HomeMy WebLinkAbouthiv-report-2016-2018-archiveHIV Epidemiology
& Surveillance Unit
Alameda County
Public Health Department
HIV in Alameda County,
2016-2018
HIV in Alameda County, 2016-2018
December 2019
HIV Epidemiology and Surveillance Unit
HIV STD Section
Division of Communicable Disease Control and Prevention
Alameda County Public Health Department
HIV in Alameda County, 2016-2018 ii
Alameda County Public Health Department
Director Kimi Watkins-Tartt
Interim Health O cer Erica Pan, 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
William Luong, MPH
Melody Yu, MPH
Management Associate Nicholas Phelps
Public Health Investigators George Banks, MD
Oliver Heitkamp
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, 2016-2018 iii
Acknowledgements
This report was produced by the HIV Epidemiology and Surveillance Unit. Neena Murgai, PhD, MPH
provided overall guidance on analysis, content, and editorial review. Daniel Allgeier, MPH; led the data
analysis and writing. Melody Yu, MPH, and William Luong, MPH, assisted with analysis and contributed
to writing. Nicholas Moss, MD, MPH provided additional input for this report.
Cover Photo: By Thomas Hawk - Can't Get You O My Mind, CC BY-NC 2.0,
https://creativecommons.org/licenses/by-nc/2.0/https://flic.kr/p/2gSpGgN.
Back Cover Photo: By Thomas Hawk - New Day Rising, CC BY-NC 2.0,https://creativecommons.org/
licenses/by-nc/2.0/. File:https://flic.kr/p/LnQsQs.
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, 2016-2018.
http://www.acphd.org/data-reports/reports-by-topic/communicable-disease.aspx#HIV. Published Decem-
ber 2019. Accessed [date].
HIV in Alameda County, 2016-2018 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3 People Living with HIV 29
Characteristics of PLHIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Prevalence Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Deaths Among PLHIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Transgender PLHIV in Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
4 The Continuum of HIV Care 43
The Overall Continuum of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Linkage to Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Retention in Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Virologic Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Appendix A: Technical Notes 68
Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Statistical Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Data Suppression Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Death Ascertainment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Appendix B: Reporting Requirements 70
Health Care Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Appendix C: HIV Surveillance in Alameda County 73
Security and Con dentiality of Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Bibliography 77
HIV in Alameda County, 2016-2018 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, 2006-2018 . . . . . . . . . . . . . . . . . . . . . . . 6
2.2 New Diagnoses by Sex and Mode of Transmission, Alameda County, 2016-2018 . . . . . . . . 6
2.3 New Diagnoses by Race/Ethnicity, Alameda County, 2016-2018 . . . . . . . . . . . . . . . . . 7
2.4 Age of New Diagnoses, Alameda County, 2016-2018 . . . . . . . . . . . . . . . . . . . . . . . . 7
2.5 Region of Origin Among Foreign-Born Newly Diagnosed,
Alameda County, 2016-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.6 Geographic Distribution of New HIV Cases by Residence at HIV Diagnosis, Alameda County,
2016-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.7 Residence at HIV Diagnosis, Oakland and Surrounding Area, 2016-2018 . . . . . . . . . . . . 9
2.8 Rates of New Diagnoses by Sex, Alameda County, 2016-2018 . . . . . . . . . . . . . . . . . . 10
2.9 Trends in Rates of New Diagnoses by Sex, Alameda County, 2006-2018 . . . . . . . . . . . . . 10
2.10 Rates of New Diagnoses by Race/Ethnicity, Alameda County, 2016-2018 . . . . . . . . . . . . 10
2.11 Trends in Rates of New Diagnoses by Race/Ethnicity, Alameda County, 2006-2018 . . . . . . 11
2.12 Percent Change in 3-Year Average Annual Diagnosis Rate, Among Females, Alameda County,
2007-2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2.13 Percent Change in 3-Year Average Annual Diagnosis Rate, Among Males, Alameda County,
2007-2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.14 Rates of New Diagnoses by Age, Alameda County, 2016-2018 . . . . . . . . . . . . . . . . . . 13
2.15 Trends in Rates of New Diagnoses by Age, Alameda County, 2006-2018 . . . . . . . . . . . . 14
2.16 Late Diagnosis by Race/Ethnicity, Alameda County, 2015-2017 . . . . . . . . . . . . . . . . . 15
2.17 Late Diagnosis by Sex, Alameda County, 2015-2017 . . . . . . . . . . . . . . . . . . . . . . . . 15
2.18 Late Diagnosis by Age, Alameda County, 2015-2017 . . . . . . . . . . . . . . . . . . . . . . . 16
2.19 Late Diagnosis by Foreign-Born Status among Newly Diagnosed, Alameda County, 2015-2017 16
2.20 First CD4 Count at Diagnosis by Race/Ethnicity, Alameda County, 2015-2017 . . . . . . . . 17
2.21 First CD4 Count at Diagnosis by Sex,
Alameda County, 2015-2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.22 First CD4 Count at Diagnosis by Age,
Alameda County, 2015-2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.1 PLHIV by Sex, Alameda County, year-end 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . 30
vi
3.2 PLHIV by Race/Ethnicity,
Alameda County, year-end 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
3.3 Age of PLHIV, Alameda County, year-end 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.4 Prevalence of HIV by Sex,
Alameda County, year-end 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.5 Prevalence of HIV by Race/Ethnicity,
Alameda County, year-end 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.6 Prevalence of HIV by Age,
Alameda County, year-end 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.7 PLHIV by Foreign-Born Status and Race/Ethnicity, Alameda County, year-end 2018 . . . . . 33
3.8 Prevalence of HIV by Census Tract of Residence, Alameda County, year-end 2018 . . . . . . . 33
3.9 Prevalence of HIV by Census Tract of Residence, Oakland and Surrounding Area, year-end
2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.10 Death Rate among Alameda County Residents Ever Diagnosed with AIDS, 1985-2017 . . . . 35
4.1 The Continuum of HIV Care in Alameda County, 2015-2017 . . . . . . . . . . . . . . . . . . . 44
4.2 Days Between Diagnosis and First CD4 or Viral Load, Alameda County, 2015-2017 . . . . . . 45
4.3 Linkage to HIV Care within 90 Days of Diagnosis by Sex, Alameda County, 2015-2017 . . . . 45
4.4 Linkage to HIV Care within 90 Days of Diagnosis by Race/Ethnicity, Alameda County, 2015-
2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
4.5 Linkage to HIV Care within 90 Days of Diagnosis by Age, Alameda County, 2015-2017 . . . . 46
4.6 Number of HIV Care Visits per PLHIV in 2017, Alameda County . . . . . . . . . . . . . . . . 47
4.7 Retention in HIV Care by Sex, Alameda County, 2017 . . . . . . . . . . . . . . . . . . . . . . 47
4.8 Retention in HIV Care by Race/Ethnicity,
Alameda County, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
4.9 Retention in HIV Care by Age, Alameda County, 2017 . . . . . . . . . . . . . . . . . . . . . . 48
4.10 Virologic Status by Sex, Alameda County, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.11 Virologic Status by Race/Ethnicity,
Alameda County, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.12 Virologic Status by Age, Alameda County, 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . 50
A.1 Timeline of Mandated HIV Reporting in California . . . . . . . . . . . . . . . . . . . . . . . . 75
A.2 The HIV Surveillance System in Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . 76
HIV in Alameda County, 2016-2018 vii
List of Tables
2.1 New HIV Diagnoses, Alameda County, 2016-2018 . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.3 HIV Diagnosis Rates by Sex and Age, Alameda County, 2016-2018 . . . . . . . . . . . . . . . 21
2.4 HIV Diagnosis Rates by Sex and Race/Ethnicity, Alameda County, 2016-2018 . . . . . . . . . 22
2.5 HIV Diagnosis Rates by Race/Ethnicity and Age, Alameda County, 2016-2018 . . . . . . . . 23
2.6 Foreign-Born Newly Diagnosed by Country of Origin, Alameda County, 2015-2017 . . . . . . 24
2.7 Late Diagnosis by Sex and Age, Alameda County, 2015-2017 . . . . . . . . . . . . . . . . . . 25
2.8 Late Diagnosis by Sex and Race/Ethnicity, Alameda County, 2015-2017 . . . . . . . . . . . . 26
2.9 Late Diagnosis by Race/Ethnicity and Age, Alameda County, 2015-2017 . . . . . . . . . . . . 27
2.10 Late Diagnosis by Foreign-Born Status, Alameda County, 2015-2017 . . . . . . . . . . . . . . 28
3.1 People Living with HIV Disease and Prevalence Rates, Alameda County, Year-End 2018 . . . 36
3.2 HIV Prevalence by Sex and Age, Alameda County, Year-End 2018 . . . . . . . . . . . . . . . 38
3.3 HIV Prevalence by Sex and Race/Ethnicity, Alameda County, Year-End 2018 . . . . . . . . . 39
3.4 HIV Prevalence by Race/Ethnicity and Age, Alameda County, Year-End 2018 . . . . . . . . . 40
3.5 Foreign-Born Status by Race/Ethnicity, Alameda County, Year-End 2018 . . . . . . . . . . . 42
4.1 Timely Linkage to HIV Care Among New Diagnoses by Sex and Age, Alameda County, 2015-
2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
4.2 Timely Linkage to HIV Care Among New Diagnoses by Sex and Race/Ethnicity, Alameda
County, 2015-2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
4.3 Timely Linkage to HIV Care Among New Diagnoses by Race/Ethnicity and Age, Alameda
County, 2015-2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
4.4 Engagement in HIV Care in 2017 Among PLHIV at Year-End 2016 by Sex and Age, Alameda
County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
4.5 Engagement in HIV Care in 2017 Among PLHIV at Year-End 2016 by Sex and Race/Ethnicity,
Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
4.6 Engagement in HIV Care in 2017 Among PLHIV at Year-End 2016 by Race/Ethnicity and
Age, Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
4.10 Viral Suppression in 2017 Among PLHIV at Year-End 2016 by Sex and Age, Alameda County 63
4.11 Viral Suppression in 2017 Among PLHIV at Year-End 2016 by Sex and Race/Ethnicity,
Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
4.12 Viral Suppression in 2017 Among PLHIV at Year-End 2016 by Race/Ethnicity and Age,
Alameda County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
HIV in Alameda County, 2016-2018 viii
.
HIV in Alameda County, 2016-2018 ix
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 four 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: This chapter 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: This chapter 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
1
Background
3/AIDS) 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 [5]. 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[8].
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 consistently or 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.
In the text regarding foreign-born persons the category labelled African American represents Blacks for
the US-born and persons from Africa for the foreign-born. In addition, the terms foreign-born and
immigrant are used interchangeably.
Geographic Area
Residential addresses are geocoded to census tract and city/census-designated place. Region and
neighborhood 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, 2016-2018 2
Background
Figure 1.1: Regions of Alameda County
Figure 1.2: Neighborhoods in the City of Oakland
HIV in Alameda County, 2016-2018 3
Background
Other Conventions Used
Analyses 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, in most cases they are 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 also 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 68).
Tables showing detailed 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 conventions used in this report can be found
in the technical notes (see Data Suppression Rules on page 69).
Lastly, in order to protect privacy, case counts less than ve are not presented in this report.
HIV in Alameda County, 2016-2018 4
New Diagnoses
2
New Diagnoses
The Alameda County Public Health Department monitors the HIV epidemic through mandated reports of
new diagnoses and laboratory results. Estimating the true incidence rate 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, surveillance data reliably describe all new HIV diagnoses and diagnosis rates. In
2018, there were an estimated 37,377 new diagnoses of HIV infection in the US for an overall diagnosis rate
of 11.4 per 100,000 persons. Nationally, rates were highest among males as compared to females (22.5 vs.
5.1 diagnoses per 100,000, respectively), those aged 20-24 or 25-29 (27.6 and 32.5 per 100,000, respectively),
African Americans and Latinos (39.9 and 16.2 per 100,000), and in the South and Northeast (15.7 and 10.0
per 100,000). Men who have sex with men (MSM), including those that inject drugs, accounted for 69.4%
of all infections, heterosexual contact accounted for 23.5%, and other modes of transmission accounted for
the remaining 7.1% [6]. In California, there were an estimated 4,791 new diagnoses for an overall statewide
rate of 12.1 diagnoses per 100,000 in 2017. 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 14.2% of
all new diagnoses among Alameda County residents [1]. In Alameda County the average annual diagnosis
rate calculated over the 3-year period of 2016-2018 was 13.5 diagnoses per 100,000.
