Introduction

This fact sheet provides a summary of the geographic distribution of HIV/AIDS in Massachusetts. Table 1 identifies the 15 localities with the highest average annual rate of HIV infection diagnosis and Table 2 identifies the 15 localities with the highest average annual number of HIV infection diagnoses. Table 3 identifies the 15 localities with the highest prevalence of HIV/AIDS per 100,000 population and Table 4 identifies the 15 localities with the highest prevalence of HIV/AIDS.

Examination of HIV infection diagnosis rates and rates of people living with HIV/AIDS within cities and towns reveals disparities that might otherwise be hidden by population size. For example, although the number of HIV diagnoses in Provincetown is much smaller than the number of cases in Boston or other large Massachusetts cities, the rate of HIV infection diagnoses is much higher since the total year-round population of Provincetown is very small. Therefore, a high rate of HIV infection or HIV/AIDS prevalence does not always indicate a high number of cases.

The numbers of people living with HIV/AIDS, and diagnosed and reported with HIV infection within the three-year period 2008 to 2010 are presented in summary tables (3–8) for each Health Service Region and for the 15 cities that were among the top fifteen by one of the following indicators:

1) the number of average annual HIV infection diagnoses from 2008 to 2010; or,

2) the number of people living with HIV/AIDS.

These analyses provide a point of reference for comparison to the statewide HIV/AIDS epidemic. It must be noted that the geographic information presented in these analyses reflect residence at the time of report or diagnosis and not necessarily current residence. Therefore, the data may not represent the current distribution of people living with HIV/AIDS.

Recent changes to the presentation of Massachusetts HIV/AIDS surveillance data

Effective January 1, 2011, the Massachusetts Department of Public Health (MDPH), Bureau of Infectious Diseases, HIV/AIDS fact sheets, epidemiologic reports and other HIV data presentations have been updated to remove all HIV/AIDS cases who were first diagnosed in another state before being reported in Massachusetts. As of January 1, 2012, this resulted in the removal of 2,924 HIV/AIDS cases, of which 808 have died and 2,116 were living. These persons living with HIV/AIDS may still continue to reside and receive care in the Commonwealth. The total number of persons living with HIV/AIDS, irrespective of location of diagnosis, is the basis for MDPH service planning. This change is partially a result of increased activities required by the Centers for Disease Control and Prevention (CDC) for de-duplication among states in an effort to identify cases that are counted multiple times in the National HIV/AIDS Surveillance System. The cases are assigned to the state that reports the earliest date of AIDS diagnosis if available. If the case has not progressed to AIDS, the case is assigned to the state with the earliest HIV diagnosis date. Please note that all previous HIV/AIDS fact sheets, data reports and presentations include cases that may have been first diagnosed in another state.

Also effective January 1, 2011, the MDPH HIV/AIDS fact sheets, epidemiologic reports, and other data presentations have been updated to eliminate the presumed heterosexual exposure mode category for males; those cases have been reassigned to the no identified risk (NIR) exposure mode category. The presumed heterosexual exposure mode category was used with the intention of identifying HIV exposure mode for females when sex with males is the only reported risk factor, there is no evidence of current or past injection drug use (IDU), and behavioral risk and HIV status information about male sexual partners are unknown. Twenty-seven percent of females living with HIV/AIDS and 40% of recent female HIV diagnoses are reported in the presumed heterosexual exposure mode category. The application of the presumed heterosexual exposure mode category to males is overly inclusive in that female to male HIV transmission is biologically less probable, and there are alternate exposure modes that are possible for males, including sex with other men (MSM) or IDU. The CDC reports males diagnosed with HIV/AIDS who report sex with females as their only risk factor, without corresponding partner risk or HIV status information, in the NIR exposure mode category. This revision to report presumed heterosexual male HIV/AIDS cases as NIR will bring Massachusetts HIV/AIDS case reporting for males in alignment with CDC standards. The MDPH will maintain presumed heterosexual and heterosexual exposure mode categories for females.

