Staten Island HIV/AIDS Fact Sheet

Prepared to provide community-based organizations with need statements for successfully funded proposals and legislators with ammunition, to fight for Staten Island. We invite you to quote from here! The first two pages are created to stand-alone and are referenced in the full document.

In April 2002, the New York State Department (NYS) of Health provided an initial summary of their new HIV/AIDS case reporting system. From June 1 to December 31, 2000, 2,817 new HIV infections; 9,036 known HIV infections, and 5,013 initial AIDS diagnoses - almost 17,000 cases - were reported. Nearly 75% were from New York City (NYC). An astonishing 88% of the new HIV infections were among people of color while 81% of the new AIDS cases were among blacks, Latinos and Asians. [4]

The vast majority of young US gay and bisexual men, the very men who are at greatest risk of HIV infection, are least likely to think they are at risk. A study conducted by the Centers for Disease Control (CDC) revealed that 440 (77%) of 573 gay and bisexual men interviewed in six major cities throughout the United States, including NYC, were unaware that they were infected with the HIV virus. Among those found to have HIV, 90% of blacks, 70% of Hispanics and 60% of whites said they did not know that they were infected. [28]

Incidence

With 2,550, Staten Island (SI) has more adults diagnosed with AIDS (PWAs[1]) than 20 states, including Oregon and West Virginia. With about 916 adults living with AIDS (PLWAs), SI also has more PLWAs than 13 states. With forty-one cumulative pediatric AIDS cases, SI also has more children (13>) diagnosed with AIDS than forty states. [1& 3]

Seroprevalence

Data presented on HIV are preliminary and are an underestimate of the total number of persons living with HIV in NYC. Mandatory reporting of HIV diagnoses and selected laboratory tests (Western Blot, detectable HIV viral load, and CD4<500 cells) began in June 2000. However, HIV surveillance data are incomplete because diagnosed2 people living with HIV (PLWH) are not all reportable under the existing law; undiagnosed3 PLWH are not reportable, and laboratory and provider reporting may be incomplete. [2] The NYC Department of Health reports that there were 346 PLWH in SI by August 2002. Further relying on the estimate of the US Centers for Disease Control and Prevention (CDC) that only 2/3 of HIV seropositive persons are aware of their HIV status, SI has about 460 seropositive individuals. [1]

Race

In SI, 48.6% of PWAs are white, 31.9% black and 18.7% Hispanic. [2]

Gender

Twenty-eight percent of PWAs in SI are women. [3] Forty-one per cent of women diagnosed with AIDS in SI are black, 41% white and 18% Hispanic. Forty-eight percent of men diagnosed with AIDS in SI are white, 30% black and 21% Hispanic. [2]

Age

SI has 2% of NYC pediat­ric cases (from birth through 12 years of age). SI has more pediatric AIDS cases than forty states. [2]

Young children and teenagers (age 0-19) account for 2.2% of PWAs in SI, age 20-29 for 10.2%, age 30-39 for 44.2%, age 40-49 for 31.7% and over 50 for 11.8%. [2]

Risk Factors

Forty-five percent of women diagnosed with AIDS in SI have injecting drug use (IDU) as their risk factor, 32% heterosexual contact, and 23% other/unknown factors. Forty nine percent of men diagnosed with AIDS have IDU as their risk factor, 27% men who sex with men (MSM), 3% MSM & IDU, 2.8% hetrosexual contact, and 17.8% other risk factors. [2] 

Sexually Transmitted Diseases (STDs)

By the end of 2001, the rates of all three reported STDs: gonorrhea, chlamydia and syphilis increased in SI from 2000 by 25%, 1.4% and 70% respectively. [4]

Tuberculosis (TB)

SI had 32 reported TB cases in 2000. Of these, 11 (34.4%) were US-born while the rest were non-US born. The crude and age-adjusted rates were 8.4 and 8.9/100/000 population respectively. [5]

Lack of Funding

In SI, people of color make up 19.6% of the population and 59.7% of PLWAs, but minority-run organizations in the borough receive only 9.1% of $2.10 million in AIDS Institute funding. [27]

NEIGHBORHOODS The UHF (United Hospital Fund) neighborhoods used below are the ones used for most AIDS reporting in NYC and NYS.

