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HomeMy WebLinkAboutMINUTES - 09221992 - 2.5 TO: BOARD OF SUPERVISORS I'O' - 1 sE l Contra r . FROM: INTERNAL OPERATIONS COMMITTEE •,�=-�. Costa 01. 40� County DATE: September 17, 1992 SUBJECT: STATUS REPORT ON THE AIDS AND TUBERCULOSIS (TB) EPIDEMICS IN CONTRA COSTA COUNTY I SPECIFIC REOUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS :. � 1 . Accept the attalched report from the Health Services Department on the recent history of the AIDS and TB epidemics in this- County. 2 . Request the Health Services Director to prepare and forward to each member of the Board of Supervisors a "Fact Sheet" on 'AIDS and TB and the interrelationship between the two diseases which can be used as a public education tool by Board members. and others in the community. 3 . Endorse the recommendations made by the Health Services Department regarding actions which should be taken by the Health Services Department in response to the TB epidemic as outlined on page 8 of the attached report. 4 . Endorse the recommendations made by the Health Services Department regarding actions which should be taken by the Health Services Department in response to the AIDS epidemic as outlined on pages 14-15 of the attached report under the section titled, "What do we plan to do in response to these findings? 5 . Request the Health Services Director to report back to our Committee on this subject at our meeting on December 14, 1992 . CONTINUED ON ATTACHMENT: • YES SIGNATURE: RECOMMENDATION OF COUNTY R RECOMMENDATION OF BOARD COMMITTEE APPROVE H k SIGNATURE s : ODER SUNNE WRIGHT McPEAK ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED S k 2 2 1992 Contact: Francie Wise, 313-6740 PHIL BATCHELOR,CLERK OF THE BOARD OF CC: SUPERVISORS AND COUNTY ADMINISTRATOR Please see Page 2 . BY DEPUTY I.O. - 1 -2- BACKGROUND: Our Committee last reported to the Board of Supervisors on this subject on May 19, 1992, at which time the Board asked the Health Services Director too prepare another report to our Committee for September 14, 1992 . On September 14, 1992, our Committee met with Dr. Wendel Brunner, Director of Public Health; Francie Wise, Director of Communicable Diseases for the Health Services Department; and Rusty Keilch, AIDS Program Director for the Health Services Department. Dr. Brunner reviewed the attached report with our Committee. In addition to the points made in I the report, Dr. Brunner noted that staff are increasingly running into drug-resistant strains of TB. While this is common on the East Coast, it has not been seen that much in this area. If this tendency spreads, the County could be back where it was in the 1930 's an'd 1940 's, with no effective tools with which to attack the drug-resistant strains of the disease. Francie Wise added - that the U.S. Immigration and Naturalization Service does not appear to be doing an effective job of enforcing the quotas on immigration from countries where TB is endemic. The impression of the workers in the field are that the majority of Asian TB patients in this County are Laotian. These immigrants do not have access to federal paid for health care through the Medi- cal Program and thus generally become a County charge. Immigrants are supposed to have a sponsor who is supposed to be responsible for the individual until the immigrant can become self-supporting in the United States. All to often, it is impossible to locate the sponsor. On the other hand, refugees are eligible for Medi-Cal and are provided at least some support by the federal government. Dr. Brunner again emphasized the close interrelationship between AIDS and TB. The HIV virus weakens an individual ' s immune system, making the individual more susceptible to TB, among other diseases . Dr. Brunner advocated that everyone who is HIV positive should be tested for TB and everyone who is tested as positive for TB should be screened for HIV. Supervisor Schroder noted his interest and concern about the level of public education in regard to TB. A number of churches, for I instance, have agreed to provide assistance in homeless shelters, an environment where diseases which can be spread as easily as TB can be spread rapidly. These church workers need to have some simple, straight-forward facts regarding what precautions they should take, how TB is and is not spread and what additional medical care such volunteers should seek, such as annual TB tests . Our Committee is endorsing the recommendations contained in the attached report. In addition, we asked Dr. Brunner if he and his staff could prepare a very simple, one-page, fact sheet which Board members and others could