HISPANICS/LATINOS AND HIV/AIDS IN THE U.S.
Hispanics/Latinos in the United States – Sincethe beginning of the epidemic, the rate of AIDS diagnosis for Hispanics/Latinos has continuously increased at disproportionate rates. According to the 2005 U.S. Census Bureau, over 40 million Hispanics/Latinos reside within the nation’s 50 states and an additional 3.8 million Latinos reside in the Commonwealth of Puerto Rico, together comprising approximately 14% of the total U.S. population.[1] At the end of 2005, the Centers for Disease Control and Prevention (CDC) estimated that approximately 18% ofthe people living with HIV/AIDS were Hispanic/Latino.[2] Of that 18% of Hispanic/Latinos living with HIV/AIDS, 23.6% wereHispanic/Latino female adults and adolescents, and 74.8% were Hispanic/Latinomale adults and adolescents,living with HIV/AIDS.[3]Of the reported AIDS cases for Hispanic/Latino male adults and adolescents, male-to-male sexual contact was the highest transmission category at 43%. Drug use came in second at 32%.[4]For Hispanic/Latino women adults and adolescents the reported AIDS cases indicated that high-risk heterosexual contact(sexual intercourse) was the highest transmission category at 49% followed by Injection Drug Use at 36%.[5]
Currently, the majority of the Hispanic/Latino population (77% or 27.1 million) is concentrated in California, Texas, New York, Florida, Illinois, Arizona and New Jersey. Half of all Hispanics/Latinos living in the United States reside in two states: California and Texas (11 million or 32% and 6.7 million or 32%, respectively). Three million Hispanics/Latinos reside in both New York and Florida. There are 22 states with Hispanic/Latino populations between 100,000 and 500,000 and 2 between 500,000 and 999,000 (New Mexico and Colorado).[6]
Rates of HIV/AIDS cases per 100,000 population–As of 2005, the rate of HIV/AIDS cases per 100,000 people in Hispanic/Latino adults and adolescents was estimated at 36.7, per 100,000 people compared to a rate of 10.4per 100,000 in Whites. For Hispanic/Latino males, the rate of HIV/AIDS was recorded at 56.2per 100,000 people compared to 18.2for White males and 124.8 for Black males. For Latinas, out of 100,000 people, 15.8Hispanic/Latinas were estimated to be infected with HIV/AIDS compared to 3.0in White women and 60.2 in Black women.[7]The states of New York and Florida bear the highest burden of estimated rates of HIV infection per 100,000 people in the U.S. The estimated rate of HIV infection at the end of 2005 in the state of New York was 237 per 100,000 people, compared to an estimated rate of 227.9 per 100,000 people in Florida.[8]
Rates of AIDS cases per 100,000 people –At the end of 2005, the rate of AIDS diagnosis for Hispanic/Latino adults and adolescents was 24 cases per 100,000 people compared to 6.9 cases per 100,000 people in White adults and adolescents. The rate of AIDS diagnoses in Hispanics/Latinos was the second highest in the nation[9].
For Hispanic/Latino adult males, the rate was recorded at 36per 100,000 people compared to 12.1 for White males. For Hispanic/Latino women, the rate of AIDS cases reflected a rate of 11.2per 100,000 people to 2 per 100,000 people for White women[10]. The AIDS case rate in Hispanic/Latino males is approximately four times greater than for Hispanic/Latino females.