· UHF Willowbrook and South Beach/Tottenville have SI’s lowest cumulative rates per 100,000 (325 and 370 respectively) and have the 1st and 3rd lowest total AIDS cases. These neighborhoods comprise 9% and 22% of SI’s PWA cases respectively. The two neighborhoods reported 2 and 10 new AIDS cases respectively in 2001. [1]

· Port Richmond and Stapleton/St. George have 976 and 1,237 cumulative rates per 100,000 respectively. Both cumulative rates exceed the average case rate for SI, which stands at 706. These neighborhoods comprise 19% and 46% of SI’s PWA cases. The two neighborhoods reported 23 and 38 new AIDS cases respectively in 2001. [1]

Seroprevalence Data presented on HIV are preliminary and are an underestimate of the total number of persons living with HIV in NYC. Mandatory reporting of HIV diagnoses and selected laboratory tests (Western Blot, detectable HIV viral load, and CD4<500 cells) began in June 2000. However, HIV surveillance data are incomplete because diagnosed people living with

HIV (PLWH) are not all reportable under the existing law; undiagnosed PLWH are not reportable, and laboratory and provider reporting may be incomplete. [2] The NYC Department of Health reports that there were 346 PLWH in SI by August 2002. Further relying on the estimate of the US Centers for Disease Control and Prevention (CDC) that only 2/3 of HIV seropositive persons are aware of their HIV status, SI has 464 seropositive individuals. [1]

Minorities In the United States at the end of the second decade of the AIDS epidemic, African-Americans are experiencing a steady rise in infections, especially among men ages 23-29 who have sex with men (MSM). The impact of HIV and AIDS in the African-American community has been devastating. Representing only an estimated 12% of the total US

population, African-Americans make up almost 38% of AIDS cases reported in this country. [7]

“It’s pretty well-known that half of the cases of AIDS among African-American men have been among MSMs…While white MSMs are more likely to leave families and communities, particularly in rural areas and small towns and move away to gay communities in major cities like San Francisco, Atlanta or New York, this is not true of black men. There is no such thing as a gay community for African-American men.” ([7] Dr. John Petersen, Psychology Professor at Georgia State University).

A recent report by the Institute of Medicine revealed that minorities in America, whether insured or not, receive lower-quality care than whites do. The report states that a nonwhite patient in the United States is far more likely to be treated by a white doctor who earns less, received less training and does not have a clear understanding of the patient’s native language or cultural heritage. The largest discrepancies in health outcomes for minorities came in the areas of cardiovascular disease, HIV/AIDS, cancer and diabetes. African-Americans, Asian-Americans, Hispanics and Native Americans were less likely to receive sophisticated treatments such as angioplasty, bypass surgery, kidney transplantation or combination drug therapy for HIV disease. The differences in proper medical provision are associated with a higher mortality rate among minority groups. By contrast, minorities more likely to receive certain less-desirable procedures, such as lower limb amputations for diabetes. [8]

· In SI, 48.6% of PWAs are white, 31.9% black and 18.7% Hispanic. [2]

Women The proportion of new AIDS cases among women has more than tripled in the last decade, and one third of all new infections are the result of heterosexual contact.” [9] The epidemic has grown most dramatically among women of color. African-American women account for 62% of AIDS cases reported among women. Although the number of AIDS deaths in women is declining, as it is for the population overall, AIDS remains the fourth-leading cause of death among women ages 25 to 44. For African-American women and Latinas, AIDS is the second- and third-leading cause of death, respectively, among this age group. [10]

A large-scale longitudinal study has found that while the most important predictors of HIV sero-conversion for men are drug-related and homosexual activities, the factor predictive of female sero-conversion is high-risk heterosexual activities. [11]

Twenty-eight percent (28%) of PWA in SI are women. [3] Forty-one per cent of women diagnosed with AIDS in SI are black, 41% white and 18% Hispanic. [2]

Children An estimated 20,000 children and adolescents in the United States are living with HIV or AIDS. HIV-1 infected children have chronic problems with both linear growth and weight gain. Viral load may directly influence growth and nutritional status of HIV-1 infected children. Fifty-six percent of young children diagnosed with AIDS in NYC are African-American and 36% are Latino; they are evenly distributed between males and females. Less than 37% of the 1,844 children are still alive. Ninety-six percent of pediatric AIDS cases in NYC were infected via maternal transmission.