share with groups in the community as a part of the obviously needed public education campaign regarding TB and AIDS so that we can assist in this education effort. Dr. Brunner indicated that such a fact sheet could be prepared and distributed to Board members and others on request. cc: County Administrator Health Services Director Director of Public Health Francie Wise, R.N. , Director of Communicable Diseases, HSD Ob:,:.UF-M. rKUP1 l -L h'UbL I1, HtHL I H I U JIZU2'bt'J44'J2 P.02 a Contra Costa County Health Services Department r, Public Health Division • # '• COMMUNICABLE DISEASE CONTROL ;0 597 Center Avenue, Suite 200A Martinez, California 94553-4669 (510) 313-6740 September 8, 1992 To: Mark Finucane, Director From: Francie Wise°*' Subject: Communicable Disease Report to the I. O. Committee Attached is the communicable disease report to the I, O. Committee of the Board on September 14. It which should go to Claude VanMarter tomorrow. Please call Wendel or me with your comments. Thank you. I I 09-09-1992 08:50A•1 FROM CCC PUELIC HEALTH TO 912026594492 P.03 September 10, 1992 To: Internal Operations Committee From: Mark Finucan c, Director, Health Services Department by Wendel Brunner, M.D., Assistant Health Services Director for Public Health Subject: Quarterly Report rt on Communicable Diseases Attached is an update of tuberculosis and AIDS issues in the last quarter. As you will note: • The incidence of TB cases in the County for 1991 was 13.2 cases per 100,000 while the nationwide objective for TB incidence by the year 2,000 is not more than 3.5 cases per 100,000 population. • Of all recent cases of TB reported in Contra Costa County, 32.6% occurred among Asian residents, 29% among African American residents; 12% were among Hispanics and 26.3% were among non-Hispanic Whites. • Most TB cases among Asians and Hispanics were among foreign-born residents of Contra Costa. Almost all cases among African Americans were U. S. born. i • Contra Costa County is part of a national and statewide epidemic of tuberculosis which is now often associated with HIV infection and homelessness. In 1989 the national incidence of tuberculosis per 100,000 population was 9.1 cases. The rate for the State of California was 12.5 per 100,000. The Contra Costa rate was 12.9 per 100,000. • The Public Health Division is coordinating with researchers from the University of California San Francisco to provide TB testing,to 200-250 out-of-treatment injection drug users in West County.I Those who accept the test will be screened and referred to special clinics for follow-up a examinations if testing positive. • 'There are currently 797 cases of AIDS in the county; 531 have died. 09-09-1992 08:50AM FROM CCC PUBLIC HEALTH TO 912026594492 P.04 Reporr to the internal Operations Comrnirrer September 10, 1992 On CommuWcabte Disuse in Contra Costa Cvunty Page 2 • Six cases of AIDS are under 12 years old. Of those, two are White; one is African American; three areHispanic children. Of the six, three boys were infected through transfusions; three girls were infected by prenatal transmission. • Of the adults and adolescents with AIDS, two-thirds 528 are White; 22% (176) are Black; 10% (77) are Hispanic; and one percent (8) are Asian/Pacific Islanders. • Forty-seven females have been diagnosed with AIDS. Of those 51% (24) are injection drug users; 36% (17) have been infected through heterosexual transmission; 11% (5) were infected through transfusion. • Approximately one in three African American drug injectors in Contra Costa County is � y { now infected with XIV. • African American drug injectors entering treatment are 18 timr§ more likely to be HIV infected than white ding injectors entering treatment in Contra Costa. • HIV is spreading rapidly among inner-city African American drug users and also potentially to their sexual. partners. Knowledge is lacking about risk reduction. Clean needles are unavailable. Most drug users are not appropriately cleaning their needles and are also not using condoms. • Added to the substantial economic difficulties that exist in inner cities and multi-drug dependency, there is insufficient awareness of personal risk for HIV infection. This lack of awareness is in spite of major educational efforts focused on this very high risk population. • If the spread of HIV is not dramatically curtailed soon, the African American injection drug using population could be saturated with HIV, with levels of infection found on the Fast Coast of the United States (60%'0-70%) by 1996. 