June 15, 2012
New HIV Diagnoses Among Latinos Decline in U.S.
by Tim Horn
The rate of new HIV diagnoses among Latinos in the United States decreased by more than 4 percent annually between 2006 and 2009, according to a new report by U.S. Centers for Disease Control and Prevention (CDC) researchers published in the June 1 issue of the Journal of Acquired Immune Deficiency Syndromes.
It is not clear if this is necessarily an encouraging finding—it could be that fewer Latinos living with HIV are accessing testing programs. What is clear, however, is that the collected data show cultural and regional disparities, and that educational programming is needed to address these challenges.
Also of concern, the CDC researchers note, is that many Latinos who test positive progress to AIDS within a year. Specifically, those who are foreign born—compared with those born in the United States—are more likely to be diagnosed with advanced HIV disease within 12 months.
It is well established that in the United States, HIV disproportionately affects Latinos. As an ethnic group, they account for 15 percent of the country’s population, yet they accounted for 21 percent of new AIDS diagnoses in 2009. That same year, the rate of new HIV diagnoses among Latinos was about three times higher than the rate for non-Latino whites.
Little is known, however, about the epidemiology of HIV infection among U.S. Latinos, notably their countries of origin and where they lived in the United States when they tested positive. Similarly, it hasn’t been clear if foreign-born Latinos are more or less likely to progress to AIDS within 12 months of their HIV diagnosis—a telltale sign of delayed HIV testing and access to care—compared with Latinos born in the United States.
To shed light on these questions, Lorena Espinoza, DDS, MPH, and her colleagues at the CDC turned to national surveillance data, notably those from Puerto Rico and 40 states where names and at least some demographic information are collected at the time of diagnosis and subsequently reported to the agency.
Roughly 33,500 Latinos were diagnosed with HIV between 2006 and 2009, the four-year interval analyzed by the CDC researchers. Birthplace information was available for more than 80 percent.
Across the board, the annual rate of HIV diagnoses among Latinos decreased by 4.3 percent. Among men, the rate decreased by 2.8 percent per year; among women, the rate decreased by 9.8 percent per year.
Among U.S.-born Latino men, the annual rate of new diagnoses remained relatively stable, decreasing by less than 1 percent each year. Conversely, among U.S.-born Latino women, the HIV diagnosis rate decreased by 6.8 percent every year.
Among foreign-born Latino men, the overall HIV diagnosis rate decreased 3.5 percent annually, with the most substantial drop (13.1 percent) found among men born in Puerto Rico. There was a 6.6 percent annual increase among men born in Central America, and there was a 0.6 percent annual increase among men born in Mexico.
Among foreign-born Latino women, the overall HIV diagnosis rate decreased more than 10 percent annually, with the most substantial drops—13.2 and 12.2 percent—found among women born in Puerto Rico or Central America, respectively. The only annual increase in this group—4.6 percent annually—was among women born in Cuba.
In terms of area of U.S. residence—broken down into three categories: urban, suburban and rural—the greatest declines, among Latino men and women, were in rural areas.
Espinoza and her colleagues also noted a high proportion of Latinos diagnosed with HIV in the United States who progressed to AIDS within a year. This was documented in 33 percent of all U.S.-born Latinos diagnosed with the virus, compared with 43 percent of foreign-born Latinos—a 20 percent difference between the two groups after adjusting the data for other demographic differences.
The authors note that the significance of their findings, notably the annual decrease in HIV diagnoses among Latinos, isn’t clear. An optimistic interpretation, they explain, is that the data reflect a decrease in new infections among Latinos, potentially as a result of prevention measures. But a more pessimistic interpretation is also possible—that fewer Latinos are getting tested for HIV and, by extension, more of them are living with HIV and unaware of their infection.
The more optimistic interpretation is possible, Espinoza and her colleagues argue, considering that HIV testing rates are high among Latinos in the United States. According to one study, they write, roughly 48 percent of Latinos have been tested for HIV at least once, compared with 41 percent of whites. The authors note, however, that Latino immigrants living with HIV, who might not access health care services because of costs or fear of deportation, may be underreported.
As for the short HIV-to-AIDS interval, Espinoza and her colleagues stress this “can indicate a delay in testing until late in the course of HIV disease, when symptoms are likely to have developed. It also may reflect inadequate care and treatment for [Latinos] who may not be getting antiretroviral treatment at an earlier stage in their infection when medication could produce better health outcomes.”
As for the disparities between U.S.- and foreign-born Latinos, the CDC researchers suggest that HIV prevention and testing programming may not be equally effective, “thus educational efforts should address the important cultural, behavioral and regional differences among [Latinos].” They caution that the Latino population is projected to triple in the United States by the year 2050—constituting 30 percent of the nation’s population—“so it will be necessary to continue to address the impact of HIV on [Latinos].”
In support of these efforts, Espinoza and her team stress that the CDC has broadened its expanded HIV testing program to include Latinos and to fund a variety of programs that direct prevention and treatment services to Latino populations. “The programs will enhance capacity building assistance services delivered to community-based organizations and community stakeholders providing HIV prevention services, support the development and implementation of effective community-based HIV prevention programs, and build partnerships with leading national [Latino] organizations to help fight the HIV [epidemic among Latinos].”
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