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

The Impact of HIV/AIDS on Women, in Context

Figure 1

1,200,000 People living with HIV/AIDS 24 – 27% People with HIV who don’t know they’re infected 42 – 59% People with HIV/AIDS not in care 300,000 Women living with HIV/AIDS 40,000 New infections each year

The U.S. Epidemic: Snapshot of Key Data

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”, 9th Conference on Retroviruses and Opportunistic Infections, 2002. Figure 2

17,000 34,000 51,000 68,000 85,000 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 140,000 280,000 420,000 New AIDS Cases People Living with AIDS

New AIDS Cases, Deaths, and People Living with AIDS, 1985-2005

Deaths among People with AIDS

Note: Data are estimates. Source: CDC, Data Request, 2006; CDC, HIV/AIDS Surveillance Report, Vol. 17; 2006

Deaths and New AIDS Diagnoses People Living with AIDS

Figure 3

Proportion of AIDS Cases, by Race/Ethnicity, 1985-2005

10 20 30 40 50 60 70

1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005

White, non-Hispanic Black American Latino Asian/Pacific Islander American Indian/ Alaska Native

Percent of AIDS Diagnoses

Note: Data are estimates. Source: CDC, Data Request, 2006; CDC, HIV/AIDS Surveillance Report, Vol. 17, 2006. Figure 4

AIDS Diagnoses and Population, by Race/Ethnicity, 2005

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.

19% 14% 50% 12% 29% 67% White, non-Hispanic Latino <1% AI/AN 1% Black, non-Hispanic Asian/Pacific Islander 4% <1% AIDS Diagnoses U.S. Population

Figure 5

HIV/AIDS Cases Among Teens, Aged 13-19, & Population, 2004 (33 States)

65% White 13% Latino

HIV/AIDS Cases Teen Population

70% Black 15% White <2% Other 14% Latino 17% Black 4% Other

Source: CDC, Slide Set: HIV/AIDS Surveillance in Adolescents and Young Adults (through 2004). Figure 6

The Impact on Women

Figure 7

Women as a Share of New AIDS Diagnoses

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.

8% 13% 20% 27% 27% 1985 1990 1995 2000 2005

Figure 8

AIDS Diagnoses by Transmission Category

1985 2005

19% IDU 65% MSM 13% Other 3% 31% Heterosexual 20% IDU 43% MSM 6% Other

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.

Heterosexual

Figure 9

New AIDS Diagnoses by Race/Ethnicity and Sex, 2005

34% White 16% Latina

Women Men

67% Black 16% White 1% Other 20% Latino 44% Black 2% Other

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 10

AIDS Case Rate per 100,000 Women by Race/Ethnicity, 2005

1.8 2.1 4.4 12.2 49.9 White Latina Black

Note: Includes women aged 13 and older. Source: CDC, HIV/AIDS Surveillance Report, Vol. 17; 2006.

American Indian/ Alaska Native Asian/ Pacific Islander

Figure 11

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).

50% 63% 71% 37% 29% 50% 13-19 20-24 25 and older Males Females

Reported HIV Cases Among Teen Girls and Younger Women, 2003

Figure 12

Access to and Use of Health Services

Figure 13

People Living with HIV/AIDS by Awareness of Serostatus and Access to Care

Undiagnosed ~250,000 (25%) In Care ~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.

Estimates Only

Figure 14

In Care/ HAART 55% Not In Care 30% In Care/ No HAART 15%

In & Not in Care: Receipt of HAART by Those Eligible for HAART, 2003

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.

Of those aged 15-49 estimated to be eligible for HAART

Figure 15

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 16

Selected Characteristics of People with HIV/AIDS in Care, 1996

59% 46% 41% 73% 64% Unemployed High School or Less Earn <$10,000/year 76% Women Men

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 17

Insurance Coverage of Persons with HIV/AIDS at Time of Diagnosis by Sex, 1994-1999*

24% 28% 23% 35% 21% 39% 16% 13% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Women Men Medicaid Other Public/Gov't Private No Coverage

*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 18

Estimated Insurance Coverage of People Living with HIV/AIDS in Care by Sex, 1996

21% 19% 14% 36% 6% 61% 39% 3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Women Men Medicaid* Medicare Private None

*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 19

Access Indicators Among People with HIV/AIDS Receiving Care by Sex, 1998

22% 19% 23% 13% 13% 14% 0% 40%

Women Men

Percent

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.

No Combination Therapy in Past Year 1 or More Hospitalization in Past 6 Months 1 or More Emergency Department Visits without Hospitalization

Figure 20

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

Figure 21

Federal Funding for HIV/AIDS by Category, FY 2006

Global (15%) Cash/ Housing Assistance (10%) Research (13%) Care (58%) Prevention (4%)

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.

