HIV Epidemiology Program: Epidemiology of HIV and AIDS in

Los Angeles County

Presentation to Public Health CommissionOctober 28, 2010

Douglas M. Frye, MD, MPHDirector, HIV Epidemiology Program

Mission Statement

Collect, analyze, and disseminate HIV/AIDS surveillance and epidemiologic study data essential for the planning, implementation,

and evaluation of programs and policies involving HIV care, prevention, education,

and research in Los Angeles County

HIV EPI PROGRAM STAFFING

• Staff positions (49 total):– 38 County employees– 11 Temporary contract employees

• Lead Surveillance/Research Staff:– 1 Medical Epidemiologist– 3 Doctoral Level Epidemiologists– 9 Masters Level Epidemiologists and

Research Analysts – 4 Public Health Nurses– 1 PHN Supervisor

Department of Public Health

Robert Kim-FarleyDivision Director

Communicable Disease Control and Prevention

Douglas FryeDirector

HIV Epidemiology Program

Mario J. PérezDirector,

Office of AIDS Programsand Policy

Jonathan E. FreedmanChief Deputy Director for

Department of Public Health

Acute Communicable Disease Control & Public

Health Laboratory

Department of Public HealthJonathan E. Fielding

Director and Health Officer

L.A. County Board of Supervisors

Sexually Transmitted Disease Control & Tuberculosis

Control

DIRECTOR

Data Acquisition

ADMINISTRATION

Data Analysis

Special Projects

BehavioralEpidemiology

HIV EPI Organizational Chart

Surveillance Units Research Units

Current Program Surveillance and Epidemiologic Research Projects

• HIV Surveillance units– Data Acquisition Unit collects case reports– Data Analysis Unit enters data, analyzes it,

distributes it to stakeholders– Enhanced Perinatal Surveillance Project

• Behavioral Epidemiology Unit– HIV Incidence and Resistant Strains Surveillance– National HIV Behavioral Surveillance

• Special Projects Unit– Medical Morbidity Monitoring Project

HIV and AIDS Reporting

• 1982: physicians and hospitals required to report confirmed and suspected cases of AIDS to local health department

• 2002: laboratories and providers required to report all non-AIDS HIV infections by code

• 2006: SB-699 signed into law; report by name• 2008: AB-1045 signed into law; CD4 reporting

by laboratories required• 2009: CDC implements evaluation-HARS• 2010: AB-2541 signed into law; HIV reporting

allowed by secured electronic means for providers, labs and local health jurisdictions

• 2011: more changes in eHARS

Importance of Reporting HIV and AIDS for L.A. County

• HIV/AIDS epidemic in Los Angeles differs from the rest of the United States by gender, race/ethnicity, mode of exposure,

• Number of cases reported translates into state and federal dollars for prevention, education, care services for persons living with HIV in LA County

• Second highest (to NYC) morbidity for among urban areas in nation

• 5% of US and 35% of California cases

How Data Are Collected• Active Reporting

– HIV EPI personnel contact health care practitioners and review medical records in hospitals and clinics

• Passive reporting– health care practitioners, hospitals, and

clinics report cases of AIDS without being reminded or contacted

• Electronic reporting– Labs and large providers report via secured

network or by CD-ROM

Persons Living with HIV and AIDS in L.A. County

Estimated Number of Persons Living with HIV and AIDS in LAC

(1) Estimate that 21.5% of HIV+ in LA County are unaware of their infection; modified from CDC estimate.(2) Of 6,700 notifications pending investigation, estimate >4,000 to be cases.

(3) Estimate based on a 1:1 ratio of HIV (non-AIDS) to living AIDS cases and includes reported, named, coded, pending and unaware HIV and AIDS cases.

010,00020,00030,00040,00050,00060,00070,000

All Living HIV/AIDS

Unaware HIV/AIDS (1)Pending HIV Cases (2)Coded Living HIVNamed Living HIVReported Living AIDS

Estimate ~ 62,800 living

with HIV & AIDS in LAC (3)

24,650

16,000

13,500

4,1504,500

Source: LAC HIV Epidemiology Program, reported as of 12/31/2009.

