HomeMy WebLinkAbouthiv-report-2014-2016-archiveHIV in Alameda County,
2014-2016
HIV Epidemiology
& Surveillance Unit
Alameda County
Public Health Department
HIV in Alameda County, 2014-2016
March 2018
HIV Epidemiology and Surveillance Unit
HIV STD Section
Division of Communicable Disease Control and Prevention
Alameda County Public Health Department
HIV in Alameda County, 2014-2016 ii
Alameda County Public Health Department
Director & Health O cer Muntu Davis, MD, MPH
Division of Communicable Disease Control and Prevention
Director Erica Pan, MD, MPH
HIV STD Section
Director Nicholas J. Moss, MD, MPH
HIV Epidemiology and Surveillance Unit
Director Neena Murgai, PhD, MPH
Epidemiologists Daniel Allgeier, MPH
Joyce Ycasas, MPH
Surveillance Clerk Chryzel Reyes
Public Health Investigators Jesus Altamirano
George Banks, MD
Maria Hernandez
Alameda County Public Health Department
HIV Epidemiology and Surveillance Unit
1000 Broadway, Suite 310
Oakland, CA 94607
Phone: (510) 268-2372
Fax: (510) 208-1278
Email: Neena.Murgai@acgov.org
HIV in Alameda County, 2014-2016 iii
Acknowledgements
This report was produced by the HIV Epidemiology and Surveillance Unit. Daniel Allgeier, MPH
conducted data analysis and compiled ndings. Overall guidance on analysis and content as well as
editorial review were provided by Neena Murgai, Ph.D., MPH. Case investigation, data collection, and data
management were conducted by the HIV Surveillance Team: Jesus Altamirano, George Banks, and Maria
Hernandez.
Cover Photo: By David Corby - Oakland California from across Lake Merritt, CC BY 2.5,
https://commons.wikimedia.org/wiki/File:Oaklandatnight02192006.JPG,
https://commons.wikimedia.org/wiki/File:Oaklandatnight02192006.JPG.
This report is available online at
http://www.acphd.org/data-reports/reports-by-topic/communicable-disease.aspx#HIV.
Suggested citation for this report:
Alameda County Public Health Department. HIV in Alameda County, 2014-2016.
http://www.acphd.org/data-reports/reports-by-topic/hivaids.aspx. Published March 2018. Accessed [date].
HIV in Alameda County, 2014-2016 iv
Contents
1 Background 1
Overview of this Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
De nitions Used in this Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Other Conventions Used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
2 New Diagnoses 5
Characteristics of New Diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Diagnosis Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Timeliness of Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
3 People Living with HIV 27
Characteristics of PLHIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Prevalence Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Deaths Among PLHIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
4 The Continuum of HIV Care 39
The Overall Continuum of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
Linkage to Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
Retention in Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Virologic Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Appendix A: Technical Notes 66
Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Statistical Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Data Suppression Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Death Ascertainment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
Appendix B: Reporting Requirements 68
Health Care Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Appendix C: HIV Surveillance in Alameda County 71
Security and Con dentiality of Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Bibliography 74
HIV in Alameda County, 2014-2016 v
List of Figures
1.1 Regions of Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
1.2 Neighborhoods in the City of Oakland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
2.1 New Diagnoses by Sex,
Alameda County, 2006-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
2.2 New Diagnoses by Sex and Mode of Transmission,
Alameda County, 2014-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
2.3 New Diagnoses by Race/Ethnicity,
Alameda County, 2014-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
2.4 Age of New Diagnoses,
Alameda County, 2014-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
2.5 Geographic Distribution of New HIV Cases by Residence at HIV Diagnosis,
Alameda County, 2014-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
2.6 Residence at HIV Diagnosis,
Oakland and Surrounding Area, 2014-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
2.7 Rates of New Diagnoses by Sex,
Alameda County, 2014-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
2.8 Trends in Rates of New Diagnoses by Sex,
Alameda County, 2006-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
2.9 Rates of New Diagnoses by Race/Ethnicity,
Alameda County, 2014-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
2.10 Trends in Rates of New Diagnoses by Race/Ethnicity,
Alameda County, 2006-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
2.11 Trends in Rates of New Diagnoses by Race/Ethnicity and Sex,
Alameda County, 2006-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
2.12 Rates of New Diagnoses by Age,
Alameda County, 2014-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
2.13 Trends in Rates of New Diagnoses by Age,
Alameda County, 2006-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
2.14 Late Diagnosis by Race/Ethnicity,
Alameda County, 2013-2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
2.15 Late Diagnosis by Sex,
Alameda County, 2013-2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
vi
2.16 Late Diagnosis by Age,
Alameda County, 2013-2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
2.17 First CD4 Count at Diagnosis by Race/Ethnicity,
Alameda County, 2013-2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
2.18 First CD4 Count at Diagnosis by Sex,
Alameda County, 2013-2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
2.19 First CD4 Count at Diagnosis by Age,
Alameda County, 2013-2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
3.1 PLHIV by Sex,
Alameda County, year-end 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
3.2 PLHIV by Race/Ethnicity,
Alameda County, year-end 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
3.3 Age of PLHIV,
Alameda County, year-end 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
3.4 Prevalence of HIV by Sex,
Alameda County, year-end 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
3.5 Prevalence of HIV by Race/Ethnicity,
Alameda County, year-end 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
3.6 Prevalence of HIV by Age,
Alameda County, year-end 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
3.7 Prevalence of HIV by Census Tract of Residence,
Alameda County, year-end 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
3.8 Prevalence of HIV by Census Tract of Residence,
Oakland and Surrounding Area, year-end 2016 . . . . . . . . . . . . . . . . . . . . . . . . . .31
3.9 Death Rate among Alameda County Residents Ever Diagnosed with AIDS,
1985-2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
4.1 The Continuum of HIV Care in Alameda County . . . . . . . . . . . . . . . . . . . . . . . . .40
4.2 Days Between Diagnosis and First CD4 or Viral Load, Alameda County, 2013-2015 . . . . . .41
4.3 Linkage to HIV Care within 90 Days of Diagnosis by Sex,
Alameda County, 2013-2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
4.4 Linkage to HIV Care within 90 Days of Diagnosis by Race/Ethnicity, Alameda County, 2013-
2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
4.5 Linkage to HIV Care within 90 Days of Diagnosis by Age,
Alameda County, 2013-2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
4.6 Number of HIV Care Visits per PLHIV in 2015,
Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
4.7 Retention in HIV Care by Sex,
Alameda County, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
4.8 Retention in HIV Care by Race/Ethnicity,
Alameda County, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
4.9 Retention in HIV Care by Age,
Alameda County, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
HIV in Alameda County, 2014-2016 vii
4.10 Virologic Status by Sex,
Alameda County, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
4.11 Virologic Status by Race/Ethnicity,
Alameda County, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
4.12 Virologic Status by Age,
Alameda County, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
A.1 Timeline of Mandated HIV Reporting in California . . . . . . . . . . . . . . . . . . . . . . . .72
A.2 The HIV Surveillance System in Alameda County . . . . . . . . . . . . . . . . . . . . . . . . .73
HIV in Alameda County, 2014-2016 viii
List of Tables
2.1 New HIV Diagnoses, Alameda County, 2014-2016 . . . . . . . . . . . . . . . . . . . . . . . . .16
2.2 HIV Diagnosis Rates by Sex and Age, Alameda County, 2014-2016 . . . . . . . . . . . . . . .18
2.3 HIV Diagnosis Rates by Sex and Race/Ethnicity, Alameda County, 2014-2016 . . . . . . . . .19
2.4 HIV Diagnosis Rates by Race/Ethnicity and Age, Alameda County, 2014-2016 . . . . . . . .20
2.5 Late Diagnosis by Sex and Age, Alameda County, 2013-2015 . . . . . . . . . . . . . . . . . .23
2.6 Late Diagnosis by Sex and Race/Ethnicity, Alameda County, 2013-2015 . . . . . . . . . . . .24
2.7 Late Diagnosis by Race/Ethnicity and Age, Alameda County, 2013-2015 . . . . . . . . . . . .25
3.1 People Living with HIV Disease and Prevalence Rates, Alameda County, Year-End 2016 . . .33
3.2 HIV Prevalence by Sex and Age, Alameda County, Year-End 2016 . . . . . . . . . . . . . . .35
3.3 HIV Prevalence by Sex and Race/Ethnicity, Alameda County, Year-End 2016 . . . . . . . . .36
3.4 HIV Prevalence by Race/Ethnicity and Age, Alameda County, Year-End 2016 . . . . . . . . .37
4.1 Timely Linkage to HIV Care Among New Diagnoses by Sex and Age, Alameda County, 2013-
2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
4.2 Timely Linkage to HIV Care Among New Diagnoses by Sex and Race/Ethnicity, Alameda
County, 2013-2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
4.3 Timely Linkage to HIV Care Among New Diagnoses by Race/Ethnicity and Age, Alameda
County, 2013-2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
4.4 Engagement in HIV Care in 2015 Among PLHIV at Year-End 2014 by Sex and Age, Alameda
County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
4.5 Engagement in HIV Care in 2015 Among PLHIV at Year-End 2014 by Sex and Race/Ethnicity,
Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
4.6 Engagement in HIV Care in 2015 Among PLHIV at Year-End 2014 by Race/Ethnicity and
Age, Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
4.7 Retention in Continuous HIV Care in 2015 Among PLHIV at Year-End 2014 by Sex and Age,
Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
4.8 Retention in Continuous HIV Care in 2015 Among PLHIV at Year-End 2014 by Sex and
Race/Ethnicity, Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
4.9 Retention in Continuous HIV Care in 2015 Among PLHIV at Year-End 2014 by Race/Ethnicity
and Age, Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
4.10 Viral Suppression in 2015 Among PLHIV at Year-End 2014 by Sex and Age, Alameda County 60
4.11 Viral Suppression in 2015 Among PLHIV at Year-End 2014 by Sex and Race/Ethnicity,
Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
ix
4.12 Viral Suppression in 2015 Among PLHIV at Year-End 2014 by Race/Ethnicity and Age,
Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62
4.13 Viral Suppression in 2015 Among PLHIV at Year-End 2014 and in Care in 2015 by Sex,
Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
4.14 Viral Suppression in 2015 Among PLHIV at Year-End 2014 and in Care in 2015 by Race/Ethnicity,
Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
4.15 Viral Suppression in 2015 Among PLHIV at Year-End 2014 and in Care in 2015 by Age,
Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
HIV in Alameda County, 2014-2016 x
Background
1
Background
Overview of this Report
This report is based on human immunode ciency virus (HIV) case surveillance in Alameda County. It
summarizes data on HIV in three chapters as described below.
1.New Diagnoses: This chapter describes patterns of HIV diagnosis in Alameda County, characterizing
those who were recently diagnosed according to demographic factors, risk factors and stage of disease.
2.People Living with HIV: The second chapter of the report describes the characteristics of all people
known to be living with HIV disease (PLHIV) in Alameda County. This chapter describes the total
burden of HIV disease in the county and how it varies by demographic factors as well as by geography. It
also describes changes in mortality rates (deaths) over time among those ever diagnosed with Acquired
Immune De ciency Syndrome (AIDS).
3.The Continuum of HIV Care: The nal chapter of this report presents the continuum of HIV care
in Alameda County. Modern medical treatments for HIV can halt the progression of the disease and
prevent its spread, but not all persons living with HIV receive eective treatment. The continuum
of HIV care (also known as the HIV care cascade) is a framework that presents dierent indicators
of engagement in HIV care among PLHIV, including linkage to care, retention in care, and viral
suppression.
HIV/AIDS
HIV attacks the immune system, weakening it over time such that people living with HIV become increasingly
susceptible to opportunistic infections and other medical conditions. The most advanced stage of infection,
when the immune system is weakest, is called AIDS. Medical treatments can inhibit HIV's ability to replicate
and greatly temper its eect, but the human body cannot clear HIV. HIV is typically transmitted through
sex, contaminated needles, or spread from mother to fetus during pregnancy.
De nitions Used in this Report
Stages of HIV Infection
For surveillance purposes, HIV disease progression is classi ed into 4 stages from acute infection (Stage 0) to
AIDS (Stage 3). In this report, we use HIV to refer to HIV disease at any stage (including Stage 3/AIDS)
HIV in Alameda County, 2014-2016 1
Background
and AIDS to refer speci cally to Stage 3 HIV disease. We use the acronym PLHIV to refer to all people
living with HIV disease, regardless of stage.
Case De nition
All reported HIV cases must meet the Centers for Disease Control and Prevention (CDC) case de nition
based on laboratory or clinical criteria. [3] Clinical criteria include a medical provider diagnosis and evidence
of HIV treatment, unexplained low CD4 count, or opportunistic infection. The full criteria may be found at
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6303a1.htm.
Transmission Category
For surveillance purposes, each reported HIV case must be classi ed according to their risk factors for
acquiring HIV. Cases with multiple risk factors are assigned a transmission category, the risk factor most
likely to have resulted in HIV transmission according to a hierarchy developed by the CDC. In this context,
heterosexual contact refers to sexual contact with a partner of the opposite sex with a known risk factor
for HIV. In some cases, partners' risk factors are unknown, leaving some heterosexual cases without known
HIV risk factors. Such cases are assigned to the unknown transmission category. The only exception is
when a case's sex at birth is female and she reported sex with males, in which case she is presumed to have
been infected through heterosexual contact in accordance with CDC-accepted guidance set by the Council
of State and Territorial Epidemiologists. [6]
Demographics
Demographic data in this report are based on investigations of medical records. Although the transgender
community is highly impacted by HIV, data on current gender identity are not reliably captured in medical
records. For this reason, all analyses are presented by sex assigned at birth, for which we use sex as
shorthand.
Data from racial/ethnic groups in which there were very small numbers were combined for these analyses.
Asians and Paci c Islanders are combined into a single category. American Indians, Alaskan Natives, and
those identifying with multiple races are combined along with those of unknown race into another group
(Other/Unk). In tables and charts, the category Asians and Paci c Islanders is abbreviated API and
African American is abbreviated AfrAmer.
Geographic Area
Residential addresses are geocoded to census tract and city/Census-designated place. Region and neigh-
borhood boundaries established by the Alameda County Community Assessment, Planning, and Evaluation
(CAPE) unit based on census tract aggregates are used. These geographic areas are shown in Figures 1.1
and 1.2.
HIV in Alameda County, 2014-2016 2
Background
Figure 1.1: Regions of Alameda County
Figure 1.2: Neighborhoods in the City of Oakland
HIV in Alameda County, 2014-2016 3
Background
Other Conventions Used
Indicators that are broken out by subgroup (e.g., race/ethnicity) are presented along with the overall group
total (e.g., all races) for comparison.
