HomeMy WebLinkAboutMINUTES - 12131994 - IO.11 TO: , s BOARD OF SUPERVISORS n C
Co }t a
r INTERNAL OPERATIONS COMMITTEE ~` Costa
FROM: ^, ��
November 28, 1994 County�'`'`�' °c
f.
.'t
DATE: ?sr�coir
REPORT ON THE STATUS OF COMMUNICABLE DISEASES
SUBJECT: IN CONTRA COSTA COUNTY
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS:
1 . ACCEPT the report from the Public Health Director, outlining
the status of communicable diseases in Contra Costa County and
EXPRESS the Board's appreciation for the very helpful
information which is provided in the Report.
2 . EXPRESS the Board' s appreciation to Juan Reardon, M.D. , M.P.H.
for the very, helpful and readable Regional Profile of the AIDS
epidemic in Alameda and Contra Costa Counties .
3 . REMOVE this subject as a referral to the 1994 Internal
Operations Committee and instead REFER it to the 1995 Internal
Operations Committee, asking the Health .Services Director to
continue to make quarterly reports to the 1995 Internal
Operations Committee on the status of communicable diseases in
Contra Costa County.
BACKGROUND:
For the past several years, the Health Services Department has been
making quarterly reports to the Internal Operations Committee on
the status of communicable diseases in Contra Costa County,
specifically AIDS and Tuberculosis .
Attached is the most recent quarterly report, which contains data
on AIDS, Tuberculosis and Influenza. Also attached is a report
prepared by Dr. Juan Reardon on the profile of the AIDS epidemic in
Alameda and Contra Costa Counties .
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF 0UNTY AD INIST TOR ECOMMENDATION OF BOARD COMMITTEE
APPROVE H
SIGNATURE (S): J ITH MARK DeSAULNIER /
ACTION OF BOARD ON ecember 13 1994 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 DEC 13 1994
Contact: County Administrator PHIL BATCHELOR,CLERK OF THE BOARD OF
cc: Health Services Director SUPERVISORS AND COUNTY ADMINISTRATOR
Wendel Brunner, M.D. , Public Health Director
Francie Wise, R.N. , Director, CommunicableDisease Control
BY —9— 0 A DEPUTY
On November 28, 1994, Dr. Wendel Brunner, Public Health Director,
reviewed the attached quarterly report with the members of our
Committee and also noted the Regional Profile of AIDS which has
been prepared by Dr. Reardon.
Dr. Brunner noted that there have now been 1461 cases of AIDS
identified in Contra Costa County, 600 of whom have died. In this
regard, Dr. Brunner noted that Contra Costa County is the only
County in the Bay Area without a needle exchange program in place.
He also noted the recognition which had been given to one of our
community health outreach workers, Gilbert Soberal, who was
recently awarded the 1994 MAYA Community Service Award by the
United Council of Spanish Speaking Organizations .
The report also notes that the level of active tuberculosis cases
in 1994 remains approximately the same as in 1993.
Our Committee believes that these quarterly reports are an
important method of allowing the Board of Supervisors to stay on
top of one of the most important and expensive public health
problems we are likely to face in the coming years, the care of
AIDS patients, and to allow the Board of Supervisors to stay aware
of the impact that tuberculosis and other communicable diseases are
having on our community. Therefore, we are asking that this
subject be referred to the 1995 Internal Operations Committee and
that the Health Services Department continue to make quarterly
reports to the Committee.
2
j Contra Costa Count
v
The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR
Tom Powers,1st District Mark Finucane, Director
Jeff Smith,2nd District
Gayle Bishop,3rd District 20 Allen Street
Sunne Wright McPeak,4th District s _ c Martinez, California 94553-3191
Tom Torlakson,5th District
(510)370-5003
County Administrator r FAX(510)370-5098
Phil Batchelor °
County Administrator •;; - ���
srA,cou'n
November 21, 1994
To: Contra Costa County Board of Supervisors
From: Wendel Brunner, M. D. for
Mark Finucane, Health Services Director
Re: Quarterly Report on Communicable Diseases
AIDS
Cases
As of November 14, 1994 1,464 cases of AIDS among adults and adolescents
have been reported to the Health Services Department. Of that number, 881 (sixty
percent) have died. Seven AIDS cases among children have been reported; six of these
have died. Of the seven children reported, four were infected through transfusions of blood
or blood products and three were born to HIV-infected mothers.
Of the 1,464 adult and adolescent cases, only three are among the 13-19 year old
group. The route of transmission of HIV for the adult/adolescent cases is demonstrated
below:
Merrithew Memorial Hospital&Clinics Public Health • Mental Health • Substance Abuse Environmental Health
Contra Costa Health Plan Emergency Medical Services • Home Health Agency Geriatrics
A-345 (2/93)
T.
Quarterly Report to the Internal Operations Committee. November 29, 1994
Status of Communicable Disease in Contra Costa County Page 2
AIDS Cases as of November 14, 1994
Contra Costa County
1000
.+ > 934
h
X
800 .,,.., ,
600
Y
aoo 1x
200 FX/
77 41
0
Legend
Gay/Bi Men IDU Gay/Bi IDU
Blood/Blood Product F%'J Heterosexual None/Other
In percentages, 63.6% (934) of all adult/adolescent cases are gay and bisexual
men with an additional 5.2% (77) being gay/bisexual injection drug users. Nineteen
percent (279) of cases are heterosexual injection drug users. Less than three percent
(2.8%) of cases (41) received a transfusion of blood or a blood product. Sixty nine people
(4.7%) have AIDS as a result of heterosexual transmission and the same number have no
identified risk.
HIV Profile of the East Bay
Last month the AIDS Program's epidemiologist, Juan Reardon, M.D., produced an
analysis of HIV in the two East Bay Counties, Alameda and Contra Costa. A copy of that
report, "HIV/AIDS Epidemiology Profile of the East Bay," is included with this report. With
assistance provided by the epidemiology and surveillance units of the two counties, Dr.
Reardon analyzed the distribution of AIDS cases across the two county region, discussed
clues about new infections and where and among whom they might be occurring, the shifts
in the HIV/AIDS epidemic , and discussed the socioeconomic impact of HIV/AIDS on our
region. I encourage you to read this report.
The report was developed specifically for an HIV prevention planning process, and
we presented its findings to the Oakland EMA HIV Planning Council earlier this month. As
you know, the Planning Council, composed of members from both Alameda and Contra
Costa County sets priorities and makes allocations of funds which enter the two counties
through the Ryan White Comprehensive AIDS Resources Emergency Act for care and
l r
c
Quarterly Report to the Internal Operations Committee November 29, 9994
Status of Communicable Disease in Contra Costa County Page 3
treatment services for people with HIV. The report was received very well by them and will
be a useful planning tool.
Consortium's Open Forum
On October 27, the Contra Costa HIV/AIDS Consortium, staffed by HIV/AIDS
Program staff, held an Open Forum to discuss HIV prevention and service needs in the
County. More than 100 people attended the Open Forum in Pleasant Hill and over 20
agencies were represented. These included AIDS Community Network, AIDS Project
Contra Costa, BAART Methadone Program, Bay Area Urban League, Catholic Charities
of the East Bay, Contra Costa County Substance Abuse Programs, Diablo Valley AIDS
Center, Familias Unidas, Family and Community Services, Hospice of Contra Costa,
Kaiser Permanente Medical Centers, Merrithew Memorial Hospital, Mount Diablo Hospital,
Oak Park Convalescent Hospital, Pittsburg Health Center, Pittsburg Preschool
Coordinating Council, Planned Parenthood Shasta-Diablo, Richmond Health Center, the
Richmond Rescue Mission, the Steven A. Genard AIDS Assistance Foundation and the
Visiting Nurse Association of Northern California. People with HIV also attended the
Forum and expressed both their continuing needs and their thanks for services that do
exist for them in the county.
The forum demonstrated the coordinated efforts and collaboration between
community based organizations and among CBOs and the Contra Costa County HIV/AIDS
Program.
1993 Childbearing Women HIV Results
We have received the results of the 1993 Statewide HIV survey of women giving
birth. In Contra Costa County, we presented a slight reduction in the percentage of HIV-
infected women who delivered babies in the third quarter of 1993. Those numbers and
percentages are below:
L
Quarterly Report to the Internal Operations Committee November 29, 1994
Status of Communicable Disease in Contra Costa County Page 4
Year Total Number Rate of
newborns HIV infection
tested positive
1988 3,029 2 6.60
1989 3,261 9 27.60
1990 3,245 4 12.33
1991 3,406 4 11.74
1992 3,258 4 12.28
1993 3,206 3 9.36
Contra Costa HIV infected women delivering babies continue to be, as in previous
years, young African American women. All three women found this year in Contra Costa
County to be HIV infected through this survey were African American: one was under 20
years old; one was between 20 and 24 years old and the third was between 25 and 29
years old.
This study, funded by the Centers for Disease Control and Prevention to the State,
continues to be a very powerful tool because it tests all the babies born in California in a
given quarter every year. The numbers over the last four years in our County are stable
and consistent with between nine and twelve HIV-infected women giving birth in a given
year. We are, of course, pleased that the numbers do not appear to be rising. Yet even
if the consequences of 9 -12 moms every year and one-third of their babies having HIV are
measured only in monetary terms, they remain staggering.
Needle exchange
There are currently 23 needle exchange programs throughout the State of California
which participate in the California Safety Education Network. Policy makers in the
following cities and counties have declared states of emergency related to needle
exchange policies: San Francisco, Berkeley, Oakland, Marin County, Santa Clara County,
San Mateo County, the City of Los Angeles, Sonoma County and Alameda County. Five
jurisdictions (San Francisco, Alameda, Marin, Santa Clara and the City of Berkeley) are
providing funding for needle exchange and related activities.
Contra Costa is the only Bay Area County without a needle exchange program in
place.
1
Quarterly Report to the Internal Operations Committee November 29, 1994
Status of Communicable Disease in Contra Costa County Page 5
1994 MAYA Community Service Award
Gilbert Soberal who has been a community health outreach worker with the
HIV/AIDS Program for seven years, was recently awarded the 1994 MAYA Community
Service Award by the United Council of Spanish Speaking Organizations. Gilbert and
Vincent Bell, both of whom reach out to people on the streets of Contra Costa County and
educate those people most at risk for HIV about how to protect themselves and those they
love against HIV deserve our deep thanks.