Deaths– In 2005, 2,444 Hispanics/Latinos died due to AIDS, a decrease of approximately three times the death rate of 7,820 in 1993. Since 2001, the death rate among Hispanics/Latinos due to AIDS has remained fairly flat at 2,436 deaths in 2001 and 2,444 in 2005[11]. At the end of 2005, the estimated percentage of deaths due to AIDS in Hispanics/Latinos was 15%, compared to 31% in Whites and 53% in Blacks. In 2005 alone, there were an estimated 16,190 deaths due to AIDS in the U.S.[12]
AIDS Diagnosis- In 2004, 43% of Hispanics/Latinos were diagnosed with AIDS in less than 12 months of their diagnosis of HIV infection[13]. The year 1996 became a turning point for those diagnosed with AIDS as protease inhibitors became widely available. The use of this medication allowed the onset of AIDS defining symptoms to be delayed.[14]
Source of Transmission - Of the male Hispanic/Latino AIDS cases nationwide, men who have sex with men (MSM) are infected at higher rates than those who are intravenous drug users (IDU), those who are infected heterosexually, as well as, those who are both MSMs and IDUs. At the end of 2005, 42% of Hispanics/Latinos were diagnosed with AIDS, identified MSM as the source of transmission. 24 % were IDU-associated AIDS cases, and 29% were AIDS cases transmitted through high-risk heterosexual contact.[15]
At the end of 2005, 19% of the estimated number of people living with AIDS in the U.S. were Hispanic/Latino. Among Hispanic/Latino males, in 2005, 56% of reported AIDS cases were among Hispanic/LatinoMSM, 25% weredue to the use of HIV contaminated syringes (10% among Whites), 12% were among high-risk heterosexual transmission and 7% among MSMs who inject drugs. Among women living with AIDS, the estimated number of Hispanic/Latino women living with AIDS at the end of 2005 was 16.6%. Among Hispanic/Latinas, 32% of the cases are attributable to use of injection drugs (39% among White women) and 66% is attributable to high-risk heterosexual contact (58% for White women).[16]
Place of Birth – The distribution of countries of origin tells us much about the diversity of AIDS cases among Hispanics/Latinos. 32% of reported AIDS cases in Hispanics/Latinos were among Hispanics/Latinos born in the continental U.S.Of those born outside the U.S., those born in Puerto Rico report the highest percent at 17.7%closely followed by those born in Mexico at 17.1%. Hispanics/Latinos infected through the use of contaminated syringes had the highest rates of infection among Hispanics/Latinos that were from Puerto Rico with 42% compared to Hispanics/Latinos from Cuba with only 13% of the infection rate. The rate of MSM infection among Hispanics/Latinos born in Mexicowas the highest at 59% compared to 17% in Hispanics/Latinos from Puerto Rico. For Hispanics/Latinos infected through heterosexual contact, Hispanics/Latinos from Central/South America were infected at higher rates at 34% compared to 27% for Hispanic/Latinos born in Cuba, but Hispanics/Latinos from Puerto Rico had the highest high-risk heterosexual AIDS cases at 36%.[17]
Estimated numbers of AIDS cases in adult and adolescent Hispanics, by transmission category and by place of birth at the end of 2005 in the U.S. and dependent areas
Place of BirthUnited States / Central/South America / Cuba / Mexico / Puerto Rico / Total
Transmission Category / No. / % / No. / % / No. / % / No. / % / No. / % / No. / %
Male-to-male sexual contact / 1,229 / 44 / 443 / 51 / 94 / 52 / 875 / 59 / 254 / 17 / 3,602 / 42
Injection drug use / 684 / 24 / 94 / 11 / 24 / 13 / 161 / 11 / 652 / 42 / 2,073 / 24
Male-to-male sexual contact and injection drug use / 131 / 5 / 21 / 2 / 14 / 8 / 62 / 4 / 65 / 4 / 345 / 4
High-risk heterosexual contact / 716 / 26 / 292 / 34 / 50 / 27 / 367 / 25 / 554 / 36 / 2,545 / 29
Other / 48 / 2 / 11 / 1 / 0 / 0 / 23 / 2 / 10 / 1 / 109 / 1
TOTAL / 2,809 / 100 / 861 / 100 / 182 / 100 / 1,488 / 100 / 1,536 / 100 / 8,674 / 100
Geography and Incidence Rates – The incidence of AIDS cases per 100,000 people for Hispanic/Latinos is highest in the Northeast. It is also the region where the greatest proportion of Hispanics/Latinos estimated to be living with AIDS are living.[18]The rate of estimated AIDS cases at the end of 2005 in Hispanics/Latinos was 24 per 100,000 people compared to 6.9 in Whites and 68.7 in Blacks.[19]On anational level, the District of Columbia bears the burden of the highest reported AIDScases at the end of 2005 with a rate of 128.4 per 100,000 persons. New Yorkfollows DC with an incidence rate of 32.7 per 100,000 people, Florida at 27.9 per 100,000 people, Puerto Rico at 26.4 and Maryland at 28.5.[20]Although many states and U.S. territories have seen declining infection rates, states with large urban cities (where many Hispanic/Latino populations are concentrated – New York, Puerto Rico, California, Chicago, Texas) continue to have the largest incidence rates. At the end of 2005, over 89% of Hispanics/Latinos living with AIDS were living in states with large Hispanic/Latino populations.[21]
HISPANICS/LATINOS IN THE DEEP SOUTH
HIV Prevention among New Hispanic/Latino Communities in the Deep South
Many new immigrants from Latin America have settled in the southern U.S., often in communities where Hispanic/Latino residents were rare just a decade ago. Their immigration status, language barriers, politically-charged environments, poor working and living conditions, and lack of access to health care make them particularly vulnerable to disease. Awareness of the risks of HIV infection is low and opportunities for HIV prevention education uncommon. Some AIDS organizations in the region are attempting to respond to the newcomers’ needs.
