Overview of HIV/AIDS in the California-Mexico Border Region
Date of Report: 05/2008
According to the U.S. Census, in 2006 California had a population of 36,457,549. The number of reported cases of AIDS from 1981 through 2004 was 135,221 (Kaiser Family Foundation State Health Facts Online). The actual number of people living with HIV was believed to be much larger. Name-based reporting of HIV/AIDS statistics began in April 2006, allowing for more exact statistics. Between April 2006 and December 2007, 147,821 cases of AIDS and 24,477 cases of HIV were reported (based on cumulative monthly surveillance reports from the California State Office of AIDS).
Of people diagnosed with AIDS in California, a majority (67%) are in men having sex with men (MSM), though this is a smaller proportion than the 74% reported previously. Injection drug use (IDUs) is associated with 9.9%, people who share these risks (MSM/IDU) make up 9%, heterosexual contact at is associated with 6.5% of the reported cases (up from 2%), blood product recipients and hemophiliacs make up 1.4%, pediatric exposure makes up a mere 0.6 % of reported, and the route of transmission in the remaining 5.5% is unknown. Men account for 90% of total cases, women account for 9.4% and transgender people account for 0.6% of total cases. Children represent a small fraction of total cases, and this number has declined sharply as most women living with HIV/AIDS receive treatment during pregnancy. Analysis of racial characteristics of reported cases April 2006-December 2007 identified 54.9% Caucasian, 17.9% Black, 23.8% Latino/Hispanic, 2.6% Asian/Pacific Islander, 0.5% in Native Americans, and 0.5% multiethnic or unidentified (California State Office of AIDS).
California has two counties that lie directly on the U.S.-Mexico border: San Diego and Imperial. As will be seen, below, information about HIV/AIDS in each County, and HIV/AIDS resources vary greatly.
San Diego County encompasses approximately 4,200 square miles and is the seventh largest city in the United States. It is bordered by Baja California to the south, Imperial County to the east, Orange County and Riverside/San Bernardino Counties to the North, and the Pacific Ocean to the west. As of 2006, San Diego County had an estimated population of 2,941,454. The majority identify as Caucasian (52%) and Latino/Hispanic (30%). Females account for 49.6% and males 50.4% of the total population. 25.3% of the population is 18 years of age or less and 11.1% of the population is over the age of 65. The median household income in San Diego as of 2004 was $51,939. (U.S. Census Bureau, 2006)
San Diego shares an international border with Tijuana, Mexico that has an estimated population of 2 million. This border is one of the most active border crossings in the world, with approximately 40 million crossings per year. The border location is believed to exacerbate the HIV/AIDS epidemic in both cities and significantly complicates service provision on the U.S. side of the border.
San Diego County is divided into five regions including, North County, Central, East, Southeast, and South Bay. Central San Diego has the largest percent of cumulative cases of AIDS within San Diego County (59%). The South Bay, which is the region directly across from Tijuana, Mexico, has the second largest percent (8%).
San Diego provides a complete spectrum of HIV/AIDS services including primary and specialty care, treatment, and prevention services; surveillance and research; housing, case management, mental health, drug/alcohol treatment and other social/support services; and training programs for medical and non-medical providers. Each region has at least one community clinic with Ryan White Title I funding that supports primary medical care. In addition to the list of resources included here, the reader might want to link to the San Diego County Office of AIDS Coordination (http://www2.sdcounty.ca.gov/hhsa/) who developed a Continuum of Public HIV/AIDS Services and Activities that outlines what services are available throughout the County and how they are funded.
San Diego is also home to a U.S./Mexico Bi-national Referral program titled Cure+, which organizes and facilitates medical care referrals for people living with HIV or tuberculosis who cross the border.
San Diego has the third highest AIDS case rate in the State of California. There are over 13,455 cumulative cases of AIDS between April 2006 and December 2007. Of these cumulative cases, 20% were Latino/Hispanic in 2003. Latinos/Hispanics appear, however, to comprise a growing proportion of newly diagnosed cases of AIDS, representing 36% of new cases in 2006, which is disproportionate relative to their population, 27% of the total population of San Diego County. Latinos historically have the second highest AIDS case rate in San Diego County, 19 cases per 100,000 persons in 1999, more than double the case rate for Caucasians (8/100,000) (Overview of EMA from Fiscal Year 2001 Title 1 Application, Sept. 2000, Office of AIDS Coordination, San Diego.)
Modes of HIV transmission have remained fairly consistent since 1982, and are similar to modes of transmission statewide, most of the cases occur in MSM or IDU, or people who share these behaviors.
