st t f th e id istate of the epidemic - department of public health · 2012-05-22 · st t f th e...
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St t f th E id iState of the Epidemic
Community in Crisis: African-Americans and HIV
Mario J. PérezDirectorOffice of AIDS Programs and Policy
Los Angeles County and Its Office of AIDS Programs and Policy Exerts a Tremendous Public
H lth Eff t t C b th HIV E id iHealth Effort to Curb the HIV Epidemic among African-Americans
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Los Angeles County• Square Miles: 4,086• Population: 10.2 Million•
Latino/a 46 5%
SPA 1: Antelope Valley
Latino/a 46.5% White 29.9%Asian/PI 13.2%African-American 9.8%Native American 1 1%Native American 1.1%
• Proportion of California Population: 29%
SPA 2:San Fernando SPA 3:
S G b i l
• Proportion of California AIDS Cases: 35%
SPA 5:West
SPA 4:Metro
San Gabriel
SPA 7:East
• Living with HIV/AIDS:• ~56,500 – 62,200
(Estimated)
SPA 6: South
SPA 8:South Bay
East
( ) y
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Persons Living with HIV/AIDS Reported by C l d Y LAC 1997 2006Calendar Year - LAC, 1997 - 2006
500005500060000 Est. PLWH/A total: 60,000+
Est PLWH/A aware: 45 000
30000350004000045000 Est. PLWH/A aware: 45,000
1000015000200002500030000
Reported PLWH/A 37,500
05000
10000
97 98 99 00 01 02 03 04 05 06 07 08
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Source: HIV/AIDS Surveillance Summary, data as of March 31, 2008.
Estimated Number Living with HIV/AIDS in Los Angeles County as of April 2007Los Angeles County as of April 2007
60 00070,000
40 00050,00060,000
Estimatebetween 56,500 and 62,200 living with HIV/AIDS in LAC
14,100 - 15,500
20,00030,00040,000 living with HIV/AIDS in LAC
21,187 - 25,424
010,00020,000
21,187
All HIVPLWA Diagnosed HIV* Undiagnosed HIV**
6Source: HIV Epidemiology Program, LAC/DPH* Estimates based on a range of 1:1 to 1.2:1 ratio of HIV (non-AIDS) to AIDS cases** Estimates based on CDC’s estimate that 25% are unaware of HIV infection (Glynn, 2005)
AIDS Cases by Race/Ethnicity and Year of Di i LAC 1993 2006Diagnosis LAC, 1993 – 2006
50
60
t
20
30
40
Perc
ent
0
10
20
93 94 95 96 97 98 99 00 01 02 03 04 05* 06*Year of AIDS Diagnosis
Black Latino White Asian/PI
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Source: HIV/AIDS Surveillance Summary, data as of December 2007.
* Data are provisional due to reporting delay.
Persons Living with AIDS in LAC 1 000 l ti b R /Eth i itper 1,000 population by Race/Ethnicity
5 0
3.45.0
4.0
5.0la
tion
2.61.82.0
3.0
00 P
opul
0.51.0
2.0
per 1
,0
0.0Black AI/AN White Latino A/PI
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Source: HIV/AIDS Surveillance Summary, data as of December 2007.
Months between first learned of HIV+ status d AIDS Di i b R /Eth i itand AIDS Diagnosis, by Race/Ethnicity
60 Early detectionLate detectionVery late
42
5050
60 detection
28
36
232630
40
Perc
ent Latino
WhiteBlack
13
612
1815
8 99610
20
P Black
0< 1 1-12 13-36 37-60 >60
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SHAS, HIV Epidemiology Program. LAC, 2000 - 2004 (N = 672)
Current IssuesCurrent Issues
– Epidemic Increasingly Among Communities ofEpidemic Increasingly Among Communities of Color
• Populations Who Infrequently and Inconsistently Access Health Care Systems
• Harder to Engage Populationsf– Number of Uninsured
– Growing Caseload– Unstable and Declining Funding– Limited Service Delivery Capacity
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OAPP Strategic ResponseOAPP Strategic Response
– Addressing the Needs of African-AmericanAddressing the Needs of African American Communities
• Are all stakeholders doing everything thatthey can?
• How can stakeholders better coordinate, communicate, and respond?communicate, and respond?
• What are the limitations to addressing
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unmet need?
