1. HIV/AIDS in Los Angeles County An Overview Charles L. Henry, Director County of Los Angeles Department of Health Services Office of AIDS Programs and Policy May 15, 2004

2. 2 Presentation Overview Review of the Local HIV Epidemiology Review Significant Changes to the Epidemic Overview of Youth Risk Behavior Role of Schools in HIV Prevention

3. Los Angeles County 4,082 Square Miles 9.9 Million Residents Proportion of State Population: 29% Proportion of State AIDS Cases: 35% Living with HIV/AIDS: 54,000 (Estimated) Population: Latino/a 45.7% White 31.0% Asian/PI 13.2% African-American 9.7% Native American 0.3% 3

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5. Source: HIV Epidemiology Program, LAC/ DHS * Data are provisional for 2002 5 Living AIDS Cases and Deaths Los Angeles County, 1987–2002 18,480

6. 6 AIDS Cases by Race/Ethnicity

7. 7 AIDS Cases by Gender

8. 8 AIDS Cases by Reported Exposure Category

9. Pediatric Spectrum of Disease (PSD), LAC, 1985-2003, as of February, 2004 9 Proportion of Perinatal HIV Transmission for Children Identified at Birth and Maternal Zidovudine (ZDV) Use

10. 10 What’s Changed Effective HIV treatment offers real hope for a healthier, longer life. HIV is 100% preventable. There is still no cure and there is no vaccine. What Hasn’t Changed

11. 11 What’s Changed In 1989, the AIDS Drug Assistance Program supported one drug (AZT – an antiretroviral) In 2004, the AIDS Drug Assistance Program supported 165 drugs (including 23 antiretrovirals or antiretroviral combinations) Drugs attack HIV at multiple stages in its life cycle New drugs are in development

12. 12 What Hasn’t Changed AIDS drugs are the most expensive drugs ever marketed AIDS drugs can have highly toxic side effects AIDS drugs do not work for everyone HIV remains highly mutagenic

13. 13 The Number and Proportion of AIDS Cases Is Highest Among Men The Most Common Mode of Transmission is Male-Male Sex What Hasn’t Changed

14. 14 What’s Changed The Rate of Perinatal (Mother-to-Child) Transmission of HIV has Significantly Declined Early Treatment is Critical Perinatal Care is Vital Women Are Not Always Aware of their HIV Risk What Hasn’t Changed

15. 15 What Has Changed The Number and Proportion of AIDS Cases Among People of Color Has Increased

16. 16 What Has Changed Our Understanding of the Risk Profiles of People Most at Risk Our Understanding of Sexual Risk Behavior Among Youth Our Targeting of Prevention Resources Our Understanding of the Role that Homophobia, Poverty and Racism play in HIV risk behavior

17. 17 What Do We Know About HIV Risk Behavior Among Youth? Sex Tied To Drug Use is Predominant Risk Behavior Risk Behaviors Occur in Clusters Similar decision pathways No clear advantage for avoiding risks Personal management/self-control may not be well developed Protective Behaviors Occur in Clusters One risk may dis-inhibit for another

18. 18 Consequences of Sexual Behavior 870,000 pregnancies each year (15-19 year olds) 490,000 live births each year (15-19 year olds) 3,000,000 STDs (15-19 year olds) 13% of persons diagnosed with HIV/AIDS were 13-24 and 37% were 25- 34

19. 19 Risk Patterns Among 7-12 th Graders (Remember the Clustering!) 11% of males and 5% of females perpetuated violence in the past year 10% of males and 6% of females smoke 6 or more cigarettes a day 20% of males and 16% of females drink alcohol 2 or more days per month 14% of males and 12% of females use marijuana at least once per month 40% of males and 37% of females have ever had sexual intercourse

20. 20 Co-Risks with Sexual Activity Sexually active teens have higher rates of most other risk behaviors, particularly those who initiate sex at a young age The younger the teen is when he or she initiates sex, the more partners he or she will have by age 20 The number of sex partners is a risk for HIV and STDs

21. 21 Connect to Protect Parents and Family Have the most influence on decisions about sex according to most teens Parents are their role models according to most teens Faith 83% of teens say religion is important in their lives 51% of 12-17 year olds attend church weekly When asked what factors most influence sexual decision making, most said ‘morals, values and religious beliefs’

22. 22 Connect to Protect Friends Most influence after parents Influence can be positive or negative Older friends are a risk factor Model behaviors and set norms Parents influence teen choice of friends

23. 23 Connect to Protect Teens Connected to Schools Less likely to engage in risk behaviors Less likely to be violent Less likely to smoke, drink and use marijuana More likely to delay sexual activity School Connectedness Influencers Perceived fair treatment by teachers Feeling part of the school Feeling closeness with others Perceived lack of prejudice Average daily attendance

24. 24 OAPP’s School-Based HIV Prevention Intervention Implemented by the LACOE & WHRAP Structural Intervention designed to influence the social, political, or environmental factors that shape HIV education in schools Targeted to School Administrators, Teachers, Parents Offers Training and Curriculum Development Technical Assistance

25. 25 Challenges and Vision Improve methods and opportunities to assess HIV risk behavior of youth Address prejudices, including sexism, homophobia and racism Increase resiliency of at-risk youth Mitigate powerful risk factors like lack of goals and hopelessness Normalize HIV testing Normalize frank discussions about sex and sexual health

26. 26 Acknowledgments Gunther Freehill, OAPP Mario Perez, OAPP Kyle Baker, OAPP Wil Strain, OAPP CDCP, Division of Adolescent and School Health DHHS, Office of Public Health & Science