This chapter describes 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 from 2016 to
2018 by sex, age and race/ethnicity are provided in Tables 2.1 - 2.5 at the end of this chapter.
HIV in Alameda County, 2016-2018 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 2018, there were 199 new diagnoses of
HIV in the county.
In Alameda County, those
newly diagnosed with HIV
disease were overwhelmingly
male. The proportion of new
diagnoses that were among
males increased from 76.2% in
2006 to 86.4% in 2018.
Figure 2.1: New Diagnoses by Sex, Alameda County, 2006-2018
0
50
100
150
200
250
300
350
20
0
6
20
0
7
20
0
8
20
0
9
20
1
0
20
1
1
20
1
2
20
1
3
20
1
4
20
1
5
20
1
6
20
1
7
20
1
8
Nu
m
b
e
r
o
f
n
e
w
c
a
s
e
s
Male Female All
NOTE: Sex here refers to sex assigned at birth.
Among the 575 men diagnosed with HIV from 2016 to 2018, the overwhelming majority (76%) were MSM.
Nearly eight in ten (78%) newly diagnosed women were reported to or presumed to have acquired HIV by
heterosexual contact with a partner with known or unknown HIV status; most of the remaining women
with a known transmission category were infected through injection drug use (IDU).
Figure 2.2: New Diagnoses by Sex and Mode of Transmission, Alameda County, 2016-2018
Males (n=575)Females (n=100)
NOTE: Sex here refers to sex assigned at birth.
HIV in Alameda County, 2016-2018 6
New Diagnoses
From 2016 to 2018, African
Americans comprised the
largest proportion (36.4%) of all
new HIV diagnoses among all
racial/ethnic groups. Latinos
had the next largest proportion
(32.2%) of new HIV diagnoses,
followed by whites (19.0%), and
API (9.8%).
Figure 2.3: New Diagnoses by Race/Ethnicity, Alameda County,
2016-2018
2.7%
9.8%
32.2%
19.0%
36.4%
0%5%10%15%20%25%30%35%40%
Other/Unk
API
Latino
White
AfrAmer
Percent of Newly Diagnosed 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 2016 to 2018 was 34 years
and the mean age was 37 years.
Most diagnoses were among
those in their twenties to forties.
Figure 2.4: Age of New Diagnoses, Alameda County, 2016-2018
0
2
4
6
8
10
12
14
12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72 75
Nu
m
b
e
r
o
f
C
a
s
e
s
Age in years at first HIV diagnosis
27 34 46
NOTE: The dashed lines indicate the 25th, 50th, and 75th percentile
values for age among the new diagnoses.
HIV in Alameda County, 2016-2018 7
New Diagnoses
Cases among the foreign-born
accounted for 29.8% of all new
diagnoses from 2016-2018. Of
these cases, more than half
(57.9%) came from Central or
South America. The next
largest proportion came from
Asia (21.6%), followed by Africa
(18.7%) (Table 2.6 on page 24).
Foreign-born cases were
overwhelmingly male (82.5%),
and 77.4% of foreign-born males
identi ed as MSM.
Figure 2.5: Region of Origin Among Foreign-Born Newly Diagnosed,
Alameda County, 2016-2018
18.7%
21.6%57.9%
1.2%0.6%
Africa Asia Central or South America Europe Oceana
New diagnoses of HIV were
most concentrated in the
Oakland area and central
county regions (as de ned in
Figure 1.1 on page 3).
Figure 2.6: Geographic Distribution of New HIV Cases by Residence
at HIV Diagnosis, Alameda County, 2016-2018
NOTE: N=591; an additional 84 diagnoses (12.4% of all) are not
represented due to incomplete street address.
HIV in Alameda County, 2016-2018 8
New Diagnoses
Within the Oakland area, new
diagnoses were less concentrated
in the Oakland hills (Northwest
Hills, Southeast Hills, and
Lower Hills neighborhoods)
than in the rest of the region.
Figure 2.7: Residence at HIV Diagnosis, Oakland and Surrounding
Area, 2016-2018
Diagnosis Rates
This section examines trends in HIV diagnosis rates. Diagnosis rates are not equivalent to true HIV
incidence rates. Trends in diagnosis rates may re ect changes in HIV incidence over time, 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 the relatively small numbers of diagnoses occurring in Alameda County in any given year, annual
diagnosis rates are statistically unstable. We performed statistical analyses to identify trends that are least
likely to re ect random year-to-year variability. Apparent trends do not indicate statistical signi cance
unless speci ed in the caption.
From 2016 to 2018, there were 675 new HIV diagnoses in Alameda County for an average annual rate of
13.5 per 100,000 residents.
HIV in Alameda County, 2016-2018 9
New Diagnoses
New diagnosis rates were six
times as high among males as
among females between 2016
and 2018.
Figure 2.8: Rates of New Diagnoses by Sex, Alameda County,
2016-2018
3.9
23.5
13.5
0 5 10 15 20 25 30
Female (N=100)
Male (N=575)
All (N=675)
Annual Diagnosis Rate per 100,000
NOTE: Sex here refers to sex assigned at birth.
HIV diagnosis rates declined
steadily and signi cantly
between 2006 and 2018,
decreasing by an average of
3.0% annually overall and 2.2%
annually among males. In
contrast, the same period, rates
among females dropped
signi cantly by 7.3% annually.
Rates were consistently higher
in men between 2006 and 2018.
Figure 2.9: Trends in Rates of New Diagnoses by Sex, Alameda
County, 2006-2018
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
An
n
u
a
l
D
i
a
g
n
o
s
i
s
R
a
t
e
p
e
r
1
0
0
,
0
0
0
All Male Female
NOTE: Sex here refers to sex assigned at birth.
From 2016 to 2018, the highest
diagnosis rate was among
African Americans, which was
more than twice as high as the
second most impacted
group Latinos. The lowest
diagnosis rate was seen among
API.
Figure 2.10: Rates of New Diagnoses by Race/Ethnicity, Alameda
County, 2016-2018
4.4
19.2
8.0
47.4
13.5
0 10 20 30 40 50 60 70
API (N=66)
Latino (N=217)
White (N=128)
AfrAmer (N=246)
All races (N=675)
Annual Diagnosis Rate per 100,000
HIV in Alameda County, 2016-2018 10
New Diagnoses
Diagnosis rates were relatively
constant since 2006 in most
racial/ethnic groups. However,
the average annual decline in
diagnosis rate was statistically
signi cant among African
Americans (3.7%) and whites
(4.0%).
Figure 2.11: Trends in Rates of New Diagnoses by Race/Ethnicity,
Alameda County, 2006-2018
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
An
n
u
a
l
D
i
a
g
n
o
s
i
s
R
a
t
e
p
e
r
1
0
0
,
0
0
0
All races AfrAmer White Latino API
The overall decline in the diagnosis rate in the county overall since 2006 was driven largely by decreases in
diagnoses among African Americans, and in particular, African American women, amongst whom rates
decreased by 6.9% per year on average. Whereas there were 42.8 new diagnoses per 100,000 African
American women in 2006-2008, that rate was 22.8 new diagnoses per 100,000 from 2016 to 2018. Rates also
declined among Latino women, by an average of 5.5% per year. Figure 2.12 shows the change in 3-year
average diagnosis rate from the previous year among females. The years indicated along the X-axis
represent the middle years of the 3-year periods for which diagnosis rate was calculated. For example, the
average annual diagnosis rate among African American women between 2008 and 2010 (as indicated by the
middle year 2009 on the X-axis) was 38% lower than the average annual diagnosis rate between 2007 and
2009. The 3-year periods centered on 2014 and 2015 show large increases in diagnosis rates for all females
regardless of race/ethnicity, but the average annual rates centered on 2016 show decreases for most
racial/ethnic groups. The rate of new diagnoses among all racial/ethnic groups declined in 2017.
HIV in Alameda County, 2016-2018 11
New Diagnoses
Figure 2.12: Percent Change in 3-Year Average Annual Diagnosis Rate, Among Females, Alameda
County, 2007-2017
-50%
-40%
-30%
-20%
-10%
0%
10%
20%
30%
40%
50%
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
%
C
h
a
n
g
e
i
n
R
a
t
e
p
e
r
1
0
0
,
0
0
0
African American White Latino API
HIV in Alameda County, 2016-2018 12
New Diagnoses
Figure 2.13: Percent Change in 3-Year Average Annual Diagnosis Rate, Among Males, Alameda County,
2007-2017
-30%
-20%
-10%
0%
10%
20%
30%
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
%
C
h
a
n
g
e
i
n
R
a
t
e
p
e
r
1
0
0
,
0
0
0
African American White Latino API
Among all males, the only signi cant trends were declines in diagnosis rates among African Americans and
whites 2.5% and 4.4% respectively per year on average. Of interest is the relative decline in diagnosis
rates among male API from 2014 to 2016, a time period coinciding with large increases in diagnosis rates
among female API; in 2017, female API showed a relatively large decrease in diagnosis rate (42.9%). The
3-year period centered on 2017 showed decreased diagnosis rates among all male racial/ethnic groups with
the exception of Latino males, which increased (Figure 2.13).
From 2016 to 2018, new HIV
diagnoses were most common
among those in their twenties,
thirties, and forties, with 31.3,
25.5, and 19.4 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 2.14: Rates of New Diagnoses by Age, Alameda County,
2016-2018
3.6
12.2
19.4
25.5
31.3
3.2
13.5
0 10 20 30 40 50
60 & over (N=35)
50-59 (N=82)
40-49 (N=131)
30-39 (N=187)
20-29 (N=225)
13-19 (N=14)
All ages (N=675)
Annual Diagnosis Rate per 100,000
HIV in Alameda County, 2016-2018 13
New Diagnoses
Figure 2.15: Trends in Rates of New Diagnoses by Age, Alameda County, 2006-2018
0
5
10
15
20
25
30
35
40
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 signi cantly from 2006 to 2018 at an average rate of 3.0% per year
among those 30-39, 5.4% per year among those 40-49 and 4.5% per year among those 50 and older. While
the rate among those 20-29 has increased since 2006, this was not a statistically signi cant trend.
Among African Americans, there were signi cant declines in diagnosis rates between 2006 and 2018 in
several age groups. There was an average annual decline of 5.2% among those aged 30-39 years, and 7.4%
among those 40-49 years. Whites 40-49 years old saw an average annual decline of 6.9% while those 60 and
older saw a decline of 6.7%. Among Latinos, there was a 7.8% decline among those 13-19 years; in contrast
there was a 3.8% increase among those age 20-29 years. There were no statistically signi cant trends
among API by age.
Strati ed diagnosis rates by sex, age and race/ethnicity are provided in tables at the end of this chapter
(Table 2.1 on page 18). The disparity in diagnosis rates between African Americans and whites was more
pronounced among females than males. African American males had 5.2 times the diagnosis rates
compared to white males diagnosed from 2016 to 2018; African American females had 13.4 times the
diagnosis rates of white females (Table 2.4 on page 22).
HIV in Alameda County, 2016-2018 14
New Diagnoses
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.
Late Diagnosis
A key indicator of late HIV diagnosis is the time to progression to AIDS (stage 3 infection). A diagnosis is
deemed 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 the years 2015 to 2017 to allow a full year of follow-up from initial HIV diagnosis. Strati ed analyses of
late diagnosis by sex, age, and race/ethnicity are 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, 21.4% of
new diagnoses between 2015
and 2017 were late. Whites and
African Americans had the
lowest rate and Latinos and
API the highest; however,
dierences by race/ethnicity
were not statistically signi cant.
Figure 2.16: Late Diagnosis by Race/Ethnicity, Alameda County,
2015-2017
29.2%
22.7%
19.7%
20.9%
21.4%
0%5%10%15%20%25%30%35%
API (N=72)
Latino (N=203)
White (N=157)
AfrAmer (N=278)
All races (N=737)
Percent with a late diagnosis
There was no dierence in late
diagnosis by sex.
