1. TB, STDs, HIV, HEPATITIS C and SUBSTANCE ABUSE: A Local Perspective Paula Kriner, MPH Imperial County Public Health Department Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing June 20-21, 2014

2. Management of TB, STDs, HIV, Hepatitis C and Substance Abuse on the Border

3. I do not have any financial arrangements or affiliations with commercial sponsors which have direct interest in the subject matter: I do not have any financial arrangements or affiliations with commercial sponsors which have direct interest in the subject matter: Management of TB, STDs, HIV, Hepatitis C and Substance Abuse on the Border

4. Objectives Describe epidemiological trends for HIV/AIDS, sexually transmitted diseases, tuberculosis, hepatitis C, and substance abuse in Imperial County Describe epidemiological trends for HIV/AIDS, sexually transmitted diseases, tuberculosis, hepatitis C, and substance abuse in Imperial County Discuss challenges to identifying, testing, and treating diseases Discuss challenges to identifying, testing, and treating diseases Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing

5. Demographics Estimated 2014 population: 180,672 Estimated 2014 population: 180,672 Predominantly Latino (>80%) Predominantly Latino (>80%) Younger population than California Younger population than California Higher rates of poverty than state Higher rates of poverty than state Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing

6. TUBERCULOSIS

7. Tuberculosis In California, tuberculosis (TB) rates have declined since 1992 In California, tuberculosis (TB) rates have declined since 1992 In Imperial County, TB case rates have fluctuated and are now on rise In Imperial County, TB case rates have fluctuated and are now on rise IC has highest TB rates in California IC has highest TB rates in California –15.2 cases per 100,000 population in IC compared to 6.1 cases/100,000 statewide Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing

8. Tuberculosis

9. Tuberculosis Nearly all cases are Latino Nearly all cases are Latino Many are foreign-born Many are foreign-born Diabetes and HIV/AIDS are increasingly common co-morbidities in persons infected with TB Diabetes and HIV/AIDS are increasingly common co-morbidities in persons infected with TB Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing

10. TB Challenges Homelessness and drug use are risk factors Homelessness and drug use are risk factors Binational cases: cross-border travel and contacts Binational cases: cross-border travel and contacts Latent TB Infection (LTBI) cases not adequately followed by local health- care providers Latent TB Infection (LTBI) cases not adequately followed by local health- care providers Management of TB, STDs, HIV, Hepatitis C and Substance Abuse: Focus on Testing

11. Sexually Transmitted Diseases (STDs)

12. STD Highlights Chlamydia is the most common STD reported Chlamydia is the most common STD reported IC Public Health participated in statewide enhanced gonorrhea surveillance project IC Public Health participated in statewide enhanced gonorrhea surveillance project County has improved local surveillance for all STDs County has improved local surveillance for all STDs Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing

13. Chlamydia

14. Chlamydia

15. Gonorrhea

16. Gonorrhea Management of TB, STDs, HIV, Hepatitis C and Substance Abuse on the Border: Focus on Testing

17. Syphilis Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing

18. STD Challenges Diagnosis and treatment of partners Diagnosis and treatment of partners –Limited use of Expedited Partner Therapy –Out-of-jurisdiction including Mexico –Other factors (drug use, co-morbidities) Limited services for counseling and testing Limited services for counseling and testing Management of TB, STDs, HIV, Hepatitis C and Substance Abuse: Focus on Testing

19. HIV / AIDS

20. HIV/AIDS AIDS: 266 cases since 1983 AIDS: 266 cases since 1983 –106 (40%) deaths reported HIV: 87 cases reported by name since April 2006. HIV: 87 cases reported by name since April 2006. –Three (3%) deceased Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing

21. AIDS Nearly all cases (90%) are male Nearly all cases (90%) are male Most (76%) are Latino Most (76%) are Latino More than half (55%) identified risk as men who have sex with men (MSM) More than half (55%) identified risk as men who have sex with men (MSM) 12% reported risk as injection drug use (IDU) 12% reported risk as injection drug use (IDU) 7% reported risk as MSM/IDU 7% reported risk as MSM/IDU Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing

