HomeMy WebLinkAboutMINUTES - 12071993 - IO.5 TO: BOARD OF SUPERVISORS 1 .0.-5 Contra
..
FROM:
INTERNAL OPERATIONS COMMITTEE Costa
lJ
°:. i5
November 22 1993 County
DATE: � CosTq �*
SUBJECT: STATUS OF COMMUNICABLE DISEASES IN CONTRA COSTA COUNTY
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS:
1 . ACCEPT the attached quarterly report from the Health Services
Director on the status of Communicable Diseases in Contra
Costa County.
2 . EXPRESS the Board's appreciation to all of the staff from the
Health Services Department who are responsible for the
excellent and informative "HIVlAIDS EPIDEMIOLOGICAL REPORT" ,
a copy of which is attached, which has been distributed widely
to individuals and organizations concerned with AIDS and HIV.
3 . ACKNOWLEDGE the prompt and accurate diagnostic work done on a
recent case of human rabies at Merrithew Memorial Hospital by
nursing staff from the Health Services Department.
4 . REQUEST staff from the Health Services Department to contact
staff from the Office of Oakland Mayor Elihu Harris and
explore the potential for Mayor Harris ' proposal for an East
Bay AIDS Foundation, developed jointly by Alameda County and
Contra Costa County and . report their findings and
recommendations to the 1994 Internal Operations Committee.
5 . REQUEST the Health Services Director to make his next
quarterly report on the subject of communicable diseases to
the 1994 Internal Operations Committee and for this purpose
and for the purpose of receiving the report requested under
Recommendation # 4, refer this subject to the 1994 Internal
Operations Committee.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S): STTNNF. WRTAHT .MCPF.AK ,TEFF SMTTH
ACTION OF BOARD ON Derember •I . 1 9 9 3 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
Contact: PHIL BATCHELOR,CLERK OF THE BOARD OF
cc: See Page 2 SUPERVISORS AND COUNTY ADMINISTRATOR
BY DEPUTY
1
I .O.-5
-2-
6 . REMOVE this item as a referral to the 1993 Internal Operations
Committee.
BACKGROUND:
Our Committee has been receiving quarterly reports on the status of
communicable diseases from the Health Services Director throughout
1993 . Attached is the latest of these reports . We would
particularly call to the Board's attention the excellent "HIV/AIDS
Epidemiology Report" , which provides a variety of statistical data
on the source of the HIV/AIDS epidemic, the characteristics of AIDS
patients, the populations which are most at risk and other
important data which needs to be studied and understood in order to
grasp the full scope of the AIDS epidemic in this County.
The Health Services Director's report also highlights the growing
problem of tuberculosis and the steps which are being taken to try
to control the spread of the disease.
Finally, we would like to note the outstanding work done recently
by the nursing staff at Merrithew Memorial Hospital in diagnosing
a very rare case of human rabies. A man from Mexico, who had
apparently been bitten by a rabid dog in Mexico and who did not
seek treatment at that time, was visiting in the United States when
he became ill . Displaying a number of fairly common symptoms, the
man eventually came to the attention of the nursing staff at
Merrithew Memorial -Hospital, who promptly diagnosed his symptoms as
a case of human rabies . Unfortunately, the diagnosis was too late
to safe the life of the man. It was, however, very helpful in
limiting the potential exposure of other staff and visitors to the
disease, thereby substantially limiting the number of individuals
who must undergo the preventive treatment for exposure to rabies .
cc: County Administrator
Health Services Director
Public Health Director
Francie Wise, Director, Communicable Disease Control
Contra Costa County
The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR
Tom Powers, 1st District Mark Finucane, Director
Jeff Smith,2nd District �E-'s""""L• o
Gayle Bishop,3rd District r_ "� 20 Allen Street
Sunne Wright McPeak,4th District f - Martinez,California 94553-3191
Tom Torlakson,5th District (510)370-5003
FAX(510)370-5098
County Administrator
Phil Batchelor �oSrq cdi kt t cPy`
County Administrator
November 18, 1993
To: Internal Operations Committee
From: Mark Finucane, Director, Health Services Department
by Wendel Brunner, M.D., Assistant Health Service Director for Public Health
Subject: Quarterly Report on Communicable Diseases
AIDS
CURRENT AIDS CASES IN CONTRA COSTA COUNTY
As of November 11, 1993, a total of 1,236 residents of Contra Costa County have been
diagnosed with AIDS. This number represents 77 new cases reported since our last report to
this committee on August 4, 1993. The increase (5%) is primarily due to cases diagnosed under
the new and expanded AIDS surveillance case definition.
HIV/AIDS EPIDEMIOLOGY REPORT
During recent months more than 2,500 copies of a report on the epidemiology of the
HIV/AIDS epidemic in Contra Costa County have been distributed to health care providers,
community organizations, city officials and others throughout the county. Data pertinent to
Contra Costa County was gathered from different sources and made available to the community
for information, education, planning and grant applications. In addition to HIV/AIDS incidence
and prevalence data, information was included describing aspects of the local response funded
by the Ryan White CARE Act in terms of services provided to people with HIV/AIDS, the
financial status of the recipients of assistance and reports of unmet needs. Copies of the
HIV/AIDS Epidemiology Report are included here.
RESULTS OF THE 1992 HIV SURVEY OF CHILDBEARING WOMEN
The California Department of Health Services has provided Contra Costa County with
the results of the 1992 HIV Survey of Childbearing Women. Every year since 1988, the blood
of all babies born during the third quarter of the year is tested for HIV to assess the prevalence
of HIV among the mothers of these babies. The babies born to infected mothers have a 30%
chance of being infected.
Merrithew Memorial Hospital&Clinics Public Health • Mental Health • Substance Abuse Environmental Health
Contra Costa Health Plan Emergency Medical Services. • Home Health Agency Geriatrics
Report to the Internal Operations Committee Page 2
On Communicable Disease in Contra Costa County
Contra Costa County has had higher rates of HIV than the State as a whole, a'trend
observed in other San Francisco Bay Area counties as;well. During 1992, four women out of
3,258 delivering babies during the third quarter were found to be HIV infected. This is the
same number, of infected mothers found in 1990 and 1991. _The rate for 1992 was 0.123%,
which is equivalent to one women infected in every 815. In 1992, two (50%) of the infected
women delivering babies were teenagers (19 years of age or younger). All four of the women.
were African American.
HIV Seroprevalence Survey of Childbearing Women
Contra Costa County
1988 1989 1990 1991 ;1992 1988-92
Number 3029 3261 3245 3406 3258 16,199
Tested
Positive 2 9 4 4 4 23
Rate per 6.60 27.60 12.33 11.74 12 28 14.19
10,000
AMERICAN JOURNAL OF PUBLIC HEALTH ARTICLE ON HIV TESTING AMONG CONTRA COSTA
COUNTY INJECTION DRUG USERS
In the October 1993 issue of the AmericanJournal of Public Health an article by
members of the Public Health Division, Communicable Disease Control Programs reported
findings on the success of voluntary, confidential HIV counseling and testing performed "in-
house" by methadone clinic staff members, as measured by the acceptance of such tests and by
the level of HIV infection awareness among HIV infected injection drug users. The information
and experience gathered in Contra Costa County has been distributed through this publication
to its more than 50,000 subscribers. Copies of this article are attached.
HIV counseling and testing is not enough to prevent all new infections and the article
makes reference to the evidence of new HIV infections among Contra Costa injection drug users,
which has previously been reported to the Board of Supervisors. Nevertheless, HIV testing was
largely accepted by injection drug users entering treatment, it facilitated access to early treatment
for HIV complications and is potentially helpful in limiting the spread of HIV to non-infected
partners.
Report to the Internal Operations Committee Page 3
On Communicable Disease in Contra Costa County
COMMUNICABLE DISEASE
TUBERCULOSIS
Tuberculosis continues, as it has for the past five years, to be reported at high rates. In
1985 our rate of tuberculosis cases was 8.5/100,000, in 1992 our case rate was 12.6/100,000.
Contra Costa County has reported 97 confirmed cases as of November 1, 1993, with four
additional cases pending confirmation. We continue to see cases in younger people, 25-44 years
of age, and in the minority populations. Additionally, the bulk of the cases, 80%, are occurring
in West and East County.
To control tuberculosis by rapidly finding new cases and preventing new infection the
Health Services Department has been working in several areas:
• TB/HIV Tail.Project - The Public Health staff in cooperation with medical staff
of the jail continue to test each entering inmate for tuberculosis infection. Those
persons testing positive are examined by a physician after receiving a chest x ray.
The additional service that has been added is that each inmate started on treatment
is met by a Public Health worker who will follow the person after he/she is
released in the Directly Observed Therapy program (DOT). This delivering of
medication to the person at home two times a week until the six month therapy
is completed will prevent infection from progressing to disease.
• STD/HIV/TB Mobile Clinic - Each Friday our mobile clinic parks in the North
Richmond area or in Pittsburg/Bay Point to provide STD diagnosis and treatment
services. The original mission of this van was to see women at risk for STD and
their partners. However, we have also added HIV testing and counseling and TB
skin testing and referral. In cooperation with Neighborhood House of North
Richmond (Northstar Drug Treatment) in the Richmond area and Pittsburg Pre
School Coordinating Council in East County we do outreach before the clinic
arrives to encourage the persons at highest risk for any of these diseases to be
seen when the clinic is held. This has been very successful, with 15-30 people
being seen at each four hour clinic. We plan to substantially increase the number
by January 1994 and add immunization and family planning services.
