In 2018, the number of people living with HIV (PLWH) in California rose to 131,013 in comparison to 135, 082 in 2017. Around 4,712 people were diagnosed with HIV in 2018. Dramatic reductions in HIV-related mortality observed statewide since the introduction of highly-effective antiretroviral treatment (ART) in 1996.
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However, according to the Centers for Disease Control and Prevention (CDC), reductions in state’s general funding on HIV control and prevention programs has led to an overall decline in the state’s testing and diagnoses trends. Moreover, many people are unaware of the infection. That’s why they fail to benefit from life-prolonging treatment for HIV. Testing for HIV at the right time is the key to addressing this underrated pandemic.
HIV testing is an extremely vital component of HIV identification, treatment, and prevention strategies. It is the first step in the cascade of treatment efforts involving HIV status detection, health care services, and lifesaving ART. Apart from the direct benefits of timely HIV treatment availed by those diagnosed with HIV, HIV testing confers far-reaching benefits to the general public as it prevents HIV transmission. Around half of all new HIV diagnoses in the USA, reportedly, come from the HIV-infected individuals who are still unaware of their condition. If HIV is diagnosed early, infected individuals will certainly opt to reduce their high-risk behavior.
Historically, California state has supplemented the federal HIV prevention and testing funding to ensure that Californian PLWH could become aware of their infection and get lifesaving ART. However, the year 2009 budget deficits led California to eliminate this supplemental funding for prevention of HIV. This caused a considerable decline in testing rates across California between 2009-2015.
In high HIV burden local health jurisdictions, the rate fell from 66,629 in 2009 to 53,760 by 2015. On the other hand, in low-burden jurisdictions in California, HIV testing rates declined up to 90%, (20,302 in 2009 to 2,116 by 2015). According to the latest analytics from Aidsvu.org, the number of new HIV diagnoses reported/diagnosed late in 2018 was 875/100,000 people, which means 18% of all the HIV cases reported in 2018 were diagnosed late.
The risks associated with late diagnoses are far too many, both for the patient and society. If the patient is diagnosed late, and their CD4 counts are less than 200 cells/µL, their morbidity and mortality chances would be higher, and their body’s response to antiretroviral therapy will be diminished. Late diagnosis of HIV, particularly in older patients, could be detrimental for their health and wellbeing. Early diagnosis is crucial to reduce high-risk sexual behaviors and counseling in HIV-infected individuals.
California has the second-largest number of people infected with HIV in the country. New York is at number one, currently. For decades, the Californian government provided supplemental funding from its general fund in addition to federal HIV prevention funding. Furthermore, CDC directly allocates funding to two main counties in the state, Los Angeles and San Francisco. It is worth noting that Los Angeles had the 3rd largest and San Francisco has the 6th largest numbers of HIV cases among all US metropolitan areas in 2014-15. The CDC also offers HIV prevention grants to 24 community-based organizations in California. Through its funding, CDC ensures science-based HIV infection monitoring, expanding the scope of service delivery, and research on HIV prevention.
Until 2009, the state provided $42 million to assist local health jurisdictions for offering HIV prevention services, including testing and counseling, prevention education, partner notification, and risk reduction.
Approx. $33m of the funds were allocated from the general fund and $9m from federal funding. The funding was used to support a statewide network of free HIV testing sites to ensure uninsured and poor populace access to testing and treatment. The California State Office of AIDS (SOA) also distributed rapid test kits free-of-charge to local health jurisdictions.
However, in 2010, the state had to experience $40 billion shortfalls in the state’s overall budget, which amounted for around 40% of the general funding. This resulted in a reduction in funding to every program that received support from the general funding, including the HIV programs. Around 80% of general funding for HIV prevention programs were reduced for the Office of AIDS in 2010, leaving the state with just $12m from CDC funding for local health jurisdictions, excluding the direct support from CDC.
Lack of state funding has severely affected the prevention strategies and contributed to the state’s overall increment in the number of new diagnoses. Increased funding is important, especially in high-burden areas like Santa Barbara, Marin and Santa Cruz, Long Beach, etc. Moreover, the state needs to expand HIV testing in those jurisdictions where state funds are still received.
Furthermore, Californian lawmakers recently passed the SB239 bill, which decreased the penalty for those intentionally or knowingly exposed people to HIV without their knowledge. The bill was approved in September 2017 by the state legislature and signed by Governor Jerry Brown. The law not only lowered the charges for intentional transmission of HIV from felony to misdemeanor, but decriminalized the intentional donation of HIV-infection blood. Such laws may seem progressive to some, by many criticized it because it further affected the state’s overall HIV testing and prevention strategies.
According to the HIV Surveillance Report 2017, between 2013 and 2017, the number of HIV diagnoses per 100,000 people increased by 0.8% (from 4,70 in 2013 to 4,790 in 2017) whereas the rate of HIV infection declined by 2.4% (12.4 in 2013 to 12.1 in 2017) in California.
During the same period, the number of PLWH increased from 124,235 to more than 135,000 and diagnosed HIV prevalence rate was 340.3, which is higher than 323 in 2013. Aidsvu.org reported that by 2018, the number of new HIV diagnoses in California state increased slightly with the number surpassing 4700. In 2018, the largest population of PLWH was identified in San Francisco with an estimated 15,900 people out of which 9,167 were living with HIV classified as AIDS, and 67% of HIV-infected people in the city were over 50-years-old. This is considerably higher than 38% of PLWH above 50 years in 2005.
Another Californian city affected the most from HIV-AIDS is Long Beach, the 2nd largest city in Los Angele County. Although the rate of new diagnoses has gone down in the past few years, the rate is still twice as high as the state’s overall rate of infections. As per the latest HIV/STD Strategy Report 2019-2022, until December 2017, over 4500 residents of Long Beach were living with HIV, and 80% of the affected ones were men having sex with other men (MSM).
California Department of Public Health reported that between 2013 and 2017, the total number of annual deaths of PLWH in California increased from 1,735 to 1,874, which marked a 4.4% increase since 2013.
In California, according to 2018 estimates, the percentage of PLWH in California by gender was extremely disproportionate. Around 88% of PLWH were males, and just 11.8% were females. Ethnicity-wise, 16.6% of the total reported cases in 2018 were African-Americans, 38% were Hispanic/Latinx, and 37% were Whites. Recent data suggests that Hispanics/Latinxs make up the largest proportion of new diagnoses with the rate reaching 47%, followed by Whites and Blacks.
In California, people aged 55 or above make up the largest proportion of HIV-infected population with over 36% of all cases, followed by the 45-54 age group with 28% and 35-44 age group reporting 18.4% of all diagnoses in 2018.
The least affected group was people aged 13-24 with 2.4% while for people between the age 25 and 34, the rate of diagnoses in 2018 was 14%.
Although the number of HIV diagnoses among Californian African-Americans is lower than whites, the rate of black males with HIV is 2.6 times more than white males. Hispanic/Latino males have 1.0 times higher diagnosis rate than white. Similarly, in comparison to white females, the rate of black females with HIV is 9.3 times higher than white females.