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Section III:
Other Issues
Communicable Diseases
  & Immunizations

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    Priority: HIV and AIDS
    (Human Immunodeficiency Virus; Acquired
    Immunodeficiency Syndrome)

    TABLE OF CONTENTS

    1. Health Data
    2. Unmet Needs
    3. Resources in Chautauqua County
    4. Opportunities for Action
    According to Healthy People 2010,

    Since the HIV/AIDS epidemic began in the 1980s, nearly 700,000 cases of AIDS have been reported in the U.S. The latest estimates indicate that 800,000 to 900,000 people in the U.S. currently are infected with HIV. The lifetime cost of health care associated with HIV infection, in light of recent advances in HIV diagnostics and therapies, is $155,000 or more per person. Figure 1 shows estimated HIV infection or AIDS rates by state for adolescents and adults in the U.S., 2003.

    Figure 1. Estimated Rates for Adults and Adolescents Living with HIV
    Infection or with AIDS Per 100,000 Population, 2003.
    Figure 1.  Estimated Rates for Adults and Adolescents Living with
HIV Infection or with AIDS Per 100,000 Population, 2003
    http://www.cdc.gov/hiv/STATS/2003SurveillanceReport.pdf


    Healthy People 2010 and HIV/AIDS

    The following chart presents the Healthy People 2010 targets for the objectives pertinent to reducing HIV/AIDS, along with baseline data for the year(s) indicated. This chapter examines Chautauqua County data for the indicators listed in bold type and selected other indicators.


    Healthy People 2010 Baselines and Targets for HIV/AIDS
    Objective 1998 Baseline*2010 Target
    13.1Reduce AIDS among adolescents and adults19.5 cases of AIDS (per 100,000 persons ages 13+)1.0 new case per 100,000 persons
    13.2Reduce the number of new AIDS cases among adolescent and adult men who have had sex with men17,847 new cases of AIDS (among males aged 13 + years)13,385 new cases
    13.3Reduce the number of new AIDS cases among females and males who inject drugs12,099 new cases of AIDS (among injection drug users age 13+ years: females, 3,667, males, 8,432)9,075 new cases
    13.4Reduce the number of new AIDS cases among adolescent and adult men who have sex with men and inject drugs2,122 new cases of AIDS (among males aged 13+ years)1,592 cases
    13.5(developmental) Reduce the number of cases of HIV infection among adolescents and adults 
    13.6Increase the proportion of sexually active persons who use condoms19952010 Target
    13.6aFemales aged 18 to 44 years23%50%
    13.6bMales aged 18 to 44 years 
    13.7(developmental) Increase the number of HIV-positive persons who know their serostatus 
    13.8Increase the number of substance abuse treatment facilities that offer HIV/AIDS education, counseling, and support58%70%
    13.9(developmental) Increase the number of state prison systems that provide comprehensive HIV/AIDS, sexually transmitted diseases, and tuberculosis (TB) education 
    13.10(developmental) Increase the proportion of inmates in state prison systems who receive voluntary HIV counseling and testing during incarceration 
    13.11Increase the proportion of adults with tuberculosis (TB) who have been tested for HIV55% of adults aged 22 to 44 years85%
    13.12(developmental) Increase the proportion of adults in publicly funded HIV counseling and testing sites who are screened for common bacterial sexually transmitted diseases (STD's) (chlamydia, gonorrhea, and syphilis) and are immunized against hepatitis B virus 
    13.13Increase the proportion of HIV-infected adolescents and adults who receive testing, treatment, and prophylaxis consistent with current Public Health Service treatment guidelines. (aged 13 years and older)19972010
     Testing
    13.13aViral load testing
    13.13bTuberculin skin testing (TST)
     Treatment
    13.13cAny Antiretroviral therapy80%95%
    13.13dAny active Antiretroviral therapy (HAART)40%95%
     Prophylaxis
    13.13ePenumocystis carinii pneumonia (PCP) prophylaxis80%95%
    13.13fMycobacterium avium complex (MAC) prophylaxis44%95%
    13.14Reduce deaths from HIV infection4.9 deaths from HIV infection per 100,000 (1998)0.7 deaths per 100,000 persons
    13.15(developmental) Extend the interval of time between an initial diagnosis of HIV infection and AIDS diagnosis to increase years of life of an individual infected with HIV 
    13.16(developmental) Increase years of life of an HIV-infected person by extending the interval of time between an AIDS diagnosis and death 
    13.17(developmental) Reduce new AIDS cases of perinatally acquired HIV infection 