TUBERCULOSIS
Cases
So far this year, 80 people have been reported to have confirmed, active
tuberculosis. We are aware of another 20 people who are probable cases. We expect that
the number of TB cases in 1994 will be approximately equal to the 110 cases reported in
Contra Costa in 1993. In past years, people with TB were predominantly over 65 years of
age. This year to date, only 16 of the 80 confirmed cases (20%) are over age 65. The
largest group (26 of 80) among those confirmed cases are between 46 and 64 years old -
32.5% of cases. Ten children, under the age of 18 have confirmed cases of TB so far this
year.
In the State overall, Asians represent about 60% of the TB cases, in our County
Asians represent 44% of cases. Whites represent 29% of cases; African Americans
represent 27% of TB cases in Contra Costa.
Cases of TB continue to be predominantly in West County (57.5%). Central County
accounts for 25% of the cases and East County for 17.5%.
We have recently increased the number of clinics in Richmond serving people with
active tuberculosis and those at high risk for TB because of their closeness to people with
active TB. Previously three clinics per month were open for this purpose and now we hold
a clinic every week at the Richmond Health Center. We also have one clinic at Merrithew
Memorial Hospital and one clinic at the Pittsburg Health Center each month.
t
i
Quarterly Report to the Internal Operations Committee November 29, 1994
Status of Communicable Disease in Contra Costa County Page 6
TB Hospitalizations
We recently reviewed data about hospitalizations for TB in hospitals throughout the
county. We learned that in 1992 (the most recent year in which complete data could be
obtained), 62 hospitalizations in that year resulted in 705 hospital days for care for patients
with tuberculosis. Merrithew Memorial Hospital accounted for 45% of those
hospitalizations and 42.3% of the hospital days. The hospital with the second highest
figures for TB care was Brookside with 13 hospitalizations (21%) and 22.5% of the hospital
days. John Muir hospital had four discharges for TB care. Kaiser Richmond and Kaiser
Walnut Creek each had three. Delta Memorial, Doctor's Hospital, Kaiser Martinez, Los
Medanos, and Mount Diablo each had two and San Ramon Hospital had one.
Fortunately, not all people with tuberculosis require hospitalization. We know that
of the 110 people with confirmed cases of active TB in 1993, 75 were cared for by the
Health Services Department.
New Funding for TB Treatment and Prevention
Our Health Services Department has received an additional $71,000 in State funds
to treat and prevent TB in our county. With these funds we are buying equipment to make
our clinics better able to protect.staff and other patients from TB bacteria. We are also
adding additional public health nurse time to teach TB prevention to faculty and staff in
Contra Costa schools and in locations where clients are at high risk for TB such as
homeless shelters, residential drug treatment programs and convalescent hospitals.
Finally, we will use these funds to produce a quarterly newsletter which will focus on TB,
its prevention and treatment and analysis of the nature of the epidemic of TB in our county.
We will also include quarterly statistics on other communicable diseases when updates are
appropriate.
In addition to this increase in funds for TB prevention and control from the State, a
new restricted form of Medi-Cal is also available (as of October 1) to treat financially
eligible people with TB. Our staff attended training this month to begin screening TB
patients for eligibility into this Medi-Cal program.
Quarterly Report to the Internal Operations Committee November 29, 1994
Status of Communicable Disease in Contra Costa County Page 7
INFLUENZA
During this month, the Immunization Program held 13 clinics to administer flu
vaccines to people for whom flu could lead to serious health problems. This year clinics
were cancelled at one point because the Food and Drug Administration did not release the
vaccine on time. Schedules at senior centers and other sites had to be recalled and flu
clinics rescheduled. This created a very chaotic clinic schedule. Because of these
problems we only gave about one third of the flu shots as in previous years: 3,331 shots
in 1994 compared to 10,113 in 1993.
HIV/AIDS Epidemiology Profile
of the EAST BAY, California
Alameda County
Contra Costa County
for
HIV Prevention Community Planning
Sponsored by
HIV/AIDS Epidemiology and Surveillance Office
Communicable Disease Division
Public Health Department
Alameda County Health Care Services Agency
HIV/AIDS Epidemiology and Surveillance Unit
AIDS Program * Communicable Disease Control Section
Public Health Division
Contra Costa County Health Services Department
October 1994
Prepared by
Juan Reardon, M.D., M.P.H
ACKNOWLEDGEMENTS
This project was made possible by the varied contributions of many people. The
contributors acknowledged below reviewed drafts of this document.
Alameda County Health Care Services Agency
Michael Shaw Education and Prevention
Barry Brinkley, MS, MPH Planning and Fiscal Director
Eugene Richards HIV/AIDS Services Division Director
Tim Livermore, MD, MPH HIV/AIDS Epidemiology and Surveillance Office
Ann Chandler, MPH , Communicable Disease Division Director
Bob Benjamin, MD Communicable Disease Division, Medical Director
Arnold Perkins Public Health Director
Barbara Allen, MD Health Officer
Contra Costa County Health Services Department
Holly Scheider, MPH HIV/AIDS Education and Prevention Coordinator
Marc Gold, MA HIV Testing Coordinator
Nancy Warren, PHN Communicable Disease Control Specialist
Rusty Keilch, MA HIV/AIDS Program Director
Francie Wise, MPH Communicable Disease Control Director
Wendel Brunner, MD, MPH Assistant Health Service Director for Public Health
Special appreciation for dedicated AIDS surveillance work by the staff of the Alameda
County AIDS Epidemiology and Surveillance (AES) Unit and the Contra Costa County
AIDS Epidemiology and Surveillance (AES) Unit:
Alameda AES Contra Costa AES
Walt Gordon Denise Johnson
Alberta Hutchinson Maureen Neftah
Jim LaRue, MPH Lavelle Anderson
George Banks, MD
Renita Alexander-Brown
Elvira Jimenez
TABLE OF CONTENTS
CHAPTER 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Background I
Profile Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . I
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Caveats • 2
CHAPTER 2. The Setinig of the HIV/AIDS Epidemic . . . . . . . . . . . . . . 4'
CHAPTER 3. The AIDS Epidemic in the EAST BAY
Cases Reported . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Mode of Infection Distribution . . . . . . . . . . . . . . . . . . . 7
Gender Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Race/Ethnicity Distribution . . . . . . . . . . . . . . . . . . . . .
7
Age Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Living Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Geographic Distribution . . . . . . . . . . . . . . . . . . . . . . 11
CHAPTER 4. The Shifts in the People with AIDS:
Newer AIDS cases compared to older cases . . . . . . . . . . 16
Mode of Infection Distribution . . . . . . . . . . . . . . . . . . 16
Gender Distribution . . . . . . . . . . . . . . . . . . . . . . . . . 17
Race/ethnicity Distribution . . . . . . . . . . . . . . . . . . . . . 17
Geographic Distribution . . . . . . . . . . . . . . . . . . . . . . 17
CHAPTER 5. People with HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Overall Estimates . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Estimates by Mode of Infection . . . . . . . . . . ... . . . . . . 20
Estimates by Race/ethnicity Group . . . . . . . . . . . . . . . . 22
Estimates by Gender . . . .. . . . . . . . . . . . . . . . . . . . . 22
CHAPTER 6. Groups Impacted the Most by HIVIAIDS . . . . . . . . . . . . 23
Men Who Have Sex with Men . . . . . . . . . . . . . . . . . . 23
Injection Drug Users . . . . . . . . . . . . . . . . . . . . . . . . 24
Heterosexual Sex Partners . . . . . . . . . . . . . . . . . . . . . 25
CHAPTER 7. Clues on New Infections . . . . . . . . . . . . . . . . . . . . . 1 26
Mode of Infection Distribution . . . . . . . . . . . . . . . . . . 27
Gender Distribution . . . . . . . . . . I. . . . . . . I . . . . . . . 28
Race/ethnicity Distribution . . . . . . . . . . . . . . . . . . . . . 28
Age Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
CHAPTER 8. The Socioeconomic Impact of HIV/AIDS . .
Years of Potential Life Lost . . . . . . . . . . . . . . . . . . . . 30
Lifelong Potential Earnings Lost . . . . . . . . . . . . . . . . . 31
Medical Cost . . . . . . . . . . . . .I . . . . . . . . . . . . . . . . 31
SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
LIST OF TABLES
Table #1 Race/Ethnicity Distribution of People with AIDS, EAST BAY . . . . . . . . . . . . . . . . . . . 7
Table#2 Proportional Distribution of Probable Mode of Infection Groups . . . . . . . . . . . . . . . . . . 8
Table#3 Population Distribution and AIDS Cases Distribution in the EAST BAY, by Race/Ethnicity and
county . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
and AIDS Cases Distribution by Race/Ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Table #4 Northwest Region of the EAST BAY (Cumulative Incidence by City) . . . . . . . . . . . . . 12
Table #5 South Region of the EAST BAY (Cumulative Incidence by City) . . . . . . . . . . . . . . . . 13
Table#6 Northeast Region of the EAST BAY (Cumulative Incidence by City) . . . . . . . . . . . . . . 13
Table #7 Central Region of the EAST BAY (Cumulative Incidence by City) . . . . . . . . . . . . . . . 14
Table #8 Estimated EAST BAY Residents Infected with HIV, by Mode of infection . . . . . . . . . . 21
Table#9 Estimated EAST BAY Residents Infected with HIV, by Race/Ethnicity . . . . . . . . . . . 22
Table#10 Estimated EAST BAY Residents Infected with HIV, by Gender . . . . . . . . . . . .. . . . . . 22
Table #11 EAST BAY Clients Testing Positive for the First Time without a Prior Negative Test, by Gender
and Mode of Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . 27
Table #12 EAST BAY Clients Testing Positive for the First Time and Reporting a Prior Negative Test, by
Race and Mode of Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . 28
LIST OF FIGURES
Figure#1 AIDS Cases in the EAST BAY, 1980-1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Figure#2 AIDS Cases in the EAST BAY, by Probable Mode of Infection Group . . . . . . . . . . . . . . 8
Figure#3 Population Distribution and AIDS Cases Distribution,by Race/Ethnicity . . . . . . . . . . . . . 9
Figure#4 Population Distribution and AIDS Cases Distribution,by Geographic Areas . . . . . . . . . . 11
Figure#5 EAST BAY Cities by Cumulative AIDS Incidence . . . . . . . . . . . . . . . . . . . . . . . . . 18
Figure#6 Proportional Distribution of AIDS Cases (1980s vs 1990s) . . . . . . . . . . . . . . . . . . . . 18
Figure#7 Proportional Re-distribution of AIDS Cases in the Northwest Region (1980s vs 1990s) 19
HIVIAIDS Epidemiology Profile of the EAST BAY z
CHAPTER 1. Introduction
saw Background
A comprehensive profile of the HIV/AIDS epidemic in the EAST BAY has not been
reported before. The present report is based on several data sources, preeminent among
k which are the HIV/AIDS Epidemiology and Surveillance Office of Alameda County and
the Epidemiology and Surveillance Unit of the Contra Costa County HIVIAIDS Program.
