State of nevada historical stats
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From 2004-2008, Nevada saw a shift in the HIV/AIDS epidemic toward blacks, youth, and heterosexual adults. To effectively plan prevention and care, it is important to identify at-risk populations. The document discusses Nevada's HIV epidemiology, including increases in infections among blacks, Hispanics, youth, MSM, and older age groups. It also summarizes community input that identified priority populations as MSM, HIV-positive individuals, youth/young adults, and minorities. Goals and strategies focused on increasing awareness, testing, interventions, condom access, and linkages to care for these at-risk groups.
State of nevada historical stats
- 1. STATE OF NEVADA HISTORICAL STATS 2004-2008 a shift in the HIV/AIDS epidemic toward, Blacks, youth, and heterosexual adults. To plan for HIV prevention and care and to allocate limited resources as the epidemic continues to change and the number of persons living with HIV continues to grow, it is extremely important to identify those populations most affected and most at risk for HIV infection.
- 2. CDC’s HIV Prevention Community Planning Guidance there are three goals in community planning: • The community planning process supports a broad-based community participation in HIV prevention planning. • Community planning identifies priority HIV prevention needs in each jurisdiction. • Community planning ensures that HIV prevention resources target priority populations and interventions set forth in the comprehensive HIV prevention plan.
- 3. What is a Comprehensive HIV Prevention Plan? NEVADANS The primary responsibility of a CPG is to develop a comprehensive HIV prevention plan that includes prioritized target populations, community services assessment, gap analysis, and effective activities/interventions targeting the priority populations. The priority populations are determined based on epidemiological data and on the ability to provide the greatest impact on the number of new HIV infections. This plan assists local health authorities and state policy makers on making health care decisions to best meet the needs of its citizens.
- 4. How Does Nevada rank? According to Henry J. Keiser Family Foundation Health Statistics (2007), Nevada ranked 26th in the nation for the number of new AIDS cases; the annual AIDS case rate for males was higher than the national AIDS case rate (25.6 vs. 22.9); ranking males 10th in the nation for AIDS cases in Nevada. Additionally, Nevada ranked 29th in the nation among HIV Infection Cases Reported among States with Confidential Name-Based Reporting, 2007 (1=High, 51=Low).
- 6. Figure 5: From 2004 to 2008, the number of new HIV infections increased among males. In 2008, the number of new HIV infections among males was 368; representing a 9% increase since 2004. The most significant increase was from 2004 to 2005, followed by a steady decline. From 2004 to 2008, the number of new HIV infections decreased among females. In 2008, the number of new HIV infections among females was 67; representing a 22% decrease since 2004.
- 7. increased among Blacks and Hispanics. declined among Whites Figure 6: • In 2008, the number of new infections among Whites was 191; representing a 15% decrease since 2004. • In 2008, new infections among Blacks was 116 and 107 among Hispanics; representing a 13% and 25% increases since 2004, respectively. Among all other races there were no significant changes from 2004 to 2008. Asian/Pacific Is23 From 2004 to 2008, the number of new HIV infections
- 8. Figure 7: In 2008, there were no new HIV infections among individuals less than 13 years old. From 2004 to 2008, the number of new HIV infections increased most significantly among 13-24 and 25-34. In 2008, the number of new infections among individuals 13-24 was 64 and among 25 to 34 years olds was 120; representing a 15% and 9% increase since 2004, respectively.
- 9. Figure 8: MSM accounted for more than two thirds (67%) of the new HIV infections in Nevada in 2008. MSM increased 11% annually from 2004 to 2008. Although heterosexual contact only accounted for 18% of the new HIV infections in 2008, it increased from 53 cases in 2004 to 80 in 2008; representing a 51% increase.
