Trends in AIDS among Hispanics in the United States, 1991-1996

Adolescent Latino Reproductive Health: A Review of the Literature

Latino adolescent reproductive health has become an increasingly important topic because of the growth in the numbers of Latino youth and because Latino youth are at high risk for negative reproductive health outcomes. Latinas now have the highest teen birth rates, and Latinos have disproportionately high rates of HIV/AIDS. These trends highlight the need for greater understanding of the sexual and reproductive health and behavior of Latino youth. This overview provides an introduction to key aspects of the Latino population. It then examines and synthesizes the existing literature by domains useful to the study of Latinos. Areas that receive in-depth coverage are socioeconomic status, family, national origin, peers and partners, and acculturation. Based on the current state of knowledge and the issues facing young Latinos, suggestions for future research and uses for existing data and past research are included.

Antiretroviral Therapy and Viral Suppression Among Foreign-Born HIV-Infected Persons Receiving Medical Care in the United States: A Complex Sample, Cross-Sectional Survey

Immigrants to the United States are more likely to be diagnosed with human immunodeficiency virus (HIV) infection compared with native-born persons. Navigating access to healthcare in the United States can be challenging for foreign-born persons, and HIV treatment outcomes may be suboptimal for these persons. We compared characteristics of and assessed disparities in clinical outcomes of foreign-born persons in care for HIV in the United States. The Medical Monitoring Project is a complex sample, cross-sectional survey designed to be nationally representative of HIV-infected adults receiving medical care in the United States. Using data from 2009, 2010, and 2011, we conducted descriptive analyses and multivariable logistic regression to assess associations between foreign-born status and antiretroviral therapy (ART) prescription, and between foreign-born status and viral suppression. In all, 13.4% of HIV-infected persons were self-identified as foreign-born; the most common regions of birth were Central America and Mexico (45.4%) and the Caribbean (16.0%). Nearly 90% of foreign-born persons were diagnosed with HIV after entry into the United States. Compared with US-born persons, foreign-born persons were more likely to be younger, Hispanic, less educated, and uninsured. The prevalence of ART prescription (prevalence ratio 1.00; 95% confidence interval 0.98-1.02) was not significantly different between foreign-born and US-born persons. A higher percentage of foreign-born persons achieved viral suppression compared with US-born persons (prevalence ratio 1.05; 95% confidence interval 1.00-1.09). No major disparities in ART prescription and viral suppression were found between foreign-born and US-born HIV-infected persons receiving medical care, despite higher percentages being uninsured.

Predictors of HIV testing among Latinos in Baltimore City

To better understand access to HIV testing and prevention services experienced by Latinos, we evaluated data compiled through Baltimore City Health Department HIV outreach efforts in 2008. Of 6,443 clients served, Latinos were more likely male, young, and less-educated than non-Latinos. A greater proportion of Latinos had never been tested for HIV compared to non-Latinos (63% vs. 20%, P < 0.001). Male gender (AOR 1.58, 95% CI 1.04, 2.44), >8th grade education (AOR 2.4, 95% CI 1.60, 3.60) were associated with accessing HIV testing in the past. Increasing age, identifying as gay or bisexual, history of sexually-transmitted disease, and injection drug use were also associated with reporting prior HIV testing. HIV prevention services for Latinos should expand to reach those who are younger, heterosexual, of lower educational level, and female.

HIV risk and prevention among Hispanic immigrants in New York: the salience of diversity

The importance of identifying differences in HIV risk between Hispanic subgroups is the focus of this article. Data are drawn from two New York?based HIV-related studies: among Puerto Rican drug users and among new immigrants from Central America, the Dominican Republic, and Mexico. Results indicated that intercultural individuals (i.e., those involved in both Puerto Rican and mainland cultures) were less risky in terms of injection- and sex-related risk behaviors and that geographic and other contextual factors, along with cultural norms, influence risk behaviors for immigrants. Both studies indicate the need to differentiate subgroup factors affecting HIV risk and prevention behaviors to develop appropriate and effective community-based interventions. The study's limitations are noted.

HIV among Haitian-born persons in the United States, 1985-2007

OBJECTIVE

Haitian-born persons have been historically stigmatized for introducing HIV to North America; however, no previous study has reported on the national HIV surveillance trends among this foreign-born group.

METHODS

Annual AIDS cases were estimated for adults and adolescents (aged >12 years) from all 50 US states and the District of Columbia who were diagnosed between 1985 and 2007, and who reported 'Haiti' as country of birth to the Centers for Disease Control and Prevention. HIV data (with or without AIDS) for Haitian-born adults and adolescents diagnosed between 2004 and 2007 were obtained from 34 US states. Denominators for AIDS rates by race/ethnicity are from postcensal estimates, the American Community Survey of the US Census Bureau and the Haitian Consulates.

