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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