Missouri Department of Health and Senior Services
Bureau of Reportable Disease Informatics
HIV/STD Statistics June 2016
Between 1982 and June 30, 2016, there have been a total of 20,688 HIV disease cases diagnosed.
There were 293 new HIV disease diagnoses from January to June 2016. In comparison, there were 234 new
HIV disease diagnoses reported during the same time period in 2015.
1
The differences in the number of individuals sub-classified as stage 3 (AIDS) cases are due to the
progression of the disease over time. For those diagnosed with HIV disease in 2006, a larger number are
currently classified as stage 3 (AIDS) cases compared to those diagnosed in 2015 because they have been
living with the virus longer.
*HIV case versus stage 3 (AIDS) case
**Cases are indicated by year of initial diagnosis reported to the Missouri Department of Health and Senior Services (the year in which the
first diagnosis of the person, whether as an HIV case or a stage 3 (AIDS) case, was documented by the Department).
†
Only includes cases diagnosed through June 30, 2016 and reported by September 30, 2016.
***These cases were either: 1) initially reported as HIV cases and then later reclassified as stage 3 (AIDS) cases because they
subsequently met the stage 3 (AIDS) case definition; or 2) initially reported as stage 3 (AIDS) cases.
Figure 1. HIV disease cases, by current status* and year of diagnosis**, Missouri, 2006—2016
†
Notes to the Reader:
HIV disease includes all individuals diagnosed with the human immunodeficiency virus (HIV), regardless of
the stage of disease progression. All persons with HIV disease can be sub-classified as either a stage 3
(acquired immunodeficiency syndrome (AIDS)) case if they are in the later stages of the disease process
and have met the case definition for stage 3 (AIDS), or an HIV case if they are in the earlier stages of the
disease process and have not met the stage 3 (AIDS) case definition. In this report, the sub-classification of
HIV or stage 3 (AIDS) is based on an individual’s status of disease progression as of June 30, 2016.
The data presented in this report only include cases diagnosed through June 30, 2016, based on
information reported to the Missouri Department of Health and Senior Services through September 30,
2016. The difference between the date of diagnosis and the date of report represents delays in case
reporting.
When assessing trends over time, please note that data presented for 2016 only represent cases diagnosed
through June 30, 2016. All data are subject to change.
Additional data quality assurances undertaken in the past year have improved data quality but have resulted
in changes in the number of reported cases over time and the number of persons living with HIV. This may
result in discrepancies when comparing the current report to previous epidemiological data.
563
608
562
537
578
532
537
467
478
468
293
0
200
400
600
800
1000
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
2016†
Number of Cases
Year of Diagnosis
Stage 3 (AIDS) Cases***
HIV Cases****
HIV/STD Statistics June 2016
-2-
The total number of deaths among those diagnosed with HIV disease in Missouri remained generally stable
from 2006 to 2010 (Figure 2). The decline since 2010 may be due to delays in death reporting.
A larger proportion of those diagnosed in 2006 have died as of June 30, 2016, compared to those diagnosed
in 2015, likely due to differences in the length of time living with the virus and current age (Figure 3).
Figure 2. HIV disease deaths*, by selected race, and by year of death, Missouri, 2006—2016
†
*Includes deaths that have occurred among those diagnosed with HIV disease in Missouri.
†
Only includes deaths through June 30, 2016, and reported by September 30, 2016.
Figure 3. Persons diagnosed with HIV disease by current vital status* and year of diagnosis**,
Missouri, 2006—2016
†
*Vital status on June 30, 2016.
**Cases are indicated by year of initial diagnosis reported to the Missouri Department of Health and Senior Services (the year in which the
first diagnosis of the person, whether as an HIV case or a stage 3 (AIDS) case, was documented by the Department).
†
Only includes events occurring through June 30, 2016, and reported by September 30, 2016.