Perinatal HIV infection has been steadily decreasing in the United States since 1994. This trend is attributed to the guidelines issued by Public Health Service (PHS) in 1994 for maternal and neonatal zidovudine (ZDV) use to reduce perinatal HIV transmission. The guidelines recommend maternal ZDV use during the second and third trimesters of pregnancy and during labor and delivery (L&D) and administration of ZDV to the neonate for the first 6 weeks of life. Sixty-seven percent of these mothers are injection drug users (IDUs) or the sexual partners of IDUs. [12]

· SI has 2% of the NYC pediat­ric cases (from birth through 12 years of age). SI has more pediatric AIDS cases than forty states. [2&3]

· At the end of December 2001, 41 pediatric AIDS cases were reported in SI. This represents 2% of the cumulative pediatric AIDS cases in NYC (60 cases per 100,000). [1]

Adolescents In the United States, 20,000 teenagers become infected with HIV every year. Young adults, particularly girls, represent a large proportion of the newly reported cases of HIV. In 2000, individuals between ages 13-24 accounted for 17% of newly reported HIV cases. HIV infection continues to increase among adolescents and young adults, and between 1998 and June 2000, the increase among this age group was 26%. According to a report in the summer issue of the Journal of the American Medical Women’s Association, teenage girls’ rate of HIV infection from heterosexual sex rose by almost 117% between 1994 and 1998. Based on data from 25 US states, the report also said that female’s ages 15 to 19 experienced a 90% increase in the rate of HIV infection due to IDU during the same period. [13]

Teenagers who drink or use drugs are more likely to have sex at a younger age and with more partners. Moreover, teenagers who are 14 years of age or younger and who drink, are two times as likely to have sex than those in the same age group who do not drink. Sixty-three percent of teenagers who drink alcohol have had sex, versus about 26% in teens who do not drink. In addition, 72% of teenagers who use drugs reported having sex, compared to 36% who do not take drugs. [14]

In SI, adolescents (13-19 year olds) account for about 1% of PLWAs, while 20-29 year olds account for 12% of PLWAs. [2]

Over 50 For most of the 20 years since the onset of the AIDS epidemic, people 50 and older have accounted for a steady 10% of all new AIDS cases diagnosed annually. But by 1997, the rate rose to 11.6%, 12.7% in 1998 and 13.4% in 1999 and about 11% in 2000. The fastest-rising mode of transmission for this age group is heterosexual sex. A 1996 CDC breakdown of the most recent available AIDS cases in individuals 50 and older has shown that cases transmitted heterosexually increased by 94% in men and 106% in women between 1991 and 1996. [15]

It is difficult to determine rates of HIV infection among older adults, as very few persons over the age of 50 at risk for HIV routinely get tested. Most older adults are first diagnosed with HIV 

at a late stage of infection-when they seek treatment for an HIV-related illness. Between 1991 and 1996 AIDS cases in the over 50-population rose more than twice as fast as those among younger adults. Despite stereotypes, many seniors are sexually active, and some are drug users – behaviors that put them at risk of contracting the disease. Seniors are unlikely to consistently use condoms during sex because of a generational mindset and unfamiliarity with HIV prevention methods. Since many HIV symptoms are similar to those associated with aging – fatigue, weight loss, dementia, skin rashes, swollen lymph nodes – misdiagnosis is common. [15]

“The fact that many adults in their 60s have never even seen a condom is one reason HIV rates among the elderly are rising, especially as Viagra increases their sexual activity. Many seniors have sex lives that are far from sedentary”. [16 Colette Vallee, Newsweek 06/03/2002]

In New York City, the number of newly diagnosed people who are over 50 is 15% compared to the nation’s 10%. [2]

In SI, 12% of PWAs are 50 and older. [2]

Modes of Transmission Forty-seven percent of PWAs in SI have Injection drug use (IDU) as a risk factor. The high concentration of PWAs in MSM & IDU risk factors indicates that providers should increase efforts to reduce HIV transmission in these populations. [2]

Injection Drug Users (IDU) Racial and ethnic minority populations in the US are most heavily affected by IDU-associated AIDS. In 1999, IDUs accounted for 37% of all AIDS cases among both African-American and Hispanic adults and adolescents, compared with 22% of all cases among white adults/adolescents. [17]