Through community mapping, including participant observations, gatekeeper and key informant interviews, information is being gathered on available services and the use of those services. In addition, information is being gathered on the process of migration and its subsequent impact on use and perception of HIV prevention services, and the sexual health needs of the Hispanic/Latino community.
Preliminary analyses indicate that most outreach activities focus on basic AIDS education and testing for HIV while group-or community-level interventions to promote sexual health are rare. Due to conflicting directives on how to provide services to immigrants, AIDS agencies sometimes avoid publicity of their services to Hispanics/Latinos. Those Hispanic/Latino community organizations that do exist are often overwhelmed by multiple demands for immediate aid to individuals with basic problems of survival. Because most recent immigrants have limited access to health care, HIV diagnoses often occur late, thus deepening the immigrants’ perception of HIV as equivalent to serious illness. Three response models to this complex situation have been observed: use of health promoters or peer educators; reliance on an outreach worker connected to a local AIDS service organization; and less frequently, quasi-experimental interventions. Because of increased service demands, rapidly changing community compositions and lack of bilingual staff at many organizations, new recruitment and outreach strategies (i.e. social networking) are needed for these emerging Hispanic/Latino communities.
TRENDS
Hispanic/Latino women and youth are impacted more disproportionately than other Hispanic/Latino groups, but for Hispanic/Latino men, the rate of infection varies by state and by place of birth. Due to the epidemic’s continued impact on Hispanics/Latinos, people are living with AIDS, but the advancement of medical treatments also allows people to live longer.
HISPANIC/LATINO OPINIONS ON KEY AIDS ISSUES
Urgent Health Issue– According to research done by the Kaiser Family Foundation, 31% of Hispanics/Latinos viewed HIV/AIDS as one of the most urgent health problem facing the nation today, second only to cancer and more important than obesity. Young people aged 18-29 are the most likely across age groups to name HIV/AIDS as the most important health problem facing the nation today.[22]
Personally Concerned-30% of Hispanics/Latinos are personally concerned about becoming infected compared to 10% for whites. Younger people are also more concerned about HIV than their older counterparts.[23]
Personally Knowing Someone- 41% of Hispanics/Latinos report personally knowing someone with HIV/AIDS or who has died from the disease.[24]
Concern for Children- Nearly three quartersof Hispanic/Latino parents with children under the age of 21 are “somewhat” or “very” concerned about their children becoming infected with HIV.[25]
More Information Needed – Hispanics/Latinos seemed to have the most questions about getting tested. Most Hispanics/Latinos (62%) say they want more information about different HIV/AIDS testing options compared to 28% in Whites. Approximately 52% of Hispanics/Latinos said they wanted more information on the costs associated with taking the HIV test compared to 25% of Whites. A large portion ofHispanics/Latinos, 45%, also needed more information about where to go to take the HIV test, compared to only 18% of Whites. Hispanics/Latinos were also reported the most in needing to know about the confidentiality in taking the test.[26]
Hispanics/Latinos have major misperceptions about HIV transmission. 31% of Hispanics/Latinos surveyed incorrectly think that HIV is transmitted by touching a toilet seat. Only 20% of Blacks and 16% of Whites believe that to be true. 23% of Hispanics/Latinos think that HIV can be transmitted by sharing a drinking glass compared to 34% in Blacks and 24% in Whites. People more likely tend to think kissing will transmit HIV with38% of Hispanics/Latinos, 48% of Blacks and 37% of Whites believing this to be true.[27]
