• DSHS HIV/STD Program

    Post Office Box 149347, MC 1873
    Austin, Texas 78714

    Phone: (737) 255-4300

    Email the HIV/STD Program

    Email data requests to HIV/STD Program - This email can be used to request data and statistics on HIV, TB, and STDs in Texas. It cannot be used to get treatment or infection history for individuals, or to request information on programs and services. Please do not include any personal, identifying health information in your email such as HIV status, Date of Birth, Social Security Number, etc.

    For treatment/testing history, please contact your local Health Department.

    For information on HIV testing and services available to Persons Living with HIV and AIDS, please contact your local HIV services organization.

Epi Profile Section 7 - Comorbidities in Texans Living with HIV


Sexually Transmitted Diseases (STD) in Texans Living with HIV 


STDs are infections that spread from person to person through sexual activity, including anal, vaginal, or oral sex. HIV is an STD, and chlamydia (CT), gonorrhea (GC), and syphilis [13] are also STDs. You can learn more in the Texas STD Surveillance Report (PDF : 2,837 kB) for 2018.

Having an STD can make it easier to get HIV. For example, an STD can cause a sore or a break in the skin, which can make it easier for HIV to enter the body. Having an STD can make it easier to transmit HIV, but only if the person living with HIV is not on antiretroviral treatment (ART). [14]  If the person living with HIV is on ART, then an STD does not increase the risk of transmitting HIV. [15]  Finally, people living with HIV can get an STD even if they are on ART.

Between 2011 and 2018, the overall annual number of Texans with an STD diagnosis rose sharply (Table 18). Most notable were the 53% increase in the number of Texans diagnosed with gonorrhea and the 91% increase in primary or secondary (P&S) syphilis diagnoses. This growth was not due to growth in the overall population, because rates of STD also rose.

The annual number of PLWH with STD also increased. The number of PLWH with a chlamydia or a gonorrhea diagnosis more than tripled. The number of PLWH with a P&S syphilis diagnosis doubled. Rates for all STD rose for both the overall population and PLWH. The STD increases likely reflect increased testing and improved reporting as well as true increases in the number of people with these STDs.

Table 18: Number and rate (per 1,000) of selected STD for all Texans and Texans living with HIV, 2011 and 2018

Chlamydia

Gonorrhea

P&S Syphilis

All Texans

PLWH

All Texans

PLWH

All Texans

PLWH

Number

Rate

Number

Rate

Number

Rate

Number

Rate

Number

Rate

Number

Rate

2011

122,872

4.8

792

12.2

306

1.2

934

13.2

1,175

0.05

329

4.7

2018

145,874

5.1

2,829

30.1

470

1.6

3,377

35.9

2,528

0.09

775

8.2

Increase

19%

6%

257%

146%

53%

37%

262%

171%

115%

91%

136%

76%

Source: Texas eHARS, 2018


Comparing rates can uncover health disparities. PLWH carry a much higher burden of STD than the general population. In 2018, rate of CT in PLWH was 6 times higher than the overall population rate, the GC rate was 22 times higher, and the P&S Syphilis rate was 94 times higher. In general, STD rates are higher in transgender women and in non-transgender men; in Black PLWH; in PLWH between 15 and 34 years old; and in MSM living with HIV, especially Black MSM (Table 20).

MSM have been particularly hard hit by syphilis. MSM made up the largest group of people with P&S and early latent syphilis diagnoses in 2018. MSM living with HIV made up about a quarter of Texans with P&S and early latent syphilis diagnoses in 2018 (Table 19).