0: 4-Oy-1592 08:51AM FROM ;CCC PUBLIC. HEALTH TO 91202659449 P.01--', Report to the Internal Operations Committee September 10, 1992 On Communicable Disease in Contra Carta County Page 3 TUBERCULOSIS This tuberculosis report is an update to the May 11, 1992 report to the Internal Operations Committee. At this time, we are introducing a new approach to the analysis of health problems affecting Contra Costa County communities. Specific health problems/indicators will be reviewed in the context of the National Health Promotion and Disease Prevention Objectives, "Healthy People 2000," developed by the U. S. Public Health Service. Cases of a specific disease will be analyW by incidence per 100,000 population and compared to national standards expected for the year 2,000. The analysis of local trends should help the county evaluate the extent to which the year 2,000 health objectives will be reached and design interventions which specifically target local needs. The local effort will Have the added dimension of being part of a nationwide endeavor. Gradual and progressi�a reduction in the incidence of disease is always a more realistic approach and often one that !helps to recruit the interest and support of related agencies and members of the community. EA health objective has to be reasonably reachable to be supported and accepted as a worthwhilel cause. The tuberculosis objective for the year 2,000 for instance does not propose the complete elimination of TB by that time. It proposes a significant reduction in its incidence. For public health, the challenge of the present decade is to be able to mobilize all possible and pertinent resources within health services organizations, service providers, and community-based organizations to advance toward these health objectives for the year 2,000. The challenge of today is to say "we can go forward" in a moment when not only the financial resources are fewer, but when many factors facilitating disease transmission seem to be increasing. We have included recommendations developed within this framework. These recommendations are very specific and most require very little additional funding. We hope that they take us forward to reach the objectives for the year 2,000 in tuberculosis control. Additionally, we hope that the picture of the gradual progress needed to reach these objectives will stimulate the involvement of other services providers and communities. Nationwide we have seen large increases in the number of TB cases since 1985. In 1988, the incidence of cases per 100,000 population was 9.1. The incidence in the State and in Contra Costa County were 12.5 and 12.9 respectively. 1 i I f 09-09-1992 oe:51AM FROM CCC PUBLIC HEALTH TO 912026594492 P.©6 Report to the Internal Operation Committee Septanber 10, 1992 On Communicable Disease in Contra Carta County Page 4 INCIDENCE RATES FOR TUBERCUTASIS National Objective: 'YIr�AIt 2 0 OII E 'I? 'Ei RED►UCE TI 'B WTO..AkfiC DE1 OF NO MORE THAM 13�'E�t W1.0' 'POP LA'TION: Table TB-1 INCIDENCE RATES FOR TUBERCULOSIS CONTRA COSTA COUNTY, 1981-1991 * Year Cases Incidence Rates per 100,000 Population 1981 50 7.5 1982 44 6.4 1983 55 7.9 1984 43 6.0 1985 60 8,2 1986 48 6.4 1987 60 7.9 1988 100 12.9 1989 120 15.2 1990 103 12.8 1991 108 1 13.2 *Source: Communicable Disease Control Section * Public Health Division* Contra Costa County Health Services Department. Casts by year of diagnoXs. Highlights In the seven year period 1981-1987 the incidence of tuberculosis remained stable at approximately seven cases per 100,000 population. After 1987, the yearly incidence almost doubled, and in 1989 the epidemic peaked. There has been a small decline in the incidence since the peak in 1989 but there is not enough evidence that this decline is a significant one or that it will continue. These data suggest that it will be unlikely for Contra Costa County to reach the year 2,000 objective without additional surveillance and treatment efforts. Deteriorating trends in the economy and concurrent epidemics of HIV and drug abuse, particularly crack cocaine, present added difficulties in meeting the objective. 09-09-1992 06:52AM FROM CCC PUBLIC HEALTH TO 912026594492 P.07 Report to the Internal Operations Committee September 10, 1992 On Communicable Disease in Contra Costa County page 5 Table TB-2 PROJECTED REDUCTIONS IN TB INCIDENCE NEEDED TO REACH THE YEAR 29,000 OBJECTIVE Year Prvg essively declining incidence Xearly case abjves rates per 100,000 needed to : .tb:'advance tic::the meet the ;year:2,000 objective year 2,000 objective 1991 13.16 I08' 1992 12.08 1993 11.01 94 . 1994 9.94 87. 1995 8.86 77 . 1996 7.79 '7Q .. .. 