• Cross Training of Personnel - We have instituted a policy of cross training all
of our field workers in the Communicable Disease Programs (STD, AIDS, TB,
Immunizations) to be able to provide information and service to the public, in all
areas of communicable disease control. They are able to give educational
information, referral and assistance to people who have questions or need any
Communicable Disease services. The program workers are now less program
specific in their training and orientation to the patient. This has been an
important change since many of these workers in the various programs were
serving the same people. Change has been made in the utilization of funding.
Although outside funding continues to be categorical, merging programs at the
local level enables us to use TB, Immunization, AIDS and STD funds in a unified
service delivery unit. Workers are often funded under more than one program.
Report to the Internal Operations Committee Page 4
On Communicable Disease in Contra Costa County
• TB/HIV Screening in the IDU Population - We have worked in cooperation
with UCSF and Dr. John Watters to test people for HIV and TB, in West
County, over the past two years. We have referred those people to services
within the county who are HIV positive. For people who were TB skin test
positive we have held several special clinics to obtain chest x rays and examine
for signs of tuberculosis disease. Those infected, without disease, who agreed
were places on preventive therapy. This out-of-treatment, drug using population
is at very high risk for both HIV and tuberculosis. For the past five years the
number of patients diagnosed with tuberculosis who use inject drugs or cocaine
has increased substantially. This is a population that does not seek medical care.
We experienced a major outbreak of tuberculosis in the cocaine using population
of West County in 1989-90 due to poor medical care, close quarters and many
other factors. The HIV rates in the drug injecting population continue to be very
high, with 26.5% infection rate for those surveyed in Richmond in 1992. This
year we hope to be working with this same project offering HIV and TB testing.
In addition, follow up Directly Observed Therapy (DOT) for those study
participants who are placed on preventive Tb therapy will be provided'.
,NIZATION
Although we have increased our immunization clinics in the past four years by more
100% per month with the cost remaining very low or free, the youngest children in the county
continue to be inadequately immunized. Last year more than 48% of the children under two
years of age were under-immunized. We have again expanded services and have added Immuni-
zation Services to other services where young children are seen in order to encourage
appropriate immunization of this highest risk population.
• Immunization Coupons - Even if the$5.00 fee is waived, on request, people do
not want to ask. We have begun handing out coupons for Free Immunizations
through our Immunization Outreach worker, WIC clinics and in any area where
immunization levels are very poor. This has been very successful in the past
when the coupons were handed out for Immunization Awareness Month. We
hope it will continue with the high rate of return.
• Immunization Outreach Worker - Through new State funding we have been
able to place an outreach worker in the field to work with communities, families
and organizations on immunization issues. He has been arranging clinics in high
need areas such as housing developments, churches which serve mainly non
English speaking populations and community centers. He will also be visiting
medical care providers giving information on immunizations and clinic resources.
The merging of service provision and cross training of workers has been a very
rewarding experience. As we continue to serve greater numbers of high risk persons, the need
to maximize each contact will grow. We will continue to expand the cross training of other
outreach workers within the Health Services Department, such as prenatal and Child Health &
Disability Prevention (CHDP) outreach workers to provide communicable disease information
and referral at each contact.
f b
p Atrtencan.loutal Are HIV=Infected Injection Drug
a
Users Taking HIV Tests?
F .Repent
r
s� � s• 1 A 3 � � i
k
yy F: i
� � F
Juan Reardon, MD, MPH, Nancy Warren, PHN, Rusty Ketleh, MA, Dale
g Jensen, RN, Francie Wise, PHN, MPH, and Wendel Brunner, MD, MPH
i� � �JBC1tNC5 1Kri0M1�t+leClge Eif utfec �
ttOtl 1S eSSenLal for human tmmtiim-q�
deft virus- � 1 1 treat �
Introduction •What is the 1991 HN-1 seroprev-
alence for all injection drug users
a � Regardless of sexual orientation,in-
jection drug users constitute 14.8% of h'entering treatment in Contra Costa
Tins evahiat4s infect ktio9vl 4 County and for those accepting a
� P g
adult acquired immunodeficiency syn-
voluntary test.
drome (AIDS) cases in California) and •Are injection drug users entering
txs3 ing among mjectton drug users, 19.3% of such cases in Contra Costa treatment accepting a confidential
particWarlythoseinfectedwtthHlV 1 HN-1 antibody test?
Methods A total of 810 utttExt County, California (San Francisco Bay �'
' S enteririg`tieatnierit m Con- Area),z where human immunodeficiency •Are those who are infected likely to
f Costa virus-type 1(HN-1)seroprevalence rates be aware of their infection?
FCoimty, were eacaut among these drug users appear to be par- •Are those who are infected and un-
teed C'Itentswetefestedwl#hunitttked aware likely to accept a test?
ro ed):tests and snnultaneousy titularly high for African Americans3.4
cottnseled and offered v v.r mit Voluntary HN-1 antibody testing of in-
Jfv4AlU�LI HIV l antkady S f jection drug users has been recommended Methods
` mF oijcorifidenti�ltestingacoeptance;pre as an effective approach to limiting the
vious testing, drug itse,rand demo spread of HIV-1 5 For example,early in- Unlinked HN-1 serosurveys were
s tervention with zidovudine has been conducted at two methadone clinics op-
gtaphrc infom�atian were oledeci:
h erating in Contra Costa County, Califor-
Results Of the 810 tested 105 proven beneficial in postponing the occur-
s r nia,from January 1 to December 31,1991.
{<13 0%) were infected The current rence of illness in people infected with Standardized research protocols devel-
cxnfidential test was accepted by SiJ7 HIV-1.6 Some people believe that drug oped by the Centers for Disease Control
s F (62 6%) HN seroprevalence m the abuse treatment personnel can develop di 12
(CDC)were used. The study population
unhnkedsurveywasfourtii�esgreater agnostic and therapeutic relationships consisted of drug users entering metha-
than in the vohuitary survey(13%and with injection drug users more effectivelydone detoxification programs and of those
3 5%, respec lively) HN,1 infer ion than can practitioners in more traditional entering or continuing methadone mainte-
K was associated w>th refusal of a eorifi settings. The reluctance or inability of nonce.A total of 810 consecutive injection
dentia) test lazgely because most'"in s _ these drug users to become involved with drug users who entered methadone treat-
traditional medical clinics may postpone meet and had their blood drawn for hep-
55 2%)already knewoftheiiitifecfion fi HN-1 diagnosis until very late,deferring otitis screening were included. Excluded
47,*
in drtiguserswhowere appropriate interventions. were clients retesting during the study pe-
tiot aware of their,tfectxoii,,12(25 5°l0) In previous work we reported that, riod(n = 294).
accepted the test :Although Afnean of all injection drug users admitted to All clients received individualized
American!mlectian drug�userV,`! a treatment in 1990, 60.0% (614/1023) ac /AIDS counseling and were offered a
sented with a higher infection rate cepted a confidential antibody test but confidential HN-1 antibody test. Demo-
.
emo-
3% were three timGess only 33.6% 36/10 of
{ )� '
es y ( the infected usersgraphic data,drug use history,and infor-
likely to)maw of their m€ection (in unlinked surveys) accepted testing.$ motion regarding acceptance of confiden
Concltcsrons '"Iri�hnc" HN-i Finding lower HIV seroprevalence rates
testing ishtghlyatoepted,anduxistin with voluntary testing surveys, com-
e fected clients
P61,treatment will learn pared to unlinked.surveys,was reported
The authors are with the Contra Costa County
their status Nevertheless,wohmtar previously in other populations,9 11 and Health Services Department,Public Health Di-
testuig data are likely#a yield mttsid the 1990 data did not include whether re- vision,Martinez,Calif.
enable=urxlerestanates.b the true'Vrate fusal of a test was owing to prior knowl- Requests for reprints should be sent to
of infedi artwttg inleCkon diug.tas edge of positive status. Therefore, our Juan Reardon, MD, MPH, Contra Costa
N County Health Services Department,597 Cen-
ers (fIm 1 I'ttblrc Health 1993;$3 analysis of 1991 data intends to clarify the ter Ave,Suite 200,Martinez,CA 94553-4669.
1414-1417) following: This paper was accepted January 12,1993.
Y'
1414 Ainertrari Journal of Pibltc Health October 1993,Vol.83,No. 10
HIV among Injection Drug Users
available to those continuing to inject The authors acknowledge the profes- 8. Reardon J,Warren N,Kedch R,Jenssen
drugs,are needed to reduce the incidence sional participation and assistance of Mary Jess D,Wise F,Brunner W.HIV serostatus and
of HN-1 in this population. Wilson, MD, MPH (California State Depart- confidential HIV antibody testing in meth-
ment of Health Services, Office of AIDS); adone clinics in Contra Costa County,Cal-
Our study shows the potential for bi- Charles Deutschman,MFCC,and Steve Love- ifomia,USA, 1990.Seventh International
ased underestimation of HIV-1 preva- seth(Contra Costa County Substance Abuse Conference on AIDS; June 16-21, 1991;
lence in voluntary testing surveys. The Division);Rodney Smith,PhD(Contra Costa Florence,Italy.Abstract WC 3367.
low rate of acceptance of voluntary con- County Public Health Laboratory); Emmett 9. Hull MF, Bettinger CJ, Gallaher MM,
fidential HN-1 testis Amon those in- Velten, PhD (Bay Area Addiction Research Keller MM,Wilson J,Mertz GJ.Compar-
g g Treatment);and the San Francisco Bay Area ison of HIV-antibody prevalence in pa-
fected resulted in a voluntary testing prev- HIV Seroprevalence Regional Coordinating tients consenting to and declining HIV-
alence estimate(3.5%)four times smaller Conunittee. antibody testing in an STD clinic.JAMA.
than the estimate obtained by the unlinked 1988;260(7):935-938.