These offices have gathered AIDS case data since the initial years of the epidemic and
have published regular epidemiological reports which summarized and up-dated the state
of the local AIDS epidemic. The present report adds to the AIDS case data other
j pertinent information with the hope of defining, more comprehensively, the extent of the
t HIV/AIDS epidemic and the populations at risk for new infections.
This report was developed specifically for an HIV prevention planning process. This
{ process is guided by both community participation and information derived from data.
By answering questions with available data regarding the status of the HIV epidemic, its
direction and shifts, the populations at risk and their characteristics and size, this profile
intends to provide a frame of reference for selecting and monitoring HIV prevention
efforts to targeted populations.
The data Provided in profiles like this. one, constitute only one of the three basic
components needed to adequately plan HIV prevention. In addition to the epidemiologic
t profile, it is essential to take into account the results and the experience of HIV
prevention programs and interventions which have taken place in Alameda and Contra
Costa counties in the past years. Furthermore, the views and perspectives of the groups
of people for whom the services are intended need to be heard and incorporated into a
comprehensive HIV Prevention Plan.
Profile Objective
The objective of this profile is to assess and describe the present extent of the HIV/AIDS
epidemic in the EAST BAY and in defined populations within these counties. This profile
consolidates most obtainable quantitative evidence related to the local epidemic and is
intended to facilitate and guide the community planning process of assessing the local
HIV prevention needs, establishing priorities among these needs and developing a
comprehensive HIV Prevention Plan.
Fit
HIV Prevention Community Planning 2
Methods
AIDS case data were reported by the HIV/AIDS Epidemiology and Surveillance Office
of Alameda County and the Epidemiology and Surveillance Unit of the Contra Costa
County AIDS Program. Estimates of HIV-infected populations were also based on the
work done by these offices with methodology suggested by the Health Resources and
Services Administration (HRSA)', of the Department of Health and Human Services.
Populations at risk for HIV were estimated using available local or regional criteria
which are presented with each estimate. The analysis of recent infections was done using
voluntary 1990-1993 testing data of clients who presented for testing at publicly funded
clinics in these counties. Testing data for each county were respectively provided by the
Alameda County Public Health Laboratory and the HIV Testing Unit, Contra Costa
County HIV/AIDS Program. Measurements of the socioeconomic impact of HIV/AIDS
were estimated using an EPI-Info program developed by the author of this profile and
based on data provided by the California Department of Health Services, Health Data and
Statistics Branch.
Caveats
AIDS cases diagnosed and reported through May 12, 1994 were analyzed. AIDS case
data are likely to represent an under-count of the true extent of the epidemic. This is
largely due to delayed reporting and under-reporting. AIDS case databases are
continuously being updated and data analyses done only a few months later are likely to
have different totals. Nonetheless, the experience of the AIDS surveillance staff is that
the main features and shifting patterns of the epidemic are consistently observed through
short intervals in the analysis. Some people, either because of health care access issues
or other reasons, never receive an AIDS diagnosis even when qualifying for one under
clinical or laboratory criteria. For many, the diagnosis of AIDS takes months to be
reported to the local health department by the diagnosing physician, facility or other
health care worker as required by law. Additionally, some people infected with HIV die
before they reach the later stages of HIV disease and are never diagnosed with AIDS Z.
All these elements need to be taken into account for adjustments of the estimates of HIV
infected populations from reported AIDS cases (back calculations).
On the other hand, in 1993 a more inclusive AIDS case.definition was implemented by
the Centers for Disease Control and Prevention (CDC) and, as a consequence, many
people with HIV who would not have received an AIDS diagnosis until some years in
the future, are now being diagnosed with AIDS. The increase of new cases observed in
1992 and 1993 is partially an effect of the definition expansion. At the same time the
number of people receiving an AIDS diagnosis is likely to peak during these years (1992-
1993) and to decline afterwards. However, there are people with AIDS by the new
definition who have been asymptomatic or relatively asymptomatic and have not had a
CD4 count, thus remaining undiagnosed. Many may not even know of their infection.
HIV/AIDS Epidemiology Profile of the EAST BAY 3
In any case, AIDS case projections are not the primary concern of prevention planning
efforts. Populations at risk, prevalence of infection, estimates of HIV incidence and the
characteristics of the people contracting the infections and the circumstances in which
they occurred are the central focus of this report.
HRSA has used ratios to estimate the number of HIV infected people with different levels
of immunosuppression. This method is crude and based on the possibly unsatisfactory
assumption that the population of the East Bay is similar to that from which the ratio is
derived (the US population). Nevertheless, adjusted back calculation estimates, a more
desirable estimate source, based on AIDS cases diagnosed with the 1987 CDC case
definition of AIDS reported through 1992, have been largely concordant with the
estimates obtained with ratio methodology.
The estimates of the size of the populations at risk included in this profile are clearly
challengeable. There is not enough information on this specific area to present these
estimates on solid ground. Each estimate must be evaluated on the basis of its own
plausibility and the rationale used. The intention of venturing into these estimates is to
provide a perspective of the possible size of the local target populations which is needed
for adequate prevention planning. An overestimation of the size of the populations at
increased risk for HIV can lead to repetitive prevention efforts to the same members of
a group which in reality is smaller in size than estimated. Underestimations, on the other
hand, may deprive many of life-saving interventions.
HIV infections of probable recent occurrence were analyzed using data from clients
voluntarily attending publicly funded clinics. Testing for HIV has also taken place in
many private practice sites. Unfortunately, information from private testing sites is not
readily available. The characteristics and trends observed in clients of publicly funded
clinics do not necessarily reflect the whole population. Nonetheless, its very likely that
they may reflect the populations which are prone to seek care from the public sector.
,
HIV Prevention Community Planning ¢
CHAPTER 2. The Setting of the HIV/AIDS Epidemic
The two counties East of the San Francisco Bay Area, Alameda and Contra Costa,
had a combination population of 2,082,914 in 1990, which is approximately 7% of
California's population. A great range of socioeconomic and race/ethnicity groups of
many cultural backgrounds reside in the region. The median family income (1989) was
$45,037 for Alameda and $51,651 for Contra Costa County.
People and communities with wealth, sophistication and access to the cutting edge of
technological progress live next to communities where poverty prevails. The 1990 census
indicated that 9.3% of the population of the EAST BAY was below the federal poverty
level and since then the economic hardships of the current recession had severe impacts
in many areas. Neighborhoods with under-privileged residents have suffered from the
national redistribution of wealth of the 1980s, the recession of the early 1990s, and the
closure of military installations. Declining employment has impacted this same group �.
disproportionally. The gap between society's economic groups has increased and although
opportunities continue to be available for highly advanced professional and managerial
positions, many blue color jobs in industry and technological centers are vanishing to be
substituted only by lower paying service jobs.
Crime statistics and unhealthy outcomes tend to follow the trends of the economy.
During the ten year period 1983-1992 3 close to 2,400 EAST BAY residents were
victims of homicide. The annual number of homicides increased from 182 in 1982 to 300
in 1992 (65% increase). During the same period other violent crimes assailed these
communities, including some 73,000 reported robberies, 94,000 reported aggravated
assaults and 10,300 reported forcible rapes.
Based on recent data 4 an average of 162 drug related deaths occur in the EAST BAY
each year. The EAST BAY has the second highest incidence rate of syphilis in the state j
(17.6 per 100,000). An average 1,300 teenage women become teenage mothers every
year and perhaps as many as 2,300 become pregnant S.
Toxicspills, school district bankruptcies, homelessness, prostitution and hate crimes are
also present or emerging in the lives of many communities and contributing to the sense
of despair.
Economic investment and government interventions have contained some of the social
damage. More profound responses from beyond and from within these communities are
needed.
1
HIV/AIDS Epidemiology Profile of the EAST BAY $
Discrimination: The common denominator in HIV risk
The lack of full acceptance of gay life-styles in the communities of the EAST BAY
continues to be a determinant of risk. Gay men, particularly gay men of color and young
gay men, often find themselves rejected, condemned, isolated, lacking organization, and
overwhelmed by the heterosexual majority. This context increases the risk for HIV when
it drives gay and bisexual men, even with good levels of HIV knowledge, to venture into
unpredictable sexual scenarios in search of reaffirmation and acceptance.
The economic disempowerment of residents of the inner-cities, many of whom have
grown up without the aspiration of meaningful employment, is also a key contextual
determinant of the evolution of the epidemic. The concerns about HIV infection are likely
to be secondary to the financial challenges of daily subsistence. Economic
disempowerment brings on despair, substance abuse and violence. The atmosphere
generated is such that it demands from many residents all their available energy and
determination, leaving very little remaining attention free to focus on long term survival
planning and life/health improvement. Substance abuse and violence are cyclically
perpetuated by the continuum of hopelessness and the lack of effective and affordable
treatment.
The reality of sexism and women's oppression adds another layer to the contextual
medium where HIV disease continues to propagate. For many women poor financial
status, substance abuse and violence have substantially limited choices, including the
choice of remaining uninfected with HIV.
These are some of the factors potentially contributing to the setting and the continuation
of the HIV epidemic. Many other factors, more individualized in nature, are likely to be
contributors as well.