1997 6.72 1998 5.64 1999 4.57 2000 3.50 3t* . The figures in the shaded column of table TB-2 represent yearly case objectives for a gradual progression towards the year 2,000 objective. Initially, augmented surveillance efforts may produce cases which typically go undetected and this could result in an increase in the incidence during the first years of augmented surveillance. Nevertheless, the treatment of these cases should produce significant reduction of the incidence in the longer run, hopefully by the year 2,000. Figure TB-1 OBSERVED INCIDENCE OF TUBERCULOSIS AND YEARLY INCIDENCE OBJECTIVES FOR CONTRA COSTA COUNTY (Ail residents) Now cases per 100,000 i 14 ' 12 10 6 -- — _ _ - -- --._._...._ -.......... 4 Your 2000 vb!•ctive 2 0 198182 88 84 .85 88 87 88 89 80 9/ 99 93 94 96 96 87 98 992000 Year .09-09-1992 09:52AM FROM CCC PUBLIC HEALTH TO 912026594492 P.02 Report to the Internal Operations Committee September 10, 1992 On Communicabk Disease in Contra Costa County Page 6 TB INCIDENCE RAM FOR SPECIAL POPULATION TARGETS The National Health Promotion and Disease Prevention Objectives,Healthy People 2000, also established specific objectives for special target populations. For tuberculosis control they are as follows: REDUCE'T`LtBERCUTASIS:TO ANN WENCE,OF'N�"14tttYtE �AI�I. 15 pER 100,000 ASIAtiPACa...'iC 3SLANDER . >l t.;1�0;000. il►FRIC, N,d, R�CAfiT 10 .. Table TB-3 1985-1990 Average TB incidence rates per 100,000 Special Target Population Contra Costa County Special Target Population Population size * ;185-; 9b .:.:; Year 2,000 objective 'aiiee per 100,000 i0i30 lat�on '....:. PoWi Asian/Pacific Islanders 73,810 " '33'' African American 72,799 10 Hispanic I 91,28295 :: : `:`' 5 I White I. ** (Not HisPa nuc� 560,146 ''.';:: 3.5 * 1990 Census D,to ** For eontparison. Not special target population. *** Data provided by the California Department of Health Services Tuberculosis and Refugee Health Unit. Data for a sir year reporting period aggregated and averaged;data collected by the State by year of report. { 09-09-1992 06:53AM FROM! CCC PUBLIC HEALTH TO 912026594492 P.09 Report to rhe rnternal Operations Committee &ptemba IO, 1992 On Commwdcabk Disease M Contra Costa Cottnry Page 7 MOWS In recent years (1985-1940) there were 438 cases of confirmed tuberculosis reported to the California Department of Health Services by Contra Costa County. Figure TB-2 describes race/gender distributions and Figure TB-3 describes the distribution by place of birth and racelethnicity. Of all rases reported 32.6% of the recent cases occurred among Asian residents, 29% among African Americans, 12% among Hispanics and 26.3% among non-Hispanic Whites. Most cases among Asians andl Hispanics were foreign born residents of Contra Costa County. Almost all cases among Afz7ican Americans are US born. Characteristics of Contra Costa County TB Cases Reported between 1"S and 1990 Figure T9•2 ,00 Iis so 4.3 x0 ` Q Aiia+ jVoo A AMWW" lNiiiiNi wa""igiiiii WM" Mab i Figure T13-3 ISO so I a Alliin AftW"Awwio" lihiniie IbMNsixnio WMft so orwown Yan Q us iota i Reporr to the Internal Operations Committee September 10, 1992 On Communicable Disease in Contra Costa County Page d Recommendations for TUbereWosis Control 1. Identify possible noncompliant TB patients and place them on directly observed therapy. 2. Increase TB screening activities among African American residents, particularly in , g 1� Y sectors of this population affected by drug use and HN. (The Public Health Division is coordinating with social researchers from the University of California San Francisco/Urban Health Study efforts to screen for TB through PPD testing of the 200-250 out-of-treatment injection drug users who are surveyed every six months in West County. The first of these screenings.will occur this month. Injection drug users who voluntarily accept the TB test will be screened and referred to special clinics for follow-up examinations if tested positive. Injection drug users who are in treatment for drug use are screened for TB on admission.) 3. Intensify the communication between the Public Health Division and other health care providers serving Asian communities in order to gain their cooperation for tuberculosis monitoring. Additionally, encourage key members and community-based organizations (i.e., Lao Family Community) in each of these communities to educate all clients regarding TB. 4. Augment the availability of TB clinic services for cases as well as for case contacts and skin test converters. S. Assure that all HTV/AIDS counselors and case managers educate clients testing positive to HIV on the value of initial and periodic skin testing to evaluate past or recent infection with TB as well as on the value of early prophylactic treatment to avoid TB illness at later stages of HIV disease. 