- 10. Annual number of Persons Living with HIV/AIDS BY SEX 2004-2008 • Figure 9: From 2004 to 2008, the number of males living with HIV/AIDS in Nevada increased 27% from 5,210 cases in 2004 to 6,617 in 2008. • Among females living with HIV/AIDS in Nevada, in 2004 there were 1,051 females living with HIV/AIDS in Nevada and in 2008 there were 1,323; representing a 6% increase. • Although a greater proportion of the male cases are AIDS compared to females; for both males and females, there was a greater increase among HIV (not AIDS) compared to AIDS cases from 2004 to 2008. • This could suggest improved case management.
- 11. From 2004 to 2008, among persons living with HIV in Nevada The most significant increase (with the exception of multi-race with an 83% annual increase) was among API, which increased 59% from 113 cases living with HIV/AIDS in 2004 to 180 in 2008 Whites which increased 20% among the Persons living with HIV/AIDS American Indians/Alaskan Natives, which increased 21%, Blacks, which increased 28%, Hispanics which increased 44%
- 12. Annual number of persons living with HIV/AIDS Nevada by age at diagnosis 2004-2008 Figure 11: Among persons living with HIV/ AIDS in Nevada there was an upward trend in all age groups. The most significant annual increases were among 55-64 year olds which increased from 161 cases in 2004 to 274 cases in 2008; representing a 70% increase. This was followed by 13-24 year olds which increased 44%, 45-54 year olds which increased 36%, 35-44 year olds which increased 27%, less than 13 year olds increased 25%, and 25-34 year olds increased 16% from 2004 to 2008 among persons living with HIV/AIDS in Nevada. These trends show that individuals are living longer with HIV/AIDS as we are seeing a significant increase among older individuals. MSM and IDU have increased 7% and 12% respectively during this time period. Perinatal exposure has increased 22% from 2004- 2008, though there were no positive perinatal HIV cases in 2008.
- 24. Participants in the MSM focus groups (N=96) also completed an anonymous quantitative survey that assessed demographics, sexual and drug risk behaviors, and HIV testing history. Because little is known about use of the internet and HIV risk among MSM in Nevada, sexual behavior questions were asked separately for partners met online and those met offline. In addition, patterns of internet use (number of hours spent online per week and websites most commonly used) and attitudes about online HIV prevention were assessed. RESULTS Sexual Behaviors and Use of the Internet Half the participants reported using the internet to meet sex partners during the past six months and 60% met partners offline (bars, clubs, friends, or organizations) (Figure 79). Over one fifth of MSM who used the internet to meet sex partners the past six months said they spend 10 hours or more searching for partners online each week (Figure 80).
- 26. Over half (58%) of participants believed that internet sites used to meet sex partners do not have enough HIV/STD information and 56% said that they would use a website for MSM who are only interested in having safe sex.
- 27. Overall, there were not large differences between in the number of partners that participants reported meeting online compared to offline during the past six months (Figure 79). However, consistent condom use was much less frequent when MSM had sex with online partners compared to offline partners: receptive anal sex (53% vs. 74%), insertive anal sex (54.5% vs. 69%), and oral sex (3% vs. 25.5%).
- 33. Youth (13-24) accounted for 15% (n=60), and there were no new HIV cases among individuals less than 13 years of age. Overall, half of the new HIV infections among Whites are among youth and young adults (13-34 year olds); however, upward trends over the past five years suggest that older White individuals are experiencing increases in new HIV infections in Nevada. Youth ages 13-24 accounted for 19% of the new HIV infections among BlacksYouth ages 13-24 accounted for 19% of the new HIV infections among Blacks, 15% were 45-54, 11% were 55-64, and about 1% were above 65 years of age at the time of HIV diagnosis. Overall, half of the new HIV infections among Hispanics are among youth and young adults (13-34 year olds); 14% were 13-24 and 36% were 25-34. From 2004-2008 the number of new HIV infections among Hispanic youth (13- 24) experienced the most notable increase; 10 cases in this group in 2004 to 15 cases in 2008, a 50% increase. In 2008, 16% of the new HIV infections among the MSM risk group were among youth 13-24 years of age.