Although the average age at time of diagnosis among the entire population continues to be between 30-39, Latinos/Hispanics typically have a younger median age and Latino/Hispanic AIDS cases, within the 20-29 age group of Latino males exceeded that of White males in 1995. (HIV/AIDS Among Racial/Ethnic Groups in California, 1999. California Department of Health Services, Office of AIDS, April 2000). Among the three largest ethnic groups in San Diego, Latinos/Hispanics have the shortest time from HIV+ diagnosis to AIDS diagnosis, and a slightly shorter time from AIDS diagnosis to death. More than 50% of all Latino/Hispanic cases were foreign-born, with 85% of those coming from Mexico.
Imperial County is primarily a rural area, representing 4,597 square miles and bordered by Mexico to the south, including Mexicali with a population of about 1 million, Arizona to the east, Riverside/San Bernardino County to the north, and San Diego County to the west. As of January 2006, the county's estimated population was 166,585 (California Department of Finance, 2006). Between April 2000 and July 2006, the population grew 12.6% (U.S, Census Bureau, 2006). Of these residents 30% are under 18 and 75.7% of residents self-identify as Latino/Hispanic (U.S. Bureau of Census, 2006).
Information on HIV and AIDS in Imperial County is limited. As of June 30, 2006, Imperial County had reported a total of 170 cumulative AIDS cases since 1981 with a case fatality rate of 42% (72), lower than the 58% case fatality rate reported for the state of California as a whole. There are currently 98 people known to be living with AIDS in Imperial County.
AIDS cases grouped by age show a marked concentration of cases among persons between 30 and 49 years of age. Cases in this age range account for 70% of all reported cases. When persons between the ages of 20 and 29 are included, persons in these age groups represent 86% of all cases. Imperial County is fortunate to have had only one pediatric case and three adolescent cases ever reported. Men account for the vast majority of the AIDS cases reported in Imperial County (91%); the remaining 9% of AIDS cases are female. No transgender cases have been reported.
Of those males who are identified as AIDS cases, 58% are men who have sex with men (MSM), a considerably lower percentage than the 74% of statewide cases reporting the risk behavior. Heterosexual contact as a mode of infection was reported among 7% of male AIDS cases in Imperial County, compared to 2% of male cases statewide. Injection drug use as a sole mode of infection accounts for 12% of all male AIDS cases reported in Imperial County, which is a higher percentage than reported among statewide cases (8%). Men diagnosed with AIDS in Imperial County who reported both MSM and injection drug use as a risk accounted for 7% of all AIDS cases among men in Imperial County, which is a lower percentage than in statewide cases (10%).
Of the women identified as AIDS cases, 67% reported heterosexual contact as their mode of infection, compared to 46% of female AIDS cases statewide. Only 4 women - representing 27% of all female AIDS cases identified in Imperial County - reported injection drug use as their mode of exposure. This is a lower percentage than reported statewide (36%).
Epidemiological data shows disparities in reported infection rates among different racial/ethnic groups in Imperial County. According to the 2000 U.S. Census, African Americans represent 3.6% of the total population of Imperial County, but this racial group accounts for 7% of all people living with AIDS. Latinos, who comprise 72.2% of the overall population, account for 76% of all reported AIDS cases. In contrast, non-Latino whites who represent 20.2% of Imperial County's population account for 16% of all AIDS cases.
Due to the small number of reported AIDS cases in Imperial County, it is difficult to track trends in the disease. As is the case throughout California and elsewhere in the United States, the death rate has fallen dramatically for most AIDS patients in Imperial County. In the early years of the epidemic (prior to 1990), the case fatality rate in Imperial County was 100 percent. Since the second half of 1990, the case fatality rate has fluctuated, ranging from 80 percent in 1991 to two reported deaths in 2004, two in 2005, and none so far in 2006.
As of April 17, 2006, a new state law now requires health-care providers and laboratories to report cases of HIV infection by name to local health departments. Between April 2008 and December 2007, 165 people living with AIDS or HIV were identified in Imperial County. During this period, a total of 55 cases of HIV and 192 cases of AIDS were reported.
As there are limited numbers of people living with HIV/AIDS in rural Imperial County, HIV-related training programs for providers are also somewhat limited. Imperial County clinicians can participate in the University of California San Diego (UCSD) AIDS Education and Training Center (AETC) HIV Mini-Residency, as well as in didactic presentations and workshops coordinated by the UCSD AETC. Some of these training opportunities are provided locally and offer continuing education credits.
Overview prepared by the University of California Los Angeles local performance site of the Pacific AETC. Statistics updated 2008.
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