survey(13.0%),which included all clients References 10. Cabral-Evins DN, Stone S,Anderson L,
admitted into treatment.In the study pop- 1. California Department of Health Services, Gaudino JA.Association of human immu-
ulation, the main reason for the lack of Office of AIDS.Calf HIVWDS Update. nodeficiency virus serostatus with confi-
1993;6(1):7. dential and unlinked antibody testing in an
acceptance of voluntary testing by the in- 2. Contra Costa County Health Services De- STD clinic.Sixth International Conference
fected clients seems to have been previous partment, Public Health Division. Quar- on AIDS;June 20-24,1990;San Francisco,
knowledge of their infection. Hence the terly Rep HIV/AIDS Stat. April-June Calif.Abstract FC-684,vol.2.
more successful the past voluntary testing 1992:2. 11. Hart G.Factors associated with requesting
programs have been, the fewer infected 3. Yano E,Longshore D,Gorman M,Hughes and refusing human immunodeficiency vi-
M,Anglin MD.HIV Infection among In- rus antibody testing. Med J Australia.
clients will accept the voluntary test in travenous Drag Users. California Depart- 1991;155(9):586-589.
subsequent survey periods,and the lower ment of Health Services, UCLA Drug 12. Jones TS,Allen DM,Onorato IM,Peter-
and more biased the estimates will be.In Abuse Research Group for the Office of sen LR,DonderoTJ,Pappaioanou M.HIV
addition, lack of knowledge, misunder- AIDS;.1991:68. seroprevalence surveys in drug treatment
standings, and fears may hinders specific 4. Watters JK, Cheng YT, Bluthenthal R, centers.Public Health Rep. 1990;105(2):
gs, Y Pe Carison J, Lorvick J. Drug injectors and 125-130.
racial or ethnic groups'acceptance of con- HIV-1 infection in the San Francisco Bay 13. Centers for Disease Control.Interpretation
fidential testing. These areas of concern Area.Eighth International Conference on and use of the Western blot assay for se-
must be adequately addressed by volun- AIDS;July 19-24,1992;Amsterdam,The rodiagnosis of human immunodeficiency
tary testing programs. ❑ Netherlands.Abstract PoC 4700. virus type 1 infections.MMWR 1989;38.
5. Brickner PW,Torres RA,Barves M,et al. (No S-7):1-7.
Recommendations for control and preven- 14. Magura S, Grossman.JI, Lipton DS,
tion of human immunodeficiency virus Amann KR,KogerJ,Gehan K.Correlates
Aelnlowledgments (HIV)infection in intravenous drug users. of participation in AIDS education and
Blinded seroprevalence surveys were funded Ann Intem Med 1989;110:833-837. HIV antibody testing by methadone pa-
by the CDC National HIV Seroprevalence Sur- 6. Volberding PA,Lagakos S,Koch MA,et tients.Public Health Rep. 104(3):231-240.
veys through the California Department of al.Zidovudine in asymptomatic human im- 15. Calsyn DA, Saxon AJ, Freeman G Jr,
Health Services,Office of AIDS.Confidential munodeficiency virus infection.N Engl J Whittaker S.Ineffectiveness of AIDS ed-
testing for HIV-1 antibodies was funded by the Med 1990;322:941-949. ucation and HIV antibody testing in reduc-
CDC through the California State Department 7. Haverkos HW. Infectious diseases and ing high-risk behaviors among injection
of Alcohol and Drug Program, Division of drug abuse.J Subst Abuse Treat. 1991;(8): drug users.Am J Public Health. 1992;
Drugs,AIDS Intervention Section. 269-275. 82(4):573-575.
rs
October 1993,Vol.83,No.10 American Journal of Public Health 1417
i,
1048 Concise Communications JID 1993;168(October)
Discrepancies in Tuberculin Skin Test Results with Two Commercial Products
in a Population of Intravenous Drug Users
Alun R. Lifson,John K. Watters, Suzanne Thompson, Departments of Epidemiology and Biostatistics and of Family and
Charles M.Crane,and Francie Wise Community Medicine.School of Medicine,and Urban Health Study,
institute for Health Policy Studies, University of California, San
Francisco,Communicable Disease Control, Public Health Division,
Contra Costa County Health Services Department,Martinez, California
Screening for tuberculosis(using the Mantoux test)and human immunodeficiency virus(HIV)
was conducted among intravenous drug users(IVDUs)recruited from a San Francisco Bay Area
neighborhood.Of 178 IVDUs skin-tested with one commercial purified protein derivative(PPD)
preparation,a reaction of-_5 mm of induration occurred in 62(47%)of 133 HIV-negative and 13
(29%)of 45 HIV-positive IVDUs(P=.037).Forty-two IVDUs with an initial PPD reaction a5
mm were retested with a second commercial preparation; 11 (26%)had no reaction(0 mm)on
retesting.These I 1 were 5(56%)of 9 HIV-positive and 6(18%)of 33 HIV-negative persons(P=
.038).These discrepancies may be unique to specific lots of product or may reflect more general
differences. A degree of caution in evaluating unexpected tuberculin skin test results may be
indicated.Response to different tuberculin products by HIV status should be further evaluated.
Screening of high-risk populations for infection with Myco- tant component of the national plan to combat tuberculosis
bacterium tuberculosis has been recommended as an impor- (TB)[1,2].Such screening is commonly done with the Man-
Received 23 March 1993;revised 7 June 1993. toux tuberculin skin test,with intracutaneous injection of 5
Presented: IX international Conference on AIDS/IV STD World Con- tuberculin units (TU) of purified protein derivative (PPD)
gress,Berlin,6-11 June 1993. [3].For certain persons who have a positive skin test without
Informed consent was obtained from study subjects,using guidelines of evidence of active TB, therapy with isoniazid is recom-
the University of California Committee on Human Research.Participants in mended [2] to prevent latent TB infection from progressing
this study received a small monetary reimbursement.
Grant support: National Institutes of Health (DA-06908); Centers for to active disease.
Disease Control and Prevention(U62-CCU902017),Office of AIDS,San TB represents a significant cause of morbidity and mortal-
Francisco Department of Public Health(83-07069).
Reprints or correspondence(present address): Dr.Alan R.Lifson,Divi- ity among intravenous drug users(IVDUs)[4, 5]. IVDUs are
sion of Epidemiology.School of Public Health. University of Minnesota, also at risk for infection with human immunodeficiency virus
1300 S.Second St..Suite 300,Minneapolis.MN 55454-1015. (HIV), which may increase the likelihood of developing ac-
The Journal of infectious Diseases 1993;168:1048-51 tive TB; in one study, the incidence of active TB among
m 1993 by The University of Chicago.All rights reserved.
0022-1899/93/6804-D039$01.00 HIV-positive PPD-positive IVDUs was 7.9 cases/100 per-
i
JID 1993;168(October) Concise Communications 1049
son-years[4]. IVDUs are therefore an important population interpretation.Trained staff measured the size of induration for
for whom TB screening is recommended[11.Preventive ther- skin test antigens by both palpation and the ballpoint pen
apy with isoniazid is recommended for all IVDUs with a method [7], results were recorded on standard forms. For this
PPD skin test of>_10 mm of induration and for certain per- analysis, we defined anergy as a reaction to PPD of 0 mm of
sons with induration >5 mm, including those infected with induration and a reaction to both controls_<I mm.
HIV [1]. Retesting. Seventy-five IVDUs had a reaction>_5 mm on the
initial screening with product A.Attempts were made to contact
As part of a study of IVDUs recruited from community- these subjects by letters, phone calls, or outreach workers to
based settings, we conducted screening for TB and HIV in offer a repeat skin test. Forty-three persons (57%) agreed to a
one San,Francisco Bay Area neighborhood. Our initial TB second skin test with product B (Tubersol, lot 233422), of
screening was done with one commercial tuberculin prepara- whom 42 returned 2 days later for skin test reading. Retesting
tion (PPD product A, Aplisol; Parke-Davis, Morris Plains, was done 2 months after the initial screening.
NJ). After this testing, we became aware of a number of Statistics. Discrete variables were compared by using the Xi
employees of the University of California, San Francisco or Fisher's exact test; continuous variables were compared by
(UCSF)who had a positive skin test reaction with product A using Student's t test.Confidence intervals(CI)were calculated
and who were retested with a different commercial prepara- about proportions. Statistical analyses comparing initial PPD
tion(PPD product B.Tubersol;Connaught,Swiftwater,PA). measurements with retest measurements on the same persons
On retesting, most of these employees were skin test—nega- are not presented because,by definition,retesting was done only
tive(R. Harrison,personal communication). Preliminary in- on persons who had an initial induration>5 mm.This selection
formation indicated that employees with discrepant results for retesting based on exceeding a certain threshold of a mea-
sured characteristic may result in a "regression toward the
had been tested with the same lot of product A used in our mean"effect at the time of the next measurement.
initial screening of IVDUs.