- 34. Youth and Young Adults are defined as those between the ages of 13 and 34. The two subpopulations among this priority group would be: 1. MSM Youth and Young Adults, ages 13 – 34 2. Heterosexual Youth and Young Adults, ages 13 – 34 Key focus areas within this population would include: 1. Youth/Young Adults who seek out sexual partners via the internet, including • chats rooms and • classified postings. 2. Youth/Young Adults engaging in high-risk sexual activity under the influence of alcohol and/or drugs. Special emphasis should be placed on minority populations, with a special emphasis on AfricanAmerican and Latino/a groups, who are disproportionately affected by HIV.
- 35. Young people in the United States are at persistent risk for HIV infection. This risk is especially notable for youth of minority races and ethnicities. Continual HIV prevention outreach and education efforts, including programs on abstinence and on delaying the initiation of sex, are required as new generations replace the generations that benefited from earlier prevention strategies. Unless otherwise noted, youth are persons who are 13–24 years of age. In Nevada, the proportion of youth living with HIV/AIDS in 2008 was 15% of the total; moreover, the prevalence rate of persons living with HIV/AIDS between 13-24 was 175.0 per 100,000 population. Additionally, the rate of new HIV infections among this age group was 13.6 per 100,000 population. From 2004 to 2008 there has been a 12% annual increase in number of new HIV infections among youth in Nevada. In 2008, the majority (94%) of the new HIV infections among youth were in Clark County and from 2004 to 2008 increased 20% in this area. In 2008, only 5% of the Whites and Blacks each made up more than one-third (34%) of the new HIV infections among youth in Nevada; Hispanics accounted for 23% of the new HIV infections, those who identified as multi-race accounted for 6%, and APIs accounted for 2% in 2008. Hispanics experienced the greatest increase in number of new HIV infections among youth, from 2004 to 2008 there was a 50% annual increase among this group.
- 37. Description and Justification of Priority Populations Special emphasis should be placed on minority populations, with a special emphasis on African-American And Latino/a groups, who are disproportionately affected by HIV. HIV+ Due to increase in treatment options for individuals infected with HIV, people have been living longer, healthier lives with HIV and AIDS. There are approximately 7,940 people living with HIV/AIDS in Nevada in 2008, over half (52 percent) of the cases are AIDS cases. MSM In Nevada in 2008, 71 percent of the newly diagnosed HIV infections had a primary risk of MSM. Over the past five years (2005- 2008), the number of newly diagnosed cases reporting MSM as primary risk factor has increased 33 percent. Although Whites accounted for the greatest proportion of new cases among MSM, Nevada is experiencing significant increases among new MSM cases for both Blacks and Hispanics. Additionally, over half (60 percent) of the persons identified living with HIV and AIDS in Nevada reported MSM as the primary risk of transmission. The high prevalence of HIV among gay and bisexual men means MSM are at elevated risk for being exposed to the infection during each sexual encounter. Therefore, MSM was determined to be the top priority population for the Nevada State HIV Prevention plan due to the rates of HIV infection among this population. Key focus areas within this population would include: 1. MSM who seek out sexual partners via the internet, including chats rooms and classified postings (ie: craigslist.org, gay.com, manhunt.net, etc) 2. Partners of MSM, including female sex partners of non-identifying MSM 3. MSM engaging in high-risk sexual activity under the influence of Alcohol and/or drugs.