216
222
216 216
219
177
190
159
143
96
49
0
50
100
150
200
250
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
2016†
Number of Deaths
Year of Death
Total Deaths White, not Hispanic Black/African American, not Hispanic
563
608
562
537
578
532
537
467
478
468
293
0
100
200
300
400
500
600
700
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
2016†
Number of Cases
Year of Diagnosis
Deceased Living
HIV/STD Statistics June 2016
-3-
There are 12,518 individuals living with HIV disease that were diagnosed in Missouri through June 30, 2016.
The proportion of the newly diagnosed cases that occurred among Hispanics was greater than the
proportion of living cases that are Hispanic.
The greatest proportion of newly diagnosed cases occurred among persons 25-44 years of age (43.0%).
Persons 45-64 years of age represented the largest proportion of those living with HIV disease (52.6%).
Table 1. Diagnosed and living HIV disease* cases by sex, by race/ethnicity, by race/
ethnicity and sex, and by current age***, Missouri, 2016
†
*Includes all individuals diagnosed with the HIV virus, regardless of current status (i.e., HIV or stage 3 (AIDS)).
†
Only includes cases diagnosed or living as of June 30, 2016, and reported by September 30, 2016.
**Per 100,000 population based on 2015 MDHSS estimates.
***Based on age as of June 30, 2016.
Note: Percentages may not total due to rounding.
Sex Cases % Cases % Rate**
Male 235 80.2% 10,349 82.7% 346.7
Female 58 19.8% 2,169 17.3% 70.0
Total 293 100.0% 12,518 100.0% 205.8
Race/Ethnicity
White 128 43.7% 6,008 48.0% 123.7
Black/African American 131 44.7% 5,709 45.6% 808.9
Hispanic 23 7.8% 546 4.4% 220.5
Asian/Pacific Islander 3 1.0% 86 0.7% 68.1
American Indian/Alaskan Native 0 0.0% 10 0.1% 38.4
Two or More Races/Unknown 8 2.7% 159 1.3% N/A
Total 293 100.0% 12,518 100.0% 205.8
Race/Ethnicity-Males
White Male 109 46.4% 5,324 51.4% 222.9
Black/African American Male 101 43.0% 4,367 42.2% 1,300.2
Hispanic Male 17 7.2% 458 4.4% 358.2
Asian/Pacific Islander Male 2 0.9% 63 0.6% 104.8
American Indian/Alaskan Native Male 0 0.0% 10 0.1% 76.2
Two or More Races/Unknown Male 6 2.6% 127 1.2% N/A
Total 235 100.0% 10,349 100.0% 346.7
Race/Ethnicity-Females
White Female 19 32.8% 684 31.5% 27.7
Black/African American Female 30 51.7% 1,342 61.9% 362.8
Hispanic Female 6 10.3% 88 4.1% 73.5
Asian/Pacific Islander Female 1 1.7% 23 1.1% 34.8
American Indian/Alaskan Native Female 0 0.0% 0 0.0% 0.0
Two or More Races/Unknown Female 2 3.4% 32 1.5% N/A
Total 58 100.0% 2,169 100.0% 70.0
Current Age***
<2 1 0.3% 1 0.0% 0.7
2-12 3 1.0% 33 0.3% 3.9
13-18 11 3.8% 51 0.4% 10.8
19-24 71 24.2% 509 4.1% 99.7
25-44 126 43.0% 4,627 37.0% 300.6
45-64 76 25.9% 6,586 52.6% 409.0
65+ 5 1.7% 711 5.7% 74.5
Total 293 100.0% 12,518 100.0% 205.8
Diagnosed 2016
†
Living 2016
†
HIV/STD Statistics June 2016
-4-
Figure 4. Living HIV disease cases by adjusted* exposure category and race/ethnicity, Missouri, 2016
†
*Cases with no identified risk were proportionately redistributed to known exposure categories. Percentages may not total 100 due to round-
ing.