Community PlanningCommunity Planning
– Prevention Planning CommitteePrevention Planning Committee• African-American MSM Taskforce• HIV Counseling and Testing Workgroupg g g p
– Commission on HIV• Minority AIDS Initiative Workgroup• Standards of Care Committee
– California HIV Planning Group
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Community PartnershipsCommunity Partnerships
Black Los Angeles HIV/AIDS Coalition– Black Los Angeles HIV/AIDS Coalition
– National Black HIV/AIDS Awareness Day
– HIV Counseling and Testing Week
– California African-American HIV/AIDS Coalition
National Minority AIDS Council– National Minority AIDS Council
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OAPP PrinciplesOAPP Principles
– Aggressive HIV CasefindingAggressive HIV Casefinding
– Improve Anti-retroviral AccessImprove Anti-retroviral Access
Maximize Treatment Outcomes– Maximize Treatment Outcomes
Prevent prevent prevent– Prevent, prevent, prevent…
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Prevention Interventions
Health Education and Risk Reduction– Health Education and Risk Reduction
– HIV Counseling and Testing
– Partner Counseling and Referral
– Jails Initiative
Targeted Social Marketing– Targeted Social Marketing
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Prevention Interventions (cont’d.)Prevention Interventions (cont d.)
Community Development Initiative– Community Development Initiative
– Faith-Based Initiative
– CDC Satellite Broadcasts
– Men’s Wellness Center
Social networking grant– Social networking grant
– NPEP
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HIV Counseling and Testing SummaryHIV Counseling and Testing Summary
Among African-Americans:Among African Americans:
– 20052005• 29% of all HIV Tests• 30% of all New Positive Results
– 2006• Decrease in New Positive Results
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2006 HCT Volume and Yield DataM d lit T ti V l P iti it R tModality Testing Volume Positivity Rate
Storefront/Combo 16,710 1.78%MTU 6,569 1.29%
Multiple Morbidity 2,591 1.78%
Routine Testing in Med. Clinics
5,649 1.31%Clinics
PCRS with Testing 244 1%
Jails 2,416 0.33%
DREX 1,511 0.40%
Court 1,505 2.19%
PCRS-STD Program 249 13.65%
Comm. Sex Venues 1,648 3.58%
STD Clinics 20,201 0.72%
Total 59,293 1.34% (n=794)
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Total 59,293 1.34% (n 794)
2020
Prevention Service Needs Among African-American Respondents (LACHNA, 2007 n=469)p ( , )
– 67% in Los Angeles County reported using any substances. *• 7% of substances users reported using meth. *
– 18% reported living in transitional facilities and 11% reported18% reported living in transitional facilities and 11% reported being homeless.
– 38% did not test for HIV * and 9% had never tested before.
– 8% had received treatment for STDs *8% had received treatment for STDs.
– 84% accessed HIV prevention services. *
21. * Within the past 6 months.
Care and Treatment InterventionsCare and Treatment Interventions
Ambulatory/Outpatient Medical– Ambulatory/Outpatient Medical
– Case Management
– Transportation Services
– Food Bank
Substance Abuse– Substance Abuse
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Care and Treatment Interventions (cont’d.)Care and Treatment Interventions (cont d.)
Mental Health Services– Mental Health Services
– Nutritional Counseling
– Housing Assistance
– Oral Health Care
Medical Specialty– Medical Specialty
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Care and Treatment Service UtilizationCare and Treatment Service Utilization
– 2005• African-American Living AIDS Cases
– 4,384 (21%)Af i A i C Cli t• African-American Care Clients
– 4,967 (21%)
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Care Service Needs among African-American R d t (LACHNA 2007) 469Respondents (LACHNA, 2007), n=469
– 37% are HIV-Positive• 46% of positives are currently symptomatic46% of positives are currently symptomatic• 55% of positives received an AIDS diagnosis
– 48% have lived >10 yrs. w/ AIDS• 95% of positives have accessed HIV/AIDS care ever95% of positives have accessed HIV/AIDS care ever
– 4% did not have a medical care visit within the last year– 22% took longer than 6 mo. to seek out medical care
• 99% are currently receiving HIV/AIDS care• 99% are currently receiving HIV/AIDS care– 72% are receiving their care at a community clinic– 13% from a private doctor
10% from a hospital/emergency room– 10% from a hospital/emergency room– 43% of those currently in care started seeing a doctorfor HIV/AIDS care after not seeing one for over 1 yr
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Capacity Building InterventionsCapacity Building Interventions
Minority AIDS Initiative– Minority AIDS Initiative• Medical Case Management
Early Intervention Program• Early Intervention Program• Oral Health
I f D l– Infrastructure Development
– Men’s Wellness Centere s e ess Ce te
– Social Network Affiliate Testing
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For More Information
Mario J. PérezDirectorDirector
Office of AIDS Programs and Policy600 South Commonwealth Ave., 10th Floor
L A l C lif i 90005 4001Los Angeles, California 90005-4001Phone: 213-351-8001
E-mail: mjperez@ph.lacounty.gov
This presentation is available atwww ph lacounty gov/aidswww.ph.lacounty.gov/aids
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