HIVAIDS in Los Angeles County An Overview

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HIV/AIDS in Los Angeles CountyAn Overview

• Charles L. Henry, Director
• County of Los Angeles
• Department of Health Services
• Office of AIDS Programs and Policy
• May 15, 2004

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Presentation Overview

• Review of the Local HIV Epidemiology
• Review Significant Changes to the
  Epidemic
• Overview of Youth Risk Behavior
• Role of Schools in HIV Prevention

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Los Angeles County

• 4,082 Square Miles
• 9.9 Million Residents
• Proportion of State Population 29
• Proportion of State AIDS Cases
  35
• Living with HIV/AIDS 54,000 (Estimated)
• PopulationLatino/a 45.7 White
  31.0Asian/PI 13.2African-American
  9.7Native American 0.3

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Living AIDS Cases and DeathsLos Angeles County,
19872002
18,480
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AIDS Cases by Race/Ethnicity
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AIDS Cases by Gender
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AIDS Cases by ReportedExposure Category
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Proportion of Perinatal HIV Transmission for
Children Identified at Birth and Maternal
Zidovudine (ZDV) Use
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Whats Changed

• Effective HIV treatment offers real hope for a
  healthier, longer life.

What Hasnt Changed

• HIV is 100 preventable.
• There is still no cure and there is no vaccine.

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Whats Changed

• In 1989, the AIDS Drug Assistance Program
  supported one drug (AZT an antiretroviral)
• In 2004, the AIDS Drug Assistance Program
  supported 165 drugs (including 23 antiretrovirals
  or antiretroviral combinations)
• Drugs attack HIV at multiple stages in its life
  cycle
• New drugs are in development

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What Hasnt Changed

• AIDS drugs are the most expensive drugs ever
  marketed
• AIDS drugs can have highly toxic side effects
• AIDS drugs do not work for everyone
• HIV remains highly mutagenic

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What Hasnt Changed

• The Number and Proportion of AIDS Cases Is
  Highest Among Men
• The Most Common Mode of Transmission is Male-Male
  Sex

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Whats Changed

• The Rate of Perinatal (Mother-to-Child)
  Transmission of HIV has Significantly Declined

What Hasnt Changed

• Early Treatment is Critical
• Perinatal Care is Vital
• Women Are Not Always Aware of their HIV Risk

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What Has Changed

• The Number and Proportion of AIDS Cases Among
  People of Color Has Increased

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What Has Changed

• Our Understanding of the Risk Profiles of People
  Most at Risk
• Our Understanding of Sexual Risk Behavior Among
  Youth
• Our Targeting of Prevention Resources
• Our Understanding of the Role that Homophobia,
  Poverty and Racism play in HIV risk behavior

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What Do We Know About HIV Risk Behavior Among
Youth?

• Sex Tied To Drug Use is Predominant Risk Behavior
  
• Risk Behaviors Occur in Clusters
• Similar decision pathways
• No clear advantage for avoiding risks
• Personal management/self-control may not be well
  developed
• Protective Behaviors Occur in Clusters
• One risk may dis-inhibit for another

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Consequences of Sexual Behavior

• 870,000 pregnancies each year (15-19 year olds)
• 490,000 live births each year (15-19 year olds)
• 3,000,000 STDs (15-19 year olds)
• 13 of persons diagnosed with HIV/AIDS were 13-24
  and 37 were 25-34

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Risk Patterns Among 7-12th Graders (Remember the
Clustering!)

• 11 of males and 5 of females perpetuated
  violence in the past year
• 10 of males and 6 of females smoke 6 or more
  cigarettes a day
• 20 of males and 16 of females drink alcohol 2
  or more days per month
• 14 of males and 12 of females use marijuana at
  least once per month
• 40 of males and 37 of females have ever had
  sexual intercourse

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Co-Risks with Sexual Activity

• Sexually active teens have higher rates of most
  other risk behaviors, particularly those who
  initiate sex at a young age
• The younger the teen is when he or she initiates
  sex, the more partners he or she will have by age
  20
• The number of sex partners is a risk for HIV and
  STDs

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Connect to Protect

• Parents and Family
• Have the most influence on decisions about sex
  according to most teens
• Parents are their role models according to most
  teens
• Faith
• 83 of teens say religion is important in their
  lives
• 51 of 12-17 year olds attend church weekly
• When asked what factors most influence sexual
  decision making, most said morals, values and
  religious beliefs

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Connect to Protect

• Friends
• Most influence after parents
• Influence can be positive or negative
• Older friends are a risk factor
• Model behaviors and set norms
• Parents influence teen choice of friends

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Connect to Protect

• Teens Connected to Schools
• Less likely to engage in risk behaviors
• Less likely to be violent
• Less likely to smoke, drink and use marijuana
• More likely to delay sexual activity
• School Connectedness Influencers
• Perceived fair treatment by teachers
• Feeling part of the school
• Feeling closeness with others
• Perceived lack of prejudice
• Average daily attendance

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OAPPs School-Based HIV Prevention Intervention

• Implemented by the LACOE WHRAP
• Structural Intervention designed to influence the
  social, political, or environmental factors that
  shape HIV education in schools
• Targeted to School Administrators, Teachers,
  Parents
• Offers Training and Curriculum Development
  Technical Assistance

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Challenges and Vision

• Improve methods and opportunities to assess HIV
  risk behavior of youth
• Address prejudices, including sexism, homophobia
  and racism
• Increase resiliency of at-risk youth
• Mitigate powerful risk factors like lack of goals
  and hopelessness
• Normalize HIV testing
• Normalize frank discussions about sex and sexual
  health

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Acknowledgments

• Gunther Freehill, OAPP
• Mario Perez, OAPP
• Kyle Baker, OAPP
• Wil Strain, OAPP
• CDCP, Division of Adolescent and School Health
• DHHS, Office of Public Health Science