Cluster 923 (19 persons)

*reported by DSHS on September 21, 2017

 Cluster 51- San Antonio
Age in years Race/Ethnicity Transmission Risk
100% 100% 100%

90% 90% 90%

80% 78%
80% 80%
74%
70% 70%
70%
63%
60% 60%
60%
50% 50%
50%
40% 40%
40%
30% 30%
30%
22% 22%
20% 20%
11% 11% 20%
10% 7% 10%
4% 4% 0% 10% 4%
0% 0% 0%
13-19 20-29 30-39 40-49 50-59
0%
MSM IDU MSM/ No Risk
IDU Identified
 Cluster 62 - San Antonio

Race/Ethnicity Transmission Risk

Age in years
100%
100% 100% 94%
90% 90% 90%
82%
80% 80% 76% 80%

70% 70% 70%

60% 60% 60%

50% 50% 50%

40% 40% 40%

30% 30% 30%

20% 20% 20%

12% 12% 12%
10% 6% 10% 10% 6%
0% 0% 0% 0% 0%
0% 0% 0%
MSM IDU MSM/ No Risk
IDU Identified
13- 19 20- 29 30- 39 40- 49 50- 59
 Cluster 151- San Antonio

Age in years Race/Ethnicity Transmission Risk

100%
100% 100% 100%

90% 90% 90%

80% 80% 80%

69%
70% 70% 70%
63%
60% 60% 60%

50% 50% 50%

40% 40% 40%

31%
30% 30% 30%

20% 20% 20%

13% 13%
10% 6% 10% 6% 10%
0% 0% 0% 0% 0%
0% 0% 0%
MSM IDU MSM/ No Risk
13- 19 20- 29 30- 39 40- 49 50- 59 IDU Identified
 Cluster 911 - San Antonio

Age in years Race/Ethnicity Transmission Risk

100%
100% 100% 100%
91%
90% 90% 90%

80% 80% 80%

73%
70% 70% 70%

60% 60% 60%

50% 50% 50%

40% 40% 40%

30% 30% 30%

20%
18% 20% 20%
9% 9%
10% 10% 10%
0% 0% 0% 0% 0% 0% 0%
0% 0% 0%
MSM IDU MSM/ No Risk
13- 19 20- 29 30- 39 40- 49 50- 59 IDU Identified
 Cluster 923 - San Antonio

Age in years Transmission Risk

100% 100% 100%
89% 89%
90% 90% 90%

80% 80% 80%

70% 70% 70%

60% 60% 60%

50% 47% 47% 50% 50%

40% 40% 40%

30% 30% 30%

20% 20% 20%
11% 11%
10% 5% 10% 10%
0% 0% 0% 0% 0% 0%
0% 0% 0%
Age Age Age Age Age Black/ Hispanic/ White Asian (MSM) (IDU) MSM/ No Risk
13- 19 20- 29 30- 39 40- 49 50- 59 African Latino Male to Injection IDU Identified
Male Drug
Sexual Contact
 Cluster Characteristics - San Antonio

• 100% Males
• Highest proportion of HIV new diagnosis in 20-29 year olds
– 65%
• Highest proportion of HIV new diagnosis among Hispanics
– 80%
• Highest proportion of HIV new diagnosis among MSM
– 89%
Comparison of San Antonio Clusters to Bexar County Newly Diagnosed HIV
- Sex at Birth

San Antonio Clusters Bexar County

12%

100% 88%

Male Female
Male Female

Source: TX DSHS prt: Molecular HIV Surveillance: Genotyping and Cluster Identification
Comparison of San Antonio Clusters to Bexar County Newly Diagnosed HIV
- Race/Ethnicity

San Antonio Clusters Bexar County

1% 2%
9% 10%
15% 15%

80%
67%

Black\African American Hispanic\Latino

White Other

Source: TX DSHS prt: Molecular HIV Surveillance: Genotyping and Cluster Identification
Comparison of San Antonio Clusters to Bexar County Newly Diagnosed HIV
- Transmission Risk

San Antonio Clusters

Bexar County
1%
0% 10%
4% 11%

6%

89% 79%

MSM IDU MSM\IDU No Risk Identified (NRI) MSM IDU MSM/IDU Heterosexual

Source: TX DSHS prt: Molecular HIV Surveillance: Genotyping and Cluster Identification
Drug Resistance in Molecular Cluster Cases in Texas

No Drug Resistance
Drug Resistance Identified
Not Determined

Source: TX DSHS prt: Molecular HIV Surveillance: Genotyping and Cluster Identification
 San Antonio TGA HIV Treatment Cascade,
2016
100
7,000
86
6,000 78 80
72
5,000

Percentage
61 60
Number

4,000

3,000 6,343 4,978 4,547 3,878 40

2,000
20
1,000

0 0
HIV+ Individuals At least 1 visit/lab Retained in Care Achieved Viral
Living, 2015 Suppression

Source: DSHS, ARIES

 Email: anita.kurian@sanantonio.gov
Phone: (210) 207-8805

https://www.sanantonio.gov/Health/News/HealthDataReports