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HIV/AIDS Among the African American Community in the Ten County Houston Area Epidemiological Trends 1992-1999: 

HIV/AIDS Among the African American Community in the Ten County Houston Area Epidemiological Trends 1992-1999 Prepared for The Houston Area HIV Services Ryan White Planning Council by The Partnership for Community Health April 2001 NEXT

Slide2: 

HIV and AIDS disproportionately impacts the African American community. The number of African Americans living with HIV and AIDS is increasing every year. Among African Americans living with HIV and AIDS, heterosexuals are the fastest growing risk group. Still, the largest risk group among African Americans remains men-who-have-sex-with-men (MSM). NEXT

Slide3: 

There is excellent data on AIDS because every diagnosed case of AIDS has to be reported to the health department. Data on HIV diagnoses is much less accurate because it has only been reported to the health department since 1999. Consequently, this report provides estimates of the impact of HIV, and a detailed analysis of the impact of AIDS on the African American community in the Houston area. NEXT

ESTIMATED HIV and AIDS: 

HIV & AIDS There are between 15,385 and 20,670 people living with HIV and AIDS in the Houston area. About 44% are African American. HIV There are between 8,800 and 12,800 people living with HIV who have not progressed to AIDS in the Houston area in the year 2000. About half are African American. ESTIMATED HIV and AIDS About 19% of the Houston area population is African American. NEXT

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Those with AIDS have advanced HIV disease. Cumulative AIDS cases represent all HIV infected persons who have progressed to AIDS, both those who have died and those who are alive. Like HIV, the statistics on cumulative AIDS cases show the disproportionate impact on the African American community. NEXT

CUMULATIVE AIDS CASES – Living and Dead Through 1999: 

733,374 cases of AIDS have been diagnosed in the U.S. 12% of of the population living in the U.S. are African American. 37% of all those diagnosed with AIDS in the U.S. are African American. CUMULATIVE AIDS CASES – Living and Dead Through 1999 18,645 cases of AIDS have been diagnosed in the Houston area. 19% of the population living in the Houston area are African American. 33% of all those diagnosed with AIDS in the Houston area are African American. NEXT

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Like all persons living with AIDS, African Americans with AIDS are living longer and their death rate is declining. However, African Americans have a higher death rate than all other ethnic groups. NEXT

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AIDS-RELATED DEATH RATES The AIDS-related death rate has declined among African Americans from 46.9 to 25.1 per hundred thousand from 1992 to 1998. However, the death rate is significantly higher for African Americans than other ethnic groups. In 1998, 57% of all AIDS deaths were African American. NEXT

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The death rate among African Americans in care is significantly lower than the death rate among African Americans who are not in care. The lower death rate for African Americans in care indicates the need for seeking care early in their HIV infection. NEXT

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DEATH RATE AMONG THOSE IN CARE African Americans in care have only a slightly higher death rate than other ethnic populations. With early detection of HIV and treatment, it is much more likely that progression to AIDS will be delayed. NEXT

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Decreased death rates, plus newly diagnosed African Americans progressing from HIV to AIDS, means more African Americans are living with AIDS and need care. In 1999 there were 2,984 African Americans living with AIDS, a 607% increase since 1992. NEXT

AFRICAN AMERICANS % Living With AIDS 1992 - 1999: 

AFRICAN AMERICANS % Living With AIDS 1992 - 1999 USA 129,943 Houston Area 2,984 422 From 1992 to 1999, there has been a 607% increase in the number of African Americans living with AIDS in the Houston area. In 1999, 2,984 African Americans living with AIDS needed care in the Houston area. NEXT

AFRICAN AMERICANS AND OTHER ETHNIC GROUPS % Living With AIDS 1992 - 1999: 

AFRICAN AMERICANS AND OTHER ETHNIC GROUPS % Living With AIDS 1992 - 1999 Since 1996, African Americans living with AIDS represent nearly 40% of all the living AIDS cases in the Houston area. From 1992 to 1999, the proportion of African Americans living with AIDS has increased steadily. NEXT

Who are the African Americans living with AIDS?: 

Who are the African Americans living with AIDS? In 1999, the largest proportion are MSM, although the number of African American MSM living with AIDS has declined from 44% in 1992 to 33% in 1999. African American heterosexuals have dramatically increased from 9% in 1992 to 26% in 1999. African American IDUs have remained a relatively constant proportion – between 24% and 28% - of African Americans living with AIDS. NEXT

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AFRICAN AMERICANS % Living with AIDS by risk group 1992-1999 MSM are the largest risk group of African Americans living with AIDS, although the proportion is declining. Heterosexuals, the majority of whom are female, are significantly increasing as a proportion of African Americans living with AIDS, surpassing IDUs. NEXT

Who are the African Americans Living with AIDS?: 

71% of African Americans living with AIDS are male. Over half of the heterosexuals are women. Over 40% of the IDUs are women. 96% live in Harris County. 50% are between the ages of 20-40. Eight percent of the men and ten percent of women have an unknown exposure. Who are the African Americans Living with AIDS? NEXT

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AFRICAN AMERICANS Number of PLWA by risk group and gender - 1999 The majority of heterosexuals are females. Over 40% of IDUs are females. NEXT

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Newly diagnosed AIDS cases indicate those most at risk for progressing from HIV to AIDS. The total number of African Americans progressing from HIV to AIDS has decreased from 571 to 265 annually between 1992 and 1999. However, African Americans represent an increasing proportion of new AIDS cases – from 32% in 1992 to 53% in 1999. NEXT

