The Impact of HIV/AIDS on Women Addressing the Disparities Alicia - PowerPoint PPT Presentation

The Impact of HIV/AIDS on Women— Addressing the Disparities Alicia L. Carbaugh, Kaiser Family Foundation Kellye McKenzie, NASTAD V. Jill Smith, Maryland Department of Health and Mental Hygiene, AIDS Administration/Center for Prevention

Figure 1 The Impact of HIV/AIDS on Women, in Context

Figure 2 The U.S. Epidemic: Snapshot of Key Data New infections each year 40,000 People living with 1,200,000 HIV/AIDS Women living with 300,000 HIV/AIDS People with HIV/AIDS not 42 – 59% in care People with HIV who don’t 24 – 27% know they’re infected Note: Data are estimates. Sources: CDC, 2006; Kaiser Family Foundation estimates based on CDC data; 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”, 9 th Conference on Retroviruses and Opportunistic Infections, 2002.

Figure 3 New AIDS Cases, Deaths, and People Living with AIDS, 1985-2005 Deaths and New AIDS Diagnoses 85,000 People Living 420,000 People Living with AIDS with AIDS New AIDS 68,000 Cases 280,000 51,000 34,000 140,000 17,000 Deaths among People with AIDS 0 0 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 Note: Data are estimates. Source: CDC, Data Request, 2006; CDC, HIV/AIDS Surveillance Report , Vol. 17; 2006

Figure 4 Proportion of AIDS Cases, by Race/Ethnicity, 1985-2005 Percent of AIDS Diagnoses 70 White, non-Hispanic 60 50 40 Black American 30 20 Latino American Indian/ 10 Asian/Pacific Islander Alaska Native 0 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 Note: Data are estimates. Source: CDC, Data Request, 2006; CDC, HIV/AIDS Surveillance Report , Vol. 17, 2006.

Figure 5 AIDS Diagnoses and Population, by Race/Ethnicity, 2005 AIDS Diagnoses U.S. Population White, non-Hispanic 29% 67% Black, non-Hispanic 50% 12% Latino 14% 19% 4% Asian/Pacific Islander <1% <1% AI/AN 1% Notes: U.S. Population estimates do not include U.S. dependencies, possessions, and associated nations. Total AIDS diagnoses in 2005 included only cases for which race/ethnicity data were provided. May not total 100% due to rounding. AI/AN = American Indian/Alaskan Native. Sources: CDC, HIV/AIDS Surveillance Report , Vol. 17, 2006; U.S. Census Bureau, 2005 Population Estimates .

Figure 6 HIV/AIDS Cases Among Teens, Aged 13-19, & Population, 2004 (33 States) <2% Other 4% Other 15% 17% White Black 13% 14% Latino 70% 65% Latino Black White HIV/AIDS Cases Teen Population Source: CDC, Slide Set: HIV/AIDS Surveillance in Adolescents and Young Adults (through 2004) .

Figure 7 The Impact on Women

Figure 8 Women as a Share of New AIDS Diagnoses 27% 27% 20% 13% 8% 1985 1990 1995 2000 2005 Note: Data includes cases among those 13 years of age and older. Sources: CDC, Special Data Request, 2006; CDC, HIV/AIDS Surveillance Report , Vol. 17, 2006.

Figure 9 AIDS Diagnoses by Transmission Category Heterosexual 3% 13% 31% Other Heterosexual 19% 65% 43% IDU MSM MSM 6% Other 20% IDU 1985 2005 Notes: Data are estimates. Sources: CDC, Presentation by Dr. Harold Jaffe, “HIV/AIDS in America Today”, National HIV Prevention Conference, 2003; CDC, HIV/AIDS Surveillance Report, Vol. 17, 2006.

Figure 10 New AIDS Diagnoses by Race/Ethnicity and Sex, 2005 1% Other 2% Other 16% White 34% White 67% 44% 16% Latina Black Black 20% Latino Women Men Note: Data are estimates for adults/adolescents aged 13 and older and do not include cases from the U.S. dependencies, possessions, and associated nations, and cases of unknown residence. Calculations based only on cases for which rate/ethnicity data were provided. Source: CDC, HIV/AIDS Surveillance Report , Vol. 17, 2006.

Figure 11 AIDS Case Rate per 100,000 Women by Race/Ethnicity, 2005 Black 49.9 12.2 Latina American Indian/ 4.4 Alaska Native White 2.1 Asian/ 1.8 Pacific Islander Note: Includes women aged 13 and older. Source: CDC, HIV/AIDS Surveillance Report, Vol. 17; 2006.

Figure 12 Reported HIV Cases Among Teen Girls and Younger Women, 2003 50% 63% 71% Males Females 50% 37% 29% 13-19 20-24 25 and older Notes: Data based on person’s age at diagnosis, from 41 areas with confidential name-based HIV surveillance for adults and adolescents in 2003. Source: CDC, Slide Set: HIV/AIDS Surveillance in Adolescents (through 2003).

