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Data & Statistics
HIV/AIDS Surveillance Data

Data for HIV and AIDS cases reported to the Bureau of HIV Prevention and Control are now available on the HIV/AIDS Surveillance Data EpiQuery Module. EpiQuery is an interactive, user-friendly system designed to guide users through basic data analysis of aggregate-level data.

The HIV Epidemiology and Field Services Program (HEFSP) of the New York City Department of Health and Mental Hygiene (DOHMH) is authorized by the New York State Department of Health1 to conduct HIV/AIDS surveillance in New York City (NYC). HEFSP manages the HIV surveillance registry, a population-based registry of all diagnoses of AIDS (since 1981) and HIV infection (since 2000) in NYC reported to the DOHMH. The Registry contains select demographic, HIV transmission risk and clinical information on persons diagnosed with HIV in NYC, as well as all diagnostic tests, viral load tests, CD4 counts, and HIV genotypes reportable to DOHMH under New York State law.1

For additional information on HIV Surveillance in NYC, see the HIV/AIDS Annual Surveillance tables.

Data available from EpiQuery
The HIV EpiQuery module includes data on new diagnoses of HIV and AIDS in NYC; persons living with HIV/AIDS (PLWHA) in NYC; and deaths among persons with HIV/AIDS for the calendar years 2006 through 2013. Reported cases and case rates (per 100,000 population) and deaths and crude death rates (per 1,000 PWHA) are available by select variables: demographic (sex, race/ethnicity, age group, and place of birth), HIV transmission risk, and geographic (citywide and by borough, United Hospital Fund (UHF) neighborhood, high-risk neighborhood, and area-based poverty level).
Outcomes

HIV diagnoses
Persons are classified with diagnosed HIV infection according to standard case definitions for surveillance established by the Centers for Disease Control and Prevention (CDC).2 Since June 1, 2000, health care providers and laboratories in New York State have been required to report new diagnoses of HIV infection and HIV-related laboratory tests. HIV diagnoses displayed in EpiQuery are limited to those made by NYC providers for 2006 and later.

AIDS diagnoses
Persons are classified with diagnosed AIDS if they are HIV-infected and have either one or more AIDS-defining opportunistic illnesses or a laboratory test indicating suppressed CD4+ cell count (<200 cells/µL), according to CDC’s case definition.2

Concurrent HIV/AIDS diagnoses
HEFSP considers persons with an AIDS diagnosis within 31 days of their HIV diagnosis to be concurrently diagnosed with HIV/AIDS. In data tables generated via the HIV module of EpiQuery, persons concurrently diagnosed with HIV and AIDS are included in the totals of both HIV diagnoses and AIDS diagnoses.

Persons living with HIV/AIDS (PLWHA)
PLWHA for a given year are defined as persons diagnosed with HIV/AIDS, reported in NYC and presumed to be living as of the end of the calendar year.

Deaths among persons with HIV/AIDS
All death rates are unadjusted and calculated per 1,000 persons with HIV/AIDS in year of interest. Rates based on a numerator of ≤10 should be interpreted with caution. Data on deaths occurring in NYC are ascertained via HIV surveillance data matches with the NYC Vital Statistics Registry, medical chart reviews, and provider reports via an HIV Provider Report Form, including HIV-positive autopsies by the Office of the Chief Medical Examiner. Data on deaths occurring outside NYC are ascertained via matches with the Social Security Death Master File and National Death Index. For technical notes on mortality data by the NYC DOHMH’s Office of Vital Statistics, see the Summary of Vital Statistics.

Population denominators
HIV and AIDS diagnosis rate and HIV prevalence calculations use the NYC DOHMH population estimates, modified from US Census Bureau intercensal population estimates 2006 – 2008, updated July, 2013 and 2009-2013 (updated July 2014). Rates based on a numerator of ≤10 should be interpreted with caution. Rates marked “NA” cannot be calculated because the underlying population size is unknown.
Geographic data

Borough, High-Risk Neighborhoods (District Public Health Office (DPHO) areas), and Neighborhood Map (United Hospital Fund (UHF) regions)
For calendar year data 2006 – 2008: geographic (borough of residence, DPHO, and UHF area) variables are assigned to each case using information on residence at the time of HIV diagnosis for cases without AIDS and AIDS diagnosis for cases with AIDS.

For calendar year data 2009 – 2013: geographic (borough of residence, DPHO, and UHF area) variables are assigned to each case using information on residence: at HIV diagnosis for new cases of HIV; at AIDS diagnosis for new cases of AIDS; for PLWHA and deaths, residence is based on the most recent record available in a given calendar year.