6. Intensify education to school children about tuberculosis. Recruit the children as messengers to families. 7. Mandate and facilitate periodic TB screening at homeless shelters and soup Idtchens in the county. i 09-09-1992 02:54AM FROM CCC PUBLIC HEALTH TO 912026594492 P.11 Rcpon to the Internal Operations Committee Septanber 10, 1992 On Communicable Disease to Contra Costa County Page 9 Ams AIDS Cases Reported in Contra Costa As of September 3, 1992, 797 AIDS cases had been reported to the repo Public Health Division. Of those, six are children; three boys and three girls; five are under five years old; one is between the ages of five and 12 years. Two of the children are White; one is African American; three are Latino. Three of the children were infected through transfusions of blood or blood products; threewere infected prenatally. Of the 791 adult cases, 47 are women. Of uses among females, 42 are injection drug users; 17 were infected through heterosexual transmission and five were infected through transfusion. Of the 791 cases among men, 74% are gay or bisexual men; 11% are injection drug users; 43 are gay or bisexual and have a history of injection drug use. Two were infected through heterosexual contact land 22 were infected through transfusion of blood or a blood product. AIDS Cases by City of the County As of September 3, 1992, Richmond continues to be the city in Contra Costa County with the highest number of AIDS cases with 174 cases. Concord and Walnut Creek are second and third with 128 and 87 cases repectively. Pittsburg now has 75 cases of AIDS. CONTRA COSTA COUNTY AIDS CASES BY CITY (Cities with five or more cases) Oak Rode 1 Alamo Olayrto Kenai ton y. �ff114to r„ Jr ,on ISO . p``afayet� � ilotifl�l ea »:� PFeaeant Miil �• Martinez ++ sPmtioch sb ID �» r• Walnut Creek r CConcord :♦ RtehfMOf►C n. O 60 100 150 200 PWA AS of Uptember 3, 1202 in-707h Anoth#r a von em*4 hset fthan thh*&"a �aeh. 09-09-1992 06:54AM FRO11CCC PUBLIC HEALTH TO 912026594492 P. 12 Reporr to the Internal Operations Committee &ptember 10, 1992 On Communicable Disease in Contra Costa Commy Page 10 HIV Infection Among African American Injection Drug Users Two kinds of HIV seroprevalence surveys have taken place in Contra Costa. One is conducted by the Health Services Department AIDS Program. This survey is an ongoing clinic- based, blinded (unlinked) survey of all injection drug users in treatment in certain clinics in the county. The protocols of this survey were developed by Centers for Disease Control which is also the funding source for the study. The other study, conducted by the U. C. S. F. Urban Health Study, was a street-based survey of injection drug users who volunteered to participate in the study. Both studies were undertaken in order to assist us in monitoring injection drug users - a population known to be at high risk for HIV infection. Nationwide, the high rate of HIV among this group is called the second wave" of HIV and follows the high rates of infection among gay and bisexual men. High rates of infection among injection drug users are seen as a warning sign that HIV may be spreading to the larger community - especially to women who may be sexual partners of injection drug users and consequently to their newborn infants. In Contra Costa, both of these surveys were inclusive of injection drug users of all races. The particularly serious prevalence of HIV among African American injection drug users became evident in both surveys. We know that only a fraction of all injection drug users are in treatment at any given time. Therefore, data from the in-treatment and out-of treatment surveys complement each other to give us a better picture of the epidemic in our county. The clinic surveys have been in effect in our county since 1989 in clinics in Richmond and Pittsburg. In these surveys, 773 unduplicated injection drug users in treatment were tested in 1991. The street-based survey has been conducted in September 1991 and March 1992 in the City of Richmond. In September 1991, 218 injection drug users were sampled. What have eve learned fro I these surveys? Seroprevalence is thel level of infection in a population. As theraP h below indicates, g in 1990 we saw that 10.9% of all injection drug users included.in the clinic survey were HIV infected. Among African Americans in the same group, 32.7% were infected --almost one third compared to slightly over one tenth. The numbers were even worse in the following year, 1991. In 1991, 13.5% of all injection drug users included in the clinic surveys were HIV infected, compared to 38.5% of African Americans. Among injection drug users surveyed in the street- based study