Among Hispanics living in 40 U.S. states and Puerto Rico, the HIV diagnosis rate fell among both men and women from 2006 through 2009, according to results of a study by the Centers for Disease Control and Prevention (CDC).1 The biggest declines were seen among Hispanics born in Puerto Rico.
In 2009 the HIV diagnosis rate was highest among Hispanics from Central America and lowest among those from Mexico. A shorter time from HIV diagnosis to AIDS was more likely among Hispanic men than women, more common in foreign-born Hispanics than U.S.-born Hispanics, and more common in people not living in cities.
Hispanics (people of Latin origin living in the United States) made up 15% of the U.S. population in 2009,2 but they represented 21% of all U.S. residents diagnosed with AIDS that year.3 Most research on HIV in Hispanics in the United States considers them as one group. Yet Hispanics clearly differ in many ways that may affect their risk of HIV infection -- for example, their reason for coming to the United States, and whether they live in cities or rural areas. Previous research showed that Hispanics in the United States also differ in (1) knowledge of HIV infection, (2) HIV risk factors, (3) views on personal HIV risk, and (4) use of HIV prevention services.
Almost 50 million Hispanics lived in the United States in 2009, and another 4 million lived in Puerto Rico. Hispanics make up at least one fifth of the population in several states: New Mexico (46%), California (37%), Texas (37%), Arizona (31%), Nevada (26%), Florida (22%), and Colorado (20%).4 CDC researchers conducted this study to estimate rates of HIV diagnosis in each year from 2006 through 2009 among Hispanics living in 40 U.S. states or Puerto Rico.
The CDC team used data on people 13 years old or older who tested positive for HIV from 2006 through 2009. All of these new HIV cases were reported to the CDC through June 2010. Data came from Puerto Rico and from 40 U.S. states, including Texas, Florida, and New York, but not including California. (See reference 5 for the full list.)
The researchers defined Hispanics as people who trace their origin to Mexico, Puerto Rico, Cuba, Central and South America, and other Spanish cultures. Hispanics can be of any race. In this study, "U.S. born" means born in one of the 50 states or Washington, DC.
The CDC investigators used standard statistical methods to estimate the year-to-year percent change in HIV diagnosis rate by sex, age group, birthplace, and area of residence. They also examined differences among Hispanic subgroups in (1) less than a 12-month interval between HIV diagnosis and AIDS diagnosis, and (2) survival more than 36 months after HIV diagnosis.
From 2006 through 2009 in Puerto Rico and the 40 states surveyed, 33,498 Hispanics tested positive for HIV. More than half of the study group (57%) became infected with HIV during sex between men, while 27% became infected during sex between men and women, 13% became infected while injecting drugs, and 13% became infected during sex between men or while injecting drugs.
The yearly HIV diagnosis rate from 2006 through 2009 fell 4.3%. In Hispanic men the yearly diagnosis rate fell 2.8%, while in Hispanic women the rate fell 9.8% (Figure 1).
Figure 1. The yearly rate of Hispanics testing positive for HIV in 40 states and Puerto Rico fell significantly for both men and women from 2006 through 2009.
Among Hispanic men 20 to 29 years old, the HIV diagnosis rate rose 4.2% over the study period, whereas the rate fell 6.6% for men 30 to 39 and fell 4.7% for men 40 to 49. For women the yearly diagnosis rate fell in every age group analyzed up to 60 years and older: The rate fell 16.7% in 13-to-19-year-olds, 10.8% in 20-to-29-year-olds, 7.4% in 30-to-39-year-olds, 9.8% in 40-to-49-year-olds, and 10.5% in 50-to-59-year-olds.
From 2006 through 2009 the HIV diagnosis rate dropped 3.5% among Hispanic men born anywhere outside the United States and 13.1% among men born in Puerto Rico. But the rate did not fall among Hispanic men born in the United States. Among Hispanic women, the HIV diagnosis rate fell 6.8% among those born in the United States, 10.7% among those born anywhere outside the United States, 12.2% among those born in Central American, and 13.2% among those born in Puerto Rico.
Over the 2006-2009 study period, the HIV diagnosis rate dropped 16.8% among rural Hispanic men, but not among men living in cities. The HIV diagnosis fell 32.2% among rural Hispanic women and 8.7% among Hispanic women living in cities.