Figure 2.17: Late Diagnosis by Sex, Alameda County, 2015-2017
21.8%
21.4%
21.4%
0%5%10%15%20%25%
Female (N=119)
Male (N=618)
All (N=737)
Percent with a late diagnosis
NOTE: Sex refers to sex assigned at birth.
HIV in Alameda County, 2016-2018 15
New Diagnoses
The proportion of late
diagnoses generally increased
with age: over a third of HIV
diagnoses among those aged 60
and over were late. Late
diagnosis was less common
among those aged 20 to 29 1 in
8 were diagnosed late in this
age group. The increase in rate
of late diagnosis with increasing
age was statistically signi cant.
Figure 2.18: Late Diagnosis by Age, Alameda County, 2015-2017
38.1%
31.2%
25.5%
23.6%
12.5%
5.6%
21.4%
0%10%20%30%40%50%
60 & over (N=42)
50-59 (N=93)
40-49 (N=145)
30-39 (N=182)
20-29 (N=255)
13-19 (N=18)
All ages (N=737)
Percent with a late diagnosis
Late diagnoses were more
common among foreign-born
cases (28.0%) compared to
U.S.-born cases (18.4%),
however, this may be
exaggerated. A small number of
foreign-born PLHIV may have
been initially diagnosed with
HIV in another country before
arriving in the US, but due to
the absence of date of initial
diagnosis, their diagnosis date
in surveillance data re ects the
earliest date of HIV diagnosis in
the US. As a consequence, late
diagnoses maybe overestimated
among the foreign-born in our
data.
Figure 2.19: Late Diagnosis by Foreign-Born Status among Newly
Diagnosed, Alameda County, 2015-2017
28.0%
18.4%
0%5%10%15%20%25%30%
Foreign Born
US born
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 preserve or increase the CD4 count. However, the longer
a person goes without taking ART, which controls the level of HIV in their body, the lower their CD4
count will drop and the more susceptible the person will be to opportunistic infections and other health
problems. Once a person's CD4 count falls below 200 cells/mm3, the person is considered to have AIDS.1.
1These analyses exclude 131 cases (17.8% of all diagnoses) with a rst CD4 count more than 90 days after diagnosis.
HIV in Alameda County, 2016-2018 16
New Diagnoses
Among those diagnosed with
HIV disease between 2015 and
2017 and for whom a CD4
count was conducted within 90
days, the median CD4 count at
the time of diagnosis was 430
cells/mm3. Whites had the
highest median CD4 count at
diagnosis among all
racial/ethnic groups and API
had the lowest, though the
dierences were not signi cant.
Figure 2.20: First CD4 Count at Diagnosis by Race/Ethnicity,
Alameda County, 2015-2017
291
391
508
430.5
430
0 100 200 300 400 500 600
API (N=61)
Latino (N=171)
White (N=137)
AfrAmer (N=212)
All races (N=604)
Median CD4
Median CD4 within 90 days of
diagnosis was slightly higher
among males than females.
Figure 2.21: First CD4 Count at Diagnosis by Sex,
Alameda County, 2015-2017
427.5
430
430
0 100 200 300 400 500
Female (N=90)
Male (N=514)
All (N=604)
Median CD4
NOTE: Sex refers to sex assigned at birth.
Those aged 20-29 had a 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 2.22: First CD4 Count at Diagnosis by Age,
Alameda County, 2015-2017
287
320
412.5
435
456.5
447
430
0 100 200 300 400 500
60 & over (N=36)
50-59 (N=73)
40-49 (N=116)
30-39 (N=155)
20-29 (N=208)
13-19 (N=15)
All ages (N=604)
Median CD4
HIV in Alameda County, 2016-2018 17
New Diagnoses
Tab
l
e
2
.
1
:
N
e
w
H
I
V
D
i
a
g
n
o
s
e
s
,
A
l
a
m
e
d
a
C
o
u
n
t
y
,
2
0
1
6
-
2
0
1
8
Ch
a
r
a
c
t
e
r
i
s
t
i
c
Ca
t
e
g
o
r
y
Av
e
r
a
g
e
An
n
u
a
l
Co
u
n
t
Pe
r
c
e
n
t
Av
e
r
a
g
e
A
n
n
u
a
l
Di
a
g
n
o
s
i
s
R
a
t
e
p
e
r
10
0
,
0
0
0
95
%
Co
n
f
i
d
e
n
c
e
In
t
e
r
v
a
l
Al
l
D
i
a
g
n
o
s
i
s
--
22
5
.
0
10
0
.
0
%
13
.
5
11
.
8
-
1
5
.
3
Se
x
a
Ma
l
e
19
1
.
7
85
.
2
%
23
.
5
20
.
2
-
2
6
.
8
Fe
m
a
l
e
33
.
3
14
.
8
%
3.
9
2.
3
-
5
.
3
Ra
c
e
/
E
t
h
n
i
c
i
t
y
b
Af
r
A
m
e
r
82
.
0
36
.
4
%
47
.
4
37
.
1
-
5
7
.
6
Wh
i
t
e
42
.
7
19
.
0
%
8.
0
5.
6
-
1
0
.
4
La
t
i
n
o
72
.
3
32
.
1
%
19
.
2
14
.
8
-
2
3
.
6
AP
I
22
.
0
9.
8
%
4.
4
3.
4
-
5
.
6
Ot
h
e
r
/
U
n
k
6.
0
2.
7
%
--
--
Ag
e
(
y
e
a
r
s
)
c
0-
1
2
*
*
*
*
13
-
1
9
*
*
*
*
20
-
2
9
75
.
0
33
.
3
%
31
.
3
24
.
2
-
3
8
.
4
30
-
3
9
62
.
3
27
.
7
%
25
.
5
19
.
2
-
3
1
.
9
40
-
4
9
43
.
7
19
.
4
%
19
.
4
13
.
6
-
2
5
.
1
50
-
5
9
27
.
3
12
.
1
%
12
.
2
9.
7
-
1
5
.
2
60
&
o
v
e
r
11
.
7
5.
2
%
3.
6
2.
5
-
5
.
0
NO
T
E
:
T
h
i
s
t
a
b
l
e
s
p
a
n
s
m
u
l
t
i
p
l
e
p
a
g
e
s
HIV in Alameda County, 2016-2018 18
New Diagnoses
Tab
l
e
2
.
1
:
N
e
w
H
I
V
D
i
a
g
n
o
s
e
s
,
A
l
a
m
e
d
a
C
o
u
n
t
y
,
2
0
1
6
-
2
0
1
8
(
c
o
n
t
i
n
u
e
d
)
Ch
a
r
a
c
t
e
r
i
s
t
i
c
Ca
t
e
g
o
r
y
Av
e
r
a
g
e
An
n
u
a
l
Co
u
n
t
Pe
r
c
e
n
t
Av
e
r
a
g
e
A
n
n
u
a
l
Di
a
g
n
o
s
i
s
R
a
t
e
pe
r
1
0
0
,
0
0
0
95
%
Co
n
f
i
d
e
n
c
e
In
t
e
r
v
a
l
Re
s
i
d
e
n
c
e
No
r
t
h
C
o
u
n
t
y
16
.
0
7.
1
%
11
.
4
8.
4
-
1
5
.
1
Oa
k
l
a
n
d
A
r
e
a
12
3
.
7
55
.
0
%
23
.
3
19
.
2
-
2
7
.
4
Ce
n
t
r
a
l
C
o
u
n
t
y
51
.
7
23
.
0
%
13
.
1
9.
5
-
1
6
.
6
So
u
t
h
C
o
u
n
t
y
22
.
7
10
.
1
%
6.
4
5.
0
-
8
.
1
Tr
i
-
V
a
l
l
e
y
10
.
0
4.
4
%
4.
4
3.
0
-
6
.
2
Re
m
a
i
n
d
e
r
o
f
c
o
u
n
t
y
*
*
*
*
Un
k
n
o
w
n
*
*
--
--
So
u
r
c
e
:
A
l
a
m
e
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e
H
A
R
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,
2
0
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HIV in Alameda County, 2016-2018 19
New Diagnoses
Table 2.2: New HIV Diagnosis Rates Among Foreign-Born Persons by Selected Characteristics, Alameda
County, 2016-2018
Characteristic Category Count Column Percent
Newly Diagnosed 2016‐2018 172 100.0%
AfrAmer 33 19.2%
White **
Latino 101 58.7%
API 34 19.8%
Other/Unk **
Male 142 82.6%
Female 30 17.4%
0‐12 **
13‐19 **
20‐29 33 19.2%
30‐39 60 34.9%
40‐49 48 27.9%
50‐59 21 12.2%
60 & over 7 4.1%
MSM 108 62.8%
IDU * *
MSM & IDU * *
Heterosexual Contact 9 5.2%
Perinatal * *
Presumed Heterosexual 18 10.5%
Unknown 33 19.2%
Source: Alameda County eHARS, 2019 Q2
Note: Excludes 115 newly diagnosed with unknown foreign‐born status
[a] 'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[b] Refers to sex assigned at birth
[*] Some cells suppressed to protect confidentiality
Foreign‐Born Newly Diagnosed 2016‐2018
Race/Ethnicitya
Sexb
Age
Mode of Transmission
HIV in Alameda County, 2016-2018 20
New Diagnoses
Table 2.3: HIV Diagnosis Rates by Sex and Age, Alameda County, 2016-2018
Sexa Age Average
Annual
Count
Percent Average Annual
Diagnosis Rate per
100,000
95%
Confidence
Interval
All All ages 225.0 100.0%13.5 11.8 - 15.3
0-4 ****
5-12 ****
13-19 4.7 2.1%3.2 1.8 - 5.4
20-24 29.0 12.9%24.8 19.9 - 30.6
25-29 46.0 20.4%37.5 26.6 - 48.3
30-39 62.3 27.7%25.5 19.2 - 31.9
40-49 43.7 19.4%19.4 13.6 - 25.1
50 & over 39.0 17.3%7.2 4.9 - 9.4
Male All ages 191.7 85.2%23.5 20.2 - 26.8
0-4 0.0 0.0%****
5-12 0.0 0.0%****
13-19 4.0 1.8%5.4 2.8 - 9.5
20-24 24.7 11.0%41.5 32.6 - 52.1
25-29 41.3 18.4%66.9 46.5 - 87.3
30-39 56.0 24.9%46.2 34.1 - 58.3
40-49 34.7 15.4%31.2 20.8 - 41.6
50 & over 31.0 13.8%12.2 9.8 - 14.9
Female All ages 33.3 14.8%3.9 2.6 - 5.3
0-4 0.0 0.0%****
5-12 ****
13-19 ****
20-24 4.3 1.9%7.5 4.0 - 12.9
25-29 4.7 2.1%7.7 4.2 - 12.8
30-39 6.3 2.8%5.2 3.1 - 8.0
40-49 9.0 4.0%7.9 5.2 - 11.5
50 & over 8.0 3.6%2.8 1.8 - 4.1
Source: Alameda County eHARS, 2019 Q2
[a] Refers to sex assigned at birth
[*] Some cells suppressed to protect confidentiality
[**] Unstable estimates not shown
HIV in Alameda County, 2016-2018 21
New Diagnoses
Table 2.4: HIV Diagnosis Rates by Sex and Race/Ethnicity, Alameda County, 2016-2018
Sexa Race/Ethnicityb Average
Annual
Count
Percent Average Annual
Diagnosis Rate per
100,000
95%
Confidence
Interval
All All races 225.0 100.0%13.5 11.8 - 15.3
AfrAmer 82.0 36.4%47.4 37.1 - 57.6
White 42.7 19.0%8.0 5.6 - 10.4
Latino 72.3 32.1%19.2 14.8 - 23.6
API 22.0 9.8%4.4 3.4 - 5.6
Other/Unk 6.0 2.7%----
Male All races 191.7 85.2%23.5 20.2 - 26.8
AfrAmer 61.0 27.1%75.2 56.3 - 94.1
White 38.0 16.9%14.3 9.7 - 18.8
Latino 67.0 29.8%34.9 26.6 - 43.3
API 20.0 8.9%8.4 6.4 - 10.8
Other/Unk 5.7 2.5%----
Female All races 33.0 14.8%3.9 2.6 - 5.3
AfrAmer 21.0 9.3%22.8 17.5 - 29.2
White 4.7 2.1%1.7 0.9 - 2.9
Latino ****
API ****
Other/Unk **----
Source: Alameda County eHARS, 2019 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
[--] Rate not calculable for lack of a denominator
HIV in Alameda County, 2016-2018 22
New Diagnoses
Table 2.5: HIV Diagnosis Rates by Race/Ethnicity and Age, Alameda County, 2016-2018