†
Only includes cases diagnosed and living as of June 30, 2016, and reported by September 30, 2016.
Of adult/adolescent cases diagnosed from January 1 to June 30, 2016, 21.5% did not have a reported risk
as of September 30, 2016. Surveillance activities have been implemented to resolve cases reported with
unknown risk information. These cases will not be proportionately redistributed until the end of the
surveillance follow-up period (Table 2).
The majority of adult/adolescent living cases are attributed to MSM (69.2%), with cases attributed to
heterosexual contact representing the second greatest proportion (18.3%). Cases with missing exposure
category information have been proportionately re-distributed into known exposure categories (Table 2).
There are differences in the distribution of exposure categories among living cases by race/ethnicity (Figure
4). Among whites, 75.1% of living cases are attributed to MSM, compared to 61.5% among blacks/African
Americans. In contrast, heterosexual contact represents the exposure category for 26.3% of living black/
African American cases but only 10.6% of living white cases.
Table 2. New and living HIV disease cases by exposure category,
Missouri, 2016
†
Exposure category
2016
†
Living*
Adult/Adolescent
Men who have sex with men (MSM) 182 63.0% 8,584 69.2%
Men who have sex with men and inject drugs (MSM/IDU) 12 4.2% 677 5.5%
Injecting drug use (IDU) 14 4.8% 817 6.6%
Heterosexual contact 19 6.6% 2,276 18.3%
Hemophilia/coagulation disorder 0 0.0% 40 0.3%
Blood transfusion or tissue recipient 0 0.0% 10 0.1%
No indicated risk (NIR) 62 21.5% ----- -------
ADULT/ADOLESCENT SUBTOTAL 289 100.0% 12,407
**
100.0%
Pediatric (<13 years old)
PEDIATRIC SUBTOTAL 4 100.0% 111 100.0%
TOTAL 293 12,518
HIV Disease
4510,
75%
364,
6%
421,
7%
78,
1%
635,
11%
White, not Hispanic
3523,
62%
397,
7%
217,
4%
76, 1%
1496,
26%
Black/African American, not
Hispanic
551,
69%
56,
7%
39,
5%
10,
1%
145,
18%
Other
*Cases with no identified risk were proportionately redistributed to known exposure categories.
†
Only includes cases diagnosed through June 30, 2016, and reported by September 30, 2016.
**Includes 3 cases with a confirmed “other” exposure category.
HIV/STD Statistics June 2016
-5-
†
Only includes cases diagnosed through June 30, 2016, and reported by September 30, 2016.
Figure 6. Persons diagnosed with HIV disease by HIV care region at time of diagnosis, Missouri, 2006-2016
†
Figure 5. Number of persons living with HIV disease by county of residence* and HIV care region at time
of diagnosis, Missouri, 1982-2016
†
*Based on residence at time of most recent diagnosis of HIV or stage 3 (AIDS). Excludes persons diagnosed in Missouri correctional
facilities (n=505).
†
Includes those living with HIV disease as of June 30, 2016, and reported by September 30, 2016.
Figure 5 presents the number of cases still presumed to be living whose most recent diagnosis (i.e. HIV or
stage 3 (AIDS)) occurred in the county. It does not reflect the current number of cases living in the county.
The majority of living cases were diagnosed in Jackson County, St. Louis City, and St. Louis County.
Although the St. Louis HIV Care Region represents approximately 35% of Missouri’s general population,
over the period from 2006 to 2016, the St. Louis HIV Care Region represented 49% of new HIV diagnoses in
Missouri (Figure 6).
0
50
100
150
200
250
300
350
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
2016†
Number of Cases
Year of Diagnosis
St. Louis HIV Care Region Kansas City HIV Care Region Northwest HIV Care Region
Central HIV Care Region Southwest HIV Care Region Southeast HIV Care Region
Corr. Facilities
HIV/STD Statistics June 2016
-6-
The number of reported cases of P&S syphilis in Missouri increased from 2011 to 2014. Overall, Missouri had 208 reported
cases through June 2016 compared to 145 for the same time period in 2015.