Misperceptions on HIV transmission among Hispanics/Latinos differed depending on the primary language spoken. For Hispanics/Latinos whose primary language is Spanish, 56% believe HIV is transmitted through kissing compared to 39% of those who identify English as their primary language. 32% of Spanish-speaking Hispanics/Latinos believe HIV is transmitted by sharing a drinking glass and 40% believe touching a toilet seat is an HIV transmitter. However, 18% and 24% of English-speaking Hispanics/Latinos believe this to be true. In addition, Hispanics/Latinos whose main language is Spanish express a greater need for more information on HIV/AIDS. 49% of English–Speaking Hispanics/Latinos, compared to 25% of Spanish-speaking Hispanics/Latinos, are more concerned about what others would think about them if others found out they were tested for HIV.[28]
Stigma - 21% of Hispanics/Latinos felt very concerned about how they were perceived if others found out they were tested for HIV. The national average of all individuals tested on how others perceive them after knowing they were tested for HIV is only 17%, yet Hispanics/Latinos have a higher rate of concern about perceptions.[29]
ACCESS TO HEALTHCARE
Low Insurance Levels- Hispanics/Latinos with HIV/AIDS are more likely than other groups to be publicly insured with half relying on Medicaid compared to 32% of Whites. Hispanics/Latinos with HIV/AIDS were more likely to have no insurance coverage at 24% compared to 17% of Whites. Only 23% of Hispanics/Latinos were likely to be privately insured compared to 44% of whites. In addition, Hispanics/Latinos were less likely than whites to have private coverage and more likely to be insured by Medicare at the time of their HIV diagnoses. The rate of Hispanics/Latinos being uninsured at the time of their diagnosis is higher than any other racial/ethnic group.[30]
Inferior Medical Care- Hispanics/Latinos with HIV receive inferior medical care. Hispanics/Latinos were almost twice as likely as Whites to have less than two office or outpatient visits over the past six months, 26% had an emergency department visit without associated hospitalization visit in 6 months, and 36% did not receive PCP prophylaxis in the last 6 months compared to 23% of whites.[31]
[1]U.S. Census Bureau. (2004).Table 1.1 Population by Sex, Age, Hispanic Origin, and Race.
[2] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Table 6, 8.
[3] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Table 9.
[4] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Table 19, 20.
[5] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Table 21, 22.
[6]U.S. Census Bureau. (2004).Table 1.1 Population by Sex, Age, Hispanic Origin, and Race.
[7] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Table 5b.
[8] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Map 1.
[9] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Table 5a.
[10] Ibid.
[11] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Table 7.
[12]Ibid.
[13] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Table 2.
[14]Aragon, Regina and Jennifer Kates. (2001). Hispanic/Latino’s Views of the HIV/AIDS Epidemic at 20 Years.
[15] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Table 6.
[16] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Table 11.
[17] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Table 6.
[18] Kaiser Family Foundation: HIV/AIDS Policy Fact Sheet: Hispanic/Latinos and HIV/AIDS (2006).
[19] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Table 5a.
[20] CDC HIV/AIDS Surveillance Report, 2005. Volume 17, Table 14.
[21] Kaiser Family Foundation: HIV/AIDS Policy Fact Sheet: Hispanic/Latinos and HIV/AIDS (2006).
[22] Kaiser Family Foundation: Survey of Americans on HIV/AIDS, 2004. Part Three – Experiences and Opinions by Race/Ethnicity and Age.
[23] Ibid
[24]Ibid.
[25]Ibid.
[26] Kaiser Family Foundation Survey of Americans on HIV/AIDS, 2004. Part Two – HIV Testing.
[27] Kaiser Family Foundation: Survey of Americans on HIV/AIDS, 2004. Part Three – Experiences and Opinions by Race/Ethnicity and Age.
[28]Regina, Aragon, Jennifer Kates, and Liberty Greene. Hispanic/Latinos’ View of the HIV/AIDS Epidemic at 20 Years. The Henry J. Kaiser Family Foundation. (2001).
[29] Kaiser Family Foundation Survey of Americans on HIV/AIDS, 2004. Part Two – HIV Testing.
[30] Kaiser Family Foundation: HIV/AIDS Policy Fact Sheet: Hispanic/Latinos and HIV/AIDS.(2006).
[31] JAMA. (1999). Variations in the Care of HIV-Infected Adults in the United States. Retrieved July 25, 2006 from HIV Cost and Services Utilization Study. 281: 2305-2315, Table 1.