Where rates are presented, they are often accompanied by error bars to convey their degree of statistical
variability. These error bars depict 95% con dence intervals (a margin of error) for the estimates. (In the
case of trends, error bands formed by connecting the ends of these margins of error are shown.) Con dence
intervals are displayed in select subgroup analyses of indicators. Con dence intervals that do not overlap
are considered statistically signi cant and generally represent true dierences that are not attributed to
chance alone, though it is still possible. Details regarding how these con dence intervals are calculated can
be found in the technical notes (see Calculation of Con dence Intervals on page 66).
Tables showing breakdowns of populations (e.g., new diagnoses, people living with HIV) for indicators (e.g.,
diagnosis rates, viral suppression) by demographic or other subgroup are included at the end of each chapter.
Note that in each table the length of the green bar is proportional to the fraction of the total population in
that subgroup. Additionally, estimates of each indicator and lines depicting 95% con dence intervals for the
estimate are also shown for absolute comparisons between subgroups. Relative comparisons of subgroups
(e.g., Late diagnosis is three times as common in group A as it is in group B) may be made by comparing
estimates, when shown. Unreliable estimates are not shown in tables, although their con dence intervals
may be. Details on data suppression can be found in the technical notes (see Data Suppression Rules 4 on
page 66).
Lastly, in order to protect privacy, case counts less than ve are not presented in this report.
HIV in Alameda County, 2014-2016 4
New Diagnoses
2
New Diagnoses
Estimating the incidence of new HIV transmissions is complex due to the variable time interval between when
a person becomes infected and when their infection is diagnosed. However, due to reporting requirements,
surveillance data reliably describe new HIV diagnoses. In 2016, there were an estimated 39,782 new diagnoses
of HIV infection in the US for an overall diagnosis rate of 12.3 per 100,000 persons. Rates were highest among
men as compared to women (24.3 vs. 5.4 diagnoses per 100,000), those aged 20-24 or 25-29 (30.3 and 34.8
per 100,000, respectively), African Americans and Latinos (43.6 and 17.0 per 100,000), and in the South and
Northeast (16.8 and 11.2 per 100,000). Men who have sex with men (MSM), including those that inject drugs,
accounted for 70% of all infections, heterosexual contact accounted for 24%, and other modes of transmission
accounted for the remaining 6%. [?] In California, there were an estimated 4,948 new diagnoses for an
overall statewide rate of 12.7 diagnoses per 100,000 in 2015. The epidemiology of HIV in Alameda County
largely mirrored that of the nation, with the exception that heterosexual contact is estimated to account for
only 18% of all new diagnoses among Alameda County residents. [2]
The sections below describe HIV in Alameda County by examining characteristics of new diagnoses, new
diagnosis rates, and the timeliness of diagnoses by demographic characteristics. Data presented in this
chapter are also summarized in Table 2.1. Detailed strati cation of newly diagnosed cases in 2014-2016 by
sex, age and race/ethnicity are provided in Tables 2.2 - 2.7 at the end of this chapter.
HIV in Alameda County, 2014-2016 5
New Diagnoses
Characteristics of New Diagnoses
Since HIV became reportable by name in California in 2006, between 200 and 300 new cases of HIV disease
have been reported each year among Alameda County residents.
In Alameda County, those
newly diagnosed with HIV
disease were overwhelmingly
male. The proportion of new
diagnoses among males
increased steadily from 77.1%
in 2006 to 87.6% in 2012 before
decreasing over the subsequent
four years to 82.9% in 2016.
Figure 2.1: New Diagnoses by Sex,
Alameda County, 2006-2016
20%
40%
60%
80%
100%
2006
(N=284)
2007
(N=307)
2008
(N=235)
2009
(N=275)
2010
(N=234)
2011
(N=210)
2012
(N=234)
2013
(N=217)
2014
(N=208)
2015
(N=263)
2016
(N=275)
Male Female
NOTE: Sex here refers to sex assigned at birth.
Among the 621 men diagnosed
with HIV from 2014 to 2016,
the overwhelming majority were
men who have sex with men
(MSM). Nearly eight in ten
newly diagnosed women were
reported to or presumed to have
acquired HIV by a heterosexual
sex partner who had a
documented HIV risk factor;
most of the remaining women
were infected through injection
drug use (IDU).
Figure 2.2: New Diagnoses by Sex and Mode of Transmission,
Alameda County, 2014-2016
Female (N=125)
Male (N=621)
0%10%20%30%40%50%60%70%80%90%100%
MSM MSM & IDU IDU
Heterosexual Contact Presumed Heterosexual Contact Unknown
NOTES: Sex here refers to sex assigned at birth.
HIV in Alameda County, 2014-2016 6
New Diagnoses
From 2014 to 2016, the largest
proportion of new HIV
diagnoses was among African
Americans, who comprised
about 37% of new diagnoses.
Whites and Latinos each
comprised nearly a quarter and
Asians and Paci c Islanders
11% of new diagnoses.
Figure 2.3: New Diagnoses by Race/Ethnicity,
Alameda County, 2014-2016
26.3%
2.4%
10.9%
36.5%
24%
Other/Unk
API
Latino
White
AfrAmer
0 100 200 300
Number of Cases
NOTE: Other/Unk includes American Indians, Alaskan Natives, and
those identifying with multiple racial categories as well as those for
whom race/ethnicity could not be identi ed.
The median age among
Alameda County residents
diagnosed with HIV disease
from 2014 to 2016 was 34.5
years. Most diagnoses were
among those in their twenties to
forties.
Figure 2.4: Age of New Diagnoses,
Alameda County, 2014-2016
27.0 34.5 47.00
25
50
75
100
0 20 40 60 80
Age in years at first HIV diagnosis
Nu
m
b
e
r
o
f
C
a
s
e
s
NOTE: The dashed lines indicate the 25th, 50th, and 75th percentile
values for age among the new diagnoses.
HIV in Alameda County, 2014-2016 7
New Diagnoses
New diagnoses of HIV were
most concentrated in the
Oakland area and in the central
county region (as de ned in 1.1
on page 3).
Figure 2.5: Geographic Distribution of New HIV Cases by Residence
at HIV Diagnosis,
Alameda County, 2014-2016
NOTE: N=716; an additional 30 diagnoses (4.02% of all) are not rep-
resented due to incomplete street address.
Within the Oakland area, new
diagnoses were less concentrated
in the Oakland hills (Northwest
Hills, Southeast Hills, and
Lower Hills neighborhoods)
than the rest of the city.
Figure 2.6: Residence at HIV Diagnosis,
Oakland and Surrounding Area, 2014-2016
Oakland
Berkeley
San Leandro
Alameda
Castro Valley
Alameda
Albany
Piedmont
Emeryville
Elmhurst
Lower HillsWest Oakland
Fruitvale
Southeast Hills
Northwest Hills
Central East Oakland
North Oakland
San Antonio
Downtown and Chinatown
DATA SOURCE: Alameda County eHARS, 2017 Q2 DUA
0 1 20.5 Miles
New HIV Diagnoses, Oakland & Surrounding Area, 2014-2016
±
San Francisco Bay
CitiesOakland neighborhoods
HIV in Alameda County, 2014-2016 8
New Diagnoses
Diagnosis Rates
This section examines trends in HIV diagnosis rates. Diagnosis rates do not necessarily mean HIV incidence.
Trends in diagnosis rates may re ect changes over time in HIV incidence, but may also re ect changes in
HIV testing practices. For example, HIV incidence could decrease while HIV diagnosis rates increase if more
HIV-unaware persons are tested and diagnosed.
Due to small numbers of diagnoses occurring in Alameda County in any given year, annual diagnosis rates
may be statistically unstable. We performed statistical analyses to identify trends that are least likely to
re ect random year-to-year variability and indicated signi cance in captions;apparent trends do not indicate
statistical signi cance unless speci ed.
From 2014 to 2016, there were 746 new HIV diagnoses with an annual rate of 15.7 per 100,000 residents in
Alameda County.
New diagnosis rates were over
ve times as high among males
as among females during
2014-2016.
Figure 2.7: Rates of New Diagnoses by Sex,
Alameda County, 2014-2016
15.7
26.7
5.2
Female (N=125)
Male (N=621)
All (N=746)
0 10 20 30
Annual Diagnosis Rate per 100,000
NOTE: Sex here refers to sex assigned at birth.
HIV diagnosis rates declined
steadily between 2006 and 2016,
decreasing by an average of
2.3% annually overall and 1.4%
annually among males. During
the same period, rates among
females signi cantly dropped
16.8% annually. Between 2012
and 2016 rates increased by
15.3%, but this trend was not
statistically signi cant. Rates
were consistently higher in men
between 2006 and 2016.
Figure 2.8: Trends in Rates of New Diagnoses by Sex,
Alameda County, 2006-2016
0
10
20
30
40
20
0
6
−
0
8
20
0
7
−
0
9
20
0
8
−
1
0
20
0
9
−
1
1
20
1
0
−
1
2
20
1
1
−
1
3
20
1
2
−
1
4
20
1
3
−
1
5
20
1
4
−
1
6
An
n
u
a
l
D
i
a
g
n
o
s
i
s
R
a
t
e
pe
r
1
0
0
,
0
0
0
All Male Female
NOTE: Sex here refers to sex assigned at birth.
HIV in Alameda County, 2014-2016 9
New Diagnoses
From 2014 to 2016, the highest
diagnosis rate was among
African Americans, which was
almost three times as high as
the second most impacted
group, Latinos. The lowest
diagnosis rate was seen among
Asians and Paci c Islanders.
Figure 2.9: Rates of New Diagnoses by Race/Ethnicity,
Alameda County, 2014-2016
15.7
52
11.5
18.1
6
API (N=81)
Latino (N=196)
White (N=179)
AfrAmer (N=272)
All races (N=746)
0 20 40 60
Annual Diagnosis Rate per 100,000
Diagnosis rates were relatively
constant since 2006 in most
racial/ethnic groups. The
apparent increase in recent
years was not a statistically
signi cant trend in any group.
However, the average annual
decline in diagnosis rate of 3.8%
among African Americans was
statistically signi cant.
Figure 2.10: Trends in Rates of New Diagnoses by Race/Ethnicity,
Alameda County, 2006-2016
0
25
50
75
100
20
0
6
−
0
8
20
0
7
−
0
9
20
0
8
−
1
0
20
0
9
−
1
1
20
1
0
−
1
2
20
1
1
−
1
3
20
1
2
−
1
4
20
1
3
−
1
5
20
1
4
−
1
6
An
n
u
a
l
D
i
a
g
n
o
s
i
s
R
a
t
e
pe
r
1
0
0
,
0
0
0
All races AfrAmer White Latino API
HIV in Alameda County, 2014-2016 10
New Diagnoses
The overall decline in the county-wide diagnosis rate was driven largely by decreases in diagnoses among
African Americans, and in particular, African American women, where rates decreased by 7.0% per year on
average. Whereas there were 42.8 new diagnoses per 100,000 African American women in 2006-2008, that
rate was more than halved by 2012-2014 to 18.2 new diagnoses per 100,000. The apparent increase in
recent years is not statistically signi cant. Rates also declined among Latino women, by an average 5.5%
per year. Among all males, the only signi cant trend was a decline among African Americans of 3.8% per
year on average.
Figure 2.11: Trends in Rates of New Diagnoses by Race/Ethnicity and Sex,
Alameda County, 2006-2016
Male Female
20
0
6
−
0
8
20
0
7
−
0
9
20
0
8
−
1
0
20
0
9
−
1
1
20
1
0
−
1
2
20
1
1
−
1
3
20
1
2
−
1
4
20
1
3
−
1
5
20
1
4
−
1
6
20
0
6
−
0
8
20
0
7
−
0
9
20
0
8
−
1
0
20
0
9
−
1
1
20
1
0
−
1
2
20
1
1
−
1
3
20
1
2
−
1
4
20
1
3
−
1
5
20
1
4
−
1
6
0
30
60
90
120
0
30
60
90
120
An
n
u
a
l
D
i
a
g
n
o
s
i
s
R
a
t
e
pe
r
1
0
0
,
0
0
0
All races AfrAmer White Latino API
NOTE: Sex refers to sex assigned at birth.
From 2014 to 2016, new HIV
diagnoses were most common
among those in their twenties,
thirties, and forties, with 37.4,
26.7, and 20.7 diagnoses per
100,000, respectively. New HIV
diagnoses were somewhat less
common among those in their
fties and least common among
those at the extremes of the age
spectrum (i.e., teens and those
aged 60 & over).
Figure 2.12: Rates of New Diagnoses by Age,
Alameda County, 2014-2016
15.7
5
37.4
26.7
20.7
16.1
5.160 & over (N=44)
50−59 (N=105)
40−49 (N=139)
30−39 (N=184)
20−29 (N=253)
13−19 (N=21)
All ages (N=746)
0 10 20 30 40 50
Annual Diagnosis Rate per 100,000
HIV in Alameda County, 2014-2016 11
New Diagnoses
Figure 2.13: Trends in Rates of New Diagnoses by Age,
Alameda County, 2006-2016
0
10
20
30
40
50
20
0
6
−
0
8
20
0
7
−
0
9
20
0
8
−
1
0
20
0
9
−
1
1
20
1
0
−
1
2
20
1
1
−
1
3
20
1
2
−
1
4
20
1
3
−
1
5
20
1
4
−
1
6
An
n
u
a
l
D
i
a
g
n
o
s
i
s
R
a
t
e
pe
r
1
0
0
,
0
0
0
All ages 13−19 20−29 30−39 40−49 50−59 60 & over
By age, diagnosis rates have decreased by an average of 3.5% per year among those 30-39 and 4.7% per year
among those 40-49. While rates among those 60 & over decreased by an average of 15.4% per year through
2012, they have increased since then. Rates among those 20-29 have increased by an average of 3.1% per
year. None of the trends by age were signi cant.
Among African Americans, there were signi cant declining trends in diagnosis rates between 2006 and 2016
in several age groups. There was an average annual decline of 5.8% among those 30-39 years of age, 7.7%
among 40-49 years of age, and 4.8% for those 50 and older. Whites 30-39 years of age saw a signi cant
average annual decline in diagnosis rate of 9.4% between 2006 and 2014, but then a dramatic annual increase
of 78.2% between 2014 and2016. Among Latinos aged 25-29, there was an average annual increase of 8.6%
between 2006 and 2016.
Strati ed diagnosis rates by sex, age and race/ethnicity are provided in tables at the end of this chapter.
