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Caring for Special Populations. Transgender, Homeless and Crystal Methamphetamine Users in Los Angeles County. Ryan White CARE Act 2006 All Grantees Conference. Juhua Wu, MA Mike Janson, MPH County of Los Angeles Department of Public Health Office of AIDS Programs and Policy August 2006.

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caring for special populations

Caring for Special Populations

Transgender, Homeless and Crystal Methamphetamine Users in

Los Angeles County

ryan white care act 2006 all grantees conference

Ryan White CARE Act 2006 All Grantees Conference

Juhua Wu, MA

Mike Janson, MPH

County of Los Angeles

Department of Public Health

Office of AIDS Programs and Policy

August 2006

los angeles county

SPA 1: Antelope Valley

SPA 2:

San Fernando

SPA 3:

San Gabriel

SPA 4:

Metro

SPA 5:

West

SPA 7:

East

SPA 6: South

SPA 8:

South Bay

Los Angeles County
  • Square Miles: 4,086
  • Population: 9.9 Million
  • Latino/a 45.7% White 31.0%Asian/PI 13.2%African-American 9.7%Native American 0.3%
  • Proportion of California Population: 29%
  • Proportion of California AIDS Cases: 35%
  • Proportion of U.S. AIDS Cases: 5%
  • Living with HIV/AIDS:
  • 57,000 (Estimated)
presentation overview
Presentation Overview
  • Population Estimates
  • Data Used in the Presentation
  • Demographics
  • Risks
  • Service Utilization
  • Complexity of Care
  • Conclusion
special populations estimates in los angeles county
Special Populations Estimates in Los Angeles County
  • Transgender
    • Estimated PLWH/A* 1,660
    • HIV Seroprevalence* 11.0%
      • Range from available data = 7.1% - 22.2%
  • Homeless
    • Estimated PLWH/A* 8,100
    • LA Homeless Services Authority

Annual Projection 7,748

    • HIV Seroprevalence* 5%
      • Range from available data = 1.4% - 5.4%

*Source: Los Angeles County HIV Epidemiology Program 2003 and 2005.

special populations estimates in los angeles county1
Special Populations Estimates in Los Angeles County
  • Crystal Meth Users
    • Estimated PLWH/A N/A
    • HIV Seroprevalence
      • Data for Meth Users of All Risks N/A
      • Among MSM Meth Users* 18-20%

*Sources: Countywide Risk Assessment Survey 2004; Los Angeles Men’s Survey 2004.

data sources
Data Sources
  • Casewatch Data 2005
    • Clients Receiving RWCA HIV Care Services Funded by OAPP
    • Mandatory Data Management System for Care Services Contractors
    • Variables
      • Demographics
      • Health Treatment History
      • Service Utilization
      • Health Outcomes
data sources1
Data Sources
  • Casewatch Data 2005
    • Limitations
      • Missing Data
      • Variables Not Including Meth Use
data sources2
Data Sources
  • County-wide Risk Assessment Survey
  • (CRAS) 2004
    • Clients Receiving HIV Prevention Services from Agencies funded by Health Department
    • Voluntary Survey Targeting High Risk Individuals
    • Survey Questions
      • Demographics
      • Drug and Sexual Risk Behaviors
      • Perception about Sex, drug use and condoms
      • Service Utilization
data sources3
Data Sources
  • County-wide Risk Assessment Survey
  • (CRAS) 2004
    • Limitations
      • Cross-Sectional
      • Self-Reported Response
      • Only for High Risk Populations
demographics
Demographics
  • Transgender by Race, Casewatch 2005

n=312

demographics1
Demographics
  • Transgender by Age (Years), Casewatch 2005

n=312

demographics2
Demographics
  • Transgender by Country of Birth, Casewatch 2005

n=312 *Missing=32

demographics3
Demographics
  • Homeless by Race, Casewatch 2005

n=2015 *Missing=4

demographics4
Demographics
  • Homeless by Gender, Casewatch 2005

n=2015

demographics5
Demographics
  • Homeless by Age (Years), Casewatch 2005

n=2015

demographics6
Demographics
  • Homeless by Country of Birth, Casewatch 2005

n=2015 *Missing=140

demographics7
Demographics
  • Transgender, Homeless, and All Clients by Race, Casewatch 2005
demographics8
Demographics
  • Meth Users by Race, CRAS 2004

