Lake Merritt, Oakland,California HIV/AIDS Epidemiology in Alameda County: State of the County Report Muntu Davis, MD, MPH County Health Officer and Public Health Director Alameda County White House Office of National AIDS Policy: Regional Listening Session Our Mission To work in partnership with the community to ensure the optimal health and well-being of all people through a dynamic and responsive process respecting the diversity of the community and challenging us to provide for present and future generations. 2 1
Our Vision Everyone in Alameda County, no matter who you are, how much money you make, where you live or the color of their skin, Live Well Alameda! has the same opportunities for a healthy, fulfilling and productive life. 3 In relationship to the HIV/AIDS epidemic... People are healthy, live well and enjoy life. 4 2
Our Desired Population Results Healthy Policies and Systems Support healthy places, healthy people and equitable opportunity Healthy Places Protect and support health, safety and well being Healthy People Have the knowledge, habits, support and opportunity to be healthy and live well 5 HIV Diagnosis Rates by Sex, Alameda County, 12 25 15 5 Male Female Alameda County California* U.S.* *Rates are for 11. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. SOURCE: CDC, Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 11 United States and 6 dependent areas. DATA SOURCE: Alameda County ehars, 14 Q1 3
Headline Indicator: HIV-related Life Expectancy/Mortality Years 9 8 7 6 5 4 Overall Life expectancy at birth in Alameda County overall is 81.4 years but a year old living with HIV is only expected to live to *Life expectancy estimate and 95% confidence interval: 46.4 (43.1,49.7) 63-7 years* PLWHA Headline Indicator: New HIV Diagnosis by Race/Ethnicity 7 6 5 4 African American Hispanic/Latino All White 6 8 7 9 8 9 11 12 11 13 API DATA SOURCE: Alameda County ehars, 14 Q1 4
Headline Indicator: HIV+ People with Undetectable Viral Loads 25% 11 25% 12 % % 15% 15% % % 5% 5% % % Source: Alameda County Enhanced HIV/AIDS Reporting System (ehars) People Living with HIV/AIDS (PLWHA): Year-End 12 5
People Living with HIV/AIDS (PLWHA): Year-End 13 Male Female % % 4% 6% 8% % N=5,565 DATA SOURCE: Alameda County ehars, 14 Q1 People Living with HIV/AIDS (PLWHA): By Race/Ethnicity, Year-End 13 African American White Hispanic/Latino API Other/Unknown % % % % 4% 5% N=5,565 DATA SOURCE: Alameda County ehars, 14 Q1 6
County Trends in HIV Diagnosis: Rates by Sex 25 15 Male All Female 5 6 8 7 9 8 DATA SOURCE: Alameda County ehars, 14 Q1 9 11 12 11 13 HIV Diagnosis Rates by Race/Ethnicity, Alameda County, 12 6 5 4 African American Hispanic/ Latino White API Alameda County California* U.S.* *Rates are for 11. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. SOURCE: CDC, Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 11 United States and 6 dependent areas. DATA SOURCE: Alameda County ehars, 14 Q1 7
County Trends in HIV Diagnosis: Rates by Sex & Race/Ethnicity 45 4 35 25 15 5 Female 6 7 8 9 11 8 9 11 12 13 All African American API White Hispanic/Latino 9 8 7 6 5 4 6 8 7 9 Male 8 9 11 11 12 13 HIV Diagnosis Rates by Age, Alameda County, 12 25 15 5 13 19 29 39 4 49 5 59 6 & over Alameda County California* U.S.* *Rates are for 11. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. SOURCE: CDC, Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 11 United States and 6 dependent areas. DATA SOURCE: Alameda County ehars, 14 Q1 8