Because we were concerned about these discrepancies and
possible inappropriate referral of subjects for isoniazid ther- Results
apy,we attempted to contact all subjects who had a reaction Initial skin testing. During the initial screening, 192
>5 mm with product A to offer retesting with product B. IVDUs had PPD skin tests with product A, 178 (93%) re-
This report summarizes our findings. turned 48-72 h later for evaluation. Of the 178 who re-
turned, 75 (42%) had a reaction ,5 mm. Induration of,5
Methods mm was present in 62 (47%) of 133 HIV-negative and 13
(29%)of 45 HIV-positive IVDUs(P= .037);a reaction>_10
Study subjects. The Urban Health Study evaluates IVDUs mm was present in 48 (36%) of 133 HIV-negative and 12
recruited from San Francisco Bay Area neighborhoods with a (27%)of 45 HIV-positive IVDUs(P> .10). Of 166 IVDUs
high prevalence of drug use. In these communities, a targeted who received both control skin tests as well as PPD and who
sample of IVDUs are recruited by experienced outreach workers returned for evaluation, 6% of HIV-negative and 20% of
[6]. All participants must be current IVDUs and have visible HIV-positive persons were classified as anergic (P = .012).
signs of recent venipuncture.The study described here was con- After those who were anergic were excluded, a reaction >5
ducted in Richmond. California. mm was present in 48% of HIV-negative and 39% of HIV-
IVDUs who agree to participate undergo an interview and positive IVDUs (P> .10). IVDUs with induration _>5 mm
HIV antibody testing. Screening for HIV antibody is done by were referred to the county health department for further
EIA with confirmation by Western blot. Minimum criteria for a
positive Western blot are the presence of bands at at least two of evaluation and possible isoniazid therapy.
the following: p24, p41, and gp120/160. Repeat PPD tests. Of 42 IVDUs who were skin-tested
Skin tests. IVDUs who had already agreed to HIV testing with both products A and B, 29 (69%) were male and 13
were asked if they would also be willing to receive a TB skin test. (3 I%)were female. Thirty-eight (90%) were African-Ameri-
Exclusion criteria for TB testing included a history of active TB, can and 4(10%)of other race/ethnicity, reflecting the study
a positive TB skin test resulting in further workup or institution population evaluated at this site. The mean age was 42.7
of preventive therapy,and a severe or allergic reaction to the TB years; 9 persons(21%)were HIV-antibody positive. Among
skin test. . the 75 persons who initially had a reaction ,5 mm, those
Screening for M. tuberculosis was done using an intradermal who returned for a second skin test reading did not differ
injection of 0.1 mL of 5 TU of PPD stabilized with Tween 80 significantly from those who did not by sex, age, race/
(Mantoux test),administered through a single-dose syringe by a ethnicity, or HIV antibody status(P> .10).
trained staff member.The initial skin tests were done with prod- Of those tested with both products A and B. the median
uct A (Aplisol, lot 00952P). Subjects were also evaluated for
anergy by using two controls: 1:100 dermatophytin "O," Can- skin test reactions were 16.0 and 12.5 mm, respectively.Ta-
dida antigen (Hollister-Steir, Spokane, WA) and mumps skin ble 1 categorizes subjects by their initial and repeat skin test
test antigen (Connaught). The location of skin test placement results.Of IVDUs retested, 11 (26 )had no reaction(0 mm)
on the arms was recorded on a standard form. Participants were with product B. No reaction on retesting occurred in 5(56 1�)
asked to return 48-72 h after the initial placement for skin test of 9 HIV-positive and 6(18%)of 33 HIV-negative persons(P
1050 Concise Communications JID 1993:168(October)
Table 1. Categorization of 42 intravenous drug users by indura- 91. For example, one report described 16 school district em-
tion response on initial and repeat tuberculin skin tests. ployees who had a positive skin test with product A. 13
Initial results(product A)
persons were retested with product B and were PPD-
negative [8].
5-9 mm 10-14 mm X15 mm Between any two tuberculin tests there may be some vari-
Repeat results ability in skin test response or interpretation,even if subjects
(product B) HIV- HIV' HIV- HIV' HIV- HIV* Total are tested with the same product [10]. To improve accuracy
0 mm 4 1 0 3 2 1 1 l and reduce variability, skin tests were administered and in-
1-4 mm 2 0 1 0 0 0 3 terpreted using standard criteria by trained staff, many of
5-9 mm 1 0 1 0 0 0 2 whom participated in both screenings. Although we cannot
10-14 mm 1 0 3 0 l 1 6 exclude variability as a partial explanation for our findings,if
a15 mm 0 0 1 0 16 3 20 the discrepancies we identified were entirely due to variabil-
NOTE. H[v- or HIv', negative or positive for human immunodefi- ity in skin test response, this raises significant questions
ciency virus. about the reliability of tuberculin skin test results.
If the discrepancies we identified were not entirely due to
variability,then some IVDUs may have had either false-po-
_ .038). Of the 1 I IVDUs with no reaction to product B, 8 sitive skin test with product A or a false-negative test with
reacted to at least one of the two skin test controls,2 had no product B. False-positive tuberculin tests may be due to hy-
reaction to either control, and l did not receive mumps but persensitivity to other mycobacteria[I 11,including Mycobac-
had no reaction to the Candida control. The two persons terium avium complex, an important cause of disease in
who did not react to either control or to product B were both HIV-infected persons. Among those retested, discrepant re-
HIV-infected. Of 31 IVDUs who had some reaction (>0 sults were more common in HIV-infected IVDUs. Dissemi-
mm) with product B, 30 reacted to at least one of the con- nated infection and disease due to M. avium complex tends
trols,and 1 had no reaction to either control. to occur in HIV-infected persons with severe immunosup-
By design,all 42 persons had induration-_5 mm with prod- pression [12]. However, it is possible that HIV-infected per-
uct A;in contrast,28(67%;95%Cl,50%-80%)had a skin test sons in this study(even in the absence of disease)were more
reaction to product B ,5 mm. Thirty-three (79%; 95% Cl, likely than HIV-negative persons to be infected with atypical
63%-89%)of those tested with product A and 26(62%;95% mycobacteria or to be colonized with greater numbers of or-
CI, 46`Yo-76%)of those tested with product B had a reaction ganisms.Another theoretical explanation for a false-positive
10 mm. Isoniazid preventive therapy is recommended for result with product A is a reaction to a different, nonmyco-
all IVDUs with a reaction to PPD>_10 mm and for HIV-posi- bacterial antigen.
tive IVDUs with induration ,5 mm [1]. Of those who were False-negative skin test reactions may be due to a number
retested,on the basis of only PPD result and HIV status, 34 of factors related to the tuberculin used,method of adminis-
IVDUs would have been referred for isoniazid therapy ac- tration, test interpretation, or person being tested [3, 11].
cording to product A results and 26 according to product B Although HIV-induced immunodeficiency may lead to fail-
results. ure to respond to diagnostic skin tests[13],it seems unlikely
Thirty-six IVDUs indicated that they had received a pre- that more than half the HIV-infected IVDUs with a positive
vious TB skin test (prior to our studies), of whom 4 (11%) initial skin test would become anergic at the time of repeat
reported that the most recent skin test preceding our initial testing only 2 months later. Furthermore,even among HIV-
screening was positive; this lower rate reflects our exclusion negative IVDUs, 18% had no reaction on retesting.
criteria. The previous skin test was not positive in 8 IVDUs There may be more than one explanation for our results.
with induration of 0 mm on retesting(product B), 1 IVDU However, several factors suggest that at least some propor-
with a reaction 1-4 mm on retest,and 23 of 27 IVDUs with a tion of the initial PPD results represent false-positive re-
retest reaction -_5 mm. sponses. Our retesting was initiated because of anecdotal re-
ports of discordant PPD results in some health care workers;
in this setting, the single positive result(with the same lot of
Discussion product A as in our initial screening) was believed most
likely to represent a false-positive skin test. In addition, the
Of 42 IVDUs who had a PPD skin test reaction ,5 mm rates of PPD positivity identified in our initial screening were
with one commercial product, 26% had no reaction when somewhat higher than we expected on the basis of studies in
retested 2 months later with a different product. Whether other cities[4, 141_and our own studies of IVDUs. For exam-
these differences were unique to a particular lot of PPD prod- ple,in another San Francisco neighborhood characterized by
uct or represent a more general problem is unknown. How- high rates of drug use and TB, 25%of HIV-negative IVDUs
ever, discordant results with use of products A and B have had induration ,10 mm and 20% of HIV-positive IVDUs
been previously described in health department bulletins[8, had induration >_5 mm [15].
..
JID 1993068(October) Concise Communications 1051
Whether the discrepancies we observed are due to differ- Hams, Jennifer Lorvick, Charles Richardson, Bernadine San-
ent concentrations of tuberculin in the two commercial skin tana, and Tia Wagner for help with the study; James Carlson
test preparations or to some other factor, both false-positive and the UCSF AIDS Tissue Bank for assistance with HIV anti-
and false-negative responses are of concern. False negatives body testing or specimen storage;and Denise Koo,Sarah Royce,
could result in failure to initiate preventive therapy in a per- George Rutherford,and Mark Segal for helpful suggestions.
son infected with M. tuberculosis. False positives may result
in inappropriate initiation of isoniazid(with the potential for
hepatotoxicity or other adverse effects)as well as diversion of References
health care resources toward following such patients. Incor-
L Centers for Disease Control.Screening for tuberculosis and tuberculous
rectly identifying an individual as having a positive PPD skin infection in high-risk populations,and the use of preventive therapy
test will also make it more difficult to detect a true skin test for tuberculous infection in the United States:recommendations of
conversion if it subsequently develops. the Advisory Committee for Elimination of Tuberculosis.MMWR
Quantitating the sensitivity and specificity of specific PPD 1990;39(RR-8):1-12.
skin test products is difficult for several reasons. Because 2• American Thoracic Society. Control of tuberculosis in the United
States.Am Rev Respir Dis 1992;146:1623-33.
there was no conclusive reference standard for latent M. tu- 3. American Thoracic Society.Diagnostic standards and classification of
berculosis infection,a definitive interpretation of discordant tuberculosis.Am Rev Respir Dis 1990;142:725-35.
skin test results was not possible. In our retesting,we evalu- 4. Selwyn PA,Hartel D.Lewis VA,et al.A prospective study of the risk of
ated only IVDUs who had a reaction>_5 mm with product A' tuberculosis among intravenous drug users with human immunodefi-
with the previously noted potential for a"regression to the ciency virus infection.N Engl J Med 1989;320:545-50.