in Richmond, 26.6% of daily injectors were found to be infected. The similarity of the overall seroprevalence levels in both surveys, strengthens the conclusion that the prevalence of HIV among African American lWection drug users is approximately 30%. P. 13 Report to the Internal Operations Committee Sepreinber 10, IW2 On Commwdcable 1 U&ve in Contra Costa County Page 11 1990-91 AIV-1 Seroprevalence, of all injection Drug Users (IDU) and of African American IDU, Contra Costa County I ua� aa� :ssw i IG1� 06 , ssn► sirsi M AN rou Cl Arm Awaims uw The rates are comparably high among both men and women and in different geographic regions of the county. i We can clearly see the serious picture of seroprevalence among African American injection drug users when we compare those rates to the seroprevalence levels of other races. In 1991, when the seroprevalence rate of African Americans in treatment was 38.6%, the seroprevalence among Latino injection drug users was 7.336 and the seroprevalence among white injection drug users was 3.3%, These clinic seroprevalence rates may not represent the level of infection among all injection jdrug users because of policies giving preferential admission to drug treatment clinics to injection drug users who are infected with HIV. These policies may tend to create a clinic-based 'sample with too many HIV-positive clients resulting in an overestimation of the true prevalence of HIV. Nevertheless, the 1991 seroprevalence data based on the clinic surveys showed that African American injection drug users were j$ tim_es more_Akely to be infected than white injection drug users, .I We estimate that there are approximately 1,200 African American injection drug users in the County (26% of all injection drug users) and 360 (30%) are estimated to be BW infected now. 4f these, 69 have already been diagnosed with AM$and the 1991 rate of AIDS diagnosis among African American injection drug users was double the rate of diagnosis from the previous three years. In contrast, we estimate that 64% of all injection drug users in the County are white, and that three percent of Ithem are currently infected. 1 Report to the Internal Opemdons Committee September 10. 1992 On Communicable Disease to Contra Costa County Page 12 i 7 Seroincidence is the number of new infections occurring in a certain period of time(year)among the susceptible population. Here, too, we see very disturbing rates among African American 14ectlon drug users. As the chart below demonstrates, we know that at-least 15 of 142 African American injection drug users who entered treatment in Contra Costa County in 1991 and were not infected a year ago became HIV infected in the twelve month period preceding their admission to treatment. This Irepresents, for African American injection drug users In our County, jL r year. RM-1 Seroprevalence and Seroincidence in African American IDU in Treatment, Contra Costa County, 1991 JRfW a wM kftw 4401 I Nat Mteated(127) infeated without test 014 yur i rlpativa test Year 1 intaoted now i 151 Seroprevalence = 38.6% (80 of 207) Seroincidence = 10.5% (15 of 142) A rate of new infections of at lust 10.S% per year is extremely .high and especially alarming at this stage of the HIV epidemic in California. The estimate of seroincidence of 10.5% per year;is only a minimum -es . If unstopped at the 10.5% rate, 90 new infections of HIV among African American injection drug users will occur in 1992 alone. I 09-09-1992 06:56AM FROM CCC PUBLIC HEALTH TO 92026594492 P.15 Report to the Internal Openvions Comrninee September 10, X992 On Commuwucabk Disease in Contra Costa County Page 13 Charactedstla of the mmupmon-Atijak Of the 218 people surveyed in the street-based survey in the.City of Richmond, 90% were African Americans. Of the 218 surveyed, 61% were high school graduates; 28.5% considered themselves to be homeless. Thirty percent stated that they began using heroin as teenagers; 21% had begun injecting cocaine as teenagers. Most injection drug users are multi-drug users or have used various drugs in the past. Of those surveyed, 85% used clack, 88% injected cocaine and 88.5% injected heroin. Twenty-six percent of the sample (55 IDUs) had_shared a_needle from someone else Burin¢ the last month. A "shooting gallery" - a known location where groups of users inject drugs - seems to have been used less frequently by drug injectors over the last year: While 44.5% of the sample had used a shooting gallery at least once in the past, 85.3% had not used a shooting gallery in the last year and 92% had not used a gallery in the last month. Thirty-nine percent of the sample stated that they had never been in