# Presentation: 737380

## FACING CHALLENGES IN TREATING AND PREVENTING HIV/AIDS AMONG LATINOS

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## SCOPE OF PRESENTATION

- Analysis of recent epi data
- Challenges for prevention
- Challenges for treatment
- Action required nationally

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## WHERE WE ARE

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## NO PROGRESS

- 200,000 OF 1.2 MILLION LIVING WITH HIV/AIDS
- 19% OF AIDS CASES DIAGNOSED WITH AIDS IN 2005 AND 18% OF HIV CASES (OF 33 STATES)
- 3.5 TIMES RATE OF WHITES BUT 1/3 RATE OF WHITES
- The greatest percentage increase in newly reported HIV cases among Americans from 1996-2003 was in Hispanics: Hispanic males 683%, Females 646%  (Compared to Caucasians and Blacks - 111%, 96% for males & 106%, 124% females respectively).

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## LITTLE OR NO IMPROVEMENT

- Latino men were developing AIDS at  three times the rate of White men to develop an AIDS diagnosis in 2000, 2001, 2002, 2004 (HIV/AIDS SSR 12:1, Table 7)
- Latinas were developing AIDS at nearly six time the rate for White women during same period. (Table 7)
- Newly reported Latino HIV infections increased 20% between 2001 and 2004 (24,524 to 30, 629 (Table 7)

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

- Estimated seroprevalence among Latinos increased by 33% between 2001 and 2005 compared to a 21% increase among Whites

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## GENDER

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## LATINO MEN

- Latino MSM HIV rates grew 30% from 2001 to 2004 (HIV/AIDS SSR 12:1 Table 9).  Was 59% of male rate in 2004, up from 53% in 2001
- Latino men with “high rise heterosexual contact” grew 25% during over same time period.  Was 14% of Latino male rates each year from 2001 to 2004.  What is going on?
- Latinos with IVDU risk grew less than I% from 2001 to 2004.  Was 26% of infections in 2001 and 20% in 2004

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## LATINO MEN

- Heterosexual transmission and injection drug use account for greater share of Latino men than White men.
- Latino, Black and White men are more likely to be infected through sex with other men.
- 5 city study 17% of Latino MSM infected with HIV.  Knowledge of those already infected very low.

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## LATINAS

- Latinas likely to be infected through IVDU increased less than 1% from 2001 to 2004.  Was 28% of Latina new HIV infections in 2001 and 24% of new infections in 2004. (HIV/AIDS SSR 12:1 Table 9)
- Latinas newly reported to be heterosexually infected increased 25% from 2001 to 2004.  Was 70% of new Latina infections in 2001 and 73% in 2004. (Table 9)

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## LATINAS

- Latinas account for 16% of new AIDS cases in 2005.  Latinas represent 6 times the rate per 100,000 than White women.
- Latinas represent 22% of AIDS case diagnosed in 2005 among Latinos while White women represent 14% among Whites and Blacks 35%

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## LATINAS

- LATINAS ARE MORE LIKELY TO HAVE BEEN INFECTED THROUGH HETEROSEXUAL TRANSMISSION THAN WHITE WOMEN.
- WHITE WOMEN ARE MORE LIKELY TO HAVE BEEN INFECTED THROUGH DRUG USE THAN LATINAS

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## COMPARITIVELY SPEAKING

- Latino men are 3 times more likely than White men to have AIDS.  Latinas are 5 times more likely than White women to have AIDS. (HIV/AIDS SSR 12:1 Table 7)
- This picture has not changed since 2000.  Why aren’t Latino AIDS rates per 100,000 going down?  Why are Whites experiencing better health outcomes with ADAP being available?

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## LATINOS AND DEATH 

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## NO DECREASE IN DEATH

- NUMBER OF DEATHS AMONG LATINOS WITH AIDS REMAIN STABLE WHILE DEATHS AMONG WHITES AND BLACKS SLIGHTLY DECREASED.  WHY?

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## DEATH

- HIV was 6th leading cause of death for 25-44 for Latinos in 2002.  The same ranking as whites.
- In 2003, HIV deaths per 100,000 from were higher among Latinos (10.3 men and 3.8 for Latinas) compared to Whites
- Puerto Rico is 1.2% of US population but has second highest death rate per 100,000 in United States (16.4%).  Average for United States in 4.9 per 100,000

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## LATINOS WITH HIV/AIDS BY AGE GROUP

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## LATINO YOUTH AND HIV/AIDS

