HIV Disease In San Diego County
Upon the enactment of the Ryan White CARE Act in August of 1990, San Diego County already had reported in excess of 2,000 cases of AIDS. At that time, the life expectancy of affected individuals averaged less than a year. Many factors in the HIV/AIDS disease epidemic have changed over the past three decades. The disease itself has changed dramatically from a death sentence to a virtually controllable, chronic illness. The advent of HAART (Highly Active Antiretroviral Therapy) in 1996 contributed to this change in life expectancy of infected individuals. Since this innovation, the lives of the vast majority of people diagnosed with HIV have not only been extended but also improved. Many have been diagnosed early with HIV and have not progressed to AIDS because of HAART therapy. However, there is still a significant number of individuals who cannot tolerate the medications that comprise the treatment regimen. With more people living with HIV and fewer progressing to AIDS, the reporting of HIV has become more important in determining the new directions of the disease.
By the end of March 2005, a cumulative total of 12,230 people have been diagnosed with AIDS in San Diego County. Since the beginning of HIV reporting, in July of 2002, over 4,693 individuals have been diagnosed with HIV disease. Locally, by comparison to Caucasians, African Americans and Native Americans are over-represented disproportionately in the AIDS epidemic. Caucasians experience the greatest number of HIV/AIDS cases; however, projections predict a continuing gradual decline in Caucasian cases, with increases in both Hispanic and African-Americans cases. According to San Diego Association of Governments’ (SANDAG) current estimates for 2004, the racial/ethnic breakdown for the county population is 52.1 percent white, 28.4 percent Hispanic, 9.9 percent Asian, 5.3 percent black and 3.1 percent for two or more other races. Provision of services in a county with this degree of ethnic diversity includes the need for culturally and linguistically appropriate services in all areas, the ability to attract traditionally disenfranchised populations into the planning process for services, and the capacity to provide continuity of services to a transient population. Additionally, the provision of services to confront this epidemic is exacerbated by the more than 40 million border crossings per year between Tijuana and San Diego.
The largest concentration of individuals diagnosed with AIDS is in central San Diego, with the South Bay and southeast San Diego area having the second largest numbers. HIV/AIDS services are correspondingly placed in the areas most severely affected. Fortunately, the primary care safety net system of community clinics has been responsive to the HIV/AIDS disease epidemic. All areas of the county have at least one community clinic with Ryan White CARE Act funding for primary medical care. The familiarity of each clinic with its surrounding community helps to foster client trust and to ensure the delivery of culturally appropriate services to each unique region.
One of the most important services provided by the county and community medical partners to promote prevention is counseling and testing. The county’s HIV Counseling and Testing Unit provides over 13,000 HIV tests a year in all regions of the county. The new Rapid Test, or OraSure, now facilitates the increasing demand for HIV testing. Just two years ago, the Rapid Test for HIV was piloted, through the state, in San Diego and is now a standard part of the menu of available testing options. This test now requires only a small sample of cells taken painlessly from the inside of the cheek. Test results are available in approximately 30 minutes. Both anonymous and confidential testing is provided. Testing is done at fixed sites and also at the Mobile Testing Unit, which travels throughout San Diego County. For more information on the availability of HIV testing, please call (619) 296-2120.
While the future for individuals affected by HIV infection or AIDS is brighter than in previous times, the future of supportive services to that same population is uncertain. Despite the increasing numbers of AIDS and HIV cases, funding is declining. Federal and state budgets have been severely impacted by a variety of external influences. Over the past few years, HIV prevention funding has been cut from $3 million to $1.7 million. Likewise, in the past two years, funding for Ryan White CARE Act care and treatment services has received over a $1 million cut.
The HIV, STD and Hepatitis Branch (formerly the two separate branches of the Office of AIDS and STD Control/Hepatitis) of Public Health Services includes the following HIV and AIDS services: HIV Prevention, AIDS Case Management, Intensive Case Management, HIV Counseling and Testing, AIDS Drug Assistance Program, Contract Monitoring, and Contract Administration. For additional information, the general phone number of the branch is (619) 296-3400. Through contracts with community partners, the county is able to provide a wide range of services to individuals whose lives have been affected by this disease.
Please note that June 27 is National HIV Testing Day (NHTD). This observance is an annual campaign, produced by the National Association of People with AIDS (NAPWA-US), to encourage at-risk individuals to receive voluntary HIV counseling and testing. Physicians are important leaders and play a unique role in the process to promote HIV prevention through HIV counseling and testing. During the month of June, and every opportunity that is appropriate, local physicians are asked to encourage patients to get tested for HIV.
San Diego County Health Stats: HIV
- For the last three years, (2002–2004, with the 2004 data still preliminary), women testing at the Anonymous HIV Counseling and Testing Services had a 0.8% HIV infection rate. The age group with the highest rate wa women 35 and up with a rate of 1.0%. The rate for women 20–34 was 0.7%. (i)
- Until 1999, more than 50% of all AIDS cases by racial/ethnic group were white. Since 2000, more than 50% of cases per year have been reported among persons of color (African Americans, Asians, Pacific Islanders, Hispanics and native Americans). (ii)
June is National HIV Testing Month. For more information, go to the National Association of People With AIDS website at www.napwa.org/hivtestinfo. To request additional health statistics describing health behaviors, diseases and injuries for specific populations, health trends and comparisons to national targets, please call San Diego County’s Community Health Statistics Unit at (619) 515-4318. To access the latest data and data links, including the 2004 Core Public Health Indicator document, go to www.sdhealthstatistics.com.
References:
- County of San Diego HIV Counseling and Testing Data. State of California, Department of Health Services, Office of AIDS, 2004.
- County of San Diego HIV/AIDS Epidemiology, 2004.