The disparity in diagnosis rates between African Americans and whites was more pronounced among females
compared to males. While African American males had 4.1 times the diagnosis rates compared to white
males diagnosed from 2014 to 2016, African American females had 8.2 times the diagnosis rates of white
females (Table 2.3).
Timeliness of Diagnosis
Diagnosis of HIV early in the course of infection is an important component of eective HIV prevention and
treatment as early treatment generally reduces both the risk of transmission to others and the impact of
HIV infection on a person's health.
HIV in Alameda County, 2014-2016 12
New Diagnoses
Late Diagnosis
A commonly-used indicator of late HIV diagnosis is the time to progression to AIDS (stage 3 infection). A
diagnosis is considered to be late if AIDS is diagnosed at the same time as a person's initial HIV diagnosis
or if the person progresses to AIDS within one year of the initial HIV diagnosis. The analyses presented in
this section are for 2013-2015 to allow a full year of follow-up from initial HIV diagnosis. Strati ed analyses
of late diagnosis by sex, age, and race/ethnicity is provided in tables at the end of this chapter. Apparent
dierences should be interpreted with caution due to the small numbers of diagnoses seen in some subgroups,
resulting in statistical instability.
In Alameda County, 26.7% of
new diagnoses between 2013
and 2015 were late. Although
whites and African Americans
appear to have the lowest rate
and Latinos the highest,
dierences by race were not
statistically signi cant.
Figure 2.14: Late Diagnosis by Race/Ethnicity,
Alameda County, 2013-2015
29.3%
29.5%
26.3%
24.4%
26.7%
API (N=82)
Latino (N=156)
White (N=167)
AfrAmer (N=262)
All races (N=688)
0%10%20%30%40%50%
Percent with a late diagnosis
There was no statistical
dierence in late diagnosis by
sex.
Figure 2.15: Late Diagnosis by Sex,
Alameda County, 2013-2015
26.4%
26.8%
26.7%
Female (N=106)
Male (N=582)
All (N=688)
0%10%20%30%40%50%
Percent with a late diagnosis
NOTE: Sex refers to sex assigned at birth.
HIV in Alameda County, 2014-2016 13
New Diagnoses
The proportion of late
diagnoses generally increased
with age: nearly half of HIV
diagnoses among those aged 60
and over were late. Late
diagnosis was less common
among those aged 20 to
29fewer than 2 in 10 were
diagnosed late in this age group.
Dierences by age group and
the trend of increasing rate of
late diagnosis as age increased,
were statistically signi cant.
Figure 2.16: Late Diagnosis by Age,
Alameda County, 2013-2015
43.9%
34.7%
30.8%
25.9%
19.4%
15.8%
26.7%
60 & over (N=41)
50−59 (N=95)
40−49 (N=143)
30−39 (N=158)
20−29 (N=232)
13−19 (N=19)
All ages (N=688)
0%20%40%60%
Percent with a late diagnosis
First CD4 Count
CD4 cell count at the time of diagnosis is another indicator of the timeliness of HIV diagnosis. CD4+ T-
cells, an important component of the human immune system, are infected and killed by HIV. Anti-retroviral
therapy (ART) allows the body to preserver or increase the CD4 count, but the longer a person goes without
taking ART, which controls the level of HIV in their body, the lower their CD4 count will be and the more
susceptible the person will be to opportunistic infections and other health problems. Once a person's CD4
count falls below 200cells/mm3, the person is considered to have AIDS.1
Among those diagnosed with
HIV disease in 2013-2015 and
for whom a CD4 count was
conducted within 90 days, the
median CD4 count at the time
of diagnosis was 389.0
cells/mm3. Whites had the
highest median CD4 count at
diagnosis among all
racial/ethnic groups and Asian
Paci c Islanders had the lowest.
Figure 2.17: First CD4 Count at Diagnosis by Race/Ethnicity,
Alameda County, 2013-2015
281.0
355.5
434.5
408.0
389.0
API (N=67)
Latino (N=126)
White (N=134)
AfrAmer (N=200)
All races (N=545)
0 100 200 300 400 500
Median CD4
1Note that the analyses presented in this section exclude 143 cases (20.8% of all diagnoses) with a rst CD4 count more than
90 days after diagnosis.
HIV in Alameda County, 2014-2016 14
New Diagnoses
Median CD4 within 90 days of
diagnosis was comparable
between males and females.
This is consistent with the lack
of dierence in late diagnosis by
sex.
Figure 2.18: First CD4 Count at Diagnosis by Sex,
Alameda County, 2013-2015
371.0
398.5
389.0
Female (N=87)
Male (N=458)
All (N=545)
0 100 200 300 400 500
Median CD4
NOTE: Sex refers to sex assigned at birth.
Those aged 20-29 had a
substantially higher median
CD4 count at diagnosis than
any other age group. Median
CD4 count was generally lower
in successively older age groups.
Those 60 and older had the
lowest median CD4 count at
diagnosis. However, data for
this group and those aged 13-19
should be interpreted with
caution due to small numbers.
Figure 2.19: First CD4 Count at Diagnosis by Age,
Alameda County, 2013-2015
267.5
322.0
324.5
413.0
437.0
430.0
389.0
60 & over (N=32)
50−59 (N=78)
40−49 (N=112)
30−39 (N=123)
20−29 (N=183)
13−19 (N=17)
All ages (N=545)
0 100 200 300 400 500
Median CD4
HIV in Alameda County, 2014-2016 15
New Diagnoses
Ta
b
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e
2
.
1
:
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w
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Co
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In
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HIV in Alameda County, 2014-2016 16
New Diagnoses
Ta
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2
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HIV in Alameda County, 2014-2016 17
New Diagnoses
Table 2.2: HIV Diagnosis Rates by Sex and Age, Alameda County, 2014-2016
Sexa Age Average
Annual
Count
Percent Average Annual
Diagnosis Rate
per 100,000
95%
Confidence
Interval
All All ages 248.7 100.0%15.7 13.8 - 17.7
0-4 0.0 0.0%****
5-12 0.0 0.0%****
13-19 7.0 2.8%5.0 3.1 - 7.7
20-24 35.3 14.2%31.0 20.7 - 41.2
25-29 49.0 19.7%44.1 31.7 - 56.4
30-39 61.3 24.7%26.7 20.0 - 33.3
40-49 46.3 18.6%20.7 14.8 - 26.7
50 & over 49.7 20.0%9.8 7.1 - 12.5
Male All ages 207.0 83.2%26.7 23.0 - 30.3
0-4 ****
5-12 0.0 0.0%****
13-19 ****
20-24 31.0 12.5%53.4 43.1 - 65.4
25-29 44.3 17.8%79.1 55.8 - 102.4
30-39 51.7 20.8%45.7 33.2 - 58.2
40-49 37.7 15.1%34.0 23.1 - 44.9
50 & over 36.7 14.7%15.5 10.5 - 20.5
Female All ages 41.7 16.8%5.2 3.6 - 6.8
0-4 ****
5-12 0.0 0.0%****
13-19 ****
20-24 4.3 1.7%7.7 4.1 - 13.2
25-29 4.7 1.9%8.5 4.6 - 14.2
30-39 9.7 3.9%8.3 5.5 - 11.9
40-49 8.7 3.5%7.7 5.0 - 11.3
50 & over 13.0 5.2%4.8 3.4 - 6.6
Source:Alameda County eHARS,2017 Q2
[a]Refersto sex assigned at birth
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 18
New Diagnoses
Table 2.3: HIV Diagnosis Rates by Sex and Race/Ethnicity, Alameda County, 2014-2016
Sexa Race/
Ethnicityb Average
Annual
Count
Percent Average Annual
Diagnosis Rate
per 100,000
95%
Confidence
Interval
All All races 248.7 100.0%15.7 13.8 - 17.7
AfrAmer 90.7 36.5%52.0 41.3 - 62.7
White 59.7 24.0%11.5 8.6 - 14.4
Latino 65.3 26.3%18.1 13.7 - 22.5
API 27.0 10.9%6.0 4.8 - 7.4
Other/Unk 6.0 2.4%----
Male All races 207.0 83.2%26.7 23.0 - 30.3
AfrAmer 66.3 26.7%81.1 61.6 - 100.7
White 51.3 20.6%19.9 14.5 - 25.3
Latino 59.7 24.0%32.4 24.2 - 40.6
API 23.7 9.5%11.0 8.6 - 13.8
Other/Unk 6.0 2.4%----
Female All races 41.7 16.8%5.2 3.6 - 6.8
AfrAmer 24.3 9.8%26.3 20.6 - 33.1
White 8.3 3.4%3.2 2.1 - 4.7
Latino 5.7 2.3%3.2 1.9 - 5.1
API 3.3 1.3%****
Other/Unk 0.0 0.0%----
Source:Alameda County eHARS,2017 Q2
[a]Refersto sex assigned at birth
[b]'Other/Unk'=American Indians and Alaskan Natives,multiple race,unknown race
[**]Unstable estimates not shown.
[--]Rate not calculable forlack of a denominator.
HIV in Alameda County, 2014-2016 19
New Diagnoses
Table 2.4: HIV Diagnosis Rates by Race/Ethnicity and Age, Alameda County, 2014-2016
NOTE:This table spans multiple pages.
Race/
Ethnicitya
Age Average
Annual
Count
Percent Average Annual
Diagnosis Rate
per 100,000
95%
Confidence
Interval
All races All ages 248.7 100.0%15.7 13.8 - 17.7
0-4 0.0 0.0%****
5-12 0.0 0.0%****
13-19 7.0 2.8%5.0 3.1 - 7.7
20-24 35.3 14.2%31.0 20.7 - 41.2
25-29 49.0 19.7%44.1 31.7 - 56.4
30-39 61.3 24.7%26.7 20.0 - 33.3
40-49 46.3 18.6%20.7 14.8 - 26.7
50 & over 49.7 20.0%9.8 7.1 - 12.5
AfrAmer All ages 90.7 36.5%52.0 41.3 - 62.7
0-4 0.0 0.0%****
5-12 0.0 0.0%****
13-19 5.0 2.0%29.8 16.7 - 49.2
20-24 17.7 7.1%146.0 109.4 - 191.0
25-29 15.7 6.3%141.7 104.1 - 188.5
30-39 19.0 7.6%83.3 63.1 - 108.0
40-49 13.0 5.2%51.8 36.8 - 70.8
50 & over 20.3 8.2%33.8 25.9 - 43.4
White All ages 59.7 24.0%11.5 8.6 - 14.4
0-4 0.0 0.0%****
5-12 0.0 0.0%****
13-19 0.0 0.0%****
20-24 5.7 2.3%18.3 10.6 - 29.3
25-29 11.3 4.6%35.8 24.8 - 50.0
30-39 15.3 6.2%24.1 17.6 - 32.1
40-49 13.0 5.2%17.1 12.1 - 23.3
50 & over 14.3 5.8%6.2 4.5 - 8.4
HIV in Alameda County, 2014-2016 20
New Diagnoses
Table 2.4: HIV Diagnosis Rates by Race/Ethnicity and Age, Alameda County, 2014-2016 (continued)
NOTE:This table spans multiple pages.
Race/
Ethnicitya
Age Average
Annual
Count
Percent Average Annual
Diagnosis Rate
per 100,000
95%
Confidence
Interval
Latino All ages 65.3 26.3%18.1 13.7 - 22.5
0-4 ****
5-12 0.0 0.0%****
13-19 ****
20-24 8.0 3.2%24.9 15.9 - 37.0
25-29 16.7 6.7%52.1 38.7 - 68.7
30-39 17.0 6.8%27.6 20.5 - 36.3
40-49 14.7 5.9%31.8 23.1 - 42.7
50 & over 7.7 3.1%12.1 7.7 - 18.2
API All ages 27.0 10.9%6.0 4.8 - 7.4
0-4 0.0 0.0%****
5-12 0.0 0.0%****
13-19 ****
20-24 ****
25-29 3.7 1.5%****
30-39 ****
40-49 ****
50 & over 5.3 2.1%3.8 2.2 - 6.2
HIV in Alameda County, 2014-2016 21
New Diagnoses
Table 2.4: HIV Diagnosis Rates by Race/Ethnicity and Age, Alameda County, 2014-2016 (continued)
NOTE:This table spans multiple pages.
Race/
Ethnicitya
Age Average
Annual
Count
Percent Average Annual
Diagnosis Rate
per 100,000
95%
Confidence
Interval
Other/Unk All ages 6.0 2.4%----
0-4 **----
5-12 0.0 0.0%----
13-19 0.0 0.0%----
20-24 **----
25-29 1.7 0.7%----
30-39 **----
40-49 **----
50 & over 2.0 0.8%----
Source:Alameda County eHARS,2017 Q2
[a]'Other/Unk'=American Indians and Alaskan Natives,multiple race,unknown race
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
[--]Rate not calculable for lack of a denominator.
HIV in Alameda County, 2014-2016 22
New Diagnoses
Table 2.5: Late Diagnosis by Sex and Age, Alameda County, 2013-2015
All Diagnoses Late Diagnoses
Sexa Age at
Diagnosis
Average
Annual
Count
Column Percent Average
Annual
Count
Row Percent
All All ages 229.3 100.0%61.3 26.7%
13-19 6.3 2.8%1.0 **
20-24 33.7 14.7%**
25-29 43.7 19.0%**
30-39 52.7 23.0% 13.7 25.9%
40-49 47.7 20.8%14.7 30.8%
50 & over 45.3 19.8% 17.0 37.5%
Male All ages 194.0 84.6%52.0 26.8%
13-19 ** 0.7 *
20-24 **3.7 *
25-29 ** 10.0 *
30-39 44.3 19.3%11.7 26.3%
40-49 39.7 17.3% 12.0 30.3%
50 & over 34.0 14.8%14.0 41.2%
Female All ages 35.3 15.4% 9.3 26.4%
13-19 **0.3 *
20-24 ****
25-29 ****
30-39 8.3 3.6% 2.0 **
40-49 8.0 3.5%2.7 **
50 & over 11.3 4.9% 3.0 **
Source: Alameda County eHARS, 2017 Q2
[a]Refers to sex assigned at birth
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 23
New Diagnoses
Table 2.6: Late Diagnosis by Sex and Race/Ethnicity, Alameda County, 2013-2015
All Diagnoses Late Diagnoses
Sexa Race/
Ethnicityb
Average
Annual
Count
Column Percent Average
Annual
Count
Row Percent
All All races 229.3 100.0%61.3 26.7%
AfrAmer 87.3 38.1%21.3 24.4%
White 55.7 24.3% 14.7 26.3%
Latino 52.0 22.7%15.3 29.5%
API 27.3 11.9% 8.0 29.3%
Other/Unk 7.0 3.1%2.0 **
Male All races 194.0 84.6% 52.0 26.8%
AfrAmer 66.7 29.1%16.3 24.5%
White 48.3 21.1% 13.0 26.9%
Latino 48.0 20.9%13.7 28.5%
API ** 7.7 *
Other/Unk **1.3 *
Female All races 35.3 15.4% 9.3 26.4%
AfrAmer 20.7 9.0%5.0 **
White 7.3 3.2% 1.7 **
Latino 4.0 1.7%1.7 **
API ** 0.3 *
Other/Unk **0.7 *
Source: Alameda County eHARS, 2017 Q2
[a]Refers to sex assigned at birth
[b]'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 24
New Diagnoses
Table 2.7: Late Diagnosis by Race/Ethnicity and Age, Alameda County, 2013-2015
NOTE: This table spans multiple pages.
