Rise of an Epidemic?

Rise of an Epidemic?

S. E. Williams

New Data System Shows Dramatic Increases in HIV/AIDS in Riverside County

A report recently released by Riverside County health officials showed the rates of people living with HIV/AIDS (PLWH) in the county is much larger than previously estimated, due to use of a new methodology. The report, Health Matters, published by the Riverside University Health System: Public Health Epidemiology & Program Evaluation, was released at the end of November. 

In 2016, Riverside County reported 5,552 cases of HIV/AIDS using the most recent data available. Utilizing the updated method, 8,404 cases were reported for the same period, a change from a rate of 236 to 357 per 100,000 residents during that time. Health officials suspect improved healthcare and the well-established HIV/AIDS care and support infrastructure in the eastern portion of the county may be partly responsible for the 51 change; more people diagnosed elsewhere have moved to eastern Riverside County than previously understood.

The terms used to describe the difference in the two approaches to calculating HIV/AIDS prevalence are Standard Prevalence (PLWH living in the county when they were diagnosed) vs. Migration Prevalence (PLWH in the county regardless of where they were diagnosed). The goal of any disease surveillance is to predict, observe, and minimize harm that results when deadly diseases are transmitted. HIV is listed among the diseases state law requires must be confidentially reported. 

Traditionally, HIV/AIDS cases are assigned to a local health jurisdiction based on where the patient was living when first diagnosed with HIV. These are the cases that are reported as the prevalent numbers for a city, county, or state health department regardless of where that PLWH moves after diagnosis. This method can lead to an inaccurate portrayal of the true population of PLWH, particularly in areas with substantial movement in or out of the jurisdiction. Yet, funding of HIV service programs is historically tied to this form of surveillance. Hence, it can result in a misallocation of funds. 

Recently, improvements in HIV surveillance data at the state level made it possible to develop a more accurate portrait of the number of PLWH who currently live within Riverside County. The newly reported HIV/AIDS rates for Riverside County are based on an individual’s current address. This approach was designed to help HIV service providers better understand the current need across the county.

The notable change in estimated PLWH in Riverside County came as no surprise to some public health officials. Officials have long suspected the prevalence of PLWH in Riverside County has been underestimated. “The Palm Springs region is known for its welcoming environment of the lesbian, gay bisexual and transgender community along with a substantial HIV care and support infrastructure,” officials noted. 

Officials believe the apparent increase was largely the result of more people living with HIV/AIDS (PLWH) who moved into the county than moved out. According to report, there may be a number of reasons for migration into the county, including housing affordability, a desire to retire in the desert communities of the Coachella Valley, and improved health care for PLWH. 

At the end of last year, there were 51.4 percent more PLWH in Riverside County than was previously reported. Under the Standard Prevalence method, the number of PLWH in Riverside County regardless of year of diagnosis, there were 236.0 cases per 100,000 population. Using Migration Prevalence, there were actually 357.2 cases of HIV/AIDS per 100,000. According to the report, 2,852 more PLWH moved into Riverside County during 2016 than moved out. 

The most notable increase due to change in method was in eastern Riverside County. 2016 increases in the prevalence rates across the county were as follows—west (13.1% more or 224 cases), south (50.4% more or 122 cases), mid (74.1% more or 237 cases) and east (69.8% more or 2,270 cases).

The prevalence of PLWH in the eastern section of the county was striking. More than 80 percent of all White PLWH and 77 percent of all PLWH 45 years of age and older in the county now live in the eastern portion of Riverside County. Reportedly, the rest of Riverside County is home to a younger (61 percent of all PLWH under 45 years old) and more ethnically diverse (60 percent of all non-white PLWH) group of those living with HIV/AIDS.

Demographically, apparent increases were noted in all categories. The largest was among White, gay, bisexual or other men who have sex with men ages 45 to 64 years-of-age. There were also increases among non-White PLWH (818 more cases), those under 45 years old (435 more cases), and those 65 years of age and older (472) and among those assigned female at birth (85 more cases). 

Commenting on the results, Public Health Officer for Riverside County Dr. Cameron Kaiser said, “We’ve always suspected the number of people living with HIV/AIDS was higher than previously reported.” 

Also according to Cameron, the data gives a more accurate picture of what’s happening in Riverside County and, “the challenges facing patients, medical providers and the systems that serve them.” In turn, more accurate information will help officials plan where state and local resources can do the most good. It should also help get people with HIV/AIDS into care and prevent new cases from occurring. 

“As a physician, I know that having accurate reporting is critical to care properly for my patients,” Cameron noted in his blog. “The same can be said for a community’s health, using the most up to date information is important to provide the best care for the residents we serve. For those living with HIV/AIDS, this is even more critical because of the importance of providing resources in areas where they are the most needed.” 

Certainly, advances in medicine and new treatments have allowed HIV/AIDS to be treated as most other chronic diseases. “But, that doesn’t mean we don’t have more work to do,” Cameron explained. “Improving our statistics and our data gives us a clearer picture of how to serve this community and one day, help stop HIV for good. In the long run, it’s interventions like these that will help everyone in our community live longer, healthier lives.” 

The California Department of Public Health has established a blueprint to guide the work of state and local health departments between 2017 and 2021, as they strive to get to zero new HIV infections, zero AIDS-related deaths, and eliminate stigma and discrimination against PLWH. 

The integrated plan should give a voice to all Californians at risk for or living with HIV while also implementing strategies that, according to the agency, “recognize the interplay between biological, behavioral, psychosocial, and structural factors that affect the health and well-being of those most profoundly affected by the epidemic.” 

View the Health Matters publication, A new HIV/AIDS prevalence estimate for Riverside County, at http:// www.rivcohealthdata.org/Portals/0/Documents/DATA_ REPORTS/COMMUNICABLE_DISEASE/HIVAIDS/ hiv_data_report.pdf?ver=2017-11-27-153342-710.

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