Improving HIV Outcomes among Hispanics and Latinos

Ken Dominguez CDC HeadshotOctober 15 is National Latinx AIDS Awareness Day. In observance, the CDC has put together several resources for the SERMO physician community about this important topic.

If you’re an M.D. or D.O. you can read more from the CDC inside SERMO.

Improving HIV Outcomes among Hispanics and Latinos

CAPT Kenneth L. Dominguez, MD, MPH (USPHS) Medical Epidemiologist, 

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 

In 2014, Hispanics and Latinos made up about 17% of the U.S. population, but they accounted for an estimated 24% of all new HIV diagnoses.1 While rates of HIV diagnoses have decreased or plateaued for non-Hispanic whites and blacks/African Americans, they are increasing among Hispanics and Latinos.2 In addition, many Hispanics and Latinos living with HIV aren’t receiving the care and treatment they need.3

cdc table 1HIV Burden on Hispanics and Latinos

Currently the largest racial and ethnic minority population in the United States, with the proportion expected to grow to nearly 1 in 4 people by 20355, Hispanics and Latinos bear a disproportionate burden of HIV relative to other races and ethnicities. In 2013, over 209,000 Hispanics and Latinos were living with HIV at an estimated rate more than double that of non-Hispanic whites. This disparity poses a serious health threat to Hispanic and Latino communities.5

Routine HIV Screening Can Help

HIV testing is the gateway to care and treatment, yet very few outpatients are routinely screened. Of the more than 1.2 million people in the United States living with HIV, 1 in 8 people are unaware of their status.6

Routine HIV screening can help physicians diagnose and treat

the infection early on. Although antiretroviral therapy, or ART, can help transform HIV from a death sentence into a chronic condition, currently less than half of HIV-diagnosed Hispanics and Latinos are prescribed ART.7 Raising the awareness of infected individuals about their HIV status and risky behaviors also can help prevent unintentional HIV transmission to others. In other words, for those who are living with HIV, knowing their HIV status can help them and their partners stay healthy.

Since 2006, CDC and other organizations have advocated including HIV screening in routine care, but many physicians have not readily embraced the recommendation to screen high-risk patients at least annually. As physicians, we need to create a community standard for HIV testing. Instead of waiting for patients to ask for the test, we should advise them that we will screen for HIV unless they opt out.

 The HIV Testing Algorithm

CDC now recommends using the fourth-generation testing algorithm, which can detect acute HIV as much as 3 to 4 weeks earlier than the previous test. This algorithm begins with a combination immunoassay that detects HIV-1 and HIV-2 antibodies and HIV-1 p24 antigen. The fourth-generation test is more sensitive at diagnosing early infection because it detects the HIV-1 p24 antigen, which appears before antibodies develop. It has several other advantages as well, including more accurate laboratory diagnosis of HIV-2 infection, fewer indeterminate results, and faster turnaround time for most test results.8

The fourth-generation test can only be used with serum or plasma specimens. When it’s not feasible to draw blood, rapid tests and oral fluid tests should be used, and preliminary positive test results should be followed up with confirmatory testing.

Covering Gaps in the Care Continuum

While routine HIV screening is a key step in identifying Hispanics and Latinos with HIV, testing doesn’t benefit patients unless we link them to the appropriate medical care and services. For example, data from 2012 and 2013 show that while 83% of Hispanics (18 years and older) diagnosed with HIV were linked to care, only about 54% attended follow-up visits and just 35% had achieved viral suppression.9

Some physicians may fear they don’t have the staff and resources to manage patients who test positive. They may ask: “Where do you send the patient for follow-up care?” “What if the patient has a difficult time emotionally after receiving a positive HIV test result?” Other potential reasons for the large dropoff between an initial medical visit and follow-up care among Hispanics and Latinos include lack of health insurance, language barriers, geographic differences, HIV-related stigma, denial, and migration patterns.10 In fact, Hispanics and Latinos are almost 3 times as likely to be uninsured as whites—though this hopefully will improve as more uninsured individuals obtain coverage through the Affordable Care Act.11

Fortunately, education centers across the country can help providers navigate these issues and link patients to local resources, such as HIV providers who speak Spanish or healthcare centers that accept patients without insurance. In addition, the government is working to better disseminate public health education resources for community health workers (promotores de salud) to educate Hispanics and Latinos about their health (http://www.cdc.gov/minorityhealth/promotores.html) and to link them to free or low-cost services (for example, see www.cdc.gov/cancer/nbccedp/screenings.htm or www.cdc.gov/minorityhealth).12 Also, a new section of CDC’s HIV Screening. Standard Care.™ program called Testing and Linking African American and Hispanic/Latino Patients to Care offers tailored materials and information to help providers improve HIV outcomes among Hispanic and Latino patients.