All Diagnoses Late Diagnoses
Race/
Ethnicitya Age at
Diagnosis
Average
Annual
Count
Column Percent Average
Annual
Count
Row Percent
All races All ages 229.3 100.0%**
13-19 6.3 2.8%1.0 **
20-24 33.7 14.7% 4.0 11.9%
25-29 43.7 19.0%11.0 25.2%
30-39 52.7 23.0% 13.7 25.9%
40-49 47.7 20.8%14.7 30.8%
50 & over 45.3 19.8%**
AfrAmer All ages 87.3 38.1%21.3 24.4%
13-19 4.3 1.9% 0.7 **
20-24 15.7 6.8%1.3 **
25-29 16.7 7.3% 4.7 **
30-39 18.0 7.8%4.7 **
40-49 13.0 5.7% 3.7 **
50 & over 19.7 8.6%6.3 **
White All ages 55.7 24.3% 14.7 26.3%
13-19 **0.0 *
20-24 ** 0.3 *
25-29 9.0 3.9%1.7 **
30-39 11.0 4.8% 3.7 **
40-49 16.3 7.1%3.7 **
50 & over 13.7 6.0%5.3 **
HIV in Alameda County, 2014-2016 25
New Diagnoses
Table 2.7: Late Diagnosis by Race/Ethnicity and Age, Alameda County, 2013-2015 (continued)
NOTE: This table spans multiple pages.
All Diagnoses Late Diagnoses
Race/
Ethnicitya Age at
Diagnosis
Average
Annual
Count
Column Percent Average
Annual
Count
Row Percent
Latino All ages 52.0 22.7%**
13-19 ****
20-24 7.3 3.2%1.0 **
25-29 12.3 5.4% 3.3 **
30-39 13.0 5.7%2.7 **
40-49 12.0 5.2% 5.0 **
50 & over **3.0 *
API All ages 27.3 11.9% 8.0 29.3%
13-19 **0.0 *
20-24 ** 1.3 *
25-29 3.7 1.6%1.0 **
30-39 ** 2.3 *
40-49 **1.7 *
50 & over 4.0 1.7% 1.7 **
Other/Unk All ages 7.0 3.1%**
13-19 0.0 0.0%***
20-24 **0.0 *
25-29 2.0 0.9% 0.3 **
30-39 **0.3 *
40-49 ** 0.7 *
50 & over ****
Source: Alameda County eHARS, 2017 Q2
[a]'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 26
People Living with HIV
3
People Living with HIV
In the United States, there were an estimated diagnosed 973,846 PLHIV at the end of 2015. Prevalence
was highest among men as compared to women (563.9 vs. 169.7 per 100,000 population), those aged 45-49
and 50-54 (703.6 and 767.9 per 100,000 respectively), African Americans and Latinos (1,017.8 and 379.4 per
100,000 respectively), and in the Northeast and South (417.8 and 359.3 per 100,000 respectively). That same
year, California had an estimated 128,415 PLHIV for an overall prevalence of 330.1 per 100,000 population.
HIV prevalence in women in California (77.1 per 100,000) was half that of women nationally. [4]
This chapter examines prevalence, or the proportion of people in Alameda County with HIV infection, re-
ecting the overall burden of HIV in the population. Data presented do not include PLHIV with undiagnosed
infection but include all those with diagnosed HIV (including the newly diagnosed), regardless of the stage
of HIV infection.1 First, characteristics of PLHIV in the county are presented. Then the prevalence of HIV
disease in dierent subpopulations is described. Finally, mortality (deaths) among PLHIV ever diagnosed
with AIDS is described. Table 3.1 summarizes data presented in this chapter. Strati ed prevalence rates by
sex, age and race/ethnicity are provided in tables at the end of this chapter.
1PLHIV counts exclude those that only moved to Alameda County after their diagnosis and have never seen an HIV healthcareprovider in Alameda County. The latter limitation is due to the criteria the California Department of Public Health (CDPH)
uses to determine the subset of the statewide HIV database to which local health departments have access ([1] resided in thecounty at rst HIV diagnosis or at progression to Stage 3 infection (AIDS), or [2] have ever had an HIV-related laboratory
result ordered by a healthcare provider in the county). So, for example, the 5,801 persons we know of and believe to have beenliving with HIV in Alameda County at year-end 2014 are not all but rather 94.7% of the 6,125 PLHIV CDPH knows of and
believes to have been living here at that time (based on data reported to them through December 31, 2015). The discrepancyin overall PLHIV counts may be oset by the fact that some of the persons believed to have been living in the county may
actually have moved out of the county as surveillance data do not re ect a person's residence at all times with perfect accuracy.
HIV in Alameda County, 2014-2016 27
People Living with HIV
Characteristics of PLHIV
At the end of 2016, there were an estimated 5,951 PLHIV in Alameda County.
Similar to the distribution of
sex among new diagnoses of
HIV, those living with HIV in
Alameda County at year-end
2016 were predominantly male
(82.9%).
Figure 3.1: PLHIV by Sex,
Alameda County, year-end 2016
17.1%
82.9%
Female
Male
0 1,000 2,000 3,000 4,000 5,000 6,000
Number of Cases
NOTE: Sex refers to sex assigned at birth.
Approximately 39.8% of PLHIV
in Alameda County were
African American and 31.6%
were white. Latinos and Asians
and Paci c Islanders each
comprised a smaller proportion
of PLHIV.
Figure 3.2: PLHIV by Race/Ethnicity,
Alameda County, year-end 2016
2.8%
6.6%
19.2%
31.6%
39.8%
Other/Unk
API
Latino
White
AfrAmer
0 1,000 2,000 3,000
Number of Cases
NOTE: Other/Unk includes American Indians, Alaskan Natives,
multiracial, and unknown categories.
HIV in Alameda County, 2014-2016 28
People Living with HIV
Half of PLHIV were in their
fties or older. Only about a
quarter were in their thirties or
younger at year-end 2016.
Figure 3.3: Age of PLHIV,
Alameda County, year-end 2016
40.0 50.0 58.0
0
250
500
750
1000
0 25 50 75 100
Age at year−end 2016
Nu
m
b
e
r
o
f
C
a
s
e
s
NOTE: The dashed lines indicate the 25th, 50th, and 75th percentile
values for age among PLHIV.
Racial/ethnic disparities in numbers of PLHIV were more apparent among women compared to menwhile
there was an approximately equal number of cases of African Americans and whites among males, there were
nearly four times as many African American women compared to white women (Table 3.3).
Prevalence Rates
At the end of 2016 there were 5,951 people living with HIV in Alameda County for a prevalence rate of 370.8
per 100,000 or 0.4% of residents.
HIV prevalence was about ve
times higher among males as
compared to females at
year-end 2016.
Figure 3.4: Prevalence of HIV by Sex,
Alameda County, year-end 2016
370.8
625.8
124.5
Female (N=1,017)
Male (N=4,934)
All (N=5,951)
0 200 400 600 800
Rate per 100,000
NOTE: Sex refers to sex assigned at birth.
HIV in Alameda County, 2014-2016 29
People Living with HIV
African Americans carried over
3.7 times the burden of HIV
compared to the next most
impacted group in Alameda
Countywhites. The burden of
HIV was lowest among Asians
and Paci c Islanders.
Figure 3.5: Prevalence of HIV by Race/Ethnicity,
Alameda County, year-end 2016
370.8
1,374.0
366.0
303.8
84.3API (N=395)
Latino (N=1,144)
White (N=1,878)
AfrAmer (N=2,366)
All races (N=5,951)
0 500 1,000 1,500
Rate per 100,000
HIV prevalence was higher in
each successive age group
ranging from 14.9 per 100,000
youth aged 13-19 to a high of
869.7 per 100,000 people ages
50-59. The number of children
aged 0-12 living with HIV was
too low to estimate a
statistically reliable prevalence
rate. Prevalence among those
aged 60 and over diered only
slightly from those in their
thirties. This nding is
consistent with the improved
survival of PLHIV in the ART
era.
Figure 3.6: Prevalence of HIV by Age,
Alameda County, year-end 2016
370.8
14.9
209.8
405.5
602.4
869.7
400.860 & over (N=1,204)
50−59 (N=1,951)
40−49 (N=1,356)
30−39 (N=931)
20−29 (N=481)
13−19 (N=21)
All ages (N=5,951)
0 250 500 750 1,000
Rate per 100,000
The disparity in prevalence rates by race was more pronounced among females compared to males. While
prevalence was about 3 times higher among African American males compared to white males, it was
more than 10 times higher among African American females compared to white females (see Table 3.3).
Additionally, although HIV prevalence was higher among white males than Latino males, this was not the
case among females.
HIV in Alameda County, 2014-2016 30
People Living with HIV
Oakland had the highest HIV
prevalence within Alameda
County followed by the central
county region.
Figure 3.7: Prevalence of HIV by Census Tract of Residence,
Alameda County, year-end 2016
Contra Costa
San Mateo
Remainder of County
Fremont
Sunol
Oakland
Hayward
Livermore
Dublin
Pleasanton
Newark
Union City
Berkeley
Remainder of County
San Leandro
Alameda
Castro Valley
Fairview
Alameda
Albany
San LorenzoAshland
PiedmontEmeryville
Cherryland
People Living with HIV Infection,Alameda County,Year-End 2016
County Prevalence: 370.8 per 100,000
±
Prevalence year-end 2016(Per 100,000)134.4 - 338.5338.6 - 548.0
548.1 - 772.7
772.8 - 1203.0
1203.1 - 2104.7Cities<10 cases
NOTE: N=5470; an additional 481 PLHIV (8.08% of all) are not rep-
resented due to incomplete street address.
The North and West Oakland,
Downtown, Chinatown, and San
Antonio neighborhoods had the
highest HIV prevalence rate,
ranging from 1-2% of residents.
Figure 3.8: Prevalence of HIV by Census Tract of Residence,
Oakland and Surrounding Area, year-end 2016
Contra Costa
Oakland
Berkeley
San Leandro
Alameda
Castro Valley
Alameda
Albany
Ashland
Piedmont
Emeryville
Elmhurst
Lower Hills
Southeast Hills
West Oakland
Fruitvale
Central East Oakland
North Oakland
San Antonio
Northwest Hills
Downtownand Chinatown
San Francisco
0 1.5 30.75 Miles
±Prevalence year end 2016Per 100,000
0.0 - 180.0
180.1 - 369.6
369.7 - 665.0
665.1 - 1106.2
1106.3 - 2104.7
HIV in Alameda County, 2014-2016 31
People Living with HIV
Deaths Among Alameda County Residents Ever Diagnosed with
AIDS
Although HIV without AIDS has only been reportable by name in California since 2006, AIDS has been
a reportable disease since the early 1980s allowing examination of long-term trends in death rates among
the subset of PLHIV ever diagnosed with AIDS. In 1985, there were 38.7 deaths (from any cause, whether
HIV-related or not) per 100 Alameda County residents ever diagnosed with AIDS. This rate dropped to 7.5
deaths per 100 by 1997 and has declined slowly, but steadily since then. In 2015, there were 66 deaths among
the 3,820 residents ever diagnosed with AIDS for a rate of 1.73 deaths per 100 residents.
Figure 3.9: Death Rate among Alameda County Residents Ever Diagnosed with AIDS,
1985-2015
10
20
30
40
50
1985 1990 1995 2000 2005 2010 2015
De
a
t
h
s
p
e
r
1
0
0
NOTE: Death rates calculated among persons ever diagnosed with AIDS while a resident of Alameda County,
regardless of county of residence at death. Deaths in PLHIV without AIDS are not reported here.
HIV in Alameda County, 2014-2016 32
People Living with HIV
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HIV in Alameda County, 2014-2016 33
People Living with HIV
Ta
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HIV in Alameda County, 2014-2016 34
People Living with HIV
Table 3.2: HIV Prevalence by Sex and Age, Alameda County, Year-End 2016
Sexa Age Count Percent Prevalence per
100,000
95%
Confidence
Interval
All All ages 5,951 100.0%370.8 361.3 - 380.2
0-12 7 0.1%****
13-19 21 0.4%14.9 9.2 - 22.7
20-29 481 8.1%209.8 191.0 - 228.5
30-39 931 15.6%405.5 379.4 - 431.5
40-49 1,356 22.8%602.4 570.3 - 634.4
50-59 1,951 32.8%869.7 831.2 - 908.3
60 & over 1,204 20.2%400.8 378.2 - 423.4
Male All ages 4,934 82.9%625.8 608.3 - 643.2
0-12 ****
13-19 ****
20-29 429 7.2%370.5 335.5 - 405.6
30-39 785 13.2%695.8 647.1 - 744.5
40-49 1,085 18.2%973.4 915.4 - 1,031.3
50-59 1,630 27.4%1,484.7 1,412.6 - 1,556.8
60 & over 987 16.6%727.5 682.1 - 772.9
Female All ages 1,017 17.1%124.5 116.9 - 132.2
0-12 ****
13-19 ****
20-29 52 0.9%45.8 34.2 - 60.1
30-39 146 2.5%125.0 104.7 - 145.3
40-49 271 4.6%238.5 210.1 - 266.9
50-59 321 5.4%280.3 249.6 - 310.9
60 & over 217 3.6%131.7 114.2 - 149.3
Source:Alameda County eHARS,2017 Q2
[a]Refersto sex assigned at birth
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 35
People Living with HIV
Table 3.3: HIV Prevalence by Sex and Race/Ethnicity, Alameda County, Year-End 2016
Sexa Race/
Ethnicityb Count Percent Prevalence per
100,000
95%
Confidence
Interval
All All races 5,951 100.0%370.8 361.3 - 380.2
AfrAmer 2,366 39.8%1,374.0 1,318.6 - 1,429.4
White 1,878 31.6%366.0 349.5 - 382.6
Latino 1,144 19.2%303.8 286.2 - 321.5
API 395 6.6%84.3 76.0 - 92.7
Other/Unk 168 2.8%----
Male All races 4,934 82.9%625.8 608.3 - 643.2
AfrAmer 1,749 29.4%2,161.7 2,060.4 - 2,263.0
White 1,708 28.7%668.4 636.7 - 700.1
Latino 997 16.8%520.6 488.3 - 552.9
API 336 5.6%149.9 133.9 - 165.9
Other/Unk 144 2.4%----
Female All races 1,017 17.1%124.5 116.9 - 132.2
AfrAmer 617 10.4%675.9 622.6 - 729.2
White 170 2.9%66.0 56.1 - 75.9
Latino 147 2.5%79.5 66.6 - 92.3
API 59 1.0%24.2 18.4 - 31.2
Other/Unk 24 0.4%----
Source:Alameda County eHARS,2017 Q2
[a]Refersto sex assigned at birth
[b]'Other/Unk'=American Indians and Alaskan Natives,multiple race,unknown race
[--]Rate not calculable forlack of a denominator.
