HIV / AIDS, Homelessness, and Race in Orange County, California
Descriptive Epidemiology Approach
Orange County, California, located south of Los Angeles, is not widely known as a place of cultural diversity. Southern Californians often think of life south of 'the Orange Curtain' as consisting of theme parks (e.g. Disneyland and Knott's Berry Farm), high-tech economic growth, master planned communities, suburban affluence, and conservative politics (Anonymous, 2004). But life in Orange County has not been static. One reflection of its dynamic character has been the rapid diversification in its population over the past decade. For the County as a whole, the 2010 U.S. Census indicated that its thirty-one cities and unincorporated areas had a population of 2.4 million, having increased approximately 25 per cent over the past decade (Rahimian et al., 2003). While the County's population remained dominated by non-Hispanic Whites (about 65 per cent of the County's population in 1990), the growth in the various minority populations constituted a primary source of overall County increases since 1980. The proportion of Asian and Pacific Islanders grew, for example, from 4.8 per cent of the total population in 1980 to 10. 3 per cent in 1990, representing a 166 per cent change over the decade. The Vietnamese community, in particular, experienced rapid growth during the 1980s, more than doubling in size, and currently representing about 3 per cent of the County's total population. The Vietnamese population tends to be concentrated in the cities of Garden Grove and Westminster (in the north-west portion of the County) (Ropers, 1988).
While the Hispanic population in Orange County did not grow as rapidly as many of the Asian Pacific groups, their proportion of the population increased from 15 per cent in 1980 to 23 per cent in 2000 (Santoyo, 2003). Hispanics in Orange County (comprised mostly of individuals of Mexican descent, and usually self-identifying as Latinos and Latinas) now total approximately 565,000 individuals. The County's largest city, Santa Ana, with a population of approximately 294,000 was about 65 per cent Latino in 2000 (Gurza, 2002). The Latino population tends to be concentrated in the northern County cities of Santa Ana and Anaheim. In general, there is relatively little interaction between the Latino and Vietnamese populations in Orange County, although there are growing professional affiliations through business associations and human service providers.
The significant changes in the demographic portrait of Orange County have implications for its racialization of work and residence. A central element in the economic development of the County, particularly between the 1950s and 1980s, was the growth in aircraft and defense-related industries (Rahimian et al., 2003). The resulting high-technology industrial complex created a polarized labor market, where highly skilled engineers, technicians, and management tended to be white, while the blue-collar labor force (involved in agriculture, construction, and bench work) provided employment for the growing Latino and Asian immigrant population (Mishra, 2010). Recently, the cutbacks on defense related spending (resulting in the closing of military bases and the downsizing of defense-related manufacturing and production), the fiscal woes of the County (suffering recently from the largest municipal bankruptcy in U.S. history), and the growing political focus on immigration have meant that low-income households, particularly recent immigrants, have been subject to a shrinking labor market, pressures to reduce or eliminate health and human services, and an increasingly vitriolic public response to their presence (Newton, 2007).
Definition of Incidence and Prevalence
While few understand Orange County as a region of rapid demographic change, even fewer (both within and outside the County) perceive this municipality as having to deal with issues of poverty and homelessness (Wood et al. 2000). As in other metropolitan areas, however, particularly during the late 2000's, homelessness became an increasingly significant issue in the County. Homeless advocates in the County estimate that there are between 12,000 and 15,000 homeless persons throughout the County on any given night (Anonymous, 2004). Perhaps because of the lack of recognition of homelessness as a significant issue, there remains relatively little policy intervention regarding emergency shelter, affordable housing, or other issues specifically associated with homelessness. Across the County, for example, there are only about 1,000 shelter beds available (Orange County HIV Planning Advisory Council, 2006). There has not been a co-ordinated County effort to address homelessness, rather programs and facilities tend to operate in an ad hoc way, with many programs extremely vulnerable to the changing nature of federal, state, and private charitable funding sources. Facilities providing services for homeless persons tend to be concentrated in the northern, more urbanized areas of the County; however, there are food banks, drop-in mental health care clinics, and other services sporadically located throughout Orange County (Orange County HIV Planning Advisory Council, 2006).
