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Speak
Epidemiology



Epidemiology
is:





 
The
scien)fic
study
of
disease
distribu)on
and

 
the
factors
that
cause
diseases
to
spread
in
 communi)es



Effec3ve
research
advocates
 •  •  •  •  •  • 

Analyze
the
facts
 Educate
others
 Build
partnership
 Lend
their
perspec3ves
 Raise
cri3cal
ques3ons
 Seek
knowledge



Useful
Tools
 Prevalence

 Incidence
 Rate
 Affected
popula3ons
 Discussions
 Future
Trends



HIV/AIDS
Prevalence
 


The
number
of
 people
living
with
 HIV/AIDS
during
a
 given
year


In
2006,
an
es+mated
 1,106,400
individuals
 were
living
with
HIV/ AIDS
in
the
United
 States



HIV
Incidence
 The
annual
number
 of
people
who
 become
HIV
infected
 in
a
given
period
of
 >me,
typically
a
year.



In
2006,
an
es+mated
 56,300
individuals
became
 HIV
infected
in
the
U.S.



Rate
 A
rate
measures
a
certain
 quan3ty
or
amount
of
one
 thing
considered
in
rela3on
to
 a
unit
of
another
thing.
 
In
public
health,
rates
help
 describe
the
number
of
 events
per
popula+on
unit,
 typically
expressed
as
 health
events
or
disease
 per
100,000
people.



Rate
 A
rate
consists
of
a
 numerator
and
a
 denominator.
 525,600
/
56,300 
=
9.33
 Annual
minutes
(numerator)
divided
by
annual
infec3ons
 (denominator)
equals
a
rate
of
9
½
minutes
per
infec>on



Rate
 Rates
allow
us
to
 compare
communi3es
of
 different
sizes.
 The
numerator
is
the
number
 of
health
events
or
disease
 and
the
denominator
is
the
 defined
popula+on
at
risk
 (including
those
who
 experience
the
event/disease):
 







numerator

 



____________
x
100,000
=
popula+on
rate
 




denominator



HIV
Rate
for
MSM
 Based
on
meta‐analysis,
 CDC
es3mates
that:
 •  An
es3mated
4%
of
U.S.
 males
had
same‐sex
 behavior
in
the
past
5
yrs
 •  7%
of
U.S.
males
have
ever
 had
MSM
behavior
 •  MSM
account
for
an
 es3mated
2%
of
the
total
 U.S.
popula3on




HIV
Rate
for
MSM
 CDC
notes
and
disclaimers:
 • • 


• 


These
es3mates
are
 preliminary!

 
More
complete
analysis

 
–
Refine
meta‐analysis
 es3mates
 
–
Re‐calculate
rates;
also
do
 by
race
and
age

 
–
May
conduct
separate
 analysis
for
young
MSM
 Iden3fy
popula3on
 es3mates
for
IDU
and
HET



HIV
Transmission
Rate
 Transmission
Rate:
 Represents
the
amount
of
 transmission
that
occurs
 annually
in
rela3on
to
the
 popula3on
infected
with
HIV.
 Technically,
this
is
HIV
 incidence
divided
by
 prevalence
in
a
given
year.



HIV
Transmission
Rate
(TR)
 CDC
published
in
2008
back‐ calcula3on
es3mates
for
HIV
 incidence
and
prevalence
 between
1977
and
2006.

The
 new
es3mates
allow
 retrospec3ve
TR
calcula3ons.




Hall
et
al.
JAMA.
2008;


300:
520‐
529.



HIV
Transmission
Rate,
United
States,
1977‐2006


Source: Holtgrave et al. JAIDS 2009


HIV
Transmission
Rate,
United
States,
1977‐2006


Source: Holtgrave et al. JAIDS 2009


Affected
Popula3ons
 •  What
are
the
characteris3cs
 of
people
who
become
 infected
with
HIV?
 •  How
do
we
understand
 popula3on
trends
in
the
 epidemic?