RESULTS

In 2007, Haitian-born persons constituted 1.2% of US AIDS cases, yet accounted for 0.18% of the total US population based on the American Community Survey estimates, which suggests a seven-fold overrepresentation in the CDC AIDS surveillance data. However, when using population estimates from the Haitian Consulate, the overrepresentation ranges from three-to-four-fold, which is similar to the AIDS rate for blacks/African-Americans.

CONCLUSION

The importance of having accurate denominators to estimate the AIDS rate for the Haitian population is paramount.

Spirituality, coping, and HIV risk and prevention in a sample of severely mentally ill Puerto Rican women

Hispanics have been disproportionately impacted by HIV/AIDS. Although HIV risk is significantly elevated among severely mentally ill persons (SMI), the risk of infection appears to be even greater among those SMI who are Hispanic, reflecting the increased risk of HIV among Hispanics. We report on findings from the first 41 participants in a qualitative study examining the context of HIV risk and risk reduction strategies among severely mentally ill Puerto Rican women residents in northeastern Ohio. Individuals participated in a baseline interview, two follow-up interviews, and up to 100 hours of shadowing. Interviews and shadowing activities were recorded and analyzed using a grounded theory. The majority of individuals reported using identification with a religious faith. A large proportion of the participants reported that their religious or spiritual beliefs were critical to their coping, had influenced them to reduce risk, and/or provided them with needed social support. Several participants also reported having experienced rejection from their faith communities. The emphasis on spirituality among Puerto Rican SMI is consistent with previous research demonstrating the importance of spirituality in the Hispanic culture and reliance on spiritual beliefs as a mean of coping among SMI. Our results support the incorporation of spiritual beliefs into secular HIV prevention efforts.

AIDS knowledge among Latinos: the roles of language, culture, and socioeconomic status

AIDS has a disproportionate effect on persons of Latino origin, who have lower knowledge of AIDS than other ethnic groups. This study assessed AIDS knowledge among Latino adults in New Jersey according to acculturation and socioeconomic status. Data on 121 Latino adults were collected in spring 2000 using bilingual telephone interviews. Respondents were selected using the Census' Latino surname methodology. Items were adapted from the National Health Interview Survey Supplement on AIDS Knowledge and Attitudes and the Marin acculturation scale. AIDS knowledge was more strongly associated with language exposure than with self-assessed English or Spanish language abilities. Low educational attainment and bilingual language exposure were associated with lower AIDS knowledge; when other factors were controlled, place of schooling, length of time in the United States, age and gender were not statistically significant. Transmission of HIV via casual contact was widely misunderstood, but general facts about AIDS and likely means of HIV transmission were well known. AIDS education materials should be designed in both English and Spanish and should take into account the lower educational attainment of recent Latino immigrants.

Correlates of HIV/AIDS knowledge among U.S.-born and foreign-born Hispanics in the United States

No national study of Hispanics has examined variation in HIV/AIDS-related knowledge by ethnicity, place of birth, and duration in the United States (for the foreign born) at least in part because of data constraints. Data from the 1991 and 1992 National Health Interview AIDS Supplements were used to examine the influence of these factors, and other sociodemographic and HIV/AIDS-related variables, on a 25-item HIV/AIDS knowledge scale. Descriptive and multivariate analyses indicate that foreign-born Hispanics with shorter durations in the United States have significantly lower levels of HIV/AIDS knowledge, as do those of Mexican and Cuban ethnicity. Numerous other factors, most of which are known to be associated with HIV/AIDS knowledge in the general population, were found to be significantly associated with HIV/AIDS knowledge among Hispanics in multivariate analyses; these include age, education, gender, rural residence, residence in the West, knowing a person with HIV/AIDS, personal risk for HIV/AIDS, and having been tested for HIV outside of the blood donation system. Results suggest that HIV/AIDS information campaigns targeted to Hispanics may not be equally effective in reaching foreign-born and U.S.-born subgroups or persons of differing ethnicities. Future studies should examine sources of HIV/AIDS information and the mechanisms of knowledge acquisition and transmission within specific subgroups of the Hispanic population.