Figure 13 Access to and Use of Health Services

Figure 14 People Living with HIV/AIDS by Awareness of Serostatus and Access to Care Estimates Only Undiagnosed ~250,000 In Care (25%) ~500,000 (50%) Diagnosed, Not in Care ~250,000 (25%) ~ 1.2 Million Sources: Glynn, K. et al., CDC, “Estimated HIV Prevalence in the United States at the end of 2003.” Presentation at the 2005 National HIV Prevention Conference; 2005; Teshale, E. et al., “Estimated Number of HIV-infected Persons Eligible for and Receiving HIV Antiretroviral Therapy, 2003—United States”, Abstract #167, 12th Conference on Retroviruses and Opportunistic Infections; February 2005. Note, among those ages 15-49; Fleming, P. et al., “HIV Prevalence in the United States, 2000”, Abstract #11, 9th Conference on Retroviruses and Opportunistic Infections; February 2002.

Figure 15 In & Not in Care: Receipt of HAART by Those Eligible for HAART, 2003 Of those aged 15-49 estimated to be eligible for HAART In Care/ No HAART 15% Not In Care 30% In Care/ HAART 55% Source: Teshale, E. et al., “Estimated Number of HIV-infected Persons Eligible for and Receiving HIV Antiretroviral Therapy, 2003—United States”, Abstract #167, 12th Conference on Retroviruses and Opportunistic Infections; February 2005.

Figure 16 Timing of AIDS Diagnosis Among Women, 2005 Within 12 Months of HIV Diagnosis 36% More than 12 Months from HIV Diagnosis 64% Note: Data from 33 states. Includes women aged 13 and older. Source: CDC, HIV/AIDS Surveillance Report, Vol. 17; 2006.

Figure 17 Selected Characteristics of People with HIV/AIDS in Care, 1996 Women Men 64% Earn <$10,000/year 41% 73% High School or Less 46% 76% Unemployed 59% Note: Includes persons 18 years of age and older. Source: Bozzette, et al., “The Care of HIV-Infected Adults in the United States,” New England Journal of Medicine , Vol. 339, No. 26; 1998.

Figure 18 Insurance Coverage of Persons with HIV/AIDS at Time of Diagnosis by Sex, 1994-1999* 100% 16% 90% 39% 80% 21% 70% Medicaid 60% Other Public/Gov't 13% 50% 35% Private 40% 23% No Coverage 30% 20% 28% 24% 10% 0% Women Men *Data includes persons with HIV/AIDS who knew their insurance status at time of diagnosis. Note: Data may not total 100% due to rounding. Source: Kates, J., Levi, J., Neal, J., Gallagher, K., Learning More About the HIV-Infected Population Not In Care in the United States: Using Public Health Surveillance Data to Inform Current Policy Challenges in Enhancing Access , Poster TuPeG 5690, XIV International AIDS Conference, Barcelona, Spain; July 2002.

Figure 19 Estimated Insurance Coverage of People Living with HIV/AIDS in Care by Sex, 1996 100% 90% 39% 80% 70% 61% Medicaid* 60% 6% Medicare 50% Private 40% 3% 36% None 30% 14% 20% 21% 10% 19% 0% Women Men *Includes those with other coverage, primarily Medicare. Notes: Includes persons 18 years of age and older. Data may not total 100% due to rounding. Source: Fleishman, J., Personal Communication, Analysis of HCSUS Data, January 2002, in Kaiser Family Foundation, Financing HIV/AIDS Care: A Quilt with Many Holes ; May 2004.

Figure 20 Access Indicators Among People with HIV/AIDS Receiving Care by Sex, 1998 Percent Women Men 40% 23% 22% 19% 14% 13% 13% 0% 1 or More 1 or More Emergency No Combination Hospitalization in Department Visits Therapy in Past Year Past 6 Months without Hospitalization Notes: All Results shown are significantly different from men (p<.05) after adjustment for CD4 count. Includes persons 18 years and older. Higher hospitalization rates result from failure to receive indicated outpatient therapy. Source: Shapiro, et al., “Variations in the Care of HIV-Infected Adults in the United States,” Journal of the American Medical Association , Vol. 281, No. 24.

Figure 21 Federal Funding of Health Care and Prevention Services for HIV/AIDS

Figure 22 Federal Funding for HIV/AIDS by Category, FY 2006 Global Research Prevention (15%) (13%) (4%) Cash/ Housing Assistance (10%) Care (58%) Total: $21 billion Note: Funding for international research attributed to global category. Sources: Kaiser Family Foundation analysis of data from the White House Office of Management and Budget, Congressional Appropriations bills, HHS Office of Budget, and Congressional Research Service.

Figure 23 Major Federal Sources of Funding for HIV/AIDS Care • Medicaid • Medicare • Ryan White Program (Title XXVI of the PHS Act as Amended by the Ryan White HIV/AIDS Treatment Modernization Act of 2006) • Others include: Department of Veterans Affairs; SAMHSA; Community and Migrant Health Centers