HIV in Alameda County, 2014-2016 36
People Living with HIV
Table 3.4: HIV Prevalence by Race/Ethnicity and Age, Alameda County, Year-End 2016
NOTE:This table spans multiple pages.
Race/
Ethnicitya
Age Count Percent Prevalence per
100,000
95%
Confidence
Interval
All races All ages 5,951 100.0%370.8 361.3 - 380.2
0-12 7 0.1%****
13-19 21 0.4%14.9 9.2 - 22.7
20-29 481 8.1%209.8 191.0 - 228.5
30-39 931 15.6%405.5 379.4 - 431.5
40-49 1,356 22.8%602.4 570.3 - 634.4
50-59 1,951 32.8%869.7 831.2 - 908.3
60 & over 1,204 20.2%400.8 378.2 - 423.4
AfrAmer All ages 2,366 39.8%1,374.0 1,318.6 - 1,429.4
0-12 5 0.1%****
13-19 12 0.2%72.4 37.4 - 126.5
20-29 220 3.7%951.7 826.0 - 1,077.5
30-39 356 6.0%1,642.4 1,471.7 - 1,813.0
40-49 503 8.5%2,047.5 1,868.6 - 2,226.4
50-59 767 12.9%2,857.7 2,655.5 - 3,060.0
60 & over 503 8.5%1,438.9 1,313.2 - 1,564.7
White All ages 1,878 31.6%366.0 349.5 - 382.6
0-12 ****
13-19 ****
20-29 75 1.3%119.1 93.7 - 149.3
30-39 195 3.3%325.8 280.1 - 371.5
40-49 379 6.4%516.6 464.6 - 568.6
50-59 743 12.5%798.5 741.1 - 855.9
60 & over 483 8.1%341.9 311.4 - 372.4
HIV in Alameda County, 2014-2016 37
People Living with HIV
Table 3.4: HIV Prevalence by Race/Ethnicity and Age, Alameda County, Year-End 2016 (continued)
NOTE:This table spans multiple pages.
Race/
Ethnicitya
Age Count Percent Prevalence per
100,000
95%
Confidence
Interval
Latino All ages 1,144 19.2%303.8 286.2 - 321.5
0-12 ****
13-19 ****
20-29 128 2.2%193.5 160.0 - 227.0
30-39 255 4.3%397.2 348.5 - 446.0
40-49 327 5.5%669.9 597.3 - 742.5
50-59 286 4.8%865.0 764.8 - 965.3
60 & over 143 2.4%425.6 355.8 - 495.3
API All ages 395 6.6%84.3 76.0 - 92.7
0-12 ****
13-19 ****
20-29 36 0.6%55.3 38.7 - 76.5
30-39 95 1.6%126.9 102.6 - 155.1
40-49 107 1.8%151.4 122.7 - 180.1
50-59 102 1.7%157.4 126.8 - 187.9
60 & over 53 0.9%63.3 47.4 - 82.9
Other/Unk All ages 168 2.8%----
0-12 **----
13-19 **----
20-29 22 0.4%----
30-39 30 0.5%----
40-49 40 0.7%----
50-59 53 0.9%----
60 & over 22 0.4%----
Source:Alameda County eHARS,2017 Q2
[a]'Other/Unk'=American Indians and Alaskan Natives,multiple race,unknown race
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
[--]Rate not calculable for lack of a denominator.
HIV in Alameda County, 2014-2016 38
The Continuum of HIV Care
4
The Continuum of HIV Care
Anti-retroviral therapy (ART), when taken regularly, can suppress HIV, limiting the damage done by the
virus to the immune system as well as lowering the likelihood of ongoing transmission. ART thus bene-
ts both PLHIV as well as the larger community. In order to maximize these bene ts, it is crucial that
PLHIV be diagnosed, linked to and retained in regular HIV care, and be prescribed and take ART. These
stepsdiagnosis, linkage, retention, and prescription of and adherence to ARTare all pre-requisites for
achieving virologic suppression. Together, these steps comprise the continuum of HIV care, also called the
HIV care cascade or the stages of HIV care. The continuum has gained enormous popularity as a framework
for conceptualizing HIV care and prevention eorts.
In the United States, the CDC estimated that 84.3% of persons diagnosed in 2015 linked to care within 3
months.1 Additionally, CDC estimated that, at the end of 2014, 85.0% of all PLHIV had been diagnosed and
that, among those still alive and who had been diagnosed by the end of the previous year, 72.5% received
any HIV care, 56.9% were retained in continuous care, and 57.9% were virally suppressed.
In California, 79.9% of those diagnosed in 2015 were estimated to have linked to care within 3 months. By
the end of 2014, 85.0% of PLHIV were believed to have been diagnosed and, among those still alive and who
had been diagnosed by the end of the previous year, 74.9% of were estimated to have received any HIV care
in 2014, 59.4% were estimated to have been retained in continuous care, and 63.2% were estimated to have
been virally suppressed at last test.2 [5]
1Among those aged 13 or older at diagnosis in the 37 jurisdictions with complete laboratory reporting.
2Data on receipt of HIV medical care and viral suppression are based on data for PLHIV aged 13 or older, diagnosed by year-end
2013, alive at year-end 2014, and residing in the 37 jurisdictions with complete laboratory reporting. CD4 or viral load testsordered in 2014 were used as markers of HIV care. Retention in continuous care is de ned 2 or more CD4 or viral load tests
at least 3 months apart and viral suppression is de ned as last viral load in 2014 <200 copies/mL.
HIV in Alameda County, 2014-2016 39
The Continuum of HIV Care
The Overall Continuum of Care
In Alameda County, between 73.9% and 84.1% of new diagnoses between 2013 and 2015 were linked to care
within 3 months, depending on whether HIV-related labs ordered on the date of diagnosis were included as
a marker of linkage. Approximately 56.0% of PLHIV in Alameda County for the entirety of 2015 had 2 or
more visits 90 or more days apart that year and so were considered retained in care. Viral suppression was
estimated to be 67.0% that same year.
Figure 4.1: The Continuum of HIV Care in Alameda County
67.0%
84.1%
76.1%73.9%
56.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Linked Retained Virally Suppressed
Incl. labs at dx 1+ visit
Excl. labs at dx 2+ visits 90+ days apart
* Of 688 total diagnoses, 14 died within 90 days and were excluded from analysis
** Of 5737 PLHIV at year-end 2014, 78 were known to have died and an additional 481 to have moved out
of Alameda County in 2015
This chapter presents data on select measures along the continuum of HIV including estimates strati ed
by demographics. Data on ART use were not available for analysis. Strati ed analysis of measures along
the continuum (linkage, retention, and virologic status) are presented in Tables 4.1-4.15 at the end of this
chapter. Note that apparent dierences should be interpreted with caution due to the small numbers in
some subgroups and resulting statistical instability.
Linkage to Care
Here we present linkage to care estimates for Alameda County. It should be noted that receipt of a CD4
count or viral load test is not always a de nitive indicator of linkage to care. For example, a health care
provider may order these tests concurrently with a con rmatory test or a patient may not return for the
test results. Labs ordered after the date of diagnosis provide an alternative method for estimating linkage to
care. We present both estimates of linkageone that includes labs done on the date of diagnosis and another
that excludes themproviding what might be considered upper and lower bounds on the proportion linked.
Patients who died within 90 days of diagnosis were not included (N=14).
HIV in Alameda County, 2014-2016 40
The Continuum of HIV Care
The median time from diagnosis
to rst CD4 or viral load among
Alameda County residents
diagnosed in 2013-2015 was 6
days. Excluding labs ordered on
the date of diagnosis, the
median time from diagnosis was
15 days.
Figure 4.2: Days Between Diagnosis and First CD4 or Viral Load,
Alameda County, 2013-2015
Overall, just under 85% of those
diagnosed with HIV in Alameda
County from 2013 to 2015 were
linked to HIV care within 90
days of their diagnosis.
Excluding labs ordered on date
of diagnosis, about 73.9% of
newly diagnosed cases were
linked. Dierences by sex
assigned at birth were not
statistically signi cant.
Figure 4.3: Linkage to HIV Care within 90 Days of Diagnosis by Sex,
Alameda County, 2013-2015
85.7%
77.1%
83.8%
73.3%
84.1%
73.9%
Female (N=105)
Male (N=569)
All (N=674)
0%25%50%75%100%
Percent linked in 90 days or less
Excl. labs at dx Incl. labs at dx
NOTE: Sex refers to sex assigned at birth.
Timely linkage to HIV care by
race/ethnicity was highest
among Asians and Paci c
Islanders and lowest among
African Americans. Dierences
by race/ethnicity were not
statistically signi cant.
Figure 4.4: Linkage to HIV Care within 90 Days of Diagnosis by
Race/Ethnicity, Alameda County, 2013-2015
86.6%
76.8%
84.9%
72.4%
84.1%
76.8%
82.6%
71.8%
84.1%
73.9%
API (N=82)
Latino (N=152)
White (N=164)
AfrAmer (N=259)
All races (N=674)
0%25%50%75%100%
Percent linked in 90 days or less
Excl. labs at dx Incl. labs at dx
HIV in Alameda County, 2014-2016 41
The Continuum of HIV Care
Linkage was generally higher at
the extremes of the age
spectrum and lower among
those in their thirties and
forties. Dierences by age group
were not statistically signi cant.
Figure 4.5: Linkage to HIV Care within 90 Days of Diagnosis by Age,
Alameda County, 2013-2015
83.8%
73.0%
88.0%
77.2%
84.1%
71.7%
83.4%
75.2%
82.3%
71.9%
94.7%
89.5%
84.1%
73.9%
60 & over (N=37)
50−59 (N=92)
40−49 (N=138)
30−39 (N=157)
20−29 (N=231)
13−19 (N=19)
All ages (N=674)
0%25%50%75%100%
Percent linked in 90 days or less
Excl. labs at dx Incl. labs at dx
HIV in Alameda County, 2014-2016 42
The Continuum of HIV Care
Retention in Care
In 2015, 76.1% of PLHIV1 had one or more visits to an HIV care provider. About 16.3% of all PLHIV had
only a single visit; however, it is possible that some had additional visits, but no lab tests were ordered.
Figure 4.6: Number of HIV Care Visits per PLHIV in 2015,
Alameda County
2.0%
3.4%
10.6%
20.9%
22.8%
16.3%
23.9%
6+
5
4
3
2
1
None
0 500 1,000 1,500
Number of PLHIV
Nu
m
b
e
r
o
f
v
i
s
i
t
s
In 2015, 56.0% of PLHIV had
two or more visits 90 days or
more apart. Dierences by sex
were not statistically signi cant.
Figure 4.7: Retention in HIV Care by Sex,
Alameda County, 2015
55.0%
56.3%
56.0%
Female (N=934)
Male (N=4,244)
All (N=5,178)
0%20%40%60%80%
Percent with 2+ visits 90+ days apart in 2014
NOTE: Sex refers to sex assigned at birth.
1PLHIV that died or moved in 2015 were excluded from all analysis of retention in care.
HIV in Alameda County, 2014-2016 43
The Continuum of HIV Care
Asian and Paci c Islander
PLHIV had the highest rates of
retention in HIV care in 2015,
followed by whites. Only about
53.1% of Latino PLHIV were
retained in care.
Figure 4.8: Retention in HIV Care by Race/Ethnicity,
Alameda County, 2015
57.9%
53.1%
57.1%
55.6%
56.0%
API (N=323)
Latino (N=960)
White (N=1,649)
AfrAmer (N=2,110)
All races (N=5,178)
0%20%40%60%80%
Percent with 2+ visits 90+ days apart in 2014
PLHIV aged 20-29 at year-end
2015 had the lowest rates of
retention in care; younger and
successively older age groups
had higher rates. Retention was
highest among those ages 13-19
and 60 and over; however the
number of PLHIV aged 13-19
was small. The general trend of
higher retention in older age
groups was statisticaly
signi cant.
Figure 4.9: Retention in HIV Care by Age,
Alameda County, 2015
64.8%
59.8%
52.3%
48.4%
45.5%
68.8%
56.0%
60 & over (N=947)
50−59 (N=1,685)
40−49 (N=1,377)
30−39 (N=752)
20−29 (N=391)
13−19 (N=16)
All ages (N=5,178)
0%25%50%75%100%
2+ visits 90+ days apart
Virologic Status
The nal measure along the care continuum is virologic suppression, de ned as a viral load under 200 copies
per ml. For the purposes of these analyses, an undetectable viral load is de ned as 75 copies per ml or less.
PLHIV that died or moved in 2015 were excluded. Disparities in virologic suppression among PLHIV in care
can suggest potential dierences in ART use or eectiveness.
HIV in Alameda County, 2014-2016 44
The Continuum of HIV Care
Approximately 67% of PLHIV
were virally suppressed at their
most recent test in 2015, with
the majority being
undetectable. Virologic
suppression was about 3% lower
among female PLHIV compared
to male PLHIV, but this
dierence was not statistically
signi cant. Among those in
care, viral suppression was
higher among males than
females (Table 4.13).
Figure 4.10: Virologic Status by Sex,
Alameda County, 2015
Female (N=934)
Male (N=4,244)
All (N=5,178)
0%10%20%30%40%50%60%70%80%90%100%
Undetectable Suppressed Unsuppressed
Only CD4 reported No CD4s or VLs reported
NOTE: Sex refers to sex assigned at birth.
In 2015, over 70% of white and
Asian and Paci c Islander
PLHIV were virally suppressed.