HIV Prevention Community Planning 6
CHAPTER 3. The AIDS Epidemic in the EAST BAY
Cases Reported
As of May 12, 1994 4,863 residents of EAST BAY communities were reported to have
received a diagnosis of AIDS. They included 3,474 (71.5%) residents of Alameda
County and 1,386 (28.5%) residents of Contra Costa County. The first case of AIDS
reported was diagnosed in 1980 and since then the number has steadily increased year
after year.
Figure #1
AIDS Cases in the EAST BAY, 1980-1994
1 ,000 .. . . . . . . . . . . . . . • - - - - - - - - - - - - - - - - - - - - - - - - - - -853- - - • - - - - - - -
687 692
800 - - • - - - - - - - - - - - - - - - • -
572 573
0 Contra Costa
Alameda
368
400 . . . . . . . . . . . . . . . . . . . 2-51 . . . . . . . . .
148 150
200 3
0 0
■
0
1994 data include cases reported through May 12, 1994
1993 and 1994 data are significantly affected by delayed reporting
HIVIAIDS Epidemiology Profile of the EAST BAY 7
Mode of Infection Distribution
Overall, 3,591 (73.9%) of all AIDS cases were men who had sex with men, nine percent
of whom injected drugs. The 315 gay or bisexual men who injected drugs represented
six and a half percent of all cases of AIDS reported in the EAST BAY.
The second largest group of people with AIDS is constituted by heterosexual injection
drug users. There were 618 (12.7%) cases reported from this population, and 184 of
these injection drug users (IDU) were women (29.7% of all IDU with AIDS). The 190
people with AIDS who acquired HIV through heterosexual contact represent the third
largest group of people with AIDS (3.9%).
The remaining cases consist of blood transfusion recipients (n=105, 2.1%), adult males
with coagulation disorders (n=38, 0.8%), the 22 (0.5%) children who were maternally
infected, and a group of people with AIDS whose mode of infection has not yet been
clearly established often due to lack of information (n=299, 6.1%).
Gender Distribution
Overall, 4,448 (91.5%) of the reported cases occurred in males and 415 (8.5%) in
females. These figures include the 18 boys and the 11 girls under 13 years of age
reported with AIDS.
Race/ethnicity Distribution:
Table #1 describes the distribution of people with AIDS by race/ethnicity groups:
Table # I
Race/ethnicity Distribution of People with AIDS, EAST BAY (n=4,522)
People with AIDS Percent of EAST BAY Percent of EAST BAY
AIDS Cases Population
White 2701 55.5% 59.5%
African American 1618 33.3% 14.2%
Latina 429 8.8% 14.2%
Asian $9 1.8% 12.4%
Native American 15 0.3% 0.5
Unknown 11 0.2% 0.2
HIV Prevention Community Planning 8 N
Figure #2
AIDS Cases in the EAST BAY, by Probable Mode of Infection Group
Maternal NIR Heterosexual IDU
Heterosexual Contact
Blood/Blood Products 6.1% 12.7%
Gay bisexual IDU
3.9% 299 618
2.9% 190
143 :6.5% ; :•.
3276
Gay/bisexual men
Table # 2
Proportional Distribution of Probable Mode of Infection Groups among AIDS Cases,
by EAST BAY
Group Alameda Co. Contra Costa Co EAST BAY Total
..........
Gay/bisexual 69.6% 61.9% .....
67 4%
Gay/bisexual IDU 7.1% 5.0% 6.5%
Heterosexual IDU 10.5% 18.2%
Female 7.8% 10.3% 8 5
Male 92.2% 89.7% 91 5
White 52.7% 62.5% > 55 5%
African American 36.2% 25.9% 33:3%
Latino 8.5% 9.5% 8 8%
Asian 1.9% 1.6% 1 8
Native American < 1.0% < 1.0%
HIV/AIDS Epidemiology Profile of the EAST BAY 9
s
Relative to their population distribution, Asians are significantly under-represented among
the EAST BAY AIDS cases. Whites and Latinos are slightly under-represented, Native
Americans are proportionally represented and African Americans are significantly over-
represented among the EAST BAY AIDS cases.
African Americans have twice the proportion of cases which would be expected in this
population by the general population distribution of the EAST BAY
Figure #3
Population Distribution and AIDS Cases Distribution in the EAST BAY, 1980-1994,
by Race/Ethnicity Groups
White 59.5% $5.5%
African American 1.4.2% 83;3%Q
Latino 13.1% 88%
Asian 12.4% :: 1;8%
Native American 0..5% 0.3a
s�
Population AIDS: Cases'
Table # 3
Population Distribution in the EAST BAY, by County, Race/Ethnicity
and AIDS Cases Distribution by Race/Ethnicity
White African Latino Asian Native Other Total
American American
4 Alameda 680,017 222,873 181,805 184,813 6,763 2911 1,279,182
Contra Costa 560,146 72,799 91,282 73,810 4,441 1,254 803,732
} EAST BAY 1,240,163 295,672 273,087 258,623 11,204 4,165 2,082,914
EAST BAY S9 5% 14.2% 13.1% 12:4% 0.5% 0.230 100.03'0
population
t
AIDS Cases 55.5% 33 3% 8 8% lib% 0.3% 0.2%O 100.0`Y
HIV Prevention Community Planning 10
Age Distribution:
Of-the people with AIDS in the EAST BAY 71.3% (n=3,468) have been diagnosed in
their thirties and forties; 694 (14.3%) were diagnosed in their twenties and 654 (13.5%) �{
were fifty years of age or older when diagnosed with AIDS. Ten (0.2%) were teenagers
and 29 (0.6%) were children.
Living Status
At least 2,899 (59.6%) of all the reported people with AIDS have already died. These
figures may represent underestimations due to delayed reporting of the deaths of persons
with AIDS.
Geographic Distribution
Approximately 40% of the EAST BAY population (750,000) reside in 12 cities located
at the Northwest corner of the EAST BAY and their vicinities (see map p. 18) Among
these 12 Northwest cities five, with approximately 28% of the EAST BAY population
have median annual household incomes under $30,000, among the lowest in the San
Francisco Bay Area. These five cities are Oakland, Berkeley, Emeryville, Richmond
and San Pablo. These five cities have the top AIDS incidence rates in the EAST BAY
(see tables #447)
The HIV/AIDS epidemic seems to have expanded in a semicircular pattern of waves. The
cumulative effect of the HIV/AIDS geographic distribution is partially the result of
population density. There are more cases where there are larger populations. However,
all factors being equal, the Northwest region of the EAST BAY would have had
approximately 40% of the AIDS cases, with 28% of all EAST BAY cases occurring in
the five cities mentioned. What is observed, conversely, is that 64% of all the EAST
BAY cases have occurred in the Northwest region (from Oakland to Rodeo) and the
2,732 people diagnosed in the five cities represent 56.2% of all cases reported in the
EAST BAY. There are more cases of AIDS in these cities than expected on the basis of
their share of the counties populations. Cumulative AIDS incidence rates by city provides
additional insight for a better picture of the AIDS epidemic and underscores the
Northwest region as the area with the highest cumulative incidence of AIDS. Tables #4
through #7 and figures #4 and #5 describe the incidence of AIDS, by city of residency
at the time of diagnosis.
HIV/AIDS Epidemiology Profile of the EAST BAY 11
Figure #4
Population Distribution and AIDS Cases Distribution in the EAST BAY, 1980-1994,
by Geographic Areas
i
......................................................................:........................................................................:.....................
€; :....:::......................... ............................:,-..............,......;...'
...........................................................
........................................................................................................
..
North West
::t::
.....................................................................................................................................................................
.................................................«...............r.................................................n................................................
............................................................ ... ...................................................
'::::::::�::::::::::::::::�::::::::::: ::.� ........... 0::: '::::......::::-::::::::�:::::::::':::':.
Centra! :..._............................... 7ao:: ... 4, : 0......:.;...:.:.......:.....:::,.........:...:
.............................
-...._.... _.. :. ..... ................_......._...._......_.
_... . ...._T............................................
......................................................................................................................................................................
........ .................... .::.......... ....................,....................—......................
... •. IIIO':atti at[[i'a:f'[[tt[I[a::......7......::�If
[.i;i;;iii:iiiiii.. ::i%iiiii:ii
South ...................:::::::............:::::::::24 ¢ ::::.
...
........................................_................................................................_................................................
.....................................................................................................................................................
..........................................
_................................................................,.................................................
......... . ....
riiiiiiiiiii:iir�risiiiii
North East iiiiiiiiii;€iisiis ...i. 0:: ::: i5;:2.... _........f.._.............................
1:: -
i
100%80% 60% 40% 20% 0% 20% 40% 60% 80% 100%
13East Bay Population MAIDS Cases
(
i
HIV Prevention Community Planning 12
Table #4: Northwest Region of the EAST BAY
Cumulative incidence of AIDS by city of residency at the time of diagnosis
"The Northwest I-80 Corridor"
City of Residency Estimated Population Reported AIDS Cases Rate per 1000
(*) Cumulative 1980-1994 residents j
Oakland 358,000 1,qg6 5.S 1
Emeryville 6,000 31 5.2
Richmond 84,000 298 3.S
San Pablo 22,000 74 3.4
Berkeley 106,000 343 3.2
Alameda 74,000 198 2.7
Pinole 17,000 30 1.8
Albany 17,000 3I 1.8
Piedmont 10,000 20 2.0
EI Cerrito
23,000 33 1.4
? Hercules 17,000 22 1.3
Unincorporated
Areas
North Richmond - 24
El Sobrante
Rodeo
Kensington
Two areas with fewer
than five cases each
a
* 1990 Census figures rounded off to the next thousand Cases reported as of 5112194
i
J
i
{
a
HIV/AIDS Epidemiology Profile of the EAST BAY 13
w Table #5: South Region of the EAST BAY
Cumulative Incidence of AIDS by city of residency at the time of diagnosis
"The South Interstate I-80 Corridor"
14
City of Residency Estimated Population Reported AIDS Cases Rate per 1000
(*) Cumulative 1980-1994 residents
San Leandro 67,000 18 2.8
Hayward 106,000 265 2.5
Newark 40,000 33 0.8
Fremont 173,000 I41 0.8
Union City 51,000 0.7
Unincorporated
Areas
Castro Valley
San Lorenzo
Tabler
#6. North-East Region of the EAST BAY
Cumulative incidence of AIDS by city of residency at the time of diagnosis
"The Highway 4 Corridor"
City of Residency Estimated Population Reported AIDS Cases Rate per 1000
(*) Cumulative 1980 1994 residents
Pittsburg 46,000 Il8 2.6
Antioch 62,000 73 1.2
Brentwood 7,000 11 1.6
Unincorporated
Areas
Bay Point
Oakley 10 .