AFRICAN AMERICANS COMPARED TO OTHER ETHNICITIES % of New AIDS Cases each Year 1992 - 1999: 

AFRICAN AMERICANS COMPARED TO OTHER ETHNICITIES % of New AIDS Cases each Year 1992 - 1999 From 1992 to 1999, the proportion of new cases among African Americans continued to increase. By 1998, African Americans represented the majority of the newly diagnosed cases in the Houston area. NEXT

AFRICAN AMERICAN % of NEW AIDS CASES EACH YEAR FROM 1992 - 1999: 

AFRICAN AMERICAN % of NEW AIDS CASES EACH YEAR FROM 1992 - 1999 By 1999 African Americans represent more than half of the new AIDS cases in the Houston area. NEXT

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The number of African American men-who-have-sex-with-men who are progressing to AIDS has declined from 38% to 26% of new AIDS cases. African American injection drug users have declined from 28% to 19% of new AIDS cases. The number of new AIDS cases among heterosexuals has increased from 12% to 27% of new AIDS cases. African American heterosexuals, the majority of whom are women, are the group most likely to progress to AIDS. NEXT

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Of all new African American AIDS cases diagnosed each year, the proportion of African American MSM and IDUs is declining. AFRICAN AMERICANS % New AIDS Cases by risk group 1992-1999 African American heterosexuals, the majority of whom are female, have significantly increased as a proportion of new African American AIDS cases diagnosed each year. NEXT

Slide23: 

1999 was the first year for HIV reporting data. While the data is not an accurate reflection of all HIV cases, it does provide insight into the profile of those newly diagnosed with HIV. In only the first year of HIV reporting, the number of male African Americans diagnosed with HIV is over twice the number diagnosed with AIDS. In the first year of HIV reporting, the number of female African Americans diagnosed with HIV is over three times the number diagnosed with AIDS. African Americans Living with HIV NEXT

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African American Seroprevalence Report NEW AIDS AND HIV CASES - 1999 In the first year that HIV data was reported: The number of African American males diagnosed with HIV in 1999 was over twice the number diagnosed with AIDS in 1999. The number of African American females diagnosed with HIV in 1999 was over three times the number diagnosed with AIDS in 1999. NEXT

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African American Seroprevalence Report Newly Diagnosed HIV by risk group and sex - 1999 In the first year that HIV data was collected: African American heterosexuals were the risk group most likely to be diagnosed with HIV. There were 138 females compared to 56 males. 150 African Americans becoming infected did not provide an HIV exposure category. NEXT

Slide26: 

Young African American Gay Men At High Risk of HIV Infection In a sample of gay men between the ages of 15-22 in seven urban areas, including Dallas, Texas, 7% were infected with HIV. Infection rates ranged from 2% to 12%. A significantly higher percentage of gay African Americans (14%) than gay Anglos (3%) were infected. While Houston was not a site of the study, Houston trends follow national trends. NEXT

Slide27: 

Adherence Among African Americans Living With HIV and AIDS In a survey conducted in summer 1999, 84% of the African Americans who had accessed care reported taking medications for their HIV infection or AIDS. Of those taking medication, nearly 50% said they frequently skipped or stopped taking it. Of those, 80% didn’t consult their doctor. African Americans are less likely to adhere to their medication than other ethnic groups. NEXT

Slide28: 

African Americans Adherence to medication More than 8 out of 10 African Americans accessing care report taking medication. Nearly 50% say they skip their medications some of the time or often. 80% skip or stop their medication without consulting their doctor. NEXT Women are more likely than men to often skip or stop taking their medication.

Slide29: 

Top HIV and AIDS Care Needs for African Americans In a survey conducted in summer 1999, about 50% of the African Americans living with HIV and AIDS said that outpatient medical care and transportation were their top needs. Between 30% and 35% of the African Americans living with HIV and AIDS said that food, rental assistance, drug reimbursement, and help finding housing were among their top needs. Women are more likely than men to say that transportation and assistance finding housing were among their top needs. African Americans are more likely than other ethnic groups to need transportation, food, and assistance finding housing. NEXT

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African Americans Top HIV and AIDS Care Needs NEXT

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Top HIV and AIDS Care Barriers for African Americans In a survey conducted in summer 1999, the highest ranked barriers for African Americans were transportation, red tape, lack of treatment knowledge, and lack of insurance coverage. These were followed by waiting for an appointment, navigating the system, rules and regulations, and confidentiality. African American men generally have higher barriers than African American women. African Americans have the highest overall barrier score. They report significantly higher barriers than other ethnic groups for obtaining treatment, child care, obtaining insurance, navigating the system, treatment knowledge, waiting for an appointment, feeling like a number, location of the organization, knowing about needed services, and transportation. NEXT

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Average Barrier Score (ranked from 1, “no barrier” to 4, “big barrier”. African Americans Top HIV and AIDS Care Barriers NEXT Total all races AA Total

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CONCLUSION HIV continues at epidemic levels in the African American community. A greater percentage of the African American community, compared to other ethnic communities, is being infected by HIV, progressing from HIV to AIDS, and dying of AIDS. By 1998, African Americans represented the majority of the newly diagnosed AIDS cases in the Houston area and within the African American community, heterosexuals are the risk group most likely to progress from HIV to AIDS. MSM continue to be the largest group of African Americans living with AIDS – although if current trends continue heterosexuals will be the largest group in the near future. The greatest care needs among African Americans are outpatient treatment, transportation, food, and rental assistance, The highest barriers are transportation, red tape, lack of treatment knowledge, and lack of insurance coverage. END

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