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L.A. County, S.F. AIDS Drop Seen in ‘90s : But Study Predicts Rise in Epidemic Elsewhere in State

Times Medical Writer

A new state study predicts a plateau and then a slight decline in the annual number of AIDS cases in Los Angeles County and San Francisco by the early 1990s but continued growth of the epidemic in other areas of California.

The new case estimates for both Los Angeles County and California as a whole are also considerably lower than earlier AIDS projections for the county and the state prepared by other groups.

Some public health officials say the trends in Los Angeles and San Francisco reflect the fact that a large number of potential infections with the human immunodeficiency virus (HIV) may have been prevented in the early 1980s, after many infected and uninfected gay men adopted safer sexual practices.

“The future burden of AIDS in California may shift away from the initial epicenters of Los Angeles and San Francisco toward other portions of the state,” according to the report by the Office of AIDS of the state Department of Health Services.

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The report is contained in the January-February issue of California AIDS Update, a department publication.

Vast Majority

The vast majority of AIDS cases over the next four years, like most of the cases that have been diagnosed in California since 1981, are expected to occur in gay men, the study said. This is in contrast to the situation in New York City, where intravenous drug users already account for about half of the acquired immune deficiency syndrome cases.

If trends continue, according to the report, the greatest rates of growth of the epidemic are expected in urban areas of Southern California other than Los Angeles and in rural areas of the state.

The report cautions that the projections for 1991 and 1992, which include the decline in AIDS cases in Los Angeles County and San Francisco, are less precise than those for 1989 and 1990 and may require revision as new data becomes available.

Through 1992, the new state study projects a total of nearly 57,000 AIDS cases for California, more than three times the approximately 17,500 AIDS cases that had been reported in the state by the end of January. By comparison, previous extrapolations based on national case estimates have projected more than 70,000 AIDS cases for California by the end of 1992.

The 1992 state projections also include a cumulative total of more than 15,000 AIDS cases for Los Angeles County, about 12,500 cases for San Francisco and about 12,500 cases for Orange, Riverside, San Bernardino and San Diego Counties combined. Individual estimates for Southern California counties, other than Los Angeles, were not produced nor were specific estimates for different racial groups.

By comparison, a widely publicized report last March by the Peat Marwick Main & Co. consulting firm projected between 19,000 and 44,000 AIDS cases in Los Angeles County by the end of 1991, or one year earlier than the period covered by the new state projections. The report was prepared at the request of county officials.

Dr. Peter Kerndt, medical director of the AIDS epidemiology program for the Los Angeles County Department of Health Services, said the new state projections for the county were reasonable and, in the light of new information, appeared more realistic.

“I think the estimates last year were high,” Kerndt said.

He added that the AIDS epidemiology program was in the process of preparing its own estimates and should be available within several months.

The new projections appear to confirm an analysis by The Times last December, which documented a dramatic slowing in the growth of the AIDS epidemic through the end of 1987 in Los Angeles County, San Francisco and New York City, the American metropolitan areas struck earliest and hardest by AIDS.

“I still see a marked slowing (in these cities),” Dr. Ruth Berkelman, chief of the surveillance branch in the federal Centers for Disease Control’s AIDS program, said in an interview. “Our thoughts have not changed in the last two months.”

Berkelman predicted that any actual decline in AIDS cases “is going to be quite slow.”

But she added, “I don’t think we are going to see another steep increase (in cases in gay men in these cities).”

On the other hand, in rural areas and other urban areas of California, most HIV infections occurred later than in Los Angeles and San Francisco, and “positive changes in behavior” among gay men may not have been as profound, according to Dr. Alan Trachtenberg of the state Office of AIDS, who was one of the authors of the report. These areas “are where the epidemic is currently in its youngest phase,” he said.

As of the end of last month, there were 6,247 AIDS cases in Los Angeles County, 5,343 cases in San Francisco and a total of 2,380 cases for the four Southern California counties excluding Los Angeles, according to state statistics.

The new state projections are designed for use in predicting future health-care needs. It is based on an analysis of trends in AIDS cases diagnosed in California through September, 1988.

The statewide projections were developed from separate projections for five regions of the state. The projections were individualized to take into account regional variations; for example, the differences in the percentage of AIDS cases in gay men or intravenous drug users in different areas of the state.

The projections also include an adjustment for delays in the reporting of AIDS cases to public health officials.

PROJECTED AIDS CASES IN CALIFORNIAThe Office of AIDS of the California Department of Health Services has issued these new estimates of the projected growth of the AIDS epidemic. Separate projections were prepared for California as a whole and for five regions of the state.

California

(56,842 cumulative AIDS cases projected by the end of 1992)

Los Angeles

(15,528 cumulative AIDS cases projected by the end of 1992*)

Southern California

(12,617 cumulative AIDS cases projected by the end of 1992,*)

San Francisco

(12,672 cumulative AIDS cases projected by the end of 1992)*

San Francisco

Bay Area

(8,069 cumulative AIDS cases projected by the end of 1992*)

Rural California

(8,256 cumulative AIDS cases projected by the end of 1992)*

California (56,842 cumulative AIDS cases projected by the end of 1992;

1988 6,373

1989 7,778

1990 9,004

1991 9,972

1992 10,686

Los Angeles

1988 2,062

1989 2,279

1990 2,302

1991 2,102

1992 1,705

Southern California

1988 1,106

1989 1,577

1990 2,133

1991 2,761

1992 3,439

San Francisco

1988 1,662

1989 1,828

1990 1,858

1991 1,730

1992 1,459

San Francisco Bay area (8,069 cumulative AIDS cases projected by the end of 1992*

1988 910

1989 1,134

1990 1,329

1991 1,469

1992 1,536

Rural California

1988 634

1989 960

1990 1,383

1991 1,910

1992 2,547

* This number includes all cases since the beginning of the epidemic

Note: The numbers listed reflect the state’s “best estimate” of the number of AIDS cases. The report also calculated a range of “low” and “high” estimates for each region for each year; these are not listed.


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