For data from all years: high-risk neighborhoods (DPHOs) are neighborhoods in NYC with generally high rates of morbidity and mortality: (1) South Bronx, (2) North and Central Brooklyn, and (3) East and Central Harlem. UHF neighborhoods reflect catchment areas for specific healthcare facilities and are aggregates of between 1 and 9 ZIP codes. UHF neighborhoods are therefore smaller than a borough. A detailed table and map of UHF neighborhoods and corresponding ZIP codes (PDF) is available.

Area-based poverty level
Area-based poverty level is based on NYC ZIP code of residence at HIV or AIDS diagnosis and is defined as the percent of the population in a given ZIP code whose household income is below the Federal Poverty Level. Income data used for analyses in this report are from the 2007-2011 American Community Survey. (ACS) for diagnoses occurring in 2006-2009 and ACS 2008-2012 for diagnoses occurring in 2010-2013. Cut-points for categories of area-based poverty in NYC were defined by a NYC DOHMH workgroup3 as follows: 0 to <10% (low poverty areas); 10 to <20%; 20 to <30%; and ≥30% (very high poverty areas). Area-based poverty is unknown for cases missing ZIP code residence data.  

Race/ethnicity, age, and HIV transmission risk data

Race/Ethnicity
Since 2010, HEFSP has reported the following race/ethnicity categories: ‘Black,’ ‘Hispanic,’ ‘White,’ ‘Asian/Pacific Islander,’ ‘Native American,’ ‘Multiracial’ (to represent cases with two or more races), and ‘Unknown’ (for cases with unknown race/ethnicity at the time of report). For more information on race/ethnicity categorization, see the technical notes (PDF).

Age: Age is calculated as age at diagnosis for HIV and AIDS diagnoses; age as of the end of the calendar year for PLWHA in a given year; and age at death for deaths.

Transmission risk
HEFSP captures information about risk factors associated with HIV transmission. The primary risk factors ascertained by surveillance are men reporting a history of sex with men, injection drug use, heterosexual sex, perinatal, other and unknown transmission risks. The men who have sex with men category includes males with reported sexual contact with another male, and males with no definitive risk and with history of a rectal STD or proctitis. The injection drug use category includes persons who took non-prescribed drugs by injection, intravenously, intramuscularly or subcutaneously. The heterosexual category includes persons who had heterosexual sex with an HIV-infected person, an injection drug user, or a person who has received blood products; and for females only, women with a history of heterosexual prostitution, multiple sex partners of the opposite sex, sexually transmitted disease, crack/cocaine use, heterosexual sex with a bisexual male, or unspecified probable heterosexual transmission. Perinatal transmission is a risk factor for infants who were infected during gestation, birth or postpartum through breastfeeding to an HIV-infected mother. Other transmission risks include hemophilia, receipt of transfusions or transplants, and non-perinatal risk in pediatric cases (<13 years). Persons with an unknown transmission risk either have no risk information reported by the provider or an expanded investigation has not been completed for them.

Data considerations

Under-ascertainment of cases
Data from the HIV Surveillance registry reflect only diagnosed cases of HIV infection and AIDS. Cases of HIV infection or AIDS in persons not yet diagnosed have not been reported to the registry and are therefore not available for analysis in EpiQuery.

Trends
The module only displays trends for the most recent five years of data, which are generated from a single dataset. Although earlier years of data are included in the module, trend analyses should only be done using the most recent five years of data.

Patient confidentiality
As required by New York State Public Health Law and following confidentiality standards established by CDC, HEFSP is responsible for the protection of patient confidentiality and security of the private health and personal information that is reported to the surveillance system. HEFSP takes specific steps to ensure patient confidentiality during public release of aggregate data, namely suppression of small data points and/or data points for population groups of small size. Specifically, case counts of 1-5 person(s) with an underlying population denominator of ≤500 persons, or non-zero counts with a denominator ≤100 as per intercensal 2013 estimates (see population denominators description above) are not shown and are marked with an asterisk (*).

References
  1. State of New York Laws. HIV Testing and Counseling. Public Health Law Section 2130 et seq. Albany, NY: State of New York.
  2. Centers for Disease Control and Prevention. Revised Surveillance Case Definition for HIV Infection — United States, 2014. MMWR April 11, 2014; 63(RR03):1-10.
  3. Toprani A, Hadler JL. Selecting and applying a standard area-based socioeconomic status measure for public health data: analysis for New York City. New York City Department of Health and Mental Hygiene: Epi Research Report. May 2013; 1-11.