Locus of control and HIV risk among a sample of Mexican and Puerto Rican women

The disproportionate impact of HIV/AIDS on Hispanic women in the United States has been variously attributed to a failure to utilize protective measures due to low levels of HIV knowledge, a denial or minimization of risk, and conflicts with cultural norms. It has been hypothesized that women's relative lack of power in relationships may be associated with higher risk sexual behavior. We examined the relationship between higher risk sexual behavior and perceived locus of control in sexual relationships among a sample of Puerto Rican and Mexican women. We interviewed 71 women of self-reported Mexican ethnicity in San Diego, California, and 79 women of self-reported Puerto Rican ethnicity in Cleveland, Ohio, to examine the relationship between HIV risk, HIV knowledge, and locus of control. Univariate logistic regression indicates that among Puerto Rican women, the perception that locus of control in a sexual relationship resides in the male partner was significantly associated with increased HIV risk, while younger age was significantly associated with increased risk among Mexican women only. In a combined sample of both Puerto Rican and Mexican women, multiple logistic regression analysis indicates that younger age, increased length of residence in the United States, and an other-focused locus of control are significantly associated with increased HIV risk. Women who have been in the United States for relatively longer periods of time may be more likely to integrate U.S. sexual norms into their own behavior and may, as a consequence, be at higher risk of HIV infection. Increased HIV prevention efforts must be made available to Mexican and Puerto Rican women born outside of the United States. These prevention efforts must necessarily focus not only on HIV prevention strategies, but also on the dynamics within male-female intimate relations. Increased attention to younger Puerto Rican and Mexican women is also needed.

Barriers to HIV-testing among Hispanics in the United States: analysis of the National Health Interview Survey, 2000

Data from the 2000 National Health Interview Survey (NHIS) were analyzed to explore barriers to HIV testing, and intentions to be tested among a nationally representative sample (n = 4,261) of the different Hispanic subgroups living in the United States. Weighted proportions and variances accounting for the complex sample design of the NHIS were estimated using the Taylor series linearization method. Regression estimates are expressed as odds ratios and their 95% confidence intervals. Two thirds of sampled Hispanics had never been tested for HIV (excluding blood donations) and 88% expressed no intention to do so in the near future. Many of the factors that influence the likelihood of having been tested in the past also impact on future HIV testing intentions including age, Hispanic subgroup, high-risk status, and self-perceived HIV risk. Compared to Puerto Ricans, Mexicans (odds ratio [OR] = 1.59, 1.1-2.3) and Mexican/Americans (OR = 1.61, 1.1-2.3) were more likely to never have been tested and Cubans were notably more likely to report negative future testing intentions (OR = 5.63, 2.5-12.8). Among Hispanics who reported high-risk status or high/medium self-perceived HIV risk, more than one quarter had never undergone testing and expressed no intention of doing so in the near future. Recognition of the HIV testing barriers identified in this study is valuable for the development and refinement of current strategies that aim to increase HIV testing practices in the heterogeneous U.S. Hispanic population.

HIV/AIDS among minority races and ethnicities in the United States, 1999-2003

BACKGROUND

During June 1981 to June 1982, 37% of more than 400 cases of AIDS reported to the CDC were in minority races and ethnicities. In 2003, 72% of the estimated 43,171 cases of AIDS diagnosed in the 50 states; District of Columbia; and U.S. dependencies, possessions and free nations were in minority races and ethnicities.

METHODS

We analyzed HIV/AIDS data for 2000-2003 reported by the 32 states that have had confidential name-based reporting of HIV infection since 1999. For analysis of AIDS data, we used data for 1999-2003 reported by the 50 states and the District of Columbia. HIV/AIDS and AIDS data were statistically adjusted for reporting delays and redistribution of cases initially reported without risk factors.

RESULTS

For all years, the numbers of HIV/AIDS and AIDS diagnoses were consistently higher among non-Hispanic blacks than among other races and ethnicities. In the 32 states with HIV reporting, the HIV/AIDS diagnosis rate in 2003 was 74 per 100,000 for blacks, 25 per 100,000 for Hispanics, 11 per 100,000 for American Indians/Alaska Natives, nine per 100,000 for whites, and seven per 100,000 for Asians/Pacific Islanders. The rates for persons living with HIV/AIDS at the end of 2003 were highest for blacks (765 per 100,000) and Hispanics (220 per 100,000). In the 50 states and the District of Columbia, AIDS diagnosis rates in 2003 were 58 per 100,000 for blacks, 20 per 100,000 for Hispanics, eight per 100,000 for American Indians/Alaska Natives, and four per 100,000 for Asians/Pacific Islanders.

CONCLUSION

HIV/AIDS disproportionately affects minority races and ethnicities in the United States. To reduce rates of HIV/AIDS in these populations, effective and culturally appropriate prevention interventions must be developed and implemented.