Research on homelessness in Orange County has indicated that it is both similar and distinct from homelessness occurring in urban, metropolitan, 'inner-city' areas, such as the Skid Row areas of cities (Mishra, 2010). Similarly to studies of inner-city homeless populations, samples drawn from the Orange County homeless population are largely male and unmarried, with large proportions newly homeless (i.e. less than one year). However, homelessness in the County also tends to reflect different demographic patterns from inner-city populations, with large proportions White and Latino / Hispanic and smaller proportions consisting of African-Americans (although African-Americans still tend to be overrepresented in the homeless population when compared to the U.S. Census describing the overall County demographic portrait). A large proportion of these homeless persons have lived in the County for long periods of time, many living in the area for five years or longer (Gurza, 2002).
HIV / AIDS has also become increasingly significant in Orange County since the late 1980s. 4 Between 1987 and 1993, over 1,500 deaths in Orange County were attributed to HIV / AIDS, with a steadily increasing trend in the number of deaths (Mishra, 2010). The Orange County Health Care Agency estimated that between 6,400 and 8,600 persons were living with HIV / AIDS as of January 1994. People living with HIV / AIDS in Orange County tend to be overwhelmingly male (approximately 90 per cent) and primarily White. Women constituted approximately 24 per cent of the population testing HIV-positive in 1994. Although the population of non-Whites living with HIV / AIDS remains relatively small, the proportion of Latinos/Latinas, African-Americans, and Asians living with HIV / AIDS has increased, particularly over the past five years (Rahimian et al. 2003). The proportion of AIDS cases by Latinos/Latinas rose from 16 per cent in 1989 to 26 per cent in 1994, the proportion of African-Americans increased from 3 per cent in 1989 to 5 per cent in 1994, and the proportion of Asians rose from 1 per cent in 1989 to 3 per cent in 1994. These 1994 statistics indicate that, in Orange County, Latinos/Latinas and African-Americans were disproportionately represented among reported AIDS cases, and Asians were underrepresented, mirroring national statistics collected through the Centers for Disease Control and Prevention (Chow, 2006).
Public perception of HIV / AIDS in the County as a whole is one of concern, tempered by its lesser priority in relation to gangs, violence, and substance abuse. A recent attitude survey of Orange County residents about AIDS education and prevention indicated that most respondents see AIDS as less problematic than crime, substance abuse, and health care for low-income persons, that most believe that AIDS education should be incorporated into high schools, and that few (about 10 per cent) would participate in protests against AIDS education and prevention programs in the public school system (Chow, 2006). Such moderate political response tends not to be the norm for a county dominated by conservative politics and which served as the birthplace for Proposition 187 (a recently passed California State initiative which would deny education and health benefits to undocumented immigrants and their families) (Ropers, 1988).
The institutional response to HIV / AIDS has tended to be relatively progressive even given the conservative nature of the County's politics. The Health Care Agency of the County of Orange has, since the early 1990s, used applied anthropology to develop culturally specific prevention and education programs for female sex workers and undocumented Spanish-speaking males (Wood et al. 2000). In addition, as a consequence of changing federal procedures for determining funding priorities and disseminating funds, the County has co-ordinated an HIV Prevention Planning process incorporating multiple perspectives: persons living with HIV / AIDS; persons of color; gay, lesbian, bisexual, and transgender persons; service agencies; academics and professional consultants; and multiple County agencies (Anonymous, 2004). Human services funded through the County associated with HIV / AIDS provide HIV testing, referral, social support, or case management services. These services tend to be concentrated in Santa Ana (the County seat) or Laguna Beach (a gay/lesbian enclave), but are also located in other cities (Mishra, 2010).
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