- Latino young men aged 15 to 29 made up 15% of Latino male _AIDS_ cases in 2000 and 16% in 2004. The cumulative AIDS cases (since 1981) for Latinos in this age range is 14% in this age range.  This 1% represents a 25% growth in the age range. (HIV/AIDS SSR 12:1 Table 5) The trend is increasing AIDS cases.
- Latinas aged 15 to 29 made 17% new Latina AIDS cases in 2000 and 14% in 2004.  Of the cumulative Latina AIDS cases since 1981, 20% have been in this age range (Table 5).  The trend is decreasing AIDS cases among young Latinas

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## Latinos 30 to 39

- Decreasing number of new AIDS cases for Latino men 30 to 39.  From 2,576 in 2000 to 2,475 in 2004 or 42% Latino male cases in 2000 and  38% in 2004.  Historically has been 45% of Latino AIDS cases since 1981.  AIDS cases decreasing. (Table 5)
- Largely decreasing number of Latinas (30 to 39) receiving an AIDS diagnosis,  722 (38% of total) in 2000 and 626 (32% of total) in 2004 – down from cumulative for this age group of 41%

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## Latinos 40 to 49

- Historically represented 26% of cumulative AIDS cases for Latino males.  In 2000 AIDS cases for this age group were at 29% and in 2004 at 31%.
- Latinas in this age group represent 23% of the cumulative AIDS case to 2004.  In 2000 Latinas 40 – 49 were 28% of AIDS cases and in 2004 were 34%
- Levels of AIDS rising among this age group. Why?

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## Latinos 50 up

- Latino men have made up 11% of Latinos with AIDS over 50 since 1981.  The percentages are increasing  - 14% in 2000 and 16% in 2004.
- Latinas have made up 11% of Latinas with AIDS over 50.  The percentages are increasing – 14% in 2000 and 17% in 2004.
-  Latinos and Latinas are living longer with HIV until they develop AIDS or more sex among seniors.  What is challenge to medical and service providers?

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## GEOGRAPHY AND LATINO AIDS CASES

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## NEW AIDS CASES BY REGION

|  | 2000 | 2001 | 2002 | 2003 | 2004 | CUM. |
| --- | --- | --- | --- | --- | --- | --- |
| NE | 2,993 | 2,788 | 2,479 | 2,286 | 2924 (33%) | 70,156 (39.5) |
| MW | 371 | 387 | 447 | 472 | 487
(5.6%) | 6,905
(3.4%) |
| SOUTH | 1,588 | 1,865 | 1,975 | 2,166 | 2,384
(27.5%) | 33,613
(18.9%) |
| WEST | 1,857 | 1,785 | 1,959 | 2,040 | 1,190
(22%) | 37,439
(21.1) |
| TERR. | 1,130 | 1,150 | 1,047 | 1,068 | 967 (11%) | 29,051
(16.4%) |
| TOTAL | 7,957 | 7,974 | 7,907 | 8,632 | 8,672 | 177,164 |

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## MAs BY LATINO IDENTITY, GENDER AND AIDS PREVELANCE IN 2004

| MALE | 2004 AIDS PREVALANCE | FEMALE | 2004 AIDS PREVALANCE |
| --- | --- | --- | --- |
| New York | 15,733 | New York | 6,541 |
| Los Angeles | 8,142 | San Juan | 2,004 |
| San Juan | 5,059 | Los Angeles | 1,099 |
| Miami | 4,615 | Miami | 931 |
| Chicago | 1,882 | Philadelphia | 407 |
| San Francisco | 1,822 | Chicago | 370 |
| Houston | 1,687 | Houston | 334 |
| San Diego | 1,396 | Hartford | 305 |
| Dallas | 1,217 | Boston | 295 |

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## NATIONALITY AND ORIGIN

- Impact not uniformly distributed.  Highest rates are in Northeast and Puerto Rico as are the greatest portion of Latinos living with AIDS (37% 2005) and new Latino AIDS cases (33% 2005)
- 89% Latinos living with AIDS in 10 states
- Latinos born in US are 41% Latino AIDS cases, 22% Puerto Rico, 22% Mexico

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## GEOGRAPHY

- Number of Latinos in the South (Deep South, Texas and Florida) experiencing poorer health outcomes because of bars to health care and poor Medicaid investment. (Kaiser State Health Facts)
- Increasing number of Latinos diagnosed with AIDS in South since 2001.
- Migrant laborers in Deep South have higher rates of AIDS than Whites
- Limited access to ADAP and other health care