5. Stoneburner RL,Des Jarlais DC,Benezra D,et al.A larger spectrum of
mean" effect. We did not detect persons who theoretically severe HIV-I—related disease in intravenous drug users in New York
could have had a negative skin test with product A and posi- City.Science 1988;242:916-9.
tive results with product B.To identify the specificity of one 6. Watters JK, Biernacki P.Targeted sampling:options for the study of
skin test product, it would also be necessary to know the hidden populations.Soc Probl 1989;36:416-30.
number of subjects who were free of M.tuberculosis infection 7• Longfield JN,Margileth AM,Golden SM.Lazoritz S,Bohan JS,Cress
DF.Interobserver and method variability in tuberculin skin testing.
with negative skin test results. For these reasons,our discus- Pediatr Infect Dis 1984;3:323-6.
sion focuses on certain discrepancies in results between the 8. Infectious Disease Branch,California Department of Health Services.
two PPD products. False positive tuberculin skin test reactions and product variability.
The existence of such discrepancies, for whatever reason, California Morbidity 1989;28(July 21):1.
9. Section of Epidemiology,Alaska Department of Health and Social Ser-
raises questions that warrant additional investigation. A de- vices.False positive Aplisol PPD reactions.State Alaska Epidemiol
gree of caution in the interpretation of specific skin test re- Bull 1992;9(May 12):1.
sults may be indicated in certain situations, particularly if 10. Chaparas SD,Vandiviere HM,Melvin 1,Koch G,Becker C.Tuberculin
such results are inconsistent with epidemiologic data Or ex- test: variability with the Mantoux procedure. Am Rev Respir Dis
pectation of M. tuberculosis infection. Additionalstudies si- 1985;132:175-7.
multaneously evaluating different PPD products in the same 11, American Thoracic Society.The tuberculin skin test.Am Rev Respir
Dis 1981;124:356-63.
persons, including those who are HIV-infected, may help to 12, Horsburgh CR. Mycobacterium avium complex infection in the ac-
further evaluate issues raised here. If significant discrepan- quired immunodeficiency syndrome.N Engl J Med 1991;324:1332=
cies between skin test products are noted, particularly in 8.
high-risk subjects such as IVDUs,this raises important issues 13. Centers for Disease Control.Purified protein derivative(PPD)-tubercu-
for TB control programs and lends support to refinement of lin anergy and HIV infection:guidelines for anergy testing and man-
agement of anergic persons at risk of tuberculosis. MMWR
current assays and development of additional diagnostic 1991:40(RR-5):27-33.
measures to identify M. tuberculosis infection in those with- 14. Graham NMH,Nelson KE,Solomon L,et al.Prevalence of tuberculin
out active disease. positivity and skin test anergy in HIV-I—seropositive and—seronega-
tive intravenous drug users.JAMA 1992:267:369-73.
Acknowledgments 15. Lifson AR, Watters JK, Thompson SM, Crane CM, Schecter GF.
Screening for tuberculosis(TB)among injection drug users(IDUs)
We thank Ricky Bluthenthal, Jose Carrasco, Myrto Conto- recruited from street-based settings.Presented:IX International Con-
gouris, Michelle Estilo, Daryl Gault, Sauda Garrett, Charles ference on AIDS/IV STD World Congress,Berlin,June 1993.
HIV/AIDS EPIDEMIOLOGY REPORT
CONTRA COSTA COUNTY
r`q COUP
August, 1993
Mark Finucane, Health Services Director
Wendel Brunner, M.D., Assistant Director for Public Health
Francie Wise, Communicable Disease Control Director
Rusty Keilch, AIDS Program Director
Prepared by:
Juan Reardon, M.D.
Derrick A. Green
Denise Johnson
Ethel Alderete
Nancy Warren
Table of Contents
Reported cases of AIDS in Contra Costa County . . . . . . . . . . . . . . . . . . . . . 1
Total cases reported (1982-1993) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I
Mode of infection and gender distribution of all AIDS cases (1982-1993) . . . . . . . 1
Race/Ethnicity distribution of all AIDS cases (1982-1993) . . . . . . . . . . . . . . . . 2
Age distribution of all AIDS cases (1982-1993) . . . . . . . . . . . . . . . . . . . . . . . 2
Year of diagnosis of all AIDS cases (1982-1993) . . . . . . . . . . . . . . . . . . . . . . 2
Cases under new CDC expanded AIDS case definition (1993) . . . . . . . . . . . . . . 3
Deaths among people with AIDS and people living with AIDS . . . . . . . . . . . . . . 4
Geographic distribution of AIDS cases (by city) . . . . . . . . . . . . . . . . . . . . . . S
Global view: World, US, California and Bay Area cases . . . . . . . . . . . . . . . . 6
Estimate of Contra Costa residents infected with HIV . . . . . . . . . . . . . . . . . . 6
The local HIV/AIDS epidemic in injection drug users (IDUs) . . . . . . . . . . . . . 7
Percent of heterosexual IDUs among new AIDS cases over time . . . . . . . . . . . . 7
HIV seroprevalence among IDUs entering treatment . . . . . . . . . . . . . . . . . . . . 7
Street surveys in West County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
New infections among IDUs 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Diseases reported among Contra Costa residents with AIDS . . . . . . . . . . . . . . 9
The AIDS epidemic in Contra Costa County: Fact sheet . . . . . . . . . . . . . . . 10-11
The local HIV/AIDS epidemic among gay and bisexual men . . . . . . . . . . . . . 12
Percent of gay/bisexual men among new AIDS cases over time . . . . . . . . . . . . . 12
HIV prevalence in non-IDU gay/bisexual men tested voluntarily . . . . . . . . . . . . 12
77te local HIV/AIDS epidemic among childbearing women, 1989-1991 . . . . . . . 13
Women of reproductive years with AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
HIV in female prostitutes and female IDUs . . . . . . . . . . . . . . . . . . . . . . . . . 14
HIV infection in women attending pre-natal clinics in Contra Costa County . . . . . 14
Children and HIV/AIDS in Contra Costa County . . . . . . . . . . . . . . . . . . . . IS
HIV/AIDS in adolescents in Contra Costa County . . . . . . . . . . . . . . . . . . . . 16
HIV infection in Contra Costa applicants for military service, 1985-1991 . . . . . . 16
California counties with highest cumulative incidence of AIDS . . . . . . . . . . . . 17
Contra Costa cities with the highest cumulative incidence of AIDS . . . . . . . . . . 17,
Surveillance of the response: Services provided and unmet needs . . . . . . . . . 18-19 _
Site of medical diagnosis/care for AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Reporting AIDS cases to the health department (AIDS surveillance) . . . . . . . . . 20
Reporting AIDS. Summary of legislation . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Referrals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Contra Costa County HIV/AIDS Epidemiology Report' 1
1169 PEOPLE WITH AIDS IN CONTRA COSTA COUNTY
Through the first halfof 1993, 1169 cases of AIDS were reported to the ,Health'
Department This represents a cumulative.incidence of 14 5 per-10,000 population .
using 1990 census data. This estimate is based only on reported cases.
Acquired Immunodeficiency Syndrome (AIDS) Surveillance Report
(Cumulative through 7/31/93)
ALL CASES
Adult and adolescent cases (n=1161)
Mode of HIV infection Males (%) Females (%) Total (%)
Gay or bisexual men 737 (69.6%) 0 (0.0%) 737 (63.5%)
Heterosexual injection drug user 155 (14.6%) 59 (57.8%) 214 (18.4%)
Gay/bisexual injection drug user 65 (6.1%) 0 (0.0%) 65 (5.6%)
Hemophiliac 15 (1.4%) 0 (0.0%) 15 (1.3%)
Heterosexual contact 6 (0.6%) 28 (27.5%) 34 (2.9%)
Transfusion with blood/products 25 (2.4%) 10 (9.8%) 35 (3.0%)
None of the above/other 56 (5.3%) 5 (4.9%) 61 (5.3%)
1059 (100%) 102 (
Total L 1009 1161 (1004b)
Pediatric cases (n=8)
Mode of HIV infection Males (%) Females (%) Total (%)
Hemophiliac 0 (0.0%) 0 (0.0%) 0 (0.0%)
Parent at risk or has AIDS/HIV 1 (25.0%) 4 (100%) 5 (62.5%)
Transfusion with blood/products 3 (75.0%) 0 (0.0%) 3 (37.5%)
None of the above/other 0 (0.0%) 0 (0.0%) 0 (0.0%)
Total 4(100%) 4(100%) IF
8 1100%
2 August 1993
ALL CASES
Race and ethnicity distribution
Race/Ethnicity Adult/adolescent Pediatric Total (%)
Cases (%)' Cases (%)
White, not Hispanic 733 (63.1%) 2 (25.0%) 735 (62.9%)
African American, not Hispanic 304 (26.2%) 2 (25.0%) 306 (26.2%)
Hispanic 109 (9.4%) 4 (50.0%) 113 (9.7%)
Asian/Pacific Islander 10 (0.9%) - 10 (0.9%)
American Indian/Alaskan 3 (0.3%) - 3 (0.3%)
Unknown 2 (0.2%) - 2 (0.2%)
Total 1161 (100%) 8 (100%) 1169 (100%)
Age at the time of AIDS diagnosis New AIDS diagnoses by year
Age Groups Total (%
Under 5 6 (0.5%)
300-
5-12 2 (0.2%)
333
13-19 2 (0.2%) 250 20
20-29 147 (12.6%) 200 175
30-39 498 (42.6%) 150-
95 98
40-49 340 (29.1%) 100 79
55
over 49 174 (14.9%) 50 41...