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Table 1. Fifteen cities/towns1 in Massachusetts2 with the highest rate of HIV infection diagnosis: average annual rate per 100,000, 2008–20103 and average number per year
Rank / City/Town / Average Rate per 100,000 / Average Number
1 / Provincetown / 348.4 / 12.0
2 / Boston / 32.0 / 178.7
3 / Holyoke / 25.1 / 10.3
4 / Everett / 21.6 / 8.0
5 / Brockton / 20.9 / 21.0
6 / Lawrence / 20.8 / 17.0
7 / Waltham / 20.7 / 12.3
8 / Springfield / 20.7 / 32.3
9 / Malden / 20.0 / 11.3
10 / Lowell / 18.6 / 19.7
11 / Worcester / 18.0 / 32.3
12 / Cambridge / 17.1 / 17.3
13 / Lynn / 15.2 / 14.0
14 / Somerville / 14.6 / 11.0
15 / Fall River / 13.0 / 12.0
1 Cities with fewer than 20 HIV infection diagnoses from 2008–2010 are excluded.
2 Effective January 1, 2011, the Massachusetts Department of Public Health, HIV/AIDS fact sheets, epidemiologic reports, and other data presentations have been updated to remove all HIV/AIDS cases that were first diagnosed in another state before being reported in Massachusetts.
3 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available three-year period after the implementation of HIV infection reporting in 1999.
Data Source: MDPH HIV/AIDS Surveillance Program, data as of 1/1/12
Table 2. Fifteen cities/towns in Massachusetts1 with the highest average number of HIV infection diagnosis: 2008–20102
Rank / City/Town / Average Number / Percent of Total
1 / Boston / 178.7 / 27.9%
2 / Springfield / 32.3 / 5.0%
2 / Worcester / 32.3 / 5.0%
3 / Brockton / 21.0 / 3.3%
4 / Lowell / 19.7 / 3.1%
5 / Cambridge / 17.3 / 2.7%
6 / Lawrence / 17.0 / 2.7%
7 / Lynn / 14.0 / 2.2%
8 / Waltham / 12.3 / 1.9%
9 / Fall River / 12.0 / 1.9%
9 / Provincetown / 12.0 / 1.9%
10 / Malden / 11.3 / 1.8%
10 / New Bedford / 11.3 / 1.8%
11 / Somerville / 11.0 / 1.7%
12 / Holyoke / 10.3 / 1.6%
1 Effective January 1, 2011, the Massachusetts Department of Public Health, HIV/AIDS fact sheets, epidemiologic reports, and other data presentations have been updated to remove all HIV/AIDS cases that were first diagnosed in another state before being reported in Massachusetts.
2 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available three-year period after the implementation of HIV infection reporting in 1999.
Data Source: MDPH HIV/AIDS Surveillance Program, data as of 1/1/12
Table 3. Fifteen cities/towns1 in Massachusetts with the highest rate of people living with HIV/AIDS per 100,000 on December 31, 2011
Rank / City/Town / Rate per 100,000 / Number
1 / Provincetown / 9,552.8 / 329
2 / Boston / 948.4 / 5,296
3 / Holyoke / 742.3 / 305
4 / Springfield / 659.4 / 1,031
5 / Chelsea / 553.8 / 189
6 / Worcester / 522.7 / 940
7 / Lawrence / 506.2 / 413
8 / New Bedford / 483.6 / 457
9 / Lowell / 482.3 / 510
10 / Malden / 461.8 / 262
11 / Everett / 434.0 / 161
12 / Brockton / 432.4 / 434
13 / Somerville / 431.2 / 325
14 / Lynn / 424.1 / 391
15 / Cambridge / 407.8 / 414
1 Cities with fewer than 20 people living with HIV/AIDS on December 31, 2010 are excluded.
2 Effective January 1, 2011, the Massachusetts Department of Public Health, HIV/AIDS fact sheets, epidemiologic reports, and other data presentations have been updated to remove all HIV/AIDS cases that were first diagnosed in another state before being reported in Massachusetts.
Data Source: MDPH HIV/AIDS Surveillance Program, data as of 1/1/12
Table 4. Fifteen cities/towns1 in Massachusetts with the highest number of people living with HIV/AIDS per 100,000 on December 31, 2011
Rank / City/Town / Number / Percent of Total
1 / Boston / 5,296 / 27.9%
2 / Springfield / 1,031 / 5.0%
3 / Worcester / 940 / 5.0%
4 / Lowell / 510 / 3.3%
5 / New Bedford / 457 / 3.1%
6 / Brockton / 434 / 2.7%
7 / Cambridge / 414 / 2.7%
8 / Lawrence / 413 / 2.2%
9 / Lynn / 391 / 1.9%
10 / Provincetown / 329 / 1.9%
11 / Somerville / 325 / 1.9%
12 / Holyoke / 305 / 1.8%
13 / Malden / 262 / 1.8%
14 / Fall River / 225 / 1.7%
15 / Waltham / 220 / 1.6%
1 Effective January 1, 2011, the Massachusetts Department of Public Health, HIV/AIDS fact sheets, epidemiologic reports, and other data presentations have been updated to remove all HIV/AIDS cases that were first diagnosed in another state before being reported in Massachusetts.
Data Source: MDPH HIV/AIDS Surveillance Program, data as of 1/1/12
Table 5. People diagnosed with HIV infection from 2008–20101 and people living with HIV/AIDS on December 31, 2011 by gender, place of birth, race/ethnicity, exposure mode, age at HIV infection diagnosis and current age: Boston HSR, Massachusetts2
/