22. HIV Most cases are Latino (76%) and male (80%) Most cases are Latino (76%) and male (80%) Most are MSM (57%) Most are MSM (57%) IDUs (14%) IDUs (14%) Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing

23. HIV/AIDS Cases Management of TB, STDs, HIV, Hepatitis C and Substance Focus on Testing

24. HIV/AIDS Challenges Stigma Stigma Many cases test out of jurisdiction -- often in Mexico -- and don’t seek care until very sick Many cases test out of jurisdiction -- often in Mexico -- and don’t seek care until very sick Limited counseling and testing services available Limited counseling and testing services available Management of TB, STDs, HIV, Hepatitis C and Substance Abuse : Focus on Testing

25. HEPATITIS C

26. Hepatitis C In 2011, one acute case and 178 newly reported non-acute HCV cases were identified countywide In 2011, one acute case and 178 newly reported non-acute HCV cases were identified countywide Many of the reported cases are incarcerated Many of the reported cases are incarcerated Management of TB, STDs, HIV, Substance Abuse and Hepatitis C: Focus on Testing

27. Hepatitis C Management of TB, STDs, HIV, Hepatitis C and Substance Abuse on the Border: Focus on Testing

28. Hepatitis C ∙ Challenges Injection drug users Injection drug users Small percentage share needles for vitamins and medicines Small percentage share needles for vitamins and medicines Many older people are not aware that they may have been exposed Many older people are not aware that they may have been exposed Management of TB, STDs, HIV, Hepatitis C and Substance Abuse: Focus on Testing

29. SUBSTANCE ABUSE

30. Substance Abuse Admission rates to treatment facilities in Imperial County have increased since 2000 Admission rates to treatment facilities in Imperial County have increased since 2000 In 2000, IC reported 417 admissions per 100,000 compared to 790 admissions per 100,000 in 2008 In 2000, IC reported 417 admissions per 100,000 compared to 790 admissions per 100,000 in 2008 IC’s alcohol and drug admission rate was higher than the state overall each year since 2000 IC’s alcohol and drug admission rate was higher than the state overall each year since 2000 Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing

31. Substance Abuse Marijuana use accounted for 29% of all treatment admissions in 2008 Marijuana use accounted for 29% of all treatment admissions in 2008 Heroin = 27% Heroin = 27% Methamphetamine = 24% Methamphetamine = 24% Alcohol = 19% Alcohol = 19% Crack/cocaine = 1% Crack/cocaine = 1% Highest rate in 25 to 34 year olds Highest rate in 25 to 34 year olds Management of TB, STDs, HIV, Hepatitis C and Substance Abuse on the Border: Focus on Testing

32. Substance Abuse Death rates due to alcohol and drug use increased slightly between 2000 and 2007 Death rates due to alcohol and drug use increased slightly between 2000 and 2007 Death rate due to alcohol use increased nominally Death rate due to alcohol use increased nominally Death rate due to drug use increased from 7.65 per 100,000 to 10.29 per 100,000 Death rate due to drug use increased from 7.65 per 100,000 to 10.29 per 100,000 Management of TB, STDs, HIV, Hepatitis C and Substance Abuse: Focus on Testing

33. Substance Abuse Challenges Substance abuse is a risk factor for sexually transmitted diseases Substance abuse is a risk factor for sexually transmitted diseases Lack of local treatment facilities Lack of local treatment facilities Homelessness and other risk factors makes it difficult to follow up and ensure completion of treatment Homelessness and other risk factors makes it difficult to follow up and ensure completion of treatment Management of TB, STDs, HIV, Hepatitis C and Substance Abuse : Focus on Testing

34. Summary Imperial County has highest rate of TB in California Imperial County has highest rate of TB in California High number of chronic hepatitis C reported annually High number of chronic hepatitis C reported annually Increasing rates of HIV and other STDs due in part to increased testing, improved surveillance and provider reporting Increasing rates of HIV and other STDs due in part to increased testing, improved surveillance and provider reporting Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing

35. Questions? Paula Kriner, MPH Imperial County Public Health Dept. (760) 482-4904 paulakriner@co.imperial.ca.us Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing