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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. 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

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  1. Caring for Special Populations Transgender, Homeless and Crystal Methamphetamine Users in Los Angeles County

  2. 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

  3. 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)

  4. Presentation Overview • Population Estimates • Data Used in the Presentation • Demographics • Risks • Service Utilization • Complexity of Care • Conclusion

  5. 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.

  6. 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.

  7. 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

  8. Data Sources • Casewatch Data 2005 • Limitations • Missing Data • Variables Not Including Meth Use

  9. 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

  10. Data Sources • County-wide Risk Assessment Survey • (CRAS) 2004 • Limitations • Cross-Sectional • Self-Reported Response • Only for High Risk Populations

  11. Demographics • Transgender by Race, Casewatch 2005 n=312

  12. Demographics • Transgender by Age (Years), Casewatch 2005 n=312

  13. Demographics • Transgender by Country of Birth, Casewatch 2005 n=312 *Missing=32

  14. Demographics • Homeless by Race, Casewatch 2005 n=2015 *Missing=4

  15. Demographics • Homeless by Gender, Casewatch 2005 n=2015

  16. Demographics • Homeless by Age (Years), Casewatch 2005 n=2015

  17. Demographics • Homeless by Country of Birth, Casewatch 2005 n=2015 *Missing=140

  18. Demographics • Transgender, Homeless, and All Clients by Race, Casewatch 2005

  19. Demographics • Meth Users by Race, CRAS 2004 n=856

  20. Demographics • Meth Users by Gender, CRAS 2004 n=856

  21. Demographics • Meth Users by Age (Years), CRAS 2004 n=856

  22. Demographics • Transgender, Homeless, Meth Users and All Respondents by Race, CRAS 2004

  23. Demographics • Transgender, Homeless, Meth Users and All Respondents by Gender, CRAS 2004

  24. Demographics • Transgender, Homeless, Meth Users and All Respondents by Age, CRAS 2004

  25. Risks • Transgender by Behavioral Risk Groups, CRAS 2004 n=199

  26. Risks • Homeless by Behavioral Risk Groups, CRAS 2004 n=1427

  27. Risks • HIV-Positive Homeless by Behavioral Risk Groups, CRAS 2004 n=150

  28. Risks • Meth Users by Behavioral Risk Groups, CRAS 2004 n=856

  29. Risks • HIV-Positive Meth Users by Behavioral Risk Groups, CRAS 2004 n=105

  30. Risks • Transgender, Homeless, Meth Users and All Respondents by Behavioral Risk Groups, CRAS 2004

  31. Risks • HIV+ Transgender, Homeless, Meth Users and All Respondents by Behavioral Risk Groups, CRAS 2004

  32. Risks • Transgender by Primary HIV Exposure, Casewatch 2005 n=312 *missing=13

  33. Risks • Homeless by Primary HIV Exposure, Casewatch 2005 n=2015 *missing=168

  34. Risks • Transgender, Homeless, and All Clients by Primary HIV Exposure, Casewatch 2005

  35. 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

  36. Service Utilization • Transgender Receiving Outpatient Medical Services by Race, Casewatch 2005 n = 207

  37. 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

  38. 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

  39. Service Utilization • Homeless Receiving Outpatient Medical Services by Race, Casewatch 2005 n = 1219

  40. 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

  41. 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

  42. 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

  43. Service Utilization • Meth Users Receiving Outpatient Medical Services by Race, CRAS 2004 n = 356

  44. Complexity of Care • Poverty Level • Insurance Status • Co-morbid conditions • Mental Health • Substance Abuse • Homelessness • STDs • Other Factors

  45. Complexity of Care • Transgender, Homeless, and All Clients by Poverty Level, Casewatch 2005

  46. Complexity of Care • Transgender, Homeless, and All Clients by Insurance Status, Casewatch 2005

  47. Complexity of Care • TG, Homeless, Meth Users, and All Respondents Receiving Mental Health or Psychosocial Support, CRAS 2004

  48. Complexity of Care • Transgender, Homeless, and All Clients Receiving Mental Health Treatment, Casewatch 2005

  49. Complexity of Care • Substance Use* Last 6 Months for TG, Homeless, Meth Users and All Respondents, CRAS 2004 *Excluding Alcohol

  50. Complexity of Care • Ever Injected Drugs for TG, Homeless, Meth Users and All Respondents, CRAS 2004

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