n=856

demographics9
Demographics
  • Meth Users by Gender, CRAS 2004

n=856

demographics10
Demographics
  • Meth Users by Age (Years), CRAS 2004

n=856

demographics11
Demographics
  • Transgender, Homeless, Meth Users and All Respondents by Race, CRAS 2004
demographics12
Demographics
  • Transgender, Homeless, Meth Users and All Respondents by Gender, CRAS 2004
demographics13
Demographics
  • Transgender, Homeless, Meth Users and All Respondents by Age, CRAS 2004
risks
Risks
  • Transgender by Behavioral Risk Groups, CRAS 2004

n=199

risks1
Risks
  • Homeless by Behavioral Risk Groups, CRAS 2004

n=1427

risks2
Risks
  • HIV-Positive Homeless by Behavioral Risk Groups, CRAS 2004

n=150

risks3
Risks
  • Meth Users by Behavioral Risk Groups, CRAS 2004

n=856

risks4
Risks
  • HIV-Positive Meth Users by Behavioral Risk Groups, CRAS 2004

n=105

risks5
Risks
  • Transgender, Homeless, Meth Users and All Respondents by Behavioral Risk Groups, CRAS 2004
risks6
Risks
  • HIV+ Transgender, Homeless, Meth Users and All Respondents by Behavioral Risk Groups, CRAS 2004
risks7
Risks
  • Transgender by Primary HIV Exposure, Casewatch 2005

n=312 *missing=13

risks8
Risks
  • Homeless by Primary HIV Exposure, Casewatch 2005

n=2015 *missing=168

risks9
Risks
  • Transgender, Homeless, and All Clients by Primary HIV Exposure, Casewatch 2005
service utilization
Service Utilization
  • Transgender Receiving RWCA Services, Casewatch 2005
    • 66% Access Ambulatory/Outpatient Medical Services
      • 72% Among General Client Population
    • 25% Receive Mental Health Treatment
    • 47% Receive Case Management Services
service utilization1
Service Utilization
  • Transgender Receiving Outpatient Medical Services by Race, Casewatch 2005

n = 207

service utilization2
Service Utilization
  • Transgender Receiving Outpatient Medical Services by Number of Visits, Casewatch 2005

n=207

Mean = 8.5 Median = 7

All Clients: Mean = 7.8 Median = 6

service utilization3
Service Utilization
  • Homeless Receiving RWCA Services, Casewatch 2005
    • 61% Access Ambulatory/Outpatient Medical Services
      • 72% Among General Client Population
    • 29% Receive Mental Health Treatment
    • 54% Receive Case Management Services
service utilization4
Service Utilization
  • Homeless Receiving Outpatient Medical Services by Race, Casewatch 2005

n = 1219

service utilization5
Service Utilization
  • Homeless Receiving Outpatient Medical Services by Number of Visits, Casewatch 2005

n=1219

Mean = 8.4 Median = 7

All Clients: Mean = 7.8 Median = 6

service utilization6
Service Utilization
  • Meth Users Receiving Care Services, CRAS 2004
    • 42% Received Outpatient Medical Services
    • 37% Received Mental Health Or Psychosocial Support
    • 48% Received Case Management Services
service utilization7
Service Utilization
  • HIV-Positive Meth Users Receiving Care Services, CRAS 2004
    • 73% Received Outpatient Medical Services
    • 63% Received Mental Health Or Psychosocial Support
    • 82% Received Case Management Services
service utilization8
Service Utilization
  • Meth Users Receiving Outpatient Medical Services by Race, CRAS 2004

n = 356

complexity of care
Complexity of Care
  • Poverty Level
  • Insurance Status
  • Co-morbid conditions
    • Mental Health
    • Substance Abuse
    • Homelessness
    • STDs
  • Other Factors
complexity of care1
Complexity of Care
  • Transgender, Homeless, and All Clients by Poverty Level, Casewatch 2005
complexity of care2
Complexity of Care
  • Transgender, Homeless, and All Clients by Insurance Status, Casewatch 2005
complexity of care3
Complexity of Care
  • TG, Homeless, Meth Users, and All Respondents Receiving Mental Health or Psychosocial Support, CRAS 2004
complexity of care4
Complexity of Care
  • Transgender, Homeless, and All Clients Receiving Mental Health Treatment, Casewatch 2005
complexity of care5
Complexity of Care
  • Substance Use* Last 6 Months for TG, Homeless, Meth Users and All Respondents, CRAS 2004