Characteristic Category Average
Annual
Count
Percent Average Annual
Diagnosis Rate per
100,000
95%
Confidence
Interval
All races All ages 225.0 100.0%13.5 11.8 - 15.3
0-4 ****
5-12 ****
13-19 4.7 2.1%3.2 1.8 - 5.4
20-24 29.0 12.9%24.8 19.9 - 30.6
25-29 46.0 20.4%37.5 26.6 - 48.3
30-39 62.3 27.7%25.5 19.2 - 31.9
40-49 43.7 19.4%19.4 13.6 - 25.1
50 & over 39.0 17.3%7.2 4.9 - 9.4
AfrAmer All ages 82.0 36.4%47.4 37.1 - 57.6
0-4 ****
5-12 ****
13-19 2.7 1.2%****
20-24 13.0 5.8%111.5 79.3 - 152.4
25-29 15.3 6.8%135.7 99.4 - 181.1
30-39 17.7 7.9%78.0 58.4 - 102.0
40-49 13.7 6.1%56.6 40.6 - 76.8
50 & over 19.3 8.6%31.5 24.0 - 40.8
White All ages 42.7 19.0%8.0 5.6 - 10.4
0-4 ****
5-12 0.0 0.0%****
13-19 0.0 0.0%****
20-24 ****
25-29 7.3 3.3%21.4 13.4 - 32.4
30-39 14.7 6.5%22.3 16.2 - 29.9
40-49 8.7 3.9%11.6 7.6 - 17.0
50 & over 9.0 4.0%3.7 2.4 - 5.4
NOTE: This table spans multiple pages
HIV in Alameda County, 2016-2018 23
New Diagnoses
Table 2.5: HIV Diagnosis Rates by Race/Ethnicity and Age, Alameda County, 2016-2018 (continued)
Characteristic Category Average
Annual
Count
Percent Average Annual
Diagnosis Rate per
100,000
95%
Confidence
Interval
Latino All ages 72.3 32.1%19.2 14.8 - 23.6
0-4 ****
5-12 0.0 0.0%****
13-19 ****
20-24 9.3 4.1%28.6 19.0 - 41.4
25-29 17.3 7.7%49.5 36.9 - 64.9
30-39 22.7 10.1%34.7 27.0 - 44.0
40-49 16.0 7.1%34.3 25.3 - 45.5
50 & over 5.7 2.5%8.4 4.9 - 13.5
API All ages 22.0 9.8%4.4 3.4 - 5.6
0-4 0.0 0.0%****
5-12 0.0 0.0%****
13-19 ****
20-24 3.0 1.3%****
25-29 4.3 1.9%12.1 6.4 - 20.6
30-39 5.7 2.5%7.1 4.1 - 11.3
40-49 ****
50 & over ****
NOTE: This table spans multiple pages
Table 2.6: Foreign-Born Newly Diagnosed by Country of Origin, Alameda County, 2015-2017
Region of Origin 3-year
Count*
Percent of
Foreign Born
Africa 32 18.7%
Asia 192 21.6%
Central of South America 99 57.9%
Europe **
Oceana **
Source: Alameda County eHARS, 2019 Q2
[*] Exclude 115 newly diagnosed with unknown foreign-born status
HIV in Alameda County, 2016-2018 24
New Diagnoses
Table 2.7: Late Diagnosis by Sex and Age, Alameda County, 2015-2017
Sexa Age at Diagnosis Average Annual
Count
Column Percent Average Annual
Count
Row Percent
All All ages 245.7 100.0%52.7 21.4%
5-12 **0.0 *
13-19 **0.3 *
20-24 33.0 13.4%3.0 **
25-29 52.0 21.2%7.7 14.7%
30-39 60.7 24.7%14.3 23.6%
40-49 48.3 19.7%12.3 25.5%
50 & over 45.0 18.3%15.0 33.3%
Male All ages 206.0 83.9%44.0 21.4%
***0.0 *
***0.3 *
20-24 28.0 11.4%2.7 **
25-29 47.0 19.1%7.0 14.9%
30-39 52.3 21.3%11.7 22.3%
40-49 38.7 15.7%10.0 25.9%
50 & over 34.0 13.8%12.3 36.3%
Female All ages 39.7 16.1%8.7 21.8%
5-12 **0.0 *
13-19 **0.0 *
20-24 5.0 2.0%0.3 **
25-29 5.0 2.0%0.7 **
30-39 8.3 3.4%2.7 **
40-49 9.7 3.9%2.3 **
50 & over 11.0 4.5%2.7 **
Source: Alameda County eHARS, 2019 Q2
[a] Refers to sex assigned at birth
[*] Some cells suppressed to protect confidentiality
[**] Unstable estimates not shown
All Diagnoses Late Diagnoses
HIV in Alameda County, 2016-2018 25
New Diagnoses
Table 2.8: Late Diagnosis by Sex and Race/Ethnicity, Alameda County, 2015-2017
Sexa Race/Ethnicityb Average Annual
Count
Column Percent Average Annual
Count
Row Percent
All All races 245.7 100.0%52.7 21.4%
AfrAmer 92.7 37.7%19.3 20.9%
White 52.3 21.3%10.3 19.7%
Latino 67.7 27.5%15.3 22.7%
API 24.0 9.8%7.0 **
Other/Unk 9.0 3.7%0.7 **
Male All races 206.0 83.9%44.0 21.4%
AfrAmer 69.0 28.1%14.7 21.3%
White 46.3 18.9%9.0 19.4%
Latino 61.7 25.1%14.0 22.7%
API **5.7 *
Other/Unk **0.7 *
Female All races 39.7 16.1%8.7 21.8%
AfrAmer 23.7 9.6%4.7 19.7%
White 6.0 2.4%1.3 **
Latino 6.0 2.4%1.3 **
API **1.3 *
Other/Unk **0.0 *
Source: Alameda County eHARS, 2019 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
All Diagnoses Late Diagnoses
HIV in Alameda County, 2016-2018 26
New Diagnoses
Table 2.9: Late Diagnosis by Race/Ethnicity and Age, Alameda County, 2015-2017
Race/Ethnicitya Age at Diagnosis Average Annual
Count
Column Percent Average Annual
Count
Row Percent
All races All ages 245.7 100.0%52.7 21.4%
5-12 **0.0 *
13-19 **0.3 *
20-24 33.0 13.4%3.0 **
25-29 52.0 21.2%7.7 14.7%
30-39 60.7 24.7%14.3 23.6%
40-49 48.3 19.7%12.3 25.5%
50 & over 45.0 18.3%15.0 33.3%
AfrAmer All ages 92.7 37.7%19.3 20.9%
5-12 **0.0 *
13-19 **0.3 *
20-24 17.0 6.9%1.7 **
25-29 18.3 7.5%3.0 **
30-39 17.3 7.1%4.3 **
40-49 13.3 5.4%3.0 **
50 & over 22.3 9.1%7.0 **
White All ages 52.3 21.3%10.3 19.7%
5-12 0.0 0.0%0.0 **
13-19 0.0 0.0%0.0 **
20-24 4.3 1.8%0.0 0.0%
25-29 10.0 4.1%1.7 **
30-39 16.3 6.6%2.3 **
40-49 10.7 4.3%3.0 **
50 & over 11.0 4.5%3.3 **
All Diagnoses Late Diagnoses
NOTE: This table spans multiple pages
HIV in Alameda County, 2016-2018 27
New Diagnoses
Table 2.9: Late Diagnosis by Race/Ethnicity and Age, Alameda County, 2015-2017 (continued)
Race/Ethnicitya Age at Diagnosis Average Annual
Count
Column Percent Average Annual
Count
Row Percent
Latino All ages 67.7 27.5%15.3 22.7%
5-12 0.0 0.0%0.0 **
13-19 1.7 0.7%0.0 0.0%
20-24 8.0 3.3%1.0 **
25-29 16.7 6.8%1.7 **
30-39 18.3 7.5%4.3 **
40-49 16.7 6.8%5.3 **
50 & over 6.3 2.6%3.0 **
API All ages 24.0 9.8%7.0 **
5-12 0.0 0.0%0.0 **
13-19 **0.0 *
20-24 **0.3 *
25-29 4.0 1.6%1.3 **
30-39 7.0 2.8%3.3 **
40-49 5.3 2.2%0.3 **
50 & over **1.7 *
Other/Unk All ages 9.0 3.7%0.7 **
5-12 0.0 0.0%0.0 **
13-19 **0.0 *
20-24 **0.0 *
25-29 3.0 1.2%0.0 0.0%
30-39 1.7 0.7%0.0 0.0%
40-49 2.3 0.9%0.7 **
50 & over **0.0 *
Source: Alameda County eHARS, 2019 Q2
[a] 'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[*] Some cells suppressed to protect confidentiality
[**] Unstable estimates not shown
NOTE: This table spans multiple pages
All Diagnoses Late Diagnoses
Table 2.10: Late Diagnosis by Foreign-Born Status, Alameda County, 2015-2017
Foreign-Born Status 3-year
Count*
Row
Percent
3-year
Count*
Row
Percent
Foreign-Born 116 72.0%45 28.0%
US-Born 275 81.6%62 18.4%
Source: Alameda County eHARS, 2019 Q2
[*] Exclude 115 newly diagnosed with unknown foreign-born status
All Diagnoses Late Diagnoses
HIV in Alameda County, 2016-2018 28
People Living with HIV
3
People Living with HIV
In the United States, there were an estimated 1,003,782 PLHIV diagnosed at the end of 2017. Prevalence
was highest among men (574.4 men vs. 169.9 women per 100,000 population), those aged 50-54 and 55-59
(767.8 and 660.6 per 100,000 respectively), African Americans and Latinos (1,022 and 379.3 per 100,000
respectively), and in the Northeast and South (417.2 and 365.5 per 100,000 respectively) [6]. At year-end
2017, California had an estimated 135,082 PLHIV for a statewide prevalence of 340.3 per 100,000
population. HIV prevalence among women in California (79.3 per 100,000) was less than half that of women
nationally [1]. At year-end 2018 in Alameda County, the prevalence of HIV was 383.8 per 100,000 residents.
This chapter examines prevalence, or the proportion of people with HIV infection living in Alameda
County, 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 newly diagnosed), regardless of
the stage of HIV infection. 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 3.2-3.4 at the end of this
chapter.
HIV in Alameda County, 2016-2018 29
People Living with HIV
Characteristics of PLHIV
At the end of 2018, there were an estimated 6,352 PLHIV in Alameda County1.
Similar to the distribution by
sex among new diagnoses of
HIV, PLHIV in Alameda
County at year-end 2018 were
predominantly male (84.0%).
Figure 3.1: PLHIV by Sex, Alameda County, year-end 2018
16.0%
84.0%
0%10%20%30%40%50%60%70%80%90%
Female
Male
Percent of Cases
NOTE: Sex refers to sex assigned at birth.
Approximately 38.7% of PLHIV
in Alameda County were
African American and 30.3%
were white. Latinos and API
each comprised a smaller
proportion of PLHIV.
Figure 3.2: PLHIV by Race/Ethnicity,
Alameda County, year-end 2018
3.7%
7.0%
20.4%
30.3%
38.7%
0%5%10%15%20%25%30%35%40%45%
Other/Unk
API
Latino
White
AfrAmer
Percent of Cases
NOTE: Other/Unk includes American Indians, Alaskan Natives,
multiracial, and unknown categories.
Racial/ethnic disparities in numbers of PLHIV were more apparent among women compared to men.
While there were approximately equal cases of African Americans and whites among men, there were
nearly four times as many cases among African American women compared to white women (Table 3.3).
HIV in Alameda County, 2016-2018 30
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 2018.
