1. The Epidemiology of HIV and AIDS Worldwide, Nationwide, and in LA County Jane Neff Rollins, MSPH

2. Initial HIV Infection HIV Antibody Test Positive Laboratory Evidence of Immuno- suppression Clinical Symptoms Opportunistic Disease (AIDS) Death 6 weeks-- 6 months Spectrum of HIV Disease ~10 years (without treatment)

3. Signs and Symptoms of Acute HIV Infection Fever Lymphadenopathy Sore throat Extreme fatigue Weight loss (more than 5 pounds in <2 weeks Night sweats Muscle and joint pain Nausea or vomiting or diarrhea Pain in feet or fingers Thrush (yeast infection in the mouth or throat) Red or dark, spotty, “measles-like” rash Oral, genital or rectal ulcers Most Common Less Common Most Definitive Signs

4. Healthcare workers with documented and possible occupationally acquired AIDS/HIV infection, reported through June, 2001, United States Occupation Dental worker, including dentist 6 Emergency med tech/paramedic--- 12 Lab technician19 17 Nurse24 35 Physician 6 18 Other 8 48 TOTAL57136 Documented Occupational Transmission Possible Occupational Transmission Source: www.cdc.gov/hiv/pubs/facts/hcwsurv.htm

5. NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings, Publication # 2000-108 Available at www.cdc.gov/niosh or 1-800-35-NIOSH Recommendations for Prevention of HIV Transmission in Health Care Settings, MMWR, August 21, 1987, Vol 36: No 27,

7. Primary and Secondary HIV Prevention Through Early Detection of HIV Infection Early Identification Early Treatment PRIMARY PREVENTION SECONDARY PREVENTION Reproductive Choices AZT/HAART during pregnancy Decrease Vertical Transmission Decreased Transmission to Sex & Needle-Sharing Partners Altered Behaviors Partner Notification Decreased Progression to AIDS Decreased Mortality Decreased Viral Load ?

8. A global view of HIV infection 36.1 million persons living with HIV/AIDS As of year-end 2000 Adult prevalence rate 15.0% – 36.0% 5.0% – 15.0% 1.0% – 5.0% 0.5% – 1.0% 0.1% – 0.5% 0.0% – 0.1% not available

9. Spread of HIV over time in sub-Saharan Africa, 1984 to 1999 Estimated percentage of adults (15–49) infected with HIV 20.0% – 36.0% 10.0% – 20.0% 5.0% – 10.0% 1.0% – 5.0% 0.0% – 1.0% trend data unavailable outside region

10. <5 5 - 14.9 15+ AIDS Rates per 100,000 Population Reported in1999 Rate per 100,000 8.4 VI 32.6 PR 32.1 DE MA RI CT NJ MD DC NH VT 3.4 3.8 25.1 24.7 17.9 23.5 10.8 29.5 161.5 36.2 15.2 42.3 16.4 24.7 21.5 19.5 15.9 18.4 2.4 16.4 3.8 4.9 2.9 3.0 4.0 4.4 4.0 2.2 1.1 3.1 1.5 2.0 6.3 6.8 13.4 7.3 5.3 7.9 6.4 7.6 9.7 12.8 6.6 6.1 7.0 13.8 10.9 10.4 13.7 6.4 Centers for Disease Control and Prevention CDC

11. HIV Infection (not AIDS) Reported in 1999 N=21,419* *Includes 361 persons who were residents of areas without HIV infection surveillance but who were reported by areas with HIV infection surveillance. HIV surveillance initiated in July 1999 † NJ CT PR VI 153 1,330 5 6,402 464 717 971 2,563 694 919 184 169 230 219 79 21 2 9 28 0 232 64 145 325 214 472 499 301 897 519 1,017 878 49 287 † Confidential HIV Reporting** Required Pediatric only **HIV cases reported by patient name Source: CDC Centers for Disease Control and Prevention CDC

12. Age at Diagnosis of HIV Infection or AIDS, Reported through 1999, United States *Data from 34 areas with confidential HIV infection surveillance HIV*AIDS Number 2,026 4,797 47,613 41,178 20,263 122,607 6,730 <13 13-19 30-39 20-29 40-49 50+ Age Number 8,718 3,725 329,066 123,580 190,087 733,374 78,198 Percent 2 4 39 34 17 5 Percent 1 1 45 17 26 11 Centers for Disease Control and Prevention CDC