Three areas with fewer
than five cases each
* 1990 Census figures rounded off to the next thousand Cases reported as of 5112194
HIV Prevention Community Planning 14
Table #7: Central Region of the EAST BAY
Cumulative incidence of AIDS by city of residency at the time of diagnosis
"The Interstate 680 Corridor"
City of Residency Estimated Population Reported AIDS Cases Rate per 1000
(*) residents
Cumulative 1980-1994
Walnut Creek 64,000 138 2.0
Martinez 31,000 60 1.9
Clayton 7,000 13 1.9
Orinda 18,000 35 1.8
Concord 111,000 203 1.7
Dublin 26,000 43 1.4
Pleasant Hill 32,000
4ffl. 1.3
Lafayette 23,000 26 1.1
Danville 32,000 30 0.9
Livermore 58,000 42 0.7
San Ramon 36,000 26 0.7
Moraga 16,500 12 0.7
Pleasanton 55,000 32 0.5
Unincorporated
Areas
Alamo
Four areas with fewer
than five cases each
* 1990 Censusfigures rounded off to the next thousand Cases reported as of 5112193
FIN
HIV/AIDS Epidemiology Profile of the EAST BAY 15
Figure #5: EAST BAY Cities by Cumulative AIDS Incidence Area
and Median Annual Household Income
Nov105
allev f
�-�• xr.z ` s �xF`#� fy `.z � Benicia
'R•--•S a�\ x, ,sst r�z
Sa tY..Gfr. Q
RQIOe) .r Y, 3;^�, c i�8,'��a+ `a�^�z OdeOk .P
alrfax Agk: R,
•erarles ►-,`r;'
^elmNR
Pr �
ROSS
Larksp F� ha a ncord "r
Corte. a er. ¢ Plea an Aati
Hill
Vail y >�� tl'C to / Yy�l-7 C oyton
Tburon Albany '' ---'.%ty Ut k.
sausolio Lafaye CCF kk
s e� Iv`edere
nt AAoraga
i'.
` rl ' Alam
� Y SS h•sC 5.�4 3+0 ��3�i
Uo�Jond sa
�` , s `x 3' 1n1e1ritihoTwl
y N C51 z ArrQotf x
Da Ci Bnihe rY n astro Livermore
A`- - 8 zs c•Y # e r r � :ub6n '-•Z
x{ _. Sw;th Sante` sQ`Baa Vclley
Paafica�
Pleasantori�.c;�
$ori frQne�eco rs
�Bru`. o� 12r�rA�vfloriolAlrpaf � t _• sy'sz..�' ..
a
��Millbr :B'r fi art a $gg Hayv�ac rnon
thllsbOfOUg11
M Monlara Stip Fosler Gty �"`
Moss Beach Maf o '= a :sy Sunol
EI Grapado R wood^111�Y -
Belmont .M
San
y Newark �. <�•
Carlos
10-10 ."ReW
Half Moon
f'aPctojf y r t
.{� 4. ,✓, x.":.� } 1.
Milpitas
Median annual household Ori—
income, by city, 1989 F
Cases of AIDS
Under� $30,000 s Alto; I per 1 000!l -�'� P + population
ills '--"-"
$30,000—$49,999 Cuperhno
0-1.9
$50,000—$74,999
Car 2-2.9
j $75,000--$99,999 0 4
3+
$100,000 and over A► Los
E
r ,
HIV Prevention Community Planning 16
CHAPTER 4. The Shifts in the People with AIDS:
The Eighties and the Nineties
The time from infection with HIV to a diagnosis of AIDS has been estimated to average
10 to 11 years. The revision in the criteria for an AIDS diagnosis implemented in 1993
by the Centers for Disease Control and Prevention (CDC), has shortened that period by
1.5 - 2 years.
The group of first AIDS cases occurring in the EAST BAY are likely to represent
individuals and populations infected earlier with HIV, during the first years of the HIV
epidemic, probably in the late 1970s and the first years of the 1980s. The people
diagnosed with AIDS in more recent years are more likely to represent HIV infections
' which occurred later.
It is appropriate to compare the first 1,907 (39.2%) cases diagnosed between 1980 and
1989 to the more recent 2,956 (60.8%) cases diagnosed between 1990 and 1993 to
evaluate changes in the populations who were infected during the periods mentioned
above. The following are the main findings of this comparison:
Number of Cases:
i
The cumulative number of cases diagnosed through the 1980s was reached and surpassed
by the number diagnosed during the first four years of the 1990s.(The ratio of cases from
1980-89 to 1990-93: 1.0:1.6). It is likely that during the 1990s the EAST BAY counties
will see at least.twice as many residents diagnosed with AIDS as it observed during the
1980s.
Mode of Infection Distribution:
Although the actual number of men who did not inject drugs and who had sex with men
continued to constitute the largest group of AIDS cases, there was a significant decrease
in their proportional representation among all AIDS cases. During the 1980s 74.3%
(n=1,417) of all cases were men who had sex with men (non-IDU). During the 1990s
62.9% (n=1,859) of all cases came from this group.
Concurrently, there was a clear increase, almost a two fold increase, in the proportion
of cases who were heterosexual injection drug users. During the 1980s they represented
7.7% (n=146) of the cases and they represented 16.0% (n=472) of all cases diagnosed
during the 1990s.
. I
HIV/AIDS Epidemiology Profile of the EAST BAY 17
Gender Distribution
During the 1980s women represented only 4.7% of the AIDS cases. During the nineties
women more than doubled their proportional representation constituting 11.0% of these
newer cases.
Race%thnicity Distribution
Of all race/ethnicity groups, higher percentages of African Americans are observed
among the cases more recently diagnosed. During the 1980s African Americans
represented 25.9% of all cases. During the 1990s their representation increased to 38.0%
of all cases. AIDS cases among Whites decreased from 63.1% in the 1980s to 50.7% in
the 1990s. Latinos and Asians, without significant changes from the 1980s to the 1990s
in their share of the AIDS cases continue to be under-represented among AIDS cases.
Latinos went from 8.7% in the 1980s to 8:9% in the 1990s. Asians remained at less than
2% through these years.
Geographic Distribution
During the 1980s, 66.4% of all EAST BAY AIDS cases were diagnosed among residents
of the Northwest cities. During the 1990s they remained as the local epicenter with
63.3% of all EAST BAY cases emerging from the region. The few percentage points of
AIDS cases lost by the Northwest region were gained by the Northeast and Central
regions. The epidemic -with this eastward move brought the reality of HIV/AIDS to
people living in more peripheral residential and suburban areas.
At the same time another geographic redistribution started occurring: Within the
Northwest region an inner-city implosion of the AIDS epidemic started to occur.
More cases started emerging from inner-city neighborhoods largely populated by
socioeconomically disadvantaged, ethnically diverse urban communities. Of all the cases
of AIDS diagnosed in the EAST BAY during the 1980s, 29.7% (n=567) occurred in
people of color residing in the Northwest region of the area. During the 1990s cases
diagnosed among people of color from this region increased to 38.0% (n=1,124) of all
EAST BAY AIDS cases.
When the Northwest region is analyzed on its own, the "inner-city implosion" of the
AIDS epidemic is suggested by the shifting of 15.3% of all cases from White to
people of color.
During the 1990s the percentage of cases in the Northwest region fell by 3.0% its share
of all EAST BAY cases. In fact reflecting a reduction of 11.4% of the cases among
White residents and an 8.3% increase in the communities of color of the Northwest
region of the EAST BAY.
HIV Prevention Community Planning 18
Proportional Distribution of AIDS Cases
EAST BAY, California, 1980-89 and 1990-94
Shifts in the HIV/AIDS Epidemic
1980-89 1990-94
GAY/BISEXUAL ;74 390 :;62.9%'
...... ...
White
People of Color 23;1% 24.814
GAY/BISEXUAL IDU 7 5% 5 89o:i '
White 4% 3 1%
People of Color 3.5% 2.7%
HETEROSEXUAL IDU 7w7%:- 16%
Men 5.6%:
11.1:%
White 1.7% 12 4%
People of Color' 3.9%: 8 7%
Women 2%v 4 99'0
White 0.5%0' 3 2%.
People of Color 15% '3.8%
HETEROSEXUAL PARTNERS
Men 0:8% 1.3% N _2 956
White N ='1 907 0.1% 0.79'0
People of Color
0.7%::1. 10.7%
Women 13% 3.8%
White 0:5% "1.4%.
People of Color 0.7% 2.4%
18-28 YEARS OLD 13.7%
Men 13% 8.1%:: ,
White 7.690' 3 7%
People of Color 5% 4 4%
Women 0.89'0 1.4%
White .0.3°k 0.3%
People of Color
NORTH WEST 66.3%. _: 63.3%"
White 36 5%• 25.1
People of Color 29:79'0....: 389'0
CENTRAL 13.7%.::.:: 15.7%
White 1'1 5% 12.2%
People of Color 2.29'0
SOUTH 16:490 14:6%
White 12.7% 10.29'0'
People of Color 3.6%i 4,8%
NORTH EAST 3.5% 6.39/0
White 2.3°ia 3 2%
People of Color - 1.2% 3.1%
FEMALES 4.7%-
White 1.790 3.2%:
African American 1:9% 6.6%
Latina 07% 1.190
Asian 0.2% 0:1%
Native American 0.16% 0.03W...'