IDU-associated AIDS accounts for a larger proportion of cases among women than among men. Since the epidemic began, 59% of all AIDS cases among women have been attributed to IDU or sex with partners who are IDU, compared with 31% of cases among men. [17]

Users of intravenous drugs are at increased risk of premature mortality. The most important natural causes of death among those using intravenous drugs are infections, AIDS, hepatitis, endocarditis – that are acquired largely through non-sterile injection practices. The HIV epidemic has greatly increased the mortality rate of the IDU population. [18]

IDU accounted for 40% of cumulative AIDS cases in NYC. In SI, male IDU accounted for 49.1% and female IDU for 45.4%. Male MSM and IDU accounted for another 3%. [2]

Men who have Sex with Men (MSM) In the United States, AIDS is most prevalent among MSMs who accounted for 46% of US cases in 2000 [19]

While the early years of the HIV/AIDS epidemic registered dramatic changes in gay male sexual behavior, recent studies have indicated that the impact of the epidemic on gay male sexual activity has not been consistent over time. [23] Recent NYC data have shown increases in sexual activity among younger men. The number of new infections is growing fastest among young black MSM, according to a CDC report. HIV incidence for gay men between 23 and 29 is 14.7% among blacks, 2.5% among whites and 3.5 among Hispanics. In general, HIV prevalence levels of US urban MSM are similar to those for sub-Saharan Africa, where seven countries have estimated adult HIV prevalence levels of 14% to 25%. [19]

The increasing prevalence of AIDS among MSM of color, and specifically the black and Hispanic sub-populations, indicate that initial prevention efforts were not as effectively targeted to these groups. [19]

“….These men, while attempting to present a heterosexual image to the outer world, frequently engage in compulsive, high-risk sex with men while engaged in ongoing sexual relationships with one or more women. This is behavior that puts girlfriends and wives in grave danger.” ([20] Bob Herbert, Editorial, The New York Times, 06/04/2001)

•  Men who have sex with men (MSM) account for 27.4% of PWAs in SI. [2]

OTHER ISSUES LINKED WITH HIV/AIDS

Sexually Transmitted Diseases (STDs) Chlamydia, gonorrhea, and syphilis are the most common bacterial STDs, and are curable with antimicrobials. Syphilis is relatively rare among adolescents. When left untreated, chlamydia and gonorrhea can cause pelvic inflammatory disease, abscesses in the fallopian tubes and ovaries, and chronic pelvic pain, and may result in ectopic pregnancy or infertility. In young men untreated infections can cause urethritis and epididymitis. STD’s may also increase susceptibility to HIV infection two – fivefold. [21]

A recent study by the CDC has found that infants born to HIV-infected mothers have a 50 times greater risk of being born with syphilis than the average child. The study, which investigated a group of HIV-infected mothers in Texas from 1988 to 1994, found that the women were more likely to be infected with an additional STD such as syphilis. [22]

Despite a 10% decline in syphilis rates for African-Americans from 1998-1999, African-Americans remain disproportionately affected by syphilis compared to other racial and ethnic groups. Reported rates of primary and secondary syphilis (P&S Syphilis) in 1999 were 30 times higher for African-Americans than for white Americans. The continued impact of syphilis on African-Americans likely reflects the effects of poverty and lack of access to or use of quality health care services. During the same period, P&S Syphilis rates increased 20% for Hispanics, but were stable for white Americans. [22]

After years of steady decline, syphilis rates in NYC have begun to rise dramatically among men. These cases are primarily among MSM. [23]

In 2001, as it did in previous years, the NYC DOH compiled a summary of STDs that included the case rates of gonorrhea, chlamydia (females only) and primary and secondary syphilis (P&S Syphilis). The rates of all three reported STDs in NYC increased by the end of 2001: P&S Syphilis by 133%, chlamydia by 11% and gonorrhea by 8%. [4]

By the end of 2001, the rates of all three reported STDs: gonorrhea, chlamydia and syphilis increased in SI from 2000 by 25%, 1.4% and 70% respectively. [4 ]