13. White not Hispanic Black not Hispanic HispanicAsian/Pacific Islander American Indian/ Alaska Native AIDS Cases in 13- to 19-Year-Olds by Race/Ethnicity, United States AIDS Cases 1999 N=312 AIDS Cases 1981-1999 N=3,725 U. S. Population N 27Million  2% 14% 60% 24% 29% 49% 20% 5% 67% 15% 14% Centers for Disease Control and Prevention CDC

14. Public Health Importance of HIV/AIDS in LA County LAC is second only to NYC in cumulative number of reported AIDS cases in metropolitan areas. 35% of all California AIDS cases are reported from LAC. Only 4 states (CA, TX, NY, FL) have reported more AIDS cases than LAC. Source: HIV Epidemiology Program, LAC/DHS, as of 12/31/99

15. MSM IDU MSM/IDU Hetero Transfusion Other/ undetermined Source: HIV Epidemiology Program, LAC/DHS, and NYC Department of Health, as of 03/00 Mode of HIV Exposure (%) of Cumulative AIDS Cases Los Angeles County vs. New York City Male Female Los Angeles CountyNew York City 78 -- 6 26 7 -- 1 46 1 8 7 19 41 -- 44 52 n/a -- 3 31 <1 1 11 16

16. HIV DISEASE IN LOS ANGELES COUNTY AIDS ~15,000 Persons Living with AIDS ~25,000 Persons Living with HIV HIV Infection Recognized HIV Infection Unrecognized Estimated 40,000 individuals living with HIV Infection, both early and advanced (AIDS)

17. AIDS Cases Reported in 1996-1999 By Gender, Race/Ethnicity, Exposure Category and Percentage Change 1996199719981999 % change % change % change No. No. No. No. 96 to 97 97 to 98 98 to 99 GENDER Male 3165 213918131745-32% -15% - 4% Female 342 269 221 212-21% -18% - 4% RACE/ETHNICITY White1672 919 663 667-45% -28% + 1% AA 679 544 516 479-20% - 5% - 7% Latino1066 876 799 750-18% - 9% - 6% Asian 71 50 49 50-30% - 2% + 2% AI/AN 10 15 5 8+50% -67% +60% EXPOSURE CATEGORY MSM2448151811251031-38% -26% - 8% MSM/IDU 180 96 100 83-47% + 4% -17% Male IDU 197 139 124 91-29% -11% -27% Female IDU 96 71 37 34-26% -48% - 8% Male Hetero 50 57 53 31+14% - 7% -42% Female Hetero 167 128 94 76-23% -27% -19% TOTAL3507240820341957-31% -16% - 4% Source: HIV Epidemiology Program, LAC/DHS, as of 12/31/99

18. AIDS Deaths Reported in 1996-1999 By Gender, Race/Ethnicity, Exposure Category and Percentage Change 1996199719981999 % change % change % change No. No. No. No. 96 to 97 97 to 98 98 to 99 GENDER Male 2038 965 623 518-53% -35% -17% Female 175 100 84 75-43% -16% -11% RACE/ETHNICITY White1051 480 295 240-54% -39% -19% AA 482 236 168 152-51% -29% -10% Latino 623 317 236 182-49% -26% - 23% Asian 50 24 5 14-52% -79% +180 AI/AN 2 6 1 2+200 -83% +100 EXPOSURE CATEGORY MSM1565 691 420 336-56% -39% -20% MSM/IDU 152 72 40 35-53% -44% -13% Male IDU 146 75 45 40-49% -40% -11% Female IDU 46 28 19 29-39% -32% +53% Male Hetero 39 13 18 12-67% +38% -33% Female Hetero 77 44 36 31-43% -18% -14% TOTAL22131065 707 593-52% -34% -16% Source: HIV Epidemiology Program, LAC/DHS, as of 12/31/99

19. Racial/Ethnic Distribution of Adult/Adolescent AIDS Cases by Year of Diagnosis Los Angeles County, 1986-2001 Source: HIV Epidemiology Program, LAC/ DHS, as of December, 2001 0001

20. Male Adolescent/Adult AIDS Rates 1 By Race/Ethnicity and Year of Diagnosis Los Angeles County, 1990-2001 1 Data are adjusted for reporting delay only. Source: HIV Epidemiology Program, LAC/ DHS, as of December, 2001 Rate per 100,000 Year of AIDS Diagnosis 1993 AIDS case definition change 000