HIV
Infec3ons
by
Subpopula3on,
2006
(es3mates)



Discussions:
Cri3cal
Thinking
 Research advocates ask critical questions: •  Do the data give an accurate picture of the epidemic? •  Where/when/how was data collected? •  What methodologies were employed in data collection, analysis, and presentation? •  Who was involved? •  How might disease surveillance be improved?


Challenging

 “No
Iden>fied
Risk”
 Change
HIV/AIDS
Surveillance
System
Categories
to
More
 Accurately
Reflect
How
Women
Acquire
HIV,
Advocates
Say
 •  •  • 

End
the
“seriously
flawed”
CDC
hierarchical
classifica3on
system
that
 classifies
most
cases
of
HIV
among
women
as
“no
iden3fied
risk”
 Allow
health
departments
to
classify
cases
as
“presumed
heterosexual”
when
 the
male
partner’s
HIV
status
and/or
risk
factors
are
unknown
 Collect
“acquisi3on
category”
informa3on
to
reflect
“sexual
networks
and/or
 social
networks”
of
elevated
HIV
prevalence.

New
data
might
include:
 –  –  – 

Prevalence
of
HIV
where
the
person
lives
 The
area’s
post‐incarcera3on
rates
 Drug/alcohol
and
homelessness
partners
for
the
area


ms.founda3on.org/File%20Library/NWAC/NWACpolicypropcharlormFINALforweb.pdf



Data
Leave
Some
Groups
Behind
 Advocates
Say
Outreach
and
 Surveillance
Programs
Undercount:
 •  •  •  •  • 

Transgender
popula3ons
 Asian/Pacific
Islanders
 Undocumented
people
 American
Indians/Na3ve
Hawaiians
 Rural
popula3ons


Without
accurate
surveillance,
undercounted
 popula>ons
may
receive
fewer
dollars
for
HIV
 preven>on,
care,
and
research
ac>vi>es



It’s
not
who
you
are,

 It’s
where
you
live
…

 Person
Living
with
AIDS
in
2005
By
Region
 Region


Rank


Number


North


2


126,867


Midwest


4


45,666


South


1


169,972


West


3


83,405


http://www.southernaidscoalition.org/policy/southern_states_manifesto_2008.pdf


It’s
not
who
you
are,

 It’s
where
you
live
…

 
San
Francisco
 Project
maps
 concentra>on
of
 HIV
viral
load
 across
the
city
to
 determine
where
 expanded
services
 are
needed



Future
Trends


To
alter
the
course
of
the
epidemic,

 We
need
to
model
where
it
is
currently
headed
   Advocates
shared
a
model
with
the
White
House
comparing
stable
growth
 in
the
epidemic
against
progress
toward
defined
goals
   They
call
on
the
federal
government
to
include
a
scien3fically
rigorous
 model
in
the
Na3onal
HIV/AIDS
Strategy
   The
paper
includes
other
important
recommenda3ons
 na3onalaidsstrategy.org/2010/advocates‐recommend‐key‐components‐of‐an‐effec3ve‐strategy/



2007‐2016
Projected
Epidemic
Based
on

 A
Constant
5%
Transmission
Rate
 Year


Incidence


Deaths


Prevalence


Minutes
per
 Infec>on


2006


56,300


18,620


1,106,400


9.30


2007


58,086


19,000


1,145,486


9.00


2008


62,273


20,876


1,186,151


8.30


2009


62,273


20,876


1,227,548


8.00


2010


64,446


21,605


1,270,389


8.00


2011


66,695


22,359


1,314,726


7.30


2012


69,023


23,139


1,360,610


7.30


2013


71,432


23,947


1,408,095


7.30


2014


73,505


24,782


1,457,238


7.00


2015


76,505


25,647


1,508,095


7.00


2016


79,175


26,542


1,560,728


6.30



Thank
you!
 David
Ernesto
Munar
 Vice
President
 AIDS
Founda3on
of
Chicago
 312‐334‐0933
 dmunar@aidschicago.org
 aidschicago.org
 aidsconnect.net/dose


Speak Epidemiology  

This helpful presentation goes over the epidemiological concepts most commonly used in AIDS advocacy.

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