Tuberculosis (TB) The tuberculosis epidemic is growing larger and at the same time much more dangerous. An estimated 10-15 million Americans are infected with TB bacteria, with the likelihood of developing active TB disease in the future. However, the risk of developing TB disease is much higher for those infected with HIV. Because HIV infection weakens the immune system severely, people dually infected with HIV and TB have a100 times greater risk of developing active TB disease and becoming infectious compared to people not infected with HIV. The CDC estimates that 10 to 15% of all TB cases and nearly 30% of cases among people ages 25 to 44 are occurring in HIV-infected individuals. [24]

Foreigners account for nearly 60% of all TB patients in NYC. The reason for the high proportion, however, is not because immigrants are bringing in new cases, but rather because old infections are resurfacing. Furthermore, it appears that past campaigns against TB focused on treating new, active cases, instead of eliminating latent infections. In most people, the immune system blocks TB bacteria, but the bacteria may break out years or even decades later. [25]

Physicians have learned how to treat and block new transmission of TB, but still do not know how to prevent the reactivation of dormant infections. [25]

• In NYC alone, nearly one third of all TB cases were found among HIV seropositive people. [26]
  • SI had 32 reported TB cases in 2000. Of these, 11 (34.4%) were US-born while the rest were non-US born. The crude and age-adjusted rates were 8.4 and 8.9/100,000 population respectively. [5]

Hepatitis C Virus (HCV) IDU accounts for 60% of all new HCV infections in the US, through sharing of syringes directly, or perhaps through sharing of drug preparation equipment. Among IDUs, HCV is usually acquired swiftly after initiation to drug injection. As a result, prevalence of HCV among IDUs is very high, estimated at up to 90%. HCV infection is acquired more quickly than other viral infections, and rates of HCV infection among young IDUs are 4 to 100 times higher than rates of HIV infection. [29]

HCV is one of the leading causes of chronic liver disease in the US. The CDC estimates that about 25% of all HIV-infected persons in the US are also infected with HCV due to past or current injection drug use or being a sexual partner of an injection drug user. Among persons infected with HIV IV drug use (mainly urban African-Americans and Hispanics) the rates are dramatically higher, estimated to be between 60%-90%. Generally, for persons not infected with HIV, it takes 30 years for HCV complications to develop and in some cases (approximately 30%) the complications never develop. For those who are HIV-infected, HCV infection often progresses more rapidly to liver damage. Acceleration increases the progression often as much as six-fold and complications for many develop in just five years. Additionally, the presence of HIV also dramatically increases the transmission rate of HCV not only through IV use, but also through sexual contact and mother-to-child transmission. According to the CDC, chronic HCV infection develops in 85% of all infected persons. Because of these high morbidity rates, HCV infection is officially viewed as an opportunistic infection in HIV-infected persons and was included in the 1999 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Living with HIV. [30]

• Given the high proportion of AIDS infections attributed to IDU use in SI and its large infected African-American and Hispanic infected population, it is expected that many PLWAs in SI, particularly those who contracted HIV through IDU use are co-infected with HCV.

Homelessness Homeless people suffer higher rates of many diseases, including HIV, than the general population. A survey of 16 US cities has shown a median HIV seroprevalence of 3.4% for homeless adults, compared to less than 1% for the general adult population. In other studies, homeless mentally ill men in NYC had 19.4% prevalence and in San Francisco, CA homeless adults had an 8.5% rate of HIV infection. For homeless youth across the US, median HIV seroprevalence was 2.3%. Of the 400,000 to 600,000 individuals currently estimated by CDC to be living with AIDS in the USA, approximately 33%-50% are either homeless or at imminent risk of homelessness. [31]

Among persons known to be at highest risk for HIV infection, including IDUs and individuals engaging in high-risk sexual behaviors, those without a stable home are even more likely to be HIV-positive. Despite their disproportionately high risk for HIV infection and transmission, homeless individuals have limited access to preventive and therapeutic HIV/AIDS care. Moreover, their limited access to comprehensive health care delays the identification of HIV and accelerates the onset of AIDS. Restricted access to health care is also a contributing factor in the increased prevalence of opportunistic infections and other medical conditions including TB. [32]

Affordable and appropriate housing in SI is a major concern for PLWAs in SI. Specific sub-populations in need of housing include immigrants, IDUs, women, children and domestic violence victims. 