Figure 3.3: Age of PLHIV, Alameda County, year-end 2018
0
100
200
300
400
500
600
700
800
6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72 75 78 81 84 87 90 93
Nu
m
b
e
r
o
f
C
a
s
e
s
Age at year-end 2017
40 51 59
NOTE: The dashed lines indicate the 25th, 50th, and 75th percentile
values for age among PLHIV.
Prevalence Rates
At the end of 2018 there were 6,352 people living with HIV in Alameda County for a prevalence rate of 383.8
per 100,000 or 0.4% of residents.
HIV prevalence was about ve
times higher among males than
females at year-end 2018.
Figure 3.4: Prevalence of HIV by Sex,
Alameda County, year-end 2018
120.9
656.0
383.8
0 100 200 300 400 500 600 700 800
Female (N=1,018)
Male (N=5,334)
All (N=6,352)
Rate per 100,000
NOTE: Sex refers to sex assigned at birth.
HIV in Alameda County, 2016-2018 31
People Living with HIV
African Americans had a four
times higher burden of HIV
prevalence compared to the
next most impacted racial
groupwhites. Prevalence was
lowest among API.
Figure 3.5: Prevalence of HIV by Race/Ethnicity,
Alameda County, year-end 2018
88.6
336.9
369.1
1,454.7
383.8
0 500 1,000 1,500 2,000
API (N=445)
Latino (N=1,294)
White (N=1,924)
AfrAmer (N=2,456)
All races (N=6,352)
Rate per 100,000
HIV prevalence was higher in
each successive age group,
ranging from 13.8 per 100,000
youth aged 13-19 to a high of
883 per 100,000 people aged
50-59 years. 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. Increasing prevalence
of HIV with age is consistent
with the greatly improved
survival of PLHIV in the ART
era.
Figure 3.6: Prevalence of HIV by Age,
Alameda County, year-end 2018
454.4
883.0
589.0
448.2
190.3
13.8
383.8
0 200 400 600 800 1,000
60 & over (N=1,477)
50-59 (N=2,014)
40-49 (N=1,323)
30-39 (N=1,062)
20-29 (N=450)
13-19 (N=20)
All ages (N=6,352)
Rate per 100,000
The disparity in prevalence rates by race diered among females and males. While prevalence was more
than three times higher among African American males compared to white males, it was 10 times higher
among African American females compared to white females (Table 3.3). Additionally, although HIV
prevalence was signi cantly higher among white males than Latino males, prevalence was lower among
white females than Latino females.
HIV in Alameda County, 2016-2018 32
People Living with HIV
Foreign-born persons are dispropor-
tionately aected by HIV [Prosser
2012, Kong 2014] and are a popu-
lation of interest in HIV prevention.
Twenty percent of PLHIV in Alameda
County are known to be foreign-born
and an additional 9% are of unknown
foreign-born status. Among foreign-
born PLHIV, most are Latino. Of
all racial/ethnic groups, API PLHIV
have the largest proportion of foreign-
born persons.
Figure 3.7: PLHIV by Foreign-Born Status and Race/Ethnicity,
Alameda County, year-end 2018
0%10%20%30%40%50%60%70%80%90%100%
Latino
Other/Unk
API
AfrAmer
White
Foreign born US born Unknown
The city of Emeryville had the
highest HIV prevalence within
Alameda County, followed by
Oakland, Ashland, and
Fairview.
Figure 3.8: Prevalence of HIV by Census Tract of Residence,
Alameda County, year-end 2018
NOTE: N=5,854; an additional 498 PLHIV (7.8% of all) are not
represented due to incomplete street address.
HIV in Alameda County, 2016-2018 33
People Living with HIV
Among the Oakland
neighborhoods, West Oakland,
Downtown, and Chinatown had
the highest HIV prevalence,
ranging between 1-2% of
residents.
Figure 3.9: Prevalence of HIV by Census Tract of Residence,
Oakland and Surrounding Area, year-end 2018
HIV in Alameda County, 2016-2018 34
People Living with HIV
Deaths Among Alameda County Residents Ever Diagnosed with
AIDS
Although HIV infection without AIDs has been reportable by name in California only 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 2018, there were
50 deaths among the 3,738 residents living with AIDs for a rate of 1.3 deaths per 100 residents living with
AIDS.
Figure 3.10: Death Rate among Alameda County Residents Ever
Diagnosed with AIDS, 1985-2017
0
10
20
30
40
50
60
70
1983 1986 1989 1992 1995 1998 2001 2004 2007 2010 2013 2016
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.
Transgender PLHIV in Alameda County
Epidemiological data shows that the transgender community carries a disproportionately higher HIV burden
compared to other groups [4] , however, attempts to characterize the speci cs of such burden is often hindered
by the lack of accurate transgender data in healthcare. Current systems for collecting and sharing health
records do not always include distinct elds to describe birth sex, current sex/gender, or transgender status.
In addition, risk of stigmatization, discrimination, social rejection, or exclusion may prevent transgender
people from seeking out healthcare or disclosing gender to providers [2]. For these reasons, transgender
persons are likely to be underestimated in routine surveillance data. At the end of 2018 there were 124
transgender PLHIV in Alameda County.
HIV in Alameda County, 2016-2018 35
People Living with HIV
Tab
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s
HIV in Alameda County, 2016-2018 36
People Living with HIV
Tab
l
e
3
.
1
:
P
e
o
p
l
e
L
i
v
i
n
g
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f
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v
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51
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1,
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31
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i
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15
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.
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.
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.
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m
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23
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4
%
25
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.
9
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.
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-
3
8
4
.
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k
n
o
w
n
8
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%
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So
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r
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e
:
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]
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]
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HIV in Alameda County, 2016-2018 37
People Living with HIV
Table 3.2: HIV Prevalence by Sex and Age, Alameda County, Year-End 2018
Sexa Age Count Percent Prevalence per
100,000
95% Confidence
Interval
All All ages 6352 100.0%383.8 374.4 - 393.2
0-12 6 0.1%****
13-19 20 0.3%13.8 8.4 - 21.4
20-29 450 7.1%190.3 172.8 - 207.9
30-39 1062 16.7%448.2 421.3 - 475.2
40-49 1323 20.8%589.0 557.2 - 620.7
50-59 2014 31.7%883.0 844.5 - 921.6
60 & over 1477 23.3%454.4 431.3 - 477.6
Male All ages 5334 84.0%656.0 638.4 - 673.6
0-12 6 0.1%****
13-19 10 0.2%****
20-29 399 6.3%334.2 301.4 - 367.0
30-39 932 14.7%796.3 745.1 - 847.4
40-49 1074 16.9%967.9 910.0 - 1025.8
50-59 1695 26.7%1517.0 1444.8 - 1589.2
60 & over 1218 19.2%827.2 780.7 - 873.6
Female All ages 1018 16.0%120.9 113.5 - 128.3
0-12 0 0.0%****
13-19 10 0.2%****
20-29 51 0.8%43.6 32.4 - 57.3
30-39 130 2.0%108.4 89.8 - 127.1
40-49 249 3.9%219.1 191.9 - 246.3
50-59 319 5.0%274.2 244.1 - 304.3
60 & over 259 4.1%145.7 128.0 - 163.4
Source: Alameda County eHARS, 2019 Q2
[a] Refers to sex assigned at birth
[**] Unstable estimates not shown
HIV in Alameda County, 2016-2018 38
People Living with HIV
Table 3.3: HIV Prevalence by Sex and Race/Ethnicity, Alameda County, Year-End 2018
Sexa Race/Ethnicityb Count Percent Prevalence per
100,000
95% Confidence
Interval
All All races 6352 100.0%383.8 374.4 - 393.2
AfrAmer 2456 38.7%1454.7 1397.2 - 1512.2
White 1924 30.3%369.1 352.6 - 385.6
Latino 1294 20.4%336.9 318.6 - 355.3
API 445 7.0%88.6 80.4 - 96.9
Other/Unk 233 3.7%----
Male All races 5334 84.0%656.0 638.4 - 673.6
AfrAmer 1848 29.1%2330.8 2224.5 - 2437.1
White 1758 27.7%676.7 645.0 - 708.3
Latino 1139 17.9%583.0 549.1 - 616.8
API 385 6.1%160.1 144.1 - 176.1
Other/Unk 204 3.2%----
Female All races 1018 16.0%120.9 113.5 - 128.3
AfrAmer 608 9.6%679.0 625.0 - 732.9
White 166 2.6%63.5 53.8 - 73.1
Latino 155 2.4%82.2 69.2 - 95.1
API 60 0.9%22.9 17.5 - 29.5
Other/Unk 29 0.5%----
Source: Alameda County eHARS, 2019 Q2
[a] Refers to sex assigned at birth
[b] 'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[**] Unstable estimates not shown
[--] Rate not calculable for lack of a denominator
HIV in Alameda County, 2016-2018 39
People Living with HIV
Table 3.4: HIV Prevalence by Race/Ethnicity and Age, Alameda County, Year-End 2018
Race/Ethnicitya Age Count Percent Prevalence per
100,000
95% Confidence
Interval
All races All ages 6352 100.0%383.8 374.4 - 393.2
0-12 6 0.1%****
13-19 20 0.3%13.8 8.4 - 21.4
20-29 450 7.1%190.3 172.8 - 207.9
30-39 1062 16.7%448.2 421.3 - 475.2
40-49 1323 20.8%589.0 557.2 - 620.7
50-59 2014 31.7%883.0 844.5 - 921.6
60 & over 1477 23.3%454.4 431.3 - 477.6
AfrAmer All ages 2456 38.7%1454.7 1397.2 - 1512.2
0-12 5 0.1%****
13-19 12 0.2%74.7 38.6 - 130.4
20-29 205 3.2%919.8 793.9 - 1045.7
30-39 412 6.5%1945.6 1757.7 - 2133.4
40-49 456 7.2%1940.4 1762.3 - 2118.5
50-59 768 12.1%2964.8 2755.1 - 3174.4
60 & over 598 9.4%1655.5 1522.8 - 1788.2
White All ages 1924 30.3%369.1 352.6 - 385.3
0-12 ****
13-19 ****
20-29 59 0.9%92.7 70.6 - 119.6
30-39 213 3.4%351.1 304.0 - 398.3
40-49 334 5.3%468.9 418.6 - 519.2
50-59 730 11.5%785.1 728.1 - 842.0
60 & over 586 9.2%390.2 358.6 - 421.8
NOTE: This table spans multiple pages
HIV in Alameda County, 2016-2018 40
People Living with HIV
Table 3.4: HIV Prevalence by Race/Ethnicity and Age, Alameda County, Year-End 2018 (continued)
Race/Ethnicitya Age Count Percent Prevalence per
100,000
95% Confidence
Interval
Latino All ages 1294 20.4%336.9 318.6 - 355.3
0-12 0 0.0%****
13-19 5 0.1%****
20-29 119 1.9%175.6 144.1 - 207.2
30-39 302 4.8%458.7 406.9 - 510.4
40-49 346 5.4%711.8 636.8 - 786.8
50-59 343 5.4%1026.8 918.1 - 1135.5
60 & over 179 2.8%493.1 420.9 - 565.4
API All ages 445 7.0%88.6 80.4 - 96.9
0-12 ****
13-19 ****
20-29 46 0.7%65.6 48.0 - 87.5
30-39 89 1.4%111.8 89.8 - 137.5
40-49 129 2.0%176.0 145.6 - 206.3
50-59 108 1.7%156.8 127.2 - 186.4
60 & over 71 1.1%74.9 58.5 - 94.5
Other/Unk All ages 233 3.7%----
0-12 0 0.0%----
13-19 0 0.0%----
20-29 21 0.3%----
30-39 46 0.7%----
40-49 58 0.9%----
50-59 65 1.0%----
60 & over 43 0.7%----
Source: Alameda County eHARS, 2019 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
NOTE: This table spans multiple pages
HIV in Alameda County, 2016-2018 41
People Living with HIV
Table 3.5: Foreign-Born Status by Race/Ethnicity, Alameda County, Year-End 2018
Race/Ethnicitya Count Row
Percent
Count Row
Percent
Count Row
Percent
All races 1289 20.3%4471 70.4%592 9.3%
AfrAmer 242 9.9%2036 82.9%178 7.2%
White 97 5.0%1629 84.7%198 10.3%
Latino 667 51.5%487 37.6%140 10.8%
API 264 59.3%122 27.4%59 13.3%
Other/Unk 19 8.2%197 84.5%17 7.3%
Source: Alameda County eHARS, 2019 Q2
Foreign-Born PLHIV US-Born PLHIV Unknown Status
PLHIV
HIV in Alameda County, 2016-2018 42
The Continuum of HIV Care
4
The Continuum of HIV Care
Anti-retroviral therapy (ART), when taken regularly, can suppress HIV, preventing disease progression as
well as preventing the transmission of HIV entirely. Thus, ART bene ts 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 is a framework for conceptualizing HIV care and prevention eorts.