21. Female Adolescent/Adult AIDS Rates 1 By Race/Ethnicity and Year of Diagnosis Los Angeles County, 1990-2001 1 Data are adjusted for reporting delay only. Source: HIV Epidemiology Program, LAC/ DHS, as of December, 2001 Rate per 100,000 Year of AIDS Diagnosis 1993 AIDS case definition change 00

22. AIDS Prevalence Rate (per 100,000)* for Males By Race/Ethnicity, 1986-1997, Los Angeles County * Prevalence Rate is the number of persons living with AIDS at any time during the year divided by the population in that year ( multiplied by 100,000) Source: HIV Epidemiology Program, LAC/ DHS, as of May 31, 1999

23. AIDS Prevalence Rate (per 100,000)* for Females By Race/Ethnicity, 1986-1997, Los Angeles County * Prevalence Rate is the number of persons living at any time during the year divided by the population in that year multiplied by 100,000 Source: HIV Epidemiology Program, LAC/ DHS, as of May 31, 1999

25. Cases, Deaths and Case Fatality Rate of Advanced HIV Disease (AIDS) by Year, Reported by December 31, 2001, Los Angeles County Year Number of Cases Number of Deaths Case Fatality Diagnosed Occurred Rate 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2354 2804 3318 4015 4170 3944 3694 3460 2706 2088 1813 1595 1357 799 2229 2549 2943 3375 3197 2605 1965 1206 631 406 303 219 184 89 Source: HIV Epidemiology Program, LAC/DHS, as of 12/01 43541 27114 95% 91% 89% 84% 77% 66% 53% 35% 23% 19% 17% 14% 11%

26. AZT Treatment for HIV+ Pregnant Women Source: NEJM, 331,1173-1180, November 3, 1994 AZTNo AZT Number of births180183 Probability of HIV 8.3 25.5 Transmission (%)

27. Median interval from first positive HIV test to AIDS diagnosis among a sample of persons reported with AIDS, 01/90-08/98 Los Angeles County, SHAS Interview project (N=2,377) Sex Male Female Race/Ethnicity White Black Latino Asian Native-American 2002(89.2)14 375(10.8)14 881(39.9)32 433(15.9) 8 1005(41.0) 8 49( 2.6) 2 6( 0.5) 11 Characteristics No. (%) Median Interval (months) Source: HIV Epidemiology Program, LAC/DHS

28. Conclusions Although Los Angeles is an area of high HIV prevalence, our findings indicate an overall low level of early HIV detection. Major sociodemographic and behavioral disparities exist in the likelihood of early detection of HIV infection. minorities, women, heterosexuals, young adults and persons of lower educational level are less likely have HIV detected early. The low level of early HIV detection promotes transmission of HIV and may help explain the current local dynamics of HIV transmission in Los Angeles. Source: HIV Epidemiology Program, LAC/DHS

29. Background HIV/AIDS and Tuberculosis Increases in TB worldwide in recent years have been attributed in large part to the HIV epidemic Immunocompromised persons such as those infected with HIV are at increased risk for tuberculosis Source: HIV Epidemiology Program, LAC/DHS

30. The U.S. Centers for Disease Control and Prevention recommends that all persons with TB be tested for HIV so that: 1) HIV infections among persons with TB can be identified early to ensure the provision of high-quality medical care that considers the comanagement of both infections. 2) the extent of comorbidity of TB and HIV in the general population can be accurately assessed. Source: HIV Epidemiology Program, LAC-DHS HIV/AIDS and Tuberculosis

31. The Los Angeles Syphilis Outbreak, 2000* Of 111 cases of syphilis identified, 108 (97%) were from LAC, and 3 cases were from Long Beach –13 primary, 43 secondary, 55 early latent stage 103 (93%) identified as MSM, 7 (7%) as transgender 58 (52%) were HIV positive –Among those, 42 (72%) were in care for HIV infection The average age was 36 years of age (range 20-50) 45% Latino, 41% white, 13% African-American, and 2% A/PI Outbreak is suggestive evidence that there may be recent increases in high-risk behaviors for some MSM * Data of of 9/29/00 Source: Sexually Transmitted Disease (STD) Program, Los Angeles County Department of Health Services

33. Young Men’s Survey HIV prevalence Percent HIV+ Source: HIV Epidemiology Program, LAC/DHS

34. Risk behaviors YMS: Risk behaviors Source: HIV Epidemiology Program, LAC/DHS

35. Risk behaviors (cont.) YMS:Risk behaviors (cont.) Source: HIV Epidemiology Program, LAC/DHS

36. Jane Neff Rollins, MSPH jnrollins@hotmail.com