7 g 15
Total 1169:(100%): 0
1982 1983 1884 1985 1986 1987 1988 1989 1990 1991 1992 1993
Contra Costa County HIV/AIDS Epidemiology Report, 3
AIDSCASES UNDER THE NEW AND EXPANDED..*.C....
.
.
DC CASE DEFINITION
In 1993,'the expanded;AIDS surveillance case;definition for:ad61es*cents and adults (1) was implemented
>y the Centers for Disease Control and:Prevention(CDC). AS a result of the:expanded en ena, dunng the
first half:of 1993, 225 new cases of AIDS were reported These people would hot have received an AIDS: '.
diagnosis under the old.definition cntena, at least until presenting one of the diseases in the old hst
More than half of these new definition`cases occurred`in previous years and`only now became reportable
The charactenstics of the new definition cases encountered to:date are'hsted below.Approximately 500 total':
new definition cases are expecfed to be reported by the end of 1993'among::Contra;;Costa residenfs
1993 Revrsed Class f cation System for MV I lection azul Exp aiuled Surveillance Case Definition for AIDS'
Among Adolescents and.Adults:: CDC*MMWR December 18, 1992: Vol 41 /No RR 17
NEW DEFINITION CASES ONLY
Total AIDS cases reported meeting the expanded definition criteria only,
by mode of infection and gender
F7Afode of HIV infection Males (%) Females (%) Total_F
(%)
Gay or bisexual men 103 (55.1%) 0 (0) 103 (45.8%)
Heterosexual injection drug user 45 (24.1%) 25 (65.8%) 70 (31.1%)
Gay/bisexual injection drug user 15 (8.0%) 0 (0) 15 (6.7%)
Hemophiliac 3 (1.6%) 0 (0) 3 (1.3%)
Heterosexual contact 3 (1.6%) 8 (21%) 11 (4.9%)
Transfusion with blood/products 2 (1.1%) 3 (7.9%) 5 (2.2%)
None of the above/other 16 (8.6%) 2 (5.3%) 18 (8.0%)
Total 187 (100%) 38 (100%) 225 (100%
AIDS cases meeting the expanded definition criteria only,
by race/ethnicity
Race/ethnicity Total (%)
White, not Hispanic 114 (50.7%)
Black, not Hispanic 87 (38.7%)
Hispanic 21 (9.3%)
Asian/Pacific Islander 1 (0.4%)
American Indian/Alaskan 2 (0.9%)
Total 225 (100)
4 August 1993
130 130
DEATHS AMONG
20 106
.... .......... . ......... ........
PEOPLE100 . .. . .. .. ........ .................. ........
DIAGNOSED 80 61 .
71 63
.................................
WITH AIDS 60 .......... ....39 51
IN CONTRA COSTA 40
BY YEAR 12
20 3
OF DEATH
0
1982 83 84 85 86 87 88 89 90 91 92 1993
Contra Costa residents living with AIDS
(As of July 31, 1993)
Mode of HIV infection Males (%) TFemales Total
Gay or bisexual men 242 (59.6%) 0 (0) 242 (52.2%)
Heterosexual injection drug user 93 (22.9%) 39 (67.2%) 132 (28.5%)
Gay/bisexual injection drug user 29 (7.1%) 0 (0) 29 (6.25%)
Hemophiliac 5 (1.2%) 0 (0) 5 (1.1%)
Heterosexual contact 5 (l.2%) 10 (17.2%) 15 (3.2%)
Transfusion with blood/products 2 (0.5%) 6 (10.3%) 8 (1.7%)
Parents at risk for HIV 1 (0.2%) 1 (l.7%) 2 (0.4%)
None of the above/other 29 (7.1%) 2 (3.4%) 31 (6.7%)
Total -406 (100%) 58 (100-
64
Race/ethnicity distribution of people living with AIDS
Race/ethnicity Adult/adolescent Pediatric Total (%)
I Cases (%) L Cases (%)
White, not Hispanic 249 (53.9%) 249 (53.7%)
Black, not Hispanic 159 (34.4%) 1 (50%) 160 (34.5%)
Hispanic 48 (10.4%) 1 (50%) 49 (10.6%)
Asian/Pacific Islander 2 (0.4%) 2 (0.4%)
American Indian/Alaskan 2 (0.4%) 2 (0.4%)
Unknown 2 (0.4%) 2 (0.4%)
Total %2 (100%) 2 (100%) IF
Contra Costa County HIV/AIDS Epidemiology Report S
CITY DISTRIBUTION OF AIDS CASES IN CONTRA COSTA COUNTY,
1982-1993
Oakley 9
Brentwood =!j 10
Bay Point _A P5
Antioch =- 59
Pittsburg 102
Alamo 8
Moraga ,o
Clayton 12
San Ramon _ 23
Lafayette = 24
Danville = 26
Orinda 0
Pleasant Hill =®;i 40
Martinez _ 47
Walnut Creek 116
Concord - 175
Rodeo 7
Kensington _!j 7
EI Sobrante =!"� ,6
Hercules = 18
North Richmond = 21
Pinole = 25
EI Cerrito 28
San Pablo 62
Richmond - 266
0 50 100 150 200 250 300
The chart includes only cities where five or more residents have been reported.
Seven additional Contra Costa cities reported fewer than five cases each.
6 August 1993
GLOBAL VIEW of the AIDS EPIDEMIC
Cases Deaths
Contra Costa. 1,169 674 (7 31),
;Bay.....
rea: 23,533; 14,938
California: 60,017 37 816
US: 289,320 182;279 (7%31)
World (estimate): > 2,500,000 500,000 (7131)
ESTIMATE OF CONTRA COSTA COUNTY RESIDENTS
INFECTED WITH HIV
Based on back calculations a total of approximately 3,800 Contra Costa County residents
are estimated to have been infected with HIV, the virus that causes AIDS. Of these, 1169
have already been reported to have AIDS. Some 500 more are expected to be diagnosed
with AIDS and reported before the end of 1993. After 1993, the number of new AIDS
diagnoses expected: 200-250 a year.
Approximately 3,800 Contra Costa
residents are estimated to have been
infected with HIV
55%
2100
People with HIV & without AIDS In 19
250+-Exp cted Old Def. Cases
7%
955 :I 275
22 8 /o
E petted New Del. Cases
6 o/
25%
Old Definition Cases New Def. Cases
Contra Costa County HIV/AIDS Epidemiology Report 7
The local epidemic among injection drug users
Percent of heterosexual injection drug users among
new Contra Costa AIDS cases, 1982-1993
("The actual number of cases is shown inside the histogram bar)
Since the first years of
the AIDS epidemic in
Contra Costa County
30%
increasing number of 25.8%
AIDS cases have been 25%
IDUs. In addition to
increasing numbers, 20%
14.1%.. ....,.,14.4% ...
IDUs are becoming
larger proportions of - 26 46 139
the people diagnosed 10%
with AIDS in Contra
s% 2.4%
Costa.
0%
1882 88 1987-'88 1889 '90 1981:83
HIV prevalence among injection drug users entering treatment in
Contra Costa County tested blindly, by year and race/ethnicty
* (xxlxxx= tested positiveltotal tested) (7131/93)
—F---]
1989 1990 1991 1992 1993 1989-93
White *11/179 171629 151468 201573 21122 6511971
6.1% 2.7% 3.2% 3.5% 1.6%
African 26/70 83%267 81%217 66/222 19/74 275/850
American ,1% 31.1% 7 %3 `3 29 7%
37 ,:25.7
Hispanic 1134 5182 6180 7/96 0/18 19/31 Q
2.9% 6.1% 7.5% 7.3% 0% 6.1%.....
Other 014 2142 2140 2/56 1123 ;7/365
0% 4.8% 5% 3.6% 4.3% 19%
IFMissing 011 014 115 018 0/0 1/18
Total 381288 107!1024 1051810 95/955 221237 367/3314
13:2% 10:4% 13:0% 9.9;%, . 9.3
IDUs tested at methadone treatment clinics. Clients readmitted during the same calendar year were excluded.
8 August 1993
HIV prevalence among injection drug users in Contra Costa County
sampled with street surveys
The University of California San Francisco Institute of Health Policy Studies, Urban
Health Study, has conducted street surveys among injection drug users of several San
Francisco Bay Area communities, including Richmond. Surveys in the city of Richmond
started in 1991. The following are the HIV prevalence rates found in these communities:
1991 (1)
Site n tested HIV antibodies HIV prevalence
positive rate
San Francisco-West 255 31 12.2%
San Francisco-Central 441 79 17.9%
San Francisco-South 366 41 11.2%
Oakland-Northeast 223 11 4.9%
Oakland-West 1 240 43 17.9%
Richmond. . 222 43 19.4%
1992 (2)
Site n tested HIV antibodies HIV prevalence
positive rate
Oakland-Northeast 327 23 7.0%
Oakland-West 351 67 19.1%
Richmond.. 313'; 83 > 26 5%
For more information seethe references or contact Dr.John Watters, Urban Health Study, (41 S)476-3400.
1. Drug Injectors and HIV-1 Infection in the San Francisco Bay Area. Watters, John K., Cheng,Y.T.,
Bluthenthal,R,at alt.International Conference on AIDS,Amsterdam, The Netherlands,July 19-24,1992.
2. HIV-11►fection and Drug Injectors in Oakland/Richmond,California.Bluthenthal,Ricky;Estilo,Michelle
and Watters, John. International Conference on AIDS, Berlin, Germany, June 7-11, 1993.
Contra Costa County HIV/AIDS Epidemiology Report,. ,:: 9
NEW INFECTIONSAMONG INJECTION DRUG USERS ?'
The high levels of;HIV.prevalence in IDUs in Contra Costa County, even after the
implementation of preferenttal admission and recruitment to drug addiction treatment:of
infected IDUs and; the death of many. infected IDUs (1), appears sustained by the
occurrence of new infections.