1
The increase in the number of reported
cases is primarily attributed to the increase in the number of reported cases in the St. Louis HIV Care Region, where 94
cases of P&S syphilis were reported through June 2016 compared to 41 during the same time period in 2015.
1
Of the P&S syphilis cases reported in Missouri from January 1 to June 30, 2016, 58 (27.9%) were co-infected with HIV. All
but one of the 58 co-infections were diagnosed among males. Fifty-one of the co-infections were attributed to MSM, two
were attributed to MSM/IDU, two were attributed to heterosexual contact, and three co-infections had no identified risk.
PRIMARY AND SECONDARY (P&S) SYPHILIS
Table 3. Reported P&S syphilis cases,
by race, by geographic area, by sex,
Missouri, 2016
†
†
Includes cases reported through June 30, 2016.
*Includes cases identified with Hispanic ethnicity.
136
157
251
352
307
208
-40
10
60
110
160
210
260
310
360
2011 2012 2013 2014 2015
2016†
Number of Cases
Year of Report
Missouri St. Louis HIV Care Region Kansas City HIV Care Region
Northwest HIV Care Region Central HIV Care Region Southwest HIV Care Region
Southeast HIV Care Region
Figure 8. Reported P&S syphilis cases by geographic area and
year of report, Missouri, 2011-2016
†
†
Only includes cases reported through June 30, 2016.
†
Includes cases reported through June 30, 2016.
Figure 7. Reported P&S syphilis cases by county,
Missouri, 2016
†
Missouri Male Female Total
White
68 15 83
Black/African American
83 19 102
Other/Unknown*
20 3 23
Total Cases
171 37 208
St. Louis HIV Care Region
White
19 4 23
Black/African American
54 7 61
Other/Unknown*
9 1 10
Total Cases
82 12 94
Kansas City HIV Care Region
White
37 9 46
Black/African American
26 10 36
Other/Unknown*
11 2 13
Total Cases
74 21 95
Northwest HIV Care Region
White
0 0 0
Black/African American
0 0 0
Other/Unknown*
0 0 0
Total Cases 0 0 0
Central HIV Care Region
White
6 1 7
Black/African American
3 2 5
Other/Unknown*
0 0 0
Total Cases 9 3 12
Southwest HIV Care Region
White
6 1 7
Black/African American
0 0 0
Other/Unknown*
0 0 0
Total Cases 6 1 7
Southeast HIV Care Region
White
0 0 0
Black/African American
0 0 0
Other/Unknown*
0 0 0
Total Cases 0 0 0
Cases
HIV/STD Statistics June 2016
-7-
124
135
220
240
247
139
0
50
100
150
200
250
300
2011 2012 2013 2014 2015
2016†
Number of Cases
Year of Report
Missouri St. Louis HIV Care Region Kansas City HIV Care Region
Northwest HIV Care Region Central HIV Care Region Southwest HIV Care Region
Southeast HIV Care Region
EARLY LATENT SYPHILIS
Figure 10. Reported early latent syphilis cases by geographic
area and year of report, Missouri, 2011-2016
†
The number of early latent syphilis cases reported in Missouri increased from 2011 to 2015. Overall, Missouri had
139 reported cases through June 2016 compared to 122 for the same time period in 2015.
1
Of the early latent syphilis cases reported in Missouri from January 1 to June 30, 2016, 51 (36.7%) were co-
infected with HIV. Males represented all co-infections diagnosed. Fifty of the co-infections were attributed to MSM,
and one was attributed to IDU.