- 38. Key questions included: • Which populations are being served? • Which populations are not being served? • Which populations are hardest to reach? • What key behaviors are placing individuals at risk for HIV? • What barriers exist that prevent individuals from protecting themselves against HIV? • Which HIV prevention services in the community are effective? • Which HIV prevention services do individuals need that are not available or accessible? The community services assessment attempts to answer these questions while creating a picture of the HIV prevention needs in Nevada and serving as a guide for identifying and setting HIV prevention priorities. The community services assessment is comprised of three key parts: • Needs Assessment • Resource Inventory • Gap Analysis
- 39. GOAL ONE Increase the number of people receiving HIV prevention awareness and education messages throughout Nevada, with a special emphasis on identified target populations. GOAL TWO Increase the number of people receiving HIV testing services throughout Nevada, with a special emphasis on identified target populations. GOAL THREE Increase the community capacity to provide referrals, supportive services, and linkages to care to those community
- 40. BEHAVIORAL INTERVENTIONS Target Population Intervention Type Men who have Sex with Men (MSM)* *includes partners and internet Many Men Many Voices D-Up: Defend Yourself Mpowerment Promise Project Explore HIV Positive* *includes partners Changes Project Holistic Health Recovery Willow Healthy Relationship Partnership for Health Clear Injection Drug Users MIP: Modelo de Intervención Psicomedica Safety Counts Shield Real Men Are Safe: REMAS Youth/Young Adults* * includes MSM and Heterosexual Sihle: Sisters Informing, Healing, Living, and Empowering Focus on Youth Be Proud, Be Responsible Street Smart Draw the Line, Respect the Line Together Learning Choices
- 41. STRATEGIES 1. Increase the availability and reach of media campaigns 2. Increase the availability of online interventions 3. Increase the number and availability of interventions that address substance use 4. Expand the availability of free and low cost HIV testing 5. Increase condom availability and appeal 6. Increase the number and availability of youth-specific interventions
- 42. INCREASE THE AVAILABILITY AND REACH OF MEDIA CAMPAIGNS THE NEED • Community member frustration over lack of media attention on HIV/AIDS • Current media campaigns only target the GLBTQI community and reinforce the stigma that associates HIV as a “gay disease” • Pharmaceutical companies heavily promote HIV as a manageable chronic disease • Sexuality and condom use still portrayed as negative, dirty, and unhealthy. INCREASE THE AVAILABILITY AND REACH OF MEDIA CAMPAIGNS THE CURRENT RESOURCES NEVADANS WORKING TOGETHER | SECTION Print (Q Vegas, LV Weekly), Online (twitter, facebook), Promo Materials South MSM, Y/YA Narrowcast Campaign: Print South MSM, Y/YA
- 43. THE CURRENT RESOURCES EZ 2 Stop Campaign: Online (twitter, facebook, myspace) South MSM, Y/YA WELLcumReno Campaign: Online (gay.com, manhunt.net) Website North MSM Spread Negativity Campaign: Website North Y/YA InSpot: Website Statewide HIV+, Y/YA, MSM Disease Investigation Profiles: gay.com, adam4adam, manhunt, facebook, myspace South MSM, Y/YA, HIV+ Peer Education Profiles: gay.com, manhunt, adam4adam, facebook, myspace Statewide MSM, Y/YA GYT Campaign: Print, Online (facebook, myspace), Television, Promotional Statewide Y/YA Bang It Out Safely Campaign: Promotional South Y/YA WELLcumReno Campaign: Print, Online (gay.com, manhunt.net), Website, Promotional North MSM TurnOnReno Campaign: Print, Online (myspace), Promotional North Y/YA Spread Negativity Campaign: Print, Website, Promotional North Y/YA InSpot: Website, Promotional Statewide HIV+, Y/YA, MSM Step Up, Get Tested Campaign: Print, Promotional North Y/YA (African American)
- 44. INCREASE THE AVAILABILITY AND REACH OF MEDIA CAMPAIGNS THE GAPS • No current media campaigns targeting injection drug users • Campaigns targeting specific minority communities and HIV+ populations need to be expanded • No current radio campaigns and limited television marketing • No current campaigns that feature celebrities, athletes, and politicians getting tested for HIV • No current campaigns that demonstrate that while HIV can be treated effectively, living with HIV is not easy and drugs have many side effects. • Expand media campaigns to portray safe sex in a healthy, fun, sexy way • Reinforce safer sex messaging on a variety of media outlets to reach diverse populations, including those with a focus on Latinos/as and African-Americans • Encourage discussion of condoms in movies and television shows • Develop campaigns that feature celebrities, athletes, and politicians getting tested for HIV • Flash statistics of the number of people who are unaware of their HIV infection to reinforce testing messages • Create advertisements that demonstrate that while HIV can be treated effectively, living with HIV is not easy and drugs have many side effects • Include prevention messages in restrooms of bars/clubs, airports, and casinos • Include information about HIV/AIDS prevention at gas stations, grocery stores, and bus stops • Develop more HIV prevention materials in Spanish.
