FACING CHALLENGES IN TREATING AND PREVENTING HIVAIDS AMONG LATINOS

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FACING CHALLENGES IN TREATING AND PREVENTING
HIV/AIDS AMONG LATINOS
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SCOPE OF PRESENTATION

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

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WHERE WE ARE
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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).

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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
  121, 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)

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

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GENDER
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LATINO MEN

• Latino MSM HIV rates grew 30 from 2001 to 2004
  (HIV/AIDS SSR 121 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

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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.

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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 121
  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)

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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

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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

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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 121
  Table 7)
• This picture has not changed since 2000. Why
  arent Latino AIDS rates per 100,000 going down?
  Why are Whites experiencing better health
  outcomes with ADAP being available?

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LATINOS AND DEATH
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NO DECREASE IN DEATH

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

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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

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LATINOS WITH HIV/AIDS BY AGE GROUP
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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 121 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

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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

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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?

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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?

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GEOGRAPHY AND LATINO AIDS CASES
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NEW AIDS CASES BY REGION
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MAs BY LATINO IDENTITY, GENDER AND AIDS
PREVELANCE IN 2004
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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

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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

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PROFILE OF DEEP SOUTH
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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.

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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.

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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.

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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.

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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.

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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

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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

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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 1602000) 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.

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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

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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.

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