Viral suppression was about 6%
lower in all other racial/ethnic
groups. Similar disparities were
seen among those in care (Table
4.14).
Figure 4.11: Virologic Status by Race/Ethnicity,
Alameda County, 2015
API (N=323)
Latino (N=960)
White (N=1,649)
AfrAmer (N=2,110)
All races (N=5,178)
0%10%20%30%40%50%60%70%80%90%100%
Undetectable Suppressed Unsuppressed
Only CD4 reported No CD4s or VLs reported
Viral suppression rates
generally increased as age
increased, ranging from about
57.3% among those ages 20-29
to 74.1% among those ages 60
and over. A similar pattern was
seen among those in care (Table
4.15).
Figure 4.12: Virologic Status by Age,
Alameda County, 2015
60 & over (N=947)
50−59 (N=1,685)
40−49 (N=1,377)
30−39 (N=752)
20−29 (N=391)
13−19 (N=16)
All ages (N=5,178)
0%10%20%30%40%50%60%70%80%90%100%
Undetectable Suppressed Unsuppressed
Only CD4 reported No CD4s or VLs reported
HIV in Alameda County, 2014-2016 45
The Continuum of HIV Care
Table 4.1: Timely Linkage to HIV Care Among New Diagnoses by Sex and Age, Alameda County,
2013-2015
All Diagnoses Linked 90 Days Incl. Dx Date
Sexa Age at
Diagnosis
Average
Annual
Count
Column Percent Average
Annual
Count
Row Percent
All All ages 224.7 100.0%189.0 84.1%
13-19 6.3 2.8%6.0 **
20-24 33.7 15.0%**
25-29 43.3 19.3%**
30-39 52.3 23.3% 43.7 83.4%
40-49 46.0 20.5%38.7 84.1%
50 & over 43.0 19.1% 37.3 86.8%
Male All ages 189.7 84.4%159.0 83.8%
13-19 ** 4.7 *
20-24 **25.0 *
25-29 ** 33.0 *
30-39 44.0 19.6%37.3 84.8%
40-49 38.0 16.9% 32.3 85.1%
50 & over 32.0 14.2%26.7 83.3%
Female All ages 35.0 15.6% 30.0 85.7%
13-19 **1.3 *
20-24 ****
25-29 ****
30-39 8.3 3.7% 6.3 **
40-49 8.0 3.6%6.3 **
50 & over 11.0 4.9% 10.7 **
Source: Alameda County eHARS, 2017 Q2
NOTE: Excludes N=14 persons who died within 90 days of diagnosis.
[a]Refers to sex assigned at birth
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 46
The Continuum of HIV Care
Table 4.2: Timely Linkage to HIV Care Among New Diagnoses by Sex and Race/Ethnicity, Alameda
County, 2013-2015
All Diagnoses Linked 90 Days Incl. Dx Date
Sexa Race/
Ethnicityb
Average
Annual
Count
Column Percent Average
Annual
Count
Row Percent
All All races 224.7 100.0%189.0 84.1%
AfrAmer 86.3 38.4%71.3 82.6%
White 54.7 24.3% 46.0 84.1%
Latino 50.7 22.6%43.0 84.9%
API 27.3 12.2% 23.7 86.6%
Other/Unk 5.7 2.5%5.0 **
Male All races 189.7 84.4% 159.0 83.8%
AfrAmer 65.7 29.2%54.0 82.2%
White 47.3 21.1% 39.3 83.1%
Latino 46.7 20.8%39.3 84.3%
API ** 21.7 *
Other/Unk **4.7 *
Female All races 35.0 15.6% 30.0 85.7%
AfrAmer 20.7 9.2%17.3 83.9%
White 7.3 3.3% 6.7 **
Latino 4.0 1.8%3.7 **
API ** 2.0 *
Other/Unk **0.3 *
Source: Alameda County eHARS, 2017 Q2
NOTE: Excludes N=14 persons who died within 90 days of diagnosis.
[a]Refers to sex assigned at birth
[b]'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 47
The Continuum of HIV Care
Table 4.3: Timely Linkage to HIV Care Among New Diagnoses by Race/Ethnicity and Age, Alameda
County, 2013-2015
NOTE: This table spans multiple pages.
All Diagnoses Linked to Care in 90 Days
Including Date of Diagnosis
Race/
Ethnicitya Age at
Diagnosis
Average
Annual
Count
Column Percent Average
Annual
Count
Row Percent
All races All ages 224.7 100.0%189.0 84.1%
13-19 6.3 2.8%6.0 **
20-24 33.7 15.0% 27.3 81.2%
25-29 43.3 19.3%36.0 83.1%
30-39 52.3 23.3% 43.7 83.4%
40-49 46.0 20.5%38.7 84.1%
50 & over 43.0 19.1% 37.3 86.8%
AfrAmer All ages 86.3 38.4%71.3 82.6%
13-19 4.3 1.9% 4.0 **
20-24 15.7 7.0%12.3 **
25-29 16.7 7.4% 14.3 **
30-39 18.0 8.0%15.0 **
40-49 13.0 5.8% 11.0 **
50 & over 18.7 8.3%14.7 **
White All ages 54.7 24.3% 46.0 84.1%
13-19 **0.3 *
20-24 ** 4.7 *
25-29 9.0 4.0%7.3 **
30-39 11.0 4.9% 8.7 **
40-49 15.7 7.0%13.0 **
50 & over 13.3 5.9%12.0 **
HIV in Alameda County, 2014-2016 48
The Continuum of HIV Care
Table 4.3: Timely Linkage to HIV Care Among New Diagnoses by Race/Ethnicity and Age, Alameda
County, 2013-2015 (continued)
NOTE: This table spans multiple pages.
All Diagnoses Linked to Care in 90 Days
Including Date of Diagnosis
Race/
Ethnicitya Age at
Diagnosis
Average
Annual
Count
Column Percent Average
Annual
Count
Row Percent
Latino All ages 50.7 22.6%43.0 84.9%
13-19 ** 1.3 *
20-24 7.3 3.3%5.7 **
25-29 12.0 5.3% 9.3 **
30-39 13.0 5.8%11.3 **
40-49 11.3 5.0% 9.7 **
50 & over **5.7 *
API All ages 27.3 12.2% 23.7 86.6%
13-19 **0.3 *
20-24 ** 4.0 *
25-29 3.7 1.6%3.7 100.0%
30-39 ** 7.7 *
40-49 **4.3 *
50 & over ** 3.7 *
Other/Unk All ages 5.7 2.5%5.0 **
13-19 0.0 0.0% 0.0 **
20-24 **0.7 *
25-29 2.0 0.9% 1.3 **
30-39 **1.0 *
40-49 ** 0.7 *
50 & over **1.3 *
Source: Alameda County eHARS, 2017 Q2
NOTE: Excludes N=14 persons who died within 90 days of diagnosis.
[a]'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 49
The Continuum of HIV Care
Table 4.4: Engagement in HIV Care in 2015 Among PLHIV at Year-End 2014 by Sex and Age, Alameda
County
All PLHIV 1+ Visits in 2015
Sexa Age at
Year-End
2014
Count Column Percent Count Row Percent
All All ages 5,178 100.0%3,939 76.1%
0-12 10 0.2%9 **
13-19 16 0.3% 14 **
20-29 391 7.6%291 74.4%
30-39 752 14.5% 533 70.9%
40-49 1,377 26.6%1,012 73.5%
50-59 1,685 32.5% 1,339 79.5%
60 & over 947 18.3%741 78.2%
Male All ages 4,244 82.0% 3,219 75.8%
0-12 **5 *
13-19 **7 *
20-29 342 6.6%254 74.3%
30-39 604 11.7% 426 70.5%
40-49 1,090 21.1%791 72.6%
50-59 1,415 27.3% 1,123 79.4%
60 & over 780 15.1%613 78.6%
Female All ages 934 18.0% 720 77.1%
0-12 **4 *
13-19 **7 *
20-29 49 0.9%37 **
30-39 148 2.9% 107 72.3%
40-49 287 5.5%221 77.0%
50-59 270 5.2% 216 80.0%
60 & over 167 3.2%128 76.6%
Source: Alameda County eHARS, 2017 Q2
NOTE: Excludes PLHIV at year-end 2014 who died (N=78) or moved out of the county (N=481) in 2015.
[a]Refers to sex assigned at birth
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 50
The Continuum of HIV Care
Table 4.5: Engagement in HIV Care in 2015 Among PLHIV at Year-End 2014 by Sex and Race/Ethnicity,
Alameda County
All PLHIV 1+ Visits in 2015
Sexa Race/
Ethnicityb
Count Column Percent Count Row Percent
All All races 5,178 100.0%3,939 76.1%
AfrAmer 2,110 40.7%1,616 76.6%
White 1,649 31.8% 1,251 75.9%
Latino 960 18.5%702 73.1%
API 323 6.2% 254 78.6%
Other/Unk 136 2.6%116 85.3%
Male All races 4,244 82.0% 3,219 75.8%
AfrAmer 1,524 29.4%1,163 76.3%
White 1,502 29.0% 1,138 75.8%
Latino 831 16.0%605 72.8%
API 270 5.2% 211 78.1%
Other/Unk 117 2.3%102 87.2%
Female All races 934 18.0% 720 77.1%
AfrAmer 586 11.3%453 77.3%
White 147 2.8% 113 76.9%
Latino 129 2.5%97 75.2%
API 53 1.0% 43 **
Other/Unk 19 0.4%14 **
Source: Alameda County eHARS, 2017 Q2
NOTE: Excludes PLHIV at year-end 2014 who died (N=78) or moved out of the county (N=481) in 2015.
[a]Refers to sex assigned at birth
[b]'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 51
The Continuum of HIV Care
Table 4.6: Engagement in HIV Care in 2015 Among PLHIV at Year-End 2014 by Race/Ethnicity and Age,
Alameda County
NOTE: This table spans multiple pages.
All PLHIV 1+ Visits in 2015
Race/
Ethnicitya Age at
Year-End
2014
Count Column Percent Count Row Percent
All races All ages 5,178 100.0%3,939 76.1%
0-12 10 0.2%9 **
13-19 16 0.3% 14 **
20-29 391 7.6%291 74.4%
30-39 752 14.5% 533 70.9%
40-49 1,377 26.6%1,012 73.5%
50-59 1,685 32.5% 1,339 79.5%
60 & over 947 18.3%741 78.2%
AfrAmer All ages 2,110 40.7% 1,616 76.6%
0-12 7 0.1%7 100.0%
13-19 11 0.2% 10 **
20-29 176 3.4%130 73.9%
30-39 317 6.1% 228 71.9%
40-49 528 10.2%395 74.8%
50-59 690 13.3% 550 79.7%
60 & over 381 7.4%296 77.7%
White All ages 1,649 31.8% 1,251 75.9%
0-12 **1 *
13-19 **2 *
20-29 60 1.2%43 **
30-39 140 2.7% 97 69.3%
40-49 389 7.5%283 72.8%
50-59 654 12.6% 515 78.7%
60 & over 402 7.8%310 77.1%
HIV in Alameda County, 2014-2016 52
The Continuum of HIV Care
Table 4.6: Engagement in HIV Care in 2015 Among PLHIV at Year-End 2014 by Race/Ethnicity and Age,
Alameda County (continued)
NOTE: This table spans multiple pages.
All PLHIV 1+ Visits in 2015
Race/
Ethnicitya Age at
Year-End
2014
Count Column Percent Count Row Percent
Latino All ages 960 18.5%702 73.1%
0-12 **1 *
13-19 **1 *
20-29 104 2.0%80 76.9%
30-39 202 3.9% 134 66.3%
40-49 310 6.0%218 70.3%
50-59 240 4.6% 186 77.5%
60 & over 101 2.0%82 81.2%
API All ages 323 6.2% 254 78.6%
0-12 **0 *
13-19 **1 *
20-29 33 0.6%25 **
30-39 68 1.3% 54 79.4%
40-49 111 2.1%82 73.9%
50-59 66 1.3% 57 **
60 & over 44 0.8%35 **
HIV in Alameda County, 2014-2016 53
The Continuum of HIV Care
Table 4.6: Engagement in HIV Care in 2015 Among PLHIV at Year-End 2014 by Race/Ethnicity and Age,
Alameda County (continued)
NOTE: This table spans multiple pages.
All PLHIV 1+ Visits in 2015
Race/
Ethnicitya Age at
Year-End
2014
Count Column Percent Count Row Percent
Other/Unk All ages 136 2.6%116 85.3%
0-12 0 0.0%0 **
13-19 0 0.0%0 **
20-29 18 0.3%13 **
30-39 25 0.5% 20 **
40-49 39 0.8%34 **
50-59 35 0.7% 31 **
60 & over 19 0.4%18 **
Source: Alameda County eHARS, 2017 Q2
NOTE: Excludes PLHIV at year-end 2014 who died (N=78) or moved out of the county (N=481) in 2015.
[a]'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 54
The Continuum of HIV Care
Table 4.7: Retention in Continuous HIV Care in 2015 Among PLHIV at Year-End 2014 by Sex and Age,
Alameda County
All PLHIV 2+ Visits 90+ Days Apart 2015
Sexa Age at
Year-End
2014
Count Column Percent Count Row Percent
All All ages 5,178 100.0%2,902 56.0%
0-12 10 0.2%7 **
13-19 16 0.3% 11 **
20-29 391 7.6%178 45.5%
30-39 752 14.5% 364 48.4%
40-49 1,377 26.6%720 52.3%
50-59 1,685 32.5% 1,008 59.8%
60 & over 947 18.3%614 64.8%
Male All ages 4,244 82.0% 2,388 56.3%
0-12 **3 *
13-19 **6 *
20-29 342 6.6%156 45.6%
30-39 604 11.7% 289 47.8%
40-49 1,090 21.1%563 51.7%
50-59 1,415 27.3% 854 60.4%
60 & over 780 15.1%517 66.3%
Female All ages 934 18.0% 514 55.0%
0-12 **4 *
13-19 **5 *
20-29 49 0.9%22 **
30-39 148 2.9% 75 50.7%
40-49 287 5.5%157 54.7%
50-59 270 5.2% 154 57.0%
60 & over 167 3.2%97 58.1%
Source: Alameda County eHARS, 2017 Q2
NOTE: Excludes PLHIV at year-end 2014 who died (N=78) or moved out of the county (N=481) in 2015.