HIV Infection Diagnoses

/

PLWH/A

Gender: / N / % / N / %
Male / 4,364 / 76% / 434 / 76%
Female / 1,360 / 24% / 136 / 24%
Place of Birth: / N / % / N / %
US / 3,906 / 68% / 357 / 63%
Puerto Rico/US Dependency3 / 339 / 6% / 34 / 6%
Non-US / 1,479 / 26% / 179 / 31%
Race/Ethnicity: / N / % / N / %
White (non-Hispanic) / 2,321 / 41% / 200 / 35%
Black (non-Hispanic) / 2,213 / 39% / 232 / 41%
Hispanic/Latino / 1,086 / 19% / 125 / 22%
Asian/Pacific Islander / 87 / 2% / --7 / --7
Other/Undetermined4 / 17 / <1% / --7 / --7
Exposure Mode: / N / % / N / %
Male-to-male sex (MSM) / 2,714 / 47% / 259 / 45%
Injection Drug Use (IDU) / 788 / 14% / 38 / 7%
MSM/IDU / 190 / 3% / 15 / 3%
Heterosexual Sex / 722 / 13% / 63 / 11%
Other / 109 / 2% / 7 / 1%
Total Undetermined / 1,201 / 21% / 188 / 33%
·  Presumed Heterosexual Sex5 / 445 / 8% / 61 / 11%
·  Undetermined6 / 756 / 13% / 127 / 22%
Age: / N / % / N / %
At Diagnosis / On December 31, 2011
Under 13 / 8 / <1% / 5 / 1%
13 to 19 / 40 / 1% / 13 / 2%
20 to 24 / 81 / 1% / 51 / 9%
25 to 29 / 164 / 3% / 76 / 13%
30 to 34 / 291 / 5% / 76 / 13%
35 to 39 / 416 / 7% / 75 / 13%
40 to 44 / 724 / 13% / 83 / 15%
45 to 49 / 1,130 / 20% / 74 / 13%
50 to 54 / 1,183 / 21% / 58 / 10%
55 to 59 / 856 / 15% / 33 / 6%
60+ / 831 / 15% / 26 / 5%

Total

/ 5,724 / 100% / 570 / 100%
1 Reflects year of HIV infection diagnosis among all individuals reported with HIV infection, with or without an AIDS diagnosis for the most recently available three-year period after the implementation of HIV infection reporting in 1999.
2 Effective January 1, 2011, the Massachusetts Department of Public Health, HIV/AIDS fact sheets, epidemiologic reports, and other data presentations have been updated to remove all HIV/AIDS cases that were first diagnosed in another state before being reported in Massachusetts.
3 Ninety-eight percent of people diagnosed with HIV infection from 2008–2010 who were born in a US dependency were born in Puerto Rico, 1% were born in the US Virgin Islands, 1% were born in Guam and 1% were born in an unknown dependency.
4 Other/Undetermined includes American Indian/Alaska Native individuals and persons of unspecified race/ethnicity
5 Includes female sex with male of unknown HIV status or risk. This category is limited to females.
6 Includes male sex with female of unknown HIV status or risk, those still being followed up for risk information, those who have died with no determined risk, and those lost to follow-up.
7 Values less than five are suppressed for populations less than 50,000 or for unknown values. Additional values may be suppressed to prevent back calculation.
Data Source: MDPH HIV/AIDS Surveillance Program (percentages may not add up to 100% due to rounding), Data as of 1/1/12
Table 6. People diagnosed with HIV infection from 2008–20101 and people living with HIV/AIDS on December 31, 2011 by gender, place of birth, race/ethnicity, exposure mode, age at HIV infection diagnosis and current age: Central HSR, Massachusetts2
/

HIV Infection Diagnoses

/

PLWH/A

Gender: / N / % / N / %
Male / 982 / 62% / 104 / 61%
Female / 612 / 38% / 67 / 39%
Place of Birth: / N / % / N / %
US / 970 / 61% / 91 / 53%
Puerto Rico/US Dependency3 / 305 / 19% / 25 / 15%
Non-US / 319 / 20% / 55 / 32%
Race/Ethnicity: / N / % / N / %
White (non-Hispanic) / 678 / 43% / 58 / 34%
Black (non-Hispanic) / 387 / 24% / 64 / 37%
Hispanic/Latino / 505 / 32% / 44 / 26%
Asian/Pacific Islander / --7 / --7 / 5 / 3%
Other/Undetermined4 / --7 / --7 / 0 / 0%
Exposure Mode: / N / % / N / %
Male-to-male sex (MSM) / 373 / 23% / 47 / 27%
Injection Drug Use (IDU) / 465 / 29% / 20 / 12%
MSM/IDU / 47 / 3% / --7 / --7
Heterosexual Sex / 300 / 19% / 32 / 19%
Other / 47 / 3% / --7 / --7
Total Undetermined / 362 / 23% / 63 / 37%
·  Presumed Heterosexual Sex5 / 166 / 10% / 27 / 16%
·  Undetermined6 / 196 / 12% / 36 / 21%
Age: / N / % / N / %
At Diagnosis / On December 31, 2011
Under 13 / 2 / <1% / 3 / 2%