    A. Health Data

    1. Incidence of HIV/AIDS in Chautauqua County

    With no new AIDS cases reported for 2003, Chautauqua County currently is below the Healthy People 2010 target of 1.0 new cases (per 100,000 population age 13+), as Table 1 shows.

    Table 1. AIDS Cases in Chautauqua County and
    New York State per 100,000 Population, 2003.
     AIDS*
    Chautauqua County0.0
    New York State (excluding NYC)5.6
    New York State Total26.1
    Healthy People 2010 Target1.0 new cases/100,000 (age 13+)

    *As of Aug 4, 2004 (excludes inmates).
    http://www.health.state.ny.us/nysdoh/cdc/2003/rates1.htm

    Table 2 presents trends in AIDS cases and HIV cases in newborns for the years 1999-2003 in Chautauqua County. Over this time period, the rate of county AIDS cases has fluctuated between 2.9 and 7.2 cases per 100,000 residents, with a rate for 2003 of 2.9 cases (100,000 population). The number of newborns with HIV has decreased since 2001 when there was 2 new cases per 1,000 births (or 0.2%).


    Table 2. Trends in AIDS Cases and HIV Seropositive Newborns in Chautauqua County, 1999-2003.
     20032002200120001999
     #RATE#RATE#RATE#RATE#RATE
    AIDS Cases**42.9107.296.585.753.6
    Healthy People 2010 Target: 1.0 new cases/100,000 (age 13+)
    Newborn HIV Seropositive**
    (per 100 births) Helathy People 2010 Target: developmental (reduced incidence)
    N/AN/AN/AN/A20.120.140.3

    Newborn Seropositivity is per 100 births. All other rates in this section are per 100,000 population.
    AIDS Cases are presented by diagnosis year and exclude prison inmates

    Source: New York State Department of Health
    (http://www.health.state.ny.us/nysdoh/cfch/pchaut.htm).

    Table 3 shows the rate of diagnosed AIDS cases in the Ryan White Region (Buffalo) for gender, age and race/ethnic groups through December 2002. More males than females (78.5% vs. 21.5%) were identified as HIV/AIDS cases. Age group 30-49 had the highest percentage of cases (69.6%), followed by age group 25-29 (12.4%). The percentages for blacks and whites are 45.1% and 42.5%, respectively; Hispanics comprise 11% of the total prevalent cases. (Data are not standardized to the population).


    Table 16. HIV/AIDS Cases* by Gender, Age and Race/Ethnicity in
    Ryan White Region: Buffalo, Diagnosed Through December 2003.

    Table 16. HIV/AIDS Cases by Gender, Age and Race/Ethnicity in Ryan White Region: Buffalo, Diagnosed Through December 2003

    * Excludes prisoners.
    **All cases reported and confirmed from June 2000-March 2004.
    *** All cases reported and confirmed from 1983-March 2004.
    Ryan White Region Buffalo: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming counties.


    2. AIDS Mortality in Chautauqua County

    Table 4 shows that a total of five deaths from AIDS occurred in Chautauqua County between 2000-2002, with an age-adjusted rate of 0.9 deaths per 100,000 residents. The county has a lower AIDS mortality rate than in the western New York region (2.6) or New York State (10.9).


