key findings

As case rates and deaths attributed to AIDS continue to decrease in San Mateo County, concerns now focus on the needs of the growing number of persons living with AIDS as a chronic disease. Although their numbers are also declining, African-American residents continue to exhibit the highest case rates.

Sexually transmitted infections seem to be declining in the county and satisfy existing objectives for the Year 2000. Incidence rates for gonorrhea are declining sharply, as they are both statewide and nationwide. Unlike state and national rates, San Mateo County incidence rates for chlamydia have also shown a consistent decline since 1990. The incidence of syphilis in San Mateo County is low and remains steady.

In contrast, whereas U.S. and California tuberculosis incidence rates are declining, San Mateo County TB incidence rates continue to increase considerably. A very high percentage of TB cases are foreign-born, with particularly strong representation among Asian residents.

Enteric diseases — those transferred hand to mouth — remain unpredictable. San Mateo County salmonellosis incidence rates have increased considerably in recent years. Recent case rates for Hepatitis A in San Mateo County are the highest since 1990. In contrast, shigellosis case rates have decreased.

Qualitative research (focus group) findings corresponding to this section can be found beginning on Appendix A: Communicable Disease page.

HIV/AIDS

Although there is no vaccine or cure, recent advances in human immunodeficiency virus (HIV) treatment can slow or halt the progression from HIV infection to AIDS. Because HIV is not a reportable disease, the only method of monitoring HIV transmission is to monitor trends in AIDS cases. Longer periods between HIV infection and progression to AIDS have made it very difficult to monitor trends in HIV infection. Prevention of HIV infection is complex, requiring targeted behavioral-based, culture- and age-specific risk reduction programs.

• While new diagnoses have decreased significantly and are expected to continue decreasing, the number of persons living with AIDS in San Mateo County is increasing. For the year 2000, there are projected to be only 18 new AIDS diagnoses and 627 persons living with AIDS in San Mateo County. There are an estimated 2,500 to 3,500 people infected with HIV in the county. ⁶²⁸
• Improved drug therapies have extended the lives of many persons living with AIDS. Now that many are living longer, new challenges – such as concerns about insurance coverage and access to expensive drug therapies – are surfacing. The promising new drug therapies (e.g., protease inhibitors) can cost as much as $15,000 per patient annually. Furthermore, the need for affordable or supportive housing will remain high. ⁶²⁹

• There has been a sharp decline in AIDS case rates in San Mateo County (from a high of 32.7 diagnosed cases per 100,000 population in 1993 to 6.2 per 100,000 in 1997). The 1997 rate is roughly equal to that recorded in 1985 near the beginning of the AIDS epidemic. ⁶³⁰

• Despite the dramatic decrease in the overall infection rate, African-Americans disproportionally suffer from AIDS. San Mateo County AIDS case rates continue to be much higher for African-American residents (26.5 per 100,000 in 1997), although this rate is also declining sharply and the gap between African-Americans and other races/ethnicities is narrowing. Case rates are comparatively low for Asian residents (1.5 per 100,000 in 1997). ⁶³¹

• Among all AIDS cases diagnosed between 1982 and 1997, 88.8% have been among men, 11.2% among women. A total of 69% of male cases and 77% of female cases have been among those between ages of 25 and 44. Overall, 2.6% of AIDS cases were persons under the age of 25. ⁶³²

• By exposure mode, the majority of male AIDS cases in 1997 continue to be among men who have sex with men (25 cases per 100,000 population) and injection drug users (10 per 100,000). However, case rates are decreasing for each of these exposure categories, most notably among the male homosexual population. ⁶³³

• Among women, injection drug use is the primary exposure category (with a rate of 4 cases per 100,000). Likewise, these cases have been decreasing considerably over the past three years.⁶³⁴

• Geographically, AIDS case rates vary within the county; the highest case rates between 1982 and 1997 have been recorded in the ZIP Codes 94014, 94005, 94044, 94063 and 94303. ⁶³⁵

perceptions of HIV risk

• In the 1998 San Mateo County Behavioral Risk Factor Survey, 4.3% of San Mateo County adults aged 18 to 64 identified themselves to be at "high" or "medium" risk for HIV infection (similar to the 4.2% response nationwide). In San Mateo County, perceived risk is higher among those with a high school education or less (6.8%), Hispanics (6.7%), those aged 18 to 39 (6.4%), men (5.7%) and Asians/Pacific Islanders (5%). ⁶³⁶

• A total of 42.4% of San Mateo County adults 18-64 personally know someone infected with the AIDS virus (compared to 30.4% of Americans).⁶³⁷

• A total of 40.9% of adults 18-64 in San Mateo County have been tested for HIV, apart from testing done when donating blood (similar to the 40.2% reported nationally). San Mateo County testing is higher among African-Americans (77.1%), Hispanics (54.1%) and adults aged 18 to 39 (50.2%). ⁶³⁸

• African-American respondents report the highest level of being tested for HIV, followed by Hispanics, and younger adults (18-39). ⁶³⁹

• Nearly two-thirds (63.4%) of San Mateo County adults believe HIV/AIDS education for children should begin in grade school (grades 1 through 6). A total of 15.6% believe it should begin in middle school (7th or 8th grade), while 6.5% believe it should begin between the 9th and 12th grades. A total of 13.3% were uncertain, and 1.2% said it should not be taught at all.⁶⁴⁰

• Most respondents (92.3%) stated that, if they had a teenager who was sexually active, they would encourage him/her to use a condom. A total of 1.4% said they would not encourage condom use, and 6.3% said they would give other advice (e.g., abstinence).⁶⁴¹

641   Ibid.