MALES 95.3% 89%
White 61.49'0 47:5%
African American 2494 31.4%
Latino 8%':: 7.9%"
Asian
Native American 0:29'. 0290
1994 includes reoortes through 5112
HIVIAIDS Epidemiology Profile of the EAST BAY jp r
Figure #7 Proportional Re-distribution of AIDS Cases in the Northwest EAST BAY
70% 0 70%
:0:3%
60% 60%
50°l0 50%
40% `' 38°./.0 . . . 40%
29 7%
30% < 30%
20% 20%
10% 10%
0% -_ 0%
All cases in NW People of Color in NW
01980-1989 ® 1990-1994
This geographic and socioeconomic redistribution of AIDS cases during the 1990s means
that approximately 250 additional cases of AIDS were diagnosed among people of color living
in communities of the Northwest region of the EAST BAY.
HIV Prevention Community Planning 20
CHAPTER 5. People with HIV
Overall Estimate of the HIV Infected Population in the EAST BAY
In September 1993 the Alameda County HIV/AIDS Epidemiology and Surveillance
Office and the Epidemiology and Surveillance Unit of the Contra Costa County AIDS
Program prepared estimates of the people living with HIV in the EAST BAY following
methodology suggested by HRSA. These estimates reported that approximately 13,550
people were living with HIV in the EAST BAY. The approximately 2,600 EAST BAY
residents who have died with AIDS brings the total overall estimate to 16,500 EAST
BAY residents infected with HIV. This estimate means that there are at least 2.6
additional persons infected with HIV for each resident already reported with an AIDS
r
diagnosis.
Estimates by Mode of Infection
The number of men who had sex with men estimated to be living with HIV was
approximately 9,300, including those who also injected drugs. If the approximately 2,030
who died with AIDS in the EAST BAY are added, the estimate results in 11,350 EAST
BAY men who had sex with men infected with HIV. These infections represent 70% of
all infections estimated to have occurred in the EAST BAY.
The number of heterosexual injection drug users (IDUs) living with HIV was estimated
to.be approximately 2,250. When added to the approximately 300 heterosexual drug
injectors (IDUs) who have died with AIDS, it results in a total equal to 2,550 IDUs,
30% of whom are women. Heterosexual injection drug users infected with HIV represent
approximately 15.8% of all HIV infections in the EAST BAY.
The number of living EAST BAY residents infected with HIV through heterosexual
contact was estimated to be approximately 520. An additional 100 persons with
heterosexually acquired HIV have died with an AIDS diagnosis. The total number of
EAST BAY residents with an heterosexually acquired HIV infection is approximately
620, 65% of whom are women. Heterosexually acquired cases of HIV infection represent
3.8% of all infections.
Approximately 110 cases of HIV infection occurred in persons with coagulation disorders
and 230 HIV infections occurred from transfusions. Finally, approximately 90 EAST
BAY children are estimated to have been infected with HIV, most of whom were born
to HIV-infected women.The exact mode of infection with HIV is not known for many
AIDS cases due to lack of information. These cases are now classified as "No Identified
Risk" (NIR). An additional 1,200 HIV infections estimated to have occurred based on
NIR cases reported
PAM
HIVIAIDS Epidemiology Profile of the EAST BAY 21
Back calculation Estimates of HIV Infected Persons in the EAST BAY.
Using back calcularion methods adjusted for under reporting (20%) and for
delayed reporting (1988— 5;%, 1989 10%, I990= IS%, 1991_ 20%, 1992 {
25%), the number of HIV iiifecti ns estimated to Have occurred in the EAST BAY
by`1989 and based on'the number of AID.:S cases under the T9$7definition criteria
is approximately 13,500. This back calculation estimate is compatible with;the
16,150 estimate from'the HRSA formula when new infections estimated to have
occurred in the period 1989=1994 are added (approximately 2,700) Estimates of
new mfectlons are extrapolated from statewide/nationwide estimates
Tables 3, 4 and 5 outline the size of the estimated HIV infected populations. Caution
must be used in the interpretation of these estimates. These estimates are intended as
crude approximations to guide the planning of services and are not exact measures.
Table #8
Estimated EAST BAY Residents Infected with HIV, by Probable Mode of Infection
Estimated Infected Percent of all HIV
cases
Men who have sex with men 11 350 70.3%
Heterosexual Injection Drug User 21550 15.8%
Heterosexual Contact 620 3.8%
Undetermined (NIR) 1;200 7.4%
Coagulation Disorder 110 0.7%
Transfusion Recipients 230 1.4%
Pediatric 90 0.6%
Total 16,150 100.0%
Fan
HIV Prevention Community Planning 22
Table #9
Estimated EAST BAY Residents Infected with HTV, by Race/ethnicity Group
Estimated Infected Percent of all HIV
cases
White $,500 52.6%
African American 5,900 36.5%
Latino/Hispanic 1,400 8.7%
Asian 270 1.7%
Native American $0 i 0.5%
Total 16,150 100.0
Table #10
Estimated EAST BAY Residents Infected with HIV, by Gender
Estimated Infected Percent of all HIV
cases
Female 1,500 9.3%
Male 14,650 90.7%
Total 16,150 100.0%
1
HIV/AIDS Epidemiology Profile of the EAST BAY 23
CHAPTER 6. Groups Impacted the Most by HIV/AIDS
Men Who Have Sex With Men
In 1948 the Kinseyreport estimated the percent of men who have P
p p e had sex with men to
be 10% of the US population and this figure became part of the conventional wisdom.
Studies from England (2:0%) and France (3.0%) estimated the percent to be smaller,
although higher in urban centers (10%). In 1989 Fay, Turner, Klassen and Gagnon I
estimated that 3% of the population have same-gender sexual encounters,fairly often. In
1991 Smith I reported that 1.5% of sexually active adults in the General Social Survey
were non-heterosexual. In 1993 researchers from the Battelle Human Affairs Research
Center in Seattle,' presented the results of a new national survey which showed that
2.3% of men aged 20-39 have had at least one same-gender sexual activity during the last
10 years and 1% reported being exclusively homosexual. In 1994 the University of
Chicago, National Opinion Research Center 2.8% of the men and 1.4% of the women
identified themselves as homosexual or bisexual, and 9% of the men and 5% of the
women had at least one homosexual experience. Homosexual men also tend to cluster in
urban centers.9 In 1987 the California Department of Health Services conducted a
General Population AIDS Survey 1°. This was a random sample telephone survey P
designed for statewide estimates. Extrapolations from this survey suggest a 4.5%
prevalence of men who have sex with men in the San Francisco Bay Area (San Francisco If
and five other counties,,including Alameda and Contra Costa). This percent estimate is
relatively consistent with the 1993 national survey mentioned above when the migration
of gay men to the San Francisco Bay Area is taken into account. The California phone
survey estimated the male population of city of San Francisco to have a prevalence of
11% of men who have sex with men. Local San Francisco prevalence estimates prefer
15%. Phone surveys are probably less inviting and trust generating when attempting to
obtain from randomly surveyed people sensitive information such as sexual orientation
or practices. Surveys like the one mentioned above are likely to underestimate the true
prevalence of non-traditional responses. San Francisco's estimates10 of the prevalence
of gay/bisexual men in the city suggests the state phone survey underestimated the
prevalence of men who have sex with men by approximately 30%. If the Bay Area
prevalence estimate (4.48%) is adjusted upwards by the ratio of discrepancy between the .
State and San Francisco(1:1.44), the adjusted San Francisco Bay Area Prevalence results
in 6.5%. If 6.5% of the 745,000 EAST BAY males aged 17-74 are men who have sex
with men, there are some 48,500 men in this group. With an estimated 11,350 who are
HIV-1 infected, the HIV-1 prevalence for the group would be 23.4% With 3,357
diagnoses of AIDS, the prevalence of AIDS would be 6.9%
Gay/bisexual Estimated Percent of Paputpttvn HIV utfected HIV% A117S Prevaten.ceusceptcbte
men GenerAl Popularton . size esru7tate estimate esttmlue < Reported, vfAI)S Poputanon10
EAST BAY 6.5% 48,500 11,350 23.4% 3,357 6.9% 37,150
M e t
HIV Prevention Community Planning 24
Injection Drug Users
Estimates of the population of.injection drug users in California are available for San
Francisco and Los Angeles. The California Department of Health Services estimated that
in urban areas like those two areas, 2% of the total local population are drug injectors,
and that outside urban areas the approximate percentage of IDUs may be 1% I'. A
rough 1.5% estimate applied to the adult EAST BAY population suggests approximately
22,000 injection drug users in the EAST BAY.
During an eight year period (1982-1990) 9,814 different injection drug users presented
for treatment at least once in the EAST BAY, although not all were necessarily EAST
BAY residents. The type of treatment facilities largely available in the EAST BAY, hints
that this number largely represents opiate injectors for whom methadone treatment was
available. Some Bay Area surveys 11 indicate that between 24% and 46% of drug
injectors interviewed have not been admitted to treatment in recent years. Adjusting by
30% the 9,814 reported IDUs, an estimate of 12,760 opiate injectors emerges. The
remaining 9,200 drug injectors from the overall estimate are likely to be cocaine and
amphetamine ("crank") injectors which have fewer treatment centers available and are
~ ` less likely to be included in clinic based data. It is likely that overlapping occurs among
these populations.
With an estimated 2,550 drug injectors who are HIV-1 infected, the HIV-1 prevalence
„- for the group would be 11.6% (Approximately one in 8 would be HIV infected). With
573 diagnoses of AIDS, the prevalence of AIDS would be 2.6%. One in every 38 has
already been diagnosed.
A 1991 HIV blinded survey " of IDUs entering methadone treatment in Alameda was
5.5% positive overall and 10.9% of the African American IDU found to be HIV
infected. Rates for IDUs entering treatment in clinics in Contra Costa County in 1991
were 11.2% overall and 32.7% . for African American IDUs.
In 1991, 463 IDUs from Oakland recruited to a street survey 14 yielded an overall
11.7% rate of infection with HIV, In 1992 " a street survey of 687 IDUs from Oakland
reported an overall 13.3% infection rate. In both surveys there were neighborhood and
race/ethnicity group differences in HIV prevalence. In Richmond, the same surveys
reported 19.4% in 1991 and 26.5% in 1992. It is likely that, as suggested by these data,
geographical and race/ethnicity variations exist.