    Table 4. AIDS Deaths and Death Rates per 100,000 Residents in Chautauqua County and New York State, 2000-2002.
     Deaths from AIDSPopulationAdjusted
     200020012002Total2001Rate *
    (100,000)
    Chautauqua County1315138,7180.9
    Western New York Region4450291231,584,6522.6
    New York State2,2992,0861,9956,38019,084,35010.9

    Source: 2000-2002 Vital Statistics Data as of August, 2004. * Adjusted rates are age adjusted to the 2000 United States population (https://commerce.health.state.ny.us/hin/).

    Figure 1 shows the mortality trend for Chautauqua County by presenting single year and 3-year average death rates for the years 1993-2002. The mortality rate has declined slightly during the ten-year time period, and the 3-year average rate smooths out year-to-year fluctuations to more clearly illustrate this trend.

    Figure 2. Trends in AIDS Death Rate in Chautauqua County, 1993-2002.

    Figure 2.  Trends in AIDS Death Rate in Chautauqua County, 1993-2002

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    B. Unmet Needs

    Summary: HIV/AIDS in Chautauqua County

    Between 1997-2001, two newborns per year were seropositive with HIV(0.2%); in 1999 there were four (0.3%). In the Ryan White Region: Buffalo (which includes Chautauqua as one of eight counties), more males than females (78.9% vs. 21.1%) were identified as HIV/AIDS cases through December 2001. In the Ryan White region, persons 30-49 years had the highest percentage of reported cases (70.1%), followed by 25-29 years (12.4%). The percentages for blacks and whites are 45.4% and 42.3%, respectively; Hispanics comprise 11% of the total prevalent cases. (Data not standardized to the population).

    The death rate from AIDS for 2000-2002 in Chautauqua County is lower than western New York or New York State. Between 1993-2002, the mortality rate for AIDS declined slightly; the 3-year average rate smooths out year-to-year fluctuations to more clearly illustrate the trend.

    Healthy People 2010

    According to the Health People 2010 Initiative,

    About one-half of all new HIV infections in the U.S. are among people under age 25 years, and the majority are infected through sexual behavior. HIV infection is the leading cause of death for African-American men aged 25 to 44 years. However, young heterosexual women, especially minority women, are increasingly acquiring HIV infection and developing AIDS. In 1998, 41 percent of reported AIDS cases in persons aged 13 to 24 years occurred in young women, and more than four of every five AIDS cases reported in women occurred in certain racial and ethnic groups (mostly African American or Hispanic). The U.S. spread of HIV infection through heterosexual transmission closely parallels other STD epidemics.

    As the 2010 Initiative describes,

    Compelling worldwide evidence indicates that the presence of other STDs increases the likelihood of both transmitting and acquiring HIV infection. Prospective epidemiologic studies from four continents, including North America, have repeatedly demonstrated that when other STDs are present, HIV transmission is at least two to five times higher than when other STDs are not present. Biological studies demonstrate that when other STDs are present, an individual's susceptibility to HIV infection is increased, and the likelihood of a dually infected person (having HIV infection and another STD) infecting other people with HIV is increased. Conversely, effective STD treatment can slow the spread of HIV at the individual and community levels.

    The U.S. Centers for Disease Control and Prevention state that

    HIV testing remains an important component of prevention activities; learning one's HIV status is the key stepping stone to care or to ongoing services to reduce behavioral risk.

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    C. Resources in Chautauqua County

    The following list includes Chautauqua County organizations, agencies and programs that offer health services and other forms of assistance related to HIV/AIDS.

    • Abstinence Education Advisory Board, Mayville
    • Chautauqua County AIDS Advisory Board, Falconer
    • Chautauqua County Health Department: confidential HIV testing
    • Child Health Plus Initiative, Jamestown
    • Health Education Network, Fredonia
    • Infant Mortality Review Committee, Mayville
    • N.Y.S. Partner Notification Program
    • BOCES Project KNOW
    • STEPS Consortium

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    D. Opportunities for Action

    Opportunities for action in Chautauqua County pertinent to HIV/AIDS, adapted from documents produced by the Healthy People 2010 Initiative and the U.S. Centers for Disease Control and Prevention, include the following:

    • Increase the number of school-based health information interventions that inform young people about HIV exposure and transmission issues, and motivate youth to modify their behaviors.
       
