1. HIV and AIDS in the Latino Population of Los Angeles County Douglas M. Frye, M.D., M.P.H. HIV EPIDEMIOLOGY PROGRAM

2. HIV Epidemiology Program – 1 Collect and analyze information on reported cases of HIV and AIDS in Los Angeles County Epidemiology  the study of the distribution and determinants of disease in a population with the aim of promoting, protecting and restoring health in that population Surveillance  the systematic and ongoing collection and analysis of information about a disease within a population, followed by the timely dissemination of that information to those who need to know so that action can be taken

3. HIV Epidemiology Program – 2 Disseminate findings via oral presentations, data requests, Surveillance Summary, Epidemiologic Profile, conferences, journal articles, etc.  Office of AIDS Programs and Policy  Commission on HIV/AIDS Health Services  Prevention Planning Committee  State Office of AIDS  Centers for Disease Control and Prevention  Care providers, CBOs, the media, the public Very careful to make sure no one can be identified through presentation of data

4. California Law and Confidentiality Only HIV tests done confidentially are reportable. Anonymous HIV testing must be made available on demand and for free at Alternative Test Sites. Patient names and identifying information reported to HIV Epidemiology Program are not sent to CDC or any federal government agency HIV/AIDS surveillance data protected under State law and by Federal Assurance of Confidentiality:  No confidential public health record can be required to be disclosed for any civil, criminal, or administrative proceeding.

5. Latinos in Los Angeles County From 1990 – 2000, fastest growing in LAC:  28% Half foreign born Represent 63% of all births in LAC Youngest ethnic group: average age = 26 yrs Represent 60% of students in LA schools 54% graduate with high school class (LAC: 62%) Median income $34,000/year (LAC: $54,000) 1 of every 4 Latinos in LAC living in poverty Highest % uninsured: 24% of adults; 10% of kids

6. Country/Region of Origin for Latinos in Los Angeles County 72% 9% Source: Census 2000. 15% 1% 3% 1%

7. Percent Latino Population for each Service Planning Area (SPA) – LAC

8. HIV and AIDS in Los Angeles County

9. Adults and children estimated to be living with HIV/AIDS as of end 2002 Total: 42 million W. Europe 570,000 North Africa & Middle East 550,000 Sub-Saharan Africa 29.4 million Eastern Europe & Central Asia 1.2 million South & SE Asia 6 million Australia & New Zealand 15,000 North America 980,000 Caribbean 440 000 Latin America 1.5 million East Asia & Pacific 1.2 million Source: World Health Organization

10. Impact of AIDS on L.A. County LAC 2 nd only to New York City among US metro areas in number of reported AIDS Only 4 states (CA, TX, NY, FL) have reported more AIDS cases than LAC LAC represents  5% of US AIDS cases  35% of California AIDS cases

11. AIDS Cases in L.A. County 48,500 total cases reported since 1981 59% have died 19,700 persons living with AIDS Estimate 56,000 persons living with HIV and AIDS in LAC CDC estimates that 1 of 4 persons with HIV/AIDS are not aware they are infected

12. Number of AIDS Cases by Year of Diagnosis - LAC, 1987 - 2002 Source: HIV/AIDS Semiannual Surveillance Summary, HIV Epidemiology Program, LAC/DHS; data as of July 2004.

13. Number of AIDS Deaths by Year of Death LAC, 1987 - 2002 Source: HIV/AIDS Semiannual Surveillance Summary, HIV Epidemiology Program, LAC/DHS; data as of July 2004.

14. Number of Persons Living with AIDS (PLWAs) by Year of Diagnosis--Los Angeles, 1987 - 2003 Source: HIV/AIDS Semiannual Surveillance Summary, HIV Epidemiology Program, LAC/DHS; data as of July 2004.

15. Number of Persons Living with AIDS by City/Area of Los Angeles County

17. Percent Adult/Adolescent AIDS Cases by Race/Ethnicity and Year of Diagnosis LAC, 1992 – 2002 Percent * 2002 data provisional due to reporting delay. ** Other race/ethnicity includes Asian/Pacific Islanders and American Indians/Alaskan Natives.

18. Number of Adults/Adolescents AIDS Cases by Race/Ethnicity and Year of Diagnosis LAC, 1992 – 2002 * 2002 data provisional due to reporting delay. ** Other race/ethnicity includes Asian, American Indian and Alaskan Native.

19. Persons Living with AIDS in LAC per 1,000 population by Race/Ethnicity* *Sometimes called “Prevalence Rate”; it is really a proportion. Data from HIV Epidemiology Program, as of November 30, 2003.