Infector Drug Estrmated Percent of Population HIV>nfected HN;�l'a AIDS Prevalence Susceptible
Users(IDUs). General Population size esrum a esfimote estimate Reported: of AIDS Population
FAST BAY 1.5% 22,000 2,550 11.6% 573 2.6% 19,450
4
F
HIV/AIDS Epidemiology Profile of the EAST BAY 25
Populations at Risk for Heterosexually Acquired HIV Infections Ft
Most infections through heterosexual contact appear to have occurred among sexual
partners of injection drug users " and two thirds of the cases have occurred among P
women. Of the 620 heterosexually transmitted infections estimated to have occurred
among EAST BAY residents, 410 occurred in women and 210 in men.
It appears that the estimated 1,780 male heterosexual IDUs infected with HIV were the
likely source of the infection for most of the 410 EAST BAY women estimated to have
occurred during the last decade.
Even under the most, conservative estimate of a single lifelong female heterosexual
partner for each heterosexual drug user, approximately 1,375 women would be at
immediate risk of HIV infection. Additionally some 13,600 female sex partners of non
HIV infected male IDUs are at increased risk for HIV if the epidemic continues to
expand in this group. P
HIV infection among heterosexual women is reflected in HIV prevalence rates among P
childbearing women of the EAST BAY. Childbearing women in the EAST BAY have
had consistently higher prevalence levels than in any other State region. The last year for
which data is available, 1992, reports that the EAST BAY communities, with only 5.9%
of the live births for the year 17, had 19.8% of all HIV infections detected. Of the 1992
childbearing women from the EAST BAY infected with HIV, 85% were women of
color.18 P
Although, male-to-female transmission appears significantly higher in studies of US and
European couples (RR:1.9) 19 there is evidence that female-to-male transmission also P
occurs'with enough frequency to warrant public health concern.
The 1,170 heterosexual women infected with HIV through heterosexual sex and/or drug P
injection appear to have constituted the source of infection for 200 EAST BAY men
infected heterosexually and could represent the source of infection of many others,
particularly if socioeconomic, drug addiction and/or other factors force these HIV
infected women in risky practices.
IF
HIV Prevention Community Planning 26
i
CHAPTER 7. Clues on New Infections
Extrapolations from national estimates the California Department of Health Services
suggest that there may be as many as 8,000 new HIV infections occurring annually in
California 20. If this is so and these cases are distributed throughout California
proportionally to the Statd population distribution, approximately 550 new infections may
be occurring yearly among EAST BAY residents.
Voluntary HIV antibody testing, the standard test to detect an HIV infection, has been
available since April 1985 and widely offered by the Alameda County Health Care
Services Agency and the Contra Costa County Health Services Department at numerous
sites in the EAST BAY. Additionally, many private providers have also offered HIV
testing.
The information provided by people choosing to take an HIV test is not necessarily
representative of the whole EAST BAY population. It represents only one possible
window into the HIV status of this population and different sub-sets of this population.
Moreover, people taking an HIV test at publicly funded clinics may not be representative
of residents who are in a more comfortable financial situation.
Nevertheless, data gathered at the time of testing has the potential of providing very
valuable information of the HiV epidemic and its trends. This data is particularly
interesting because part of this data seems; to represent recent infections which may be
explored to confirm HIV/AIDS epidemic trends based on AIDS diagnoses. In addition,
some data variables available in testing data may help clarify the areas in need of special
attention for prevention efforts.
Between January 1, 1990 and December 1, 1993 approximately 62,500 HIV tests were
provided to clients, half men and half women, presenting to publicly funded sites in the
EAST BAY. Many clients choose to test more than once and consequently that number
does not represent un-duplicated clients. However, some 32,700 of these tests were
provided to people who reported that they had no prior test.
Of all people tested, 1,152 learned that they were infected the very first time they
took a test. No data is available to clarify the time of occurrence of the infections.
It was noticed that 11.8% of these people came in for the HIV test because a partner
notified them of their potential exposure to HIV, either directly (8.2%, n=95)or through
a health care worker (3.6%, n=41). Sixteen of the positive women in this group were
pregnant. The demographic distribution of these clients is presented in table #6.
A
HIV/AIDS Epidemiology Profile of the EAST BAY 27
Table #6: 1,152 Clients Testing Positive HIV Antibodies for the First Time (1990-1993)
and without a Prior Negative Test, by Gender and Probable Route of Infection
Men Women Data<M►ssmg Total (%)
Gay/bisexual men: 368
Gaylbisexual;men Il)U > 48 - - 48
Heterosexual IDU 173 95 2 270
Heterosexual;Partners 175 127 1
Other 36 21 4 61
777
Data M.....
ssing 60 30 12
Total 281 107 4 1152 (100%)
J
Recent Infections
On the other hand, 365 additional clients were also found to be infected but reported that
they had previously tested HIV negative. Of these HIV infected people who knew the
date of their prior negative test, 226 (61.9%) reported that the prior negative test took -�
place during or after 1990. The remaining 139 (38.1%) infected people reported a prior
negative test between 1985 and 1988.
These 365 people who report having being infected in recent years, provide some
clues about where and how new infections are occurring. The frequency distributions for
these 365 recently infected people cannot be assumed to represent all recently infected
EAST BAY residents. People tested elsewhere may have different characteristics.
r
Mode of Infection Distribution
Gay-bisexual men who have not injected drugs, represent 35.9% (n=131) of these new
infections. Injection drug users constitute 35.3% (n=129) of these recent infections and
half of the newly infected IDUs were women (n= 64). Heterosexual contact was the —
mode of infection of 18.4% (n=67), almost half of whom were women. Gay-bisexual
men who injected drugs represented 4.7% (n=17) of these recent infections.
Gender Distribution
Overall, women constituted 28.2% (n=103) of all the recent infections. Approximately
62.1% (n=64) of the women infected injected drugs and 28% (n=29) were infected
through sexual contact.
HIV Prevention Community Planning 28
1
Race/ethnicity Distribution
African American constituted 55.3% (n= 202) of all these recent infections, White
27.9% (n=102), Latino 10.7% (n=39), Asian 1% (n=4), and Native American 1%
(n=5). Furthermore, 35.1% (n=46) of the gay/bisexual men recently infected, 72.9%
(n=94) of the heterosexual IDUs, 68.7% (n=46) of the heterosexual partners and
78.6% (n=81) of the women among these recently infected people were African
American.
Age Distribution
The mean age of these clients with recent infections was 34.4 years, with a range of 19-
71. Of the gay/bisexual men of this group had a mean age of 31:3 and 20.6% (n=27)
were 25 years of age or younger. The heterosexual IDUs of this group had a mean age
of 38.1 and only 2.3% (n=3) were 25 years of age or younger. The heterosexual
partners of this group had a mean age of 32.1 and 19% (n=13) were 25 years of age
or younger. Women heterosexual partners had a mean age of 29.5 and 31% (n=9) were
under 25 years of age.
Table #7: 365 Clients Testing Positive HIV Antibodies for the First Time (1990-1993)
and Reporting a Prior Negative Test, by Gender and Probable Route of Infection
r .. ...
Men; Women Data Missing Total(%)
Gay/bsexuaI:men 131 - - 13 %)
GaylbMktial men TDU 17 - - 17.;(4 3%);
Heterosexual;IDU 63 64 2 129;;:(35.3%)
Heterosexual Partners < . 38 * 29 * - 67.(18
Other .; 2 3
DaIVlissmg 8 7 1 4 1%)
Total 259: 103 2., 365.> i00%'.
* It is important to be careful in the utilization of risk factor data originating at test sites,particularly when
"heterosexual contact" is reported as the only risk. Riks are the ones reported by clients upon presention
for testing and no further investigation is performed.Many people diagnosed with AIDS who initially report
only "heterosexual contact"as the mode of infection subsequently acknowledge other risk behaviors.
a�
a • y:
HIV/AIDS Epidemiology Profile of the EAST BAY 29
Of these people, 13.1 (n=50) came in for an HIV test because a partner notified them
of their potential exposure to HIV, either directly (8.2%, n=30) or through a health care
worker (5.5%, n=20). Ten on the women in this group were pregnant. A sexually
transmitted disease (STD) during the year preceding the HIV test was reported by 11.2%
(n=41). The Northwest region of the EAST BAY was the area of residency of 70.2%
(n=256), and 51.8% of all infected clients were African Americans residing in the
Northwest region of the EAST BAY. The average and median number of partners during
the preceding year for young gay/bisexual men (25 years of age or younger) was 3.5 sex
partners. For female injection drug users the average number of sex partners was 4.9 (
median = 1 partner). For female sex partners the mean number of sex partners was 9.1
( median = 1 partner).
Figure #7 : Clients Testing Positive for HIV Antibodies (1990-1993)
and Reporting a Prior Negative Test,
by Race, Probable Route of Infection and Gender Groups (*)
African American IDU 9
White IDU 22
Other IDU 10
African American MSM 46
Other MSM 22
MSM of Color 68
White MSM 58
AA Hetero Partner 46
Other Hetero Partner 10
White Hetero Partner 11 ;
0 20 40 60 80 100
e Men V2Women
f
6
HIV Prevention Community Planning 30
CHAPTER 9 Socioeconomic Impact of HIV/AIDS
The early death of EAST BAY residents to AIDS has deprived from these individuals,
their families and communities many years of potential life. The list which follows outlines the
years of potential years of life lost (YPLL) by residents who died with AIDS.
Years of Potential Life Lost
Total Cumulative Years of Potential Life Lost: . . . . . . . . . . . . . . . . . . . 88,200
Women . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,977
Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81,223
White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50,425
African .American . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28,211
Latino . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,109
Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,026
Native American . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Gay/bisexual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61,863
Heterosexual Drug Injectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,523
Gay/bisexual Drug Injectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,174
Heterosexual Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,354
Blood/blood product recipients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,442
Other (NIR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,665
Northwest Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55,569
Central Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,277
South Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,610
Northeast Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,659
r
{
HIVIAIDS Epidemiology Profile of the EAST BAY 31
I
The early death of EAST BAT residents to AIDS has also deprived from their families and
communities many valuable and needed resources. The list which follows outlines the lifelong
potential earnings lost (YPLL) by residents who died with AIDS.
