1. Epidemiology of HIV and AIDS in the Riverside/San Bernardino, Transitional Grant Area (TGA)
Compiled by:
Riverside County Community Health Agency
Department of Public Health
Epidemiology and Program Evaluation Branch
With Data and Tables Provided by:
San Bernardino Department of Public Health,
HIV and STD Surveillance Program
2007

2. Data Sources
Unless otherwise noted, all HIV/AIDS statistics come from HIV and AIDS cases reported to Riverside County or San Bernardino County Departments of Public Health as of December 31, 2006.

3. Inland Empire Demographic Profile
The 4th and 5th most populous counties, combined population exceeds four million.
Among the fastest growing counties in California.
Metropolitan area fifth-fastest growing in nation, 14th largest nationwide.
Area larger than the states of Connecticut, Delaware, Massachusetts, and New Jersey combined
Increasing Hispanic/Latino population
Potential language barriers
Both of the two counties that comprise the Transitional Grant area are over 2 million population each.

4. AIDS Surveillance Summary Riverside/San Bernardino CA, TGA
California 1
United States 2
Cumulative Cases
8,738
143,946
988,376
Cumulative Deaths
4,181
82,989
550,394
Living Cases
4,557
60,957
437,982
Cumulative Case-fatality rate
48%
58%
56%
cumulative reported cases as of December 31, Note lower cumulative case-fatality rate for EMA. By county, R.C. accounts for 60% of the reported cases, S.B. 40%. Of the living (prevalence), R.C. 64%, S.B. 36%. Fatality rate for R.C. is even lower, at 44%, S.B. 53.2%.
Since 1981, a total of 8,404 AIDS cases have been reported in the EMA.
When reported:
90% of all AIDS cases were male, (HARS gender categories do not specify “transgender” )
70% were between the ages of 24 and 44
25% were 45 years old or older
and 63% were risk category of “men who have sex with men” (MSM).
60% of the AIDS cases resided in Riverside County and
40% in San Bernardino County.
The incidence of reported AIDS cases peaked in 1993 with over 1,100 cases and has decreased since to 286 AIDS cases in This was a decrease from 375 reported AIDS cases in Preliminary counts for 2005 total 311, yet this total is subject to further review
Regarding prior residency, a issue that can result in cases being attributed to other counties.
1 California Office of AIDS. AIDS Surveillance Report for California, December 31, 2006.
2 Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 2005

5. Names-based HIV Reporting
Federal HIV/AIDS funding cuts to states without reliable HIV tracking systems.
California Senate Bill 699 allowing name-based reporting signed April 2006.
Names-based reporting will hopefully improve access to early interventions.
3,255 HIV positive cases reported in the TGA, with 98% living.
7/2002 – 3/2006: “No Name” reporting
4/2006 – : “Name” reporting (501 cases)
Reporting of HIV+ cases began in California in mid-2002, using a “no names”, code-based system. April 2006, change to “Names” based reporting. Reports will run this July for reporting April 2006 through June 2007, examining the results for the first Names-based time period. The local TGA counties are undertaking efforts to re-assessing prior cases where possible for our reporting needs.

6. Profile of People Living with HIV/AIDS:
Riverside/San Bernardino, California Transitional Grant Area
Gender, Race/Ethnicity, Age Group,
and Mode of Transmission

7. Proportion of the Population, Proportion of Prevalent AIDS Cases, Proportion of Prevalent HIV Cases by Race/Ethnicity
White,non-hispanic and African American/Black populations disporportionately affected; lower case distribution in Hispanic population

8. Prevalence Rate by Race/Ethnicity
Rate per
100,000
Rate disparities concerning Living AIDS Cases in the TGA, African-American/Black population highest prevalence rate followed by White non-hispanic. Note low actual case number for Native American generates comparatively high rate.

9. TGA Medi-Cal (HIV) and ADAP Users by Race/Ethnicity, Fiscal Year 2004/2005
ADAP and Medi-Cal users for HIV/AIDS related services profiled by race/ethnicity. As with case reporting, White non-hispanic accouts for largest portion in the TGA. 59% of living AIDS cases are White, 24% Hispanic, and 16% African American/Black. Large % Unknown with Medi-Cal billing system.

10. Proportion of Persons Living With HIV/AIDS by Gender
TGA AIDS Prevalence
TGA HIV Prevalence
Majority of both living AIDS and HIV positive cases in the TGA are Male

11. Proportion of Persons Living With HIV/AIDS by Age Group
TGA AIDS Prevalence
TGA HIV Prevalence
Young adult age group accounting for majority of living AIDS and HIV postiive cases.

