Hispanics or Latinos are not only the fastest-growing segment of the US population, but they represent a disproportinately large share of people infected wtih HIV. This largely unrecognized problem poses issues for both the Hispanic community and for the health care professions.
Since the recent Presidential election, we’re more aware than ever that Hispanics and Latinos (referred to as Latinos hereafter) are the fastest-growing segment of the US population. But we may not be as aware of the increasing rate of new HIV cases in this population.
A recent report from the Centers for Disease Control and Prevention found that although Latinos make up 14% of the US population, they account for 20% of those diagnosed with HIV/AIDS. In 2010, rates of new HIV infections in Latinos were nearly three times higher than those in whites, second only to blacks.
The CDC report also found substantial geographic variations in HIV infections among Latinos, with the highest percentage among those born in Puerto Rico who had heterosexual contact or were injectable drug users. States in the northeast had rates nearly 4 times higher than those in the South, at 1,252.6/100,000 versus 333.7/100,000.
Guillermo Chacon knows the numbers well. As president of the Latino Commission on AIDS, it is his job to get the word out to the Latino population and to healthcare professionals who treat them about prevention, testing, and the importance of early and sustained treatment.
He doesn’t have an easy job.
Among his challenges:
• Diversity of messaging. Information not only has to be in English and Spanish, but targeted to subsets of the Latino population, such as Puerto-Rican-Americans, Cuban-Americans, and Mexican-Americans.
• Population diversity. There has been a huge migration of Latinos from population centers in California, Texas, and Florida to states throughout the US, particularly in the south. Many of those infected live in US territories such as Puerto Rico and the Virgin Islands. “You will not see too much attention paid to these islands,” said Chacon.
• Anti-immigrant sentiment. This makes even legal immigrants loath to visit hospitals or clinics for testing, increasing the risk that they will spread the infection and/or develop AIDS. Indeed, the CDC finds that Latinos are more likely than whites or blacks to be tested for HIV late in their illness (defined as diagnosis with AIDS within one year of a positive HIV test).1 Since the insurance mandate in the Affordable Care Act doesn’t cover illegal immigrants, this problem will continue even after most Americans get health insurance in 2014.
• Stigma. There is significant stigma associated with HIV in the Latino population, which increases their reluctance to get tested and reduces treatment adherence. “A lot of people still believe the problem only exists in the gay community,” Chacon said. In 2009, men who have sex with men (MSM) accounted for 81% of new HIV infections among all Latino men, 45% in those under 30. Latina women accounted for 21% of new infections, a rate more than four times that of white women. “We always remind people that HIV does not discriminate,” Chacon said.
• Retaining patients in care. Latinas are less likely than whites to remain in care and remain adherent to ART.2 “If the person in care gets disconnected from treatment, when they return it will cost 5 to 10 times more to treat them, and, of course, we will have fewer resources,” Chacon said. Treatment discontinuation also increases the risk of viral resistance to anti-retroviral therapy (ART).
• Physician barriers. This includes poor communication between healthcare providers and Latinos, lack of cultural competency by healthcare providers, discrimination, and stereotyping. Chacon also highlights physician shortages in many predominately Latino neighborhoods.
The Commission runs a variety of programs available to providers around the country, including:
• Treatment Now, an intensive “boot camp” for providers and HIV-positive consumers about HIV/AIDS from the point of view of those living with the disease
• National Latino AIDS Awareness Day to spread awareness of prevention and testing
• A partnership with the Hispanic Medical Association to improve the quality of care and outreach provided to the Hispanic/Latino community
• Bridges to Health, a New York statewide initiative that educates clinicians on the needs of Latino lesbian, gay, bisexual, and transgender people
To identify more Hispanic/Latino individuals at risk for HIV, encourage testing, and retain patients in treatment, Chacon says, primary care physicians have to fully engage their patients. A brief from Mathematica Policy Research, Inc identified 43 successful strategies that Ryan White-funded healthcare clinics are using, including referrals for social services, targeted outreach to Latino populations, peer health counselors, special materials in Spanish, home or clinic delivery of HIV medications, conferences and media efforts targeted to Latinos, and Latino representation on HIV prevention and treatment planning councils.
“If the doctor is not engaged in supporting the delivery of care, or the patient isn’t aware of the level of complications HIV implies, patients might go to one appointment and no more,” Chacon said. “This is a tremendous challenge in our community.”
REFERENCES: 1. Centers for Disease Control and Prevention. Previous HIV Testing Among Adults and Adolescents Newly Diagnosed with HIV Infection - National HIV Surveillance System, 18 Jurisdictions, United States, 2006â2009. MMWR. 2012;61(22):441-445.2. Hargreaves M, Hidalgo J, Byrd V, et al. Strategies for Engaging and Retaining Latinos in HIV Care. Mathematica Policy Research, Inc; 2010.