Disparities in Health Outcomes by Race Among HIV-Positive Clients of Los Angeles County Ryan White CARE Act-Funded Services in 2002 Ijeoma C. Nwachuku, Ph.D.Earl H. Leonard, M.S.County of Los AngelesDepartment of Health ServicesOffice of AIDS Programs and Policy

November 8, 2004

* Estimates from LAC HIV Epidemiology Program and CDC as of February 2004 2

Estimated Persons Living with HIV/AIDS in Los Angeles County

0

10,000

20,000

30,000

40,000

50,000

60,000

All HIV

Undiagnosed HIVDiagnosed HIV PLWA

Estimated 54,000 living

with HIV/AIDS in Los Angeles

County

12,000-15,000

19,000-27,000

18,000

3

Clients Served

24,513

22,179

16,469

19,411

16,111

12,968

0

5,000

10,000

15,000

20,000

25,000

30,000

YEAR 2000 YEAR 2001 YEAR 2002

NUM

BER

OF

CLIE

NTS

All Clients HIV-Positive Clients

4

New Clients

3,6063,731

5,797

0

1,000

2,000

3,000

4,000

5,000

6,000

YEAR 2000 YEAR 2001 YEAR 2002

5

Clients in Medical Care

15,824

12,301

7,667

6,676

10,554

14,417

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

YEAR 2000 YEAR 2001 YEAR 2002

All Clients in Medical Care HIV-Positive Clients in Medical Care

6

Clients by Race

31%28%

31%

25%

26%

24%35%

39%

38%

1.3% 2%2%

.2% .1%.4%1.2% .9% .5%

6.3% 4% 4.1%

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

NU

MB

ER

OF

CL

IEN

TS

White 5,146 5,483 7,481

African American 4,086 4,998 5,992

Latino 5,723 7,511 9,355

Asian 245 344 422

Pacific Islander 27 24 95

Native American 190 173 127

Others 1,052 878 1,041

YEAR 2000 YEAR 2001 YEAR 2002

7

Baseline CD4 Levels by Race

33%30%

36%

30%

33%

23%

29%

23%31%

29%

31%

29%

40%30%

28%

33%

30%

39%

8%7%5%

8%6%9%

0

200

400

600

800

1000

1200

1400

1600

1800C

D4

Va

lue

<200 842 1599 953 96 18 112

200-399 1054 1488 907 82 14 96

400-799 1407 1481 1045 73 24 100

>799 336 272 264 14 4 28

White Latino African AmericanAsian or Pacific

IslanderNative American Others

8

Clients with CD4 Levels <200 at Service Entry

All differences (except Native Americans) significant at p<0.001 - (N=12,309)

23.1%

33.0%

30.1%

36.2%

30.0%

33.3%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%

White

Latino

African American

Asian or Pacific Islander

Native American

Others

9

Clients With No Change or Decrease in CD4 Levels

57.5%

61.3%

68.0%

50.2%

63.3%

65.8%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

White

Latino

African American

Asian or Pacific Islander

Native American

Others

10

Change in CD4 Levels (Latinos)

21%

40%

61%39%

Increase

No Change

Decrease

CD4 Change (Whites)

43% 58%

25%

32%

Difference significant at p<0.001 (Latino N=4840; White N=3639)

11

Change in CD4 Levels (African Americans)

22%

46%

68%32%

Increase

No Change

Decrease

CD4 Change (Whites)

43%

32%

58%

25%

Difference significant at p<0.001 (African American N=3169; White N=3639)

12

Change in CD4 Levels (Asians or Pacific Islanders)

50%50%

20%

30%

Increase

No Change

Decrease

CD4 Change (Whites)

32%

25%

58%43%

Difference significant at p=0.0236 (Asian and Pacific Islander N=265; White N=3639)

13

Change in CD4 Levels (Others)

21%

45%

66%34%

Increase

No Change

Decrease

CD4 Change (Whites)

58%

32%

25%

43%

Difference significant at p=0.0038 (Others N=336; White N=3639)

14

Acknowledgments

A special thanks to all of the local service providers who collect this valuable information while delivering quality client care.