Figure 9. Reported early latent syphilis cases by county,
Missouri, 2016
†
Table 4. Reported early latent syphilis
cases, by race, by geographic area, by
sex, Missouri, 2016
†
Missouri Male Female Total
White
52 9 61
Black/African American
55 9 64
Other/Unknown*
11 3 14
Total Cases
118 21 139
St. Louis HIV Care Region
White
22 0 22
Black/African American
47 4 51
Other/Unknown*
5 1 6
Total Cases
74 5 79
Kansas City HIV Care Region
White
20 7 27
Black/African American
6 5 11
Other/Unknown*
4 2 6
Total Cases
30 14 44
Northwest HIV Care Region
White
1 0 1
Black/African American
0 0 0
Other/Unknown*
0 0 0
Total Cases 1 0 1
Central HIV Care Region
White
3 1 4
Black/African American
2 0 2
Other/Unknown*
0 0 0
Total Cases 5 1 6
Southwest HIV Care Region
White
6 1 7
Black/African American
0 0 0
Other/Unknown*
2 0 2
Total Cases 8 1 9
Southeast HIV Care Region
White
0 0 0
Black/African American
0 0 0
Other/Unknown*
0 0 0
Total Cases 0 0 0
Cases
†
Includes cases reported through June 30, 2016.
†
Only includes cases reported through June 30, 2016.
†
Includes cases reported through June 30, 2016.
*Includes cases identified with Hispanic ethnicity.
HIV/STD Statistics June 2016
-8-
GONORRHEA
Figure 12. Reported gonorrhea cases by geographic area and
year of report, Missouri, 2011-2016
†
A total of 5,392 gonorrhea cases were reported in Missouri through June 30, 2016 (Table 5).
The number of reported gonorrhea cases in Missouri generally decreased from 2011 to 2014 but then
increased in 2015 (Figure 12). More gonorrhea cases have been reported during the first six months of 2016
(5,392) compared to the same time period in 2015 (4,154
1
).
7,802
7,889
7,546
7,387
8,942
5,392
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
2011 2012 2013 2014 2015
2016†
Number of Cases
Year of Report
Missouri St. Louis HIV Care Region Kansas City HIV Care Region
Northwest HIV Care Region Central HIV Care Region Southwest HIV Care Region
Southeast HIV Care Region
Figure 11. Reported gonorrhea cases by county,
Missouri, 2016
†
Table 5. Reported gonorrhea cases,
by race, by geographic area, by sex,
Missouri, 2016
†
Missouri Male Female Total
White
778 786 1,564
Black/African American
1,707 1,338 3,045
Other/Unknown*
434 349 783
Total Cases
2,919 2,473 5,392
St. Louis HIV Care Region
White
191 123 314
Black/African American
1114 845 1,959
Other/Unknown*
221 176 397
Total Cases
1,526 1,144 2,670
Kansas City HIV Care Region
White
199 189 388
Black/African American
387 378 765
Other/Unknown*
103 85 188
Total Cases
689 652 1,341
Northwest HIV Care Region
White
50 58 108
Black/African American
19 8 27
Other/Unknown*
10 11 21
Total Cases
79 77 156
Central HIV Care Region
White
65 114 179
Black/African American
49 30 79
Other/Unknown*
33 30 63
Total Cases
147 174 321
Southwest HIV Care Region
White
227 200 427
Black/African American
53 18 71
Other/Unknown*
51 26 77
Total Cases
331 244 575
Southeast HIV Care Region
White
46 102 148
Black/African American
85 59 144
Other/Unknown*
16 21 37
Total Cases
147 182 329
Cases
†
Includes cases reported through June 30, 2016.
†
Only includes cases reported through June 30, 2016.
†
Includes cases reported through June 30, 2016.
*Includes cases identified with Hispanic ethnicity.
HIV/STD Statistics June 2016
-9-
CHLAMYDIA
A total of 15,028 chlamydia cases were reported in Missouri through June 30, 2016 (Table 6).