Integrating qualitative and quantitative methods: comparing HIV-related risk behaviors among Puerto Rican drug users in Puerto Rico and New York

A dual site project was conducted to assess determinants of injection and sex-related risk behaviors among Puerto Rican drug users. The project focused on injection drug users and crack smokers, and was conducted in East Harlem, NY and Bayamón, PR in 1996-2000. Qualitative methods included ethnographic mapping, focus groups, in-depth interviews, and observations. A survey component (East Harlem, n = 800; Bayamón, n = 400) was also conducted. Procedures to ensure integration of methodologies and comparability of data were developed. This paper describes the qualitative and survey methods used, and presents the comparative HIV risk behaviors. The integration of the two methodologies served multiple functions: each component identified issues to be addressed in the other, enhanced cross-site comparability of data, and assisted in interpretation of findings. The survey data showed high levels of risk behaviors in both communities, with significantly higher levels of risk reported in Bayamón. Conducting studies of similar ethnic groups in different communities provides opportunities to examine diverse sources of influence on risk behaviors. The integration of qualitative and quantitative methods can enhance comparability and understanding of findings, particularly when there are differences in behaviors between communities.

Gender-specific profiles of self-reported adolescent HIV risk behaviors

The purposes of this study were to (a) identify behaviors that put adolescents at risk for HIV infection by retrospectively comparing a cohort of HIV positive and negative young adults and (b) determine gender-specific high-risk profiles. HIV-positive (n = 61) and HIV-negative (n = 124) individuals from two midwestern cities completed a survey tool prepared by the investigators examining six areas of behavior and activity identified in the literature as high risk. Alcohol use, drug use, and gang-related behaviors were not associated with HIV status in these young adults. Early, frequent, and unprotected sex with large numbers of partners were the predictive risk factors for HIV-seropositive status. Gender profiles, however, differed. Whereas the female profile suggested that early and unprotected sex were the only reliable predictors, HIV-positive male subjects had larger numbers of partners, engaged in more risky sexual behaviors, were more likely to have experienced sexual abuse before and during adolescence, and were more likely to have used cocaine during their adolescence. Conclusions include the confirmation of a resurgence of HIV among young males having sex with males and confirmation of females as the largest growing group of HIV-positive young adults.

Sociodemographic diversity and behavioral medicine

The broad array of economic and cultural diversity in the U.S. population correlates with and impacts on the study of behavioral aspects of health. The purpose of this article was to provide a selective overview of behavioral medicine research on sociodemographically diverse populations, with a focus on ethnicity, gender, and socioeconomic status. Suggestions are provided with regard to methodological refinement of research and insights into possible future directions in behavioral medicine research on ethnically and economically diverse populations.

Latino AIDS immigrants in the Western Gulf states: a different population and the need for innovative prevention strategies

Immigrant HIV infected Latinos, and those at highest risk for infection, demonstrate strikingly different patterns of risk behaviors and origins. This complicates the already complex acculturation process impacting their lives. By weaving together immigration and AIDS epidemiological patterns, the impact of tightening immigration policy, and masked sexual behaviors, the authors express concern for a lack of communication with, and lack of health care access for, Latinos in the Western Gulf Coast. To combat this deficit, health care and social workers need to be aware of different social, cultural, and behavioral contexts in Latino populations. Policy makers should support efforts to provide health care workers with skills through appropriate language and cultural sensitivity workshops. HIV prevention strategies specific to Latinos are also discussed.

Trends in HIV seroprevalence and needle sharing among Puerto Rican drug injectors in Puerto Rico and New York: 1992-1999

This study assessed trends in HIV seroprevalence and needle-sharing behaviors among Puerto Rican injection drug users (IDUs) in Puerto Rico and New York. Data from two studies of IDUs conducted from 1992 through 1995 and 1998 through 1999 in Bayamón, Puerto Rico, and East Harlem, New York, were examined to assess trends over this period. Separate analyses were conducted for IDUs who were current crack smokers. Significant decreasing trends in seroprevalence were found among IDUs in the New York and Puerto Rico samples (p <.001). Significant decreasing trends in receptive and distributive needle sharing were found in the New York sample, and a significant decline in receptive sharing was found in the Puerto Rico sample. Overall, higher levels of needle-sharing behaviors were reported in Puerto Rico compared with New York. Decreasing trends in needle sharing and seroprevalence in both communities are an encouraging finding. Ongoing epidemiologic studies to monitor the epidemic and continued prevention efforts to help maintain or further these declines are needed, particularly to address the higher rates of needle sharing in Puerto Rico.

Sexual prevention of HIV: a model for Latinos

Despite reductions in AIDS deaths in the general population, Latino AIDS deaths in the United States have been increasing. The underlying cause of the rising HIV infection rates in the U.S. Latino population is not fully understood. Focus groups among Mexicans in North Carolina revealed methods of prevention that were different from those recommended by the Centers for Disease Control and Prevention (CDC). A research-based Mexican model of HIV prevention is proposed and contrasted with a model deducted from CDC prevention strategies. Recently immigrated Mexicans may be unlikely to adopt the CDC model of HIV prevention due to their culturally specific views of prevention.