    • Expand school-based health programs that provide services for other health problems, such as alcohol consumption and substance abuse, especially injection drug use.
       
    • Assist parents to become better at imparting STD and HIV/AIDS information. Currently, a small percentage of adolescents receive prevention information from parents.
       
    • Expand education and family planning services to help persons abstain from sexual intercourse, delay initiation of intercourse, reduce the number of sex partners, and increase the use of more effective physical barriers, such as condoms.
       
    • Expand education to help persons avoid illegal substances use, especially injection drug use.
       
    • Support local mass media campaigns that can bring about significant changes in awareness, attitude, knowledge, and behaviors for other health problems, including smoking, alcohol consumption, and use of illegal substances.
       
    • Support national communication efforts to help overcome widespread misinformation and lack of awareness about HIV/AIDS.
       
    • Expand outreach efforts to high-risk youth who visit traditional health care settings, such as hospitals and public clinics.
       
    • Expand efforts to screen for bacterial STD infections (e.g., chlamydia and gonorrhea) of institutionalized high-risk individuals prior to release, such as those in adult corrections facilities and youth detention centers.
       
    • Determine the rate at which uninfected individuals have sex with infected persons (rate of sex partner exchange or exposure) so that HIV disease-outbreak models can be refined and new primary prevention strategies identified.
       
    • Promote and strengthen education on correct and consistent condom use for dual protection against STDs/HIV and pregnancy, particularly in high-risk groups and for young, sexually active persons.
       
    • Educate women who use the most effective forms of contraception (sterilization and hormonal contraception) to use condoms for STD/HIV prevention.
       
    • Enhance strategies to identify and treat partners of persons with curable STDs to break the chain of transmission of STDs in a sexual network. STDs increase the risk of acquiring HIV. Future sex partners are protected from STDs by treating partners; thus, this treatment strategy also benefits the community.
       
    • Strengthen communications connections among private health care providers, managed-care organizations, and health departments so that barriers to rapid and effective treatment for STDs of non-plan sex partners of health plan members are reduced or eliminated.
       
    • To modify both transmission and duration factors, expand screening and treatment of STDs in both public and private sectors. For curable STDs, screening and treatment can be cost-effective, or even cost-saving, in altering the period during which infected persons can infect others.
       
    • Enhance screening efforts for STDs that frequently are asymptomatic (e.g., chlamydia), especially in women.
       
    • Seek funding for STD screening of underserved groups in nontraditional settings using newer sensitive and rapid diagnostic tests, such as those that can be performed on a urine specimen. Encourage communities and institutions to support such tests and to ensure the availability of well-trained health care providers and well-equipped and accessible laboratories.
       
    • Obtain surveillance data on HIV infection, rather than relying on AIDS data alone. Some persons with a newly diagnosed case of HIV infection were infected recently; others were infected some time in the past. Surveillance data on HIV can provide a more complete picture of the HIV epidemic and better allocate resources and evaluate program effectiveness (such as the need for prevention and care services).
       
    • Obtain information on the distribution of risky behaviors in the population, and the association between these risky behaviors and infection, in order to tailor HIV prevention programs to selected groups, such as men who have sex with men and injection drug users.
       
    • Expand the number of centers that will offer confidential HIV testing and increase access to rapid HIV testing. Learning one's HIV status is the key stepping stone to care, or to ongoing services to reduce behavioral risk.
       
    • Expand prevention efforts focused on persons at high risk to increase the knowledge of HIV serostatus among those who are infected, in order to provide sustained behavioral risk-reduction interventions as well as care and treatment.

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