HIV Screening. Standard Care. 

CDC recommends HIV screening for all patients ages 13 to 64. CDC’s Act Against AIDS campaign focuses on raising awareness among all Americans and reducing the risk of infection among the hardest hit groups, including gay and bisexual men, African Americans, and Hispanics and Latinos. As part of this effort, CDC developed the HIV Screening. Standard Care. program, which provides free tools and resources for incorporating HIV testing into primary care settings.

Prevention IS Care 

Persons living with HIV often adopt healthy behaviors after their initial diagnosis, but then revert back to risky behaviors, putting their health and the health of others at risk. Ongoing, brief prevention counseling is a cost-effective measure that can be incorporated into routine care for individuals living with HIV. CDC’s Prevention IS Carecampaign has tools that providers can use on a daily basis with patients living with HIV.

Additional Resources

  • HIV testing: Centers for Disease Control and Prevention. HIV tests that are FDA-approved for use in the United States (laboratory tests, home tests, and HIV testing in clinical and non-clinical settings). http://www.cdc.gov/hiv/testing/index.html. Updated June 30, 2015.
  • Fourth Generation Testing Algorithm: Centers for Disease Control and Prevention. Laboratory testing for the diagnosis of HIV infection: updated recommendations. http://stacks.cdc.gov/view/cdc/23447. Updated June 27, 2014.
  • AIDS Education and Training Centers (AETC) National Resource Center: HRSA Ryan White HIV/AIDS Program. http://www.aidsetc.org/.
  • AIDS Drug Assistance Program (ADAP): HRSA Ryan White HIV/AIDS Program. http://hab.hrsa.gov/abouthab/partbdrug.html
  1. CDC. (2015). HIV Surveillance by Race/Ethnicity (through 2014) (Slide Set). Retrieved January 11, 2016 from http://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-surveillance-race-ethnicity.pdf Slide 5
  2. CDC. (2015). HIV Surveillance by Race/Ethnicity (through 2014) (Slide Set). Retrieved January 11, 2016 from http://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-surveillance-race-ethnicity.pdf Slide 2 and Slide 3
  3. CDC. (2015, October 15). HIV among Hispanics/Latinos. Retrieved February 8, 2016 from http://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/.
  4. CDC. (2015, Oct 15). HIV among Hispanics/Latinos. Retrieved on October 20, 2015 from http://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/.
  5. CDC. (2015, May 5). Vital signs: Hispanic Health. Retrieved on October 20, 2015 from http://www.cdc.gov/vitalsigns/hispanic-health/.
  6. CDC. (2015, July). HIV in the United States: At a glance July 2015. Retrieved on October 20, 2015 from http://www.cdc.gov/hiv/pdf/statistics_basics_ataglance_factsheet.pdf.
  7. CDC. (2015, Oct 15). HIV among Hispanics/Latinos. Retrieved on October 20, 2015 from http://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/.
  8. CDC. (2014, June 27). Laboratory testing for the diagnosis of HIV infection: updated recommendations. Retrieved on October 20, 2015 from http://stacks.cdc.gov/view/cdc/23447. Page 8
  9. CDC. (2015, Oct 15). HIV among Hispanics/Latinos. Retrieved on October 20, 2015 from http://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/.
  10. CDC. (2014, Oct 10). Hispanics or Latinos living with diagnosed HIV: Progress along the continuum of HIV care — United States, 2010. Retrieved on October 20, 2015 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6340a2.htm. Page 1
  11. CDC. (2015, May 5). Vital signs: Hispanic Health. Retrieved on October 20, 2015 from http://www.cdc.gov/vitalsigns/hispanic-health/.
  12. CDC. (2015, May 5). Ibid.

Citation (also found in the references above)- http://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-surveillance-race-ethnicity.pdf  Slide 5

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