AIDS Meeting Will Examine Epidemic : Health: Participants will look at dynamics of the disease, which are changing in the county. Treatments, testing of pregnant women will also be addressed.

When the Orange County HIV/AIDS conference convenes today, speakers will confront the changing face of the AIDS epidemic in Orange County, where the disease, once largely confined to white gay men, is cropping up among Latinos, blacks and heterosexuals, and among women and children.

“We still have HIV disease, and we are still hearing reports of newly infected people,” said Penny Weismuller, who is in charge of the county’s AIDS programs, adding that she doesn’t think the disease has reached its peak here.

The Orange County Health Care Agency--which is sponsoring the two-day Seventh Annual HIV/AIDS on the Frontline conference--reports that as of December, 1993, 3,091 cases of acquired immune deficiency syndrome have been recorded in the county. The number of new cases identified annually here has grown sharply since the first cases were reported in 1981.

When the county passed the threshold of 2,000 cumulative AIDS cases in 1992, it qualified for the first time for special federal funding that is providing close to $2 million for medical and social services for those with HIV.

In 1993, 789 new AIDS cases were reported in Orange County, a 72% increase over the 458 cases reported in 1992. However, county officials credit the huge increase last year to a much broader definition of AIDS adopted nationally that catches the disease in earlier stages.

In 1992, the latest year for which such data is available, HIV infection was the leading cause of death in persons 25 to 44 years of age in the county.

AIDS remains far more concentrated among white men in Orange County than in the rest of the nation, with whites representing 75% of cumulative AIDS cases in 1993, compared to about 50% nationally.

In 1992, Laguna Beach had a higher rate of AIDS than any other U.S city; San Francisco was second.

But the distribution of AIDS in the county is gradually changing.

The proportion of whites with AIDS has declined from 86% of cases before 1988 to 65% of the cases reported in 1993, while Latinos have increased from 10% of AIDS cases before 1988, to 21% of new cases in 1992, to 26% in 1993.

Weismuller said Latino men are passing the AIDS virus to women in part because of bisexual and extramarital sexual activity. Also, county figures show that more Latino men than white men acquire AIDS from drug injections.

AIDS rates have increased most rapidly, however, among black men and women, who represented 6% of AIDS cases reported in 1993, up from 3% in 1991. The spread of AIDS among African Americans in the county mirrors what is happening nationally, county officials report.

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While men having sex with other men is still the most prevalent form of AIDS transmission in Orange County, intravenous drug use is becoming an important factor. It accounted for only 3% of AIDS cases reported before 1988, but 13% of cases reported in 1993.

AIDS has gradually begun to infect the county’s women.

The county found female AIDS cases rose from 6% of all those reported in 1991 to 6.6% in 1992, to 8.2% in 1993. But that is lower than nationally, where 12% of AIDS cases are women.

Dr. Beverly Sansone, director of the gynecological clinic for HIV-infected women at UCI Medical Center, said she had doubted AIDS was a significant problem among women in Orange County until two years ago, when she began to get referrals from the UCI women’s clinic. She was asked to treat their AIDS-related gynecological problems.

“It opened my eyes,” said Sansone, who in 1993 treated 65 female patients newly diagnosed with AIDS.

Sansone, who will speak at the conference at the Red Lion Inn, said her mission is to increase awareness among the public and the county’s physicians about the importance of testing for HIV in women, especially those who have chronic yeast and herpes infections, which may be symptomatic of the disease.

Another topic expected to be discussed at the conference is the importance of testing for HIV in pregnant women, especially in the wake of reports that showed giving AZT to pregnant women may protect fetuses from contracting HIV. So far, 21 cases of AIDS in children have been reported in Orange County; 13 of the children got the disease from infected mothers.

“The American College of Obstetrics and Gynecology has recommended that all pregnant women be tested,” said Sansone, noting that routine HIV testing of pregnant women has been instituted at UCI’s obstetrical clinics within the past two years.

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Developments in the treatment of HIV-infected patients also will be discussed at the conference, said Dr. Jody Meador, the county’s AIDS medical director.

“I think over the last several years we have made significant gains in keeping patients healthy longer primarily by medications that prevent complications and by the use of antivirals like AZT, DDI and DDC,” she said.

Conferences like the one in Orange County, Meador said, are attended by physicians trying to keep up with fast-evolving treatment strategies. Among those issues are choosing the right time to start administering antiviral drugs and deciding whether such drugs should be given alone or in combination, she said.

The conference, which addresses topics ranging from HIV in adolescents to death and the grieving process, is also expected to attract educators, paramedics, hospital administrators and social workers, as well as people infected with HIV.

The public may register at the door. The fee is $120 for both days or $75 for one day.

Over the past seven years, county organizers said, the conference has expanded from a gathering of 200 local participants to a much more sophisticated scientific event, which this year is expected to attract 800 people, including international AIDS experts.

AIDS in Orange County

The number of new AIDS cases reported in Orange County each year has increased rapidly since the first case was identified in 1981. The increase from 1990 to 1991 is due, in part, to a more intensive surveillance effort undertaken to qualify for special AIDS funding. The slight decrease between 1991 and 1992 represents return to a less intensive reporting program. The 72% increase in 1993 is due mainly to an expansion of the definition of AIDS. Using the 1992 definition, just 269 cases (34%) would have been recorded.

1981: 0

1993: 789

Ethnic Trends

During the past five years, the percentage of whites among new AIDS cases has been shrinking. At the same time, the number of Latino cases has almost doubled. Precent of new AIDS cases:

Year White Latino Black Asian Other/unknown 1988 82% 16% 4% *% *% 1989 77 16 3 1 3 1990 82 13 3 * 2 1991 75 20 3 1 1 1992 70 21 5 3 1 1993 65 26 6 1 2

* Less than 1% AIDS Transmission

Homosexual activity is the largest single source of AIDS among Orange County men. Among women, heterosexual contact and intravenous drug use are about equally responsible. Exposure categories, 1988-93:

Men

Homosexual/bisexual: 77%

Other/unknown: 5%

Hemophiliac: 1%

Transfusion recipient: 1%

Heterosexual: 2%

Intravenous drug user: 14%

Women

Homosexual: 40%

Other/unknown: 5%

Pediatric*: 5%

Transfusion recipient: 14%

Intravenous drug user: 36%

*Includes transfusion recipients, hemophiliacs and those with HIV-infected mothers.Comparative Rates:

There are 12 counties in California with higher rates of AIDS than Orange County. The highest: San Francisco County, with 2,190 per 100,000 residents. Here’s how Southern California counties compare to one another and to the state. Cumulative cases per 100,000 residents, 1981-1993:

Los Angeles: 258

San Diego: 200

Riverside: 127

Orange: 121

San Bernardino: 91

Ventura: 57

California: 213

Sources: Orange County Health Care Agency; California Department of Health Services: Researched by APRIL JACKSON and LESLIE BERKMAN / Los Angeles Times