Table 19: 2018 Syphilis diagnoses in Texas MSM

P&S Syphilis

Early Latent Syphilis

Total
Cases

Cases in
PLWH

%

Total
Cases

Cases in
PLWH

%

Total MSM

1,384

581

42%

1,846

1,058

57%

White MSM

393

148

38%

464

239

51%

Black MSM

399

223

56%

517

368

71%

Hispanic MSM

509

188

37%

771

417

54%

Total

2,526

776

31%

4,220

1,873

44%

Source: Texas eHARS, 2018


Table 20: Rates of STD in PLWH (per 1,000), 2018

Chlamydia

Gonorrhea

P&S Syphilis

Early Latent Syphilis

PLWH

Cases in
PLWH

Rate

Cases in
PLWH

Rate

Cases in
PLWH

Rate

Cases in
PLWH

Rate

Birth sex/Gender identity
Women

19,821

292

14.7

145

7.3

15

0.8

24

1.2

Men

73,462

2,493

33.9

3,196

43.5

748

10.2

1,817

24.7

Transgender women

801

45

56.2

37

46.2

13

16.2

32

40.0

Transgender men

22

0


0


0


0


Race/Ethnicity
White

22,895

565

24.7

750

32.8

181

7.9

431

18.8

Black

34,648

1,092

31.5

1,385

40.0

309

8.9

686

19.8

Hispanic

31,643

873

27.6

898

28.4

250

7.9

678

21.4

Age groups (years)
15-24

3,747

491

131.0

601

160.4

140

7.4

216

57.6

25-34

19,039

1,269

66.7

1,649

86.6

334

17.5

767

40.3

35-44

21,321

620

29.1

658

30.9

147

6.9

451

21.2

45-54

25,109

323

12.9

334

13.3

108

4.3

291

11.6

55-64

18,650

112

6.0

117

6.3

40

2.1

129

6.9

65+

6,034

14

2.3

18

3.0

6

1.0

19

3.1

Transmission Group 

All MSM

57,602

2,310

40.1

2,950

51.2

693

12.0

1,683

29.2

Black MSM

16,373

841

51.4

1,214

74.1

289

17.7

636

38.8

Hispanic MSM

21,614

755

34.9

804

37.2

223

10.3

613

28.4

White MSM

16,639

470

28.2

628

37.7

151

9.1

365

21.9

Total

94,106

2,830

30.1

3,378

35.9

775

8.2

1,873

19.9

PLWH with unknown age are not broken out, but they are included in the total for each disease. The count of MSM in this table differs from others in this report because the methods used to redistribute case reports with no known risk cannot be used with matched data.
Source: Texas eHARS, 2018




Tuberculosis in People Living with HIV


The rate of Tuberculosis (TB) in Texas PLWH is 15.7 times higher than in the general population (4.0/100,000). However, TB is still relatively rare in PLWH–less than 2% of the Texans living with HIV in 2018 had been diagnosed with TB in the years following their HIV diagnosis. PLWH who also have latent TB infections are more likely to develop TB disease because their immune system is weakened.

As seen in Table 21, Hispanic and Black PLWH made up 85% of those co-infected with TB in 2018. Although not shown explicitly in this table, persons of Asian descent living with HIV are more likely to develop TB disease. Disproportionate impact on these three groups is shown in their higher rates, which is mainly due to a higher prevalence of latent TB infection in these populations.

Table 21: Number and percent of Texas PLWH with a TB co-morbidity

TB Diagnoses
Ever (1993-2018)

In 2018

PLWH

PLWH with  
TB Diagnosis
after
HIV Diagnosis

% of
PLWH

Number of
PLWH with
TB Diagnosis

% of
Persons with
TB-HIV
coinfection 

Rate per
100,000
population

Sex at birth
Female

19,843

318

1.6%

15

25.4%

75.6

Male

74,264

1,171

1.6%

44

74.6%

59.2

Race/Ethnicity*
White

22,895

124

0.5%

4

6.8%

17.5

Black

34,648

610

1.8%

25

42.4%

72.2

Hispanic

31,643

653

2.1%

25

42.4%

79.0

Age group (years)
0-14

206

1

0.5%

0

0.0%

0.0

15-24

3,747

8

0.2%

4

0.0%

106.8

25-34

19,039

86

0.5%

11

18.6%

57.8

35-44

21,321

303

1.4%

16

27.1%

75.0

45-54

25,109

541

2.2%

17

28.8%

67.7

55-64

18,650

422

2.3%

10

16.9%

53.6

65+

6,034

182

2.1%

1

9.1%

16.6

Current Residence
Austin TGA

6,445

101

1.6%

4

6.8%

62.1

Dallas EMA

23,036

365

1.6%

14

23.7%

60.8

Fort Worth TGA

6,290

89

1.4%

6

10.2%

95.4

Houston EMA

29,078

520

1.8%

20

33.9%

68.8

San Antonio TGA

6,893

86

1.0%

4

7.0%

58.0

Total

94,106

1,489

1.6%

59

100.0%

62.7

* The percentages do not add up to 100% as multi-race and other race/ethnic categories were not illustrated for brevity.



Note 13. Syphilis is divided into four stages: primary, secondary, latent, and tertiary. It is most transmissible during the primary and secondary stages and can also be transmitted in the early latent stage.

Note 14. Cohen MS, Hoffman IF, Royce RA, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. Lancet 1997; 349:1868-1873.

Note 15. Cohen MS, Council OD, Chen JS. Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention:  the biologic basis for epidemiologic synergy. Journal of the International AIDS Society 2019, 22(s6) e25355.


Epi Profile

Table of Contents | 1. Executive Summary | 2. Texans Living with HIV in 2018 | 3. Texans with New HIV Diagnoses | 4. New Diagnoses in MSM | 5. Texans with Newly Acquired HIV | 6. Deaths in Texans Living with HIV | 7. Comorbidities in Texans Living with HIV | 8. HIV Testing in Programs Funded by DSHS | 9. Sex and Substance Use in PLWH | 10. Sex and Substance Use in People at Increased Risk for HIV in Dallas, Texas | 11. Texas Treatment Cascade for 2018 | Data Sources and Notes


Last updated June 18, 2020