[a]Refers to sex assigned at birth
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 55
The Continuum of HIV Care
Table 4.8: Retention in Continuous HIV Care in 2015 Among PLHIV at Year-End 2014 by Sex and
Race/Ethnicity, Alameda County
All PLHIV 2+ Visits 90+ Days Apart 2015
Sexa Race/
Ethnicityb
Count Column Percent Count Row Percent
All All races 5,178 100.0%2,902 56.0%
AfrAmer 2,110 40.7%1,174 55.6%
White 1,649 31.8% 942 57.1%
Latino 960 18.5%510 53.1%
API 323 6.2% 187 57.9%
Other/Unk 136 2.6%89 65.4%
Male All races 4,244 82.0% 2,388 56.3%
AfrAmer 1,524 29.4%849 55.7%
White 1,502 29.0% 864 57.5%
Latino 831 16.0%438 52.7%
API 270 5.2% 159 58.9%
Other/Unk 117 2.3%78 66.7%
Female All races 934 18.0% 514 55.0%
AfrAmer 586 11.3%325 55.5%
White 147 2.8% 78 53.1%
Latino 129 2.5%72 55.8%
API 53 1.0% 28 **
Other/Unk 19 0.4%11 **
Source: Alameda County eHARS, 2017 Q2
NOTE: Excludes PLHIV at year-end 2014 who died (N=78) or moved out of the county (N=481) in 2015.
[a]Refers to sex assigned at birth
[b]'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 56
The Continuum of HIV Care
Table 4.9: Retention in Continuous HIV Care in 2015 Among PLHIV at Year-End 2014 by Race/Ethnicity
and Age, Alameda County
NOTE: This table spans multiple pages.
All PLHIV 2+ Visits 90+ Days Apart 2015
Race/
Ethnicitya Age at
Year-End
2014
Count Column Percent Count Row Percent
All races All ages 5,178 100.0%2,902 56.0%
0-12 10 0.2%7 **
13-19 16 0.3% 11 **
20-29 391 7.6%178 45.5%
30-39 752 14.5% 364 48.4%
40-49 1,377 26.6%720 52.3%
50-59 1,685 32.5% 1,008 59.8%
60 & over 947 18.3%614 64.8%
AfrAmer All ages 2,110 40.7% 1,174 55.6%
0-12 7 0.1%5 **
13-19 11 0.2%8 **
20-29 176 3.4%79 44.9%
30-39 317 6.1% 162 51.1%
40-49 528 10.2%274 51.9%
50-59 690 13.3% 409 59.3%
60 & over 381 7.4%237 62.2%
White All ages 1,649 31.8% 942 57.1%
0-12 **1 *
13-19 **1 *
20-29 60 1.2%26 **
30-39 140 2.7% 62 44.3%
40-49 389 7.5%212 54.5%
50-59 654 12.6% 378 57.8%
60 & over 402 7.8%262 65.2%
HIV in Alameda County, 2014-2016 57
The Continuum of HIV Care
Table 4.9: Retention in Continuous HIV Care in 2015 Among PLHIV at Year-End 2014 by Race/Ethnicity
and Age, Alameda County (continued)
NOTE: This table spans multiple pages.
All PLHIV 2+ Visits 90+ Days Apart 2015
Race/
Ethnicitya Age at
Year-End
2014
Count Column Percent Count Row Percent
Latino All ages 960 18.5%510 53.1%
0-12 **1 *
13-19 **1 *
20-29 104 2.0%52 50.0%
30-39 202 3.9% 90 44.6%
40-49 310 6.0%151 48.7%
50-59 240 4.6% 146 60.8%
60 & over 101 2.0%69 68.3%
API All ages 323 6.2% 187 57.9%
0-12 **0 *
13-19 **1 *
20-29 33 0.6%13 **
30-39 68 1.3% 36 **
40-49 111 2.1%60 54.1%
50-59 66 1.3% 48 **
60 & over 44 0.8%29 **
HIV in Alameda County, 2014-2016 58
The Continuum of HIV Care
Table 4.9: Retention in Continuous HIV Care in 2015 Among PLHIV at Year-End 2014 by Race/Ethnicity
and Age, Alameda County (continued)
NOTE: This table spans multiple pages.
All PLHIV 2+ Visits 90+ Days Apart 2015
Race/
Ethnicitya Age at
Year-End
2014
Count Column Percent Count Row Percent
Other/Unk All ages 136 2.6%89 65.4%
0-12 0 0.0%0 **
13-19 0 0.0%0 **
20-29 18 0.3%8 **
30-39 25 0.5% 14 **
40-49 39 0.8%23 **
50-59 35 0.7% 27 **
60 & over 19 0.4%17 **
Source: Alameda County eHARS, 2017 Q2
NOTE: Excludes PLHIV at year-end 2014 who died (N=78) or moved out of the county (N=481) in 2015.
[a]'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 59
The Continuum of HIV Care
Table 4.10: Viral Suppression in 2015 Among PLHIV at Year-End 2014 by Sex and Age, Alameda County
All PLHIV Suppressed at Last Viral Load
in 2015
Sexa Age at
Year-End
2014
Count Column Percent Count Row Percent
All All ages 5,178 100.0%3,473 67.1%
0-12 10 0.2%7 **
13-19 16 0.3%9 **
20-29 391 7.6%224 57.3%
30-39 752 14.5%446 59.3%
40-49 1,377 26.6%868 63.0%
50-59 1,685 32.5%1,217 72.2%
60 & over 947 18.3%702 74.1%
Male All ages 4,244 82.0%2,866 67.5%
0-12 **4 *
13-19 **5 *
20-29 342 6.6%200 58.5%
30-39 604 11.7%357 59.1%
40-49 1,090 21.1%694 63.7%
50-59 1,415 27.3%1,021 72.2%
60 & over 780 15.1%585 75.0%
Female All ages 934 18.0%607 65.0%
0-12 **3 *
13-19 **4 *
20-29 49 0.9%24 **
30-39 148 2.9%89 60.1%
40-49 287 5.5%174 60.6%
50-59 270 5.2%196 72.6%
60 & over 167 3.2%117 70.1%
Source:Alameda County eHARS,2017 Q2
NOTE:Excludes PLHIV at year-end 2014 who died (N=78)or moved out of the county (N=481)in 2015.
[a]Refers to sex assigned at birth
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 60
The Continuum of HIV Care
Table 4.11: Viral Suppression in 2015 Among PLHIV at Year-End 2014 by Sex and Race/Ethnicity,
Alameda County
All PLHIV Suppressed at Last Viral Load
in 2015
Sexa Race/
Ethnicityb
Count Column Percent Count Row Percent
All All races 5,178 100.0%3,473 67.1%
AfrAmer 2,110 40.7%1,356 64.3%
White 1,649 31.8%1,163 70.5%
Latino 960 18.5%619 64.5%
API 323 6.2%235 72.8%
Other/Unk 136 2.6%100 73.5%
Male All races 4,244 82.0%2,866 67.5%
AfrAmer 1,524 29.4%981 64.4%
White 1,502 29.0%1,063 70.8%
Latino 831 16.0%535 64.4%
API 270 5.2%198 73.3%
Other/Unk 117 2.3%89 76.1%
Female All races 934 18.0%607 65.0%
AfrAmer 586 11.3%375 64.0%
White 147 2.8%100 68.0%
Latino 129 2.5%84 65.1%
API 53 1.0%37 **
Other/Unk 19 0.4%11 **
Source:Alameda County eHARS,2017 Q2
NOTE:Excludes PLHIV at year-end 2014 who died (N=78)or moved out of the county (N=481)in 2015.
[a]Refers to sex assigned at birth
[b]'Other/Unk'=American Indians and Alaskan Natives,multiple race,unknown race
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 61
The Continuum of HIV Care
Table 4.12: Viral Suppression in 2015 Among PLHIV at Year-End 2014 by Race/Ethnicity and Age,
Alameda County
NOTE:This table spans multiple pages.
All PLHIV Suppressed at Last Viral Load
in 2015
Race/
Ethnicitya Age at
Year-End
2014
Count Column Percent Count Row Percent
All races All ages 5,178 100.0%3,473 67.1%
0-12 10 0.2%7 **
13-19 16 0.3%9 **
20-29 391 7.6%224 57.3%
30-39 752 14.5%446 59.3%
40-49 1,377 26.6%868 63.0%
50-59 1,685 32.5%1,217 72.2%
60 & over 947 18.3%702 74.1%
AfrAmer All ages 2,110 40.7%1,356 64.3%
0-12 7 0.1%6 **
13-19 11 0.2%6 **
20-29 176 3.4%91 51.7%
30-39 317 6.1%182 57.4%
40-49 528 10.2%317 60.0%
50-59 690 13.3%482 69.9%
60 & over 381 7.4%272 71.4%
White All ages 1,649 31.8%1,163 70.5%
0-12 **1 *
13-19 **1 *
20-29 60 1.2%35 **
30-39 140 2.7%83 59.3%
40-49 389 7.5%254 65.3%
50-59 654 12.6%486 74.3%
60 & over 402 7.8%303 75.4%
HIV in Alameda County, 2014-2016 62
The Continuum of HIV Care
Table 4.12: Viral Suppression in 2015 Among PLHIV at Year-End 2014 by Race/Ethnicity and Age,
Alameda County (continued)
NOTE:This table spans multiple pages.
All PLHIV Suppressed at Last Viral Load
in 2015
Race/
Ethnicitya Age at
Year-End
2014
Count Column Percent Count Row Percent
Latino All ages 960 18.5%619 64.5%
0-12 **0 *
13-19 **1 *
20-29 104 2.0%68 65.4%
30-39 202 3.9%115 56.9%
40-49 310 6.0%192 61.9%
50-59 240 4.6%166 69.2%
60 & over 101 2.0%77 76.2%
API All ages 323 6.2%235 72.8%
0-12 **0 *
13-19 **1 *
20-29 33 0.6%21 **
30-39 68 1.3%48 **
40-49 111 2.1%77 69.4%
50-59 66 1.3%54 81.8%
60 & over 44 0.8%34 **
HIV in Alameda County, 2014-2016 63
The Continuum of HIV Care
Table 4.12: Viral Suppression in 2015 Among PLHIV at Year-End 2014 by Race/Ethnicity and Age,
Alameda County (continued)
NOTE:This table spans multiple pages.
All PLHIV Suppressed at Last Viral Load
in 2015
Race/
Ethnicitya Age at
Year-End
2014
Count Column Percent Count Row Percent
Other/Unk All ages 136 2.6%100 73.5%
0-12 0 0.0%0 **
13-19 0 0.0%0 **
20-29 18 0.3%9 **
30-39 25 0.5%18 **
40-49 39 0.8%28 **
50-59 35 0.7%29 **
60 & over 19 0.4%16 **
Source:Alameda County eHARS,2017 Q2
NOTE:Excludes PLHIV at year-end2014 who died (N=78)or moved out of the county (N=481)in 2015.
[a]'Other/Unk'=American Indians and Alaskan Natives,multiple race,unknown race
[*]Some cells suppressed to protect confidentiality.
[**]Unstable estimates not shown.
Table 4.13: Viral Suppression in 2015 Among PLHIV at Year-End 2014 and in Care in 2015 by Sex,
Alameda County
All PLHIV Suppressed at Last Viral Load
in 2015
Sexa Count Column Percent Count Row Percent
All 3,939 100.0%3,473 88.2%
Male 3,219 81.7%2,866 89.0%
Female 720 18.3%607 84.3%
Source:Alameda County eHARS,2017 Q2
NOTE:Excludes PLHIV at year-end 2014 who died (N=78),moved out of the county
(N=481),or did not have any HIV labs reported (N=1239)in 2015.
[a]Refers to sex assigned at birth
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 64
The Continuum of HIV Care
Table 4.14: Viral Suppression in 2015 Among PLHIV at Year-End 2014 and in Care in 2015 by
Race/Ethnicity, Alameda County
All PLHIV Suppressed at Last Viral Load
in 2015
Race/
Ethnicitya Count Column Percent Count Row Percent
All races 3,939 100.0%3,473 88.2%
AfrAmer 1,616 41.0%1,356 83.9%
White 1,251 31.8%1,163 93.0%
Latino 702 17.8%619 88.2%
API 254 6.4%235 92.5%
Other/Unk 116 2.9%100 86.2%
Source:Alameda County eHARS,2017 Q2
NOTE:Excludes PLHIV at year-end 2014 who died (N=78),moved out of the county (N=481),
or did not have any HIV labs reported (N=1239)in 2015.
[a]'Other/Unk'=American Indians and Alaskan Natives,multiple race,unknown race
[**]Unstable estimates not shown.
Table 4.15: Viral Suppression in 2015 Among PLHIV at Year-End 2014 and in Care in 2015 by Age,
Alameda County
All PLHIV Suppressed at Last Viral Load
in 2015
Age at
Year-End
2014
Count Column Percent Count Row Percent
All ages 3,939 100.0%3,473 88.2%
0-12 9 0.2%7 **
13-19 14 0.4%9 **
20-29 291 7.4%224 77.0%
30-39 533 13.5%446 83.7%
40-49 1,012 25.7%868 85.8%
50-59 1,339 34.0%1,217 90.9%
60 & over 741 18.8%702 94.7%
Source:Alameda County eHARS,2017 Q2
NOTE:Excludes PLHIV at year-end 2014 who died (N=78),moved out of the county (N=481),
or did not have any HIV labs reported (N=1239)in 2015.
[**]Unstable estimates not shown.
HIV in Alameda County, 2014-2016 65
Technical Notes
Appendix A: Technical Notes
Data Sources
All counts and proportions in this report were calculated using data from the Enhanced HIV/AIDS Reporting
System (eHARS). Numerators of rates were also obtained from eHARS; denominators were derived using
data from the United States Census (2000 and 2010) and Environmental Systems Research Institute (2012
and later). Mid-year population estimates for intercensal years prior to 2012 as well as all year-end estimates
were obtained through linear interpolation.
Statistical Analysis
Calculation of Con dence Intervals
All con dence intervals (CI) depicted in the report are at the 95% con dence level. CIs for proportions are
calculated on the log odds (logit) scale and then antilogit-transformed in order to preclude lower limits
less than 0% and upper limits greater than 100%. Con dence limits for rates are calculated using a Poisson
distribution for counts less than 100 and a binomial distribution for counts of 100 or greater.
Signi cance Testing and Statistical Modeling
The statistical signi cance of associations between categorical variables was tested by Pearson's chi square
test or Fisher's exact test, as appropriate. Dierences in CD4 count at diagnosis were assessed using ANOVA
unless Levene's Test for Homogeneity of Variances yielded a signi cant result (at alpha = 0.05), in which
case Welch's ANOVA was used. Trend analyses were performed using Join Point [1] to model crude rates as
a log-linear function of year separately for each stratum of the categorical variable(s); errors were assumed to
have Poisson variance and to be independent. Grid search and the modi ed Bayesian Information Criterion
were used to select the best tting model from among those with zero to four join points at least 2 years
apart between 2007 and 2015 (the second and second-to-last years examined).
