California HIV Prevention Indicators 2 nd Edition McCandless RR 1,Truax SR 2, Aoki BK 1, Lemp GF 1, Montgomery M 2, Webb DS 2, Lees N 2 1 Universitywide AIDS Research Program, University of California 2 Office of AIDS, California Department of Health Services

Characteristics of Populations Characteristics of Interventions Risk-Taking and Protective Behaviors Disease Impacts Utilization of Interventions HIV Prevention Indicators POLICIES

Policies: Prevention Effort Federal and State funds spent annually for HIV prevention by the California State Office of AIDS increased up through fiscal year The amount decreased in FY Source: Laurel Cima, California State Office of AIDS

CHARACTERISTICS OF POPULATIONS Characteristics of Interventions Risk-Taking and Protective Behaviors Disease Impacts Utilization of Interventions HIV Prevention Indicators Policies

Populations: Number of Gay and Bisexual Men Alternative estimates of the number of men who identify as gay or bisexual range from 321,000 to 427,000. Sources: Joel Moskowitz, HIV/AIDS KABB. Nadereh Pourat, CHIS

Populations: Number of Injection Drug Users; and Number of Non-Injecting Methamphetamine, Cocaine and Crack Users The number of injection drug users entering treatment in California declined over the past decade. However, the number of non- injecting methamphetamine, cocaine and crack users doubled. Source: Sally Jew, California Department of Alcohol and Drug Programs

Populations: Number of Persons in State Prisons and Jails The number of persons in California prisons and jails increased up through 1998 and has since leveled off. Sources: Bureau of Justice Statistics, U.S. Dept. of Justice; and California Board of Corrections

Populations: Prevalence of HIV Infection An estimated 150,000 persons had HIV in the year However, the very wide 95% confidence interval for the estimate suggests a range of 25, ,000. Source: California 2000 HIV/AIDS Knowledge, Attitudes, Beliefs, and Behaviors Survey

Populations: Prevalence of HIV Infection among MSM Ongoing convenience samples of MSM in public places in San Francisco suggest that HIV prevalence among that population is about 12%-16%. Source: Stop AIDS Project. Roop Prabhu, SFDPH

Populations: Prevalence of HIV Infection among Counseling and Testing Program Clients Case-mix adjusted data from the HIV Counseling and Testing Program show little change in the percentage of clients who test positive. The percentage may have decreased among MSM clients. Source: David Webb, Nancy Berman Lees, Christine Dahlgren, California State Office of AIDS

Populations: Prevalence of HIV Infection in STD Clinics About 1.0%-1.5% of samples from STD clinics (excluding Los Angeles and San Francisco) tested positive for HIV, with a possible “V”-shaped trend over time. Source: California HIV Seroprevalence Reports, California State Office of AIDS

Populations: Prevalence of HIV Infection among Women in the HIV Counseling and Testing Program About 0.5% of women in the HIV Counseling and Testing Program test positive for HIV. The data are not adjusted for change in case- mix over time. Source: David Webb, Nancy Berman Lees, California State Office of AIDS

Populations: Prevalence of HIV Infection among Child-Bearing Women Estimated numbers of childbearing women with HIV range from in any given year, with no evidence of a trend over time. Source: Zukowski and Ruiz, California State Office of AIDS

Populations: Prevalence of HIV Infection among State Prisoners About 0.7%- 1.0% of state prisoners are known to carry HIV in any given year. However, there is no routine testing program. Source: Bureau of Justice Statistics, U.S. Dept. of Justice

Populations: Intent to Use Condoms for Anal Sex In an ongoing convenience sample of MSM in public places in San Francisco, among MSM who practiced anal sex and had more than one partner in the past six months, about 82%-93% expressed intent to use condoms. Source: Stop AIDS Project. Roop Prabhu, SFDPH

Characteristics of Populations CHARACTERISTICS OF INTERVENTIONS Risk-Taking and Protective Behaviors Disease Impacts UTILIZATION OF INTERVENTIONS HIV Prevention Indicators Policies

Interventions: Adults Who Tested for HIV in the Past Year In a series of telephone surveys, about 32%-37% of adults said that they tested for HIV in the past year. Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control

Interventions: Annual Volume of HIV Testing Services The number of HIV tests provided by the Counseling and Testing Program increased rapidly up through 1992 and has since leveled out at about 200,000 annually. Since 1995, the number of tests for MSM increased from 29,100 to 37,400. Source: David Webb, Nancy Berman Lees, Christine Dahlgren, California State Office of AIDS

Interventions: Continuity: HIV Tests Where Clients Do Not Return for Results About ¼ of clients in the Counseling and Testing Program do not return for HIV test results. MSM have a better return record. The increasing trend among MSM likely reflects increased program emphasis on higher risk populations. Source: David Webb, Nancy Berman Lees, Christine Dahlgren, California State Office of AIDS

Interventions: Continuity: HIV Positive Clients Who Do Not Return for Test Results About 30% of HIV+ clients in the Counseling and Testing Program do not return for test results. MSM have a better return record. The increasing trend among MSM likely reflects increased program emphasis on higher risk populations. Source: David Webb, Nancy Berman Lees, Christine Dahlgren, California State Office of AIDS

Interventions: Timeliness of Testing for Persons with HIV Among the MSM population with AIDS, the number without an early HIV diagnosis peaked in 1994 and has since fallen sharply. Among non-MSM, however, the numbers have been slow in coming down. Source: A. Nakamura, California AIDS Registry, California State Office of AIDS