Lack of Funding A study by Housing Works, a NYC AIDS service and advocacy organization, reveals that minority-run organizations in NYS receive only about 30% of discretionary state funding for HIV/AIDS treatment, prevention and education programs. This is despite the fact that people of color now make up 83.38% of new AIDS cases and 76.5% of all PLWAs in NYS. Minority-run organizations received about $40 million less than non-minority organizations last year, even though minorities make up the bulk of AIDS cases. [27]

In NYC, people of color with AIDS make up 79.2% of PLWAs though they make up only 56.6% of the general population. Despite the high proportion of minority PLWAs, minority-run organizations receive only 34.7% of the $63.10 million in AIDS Institute funding. [27]

In SI, people of color make up 19.6% of the population and 59.7% of PLWAs, but minority-run organizations in the borough receive only 9.1% of $2.10 million in AIDS Institute funding. [27]

BIBLIOGRAPHY

Consider this a tool to find more information - not just these publications, but also these types of publications. Note that we provide information on how to get these publications or updates on your own.

1) HIV/AIDS New York City, Surveillance Update, including Persons Living with AIDS in New York City; Reported through 12/2001. (June 2002) NYC Office of AIDS Surveillance; NYC Department of Health, Box 44, 346 Broadway, Room 706; NYC, New York 10013 (212) 442-3388. http://www.ci.nyc.ny.us/

2) Church Avenue Merchants Block Association, Inc. (CAMBA) HIV/AIDS Report, Volume 5, Issue No. 1 (first quarter 2002 data) Released July 2002. 1720 Church Avenue, 2nd Floor, Brooklyn, NY 11226, (718) 462-8654, Fax (718) 703-7212.

3) Centers for Disease Control and Prevention, Center for HIV, STD and TB Prevention. Surveillance Report Vol. 13, no. 1. December 2001.

4) 1996-2001 STD Surveillance Data by New York City Neighborhoods, New York City Department of Health, Box 44, 346 Broadway, Room 706; NYC, New York 10013 (212) 788-4462. {Contact Laura Naylans for more information}.

5) Tuberculosis in New York City 2000 Information Summary (2000) Bureau of Tuberculosis Control, NYC Department of Health; 125 Worth Street, NYC, NY 1007 (212) 553-4283.

6)NYSDOH releases first HIV case reporting data; initial data confirms demographic trends. AIDS Issues and Advocacy. Housing Works, May 6, 2002. www.housingworks.org.

7) “The Deadly Secret,” The Atlanta Journal Constitution, National News, 07/08/2001. Gracie Bonds Staples.

8)“Report says minorities get lower-quality health care; moral implications of widespread pattern noted” The Washington Post, by Ceci Connolly, March 21, 2002.

9) Statement by House Democratic Leader Richard A. Gephardt and Congresswoman Nancy Pelosi (Dem. NC) Washington DC June 5, 2001. US Newswire. Released by the Office of House Democratic Leader Richard Gephardt.

10) CDC Update – CDC Fact Sheet: Need for Sustained HIV Prevention – Young and Minority Men at High Risk http://www.cdc.gov/nchstp/hiv_aids/pubs/facts/msm.htm

11) Percent of AIDS Cases in Women and Girls Reported Through December 1999.Centers for Diseases Control HIV/AIDS Surveillance Report. 2000; 9:12

12) Progress Toward Elimination of Perinatal HIV Infection Morbidity and Mortality Weekly Report (02.08.02) Vol. 51, No. 05, P. 94-7.

13) Estimates of Persons Living with AIDS in New York City. 1999 Edition. (Issued March 2000) New York City Department of Health, Office of AIDS Surveillance 346 Broadway, Rm # 706, DOH CN44, New York, NY 10013-4089. http://www.ci.nyc.ny.us/html/doh/html/dires/dires.html

14) Centers for Disease Control and Prevention. Young people at risk-epidemic shifts further toward young women and minorities. Fact sheet prepared by the CDC. July 1998.

15) Centers for Disease Control & Prevention. National Center for HIV, STD, and TB Prevention. Divisions of HIV/AIDS Prevention, May 2000.

16) “Does Gran Get It On?” Newsweek 06/03/2002. Daniel McGinn and Catherine Skipp.

