Service Area

1. Service Area Los Angeles County Ventura County

2. Epidemiology

3. Overview • Worldwide • United States • California • Los Angeles County

4. Worldwide • Since the beginning of the HIV/AIDS epidemic, 60 million people have contracted HIV and 25 million have died of AIDS-related causes. • In 2008, an estimated 2 million adults and children died from AIDS, a 10% reduction from the peak number of AIDS-related deaths in 2004. • As of 2008, 33.4 million people were living with HIV/AIDS worldwide. • The annual number of new HIV infections declined from 3.2 million in 2001 to 2.7 million in 2008. Still, more than 7,000 people contract HIV every day. • More than ½ of new infections are among those under 25 yrs of age. • Though not at the astronomical prevalence levels seen in Africa 4.4-4.8, The Americas, are still the second highest contributors (0.5) to the global prevalence rate of 0.8%.

5. United States • Since the AIDS epidemic began in 1981, 1.7 million Americans have been infected with HIV and 583,298 have died of AIDS-related causes through 2007 • 1.1 million Americans are living with HIV (including more than 468,000 with AIDS) • An estimated 21% of people living with HIV are undiagnosed • Every 9.5 minutes, someone in the U.S. is infected with HIV • Gay and bisexual men continue to bear the greatest burden of HIV infection, accounting for an estimated 53% of new HIV infections • African-Americans and Latinos are disproportionately affected by HIV and AIDS. Blacks accounted for 45% of new HIV infections in 2006 and 47% of those living with the disease, yet they make up only 12% of the U.S. population. Latinos account for 17% of new infections yet comprise 15% of the U.S. population, while whites represent 35% of new infections and account for 66% of the total population. • The AIDS case rate for African Americans is more than 9 times that of whites, and the HIV rate is 7 times greater among blacks than whites. Survival after an AIDS diagnosis is lower for blacks than any other racial/ethnic group. • Young adults and teens between 13 and 29 represent 34% of new HIV infections, the largest share of any age group. Black teens are disproportionately affected, representing 68% of reported AIDS cases among 13 to 19-year-olds in 2007.

6. United States • New infections due to injection drug use have declined by about 80% since the mid-to-late 1990s, accounting for 12% of new infections in 2006. • Women now account for 27% of HIV infections, with 280,000 women living with HIV and AIDS. Black women accounted for 65% of new AIDS cases among women in 2007 and the largest share of new HIV infections (61%). • 71% of all AIDS cases reported since the beginning of the epidemic are concentrated in 10 states or territories. While the District of Columbia has the highest AIDS case rate (148.1 per 100,000 in 2007), the states of New York (17.6%), California (14.4%) and Florida (10.6%) have the most cumulative AIDS case • 1,148,200 persons aged 13 years and older are living with HIV infections, including 207,600 (18.1%) that are unaware of their infection. • In 2010, there were an estimated 47,500 new HIV infections.  • Estimated 872,990 people in the US were living HIV in 2010

7. United States • In 2011, the estimated number ofdiagnoses of HIV infection in the United States was 49,273 • In 2011, the estimated number of persons diagnosed with AIDS in the United States was 32,052 • At the end of 2010, an estimated 487,692 persons in the United States were living with AIDS • The cumulative estimated number of AIDS through 2010 in the United States was 1,155,792 • Blacks/African Americans continue to experience the most severe burden of HIV, compared with other races and ethnicities • Blacks represent approximately 12% of the U.S. population, but accounted for an estimated 44% of new HIV infections in 2010. They also accounted for 44% of people living with HIV infection in 2009 • Since the epidemic began, more than 260,800 blacks with an AIDS diagnosis have died, including an estimated 7,678 in 2010 • Estimated 1 in 16 black men and 1 in 32 black women will be diagnosed with HIV infection • Hispanics/Latinos are also disproportionately affected by HIV. • Hispanics/Latinos represented 16% of the population but accounted for 21% of new HIV infections in 2010 • Hispanics/Latinos accounted for 19% of people living with HIV infection in 2009 • Disparities persist in the estimated rate of new HIV infections in Hispanics/Latinos. In 2010, the rate of new HIV infections for Latino males was 2.9 times that for white males, and the rate of new infections for Latinas was 4.2 times that for white females • Since the epidemic began, more than 96,200 Hispanics/Latinos with an AIDS diagnosis have died, including 2,370 in 2010