a drug treatment program. Eighty-six percent of the sample had not tried to enter a drug treatment program in the last year. Thirteen percent (28) had tried to enter a drug treatment program, but were unable. Of those 28, 19 were placed on a waiting list; eight others did not have the funds to pay for treatment. Regarding behaviors known to reduce the risk of HIV infection, sixty-three percent of the sample of injection drug users who were sexually active stated that they never use a condom. Of the 55 who had used a needle from someone else during the last month, 69% (38 IDUs) had used at least once without cleaning or used water only (not bleach) for the cleaning of the needle. In spite of what seem like obvious high risk behaviors (both unprotected sexual activity and needle sharing among injection drug users), over 70% of those surveyed stated that they had little or no chance of acquiring AIDS. Less than ten percent believed that they were at high risk for AIDS. In spite of our four year program which has included three full time community health outreach workers - two of whom work in Richmond - and the availability of HIV/AIDS education and testing at the drug treatment clinics and in Public Health clinics, over 30% of those surveyed in the street-based survey stated that they had never received AID_ S information from An„yonelin the community. Of those who had learned about the risk for HIV from sharing needles, 712% had learned risk reduction information in the last five years. Over 13% had learned this information only in the last year. These numbers are staggering given that we are in the second decade of AIDS. ! F�7-177-177 UbentHl'I t-KUI'I V-A- r-UZLl1. rr-HLIrl IU 71�L�b�`J44`.jc N.1b Report to the Internal Oporwlom Commi tee Septea+ber 10, 1992 On Communimble Disedue in Gonna Costa County Page 14 M19 does this information mean to us? • Approximately one in, three African American drug injectors in Contra Costa County is now infected with HI . • African American drug injectors entering treatment are 18 times more likely to be Hry infected than white drug injectors entering treatment in Contra Costa. • HIV is spreading rapidly among inner-city African American drug users and also potentially to their sexual partners. Knowledge is lacking about risk reduction. Clean needles are unavailable. Most drug users are not appropriately cleaning their needles or using condoms. 1 • Added to the substantial economic difficulties that exist in inner cities and multi-drug dependency, there is insufficient awareness of personal risk. This lack of awareness is in spite of major educational efforts focused on this very high risk population. • If the spread of HIV is not dramatically curtailed soon, thispop ulation could be saturated with HIV, approaching levels of infection found on the East Coast of the United States (60 - 709 ) by 1996. • The lifetime cost of treating an additional 500 people for HIV/AIDS related conditions will be over S40 million. The amount of suffering by these persons and their families is immeasurable. What do we pian to do in I posse to these fin i ? • Escalate coordinated efforts between the Public Health and Substance Abuse Divisions to secure Federal and State funds to support augmented oufreach and education efforts to this population with linkages to drug treatment and clinical services. • Continue efforts to obtain State funding for an outdoor media campaign about the risks of AIDS from injection drug use and methods known to decrease those risks. In the absence of State funding, produce a media campaign at little or no cost. • Initiate community forums to discuss the feasibility of needle exchange programs in the most affected areas of the county. • Continue efforts to involve city, community and church leaders to enlist their leadership, networks and members to assist us in getting AIDS prevention messages delivered in the most affected areas of the county. • Study reordering funding priorities to include more targeted outreach to African American injection drug users and their partners. LJ�-IJy-1 yy� ub;�'(HM h-KUM UUU t UeL l U HtHL I H J U 912026594492 P.17 Report to the Internal Operations C,ommiaee Sepmnber 10, 1992 On Com muntcable Disease In Contra Costa County Page 1S • Work with all divisions within the Health Services Department to ensure that HIV prevention messages to African American clients are a priority of X11 service delivery programs. • Encourage and enlistsupport from other county departments in efforts to reach African American drug users with HIV prevention messages. 0 Pursue efforts to increase drug treatment options for drug users. I i TOTAL P. 1r