Almost 20 years after first declaring "A local State of Emergency due to the AIDS epidemic," the city of Oakland continues to be disproportionately impacted.
Dr. Neena Murgai, Deputy Director of Epidemiology and Surveillance for the Alameda County office of AIDS, has been tracking HIV & AIDS in the county. According to Murgai, over half of all HIV cases in Alameda County are still diagnosed in Oakland.
"The epidemic is most concentrated in the Oakland and Oakland area," Murgai said. "As we know from a lot of the other data, [the] Oakland area is the area of greatest burden of several health conditions that are associated with higher concentrations of poverty and other social conditions."
In the early years of the epidemic, before a test for HIV infection was available, California required all county health departments to track AIDS cases - individuals who had developed the disease because of their underlying HIV infection. When a test for HIV infection was developed, cases of HIV infection without AIDS began to be reported to the health department, as well using a coding system rather than names.
Since effective medications became available, many people are able to live for years, even decades while infected with the virus. It is the Acquired Immune Deficiency Syndrome and it's related infections and vulnerabilities that cause death. In 2006, the state started to require confidential tracking of both AIDS cases and new HIV infections with names.*
These two numbers - who's infected with HIV and who has progressed to "full-blown" AIDS -- can show the health of individuals and the ways that community members are or are not accessing health resources.
Carla Dillard agrees with this neighborhood approach to HIV/AIDS data. Dillard has worked in prevention, treatment and research for more than a decade, first at Cal-Pep - California Prostitute Education Project - and now at Pangaea Global AIDS Foundation.
"Zip code plays a role in risk," Dillard said. "It's not just what you do, but it's also where you live."
Local advocates and activists have consistently challenged city, county and state officials to address the realities of day to day life for Oakland residents. At a recent community event hosted by W.O.R.L.D. (Women Organized to Respond to Life-threatening Disease), one attendee lamented, "Alameda County wants to do things from the offices, but people are dying in the streets. We have to go where the people are dying."
These kind of comments refer to both prevention and treatment efforts. While Ron Dellums was mayor, he earmarked funds for Get Screened Oakland. This public-private partnership used billboard ads, community events, a website and toll free number to increase the number of Oakland residents participating in routine HIV screening. It's clear that the program helped to raise awareness about HIV testing nd prevention. But the website has grown more and more outdated since Mayor Jean Quan was sworn in early this year. Get Screened Oakland leadership have all moved on to other projects and it's not clear if the city is still funding any testing or educational activities.
Calls to "Get Screened Oakland" went unanswered. The toll free number, still featured on the site, is now disconnected.
In Oakland, as in many parts of the country, overall new HIV infections have leveled off or are going down. However, in certain neighborhoods and demographics, new HIV infections in Oakland are going up. African-Americans, in general, continue to show increasing rates of infection - at five times the rate of Whites and Latinos. African-American women also continue to have high infection rates. More and more African-American men who have sex with men are also getting HIV. Young African-Americans, in their teens and twenties and thirties, are another group who's numbers are not level or going down, but going up.
There are more agencies offering HIV tests in Oakland than other cities in the county [link to map for Oakland test sites]. Yet Dillard cautions that, across the board, many people living with HIV are not getting tested.
"All the national data says that 25 percent of the people who are positive don't know it," Dillard said. "We're not reaching all the positive people."
* The switch to named reporting was so that health departments could ensure their data included only one report per person (no duplicates) and at the state level, so that people wouldn’t be recounted when they moved to a new place.
This article is the first in a series of articles created in partnership with HealthyCal.org in December 2012.
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