05000

10000150002000025000300003500040000

2002 2003 2004 2005 2006* 2007* 2008*

Year

Nu

mb

er MaleFemale

Number of Persons Living with HIV/AIDS, by Gender and Year, LAC, 2002-08

*Data is provisional due to reporting delay (2006-2008)

Source: HIV Epidemiology Program, LAC-DPH; data as of May 31, 2009

12%

88%

Proportion of LAC PLWHA Cases by Race/ Ethnicity* & Diagnosis Year, 1997-07

0%

10%

20%

30%

40%

50%

97 98 99 00 01 02 03 04 05 06 07

Year of AIDS Diagnosis

*American Indian and Alaska Native are not presented here but consistently comprise <1% of cases. *Data are provisional due to reporting delay.Source: HIV Epidemiology Program, LAC-DPH; data as of December 31, 2009

WhiteHispanic

Black Asian/PI

22%

39%

3%

36%

Persons living with HIV and AIDS in LAC, by Race/Ethnicity (N=44,450), 12/31/2009

WhiteBlackLatinoAsianAI/AN

21%

35%

3%

39%

<1%

Source: HIV/AIDS Surveillance Summary, data as of 9/30/2010.

1025

678

503349

100

0

200

400

600

800

1000

1200

Black AI/AN White Latino A/PI

per

10

0,0

00

Po

pu

lati

on

*Sometimes called “Prevalence Rate”; it is really a proportion.

Persons Living with HIV and AIDS in LACper 100,000 population by Race/Ethnicity*

Source: HIV/AIDS Surveillance Summary, data as of Dec. 2009.

1%8%

20%

39%32%

<1%0%

10%

20%

30%

40%

50%

<13 13-19 20-29 30-39 40-49 50+Age (years)

Source: HIV/AIDS Surveillance Summary, data as of 9/30/2010.

Current Age of Reported Persons Living with HIV and AIDS in LAC, 2010 (N=43,829)

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

97 98 99 00 01 02 03 04 05 06 07

Year

Men who have sex with men

Heterosexual

MSM IDU IDU

**NRR = no reported risk.*Data are provisional due to reporting delay.Source: HIV Epidemiology Program, LAC-DPH; data as of December 31, 2009

Proportion of LAC PLWHA by Mode of Exposure and Calendar Year, 1997-2007*

17%

7%

64%

6%NRR**

5%

2%12%

7%

7%

72%

MSMIDUMSM/IDUHeterosexOther

Persons living with HIV and AIDS in LAC, 2007, by Mode of Exposure, Adjusted (N=40,000)

Source: HIV/AIDS Surveillance Summary, data as of Sept. 2008.

1%<1%

4%

8%5%

82%

MSM

MSM/IDU

IDU

Heterosexual

Other

Undetermined 1%6%68%

24%

Male (n=35,035) Female (n=4,968)

*Persons who had no reported risk for HIV infection had been redistributed to a valid mode of exposure category based on the CDC method for distribution of reclassified cases.

Source: HIV/AIDS Surveillance Summary, data as of September 2008.

Adjusted Mode of Exposure for Persons Living with HIV/AIDS by Gender in LAC, December 2007

Persons Living with HIV and AIDS by Zip Code and Service

Planning Area (SPA) in Los

Angeles County, as of Dec. 31, 2009 (N=44,450)

Source: HIV/AIDS Surveillance Summary.

Number, Percent, and

Rate of Persons Living with HIV

and AIDS by Service

Planning Area (SPA) in Los

Angeles County, as of Dec. 31, 2009

(N=44,450)

Source: HIV/AIDS Surveillance Summary.

Source: HIV Epidemiology Program, LAC-DPH; data as of December 31, 2009

Percent of Newly Diagnosed Severe HIV Disease (AIDS) Cases Among Persons 50 Years and

Older, by Year of Diagnosis 1984-2006

0%2%4%6%8%

10%12%14%16%18%20%

84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Year of AIDS Diagnosis

Per

cent

(%

)

11%

17%

Percent Perinatal HIV Transmission by Birth Year, Los Angeles County, 1996 – 2009

Year of Birth

Per

cen

t

0

5

10

15

20

96 97 98 99 00 01 02 03 04 05 06 07 08 09

SB889

AB1676

AB682

Contact Information

Douglas M. Frye(213) 351-8190

HIV Epidemiology ProgramPhone: (213) 351 – 8196

www.publichealth.lacounty.gov/hiv