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## PROFILE OF DEEP SOUTH

| STATE | AIDS RATE HISP/ WHITE | LIVING WITH AIDS IN 2004 HISP/ WHITE | ENROLLED IN ADAP HISP/WHITE |
| --- | --- | --- | --- |
| North Carolina | 8.3/5.8 | 4% / 25.6% | 10% / 34% |
| South Carolina | 28.3 / 6.4 | 2% / 24% | 3% / 26% |
| Georgia | 16 / 6.8 | 3.6%/ 25.7% | 29% / 4% |
| Alabama  | 9.6 / 4.8 | 2% / 34.5% | 12% / 23% |
| Tennessee  | 29.8 / 6.8 | 2.5% / 45% | 0% / 45% |
| Mississippi | 41.6 / 7.1 | 1.2% / 26% | 0% / 25% |
| Louisiana | 22.2 / 4.6 | 2.8% / 31% | 3% / 36% |
| National  | 26.8 / 7.7 | 20% / 35% | 26% / 36% |

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## PERSPECTIVES ON LATINOS IN DEEP SOUTH

- Migrant laborers drawn by hospitality industry, construction, poultry and agriculture.
- Migrants in urban areas experience a kind of freedom once removed from small villages and experiment in new things.
- Few institutions with cultural and linguistic skills to meet needs.

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## WHAT ARE WE DOING TO PREVENT OR LOWER THE NUMBER OF NEW LATINO HIV INFECTIONS?

- _No CDC approved intervention_ for heterosexual Latinas who do not use drugs.  SISTA, according to the CDC, is only for Black Women.  So SISTA cannot be adapted or funded as an intervention for Latinas. What interventions can be used for Latinas six years after the Advancing HIV Prevention directive?  Waiting ....
- No DEBI can be unpacked from the box, wound up and left to run. Needs assistance with adaptation
- Need to figure the acculturation levels of target populations, the role of stigma, need to invest in peers, constantly evaluate.

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## IS HIV TESTING TAKING THE PLACE OF HIV PREVENTION

- Are we making HIV positive people shoulder the entire burden of prevention?
- Does knowing you are HIV positive automatically mean you will have safer sex?  What are the limits of the studies?
- Are we afraid to explore pharmacological interventions that would sharply reduce the likelihood of HIV prevention? Those taking meds are less likely to transmit.

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## STILL SORTING OUT THE DEBIs

- Need a DEBI for heterosexual males and females who have unsafe sex.
- Whole host of skills that need to be in place to even begin using DEBIs for Latinos – develop acculturation measures, devise peer training and retention strategies, group facilitation, learn how to run focus groups, trained on cultural relevance.

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## NEED TO FOCUS ON LATINO FAITH COMMUNITIES

- “AIDS is punishment from God” “Only bad people get AIDS” “People with HIV are different from me”
- All these beliefs help people to deny their own risk. Isolate sexual or drug using behavior from social support networks.
- Faith leaders are in a unique position for Latinos to mount campaigns against these unhealthy and stigmatizing beliefs.

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## HOW TO LOWER RATES OF INFECTION AMONG LATINOS

- COMMUNITY MOBILIZATION FOR TESTING AND SEX EDUCATION
- FEDERAL SUPPORT FOR NEEDLE EXCHANGE
- OFFER ROUTINE TESTING AS PART OF MEDICAL CARE (INCLUDING PRISONS)
- MORE DEBIs THAT CAN BE USED WITH URBAN LATINAS WHO DO NOT USE DRUGS
- SOCIAL MARKETING TO ADDRESS STIGMA
- ASSOCIATED WITH TESTING AND AIDS

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## HOW TO LOWER RATES OF INFECTION AMONG LATINOS

- Increase access to healthcare without proof of legal status
- CDC needs to offer RFPs that specially target Latino at risk groups
-  CDC needs to do more to support social scientists that are sources of models for prevention for Latinos

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## HOW TO LOWER RATE OF PROGRESSION TO AIDS

- Culturally competent health care. Need training on levels of acculturation and language
- Transportation: Latinos most likely to report delaying care due to lack of transportation and other factor
- Latinos are more likely to delay care after diagnosis (Archives 160:2000):  Need treatment education and real connections to care.
- Reduce delayed testing – 43% test one year or less before contracting AIDS.
- Immigration status is obstacle to using hospital and other care.

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## HOW TO LOWER RATE OF PROGRESSION TO AIDS

- Offer more materials in Spanish – few of DEBIs have materials in Spanish
- CDC, HRSA and SAMHSA need Latino strategies
- Puerto Rican healthcare system for people with HIV is collapsing before our eyes

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## NATIONAL LATINO AIDS AWARENESS DAY

- OCTOBER 15 (SUNDAY THIS YEAR)
- Last day of Hispanic Heritage Month and first day in the Latino fight against AIDS.
- Is an opportunity to make elected and appointed officials aware of Latino issues.
- Opportunity to promote testing and prevention.
- Opportunity to make link between Latino culture and the cure
- Opportunity to raise awareness in local media.

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES

## Go to www.nlaad.org and sign up to make a difference

- LATINOS AND HIV/AIDS - NEW PERSPECTIVES