In the United States, the CDC estimated that 86.8% of persons diagnosed in 2017 linked to care within 3
months1. Additionally, the CDC estimated that, at the end of 2016, 85.8% of all PLHIV had been
diagnosed and that, among those still alive and who had been diagnosed by the end of the previous year,
74.2% received any HIV care, 57.6% were retained in continuous care, and 61.5% were virally suppressed[7].
In California, 84% of those diagnosed in 2017 were estimated to have linked to care within 3 months. By
the end of 2017, among those living with diagnosed HIV in California, 74% were estimated to have received
any HIV care in 2017, 55% were estimated to have been retained in continuous care, and 63% were
estimated to have been virally suppressed at last test2 [3].
This chapter examines the continuum of HIV care in Alameda County and describes discrepancies in care
outcomes based on demographic dierences such as race/ethnicity, age, and sex at birth. The continuum
measures look at data one year earlier than what is available in the New Diagnoses and People Living with
HIV in order to allow for more laboratory records to be included in the analyses.
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
2016, alive at year-end 2017, and residing in the 37 jurisdictions with complete laboratory reporting. CD4 or viral load testsordered in 2017 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 2017 <200 copies/mL.
HIV in Alameda County, 2016-2018 43
The Continuum of HIV Care
The Overall Continuum of Care
In Alameda County, 79% of new diagnoses between 2015 and 2017 were linked to care within 3 months if
HIV-related labs ordered on the date of diagnosis were excluded; 88.4% were linked to care if labs done on
the date of diagnosis were included. Approximately 58.4% of PLHIV in Alameda County for the entirety of
2017 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 70.5% that same year.
Figure 4.1: The Continuum of HIV Care in Alameda County, 2015-2017
NOTE:1) Of 730 total diagnoses, 78 died within 90 days and were excluded from analysis. 2) Of 6,247
PLHIV at year-end 2016, 78 were known to have died and an additional 428 to have moved out of Alameda
County in 2017
This chapter presents data on select measures along the continuum of HIV care 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 a de nitive indicator of linkage to care. For example, a health care provider
may order these tests concurrently with a con rmatory HIV test or before a patient even knows the
diagnosis. 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 a range of what might be considered linked to care. Patients who
died within 90 days of diagnosis were not included (N=7).
HIV in Alameda County, 2016-2018 44
The Continuum of HIV Care
The median time from diagnosis
to rst CD4 or viral load among
Alameda County residents
diagnosed from 2015 to 2017
was four days. Excluding labs
ordered on the date of
diagnosis, the median time from
diagnosis was 12 days.
Figure 4.2: Days Between Diagnosis and First CD4 or Viral Load,
Alameda County, 2015-2017
4
12
39.9
65.5
0
10
20
30
40
50
60
70
Including dx date (days)Excluding dx date (days)
Da
y
s
t
o
l
i
n
k
a
g
e
t
o
c
a
r
e
median mean
Overall, 88.4% of those
diagnosed with HIV in Alameda
County from 2015 to 2017 were
linked to HIV care within 90
days of their diagnosis.
Excluding labs ordered on date
of diagnosis, 79% of newly
diagnosed cases were linked.
Dierences by sex were
statistically signi cant.
Figure 4.3: Linkage to HIV Care within 90 Days of Diagnosis by Sex,
Alameda County, 2015-2017
70.9%
80.6%
79.0%
0%10%20%30%40%50%60%70%80%90%100%
Female (N=117)
Male (N=613)
All (N=730)
Percent linked in 90 days or less
NOTE: Sex refers to sex assigned at birth.
Dierences in linkage to care 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, 2015-2017
79.2%
81.2%
80.4%
76.4%
79.0%
0%10%20%30%40%50%60%70%80%90%100%
API (N=72)
Latino (N=202)
White (N=153)
AfrAmer (N=276)
All races (N=730)
Percent linked in 90 days or less
HIV in Alameda County, 2016-2018 45
The Continuum of HIV Care
Linkage was generally higher at
the extremes of the age
spectrum and lower among
those in their forties. The trend
was not statistically signi cant;
however the dierence between
age groups was signi cant when
excluding labs done at date of
diagnosis.
Figure 4.5: Linkage to HIV Care within 90 Days of Diagnosis by Age,
Alameda County, 2015-2017
81.1%
70.2%
81.3%
81.4%
80.8%
88.9%
79.0%
0%10%20%30%40%50%60%70%80%90%100%
50 & over (N=132)
40-49 (N=141)
30-39 (N=182)
25-29 (N=156)
20-24 (N=99)
13-19 (N=18)
All ages (N=730)
Percent linked in 90 days or less
HIV in Alameda County, 2016-2018 46
The Continuum of HIV Care
Retention in Care
In 2017, 78.6% of PLHIV1 had one or more visits to an HIV care provider as indicated by a new lab.
About 15.9% of all PLHIV had only a single visit resulting in a lab. However, it is possible that some had
additional visits in which no lab tests were ordered.
Figure 4.6: Number of HIV Care Visits per PLHIV in 2017, Alameda County
21.4%
15.9%
27.0%
19.2%
10.2%
3.8%2.5%
0%
5%
10%
15%
20%
25%
30%
None 1 2 3 4 5 6+
Number of visits in 2017 among PLHIV
In 2017, 58.4% of PLHIV had
two or more visits 90 or more
days apart. Dierences by sex
were statistically signi cant.
Figure 4.7: Retention in HIV Care by Sex, Alameda County, 2017
55.5%
59.0%
58.4%
0%20%40%60%80%
Female (N=961)
Male (N=4,780)
All (N=5,741)
Percent with ≥2 visits ≥90 days apart in 2017
NOTE: Sex refers to sex assigned at birth.
1PLHIV that died or moved in 2017 were excluded from all analyses of retention in care.
HIV in Alameda County, 2016-2018 47
The Continuum of HIV Care
Rates of retention in HIV care
were highest among API
(62.0%) and white (59.3%)
PLHIV in 2017. Only 56.9% of
Latino PLHIV were retained in
care. Dierences by
race/ethnicity were not
statistically signi cant.
Figure 4.8: Retention in HIV Care by Race/Ethnicity,
Alameda County, 2017
62.0%
56.9%
59.3%
57.2%
58.4%
0%20%40%60%80%
API (N=387)
Latino (N=1,110)
White (N=1,838)
AfrAmer (N=2,203)
All races (N=5,741)
Percent with ≥2 visits ≥90 days apart in 2016
PLHIV aged 20-29 at the end of
2017 had the lowest rates of
retention in care; younger and
successively older age groups
had higher rates. Retention was
highest among those aged 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 statistically
signi cant.
Figure 4.9: Retention in HIV Care by Age, Alameda County, 2017
66.4%
59.5%
57.5%
50.8%
49.1%
65.0%
58.4%
0%20%40%60%80%
60 & over (N=1,158)
50-59 (N=1,925)
40-49 (N=1,320)
30-39 (N=878)
20-29 (N=432)
13-19 (N=20)
All ages (N=5,741)
Percent with ≥2 visits ≥90 days apart in 2017
HIV in Alameda County, 2016-2018 48
The Continuum of HIV Care
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 2017 were excluded. Disparities in virologic suppression among
PLHIV in care can suggest possible dierences in ART use or access to care.
Approximately 70.5% of PLHIV
were virally suppressed at their
most recent test in 2017, with
the majority being
undetectable. Virologic
suppression was not
signi cantly dierent between
male and female PLHIV.
Figure 4.10: Virologic Status by Sex, Alameda County, 2017
68.5%
70.9%
70.5%
0%10%20%30%40%50%60%70%80%
Female (N=961)
Male (N=4,780)
All (N=5,741)
NOTE: Sex refers to sex assigned at birth.
In 2017, 77.3% and 74.4% of
API and white PLHIV,
respectively, were virally
suppressed. Viral suppression
was about 4 to 10% lower in all
other racial/ethnic groups. The
dierences between
racial/ethnic groups were
signi cant. Similar disparities
were seen among those retained
in care (Table 4.14).
Figure 4.11: Virologic Status by Race/Ethnicity,
Alameda County, 2017
77.3%
67.0%
74.4%
67.7%
70.5%
0%10%20%30%40%50%60%70%80%
API (N=387)
Latino (N=1,110)
White (N=1,838)
AfrAmer (N=2,203)
All races (N=5,741)
HIV in Alameda County, 2016-2018 49
The Continuum of HIV Care
Viral suppression rates
generally increased as age
increased, ranging from 61.8%
among those ages 20-29 to
76.0% among those ages 60 and
over. A similar pattern was seen
among those in care (Table 4.9).