- 45. INCREASE THE AVAILABILITY OF ONLINE INTERVENTIONS THE NEED • Increase in the availability and use of internet sites and phone applications that people use for the purpose of seeking sexual partners (ie: gay.com, adam4adam, craigslist, grindr, etc.) • Increase in the availability and use of social networking and dating sites that people use for the purpose of seeking sexual partners (ie: facebook, myspace, match.com, etc.) • Advances in technology allow people easier access to meet sexual partners in a private and efficient manner THE GAPS • Limited staffing for active peer education • Limited staffing for disease investigation • No coordinated statewide internet interventions/marketing campaigns • No active online intervention on craigslist • Lack of interventions reaching out to MSM population in non-MSM online venues • Limited educational outreach on online sites, such as chat room educational sessions
- 46. THE RECOMMENDED STRATEGIES Increased online HIV prevention interventions may be the most efficient way to reach sexually active MSM, particularly those who do not self-identify as gay or bisexual, as well as younger populations. • Require users of dating or sexual networking websites to click on a pop-up that acknowledges the importance of using condoms • Display local links for HIV testing and services on the first page of websites • Have peer educators create profiles and respond to ads with information about where to obtain free condoms and/or free testing • Have peer educators set up an educational profile on social networking sites and ‘friend’ others • Create social networking profiles (myspace, facebook, twitter) that send information about HIV prevention• Have public health professionals host live chats where individuals can ask questions about HIV and other STDs • Display HIV risk reduction pop-ups that will catch the attention of target populations (ie: using attractive models and positive promotion of safer sex) • Randomly display innovative and diverse condom advertisements • Include a standard place for HIV status disclosure on all sites • Development of a sex-positive branding strategy that promotes safer sex and harm reduction approaches
- 47. INCREASE THE NUMBER AND AVAILABILITY OF YOUTH-SPECIFIC INTERVENTIONS THE NEED • Community frustration with the quality and content of sexual health education that is delivered in schools • Urgent need to develop sexual health programs that involve parents and include the roles of home and community • Youth have become de-sensitized to HIV prevention messages • Youth see HIV as a chronic manageable disease • Youth are more concerned with pregnancy prevention than HIV/STD prevention THE GAPS • Limited resources and programming that target youth and young adults • Lack of coordination and collaboration with sexual health education programming in school districts • Lack of parent/child intervention programs • Lack of peer sexual health education programs for youth • Limited support groups for HIV+ youth and youth adults THE RECOMMENDED STRATEGIES • Develop sexual health education programs for parents and increase parent involvement in sexual health interventions. • Advocate for consistent and comprehensive sexual health education programs throughout all school districts in Nevada. • Include a discussion of homosexuality in sexual health programs • Address the stigma associated with discussion of sexuality, birth control and HIV/STD testing • Create programs were HIV-positive youth share their experience with other youth • Create a “tip sheet” on how to bring up condoms with a partner distributed at youth-focused events • Provide opportunities for youth to role-play condom negotiation • Create peer education and mentorship programs for young MSM, as well as heterosexual youth
- 48. EXPAND THE AVAILABILITY OF FREE AND LOW COST HIV TESTING THE NEED • Community members are engaging in risky sexual and/or needle sharing behavior; yet, these people are not getting tested for HIV due to barriers in cost and availability • Minority communities, although disproportionately at risk for HIV, report less availability of free or low cost HIV testing options in their communities • The Centers for Disease Control and Prevention recommend routine screening of HIV in health care settings for all adults • There is community stigma around HIV testing; HIV testing has not yet been “normalized” THE CURRENT RESOURCES Free and low cost HIV testing is available at on-site and limited off-site locations statewide targeting MSM, Y/YA, and