12. Proportion of Persons Living With HIV/AIDS by Mode of Transmission
TGA AIDS Prevalence
TGA HIV Prevalence
MSM accounts for highest reported risk/mode of transmission for both HIV and AIDS living cases, followed by IV drug use. Slightly higher % for heterosexual reported risk with HIV+, however difference very small..9% compared to 11%.

13. Epidemiology of HIV/AIDS:
Riverside/San Bernardino, California Transitional Grant Area
Incidence, Prevalence, Evolving Trends,
and Forecast

14. Percent of AIDS Cases by Race/Ethnicity and Year of Diagnosis
Percent distribution of AIDS cases by year diagnosed, recent years since White, non-hispanic highest totals reporting, followed by Hispanic, and African-American/Black.

15. AIDS Incidence Rates by Race/Ethnicity and Year of Diagnosis
Rate per
100,000
However, when focused on rates within race/ethnicity, rates for African-American highest.

16. Diagnosed AIDS Cases by Year 2010 Projection
R.C.
200
Cases continue to be projected to decline. Analysis based on cases diagnosed each year, from first year of present case-definition (1993). Note slight increase for 2002, when HIV+ case reporting began diagnosed for year 2006 at this time, yet 303 “reported” in 2006.
S.B.

17. Epidemiology of HIV/AIDS:
Riverside/San Bernardino, California Transitional Grant Area
The Components: Profiles By County
and Service Area

18. AIDS Prevalence by EMA Service Area of Residence
Rate per
100,000
Slide factors in cases reported, deceased, living. Highest living case rate for Eastern service area of Riverside County, the desert cities/communities, followed by SB East, and RC West.

19. Living AIDS Cases by Race/Ethnicity
Prevalence rates by race/ethnicity and County, showing the differences in profile. R.C.highest White, non-hispanic, S.B. African American/Black, as is TGA. “N” provided to document rates for other/unknown based on smaller case totals.
N=37

20. HIV Testing Risk Factors: July 1, 2005 to June 30, 2006
HIV Testing (from HIV6 reporting data), used to show similar percents for risk as for case, with differences by county. Large % for N/R/Unk column is due in part to combining totals for where no known mode accounted for.

21. TGA ADAP and Medi-Cal Users (HIV) by HARS Reporting County, Fiscal Year 2004/2005
ADAP and Medi-Cal HIV/AIDS services users profiled by county of original HARS reporting. Even though Medi-Cal data not as complete as ADAP as to linking this information, percentages show outside original diagnoisis county and consequently counts used by other jurisdicitions when HARS data called for. Close to 30% when looking at the more complete ADAP. Caution, however, as the use of such databases is in exploritory stages and unverified.

22. Totals for those living with HIV and AIDS approaches 8,000, although true total in EMA unknown as numbers based on HARS reporting only. Migration to and perhaps to a lesser degree, out, not taken into account, nor are those undiagnosed…(CDC est. 25%?). New cases continue to be reported, yet in declining numbers, while deaths decline, adding up to more living with HIV/AIDS in the TGA.

23. Aging Service Population: Riverside County Living AIDS Cases by Age at Report/Age Now
Riverside County age at reporting, which is the basis of most reports, verses age now for those surviving. Note more now in older age grouping, and consequently issues of chronic disease, etc, are factors. Median age at time of report for survivors, 39, age now 46

24. Summary Majority of incident and prevalent cases White, MSM
Rates by race/ethnicity show disparity
African Americans have the highest rates
AIDS case reporting (HARS) profile by race/ethnicity distribution similar to services utilization data.
Service use data (ADAP/Medi-Cal) show local users HARS reported in other counties
Effective drug therapies have resulted in greater survival
Service population aging, chronic disease concerns
Disparity by race/ethnicity, and profile differs between the two counties of the TGA. Survival, newer reports cite lifespan of 20 or more years, indicating survivial to older ages and issues of chronic disease.

25. Acknowledgements
Riverside County
San Bernardino County
Aaron Gardner
Phill Coon
Becky Nanyonjo
Marshare Penny

26. Contact Information
Riverside County Department of Public Health
Epidemiology and Program Evaluation Branch
(951)
San Bernardino County Department of Public Health
AIDS, STD, & Reproductive Health Programs
(909)