Lifelong Potential Earnings Lost
!{ Total Cumulative Lifelong of Potential Earnings Lost: $ 1,689,163,000 (1.6 billion)
t
.`y
;} Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 77,355,000
Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,611,808,000
4d
,a
q White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $78,272,000
African American . . . . . . . . . . . . . . . . . . . . . . . . . . $529,993,000
t Latino . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $153,331,000
Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $19,262,000
Native American . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $5,556,000
i Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$2,747,000
Gay/bisexual . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,238,883,000
Heterosexual Drug Injectors . . . . . . . . . . . . . . . . . . . . . . . . . . $170,759,000
Gay/bisexual Drug Injectors . . . . . . . . . . . . . . . . . . . . . . . . . . $126,044,000
Heterosexual Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $44,883,000
Blood/blood product recipients . . . . . . . . .. . . . . . . . . . . . . . . . . . $33,621,000
Other (NIR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $65,642,000
I
Medical Costs
Each new infection occurring in THE EAST BAY is depriving society and communities
of more than $100,000 in medical costs.
The estimated 16,500 residents of the EAST BAY may cumulatively add up to more than
1.6 billion dollars in medical costs.
f
I
i
}
HIV Prevention Community Planning 32
Summary
During the summer of 1994 the communities of the two counties East of the San
Francisco Bay reached the landmark of 5,000 residents diagnosed with AIDS. This tragic
milestone underscores the seriousness of the HIV/AIDS epidemic in the EAST BAY and
is a reminder to our communities and to local, state and federal governments not to
become complacent about the epidemic. It is imperative that urgent attention and
adequate funding for HIV prevention be placed in the EAST BAY to avoid further
catastrophic consequences.
The analysis of the data presented in this report supports the concept that this epidemic,
like others, is not occurring in a social vacuum. It takes place in very particular
contextual realities which have allowed and facilitated the spread of HIV. These realities,
which impact each individual differently, are essentially collective in nature, different
from group to group; they change over time. They must be taken into account and
addressed if any significant prevention efforts are to take place. Prevention strategies
which are exclusively based on individualized education and behavior modification
encouragement will not be able to break the barriers of the contextual determinants.
The HIV/AIDS epidemic has significant impact among gay and bisexual men residing in
the EAST BAY. Although high estimates indicate that gay/bisexual people are a
maximum of 10% of the population, gay or bisexual men represent 74% of all
cumulative cases, regardless of other risk factors including drug injection. The injection
of drugs is a practice estimated not to exceed one or two percent of the population.
Nevertheless, heterosexual drug injectors constitute the second largest group of people
with AIDS (12.7%). African Americans have a disproportional representation in the
EAST BAY HIV/AIDS epidemic. With approximately 14.2% of the EAST BAY
population, African American cases represent 33.3% of the AIDS cases reported.
Furthermore, People of color constitute 36.7% of gay/bisexual men with AIDS and
75.9% of heterosexual drug injectors with AIDS. People with AIDS who were residents
of communities in the Northwest region of the EAST BAY, from Oakland to San Pablo
and surrounding areas, represented 64% of all cumulative cases in the EAST BAY.
The HIV/AIDS epidemic is shifting. Among more recent cases (1990-1994), increasing
y percentages are heterosexual drug injectors (16%), particularly among people of color
(12.5%); women,(who constitute 11% of the newer cases), and heterosexual partners
(5%), mostly women (3.8%). The increased percentage among people of color is
essentially reflecting an increased number of AIDS cases among African Americans
(31.4%). Although White gay/bisexual men have reduced their percentage among AIDS
cases by one fourth (from 51.2% to 3 8.1%), gay/bisexual men of color increased their
representation among all AIDS cases (from 23.1% to 24.8%). Overall, gay/bisexual
men continue to represent the largest group (62.9%) among recent AIDS cases.
Additionally, in more recent years, proportionally more cases have emerged from
HIV/AIDS Epidemiology Profile of the EAST BAY 33
communities located in Central and Northeast regions of the EAST BAY, while the
Northwest region (Oakland through Hercules) remained the one with the highest
percentage of AIDS cases (63.3%). Also, within the Northwest region, there is evidence
of a concentrating move of the AIDS cases in neighborhoods largely populated by
African American, Latino and Asian populations. The shift in the AIDS epidemic from
AIDS in middle and upper class White men to disenfranchized people of color, from the
hills of Oakland, Berkeley and Richmond to their flat-lands represents a sort of epidemic
implosion.. This implosion is characterized by an increase of the intensity of the
HIV/AIDS epidemic in the weakest socio-economic strata of this geographic area.
New infections continue to occur. Extrapolating from national and statewide estimates
as many as 550 new infections may be occurring every year in the EAST BAY (340 in
Alameda County and 210 in Contra Costa County). Available testing data for recent
years suggest that many of the new infections are occurring among gay and bisexual men
of color, injection drug users, women and heterosexual partners.
Accidental exposure to HIV through blood occurs occasionally in occupational or
emergency situations. This is an unfortunate possibility for all residents of the EAST
BAY to differing degrees. Nonetheless, some populations are at increased risk for HIV
infection. The estimated 37,000 uninfected gay and bisexual men and the estimated
19,000 uninfected injection drug users require special education and support efforts to
limit their probabilities of HIV infection. These efforts are also needed for the at least P.
15,000 female sexual partners of heterosexual IDUs. These populations deserve particular
attention because of their size and HIV prevalence rates. Other individuals also find
themselves at risk for HIV by circumstances and events of smaller probabilities (i.e. P
occupational exposures and blood transfusions) which also require adequate responses.
The size of thePoP ulations at increased risk for HIV hints that the epidemic may reach,
in the future, new peaks and that the risk for an endemic perpetuation of HIV/AIDS in
the EAST BAY communities is significant. The economic impact of the HIV/AIDS
P
epidemic has been enormous and is growing. Health cares stems, public and private,
have found themselves channeling more and more resources to address the needs of the
sick and dying. In the EAST BAY, families and communities of people dying with AIDS P
have not only lost the lives of their loved ones, they have already lost 88,200 years of
potential life and 1.7 billion dollars of lifelong potential earnings, by these premature
deaths. The EAST BAY has similar size populations of uninfected men who have sex
with men and twice as many IDUs at risk for HIV from drug injection compared to the
city and county of San Francisco. Even so the EAST BAY communities receive only a
fraction the amount of funds from Federal and State HIV Prevention funding. The City
and County of San Francisco clearly deserve support and funding to prevent further HIV
infections. At the same time it is imperative that the communities of the EAST BAY
receive at least similar funding levels to continue and expand targeted interventions with
appropriate strategies to prevent a further HIV/AIDS EAST BAY catastrophe.
P
HIV Prevention Community Planning 34
REFERENCES
HRSA. Standard Protocol for Baseline Needs Assessment Data Collection:Basis for A Community HIV
Needs Assessment Process: Attachment 2: Background for the Development of HIV Population
Estimation Work sheet. Steve Niemeryk, PhD. Office of Science and Epidemiology, Bureau of Health
Resources Development, HRSA pp 1-21
2. Reardon J., et al. Prevalence of HIV-1 in Forensic Cases. Abstract APHA 122nd Annual Meeting.
Washington, DC. October 30-November 3, 1994
3. California Department of Justice. California Criminal Justice Profile 1992. October 1993.
4. Department of Health Services and the California Conference of Local Health Officers. County Health
Status Profiles, 1994. April 4-10, 1994
5. Henshaw SK; Kenney, "; Somberg D; and Van Vort J; Teenage Pregnancy in the United States: The
Scope of the Problem and the State Responses. New York: The Alan Guttmacher Institute, 1989.
6. Fay, RE; Turner, CF,- Klanssen, AD; & Gagnon, JH. Prevalence and Patterns of Same-gender Sexual
Contact among men. Science, 243, 338-348, 1989
7. Smith, TW.Adult Sexual Behavior in 1989:Number of partners,frequency of intercourse and risk of AIDS.
Family Planning Perspectives, 23(3), 102-107, 1991
8. Billy, J.O.G., Tanfer K., Grady, WR, Klepinger, DH. The Sexual behavior of Men in the United States.
Family Planning Perspectives, 25:52-60, 1993
9. University of Chicago Press. Social Organization of Sexuality. 1994
+.0 10. Frank Capell. Personal Communication. Data from the survey available from the Sate Office of AIDS.
10. San Francisco Department of Public Health. Surveillance Branch, AIDS Office. HIV Incidence and
Prevalence in San Francisco in 1992: Summary Report from an HIV Consensus Meeting.2112192.
11. Longshore,D.HIV/AIDS and Drug Use Epidemiology in California:Directions for Research and Disease
Surveillance. Summary of the San Francisco Airport Marriot Meeting: February 26, 1992.
12. Watters JK, Lewis DK. HIV Infection, Race and Drug Treatment History. AIDS, 1990, 4:697-702
13. Longshore,D.HIV/AIDS and Drug Use Epidemiology in California:Directions forResearch and Disease
Surveillance. Summary of the San Francisco Airport Marriot Meeting: February 26, 1992.
14. Watters, JK, Cheng YT, Bluthenthal R, Carlson, J, Lorvick J. Drug Injectors and HIV-1 Infection in the
San Francisco Bay Area. VIII International Conference on AIDS, Amsterdam, 19-24 July, 1992.
15. Bluthenthal, R, Estilo, M; Watters, J.HIV-1 Infection and Drug Injectors in Oakland/Richmond,
California. IX International Conference on AIDS, Berlin, June 7-11, 1993.
I
HIV/AIDS Epidemiology Profile of the EAST BAY 35
16. Centers for Disease Control and Prevention. HIV AIDS Surveillance Report.December 1993. Vol. S, No.4
pp 9-10
17. Center for Health Statistics. Data Matters. Birth Profile by County and Zip Code, California, 1992.
September 1993.
18. Department of Health Services. Office of AIDS. HIV Survey of Childbearing Women. August 20, 1993.
19. Haverkos; HW, Battjes RJ. Female-to-Male Transmission of HIV. JAMA, October 14, 1992; Vol. 268,
No.14.: 1855
20. California Department of Health Services. California and the HIV/AIDS Epidemic. State of-the State
Report. August 1993.