County Trends in HIV Diagnosis: Rates by Age 35 25 15 5 All 29 4 49 39 5 59 13 1919 6 & over 6 8 7 9 8 DATA SOURCE: Alameda County ehars, 14 Q1 9 11 12 11 13 County-Funded HIV Testing: By Race and By Age, 13 6,334 tests done 65.2% male, 24%transgender 2.4% 77 positives total ( preliminary) for.74% positivity All Tests By Race/Ethnicity All Tests By Age Black/African American White Hispanic/Latino(a) Asian/Pacific Islander Other 5 & over 4 49 39 25 29 24 13 19 % % % % 4% 5% % 5% % 15% % 25% DATA SOURCE: LEO, CY13 9
County Trends in HIV Diagnosis: By Sex & Mode of Transmission, 11-13 MSM MSM & IDU IDU Hetero contact Male (N=56) Female (N=91) Unknown % % 4% 6% 8% % DATA SOURCE: Alameda County ehars, 14 Q1
County-Funded HIV Testing: By Gender and Patient Risk Factor, 13 Other risk factors Gonorrhea/syphilis diagnosis MSM/IDU Female Male Ml Sex worker Stimulant drug user (last 12 months) HIV+ or high risk sex partner No indicated/reported risk IDU Heterosexual single sex partners Heterosexual with multiple partners MSM % 5% % 15% % 25% % 35% 4% 45% DATA SOURCE: LEO, CY13 HIV/AIDS Care: Diagnosis, Linkage & Evidence of Care New Diagnoses, 12 (N=68) % % 9% 9% 8% 8% 7% 7% 6% 6% 5% 5% 4% 4% % % % % % Diagnosed Linked* % % % PLWHA, Year End 12 (N=5,57) Some care^ Undetectable** *CD4 or VL done within 9 days of diagnosis ^ Some care defined as one or more laboratory tests done between March, 12 March 29, 13 ** Most recent viral load <=75 (ordered between March, 12 March 29, 13) DATA SOURCE: Alameda County ehars, 14 Q1 11
County Late Diagnosis*: By Race/Ethnicity, 11-13 5% 45% 4% 35% % 25% % 15% % 5% % All (N=651) African American (N=272) Hispanic/Latino (N=154) White (N=142) API (N=67) * AIDS at or within a year of initial HIV diagnosis. Proportions are of the racial/ethnic group specified. Other/Unknown race/ethnicity not shown (N=16). DATA SOURCE: Alameda County ehars, 14 Q1 Special lthanks to HIV Epidemiology and Surveillance Unit HIV STD Section Division of Communicable Disease Control and Prevention Alameda County Public Health Department Any questions? Thank you. Muntu Davis, MD, MPH Email: muntu.davis@acgov.org 12
Getting from Talk to Action: Turn the Curve Measuring Impact (Effect): HIV Education Services # Trained, total # Trained, high risk h ik group # Forums/Workshops # Outreach % report training as helpful l % decide to be tested for HIV % who know their status % with increased HIV knowledge (Pre & Post) % who know how to prevent HIV % reporting reduced risk behaviors 13
Measuring Impact (Effect): HIV Testing Services # Tested Trained, total % tested report who training are as in # IV Trained, Drug Users high risk target helpful population # group MSM % tested decide who to be are tested HIV+ # Sex Forums/Workshops Workers for HIV # Partners Outreachof HIV+ People # HIV Tests % tested who know who their know status their HIV % with status increased (got results) HIV % knowledge testing HIV+ (Pre who & Post) were linked % who to know care how within to 3 months prevent HIV % reporting reduced risk behaviors Data Development % testing HIV who stay HIV % reporting risk reduction behavior % HIV+ who notified partners of status % reporting incr. knowledge of HIV transmission Measuring Impact (Effect): Linkage to Care Services # Served % followed up with # by Race/Ethnicity % linked within 3 # by Sex months # by Sexual Orientation % re linked to care # by Age Group % linked to culturally # by Substance Abuse competent provider # by Housing Status # in Foster Care Data Development % linked to care now with undetectable VL % reporting reduced risk behaviors % adhering to treatment 14