8. United States

9. California • The rate of diagnoses of HIV among adults and adolescents in 2011 in CA was 19.2 • CA reported the highest number of HIV diagnoses in 2011 • Nearly 200,000 Californians have reportedly contracted HIV/AIDS and nearly 90,000 have died since the epidemic began in the early 1980s • CA ranks 2nd in the nation to cumulative AIDS cases at 157,719, surpassed only by NY • Appr. 109,000 Californians are HIV-positive, among whom 69,728 are living with HIV • There are up to 7,000 new HIV infections in the state every year • 75.7% of all HIV/AIDS cases occur among gay men, far exceeding the 53% nationally • Men make up 89.5%. Women account for 9.8% of cases, and transgender persons for 0.6% • Of all HIV cases, whites account for 46.7%,Hispanics 29.2% and AA at 18.9%

10. California • HIV infection and risk behaviors are high among populations who are at-risk for incarceration, currently incarcerated, or recently discharged. The rate of new AIDS cases among the incarcerated population in the U.S. is estimated to be three times higher than in the general population. Further, 20-26% of the HIV-infected U.S. population is estimated to pass through a correctional facility at some point annually. Although HIV prevalence is lower among prisoners in California than in many other parts of the country, it is disproportionately high when compared to the general population. • 0.7% of California State and Federal prisoners are known to their prison systems to be infected with HIV and the HIV seroprevalence in California state prisons is 1.4% among males, according to an unlinked seroprevalence study conducted by the State Office of AIDS in 1999. This compares to an HIV prevalence of 0.03% for military applicants and 1% for STI clinic patients in California in 2000 • More than 60% of Californians living with HIV reside in Los Angeles County or the San Francisco Bay Area.

11. California

12. Los Angeles • LA County was a recipient of a Ryan White Part A HIV Emergency Relief Grant from HRSA • The rate of diagnoses of HIV infection among adults and adolescents in 2011 in Los Angeles was 18.1 • The total # of HIV cases reported as of June, 2012 is 17,991 with 17,170 living cases and 821 deceased. The total # of AIDS cases reported as of June, 2012 is 59,955 with 26,283 living cases and 33,672 deceased • Approximately 58,000 people are living with HIV in LA in 2013. Including 45,500 reported living with HIV; 10,500 people unaware of their infection; and of 4,200 notifications pending investigation approximately 2,000 will have detectable VL or a confirmatory test

13. Santa Barbara and Ventura Santa Barbara: • 2012 Cumulative HIV/AIDS cases = 1076, Total Deaths = 523. People living with HIV/AIDS = 553 – primarily 30-39 yrs, male, MSM/BI and Latino • HIV/AIDS cases have steadily risen since 2010 Ventura: • As of December 31, 2010, 1,146 reported cases of AIDS with 599 deaths, 337 cases of HIV reported • In 2010, Ventura County Public Health’s (VCPH) HIV/AIDS Surveillance reported 61% of the new cases of HIV were white and 32% were Hispanic while 54% of the AIDS cases were white and 32% were Hispanic. White and Hispanic males continue to be the largest population of new cases. • The primary mode of HIV transmission is MSM (70%) and in women is heterosexual contact (60%). • The largest % of cases reported have been between 30-50 yrs. AAs account for barely 3% of the population but account for 4% of HIV/AIDS cases in 2010

14. Epidemiology – Los Angeles

15. Epidemiology – Los Angeles Los Angeles County’s Comprehensive HIV Plan (CHP) (2012-2014), prepared by the Los Angeles County Commission on HIV and the County of Los Angeles Public Health Department, lists Los Angeles’ most vulnerable populations as those most impacted by: • Poverty • Lack of insurance • Unemployment • Mental illness • Substance abuse • Homelessness The CHP also highlights communities of color as they are the most impacted by the epidemic and they comprise the majority of all people living with HIV/AIDS as well as those who are newly diagnosed.

16. Epidemiology – Los Angeles • African Americans/Blacks • Currently/Chronically Homeless • Incarcerated/Formerly Incarcerated • Latinos • Men of Color Who Have Sex With Men (MSM • Mentally Ill (severe, persistent mental illness • Monolingual Latinos: • American Indian/Alaska Native • People with Sensory Disabilities/Impairments • Sex Workers/People Engaged in Survival or Exchange Sex • Injection Drug Users (IDUs) • Transgender Individuals • Undocumented Latinos • Women • Youth/Adolescents To add to the list of vulnerable populations above, the 2010‐2011 Los Angeles Coordinated Needs Assessment‐Care (LACHNA‐Care) project outlines 15 “special populations of interest” with special HIV care and service needs.

17. Needs Assessment • In 2012 a collaborative LA Region LPS needs assessment was conducted via Survey Monkey • 165 health providers responded • Approximately ½ were from Ryan White funded agencies • 67% were female and 32% male • 67% provided HIV services directly to clients • The data was analyzed and popular training topics were extracted and LA Region LPSs responded programmatically • A question about the preferred method of delivery was also included in the survey. Results showed: • Workshops 87.5% • Consultations/Case reviews/Case presentations 67.8% • Clinical experience 56.0% • Web training 54.3%