1. HIV, AIDS and HIGH RISK BEHAVIORS among BEHAVIORAL RISK GROUPS in LOS ANGELES COUNTY As presented by Dr. Douglas Frye to the PPC on January 6, 2004 ~ ~ Revised to include Transgender BRG ~ HIV Epidemiology Program Los Angeles County Department of Health Services Public Health

2. Outline Estimates of BRG populations HIV and AIDS Estimates for BRGs based on HARS New HIV Infections at State-funded Testing Sites Distribution of persons living with AIDS by BRG, Service Planning Area, and Race/Ethnicity High risk behaviors in BRGs Transgendered persons American Indians/Alaskan Natives

3. Estimates of BRG Populations in Los Angeles County

4. Estimated Population Size of Behavioral Risk Groups - LAC, as of 2000

5. HIV and AIDS Estimates for BRGs Based on HARS (HIV/AIDS Reporting System)

6. Persons Living with AIDS by Behavioral Risk Group - LAC HARS, as of 2/28/03

7. Estimated Number of Persons Living with HIV (including AIDS) by BRG 28,400 6,400 4,200 3,100 1,700 # BRG with AIDS 1,700

8. Proportion of Persons Living with HIV and AIDS by BRG - LAC, 2003 55% 3% 4% 8% 12% 6% 3%

9. Proportion of Estimated Annual HIV Incidence by BRG - LAC, 2003 53.5% 3% 6% 8.5% 6% 13.5% 6% 3.5%

10. Estimated Annual HIV Incidence Proportion of All BRGs - LAC, 2003 57% 3% 4% 9% 6% 15% 6%

11. Number of Persons Living with AIDS in LAC by BRG and Service Planning Area * *HARS data as of 2002; does not include 801 cases with unknown SPA.

12. Source: Data Analysis Unit, HIV Epidemiology Program

13. Persons Living with AIDS in LAC Percent BRG by Service Planning Area* *HARS data as of 2002; does not include 801 cases with unknown SPA.

14. Estimated HIV Seroprevalence (including AIDS) by BRG in LAC - as of 2/28/03 % living with AIDS 18% 13% 8.7% 6.5% 3.9% 2.1% Source: HIV Epidemiology Program, LAC/DHS. 17%

15. New HIV Infections at State-funded Testing Sites

16. Rate of New HIV Infections among Repeat Testers at State-funded Test Sites by BRG - LAC, 1997 - 2001 N= 48N= 10N= 20N= 81N= 113N= 653 Behavioral Risk Group *TG refers to new infections among transgendered females. There were no new infections among transgendered males. N= 36 Source: OAPP and HIV Epidemiology Program.

17. Rate of New HIV Infections among Repeat Testers at State-funded HIV Test Sites by Race/Ethnicity and BRG - LAC, 1997 - 2001 White Black Latino * * * * * * = Statistically higher rate than non-starred race/ethnicity within BRG * Source: OAPP and HIV Epidemiology Program, LAC/DHS.

18. Percent Tested and Testing Positive at State- funded Test Sites by SPA - LAC, 2001 Testing Positive (N = 614) Source: OAPP, LAC/DHS. 12345678 Tested (N = 44,951) Service Planning Area

19. Percent Tested and Testing Positive at State- funded Test Sites by BRG - LAC, 2001 Tested (N = 44,967) Testing Positive (N = 657) Source: OAPP, LAC/DHS.

20. Race/Ethnicity Percent Tested and Testing Positive at State- funded Test Sites by Race/Ethnicity - 2001 Tested (N = 44,967) Testing Positive (N = 657) Source: OAPP, LAC/DHS.

21. Men who have sex with men (MSM)

22. Persons Living with HIV and AIDS Proportion by Behavioral Risk Group Los Angeles County, 2003 54% MSM

23. MSM Living with AIDS by SPA and Race/Ethnicity - as of 12/31/02 N=81 N=538 N=576N=649 N=1,826 N=636 N=4,516 N=1,346

24. MSM Living with AIDS by SPA and Race/Ethnicity - as of 12/31/02

25. Men who have sex with men and women (MSM/W)

26. Persons Living with HIV and AIDS Proportion by Behavioral Risk Group Los Angeles County, 2003 12% MSM/W

27. MSM/W Living with AIDS by SPA and Race/Ethnicity - LAC, as of 12/31/02 N=27 N=184 N=148 N=259 N=352 N=81 N=627 N=247

28. MSM/W Living with AIDS by SPA and Race/Ethnicity - LAC, as of 12/31/02

29. Men who have sex with men and are injection drug users (MSM/IDU)

30. Persons Living with HIV and AIDS Proportion by Behavioral Risk Group Los Angeles County, 2003 6% MSM- IDU

31. MSM-IDU Living with AIDS by SPA and Race/Ethnicity - LAC, as of 12/31/02 N=12 N=58 N=43 N=75 N=225 N=46 N=407 N=121

32. MSM - IDU Living with AIDS by SPA and Race/Ethnicity - LAC, as of 12/31/02

33. Heterosexual male injection drug users (HMIDU)

34. Persons Living with HIV and AIDS Proportion by Behavioral Risk Group Los Angeles County, 2003 8% HMIDU

35. HMIDU Living with AIDS by SPA and Race/Ethnicity - LAC, as of 12/31/02 N=27 N=64 N=91 N=141 N=245 N=40 N=261 N=144

36. HMIDU Living with AIDS by SPA and Race/Ethnicity - LAC, as of 12/31/02

37. Female injection drug users (FIDU)

38. Persons Living with HIV and AIDS Proportion by Behavioral Risk Group Los Angeles County, 2003 3% FIDU

39. FIDU Living with AIDS by SPA and Race/Ethnicity - LAC, as of 12/31/02 N=8 N=30 N=57 N=81 N=101 N=21 N=107 N=62

40. FIDU Living with AIDS by SPA and Race/Ethnicity - LAC, as of 12/31/02

41. Women at Sexual Risk (WSR)

42. Persons Living with HIV and AIDS Proportion by Behavioral Risk Group Los Angeles County, 2003 8% WSR

43. WSR Living with AIDS by SPA and Race/Ethnicity - LAC, as of 12/31/02 N=21 N=157 N=45 N=222 N=97 N=221 N=134 N=236

44. WSR Living with AIDS by SPA and Race/Ethnicity - LAC, as of 12/31/02

45. High-Risk Behaviors in BRGs

46. MSMIDU, MSM*, MSMW*: Unprotected Anal Receptive Sex in Last 6 Months by BRG LA Young Men’s Survey, 1999 - 2000 * MSMW self-identified as bisexual; MSM as gay or homosexual.

47. Percent MSM Living with AIDS Reporting Unprotected Anal Intercourse (UAI) at Last Sex and Reporting 10+ Sex Partners in Last Year Los Angeles SHAS, 1998 - 2003  = UAI at last sex  = 10+ partners/year (4)

48. Percent Unprotected Anal Receptive Sex Last 12 Months Among PLWA by BRG Los Angeles SHAS, 2000 - 2003

49. MSMIDU, MSM, MSMW: Percent Having Sex by Type of Partner - APLA, 2001 Note: “Gay” = MSM; “Bisexual” = MSMW; “Gay IDU” = MSMIDU

50. Percent Ever had an STD by Behavioral Risk Group Los Angeles SHAS, 2000 - 2003

51. Percent High on Drug/Alcohol at Last Sex by Behavior Risk Group Los Angeles SHAS, 2000 - 2003

52. MSMIDU, MSM*, MSMW*: Percent High on Drug/Alcohol at Last Sex LA Young Men’s Survey, 1999 - 2000 * MSMW self-identified as bisexual; MSM as gay or homosexual.

53. MSMIDU, MSM, MSMW: Percent Who Used Drug/Alcohol During Sex in the last 6 months - APLA, 2001 Note: “Gay” = MSM; “Bisexual” = MSMW; “Gay IDU” = MSMIDU; Always includes “Nearly always”; Sometimes includes “Half the time.”

54. Percent Reporting High-Risk Behaviors* Among Transgendered Women in the L.A. Transgender Health Study 1999 - 2000 *In last 6 months, unless otherwise noted.

55. American Indians/ Alaskan Natives

56. Persons Living with AIDS per 1,000 Population by Race/Ethnicity, LAC * *HIV/AIDS data from HIV Epidemiology Program, as of 11/30/2003. 2002 population estimate from California Department of Finance. American Indians/Alaskan Natives have 2nd highest prevalence “rate” in LAC

57. American Indians/Alaskan Natives Out of ~30,000 AI/AN living in LAC, number living with AIDS: 96 (0.3%) BRGs and other modes of exposure: –MSM 49% –MSM/W 14% –MSM/IDU 10% –FIDU 5% –HMIDU 5% –WSR 5% –Pediatric 1% –MSW 0% –Unknown/other11%

58. American Indian/Alaskan Native Population and Living AIDS Cases by SPA - LAC, 2002 Population (N = 29,987) Source: HIV Epidemiology Program, LAC/DHS, data as of April 2002. 12345678 PLWA (N = 96) Service Planning Area

59. ACKNOWLEDGMENTS Gordon Bunch (HIV Epidemiology Program) Amy Wohl (HIV Epidemiology) Denise Fearman-Johnson (HIV Epidemiology) Virginia Hu (HIV Epidemiology) Julie Ann Carlos (OAPP) Trista Bingham (HIV Epidemiology) and Curtis Croker (Health Assessment and Epidemiology) Uyen Bui and Matt Mutchler (APLA) Paul Simon (Health Assessment and Epidemiology) and Cathy Reback (VNRH)