Total: $21 billion

Figure 22

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

Figure 23

• Provides health & long-term care

coverage for more than 55 M low- income people

• Largest source of coverage for

people with HIV/AIDS – 266,000 Medicaid beneficiaries with HIV/AIDS – Reflects epidemic’s impact on low-income populations

• Many with HIV/AIDS qualify

through disability-related pathway

• Mandatory and Optional Services

Medicaid’s Role in HIV/AIDS Care

Federal Medicaid Spending on HIV/AIDS Care as Percent of Federal Spending on HIV/AIDS Care FY 2006 Medicaid 51% ($6.3B) All Other 49% ($6.0B)

Total: $12.3 B

Sources: Kaiser Family Foundation, Medicaid and HIV/AIDS, 10/06; KCMU, The Medicaid Program at a Glance, 5/06. Medicaid HIV/AIDS spending estimate from CMS, Office of the Actuary and HHS Office of the Budget, 2006. Figure 24

• Covers nearly 43 M seniors and

persons with disabilities

• Second largest source of

HIV/AIDS coverage – 100,000 Medicare beneficiaries with AIDS

• New Medicare Part D Drug

Coverage – Concerns about adequacy of plans and formularies – Effect on ADAP?

Medicare’s Role in HIV/AIDS Care

Sources: Kaiser Family Foundation, Medicare and HIV/AIDS, 10/06; Kaiser Family Foundation, Medicare at a Glance, 7/06. Medicare HIV/AIDS spending estimate from CMS, Office of the Actuary and HHS Office of the Budget, 2006.

Medicare Spending on HIV/AIDS Care as Percent of Federal Spending on HIV/AIDS Care FY 2006

Total: $12.3 B

Medicare 26% ($3.2B) All Other 74% ($9.1B)

Figure 25

The Ryan White Program

• 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 2006
• Reauthorized for third time, December 2006

Figure 26

Components of the Ryan White Program

• Part A (Title I): Eligible Metropolitan Areas (Cities) &

Transitional Grant Areas

• Part B (Title II): Funding to States

– Includes earmark for AIDS Drug Assistance Program (ADAP)

• Part C (Title III): Funds early intervention services, capacity

building, planning

• Part D (Title IV): Funds services for women, youth, children,

infants

• Part F: Other Funding for AIDS Education and Training

Centers, Dental Services, Special Projects of National Significance

Sources: DHHS, HRSA, HIV/AIDS Bureau. Figure 27

HIV Prevention

• Centers for Disease Control and

Prevention (CDC) – Most prevention funding – Funds go to states; some cities; community based

• rganizations; other

entities/programs

• Additional prevention funding

also at: Department of Veterans Affairs, SAMHSA, and other agencies

• National HIV prevention goal

(reduce new infections by 50% by 2005) was not met HIV Prevention Funding at CDC, FY 1996-2006 (US $ Millions)

Sources: CDC, Personal Communication, 2006; CDC, HIV Prevention Strategic Plan Through 2005.

$584.1 $624.9 $652.2 $785.2 $738.0 $719.7 1996 1998 2000 2002 2004 2006

Figure 28

CDC’s Revised Testing Guidelines in Health Care Settings

• Revised recommendations published in September 2006

– Replaces CDC’s 1993 and 2001 recommendations

• Intended for all public- and private-sector health care providers

– Hospital emergency departments, urgent care clinics, inpatient services, public health and community clinics, and primary care settings

• Select revisions:

– “Opt-out” HIV screening recommended in all health care settings, including for pregnant women – Persons at “high risk” for HIV should be screened at least once a year – Screening in the third trimester recommended in areas with high rates of HIV infection among pregnant women

Source: CDC, “Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health- Care Settings,” MMWR, Vol. 55, No. RR-14; September 22, 2006. Figure 29

HIV/AIDS is Local: The Impact Across the Country

Figure 30

*Rates were not calculated for states that reported fewer than 5 AIDS cases in females in 2004. SOURCE: CDC, Slide Set: HIV/AIDS Surveillance in Women, 2004.

<4 4-10 >10

AIDS Case Rates per 100,000 Women, 2004

Rate (per 100,000 population) DC Puerto Rico Virgin Islands (US)

Figure 31

12,798 6,685 6,135 5,769 4,703 4,398 3,858 2,655 3,242 New York Florida California Texas New Jersey Maryland Pennsylvania Georgia Illinois District of Columbia

Top 10 States by Number of Women Living with AIDS, 2005

Source: Kaiser Family Foundation, State Health Facts (CDC, Special Data Request, November 2006).

22,100

Figure 32

100.0 24.2 23.6 20.2 19.4 18.9 17.9 15.7 15.6 17.0 District of Columbia Maryland New York Florida Virgin Islands Delaware Puerto Rico Georgia Louisiana Connecticut

Top 10 States by AIDS Case Rate per 100,000 Women, 2005

U.S. Rate = 8.6

Source: Kaiser Family Foundation, State Health Facts (CDC, Special Data Request, November 2006). Figure 33

2,007 2,186 2,599 2,711 2,753 3,444 1,864 4,208 6,845

Atlanta, GA San Juan, PR Houston, TX Los Angeles, CA Chicago, IL-IN-WI Baltimore, MD Philadelphia, PA-NJ-DE-MD Washington, DC-VA-MD-WV Miami, FL New York, NY-NJ-PA

Top 10 MSAs by Number of Women Living with AIDS, 2004

Notes: MSA=Metropolitan Statistical Area. Includes areas with population 500,000). Source: CDC, HIV/AIDS Supplemental Report, Vol. 12, No. 2.

23,351

Figure 34

Concern About HIV/AIDS Among Women

22% 51% 53% 30% White Latina Black Overall

Note: Includes non-elderly women, aged 18-64. Source: Kaiser Family Foundation, 2006 Survey of Americans on HIV/AIDS; 2006.

Percent Very or Somewhat Concerned About Becoming Infected with HIV:

Figure 35