20. Comparison of Persons living with AIDS and Cases Diagnosed in 2002, by Race/Ethnicity Source: HIV/AIDS Surveillance Summary, LAC/DHS, data as of June 2004. 22% 37% 3% 38% 32% 21% 3% 43% Living with AIDS 2002

21. Cumulative Cases of AIDS in Latinos by Mode of Exposure – LAC 7% 63% 5% Source: HIV/AIDS Surveillance Summary, LAC/DHS, data as of June 2004. 16% 2% *No Identified Risk 2 of every 3 cases are MSM

22. Latino MSM at risk for HIV Among highest rates of new infection seen at HIV Testing sites: 3 - 5% per year – Latino MSM (men who have sex with men) – Latino MSM who inject drugs – Latino MSM who also have sex with women Young Men’s Survey of 15 – 23 year olds: – 2/3rds Latino MSM say ethnic identity important – 2/3rds also say most people of their ethnicity disapprove of gays Studies find MSM of color don’t disclose sexual orientation: stigma, discrimination, marginalized

23. Latinos Living with AIDS in LAC 45% of children diagnosed with AIDS 47% of AIDS Drug Assistance Program 80+% of those needing services, got them Most likely to be hospitalized in last year Least likely to know CD4 count, Viral Load Latinos with AIDS have 4 times odds of having also had Tuberculosis (TB)

24. Crude Mortality Rate (% per year*) by Race/Ethnicity, LAC: 1990 – 2002 *Annual deaths per 100-person years. Source: HEP’s Adult Spectrum of HIV Disease Study.

25. Supplement to HIV/AIDS Surveillance Project (SHAS)

26. Comparison of Latinas with Other Women in LAC Living with HIV/AIDS * 3 times more likely single mother (48% vs. 25%) 2-½ times more likely living with spouse or family (78% vs. 60%) 5 times more likely primary income source = spouse or family (34% vs. 9%) 13 times as likely not completed high school (51% vs. 7%) Less likely to be on public assistance (40% vs. 68%) Much less likely to have ever been in jail (23% vs. 58%) * SHAS: 92 Latinas, 69 non-Latinas in SHAS, 2000 – 2004

27. Comparison of Latinas with Other Women in LAC Living with HIV/AIDS – 2 Latinas more likely to get medications from AIDS Drug Assistance Program (43% vs. 25%) or a public clinic (28% vs. 7%), and less likely to get meds through health care insurance (24% vs. 55%) More than twice as likely to never have had health insurance (47% vs. 28%) About as likely as non-Latino study participants to: –be single 48% –make less than $10,000 /year 58% –be employed 25% –used condom as birth control42% –have ever been pregnant 97%

28. Comparison of HIV Risk Among Latinas with Other Women Living with HIV/AIDS Two-thirds used condom at last sex..................... 65% Older at first sexual intercourse.... 17 yrs vs. 15.9 yrs Fewer lifetime sex partners............... median, 3 vs. 10 Less likely to have “exchange sex”........ 11% vs. 36% Less likely to have ever had an STD....... 28% vs. 57% About as likely to have injected drugs.....17% vs. 23% Much less likely to have used non-injection drugs (marijuana, cocaine, crack)....................... 18% vs.68% Less likely to be able to identify how they were exposed to HIV.......................................... 42% vs. 65%

29. Time, in months, between first learned of HIV+ status and AIDS Diagnosis, by Race/Ethnicity SHAS, LAC, 2000 - 2004 (N = 819) Time Interval (months) Early detectionLate detectionVery late detection

30. Summary Large and growing segment of population Challenges:  low income and poverty  low levels of educational achievement  many without health insurance  many foreign born, language barriers Decreasing number of new AIDS diagnoses Decreasing number of AIDS deaths Relatively low AIDS rate per 100,000 persons

31. Summary 2 of 3 Latino AIDS cases among MSM High rate of new HIV infection in MSM Latino MSM often don’t identify as “gay” or “bisexual” and don’t disclose their orientation Many HIV-infected Latinas unaware that they were ever at risk for HIV In 4 of 5 Latinos with AIDS, HIV infection not detected until very late - within a year of AIDS diagnosis

32. Primary Prevention of HIV Infection Prevent HIV infection and transmission  educate people about risk so they can modify their behavior  treat HIV-infected pregnant women with anti-retroviral drugs to prevent transmission to fetus/infant – new State law allows women to “opt out” of test  provide for an environment more conducive for an open and rational discussion of prevention needs

33. Secondary Prevention of HIV Disease Prevent persons infected from progressing to advanced disease and AIDS  screen for infection: HIV (hepatitis C, TB)  start HAART before progression to AIDS  start drugs to prevent PCP, TB, etc.  vaccinate against hepatitis A and B  use post-exposure prophylaxis (PEP)  treat infants born to HIV+ mothers

34. Contact Information Douglas M. Frye Phone: (213) 351 – 8149 dfrye@ladhs.org HIV Epidemiology Program Phone: (213) 351 – 8196 www.lapublichealth.org/hiv