Among 6657 Hispanic people diagnosed with HIV in 2009 with a reported place of birth, 55% were born outside the United States. The HIV diagnosis rate was 23.1 per 100,000 people among those born outside the United States and 26.8 per 100,000 among those born in the United States. In 2009 the HIV diagnosis rate was highest in people born in Central America and lowest in those born in Mexico:
|HIV Diagnosis Rate in 2009 per 100,000 People by Birthplace|
Among Hispanics diagnosed with HIV from 2006 through 2009, 39% had AIDS within 12 months of their positive HIV test. Having AIDS within 12 months of a positive HIV test was more likely among Hispanic men than women (Figure 2), more likely among Hispanics born outside the United States than in the United States, and more likely in nonurban areas than in cities.
Figure 2. Among Hispanics living in 40 U.S. states or Puerto Rico, men, older people, and people born outside the United States rather than in the United States were more likely to have AIDS within 12 months of a positive HIV test.
Compared with people 13-to-29-years-old, having AIDS within 12 months of a positive HIV test was 46% more likely in 30-to-39-year-olds, 64% more likely in 40-to-49-year-olds, and 83% more likely in people 50 and older (Figure 2).
The proportion of Hispanics who survived more than 36 months after a positive HIV test was highest among 13-to-29-year-olds (96%) and lower among 30-to-49-year-olds (90%) and 50-and-older people (78%). Survival more than 36 months after HIV diagnosis was lower in people living in rural areas than in city dwellers (83% versus 91%) and lower in injection drug users (84%) than in gay men who injected drugs (90%), people infected during sex between men and women (91%), and gay men who did not inject drugs (92%).
Hispanics born in South American or the United States had the highest proportion who survived more than 36 months after a positive HIV test, while those born in Mexico, Puerto Rico, or Central America had the lowest proportion:
|Survival Beyond 36 Months After HIV Diagnosis by Birthplace|
This study in 40 U.S. states and Puerto found that the rate at which Hispanics tested positive for HIV fell from 2006 through 2009. The falling HIV diagnosis rate held true for both men and women. These encouraging results could mean fewer Hispanics are getting infected with HIV and/or that fewer Hispanics are getting tested for HIV.
Other recent research showed a higher HIV testing rate among Hispanics than among whites in the United States from 2001 through 2009.6 So it seems likely that the falling HIV diagnosis rate in Hispanics mainly reflects a falling HIV infection rate. That probably means more Hispanic men and women in the United States, Mexico, South America and elsewhere are becoming more aware of HIV and are taking steps to protect themselves from infection -- like consistently wearing condoms during sex.
People who already have HIV can help slow its spread by telling sex partners they have HIV and by always using a condom during sex. Using condoms consistently is important even when two HIV-positive people have sex, because condoms protect you from getting infected with a second HIV virus, and they protect you from getting other sexually transmitted infections (like chlamydia and syphilis).
This study was large enough to track yearly HIV diagnosis rates in several Hispanic subgroups. These analyses showed that the HIV diagnosis rate is not falling in every subgroup and that it is rising in some subgroups. For example, the rate rose 4.2% from 2006 through 2009 in Hispanic men 20 to 29 years old. Also, among Hispanic men the HIV diagnosis rate fell sharply (13.1%) among those from Puerto Rico, but not among those from the United States, Cuba, Mexico, Central America, or South America. For Hispanic women, the HIV diagnosis rate fell significantly for those born in Puerto Rico (13.2%), Central America (12.2%), and the United States (6.8%), but not for those born in Cuba, Mexico, or South America. These findings underline possible differences in HIV awareness and risk-taking between Hispanics born in different countries.
Many Hispanics come to the United States to work in farming in rural areas or to join family or friends in cities. Migration itself can raise the risk of HIV infection by resulting in homelessness, loneliness, isolation, and poverty. The researchers point out that these factors can lead migrants to new sex partners, commercial sex, and drug use; they can also make it more difficult to access health care. Undocumented migrants may avoid health care or HIV testing because they fear being sent back to their home country.
A short time from a positive HIV test to AIDS may indicate HIV testing late in the course of HIV infection (at a lower CD4 count). A short HIV-to-AIDS time may also indicate poor access to health care or poor care. Hispanics who work as migrant farmers, have no health insurance, or have difficulty working with a healthcare system in an English-speaking country may have poor access to care.
Lower survival rates among Hispanics living in rural areas rather than cities could reflect later HIV diagnosis, lack of health care, or lack of insurance.
See the box for AIDS Hotlines that offer help en Español.
|AIDS Hotlines en Español|
AIDSinfo, U.S. Department of Health and Human Services
New York State hotline
For other hotlines: www.projectinform.org/hotlines/.