Figure 4.12: Virologic Status by Age, Alameda County, 2016
76.0%
72.7%
69.0%
64.7%
61.8%
85.0%
70.5%
0%20%40%60%80%
60 & over (N=1,158)
50-59 (N=1,925)
40-49 (N=1,320)
30-39 (N=878)
20-29 (N=432)
13-19 (N=20)
All ages (N=5,741)
HIV in Alameda County, 2016-2018 50
The Continuum of HIV Care
Table 4.1: Timely Linkage to HIV Care Among New Diagnoses by Sex and Age,
Alameda County, 2015-2017
Sexa Age at Diagnosis Average Annual
Count
Column Percent Average Annual
Count
Row Percent
Latino All ages 243.3 100.0%215.0 88.4%
5‐12 **0.7 *
13‐19 **5.3 *
20‐24 33.0 13.6%28.3 85.9%
25‐29 52.0 21.4%47.0 90.4%
30‐39 60.7 24.9%53.3 87.9%
40‐49 47.0 19.3%40.3 85.8%
50 & over 44.0 18.1%40.0 90.9%
Male All ages 204.3 84.0%182.7 89.4%
5‐12 **0.3 *
13‐19 **5.0 *
20‐24 28.0 11.5%24.7 88.1%
25‐29 47.0 19.3%42.7 90.8%
30‐39 52.3 21.5%46.7 89.2%
40‐49 37.7 15.5%32.7 86.7%
50 & over 33.3 13.7%30.7 **
Female All ages 39.0 16.0%32.3 82.9%
5‐12 **0.3 *
13‐19 **0.3 *
20‐24 5.0 2.1%3.7 **
25‐29 5.0 2.1%4.3 **
30‐39 8.3 3.4%6.7 **
40‐49 9.3 3.8%7.7 **
50 & over 10.7 4.4%9.3 **
Source: Alameda County eHARS, 2019 Q2
NOTE: Excludes N=7 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
All Diagnoses Linked to Care
HIV in Alameda County, 2016-2018 51
The Continuum of HIV Care
Table 4.2: Timely Linkage to HIV Care Among New Diagnoses by Sex and Race/Ethnicity,
Alameda County, 2015-2017
Sexa Race/Ethnicityb Average Annual
Count
Column Percent Average Annual
Count
Row Percent
All All races 243.3 100.0%215.0 88.4%
AfrAmer 92.0 37.8%79.3 86.2%
White 51.0 21.0%46.0 90.2%
Latino 67.3 27.7%60.7 90.1%
API 24.0 9.9%21.0 **
Other/Unk 9.0 3.7%8.0 **
Male All races 204.3 84.0%182.7 89.4%
AfrAmer 68.7 28.2%60.7 88.3%
White 45.3 18.6%41.0 90.4%
Latino 61.3 25.2%55.3 90.2%
API **18.3 *
Other/Unk **7.3 *
Female All races 39.0 16.0%32.3 82.9%
AfrAmer 23.3 9.6%18.7 80.0%
White 5.7 2.3%5.0 **
Latino 6.0 2.5%5.3 **
API **2.7 *
Other/Unk **0.7 *
Source: Alameda County eHARS, 2019 Q2
NOTE: Excludes N=7 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
All PLHIV Linked to Care
HIV in Alameda County, 2016-2018 52
The Continuum of HIV Care
Table 4.3: Timely Linkage to HIV Care Among New Diagnoses by Race/Ethnicity and Age,
Alameda County, 2015-2017
Race/Ethnicitya Age at Diagnosis Average Annual
Count
Column Percent Average Annual
Count
Row Percent
All races All ages 243.3 100.0%215.0 88.4%
5‐12 **0.7 *
13‐19 **5.3 *
20‐24 33.0 13.6%28.3 85.9%
25‐29 52.0 21.4%47.0 90.4%
30‐39 60.7 24.9%53.3 87.9%
40‐49 47.0 19.3%40.3 85.8%
50 & over 44.0 18.1%40.0 90.9%
AfrAmer All ages 92.0 37.8%79.3 86.2%
5‐12 **0.7 *
13‐19 **3.0 *
20‐24 17.0 7.0%14.3 **
25‐29 18.3 7.5%16.7 **
30‐39 17.3 7.1%14.7 **
40‐49 13.3 5.5%11.3 **
50 & over 21.7 8.9%18.7 **
White All ages 51.0 21.0%46.0 90.2%
5‐12 0.0 0.0%0.0 **
13‐19 0.0 0.0%0.0 **
20‐24 4.3 1.8%3.7 **
25‐29 10.0 4.1%8.7 **
30‐39 16.3 6.7%14.7 **
40‐49 9.7 4.0%8.3 **
50 & over 10.7 4.4%10.7 100.0%
NOTE: This table spans multiple pages
All Diagnoses Linked to Care
HIV in Alameda County, 2016-2018 53
The Continuum of HIV Care
Table 4.3: Timely Linkage to HIV Care Among New Diagnoses by Race/Ethnicity and Age,
Alameda County, 2015-2017 (continued)
Race/Ethnicitya Age at Diagnosis Average Annual
Count
Column Percent Average Annual
Count
Row Percent
Latino All ages 67.3 27.5%60.7 90.1%
5‐12 0.0 0.0%0.0 **
13‐19 1.7 0.7%1.7 100.0%
20‐24 8.0 3.3%7.0 **
25‐29 16.7 6.8%15.3 **
30‐39 18.3 7.5%16.3 **
40‐49 16.3 6.8%14.7 **
50 & over 6.3 2.6%5.7 **
API All ages 24.0 9.8%21.0 **
5‐12 0.0 0.0%0.0 **
13‐19 **0.7 *
20‐24 **2.3 *
25‐29 4.0 1.6%3.7 **
30‐39 7.0 2.8%6.0 **
40‐49 5.3 2.2%4.3 **
50 & over **4.0 *
Other/Unk All ages 9.0 3.7%8.0 **
5‐12 0.0 0.0%0.0 **
13‐19 **0.0 *
20‐24 **1.0 *
25‐29 3.0 1.2%2.7 **
30‐39 1.7 0.7%1.7 100.0%
40‐49 2.3 1.0%1.7 **
50 & over **1.0 *
Source: Alameda County eHARS, 2019 Q2
NOTE: Excludes N=7 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
NOTE: This table spans multiple pages
All Diagnoses Linked to Care
HIV in Alameda County, 2016-2018 54
The Continuum of HIV Care
Table 4.4: Engagement in HIV Care in 2017 Among PLHIV at Year-End 2016 by Sex and Age,
Alameda County
Sexa Age Count Column Percent Count Row Percent
All All ages 5741 100.0%4513 78.6%
0-12 8 0.1%7 87.5%
13-19 20 0.3%19 95.0%
20-29 432 7.5%324 75.0%
30-39 878 15.3%663 75.5%
40-49 1320 23.0%1020 77.3%
50-59 1925 33.5%1538 79.9%
60 & over 1158 20.2%942 81.3%
Male All ages 4780 83.3%3759 78.6%
0-12 ****
13-19 ****
20-29 383 6.7%288 75.2%
30-39 743 12.9%561 75.5%
40-49 1064 18.5%821 77.2%
50-59 1621 28.2%1292 79.7%
60 & over 951 16.6%781 82.1%
Female All ages 961 16.7%
0-12 ****
13-19 ****
20-29 49 0.9%36 73.5%
30-39 135 2.4%102 75.6%
40-49 256 4.5%199 77.7%
50-59 304 5.3%246 80.9%
60 & over 207 3.6%161 77.8%
Source: Alameda County eHARS, 2018 Q2
[a] Refers to sex assigned at birth
[*] Some cells suppressed to protect confidentiality
All PLHIV Any Visit in 2017
HIV in Alameda County, 2016-2018 55
The Continuum of HIV Care
Table 4.5: Engagement in HIV Care in 2017 Among PLHIV at Year-End 2016 by Sex and Race/Ethnicity,
Alameda County
Sexa Race/Ethnicityb Count Column Percent Count Row Percent
All All races 5741 100.0%4513 78.6%
AfrAmer 2203 38.4%1731 78.6%
White 1838 32.0%1469 79.9%
Latino 1110 19.3%825 74.3%
API 387 6.7%315 81.4%
Other/Unk 203 3.5%173 85.2%
Male All races 4780 83.3%3759 78.6%
AfrAmer 1629 28.4%1276 78.3%
White 1681 29.3%1348 80.2%
Latino 964 16.8%717 74.4%
API 333 5.8%270 81.1%
Other/Unk 173 3.0%148 85.5%
Female All races 961 16.7%754 78.5%
AfrAmer 574 10.0%455 79.3%
White 157 2.7%121 77.1%
Latino 146 2.5%108 74.0%
API 54 0.9%45 **
Other/Unk 30 0.5%25 **
Source: Alameda County eHARS, 2019 Q2
[a] Refers to sex assigned at birth
[b] 'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[**] Unstable estimates not shown
Any Visit in 2017All PLHIV
HIV in Alameda County, 2016-2018 56
The Continuum of HIV Care
Table 4.6: Engagement in HIV Care in 2017 Among PLHIV at Year-End 2016 by Race/Ethnicity and Age,
Alameda County
Race/Ethnicitya Age Count Column Percent Count Row Percent
All All ages 5741 100.0%4513 78.6%
0-12 8 0.1%7 87.5%
13-19 20 0.3%19 95.0%
20-29 432 7.5%324 75.0%
30-39 878 15.3%663 75.5%
40-49 1320 23.0%1020 77.3%
50-59 1925 33.5%1538 79.9%
60 & over 1158 20.2%942 81.3%
AfrAmer All ages 2203 38.4%1731 78.6%
0-12 5 0.1%4 80.0%
13-19 11 0.2%11 100.0%
20-29 203 3.5%154 75.9%
30-39 335 5.8%258 77.0%
40-49 462 8.0%354 76.6%
50-59 721 12.6%576 79.9%
60 & over 466 8.1%374 80.3%
White All ages 1838 32.0%1469 79.9%
0-12 ****
13-19 ****
20-29 66 1.1%46 69.7%
30-39 185 3.2%142 76.8%
40-49 370 6.4%301 81.4%
50-59 744 13.0%597 80.2%
60 & over 471 8.2%382 81.1%
All PLHIV Any Visit in 2017
HIV in Alameda County, 2016-2018 57
The Continuum of HIV Care
Table 4.6: Engagement in HIV Care in 2017 Among PLHIV at Year-End 2016 by Race/Ethnicity and Age,
Alameda County (continued)
Race/Ethnicitya Age Count Column Percent Count Row Percent
Latino All ages 1110 19.3%632 56.9%
0-12 ****
13-19 ****
20-29 105 1.8%62 59.0%
30-39 238 4.1%120 50.4%
40-49 324 5.6%170 52.5%
50-59 298 5.2%178 59.7%
60 & over 139 2.4%96 69.1%
API All ages 387 6.7%240 62.0%
0-12 ****
13-19 ****
20-29 35 0.6%23 54.3%
30-39 87 1.5%33 54.0%
40-49 109 1.9%55 57.8%
50-59 100 1.7%62 70.0%
60 & over 53 0.9%29 71.7%
Other/Unk All ages 203 3.5%130 64.0%
0-12 ****
13-19 ****
20-29 23 0.4%10 43.5%
30-39 33 0.6%21 63.6%
40-49 55 1.0%32 58.2%
50-59 62 1.1%43 69.4%
60 & over 29 0.5%24 82.8%
Source: Alameda County eHARS, 2019 Q2
NOTE: Excludes PLHIV at year-end 2016 who died (N=78) or moved out of the country (N=428) in 2017
[a] 'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[*] Some cells suppressed to protect confidentiality
All PLHIV Retained in Care
NOTE: This table spans multiple pages
HIV in Alameda County, 2016-2018 58
The Continuum of HIV Care
Table 4.7: Retention in Continuous HIV Care in 2017 Among PLHIV at Year-End 2016 by Sex and Age,
Alameda County
Sexa Age Count Column Percent Count Row Percent
All All ages 5741 100.0%3352 58.4%
0-12 8 0.1%7 87.5%
13-19 20 0.3%13 65.0%
20-29 432 7.5%212 49.1%
30-39 878 15.3%446 50.8%
40-49 1320 23.0%759 57.5%
50-59 1925 33.5%1146 59.5%
60 & over 1158 20.2%769 66.4%
Male All ages 4780 83.3%2819 59.0%
0-12 ****
13-19 ****
20-29 383 6.7%187 48.8%
30-39 743 12.9%381 51.3%
40-49 1064 18.5%614 57.7%
50-59 1621 28.2%977 60.3%
60 & over 951 16.6%648 68.1%
Female All ages 961 16.7%533 55.5%
0-12 ****
13-19 ****
20-29 49 0.9%25 51.0%
30-39 135 2.4%65 48.1%
40-49 256 4.5%145 56.6%
50-59 304 5.3%169 55.6%
60 & over 207 3.6%121 58.5%
Source: Alameda County eHARS, 2019 Q2
NOTE: Excludes PLHIV at year-end 2016 who died (N=78) or moved out of the country (N=428) in 2017
[a] Refers to sex assigned at birth
[*] Some cells suppressed to protect confidentiality
All PLHIV Retained in Care
HIV in Alameda County, 2016-2018 59
The Continuum of HIV Care
Table 4.8: Retention in Continuous HIV Care in 2017 Among PLHIV at Year-End 2016 by Sex and
Race/Ethnicity, Alameda County
Sexa Race/Ethnicityb Count Column Percent Count Row Percent
All All races 5741 100.0%3352 58.4%
AfrAmer 2203 38.4%1260 57.2%
White 1838 32.0%1090 59.3%
Latino 1110 19.3%632 56.9%
API 387 6.7%240 62.0%
Other/Unk 203 3.5%130 64.0%
Male All races 4780 83.3%2819 59.0%
AfrAmer 1629 28.4%936 57.5%
White 1681 29.3%1012 60.2%
Latino 964 16.8%553 57.4%
API 333 5.8%207 62.2%
Other/Unk 173 3.0%111 64.2%
Female All races 961 16.7%533 55.5%
AfrAmer 574 10.0%324 56.4%
White 157 2.7%78 49.7%
Latino 146 2.5%79 54.1%
API 54 0.9%33 **
Other/Unk 30 0.5%19 **
Source: Alameda County eHARS, 2019 Q2
NOTE: Excludes PLHIV at year-end 2016 who died (N=78) or moved out of the country (N=428) in 2017
[a] Refers to sex assigned at birth
[b] 'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[**] Unstable estimates not shown
All PLHIV Retained in Care
HIV in Alameda County, 2016-2018 60
The Continuum of HIV Care
Table 4.9: Retention in Continuous HIV Care in 2017 Among PLHIV at Year-End 2016 by Race/Ethnicity
and Age, Alameda County
Race/Ethnicitya Age Count Column Percent Count Row Percent
All All ages 5741 100.0%3352 58.4%
0-12 8 0.1%7 87.5%
13-19 20 0.3%13 65.0%
20-29 432 7.5%212 49.1%
30-39 878 15.3%446 50.8%
40-49 1320 23.0%759 57.5%
50-59 1925 33.5%1146 59.5%
60 & over 1158 20.2%769 66.4%
AfrAmer All ages 2203 38.4%1260 57.2%
0-12 5 0.1%**
13-19 11 0.2%**
20-29 203 3.5%90 44.3%
30-39 335 5.8%169 50.4%
40-49 462 8.0%276 59.7%
50-59 721 12.6%423 58.7%
60 & over 466 8.1%292 62.7%