Dunng 1991; 16 IDUs tested positive for HIV antibodies from a group of 685 who
reported a prior negative status within'12 months (2.3%-.95%C11.4% 3.7%). Fifteen of ';
the newly infected IDUs were African American.
Data for the year 1992 show a similar picture There were . IDUs who tested positive
out of;1,001;;reporting a prior negative status This suggests new infections in' 2.1%
(95%CI 1.4%-3.2%) of the IDUs in methadone treatment. All 21 apparently new
infections presented.in AfncanAmerican injection drug.:users
1,Preferential Admission of HIV 1 Infected Injection Drug Users (IDUs) !o Methadone Maintenance
Treatment: Policy Success aiul Eecttveness Reardon, Juan; Velten, E, Brunner,W,;Deutsehman, C
&Rutz,J Ixth Lttern mortal Coh rence on AIDS,Berlin,Germany,June 6-11,1993;Abs:#{P0=D183935. ;!
Most common diseases reported in people with AIDS in Contra Costa
The available data largely represents the distribution of diseases present among PWA at the time of their
first AIDS diagnosis, because diseases ocurring in people with AIDS after the initial AIDS diagnosis are
usually not reported. The diseases listed are only the most commonly reported(07/93)
Disease In injection drug users In!all people
with AIDS with AIDS,
Pneumocystis carinii pneumonia 28.5% 38 7
Kaposi's sarcoma 1.9%
Wasting syndrome 14.0% 11.5
Mycobacterium avium 12.1% 9.1
Candidiasis, esophageal 9.8% 8 9
HIV encephalopathy 4.7% 0
Cytomegalovirus disease, retinitis 0.9% :5.5%,
Cryptococcosis 2.8% 3 4%
Pulmonary TB, Other TB 8.4% 2.4
Toxoplasmosis of the brain 0.9% 2.3%
to THE HI VIAIDS EPIDEMIC
What is the problem?
• AIDS stands for Acquired Immune Deficiency Syndrome, a condition that destroys the
body's defenses against certain infections and cancers. AIDS is a fatal disease.
• AIDS results from infection with the Human Immunodeficiency Virus (HIV). HIV is
passed from one person to another through blood or sexual contact. HIV infection can
result from one sexual encounter or from sharing a needle to inject drugs.
• Many people with HIV infection appear healthy and do not know they are infected. HIV
infection can be detected through an HIV antibody test, but many people most at risk for
HIV infection have not yet taken a test.
• Although medications can slow the deterioration of the immune system, there is no cure.
• AIDS can be avoided, but risky behaviors are difficult to change even knowing the facts.
Who is being affected by HIV/AIDS?
• Since 1982, 1169 cases of AIDS have been reported in Contra Costa County. At least 701
persons have died. Currently an estimated 3,800 Contra Costans are infected with HIV. An
additional 500 AIDS cases are projected by the end of 1993. To date 1059 men, 102 women,
and 8 children have been diagnosed with AIDS.
• The majority of people with AIDS are gay and bisexual men (63%) or gay/bisexual men who
injected drugs (6%), although increasing proportions of the people with AIDS are heterosexual
injection drug users, women, African Americans and Latinos. The numbers of such cases are
disproportionate to the population size.
• Heterosexual injection drug users account for 18% of the cases. If the spread of HIV among
injection drug users is not dramatically curtailed, this population soon could reach the levels of
infection found in areas of the East Coast of the United States (60-70%). Currently the rate of
infection among African American injection drug users in Contra Costa is 30%.
• At least .5% of the general population, 10%-13% of all drug injectors, 12%-20% of gay and
bisexual men, and 1 per thousand women delivering babies in Contra Costa are estimated to be
HIV infected.
• Increasingly, AIDS is occurring in West County and East County. Of people now living with
AIDS, 40% now live in Central County, 40% in West County and 20% in East County.
• AIDS in poor communities puts an increasing burden on the public health care system.
IN CONTRA COSTA COUNTY 11
What are the social and economic costs of HIV/AIDS?
• AIDS is largely a disease of the young. Already, early deaths of Contra Costa County residents
from AIDS represents a loss of 19,000 potential years of life. If all HIV-infected Contra Costa
residents develop AIDS, our communities could lose 130,000 potential years of life.
• The estimated potential earnings lost by Contra Costa residents who have died from AIDS totals
$388 million. Using the same rates for all persons estimated to be HIV-infected, the potential
lost earnings could amount to more than $2.5 billion.
• The annual cost of medical care for each person with AIDS is now estimated to be$38,000. The
lifetime cost of caring for all Contra Costa residents estimated to be HIV-infected could require
an additional $300 million. The amount of suffering by these persons and their families is
immeasurable.
What needs to be done?
• Learn all you can about HIV and AIDS. Inform your families and friends and influence them
to adopt healthy behaviors.
• Increase AIDS awareness so that Contra Costa residents understand the disease. Understanding
helps to eliminate unnecessary fears and prejudices and encourages a compassionate and
supportive response to those who are suffering.
• 'Protect people living with HIV infection from discrimination.
• Provide testing, counseling, medical care and support for all people infected with HIV.
• Increase HIV/AIDS prevention efforts by county, city and community agencies.
• Reach the populations most at risk with concentrated prevention messages and innovative
programs.
• Expand efforts to involve city, community and church leaders in delivering AIDS prevention
messages in the most affected areas of the county.
12 August 1993
The local HIV/AIDS epidemic among gay and bisexual men
Percent of gay/bisexual men among new AIDS cases,
1982-1993 (The actual number of cases is shown inside the histogram bars)
Gay/bisexual men --� -
constitute the group
from which over 60%
of all cases have been t00%
reported in Contra 75.9%
Costa and the largest 60% 84,8% 70% 69%
group from which new 601
s2.4%
cases are emerging. 60%-
Nevertheless,
0%Nevertheless, a i?
declining trend is g 40%-
observed
0%observed in the I(
proportion of AIDS ' 20% 132 s7 101 120 122 116 37
cases from this group. ]
1
0%-
1982-87 1988 1989 1990 1991 1992 1993
HIV prevalence among non-IDU gay/bisexual men tested voluntarily
in Contra Costa County publicly funded clinics, 1985-1993
* (x /xxr= tested positiveltotal tested)
1985-87 1988 1989 1990 1991 1992 1993 1985-93
*148/786 84/490 56/443 51/469 45/570 31/643 19/282 434/3683
18.8% 17,1% 12.6% 14.9% 7,9% 4.8% 6.7%
Data includes only clients without a prior positive test. The tests may be of clients who repeated testing.
18.8%
20% - 17.1%
15% 12.6%
10.4%
10% -
7.9%
6.7%
4.8%
5%
4$' 84 56 51 5 31 19
0% -
1985-87 1988 1989 1990 1991 1992 1993
Contra Costa County HN/AIDS Epidemiology Report 13
The local HIV/AIDS epidemic in women
Annual HIV prevalence among childbearing women in
Contra Costa County and California
per 10,000 births
Contra Costa...... .....
California
30
2 5 _..............
20
_ 27 7 12. 1 1 .7
15
10
5 7.6 6.4 7 8
o '
1988 1989 1990 1991
Women of reproductive age with AIDS in Contra Costa County,
by age group (n=91)
40 ..._.. 34 ...... ...... . ............__..
35
_.. ....... .......... ..... ......_....
Women constitute
approximately 9% 30
of adult AIDS cases. 25 20
Assuming they may ........... .-16 ........._.
also represent 9% of 20
all HIV infections,
some 300 Contra 15 _ _ 9....
Costa women of 10 -
reproductive
0repro uctive age may 2
be infected with HIV. 5
At least 43 babies
have already been
13-19 20-24 25-29 30-34 35-39 40-44
born to these women. AGE GROUP
Data collected through July 31,1993
14 August 1993
HIV seroprevalence in female prostitutes and female injection drug users (IDUs):
Between September 1989 and February 1992, 77 different female prostitutes were tested
for HIV antibodies after a conviction in a local municipal court (Pittsburg, California).
During the same period of time 244 female injection drug users residing in the same area
(Pittsburg/Antioch) were blindly tested for HIV upon admission to methadone treatment.
Results:
Ten of the 77 female prostitutes (13%, 95% Cl 7.2%-22.3%)
26 of the 244 female IDUs (10.7%, 95% CI 7.4%-15.2%)
HIV infection among women attending pre-natal care clinics
in Contra Costa County, 1989-1992
* (xx/xxx= tested positive/total tested)
**HIV infected per 1000 pregnant women
1989IF 1990 1991 1992 1989-1992
White * 0/479 1/810 2/642 0/5773/2508
** 1.23 3.1 1.2
African 4/258 2/305 0/284 4/288 10/1135
American 15.5 6.6 13.9 8.8!
Hispanic 0/378 0/620 0/781 0/855 0/2634
Other 0/60 1/88 0/94 0/121 1/366
11.4 2.7
Missing 2/52 1 1/51 J 0/42 0/72 3/69Q.