17) CDC Update – CDC Fact Sheet: Need for Sustained HIV Prevention – Young and Minority Men at High Risk as available via the internet at: http://www.cdc.gov/hiv/pubs/facts/idu.htm

18) Langedam, Miranda W., PHD; Brussel, Geil H.A., MD; Coutinho, Roel A., MD; Ameijden, Erik, J.C., PHD. “The impact of harm-reduction-based methadone treatment on mortality among heroin users,” American Journal of Public Health, Vol.91; No.5 pp.775-780.

19) Cantania, J., PHD; et al. “The Continuing HIV Epidemic Among Men who Have Sex with Men”. American Journal of Public Health, Vol.91, No. 6, pp 907-914.

20) A Black AIDS Epidemic, by Bob Herbert, The New York Times, 06/04/2001.

21) “HIV Infected Moms Likely to Pass Along Syphilis”. NY Times July 11, 2001. www.nytimes.com/reuters/health.

22) “Primary and Secondary Syphilis – United States, 1999” Morbidity and Mortality Weekly Report. 02/ 23/01 vol. 50, no. 7, p.113.

23) The City of New York Department of Health, letter by Millicent Freeman, Director of Outreach and Training, released on 07/10/2001.

24) Centers Disease Control and Prevention, Division of HIV/AIDS Prevention. “The Deadly Intersection Between TB and HIV, November 1999. http://www.cdc.gov/hiv/pubs/facts/hivtb.htm

25) “Latent Infections, Not New Ones, Causing Bulk of New TB Cases,” The Associated Press, 05/09/2002. From a report in the New England Journal of Medicine (v. 346, 1453-1458, 2002).

26) “The Tuberculosis Threat” Editorial, The New York Times July 19, 2001.

27) New York State Funding 3001. Housing Works, Inc. – New York City Advocacy Department: 594 Broadway, Suite 700, NYC 10012, ph. 212-966-0466, ext. 296.

28) “AIDS Study Finds Many Unaware they Have Virus” July 08, 2002 Lawrence K. Altman, The New York Times.

29) Westley Clark, M.D., MPH, JD. Report on a daylong symposium co-hosted by OASAS, CSAT, and Mt. Sinai / New York University Medical Center in New York City on March 1, 1999.

30) John Y. Song, M.D., M.P. H., M.A.T. HIV/AIDS & Homelessness, Recommendations for Clinical Practice and Public Policy. National Health Care for the Homeless Council, Inc. HCH Clinicians’ Network, November 1999.

31) Allen DM, Lehman JS, Green TA, et al. HIV infection among homeless adults and runaway youth, United States, 1989-1992. AIDS. 1994; 8:1593-15, 1998 (http://www.caps.ucsf.edu/homelesstext.html)

32) John Y. Song, M.D., M.P. H., M.A.T. HIV/AIDS & Homelessness, Recommendations for Clinical Practice and Public Policy. National Health Care for the Homeless Council, Inc. HCH Clinicians’ Network, November 1999.

Prepared by Marda Yilma, Community Resources Developer for the Brooklyn AIDS Task Force Community Resources Project . This publication was supported by grant number 5H89HA00015-12 from the U.S. Health Resources and Services Administration (HRSA). This grant is funded through Title I of the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, as amended by the Ryan White CARE Act Amendments of 1996 and 2000, through the NYC Department of Mental Hygiene to the Medical and Health Research Association of NYC, Inc. It’s contents are solely the responsibility of the Brooklyn AIDS Task Force, Inc. and do not necessarily represent the views of the funders. Phone ( 718) 783-0883 X129 with questions or e-mail: myilma@batf.net. For information about BATF’s other programs, call 718-622-2910 or access: www.batf.net.

[1] “People diagnosed [1] “People diagnosed with AIDS” (PWAs) and “Cumulative AIDS Cases” are used interchangeably throughout this document. PWAs minus “known dead” as reported by the NYC Department of Health, equal “people living with AIDS” (PLWAs).

2 Persons diagnosed with HIV prior to June 2000 who have not progressed to AIDS, have not had a detectable viral load or CD4<500 since June 2000 are not reportable under existing law until they experience a reportable event. This includes persons diagnosed with HIV prior to June 2000 who are not in the care system.

3 CDC estimates that nationally only 2/3 of HIV seropositive persons are aware of their HIV status. This figure may be higher or lower for New York City.