Interventions: Outreach for HIV Testing About 10% of Counseling and Testing Program clients are recruited by outreach. Among clients who are injection drug users or sex workers, about 20% are recruited by outreach. Source: David Webb, Nancy Berman Lees, California State Office of AIDS

Interventions: Untreated Childbearing Women with HIV In 1998, an estimated 69 childbearing women with HIV in California did not receive relevant treatment prior to delivery. The 95% confidence interval for the estimate ranges from 41 to 109. Source: Zukowski and Ruiz, California State Office of AIDS

Characteristics of Populations Characteristics of Interventions RISK-TAKING AND PROTECTIVE BEHAVIORS Disease Impacts Utilization of Interventions HIV Prevention Indicators Policies

Risk-Taking Behavior: More than Five Sex Partners Up through the year 2000, clients in the Counseling and Testing Program, particularly MSM, were increasingly likely to have had more than 5 sex partners in the past year. While the measure changed in 2001, the trend has continued. Source: David Webb, Nancy Berman Lees, Christine Dahlgren, California State Office of AIDS

Risk-Taking Behavior: HIV Positive Sex Partner Case-mix adjusted data for clients in the Counseling and Testing Program suggest that the percentage who had an HIV positive sex partner declined. While percentages for MSM are higher, they also have declined. Source: David Webb, Nancy Berman Lees, Christine Dahlgren, California State Office of AIDS

Risk-Taking Behavior: Casual Sex Partner and No Condom A telephone survey of California adults in the year 2000 found that 4.9% had unprotected sex with a casual partner in the past year. The 95% confidence interval for the estimate ranged from 3.7% to 6.3%. Source: Joel Moskowitz. California 2000 HIV/AIDS KABB Survey

Risk-Taking Behavior: Unprotected Anal Intercourse In an ongoing convenience sample of MSM in public places in San Francisco, among MSM who practiced anal sex in the past 6 months, an increasing percentage did not always use a condom. Source: Stop AIDS Project. Roop Prabhu, SFDPH

Risk-Taking Behavior: Unprotected Receptive Anal Sex Case-mix adjusted data for clients in the Counseling and Testing Program suggest that, of those who practiced receptive anal intercourse in the past 2 years, a slightly increasing percentage failed to use protection at least once. Percentages for women have been fairly constant at 85%. Source: David Webb, Nancy Berman Lees, California State Office of AIDS

Risk-Taking Behavior: Needle Sharing Case-mix adjusted data for injection drug users in the Counseling and Testing Program suggest that the percentage who shared needles in the past two years has slightly decreased. Source: David Webb, Nancy Berman Lees, California State Office of AIDS

Characteristics of Populations Characteristics of Interventions Risk-Taking and Protective Behaviors DISEASE IMPACTS Utilization of Interventions HIV Prevention Indicators Policies

Disease Impacts: New HIV Infections California’s new HIV reporting system received 5,090 reports of new infections for the year About 62% were associated with MSM. Source: A. Nakamura, California HIV Reporting System, California State Office of AIDS

Disease Impacts: New HIV Infections The number of new HIV cases identified in the Counseling and Testing Program declined rapidly in the early 1990s. More recent counts have been fairly level. Source: David Webb, Nancy Berman Lees, Christine Dahlgren, California State Office of AIDS

Disease Impacts: New HIV Infections per 100 Person-Years at Risk Among persons who previously tested negative, there have been increases in case- mix adjusted rates of new infections per 100 person-years at risk. Rates have particularly increased among the MSM clients. Source: David Webb, Nancy Berman Lees, Christine Dahlgren, California State Office of AIDS

Disease Impacts: Primary and Secondary Syphilis The annual number of reported primary and secondary syphilis cases decreased dramatically in the early 1990s. For males, counts have climbed rapidly in recent years. Source: STD Control Branch, California Department of Health Services

Disease Impacts: HIV among Primary and Secondary Syphilis Cases Among MSM with primary or secondary syphilis, about 60% also have HIV. Among non-MSM and unknowns, about 1/3 also have HIV. Source: STD Control Branch, California Department of Health Services

Disease Impacts: AIDS Diagnoses The annual number of diagnosed AIDS cases peaked in 1992 and has since fallen substantially. In 2002, the number slightly increased. Among non-MSM, the number of reported cases has not declined as rapidly, and non- MSM now represent about 2/5 of reported cases. Source: A. Nakamura, California AIDS Registry, California State Office of AIDS

Disease Impacts: Persons Living with AIDS The number of persons living with AIDS is climbing at a regular pace of about 2,800 persons per year. Non-MSM, who a decade ago represented 19% of the total, now are up to 28%. Source: A. Nakamura, California AIDS Registry, California State Office of AIDS

Disease Impacts: Deaths of Persons with AIDS The number of deaths among persons with AIDS plummeted after the introduction of anti-retroviral therapy. Non- MSM, who a decade ago represented 16% of the total, now are up to 37%. Source: A. Nakamura, California AIDS Registry, California State Office of AIDS

GOOGLE California HIV Prevention Indicators GOOGLE California HIV Prevention Indicators Universitywide AIDS Research Program Conclusions California made substantial progress toward HIV prevention until the mid-1990s. However, in the latter half of that decade, there were few if any further gains. Now, in recent years, we see increases in high risk behaviors, notably widespread use of methamphetamines and increasing high risk sexual activity; and while the data are not conclusive, there is mounting evidence of modest increases in new HIV infections.