Total
611731': 5/1922 2/I936 4/1960 17/754
T9
3.4 xx2.6`< 10 2 0 2:3
Contra Costa County HIV/AIDS Epidemiology Report 15
Children and HIV/AIDS
Eight Contra Costa children (1-12 years) 'have been reported with AIDS
At east 43 Contra Costa children:were ,born to HIV infected women
Children's Hospital......Oakland Pediatric AIDS/HIV,Program has evaluated, cared for and
monitored 43 children with residence in Contra Costa who at some time presented with;
I.
antibodies against the HIV virus. Of these; a third is estimated to be infected
The maternal antibodies present m the others will disappear by the second year:
Demographic characteristics of the above 43 children
Gender Race/ethnicity
Male 22 (51 2%yWhite= 9 (20.9%)
Female= 21 (48.8% African American= 27
Hispanic= 7 (16;3%)
Year when these children were referred to the above program
1986-1989= 12 children referred
1990-1993-131:children referred
Risk factor for.HIV of the mothers of the above children
Injection Drug'Use= J2:(14.4%`
Sexual Contact 8 (18.6)
Unknown 3 (7%)
16
August 1993
IIIV/AIDS in teenagers in Contra Costa
. Y:two of the 1169C
on ra Costa AIDS cases reported since the be nnin of
the epidemic were teenagers'at the time of their diagnosis, g g
A total of six young adults from Contra Costa County are being cared for and
followed up at Oakland Children's Hospital Five of these ix cases are
hemophiliac
During 1992 a total of 951 teenagers presented voluntarily `for testin at
publicly funded sites in Contra Costa County: No HIV infections were found:
Kaiser Northern California Centers (1) reported.that during 1989, 10,000
members, including approximatel 200 teenagers (15-14) were blindly tested for
HIV, No HIV infections were found in Kaiser members
aged 15-19.
Young gay and bisexual men`(17-19,years old) in the an Francisco Bay
Area
often continueto have unprotectedsex (35.2%) and presentedwitfi`a 4.1`% HIV
infection rate.(2)
Contra Costa Teenagers represented'26% of the 560 cases of penicillin resistant.
gonorrhea (PPNG) and;15% of the;1,129 cases of syphilis reported in 'Contra
Costa County between 1988 and 1991.
(11 Seroprevalence of HIV-ape 1 in n Northern California Health Plmi Population:AlUnlinked
Survey. Hiatt RA, Capell FJ, Ascher;MS Amencan Journal of Public Health, vol 82, 4, April<
Y992,pp 564-567
(2)HIV-1 Seroprevalence and Rrsk Behaviors Among Young Men lvho Nave Sex with.Men.Lem
GF HtroZawaA Givertz D et al San Frmrcisco De t, o Pubkc Health,Sart Francesco Cu. 1993 .,
HIV prevalence for civilian applicants for military service
from Contra Costa County, by year
* (xxl=x tested positive/total tested)
11
1985 1986 1987 1988 1989 1990 1991 1985-91
* 0/307 5/1417 3/1358 4/1245 1/1248 0/978 0/935 13/7488
0.0% 0.35% 0.22% 0.32% 0.08% 0.0% 0.0%
Data provided by the U.S.Department of Defense,and CDC.Data co lection between 10/85 2/91
Contra Costa County HIV/AIDS Epidemiology Report 17
California counties with the highest cumulative incidence of AIDS
cases per 100,000 population
r
San Francisco -
�, 1894.17
Marin -NOW
313.35
Los Angeles -
225.53
Alameda -
216.31
Sonoma -
205.04
San Diego f-
116.62 169.97
San Mateo
146.7
Contra Costa
126.78
Solano
Sacramento - 112.46
0 500 1000 1500 2000 2500
Contra Costa County cities with the highest cumulative incidence of AIDS
(Population based incidence per 1,000 residents reported for cities with >50 cases)
Richmond -
2.7
San Pablo -
2.4
Pittsburg -
� 2.1
Walnut Creek
1.9
Concord
1.5
Antioch -
0.96
0 0.5 1 1.5 2 2.5 3 3.5
Residents of unincorporated areas (i.e. Bay Point, North Richmond) have not been included in this analysis.
18 August 1993
Surveillance of the response to needs emerging from
the AIDS epidemic in Contra Costa County
In the last 12 months, 918 unduplicated individuals were provided services by
eight agencies receiving funds from the federal government under the Ryan White
CARE Act and Housing Opportunities for People with AIDS (HOPWA). The
funds received totaled $1.1 millon.
There were a total of 14,561 client contacts, which represents an average of 1,200
contacts per month, 40 contacts per day.
For 403 (44%) of these clients the following income information is available:
Income n °Io
Less than $600 per month 238 59.0%
<Between $601 and $900 per month 106 26.3%
Between $901 and $1,200 permontfi 34. 84%
Over $1,200 per month 25 62%
The HIV/AIDS status of 538 (58.6%) of these clients is known, as follows:
_ _ _ _ _ __
_. _ _.
_. __ ...... _ __ _ ....... ......
__ _ __ __ __ .......... .... ............
HIV/AIDS`Status n
AIDS' 238 44 2%
ARC/Disabling HIV 106 19 7%
HIV Infected 184 34.2%
Family members of people with HIV 10 18%
1,400 vouchers were issued to people with HIV for items such as food,transportation to and from
medical appointments, emergency housing/utility payments to allow to maintain secure housing.
3,696 bags of groceries were delivered to 175 clients.
80 West County residents took advantage of the drop in center at Tranquilium.
55 clients received housing advocacy services to maintain or acquire affordable housing.
82 clients became eligible for AIDS Drug Assistance Program(State-funded program to subsidize
medically prescribed therapies).
(The above list of services provided is only a partial one. Data is not available from several local organizations
and many individuals assisting those affected by the epidemic are not funded by the CARE Act or HOPWA).
Contra Costa County HIVIAIDS Epidemiology Report 19
Surveillance of;unmet needs
The following'unmeet needs have been`reported by community based organizations
'as not:
available for the HIV/AIDS clients they serve or in.need of expansion
* Increase case management services = espeeially in Central County:
Increase services of all ands;in Spanish and other languages
Housing (particularly in East;County) fon HIV/AIDS unemployed people
Day drop n center in East County
Increase:services::(all kinds) in North Richmond;
* Dental care
Residential hospice in each region of the County
Increase direct financial assistance;for food and transportation
<* Mental health services
Increase services m the,lails
Increase testing services to persons at mcreased;nsk
Contra Costa County AIDS diagnoses by diagnosing medical care facility type
(The distribution of medical facilities where AIDS cases were diagnosed is likely to mimic the
distribution of medical facilities providing health care for HIV infected Contra Costans)
Medical Facility AIDS Diagnoses
Contra Costa County hospital and clinics: 386 33.0%
Kaiser Permanente Facilities in Contra Costa and the Bay Area: 273 23.4%
Private Facilities in other counties: 130 11.1%
Public Facilities in other counties: 109 9.3%
Other Private Hospitals in Central Contra Costa County: 95 8.1%
Other Private Hospitals in West Contra Costa County: 54 4.6%
Other Private Hospitals in East Contra Costa County: 14 1.2%
Private Medical Doctors: 60 5.1%
VA/Naval Hospitals: 46 3.9%
Diagnoses at medical facilities in other counties largely reflect diagnoses which occurred at the beginning
of the AIDS epidemic when diagnosis and treatment was available only in a few sites of the region.
20 August 1993
REPORTING AIDS CASES
All health care providers are required to report AIDS cases to their local health
department. AIDS is reportable under the California Code of Regulations, .Title 17,
Health, Section 2500.
HOW TO REPORT:
By telephone.
By completing a Confidential Morbidity Report (CMR) card.
By completing an Acquired Immunodeficiency Syndrome Pediatric or Adult
Confidential Case Report Form.
WHERE TO REPORT:
Contra Costa Department of Health Service
AIDS Program
597 Center Street, Suite 200
Martinez, CA 94553
Denise Johnson (510) 313-6793 or
Derrick A. Green (510) 313-6792
WHY REPORTING IS NECESSARY:
* It is the law.
* To monitor trends in HIV-related disease.
* To monitor trends in HIV-infection.
* To project future numbers of AIDS cases.
* To plan for future health care needs and services.
* To provide information on the natural history of HIV infection.
* To plan prevention and educational activities.
* To identify persons in need of specific services from State and local health
departments, (i.e. voluntary partner notification, counseling, and treatment).
* To develop funding formulas and eligibility criteria for distributing AIDS .
resources from agencies such as the Health Resources Administration (HRSA),
the National Institute on Drug Abuse (NIDA), the Centers for Disease Control
and Prevention (CDC) and the million of dollars to State and local health
departments for programs such as AIDS drug distribution, hospice care, outreach
programs,prevention programs, coordination of patient services, pediatric AIDS
health care and out-of-hospital care programs.
Contra Costa County HIV/AIDS Epidemiology Report 21
Reporting AIDS: Summary of Legislation
California Administrative Code, Title 17 (Section 1603 1) " a hospital shall report
the name, date of birth, :address; soctal secrsrrty number; name: of hospital; the date of
hospitalization, and any ober information regurred on all confirmed cases of AIDS'to the
State Department of Health and'the county health officer "
Californa Administrative Code, Title 17 (Section 2500, 2503, 25049 2505 .and
2508)."Every person mid. ..or . . the Healih Officer any diagnosed or suspected case
of any of the following diseases or conditions: Acquired Immunodeficiency Syndrome "
California Administrative Code, Title 17 (Section 2512): Allows the local health officer;;
to investigate'commumcable diseases
California Health and Safety Code; (Section 199 21i[i]) HIV test results may he
r1.eported to local health authorities as part of AIDS diagnosis
California Health and Safety";Code, (Section 199 21,199 22 and 1603.3) Allows;
.
disclosure to public health authorities of result;of HIV test performed ori cadavers Allows
for HIV test to be performed on cadavers without written consent as>part of an autopsy r j
or in conjunction with anatomical gifts:
California Health and Safety,Code,; (Section 199 271Allows for voluntary contact
tracing, with the written consent;of the HIV'seropositive indrvldual
REFERRALS s:
For information on services available for people with HIV/AIDS
in Contra Costa County call the HIV/AIDS program 313=6770::
: ,
Copies of this;report or additional epidemiological:information
can be,obtained by calling: 313-6791