*Excluding Alcohol

complexity of care6
Complexity of Care
  • Ever Injected Drugs for TG, Homeless, Meth Users and All Respondents, CRAS 2004
complexity of care7
Complexity of Care
  • IDU Last 6 Months for TG, Homeless, Meth Users and All Respondents, CRAS 2004
complexity of care8
Complexity of Care
  • Received Drug/Alcohol Treatment for TG, Homeless,
  • Meth Users and All Respondents, CRAS 2004
complexity of care9
Complexity of Care
  • Homelessness for TG, Homeless, Meth Users and All Respondents, CRAS 2004
complexity of care10
Complexity of Care
  • TG, Homeless, Meth Users and All Respondents Receiving Housing/Shelter Services, CRAS 2004
complexity of care11
Complexity of Care
  • Homelessness for Transgender, Homeless, and All Clients, Casewatch 2005
complexity of care12
Complexity of Care
  • Transgender, Homeless, and All Clients Received STD Screen, Casewatch 2005
complexity of care13
Complexity of Care
  • Transgender, Homeless, and All Clients Received STD Treatment, Casewatch 2005
conclusion
Conclusion
  • Transgender
    • Majority Latino/a and African American
    • Older Population
    • High Proportion Foreign Born
    • Primary HIV Risk/Exposure = MSM
    • Comparing to General Clients
      • Fewer Access Medical Services but Access More Frequently
      • More Access Mental Health and Case Management Services
conclusion1
Conclusion
  • Transgender
    • Present Higher Level of Complexity in All Indicators
      • Mental Health
      • STDs
      • Homelessness
      • Substance Use
conclusion2
Conclusion
  • Homeless
    • Majority African American and Male
    • Older Population
    • More US Born than General Clients
    • HIV Risk/Exposure = MSM, IDU, Heterosexual Contact
    • Comparing to General Clients
      • Fewer Access Medical Services but Access More Frequently
      • More Access Mental Health and Case Management Services
conclusion3
Conclusion
  • Homeless
    • Present Higher Level of Complexity in All Indicators
      • Mental Health
      • Injection Drug Use
        • High Utilization of Substance Abuse Treatment Services
      • Housing Issue
conclusion4
Conclusion
  • Meth Users
    • Majority Latino and Male
    • Younger Population
    • More US Born than General Clients
    • Primary HIV Risk/Exposure = MSM among HIV+ Meth Users
    • High Utilization of Health Care Services, Especially among HIV+ Meth Users
conclusion5
Conclusion
  • Meth Users
    • Complexity of Care
      • Mental Health
      • Substance Use and IDU
        • High in Use but Low in Treatment
      • Homelessness
        • Low Utilization of Housing Services
acknowledgments
Acknowledgments
  • Eunice Muthengi, MSW

Data Analysis

Los Angeles County

Department of Public Health

Office of AIDS Programs and Policy

  • Los Angeles County HIV Prevention Planning Committee
  • Los Angeles County HIV Prevention and Treatment Providers
for additional information
Juhua Wu

HRSA Analyst

Office of AIDS Programs and Policy

600 S Commonwealth Ave Sixth Floor

Los Angeles, CA 90005

Phone: 213/351-8138

Fax: 213/381-8023

E-mail: juwu@ladhs.org

For Additional Information

Mike Janson

Research Manager

Office of AIDS Programs and Policy

600 S Commonwealth Ave Sixth Floor

Los Angeles, CA 90005

Phone: 213/351-8355

Fax: 213/381-8023

E-mail: mjanson@ladhs.org