IDU. HOPES Rapid and Oral Standard Free on-site testing Free limited off-site testing North Washoe County Health District Rapid, Oral Standard, and Blood Standard Low cost on-site testing Free limited off-site testing North Planned Parenthood Rapid and Blood Standard Low cost on-site testing Statewide Northern Nevada Outreach Team Oral Standard Free limited off-site testing North Southern Nevada Health District Rapid, Oral Standard, and Blood Standard Low cost on-site testing Free limited off-site testing South THE GAPS • No rapid testing in the field | North • Limited diversity in HIV testing providers | South • No online HIV test result options • Limited education to providers about routine HIV testing • Lack of testing incentives for high risk populations • Limited free off-site testing outreach to minority and heterosexual communities THE RECOMMENDED STRATEGIES • Offer more rapid testing to increase the number of people who receive their test results • Offer more oral testing options to increase the number of people who are willing to test • Test where straight-identifying people hang out (e.g., “straight” bars, clubs, and concerts) to reach MSM who are not “out” and high-risk heterosexuals • Encourage testing at fraternities, sororities, and the dorms • Offer testing in more “mainstream” locations (farmers markets, grocery stores, schools) • Encourage providers to make HIV testing a routine part of medical exams • Increase street-based HIV testing to reach sex workers and their partners • Encourage testing with one’s partner • Give incentives for testing (discounted admission to shows, free drinks, vouchers for STD screening and/or birth control) • Offer testing at special events and/or host new community events for targeted populations at risk (i.e., block parties, Cinco de Mayo, and community barbecues) • Expanding testing and outreach in the jails and in collaboration with probation and parole services
- 49. INCREASE CONDOM AVAILABILITY AND APPEAL THE NEED • Community members stated lack of accessible, free condom distribution locations • Community stigma surrounding the purchase and/or use of condoms result in less frequent use • Few bars and clubs offer free condoms • Free condoms that are available lack appeal The Current Resources: Free, yet limited, condom availability in the Reno and Las Vegas areas at MSM and Y/YA targeted sites. THE GAPS • Lack of funding and resources for widespread condom availability • Limited locations for free condom distribution sites • Limited hours of operations for many free condom distribution sites • Lack of funding and resources for “appealing” condoms THE RECOMMENDED STRATEGIES: • Widely distribute condoms in both gay and non-gay establishments, including mainstream locations such as barber shops, bus stops, movie theaters, dorms, bars, and clubs • Advertise and provide a wider variety of condoms (range of flavors, colors, sizes) • Couple condom distribution with campaigns that promote condom use as sexy and desirable • Advertise locations of free/reduced-cost condoms • Have nightclub bouncers hand out condoms as people enter the establishment • Install condom machines at bars, clubs, and gyms • Distribute condoms at locations frequented by youth such as skate parks, schools, Boys & Girls Club • Actively hand out condoms in places of high-risk activity
- 50. INCREASE THE NUMBER AND AVAILABILITY OF INTERVENTIONS THAT ADDRESS SUBSTANCE USE THE GAPS • No statewide needle exchange program • Lack of substance use interventions in Spanish • Lack of online substance use interventions • Lack of coordination between substance abuse agencies and HIV prevention efforts THE RECOMMENDED STRATEGIES • Implement a statewide needle exchange program • Develop campaigns that highlight substance use as a risk factor for HIV • Develop more substance use educational materials in Spanish • Promote online substance abuse prevention efforts Increase the availability of substance abuse treatment for diverse populations • Decrease the stigma surrounding addiction THE CURRENT RESOURCES Street Smart North Y/YA FACT South Y/YA SAPTA Testing Sites South IDU Street Outreach (bleach kits, disbursement and education) North IDU THE NEED • Substance use is a growing issue in all communities throughout Nevada • Used syringes are being found on streets and in parks throughout Nevada • Community members stated that they engaged in the “most risky” sexual behavior while under the influence of alcohol and/or drugs • Syringe access (needle exchange) is illegal in the state of Nevada