Data Suppression Rules
Proportions
In accordance with draft guidelines released by the National Center for Health Statistics [7], proportions are
considered to be statistically unreliable and are not presented if they meet either of the following criteria:
HIV in Alameda County, 2014-2016 66
Technical Notes
1.The absolute CI width exceeds 20%.
2.The absolute CI width does not exceed 20%, but the relative CI width (the absolute CI width divided
by the lesser of the proportion and its complement) exceeds 120%.
Rates
Rates for subpopulations with fewer than 12 cases are considered to be statistically unreliable and were not
presented. In these instances, the relative standard error of the rate exceeds 30%.
Death Ascertainment
Alameda County HIV surveillance o cials are noti ed by the local O ce of Vital Registration whenever
HIV is documented on a death certi cate led in Alameda County. Additionally, the California O ce of
AIDS periodically matches state HIV registry data to national death databases such as the National Death
Index and the Social Security Administration's Death Master File. PLHIV who died outside of Alameda
County and were ever associated with Alameda County or whose HIV was not documented on their death
certi cate are thus generally captured through this process with some delay.
HIV in Alameda County, 2014-2016 67
Appendix B: Reporting Requirements
The representativeness and accuracy of HIV surveillance data depend on the reliable, complete, and timely
reporting of data by health care providers and laboratories in accordance with California law. The Adult
HIV/AIDS Case Report Form, which is used to report data on cases of HIV infection, is available at
https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/cdph8641a.pdf. Help
completing it in Alameda County can be obtained by calling (510) 268-2372.
Health Care Providers
Title 17, Section 2643.5, HIV Reporting by Health Care Providers, requires health care providers to report
cases of HIV disease (at any stage) to the local health department in the jurisdiction of their practice:
(a)Each health care provider that orders a laboratory test used to identify HIV, a component of HIV,
or antibodies to or antigens of HIV shall submit to the laboratory performing the test a pre-printed
laboratory requisition form which includes all documentation as speci ed in 42 CFR 493.1105 (57 FR
7162, Feb. 28, 1992, as amended at 58 FR 5229, Jan. 19, 1993) and adopted in Business and Professions
Code, Section 1220.
(b)The person authorized to order the laboratory test shall include the following when submitting infor-
mation to the laboratory:
(1)Complete name of patient; and
(2)Patient date of birth (2-digit month, 2-digit day, 4-digit year); and
(3)Patient gender (male, female, transgender male-to-female, or transgender female-to-male); and
(4)Date biological specimen was collected; and
(5)Name, address, telephone number of the health care provider and the facility where services were
rendered, if dierent.
(c)Each health care provider shall, within seven calendar days of receipt from a laboratory of a patient's
con rmed HIV test or determination by the health care provider of a patient's con rmed HIV test,
report the con rmed HIV test to the local Health O cer for the jurisdiction where the health care
provider facility is located. The report shall consist of a completed copy of the HIV/AIDS Case Report
form.
68
Technical Notes
(1)All reports containing personal information, including HIV/AIDS Case Reports, shall be sent to
the local Health O cer or his or her designee by:
(A)courier service, U.S. Postal Service Express or Registered mail, or other traceable mail; or
(B)person-to-person transfer with the local Health O cer or his or her designee.
(2)The health care provider shall not submit reports containing personal information to the local
Health O cer or his or her designee by electronic facsimile transmission or by electronic mail or
by non-traceable mail.
(d)HIV reporting by name to the local Health O cer, via submission of the HIV/AIDS Case Report,
shall not supplant the reporting requirements in Article 1 of this Subchapter when a patient's medical
condition progresses from HIV infection to an Acquired Immunode ciency Syndrome (AIDS) diagnosis.
(e)A health care provider who receives noti cation from an out-of-state laboratory of a con rmed HIV test
for a California patient shall report the ndings to the local Health O cer for the jurisdiction where
the health care provider facility is located.
(f)When a health care provider orders multiple HIV-related viral load tests for a patient, or receives multiple
laboratory reports of a con rmed HIV test, the health care provider shall be required to submit only
one HIV/AIDS Case Report, per patient, to the local Health O cer.
(g)Nothing in this Subchapter shall prohibit the local health department from assisting health care providers
to report HIV cases.
(h)Information reported pursuant to this Article is acquired in con dence and shall not be disclosed by
the health care provider except as authorized by this Article, other state or federal law, or with the
written consent of the individual to whom the information pertains or the legal representative of that
individual.
Note: Authority cited: Sections 120125, 120130, 120140, 121022, 131080 and 131200, Health and Safety Code.
Reference: Sections 1202.5, 1206, 1206.5, 1220, 1241, 1265 and 1281, Business and Professions Code; and
Sections 1603.1, 101160, 120175, 120250, 120775, 120885-120895, 120917, 120975, 120980, 121015, 121022,
121025, 121035, 121085, 131051, 131052, 131056 and 131080, Health and Safety Code.
Laboratories
Title 17, Section 2643.10, HIV Reporting by Laboratories, requires laboratories to report all HIV-related
laboratory tests to the local health department in the jurisdiction of the ordering provider:
(a)The laboratory director or authorized designee shall, within seven calendar days of determining a con-
rmed HIV test, report the con rmed HIV test to the Health O cer for the local health jurisdiction
where the health care provider facility is located. The report shall include the
(1)Complete name of patient; and
(2)Patient date of birth (2-digit month, 2-digit day, 4-digit year); and
(3)Patient gender (male, female, transgender male-to-female, or transgender female-to-male); and
HIV in Alameda County, 2014-2016 69
Technical Notes
(4)Name, address, and telephone number of the health care provider and the facility that submitted
the biological specimen to the laboratory, if dierent; and
(5)Name, address, and telephone number of the laboratory; and
(6)Laboratory report number as assigned by the laboratory; and
(7)Laboratory results of the test performed; and
(8)Date the biological specimen was tested in the laboratory; and
(9)Laboratory Clinical Laboratory Improvement Amendments (CLIA) number.
(b)(1)All reports containing personal information, including laboratory reports, shall be sent to the local
Health O cer or his or her designee by:
(A)courier service, U.S. Postal Service Express or Registered mail, or other traceable mail; or
(B)person-to-person transfer with the local Health O cer or his or her designee.
(2)The laboratory shall not submit reports containing personal information to the local Health O cer
or his or her designee by electronic facsimile transmission or by electronic mail or by non-traceable
mail.
(c)A laboratory that receives incomplete patient data from a health care provider for a biological specimen
with a con rmed HIV test, shall contact the submitting health care provider to obtain the information
required pursuant to Section 2643.5(b)(1)-(5), prior to reporting the con rmed HIV test to the local
Health O cer.
(d)If a laboratory transfers a biological specimen to another laboratory for testing, the laboratory that
rst receives the biological specimen from the health care provider shall report con rmed HIV tests to
the local Health O cer.
(e)Laboratories shall not submit reports to the local health department for con rmed HIV tests for patients
of an Alternative Testing Site or other anonymous HIV testing program, a blood bank, a plasma center,
or for participants of a blinded and/or unlinked seroprevalence study.
(f)When a California laboratory receives a biological specimen for testing from an out-of-state laboratory
or health care provider, the California director of the laboratory shall ensure that a con rmed HIV
test is reported to the state health department in the state where the biological specimen originated.
(g)When a California laboratory receives a report from an out of state laboratory that indicates evidence
of a con rmed HIV test for a California patient, the California laboratory shall notify the local Health
O cer and health care provider in the same manner as if the ndings had been made by the California
laboratory.
(h)Information reported pursuant to this Article is acquired in con dence and shall not be disclosed by the
laboratory except as authorized by this Article, other state or federal law, or with the written consent
of the individual to whom the information pertains or the legal representative of the individual.
Note: Authority cited: Section 1224, Business and Professions Code; and Sections 120125, 120130, 120140,
121022, 131080 and 131200, Health and Safety Code. Reference: Sections 1206, 1206.5, 1209, 1220, 1241,
1265, 1281 and 1288, Business and Professions Code; and Sections 101150, 120175, 120775, 120885-120895,
120975, 120980, 121022, 121025, 121035, 131051, 131052, 131056 and 131080, Health and Safety Code.
HIV in Alameda County, 2014-2016 70
Appendix C: HIV Surveillance in Alameda County
California Code of Regulations (CCR) Title 17, Section 2643.5 requires all health care providers (HCP) to
report all cases of HIV disease they encounter in their clinical practice to the county/local health jurisdiction
in which the encounter occurs. Additionally, CCR Title 17, Section 2643.10 requires all commercial labo-
ratories to report all HIV-related laboratory tests they conduct to the local health jurisdiction of the HCP
who ordered the test, providing an additional means by which local health departments may learn of a case
of HIV disease.
In November 2015, California adopted the Electronic Laboratory Reporting (ELR) system for laboratories
performing HIV testing. HIV test results delivered through ELR meet the statutory and regulatory re-
porting requirements for HIV test results. HIV-related laboratory results are submitted to the California
Department of Public Health (CDPH) and routed to Alameda County for investigation. Establishment
of ELR resulted in major changes in the local processing and management of laboratory results for HIV
surveillance. Figure A.2 illustrates the steps involved in processing lab results, including ELR, for HIV
surveillance in Alameda County. As shown in the gure, reported labs are checked against a local database
to identify cases not previously reported. Potential new cases are investigated by trained eld sta, who
visit the o ce of the HCP that ordered the laboratory tests(s) or submitted the report and complete a stan-
dardized case report form (available at https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%
20Library/cdph8641a.pdf) using information abstracted from the patient's medical record and obtained
from the HCP. Forms are then transmitted to CDPH, which in turn routinely submits de-identi ed data to
CDC. When cases reported by dierent states appear to be the same person, CDC noti es the appropriate
states to contact each other directly and determine whether the cases are duplicates.
Security and Con dentiality of Data
In accordance with the county's data use and disclosure agreement with CDPH, all data collected in the
course of conducting HIV surveillance are used solely for public health purposes. Additionally, administrative,
technical, and physical safeguards are in place to ensure the security and con dentiality of these data.
All paper records are stored in locked le cabinets in an o ce with restricted access. Electronic data
transmissions are encrypted and occur over a secure le transfer network. All electronic data are stored in
a restricted access directory on a protected server.
71
Technical Notes
Limitations of Surveillance Data and of County Analysis
A major strength of HIV surveillance data is that it captures and re ects the entire population of HIV
diagnosed individuals. HIV surveillance data are not without their limitations however, which limit the
analyses that can be done. These limitations include, but are not limited to:
Data quality:Public health investigators extract required information from medical records for HIV
reporting. Some information, such as risk factors or identi cation as transgender may not have been
available in the medical record, elicited from the patient by the HCP, or adequately described.
Data quantity:In small subpopulations, the number of new diagnoses or PLHIV was not large
enough to allow certain analyses. Statistical analyses based on small numbers may result in unstable
estimates which can be misleading.
Timeliness of reporting:Surveillance data are the product of a long process triggered by a visit
to a HCP by an HIV-infected individual and culminating in the entry of case data into the statewide
HIV surveillance database at the California Department of Public Health. Intermediate steps include,
but are not limited to, laboratory testing, submission of case reports and lab results to the local
health department, and investigation of each report. Data preparation, analysis and interpretation
take additional time. For these reasons, there can be a 6-12 month delay in estimating numbers of
diagnoses or PLHIV and in estimating any measures dependent on laboratory test results.
History of reporting laws:The laws mandating the reporting of HIV-related laboratory test results
and of cases of HIV disease at its dierent stages have changed over time, and this impacts our ability
to characterize the epidemic at dierent points in the past. Although AIDS has been reportable since
1983, HIV disease at its earlier stages was not reportable until mid-2002 and even then only by a non-
name code. More reliable, name-based data on HIV non-AIDS cases became mandated in 2006, and
HIV-related labs became reportable in California in 2009. Consequently, most of analyses are limited
to 2006 and later, and analyses relying on laboratory reporting are limited to 2010 and later.
Figure A.1: Timeline of Mandated HIV Reporting in California
1983
2002
2006
2009HIV−related laboratory
results reportable
HIV non−AIDS reportable
by name
HIV non−AIDS reportable
by non−name code
Stage 3 HIV infection
(AIDS) reportable
1990 2000 2010
Year
HIV in Alameda County, 2014-2016 72
Technical Notes
Figure A.2: The HIV Surveillance System in Alameda County
HIV in Alameda County, 2014-2016 73
Technical Notes
HIV in Alameda County, 2014-2016 74
Bibliography
[1]Joinpoint regression program, version 4.3.1.0, April 2016. URL
https://surveillance.cancer.gov/joinpoint/.
[2]California hiv surveillance report 2015, October 2017. URL https://www.cdph.ca.gov/Programs/
CID/DOA/CDPH%20Document%20Library/California%20HIV%20Surveillance%20Report%20-%202015%
20(Final%20Version%20Submitted%20for%20Approval).pdf.
[3]Centers for Disease Control and Prevention. Revised surveillance case de nition for hiv infection
united states, 2014, April 2014. URL http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6303a1.htm.
[4]Centers for Disease Control and Prevention. Diagnoses of hiv infection in the united states and
dependent areas, 2016, November 2017. URL https://www.cdc.gov/hiv/pdf/library/reports/
surveillance/cdc-hiv-surveillance-report-2016-vol-28.pdf.
[5]Centers for Disease Control and Prevention. Monitoring selected national hiv prevention and care
objectives by using hiv surveillance dataunited states and 6 dependent areas2015, July 2017. URL
https://www.cdc.gov/hiv/pdf/library/reports/surveillance/
cdc-hiv-surveillance-supplemental-report-vol-22-2.pdf.
[6]Eve Mokoto, Lucia V. Torian, Monica Olkowski, James T. Murphy, Dena Bensen, Maree Kay Parisi,
and Jennifer Chase. Positions statements 2007: Heterosexual hiv transmission classi cation, 2007. URL
www.cste.org/resource/resmgr/PS/07-ID-09.pdf.
[7]Jennifer Parker. Draft suppression/presentation guidelines guidelines for proportions, January 2015.
URL https://www.cdc.gov/nchs/data/bsc/bscpres_parker_january2015.pdf.
HIV in Alameda County, 2014-2016 75
Alameda County
Public Health Department
1000 Broadway, Suite 310
Oakland, CA 94607