The profile of HIV and AIDS patients in California has shifted significantly since the disease first made headlines 30 years ago, reflecting the success of drugs to extend patients’ lives and the failures to stem the spread of the disease in diverse communities.
A statewide analysis of health data [PDF] completed in recognition of World AIDS Day, celebrated today, reveals the changing face of patients in the state, including an increase in older patients and rising rates of infection among blacks and Hispanics.
The review by the Office of Statewide Health Planning and Development also shows that hospitalization rates among HIV and AIDS patients have plummeted since 1988, reflecting the power of antiretroviral drug cocktails to keep the condition in check.
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Dr. Ron Chapman, director of the California Department of Public Health, said in a conference call with reporters yesterday that he was a family doctor in Redding in the 1990s when he saw young men return to their families to die.
“We’ve come a long way since then,” he said. “There have been miraculous advances in treatment, yet we’ve still got a ways to go.”
Among the findings:
- Patients are older. In 1988, 24 percent of HIV/AIDS patients were 20 to 29 years old. In 2008, that age segment represented only 7 percent of the state’s patients, and 40- to 49-year-old patients were the largest segment, representing 40 percent of cases.
- What started as a white man’s disease has changed. While the number of white patients living with HIV or AIDS has nearly doubled since 1988, the numbers more than tripled among black patients and went up nearly fivefold among Hispanics.
- Hospitalization rates have fallen dramatically. They were at a high in 1992, when there were 464 hospitalizations for every 1,000 people with HIV or AIDS. The low was in 2008, when the hospitalization rate fell to 129 hospitalizations per 1,000.
Public health authorities endorsed HIV testing as a major means of stemming disease transmission, saying as many as 20 percent of people living with the condition don’t know they have it.
The report warns that the gains in patient stability and longevity might be reversed if access to antiretroviral drugs is limited.
Whitney Engeran-Cordova, senior director of public health for the Los Angeles-based AIDS Healthcare Foundation, said the organization has been watching the trends discussed in the new report and is seeking solutions.
He said the group has done intense advocacy in states such as Florida and Ohio that proposed limiting access to AIDS Drug Assistance Programs that pay for drugs that help freeze disease transmission and progression. The group also has called on drugmakers to curb the $11,000 annual price tag on the drugs.
The organization also has done outreach in minority communities and sent mobile HIV testing vans to black neighborhoods.
Engeran-Cordova said the latest data changing the way the advocacy community works has been a finding that as many as 40 percent of people who learn they have HIV take no steps to seek health care. "They feel fine, or they're scared," he said.
He said his group is sending volunteers with iPads to testing sites and getting appointments for people who test positive at their network of clinics. The AIDS Healthcare Foundation is also advocating for more widespread HIV testing, including at the emergency room.
"If we don't do something systemic," he said, "then we've lost the battle."