The number of reported chlamydia cases in Missouri remained relatively stable during the period from 2011
to 2015. The number of reported cases increased by 3.5% from 2014 to 2015 (Figure 14). More cases of
chlamydia were reported in the first six months of 2016 (15,028) compared to the same time period in 2015
(14,435
1
).
Figure 14. Reported chlamydia cases by geographic area and
year of report, Missouri, 2011-2016
†
27,887
27,835
27,328
27,981
28,948
15,028
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
2011 2012 2013 2014 2015
2016†
Number of Cases
Year of Report
Missouri St. Louis HIV Care Region Kansas City HIV Care Region
Northwest HIV Care Region Central HIV Care Region Southwest HIV Care Region
Southeast HIV Care Region
Figure 13. Reported chlamydia cases by county,
Missouri, 2016
†
Table 6. Reported chlamydia cases,
by race, by geographic area, by sex,
Missouri, 2016
†
Missouri Male Female Total
White
1,719 4,286 6,005
Black/African American
2,150 3,667 5,817
Other/Unknown*
1,026 2,180 3,206
Total Cases
4,895 10,133 15,028
St. Louis HIV Care Region
White
415 829 1,244
Black/African American
1,158 2,065 3,223
Other/Unknown*
442 915 1,357
Total Cases
2,015 3,809 5,824
Kansas City HIV Care Region
White
307 835 1,142
Black/African American
571 1,105 1,676
Other/Unknown*
297 548 845
Total Cases
1,175 2,488 3,663
Northwest HIV Care Region
White
91 223 314
Black/African American
26 17 43
Other/Unknown*
24 48 72
Total Cases
141 288 429
Central HIV Care Region
White
275 789 1,064
Black/African American
152 236 388
Other/Unknown*
97 247 344
Total Cases
524 1,272 1,796
Southwest HIV Care Region
White
519 1,181 1,700
Black/African American
135 85 220
Other/Unknown*
116 296 412
Total Cases
770 1,562 2,332
Southeast HIV Care Region
White
112 429 541
Black/African American
108 159 267
Other/Unknown*
50 126 176
Total Cases
270 714 984
Cases
†
Includes cases reported through June 30, 2016.
†
Only includes cases reported through June 30, 2016.
†
Includes cases reported through June 30, 2016.
*Includes cases identified with Hispanic ethnicity.
HIV/STD Statistics June 2016
-10-
References
1. Missouri Department of Health and Senior Services. HIV/STD Statistics, June 2015. http://health.mo.gov/
data/hivstdaids/pdf/15statsheet.pdf. Published November 2015.
HIV/STD Statistics June 2016
-11-
Appendix
HIV Care Region vs. HIV Region: Previous HIV/STD Statistics reports divided the state into geographic regions
known as HIV Regions using the HIV prevention planning regions. Based on guidance from the Bureau of HIV,
STD, and Hepatitis (BHSH), the data in the 2016 HIV/STD Statistics report are presented by HIV care regions in
an effort to align with future goals to have a single definition for the geographic regions used for HIV planning.
Beginning with the 2014 Epidemiologic Profiles of HIV, STD, and Hepatitis in Missouri, the state was divided into
geographic regions known as HIV care regions using the HIV medical case management (care) regions. The
transition to care regions resulted in some changes. The North Central HIV Region is now known as the Central
HIV Care Region. The remaining five regions retained the same names. The counties comprising the St. Louis,
Southeast, and Southwest HIV Care Regions remained the same. The Northwest HIV Care Region no longer
contains Clinton County. Clinton County now belongs in the Kansas City HIV Care Region. The Kansas City HIV
Care Region no longer contains Johnson, Bates, Henry, and Benton Counties. These four counties now belong
in the Central HIV Care Region. As a result of these changes, regional data in the 2016 HIV/STD Statistics
report should not be compared to reports published prior to 2015. Additionally, calculations for the past ten years
were recalculated using the HIV care regions at the regional level in order to accurately display trends over time
in the 2016 HIV/STD Statistics report.