White All ages 1838 32.0%1090 59.3%
0-12 ****
13-19 ****
20-29 66 1.1%31 47.0%
30-39 185 3.2%89 48.1%
40-49 370 6.4%218 58.9%
50-59 744 13.0%432 58.1%
60 & over 471 8.2%319 67.7%
All PLHIV Retained in Care
NOTE: This table spans multiple pages
HIV in Alameda County, 2016-2018 61
The Continuum of HIV Care
Table 4.9: Retention in Continuous HIV Care in 2017 Among PLHIV at Year-End 2016 by Race/Ethnicity
and Age, Alameda County (continued)
Race/Ethnicitya Age Count Column Percent Count Row Percent
Latino All ages 1110 19.3%632 56.9%
0-12 ****
13-19 ****
20-29 105 1.8%62 59.0%
30-39 238 4.1%120 50.4%
40-49 324 5.6%170 52.5%
50-59 298 5.2%178 59.7%
60 & over 139 2.4%96 69.1%
API All ages 387 6.7%240 62.0%
0-12 ****
13-19 ****
20-29 35 0.6%23 54.3%
30-39 87 1.5%33 54.0%
40-49 109 1.9%55 57.8%
50-59 100 1.7%62 70.0%
60 & over 53 0.9%29 71.7%
Other/Unk All ages 203 3.5%130 64.0%
0-12 ****
13-19 ****
20-29 23 0.4%10 43.5%
30-39 33 0.6%21 63.6%
40-49 55 1.0%32 58.2%
50-59 62 1.1%43 69.4%
60 & over 29 0.5%24 82.8%
Source: Alameda County eHARS, 2019 Q2
NOTE: Excludes PLHIV at year-end 2016 who died (N=78) or moved out of the country (N=428) in 2017
[a] 'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[*] Some cells suppressed to protect confidentiality
All PLHIV Retained in Care
NOTE: This table spans multiple pages
HIV in Alameda County, 2016-2018 62
The Continuum of HIV Care
Table 4.10: Viral Suppression in 2017 Among PLHIV at Year-End 2016 by Sex and Age, Alameda County
Sexa Age Count Column Percent Count Row Percent
All All ages 5741 100.0%4048 70.5%
0-12 8 0.1%7 87.5%
13-19 20 0.3%17 85.0%
20-29 432 7.5%267 61.8%
30-39 878 15.3%568 64.7%
40-49 1320 23.0%910 68.9%
50-59 1925 33.5%1399 72.7%
60 & over 1158 20.2%880 76.0%
Male All ages 4780 83.3%3390 70.9%
0-12 ****
13-19 ****
20-29 383 6.7%237 61.9%
30-39 743 12.9%484 65.1%
40-49 1064 18.5%741 69.6%
50-59 1621 28.2%1183 73.0%
60 & over 951 16.6%730 76.8%
Female All ages 961 16.7%658 68.5%
0-12 ****
13-19 ****
20-29 49 0.9%30 61.2%
30-39 135 2.4%84 62.2%
40-49 256 4.5%169 66.0%
50-59 304 5.3%216 71.1%
60 & over 207 3.6%150 72.5%
Source: Alameda County eHARS, 2019 Q2
NOTE: Excludes PLHIV at year-end 2016 who died (N=78) or moved out of the country (N=428) in 2017
[a] Refers to sex assigned at birth
[*] Some cells suppressed to protect confidentiality
All PLHIV Suppressed at Last Viral
Load in 2017
HIV in Alameda County, 2016-2018 63
The Continuum of HIV Care
Table 4.11: Viral Suppression in 2017 Among PLHIV at Year-End 2016 by Sex and Race/Ethnicity,
Alameda County
Sexa Race/Ethnicityb Count Column Percent Count Row Percent
All All races 5741 100.0%4048 70.5%
AfrAmer 2203 38.4%1491 67.7%
White 1838 32.0%1368 74.4%
Latino 1110 19.3%744 67.0%
API 387 6.7%299 77.3%
Other/Unk 203 3.5%146 71.9%
Male All races 4780 83.3%3390 70.9%
AfrAmer 1629 28.4%1096 67.3%
White 1681 29.3%1264 75.2%
Latino 964 16.8%649 67.3%
API 33 5.8%258 77.5%
Other/Unk 173 3.0%123 71.1%
Female All races 961 16.7%658 68.5%
AfrAmer 574 10.0%395 68.8%
White 157 2.7%104 66.2%
Latino 146 2.5%95 65.1%
API 54 0.9%41 **
Other/Unk 30 0.5%23 **
Source: Alameda County eHARS, 2019 Q2
NOTE: Excludes PLHIV at year-end 2016 who died (N=78) or moved out of the country (N=428) in 2017
[a] Refers to sex assigned at birth
[b] 'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[**] Unstable estimates not shown
All PLHIV Suppressed at Last Viral Load in
2017
HIV in Alameda County, 2016-2018 64
The Continuum of HIV Care
Table 4.12: Viral Suppression in 2017 Among PLHIV at Year-End 2016 by Race/Ethnicity and Age,
Alameda County
Race/Ethnicitya Age Count Column Percent Count Row Percent
All All ages 5741 100.0%4048 70.5%
0-12 8 0.1%7 87.5%
13-19 20 0.3%17 85.0%
20-29 432 7.5%267 61.8%
30-39 878 15.3%568 64.7%
40-49 1320 23.0%910 68.9%
50-59 1925 33.5%1399 72.7%
60 & over 1158 20.2%880 76.0%
AfrAmer All ages 2203 38.4%1491 67.7%
0-12 5 0.1%**
13-19 11 0.2%**
20-29 203 3.5%118 58.1%
30-39 335 5.8%212 63.3%
40-49 462 8.0%297 64.3%
50-59 721 12.6%513 71.2%
60 & over 466 8.1%338 72.5%
White All ages 1838 32.0%1368 74.4%
0-12 ****
13-19 ****
20-29 66 1.1%41 62.1%
30-39 185 3.2%124 67.0%
40-49 370 6.4%281 75.9%
50-59 744 13.0%556 74.7%
60 & over 471 8.2%365 77.5%
All PLHIV Suppressed at Last Viral
Load in 2017
NOTE: This table spans multiple pages
HIV in Alameda County, 2016-2018 65
The Continuum of HIV Care
Table 4.12: Viral Suppression in 2017 Among PLHIV at Year-End 2016 by Race/Ethnicity and Age,
Alameda County (continued)
Race/Ethnicitya Age Count Column Percent Count Row Percent
Latino All ages 1110 19.3%744 67.0%
0-12 ****
13-19 ****
20-29 105 1.8%69 65.7%
30-39 238 4.1%145 60.9%
40-49 324 5.6%212 65.4%
50-59 298 5.2%206 69.1%
60 & over 139 2.4%106 76.3%
API All ages 387 6.7%299 77.3%
0-12 ****
13-19 ****
20-29 35 0.6%29 82.9%
30-39 87 1.5%65 74.7%
40-49 109 1.9%81 74.3%
50-59 100 1.7%79 79.0%
60 & over 53 0.9%42 79.2%
Other/Unk All ages 203 3.5%146 71.9%
0-12 ****
13-19 ****
20-29 23 0.4%10 43.5%
30-39 33 0.6%22 66.7%
40-49 55 1.0%39 70.9%
50-59 62 1.1%45 72.6%
60 & over 29 0.5%29 100.0%
Source: Alameda County eHARS, 2019 Q2
NOTE: Excludes PLHIV at year-end 2016 who died (N=78) or moved out of the country (N=428) in 2017
[a] 'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[*] Some cells suppressed to protect confidentiality
All PLHIV Suppressed at Last Viral
Load in 2017
NOTE: This table spans multiple pages
HIV in Alameda County, 2016-2018 66
The Continuum of HIV Care
Table 4.13: Viral Suppression in 2017 Among PLHIV at Year-End 2016 and in Care in 2017 by Sex,
Alameda County
Sexa Count Column Percent Count Row Percent
All 4513 100.0% 4048 89.7%
Male 3759 83.3% 3390 90.2%
Female 754 16.7% 658 87.3%
Source: Alameda County eHARS, 2019 Q2
NOTE: Excludes PLHIV at year‐end 2016 who died (N=78) or moved out of the country (N=428),
or did not have any HIV labs reported (N=1228) in 2017
[a] Refers to sex assigned at birth
[**] Unstable estimates not shown
All PLHIV Suppressed at Last Viral
Load in 2017
Table 4.14: Viral Suppression in 2017 Among PLHIV at Year-End 2016 and in Care in 2017 by
Race/Ethnicity, Alameda County
Race/Ethnicitya Count Column Percent Count Row Percent
All races 4513 100.0% 4048 89.7%
AfrAmer 1731 38.4% 1491 86.1%
White 1469 32.6% 1368 93.1%
Latino 825 18.3% 744 90.2%
API 315 7.0% 299 94.9%
Other/Unk 173 3.8% 146 84.4%
Source: Alameda County eHARS, 2019 Q2
NOTE: Excludes PLHIV at year‐end 2016 who died (N=78) or moved out of the country (N=428),
or did not have any HIV labs reported (N=1228) in 2017
[a] 'Other/Unk' = American Indians and Alaskan Natives, multiple race, unknown race
[**] Unstable estimates not shown
All PLHIV Suppressed at Last Viral
Load in 2017
HIV in Alameda County, 2016-2018 67
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.
To calculate prevalence of HIV among foreign-born and US-born individuals, estimates of the proportions
of foreign-born and US-born in Alameda County were obtained from American Community Survey (ACS)
and applied to the Community Assessment, Planning, and Evaluation (CAPE) mid-year population
estimates of all people living in Alameda County.
PLHIV at the end of 2018 were identi ed from eHARS.
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 [JoinPoint] 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 2018 (the second and second-to-last years examined).
HIV in Alameda County, 2016-2018 68
Technical Notes
Data Suppression Rules
Proportions
In accordance with draft guidelines released by the National Center for Health Statistics [9], proportions are
considered to be statistically unreliable and are not presented if they meet either of the following criteria:
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, 2016-2018 69
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
information 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.
(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:
(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.
70
Technical Notes
(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, 2016-2018 71
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.
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.
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.
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.
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.
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.
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, 2016-2018 72
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 laboratories 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
reporting 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 lab report and complete a
case report using information abstracted from the patient's medical record and obtained from the HCP. For
adult cases, standardized case report forms are completed and submitted in the California Reportable
Disease Information Exchange (CalREDIE)the secure CDPH system for electronic disease reporting and
surveillance. Hard copies of death certi cates and pediatric HIV cases documented on a paper case report
form are mailed to the CDPH O ce of AIDS. All case reports submitted to CDPH are routinely
de-identi ed and transmitted 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.
73
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. STDs
are recognized to be widely under-reported, which may aect the gures reported here.
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.
Diagnosis date assigned to foreign-born cases:A small number of foreign-born PLHIV may
have been initially diagnosed with HIV in another country before arriving in the US, but due to the
absence of veri ed information on date of initial diagnosis, their diagnosis date in the surveillance
data re ects the earliest date of HIV diagnosis in the US. As a consequence new diagnoses and late
diagnoses may be overestimated in our data.
HIV in Alameda County, 2016-2018 74
Technical Notes
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, 2016-2018 75
Technical Notes
Figure A.2: The HIV Surveillance System in Alameda County
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77
In memory of Jesus Altamirano, a dedicated and valued member
of the HIV Surveillance team who passed away June 10th, 2019.
HIV in Alameda County, 2016-2018 78
HIV Epidemiology
& Surveillance Unit
Alameda County
Public Health Department
HIV in Alameda County,
2015-2017
Alameda County
Public Health Department
1000 Broadway, Suite 310
Oakland, CA 94607