Making sense of California's HIV statistics requires a few emails to the state Office of AIDS, because the epidemiology surveillance reports continue to be confusing and difficult to decipher.
The latest semi-annual report contained a chart (see below), with annual HIV figures represented with practically indistinguishable colored lines and no yearly breakdowns of transmission categories, personal demographics or by county. Let's get to my Q & A with the California Department of Public Health:
QUESTION 1: Are California's HIV reported cases up, down or stable?
CDPH RESPONSE: The numbers of new HIV diagnoses reported to the Office of AIDS for the last two years were 4,944 (2011) and 4,960 (2012). This small 0.3 percent difference suggests that newly reported HIV diagnoses were stable across the two years. The total number of people living with HIV/AIDS in the state continues to increase since the number of new diagnoses is stable and people with HIV/AIDS are living longer.
QUESTION 2: Since chart of annual HIV stats uses very similar colors for recent years that overlap, making it impossible to determine the difference in stats each year, why does the AIDS Office make it difficult for the public to make sense of the chart?
CDPH RESPONSE: Thank you for this feedback. We will use colors that are more dissimilar in future reports.
QUESTION 3: I've advocated for years that the state provide the public and HIV prevention and treatment organizations with year by year and county by county breakdowns, so we can see what's happening with stats and transmissions and all, and better direct services and dollars. Why is the semi annual report not providing these breakdowns?
CDPH RESPONSE: These data will soon be easy to access. Summary HIV surveillance data for 2012 will be placed on the new CDPH Data Portal by the end of the year, and previous years will be added in the near future. The Data Portal allows for easy access to public data and can be found at https://health.data.ca.gov/ . Additionally, OA is actively working to revise our semi-annual report to provide more useful surveillance data, including data broken out by year.
QUESTION 4: Is there any evidence that HIV diagnoses have dropped due to Truvada as a PrEP method, or maybe because of PWAs being on cocktails with undetectable viral loads, or sero-sorting and poz people having sex only with poz people?
CDPH RESPONSE: The numbers of new HIV diagnoses reported between 2011 and 2012 is stable, so there is no evidence of a drop that could be attributed to using Truvada as PrEP, which received federal Food and Drug Administration (FDA) approval in July 2012. In the longer term, California has experienced a decline in new HIV diagnoses since the early 1990s. However, we do not have the data to be able to attribute this to any particular intervention or behavior change.
It's good to have this information and I have some responses to share.
I must point out that the state Office of AIDS has been promising for years to make the annual stats chart easier to read and to use a color scheme that allows readers to grasp the rates, and it shouldn't take the agency years to simply redesign one chart.
Since the agency again confirms declining HIV rates for about two decades, it's troubling they can't attribute any cause or two or more to why the transmission rates have fallen. It's never too early to ask questions about new prevention modalities such as taking Truvada as part of a pre-exposure prophylaxis plan.
If the state lacks data about the decline's causes, how many more years are needed before determining the causes and we should know this data to keep the numbers going down.
Follow this link to read the new semi-annual report: http://tinyurl.com/lwtdsey.