1. A Community Assessment of Nutritional Needs/Status
of HIV/AIDS among Latinos
in the San Joaquin Valley of California
Infection by Human immunodeficiency virus (HIV) causing acquired immunodeficiency
syndrome (AIDS) is a significant problem in public health among both sexes and all ages of
Latinos in the US although males are disproportionally affected.1,2,3 Latinos represented 21% of
all new HIV infections in 2010 although they represented 16 % of the US population.3 Early
HIV screening and detection are important for community nutritionists for effective nutrition
intervention.4 However, barriers such as income, language, health insurance and immigration
status may delay the diagnosis and treatment.5 There are no data on the accessibility of HIV
prevention and health care services to undocumented immigrants among the Latino population in
the San Joaquin Valley of California. In this paper, recommendations are provided based on
information about the community assessment nutrition needs and status.
California (CA) has the largest Latino population in the US,6 accounting for 38.2% of the total
population in CA and 16.9% of the US population in 2012.7 Twenty-three percent of the
undocumented immigrants in the US reside in CA. About 80% of undocumented immigrants
are from Latin America.8 California is an important producer of many agricultural products.
About 36 % of US farm-workers reside in CA and about two-thirds (67.9%) are Latinos and
almost all (95.2%) are from Mexico.9.10 In the US, about 50 % of farm-workers are not legally
authorized.11 Based on the statistical information, there appears to be a large unauthorized
population of Latino immigrants living in the agricultural communities of CA. One large
agricultural area is the San Joaquin Valley which includes 8 counties. This region suffers from
high unemployment rates. The data from December 2012 showed that this region had more than
a 13 % unemployment rate while the US average was 7.6 %.12 Most reported cases of
3. HIV/AIDS are in metropolitan areas such as San Francisco and Los Angeles, accounting for
54 % of the total in CA.13 In order to achieve the HIV-related Healthy People 2020 objectives14
it will be important to focus on the population in non-metropolitan areas, such as the San Joaquin
Valley. This is especially true in the categories of HIV prevention, HIV testing, and care after
diagnosis. People in this area are at higher risk for HIV infection due to the barriers of job
security, poverty, lack of transportation, poor education, health insurance, language and so on.14
Screening and Treatment
Over 1.1 million people infected with HIV live in the US of which the center for disease control
(CDC) estimates that about 20 % have not been diagnosed and are unaware of their infection.15
HIV screening tests are usually conducted in community or clinical settings.16,17 Screening at
home is also possible because there is now a type of test available at drug stores for home use.16
The two types of HIV tests are classified as strictly laboratory tests or those approved for use
outside of the clinical settings.16 The tests approved for outside use are less complex and may be
used for both clinical and non-clinical settings including the community and outreach
environments.16 The HIV antibody test is the most common HIV test.16 According to the
algorithm recommended by the CDC, 4th generation HIV - 1/2 immunoassay should be used as
the initial test.18 This test detects HIV during the highly infectious phase of HIV infection,
unlike the previously recommended test which cannot detect infection during this phase (called
the window period),.18 To confirm HIV infection, a Western blot test is used as the second test.19
The CDC provides free HIV testing services such as a campaign called Reasons, specifically
targeting Latino gay and bisexual men.20 There are a variety of drugs to treat HIV/AIDS
although no drugs are available to cure the infection. The recommended treatment for HIV is the
use of antiretroviral therapy (ART).19,21 In patients whose CD4 levels drop to below 200 cells /
4. µl and these with symptoms of developed HIV, ART is recommended.21 In ART, patients take a
combination of anti-HIV drugs such as Isentress, Norvir, Prezista, Reyataz and Sustiva to control
virus replication and preserve the numbers of CD4 cells to maintain the immune system and
prevent disease progression.19,21
Nutritional status and control of viral load by ART are both important to maintain immune
function and limit progression of the disease.4 Common nutritional problems among people
living with HIV infection are protein-malnutrition, anemia, and changes in micronutrient status.4
Early nutrition intervention would help delay the progression of weight loss which affects
morbidity and mortality.4 It is thought that a high protein diet may be beneficial for prevention
of protein-malnutrition.4 Micronutrients such as zinc, selenium, B vitamins, vitamin C and
vitamin E seem to have important roles for the immune system affecting progression and
symptoms of the disease.4 HIV-associated lipodystrophy syndrome (HALS) is prevalent in
people with HIV infection.22 A Mediterranean style diet, possibly due to the effect of n-3 PUFA
may contribute to reduce symptoms of HALS.22 Food hygiene is also important because the
immune system of people with HIV is affected.4 People with HIV infection also are more likely
to use complementary and alternative medicine (CAM).4 Registered dietitians should be aware
of the effects of CAM such as potential interactions with other medications.4
HIV is transmitted through sexual contact, blood, and mother-to-child. Sharing needles,
unprotected sex, and infants born from mothers having HIV infection without receiving HIV
therapy during pregnancy are examples of high HIV infection risks. Avoiding these situations
helps prevent HIV infection.23 Certain lifestyles (smoking, drinking alcoholic beverages and
5. abusing drugs, age, sexually promiscuous behavior, obesity and being underweight) are risk
factors which need to be evaluated to prevent complications of chronic HIV infection.4 Exercise
is recommended for people with HIV to maintain body function and reduce symptoms.24,25
Lifestyle modifications such as exercise, changes in alcohol, fat and fiber intake will be
beneficial to HIV patients with high blood cholesterol levels.26
An example of a federal HIV/AIDS prevention education program is the Act Against AIDS
campaign launched by CDC in 2009.27 It consists of several campaigns and each has a different
specific target audience.27 The relevant ones to Latino communities are Act Against AIDS™,
Let's Stop HIV Together™, and Testing Makes Us Stronger™.27 Another example is the
program offered by the AIDS Education and Training Centers (AETC) which is supported by the
Health Resources and Services Administration.28 AETC is a provider of education and training
programs to healthcare professionals.29
Latinos are a large group in the farming communities in the San Joaquin Valley. The data6-12
shows many suffer from common issues such as poverty and alien status. This group has limited
access to a number of governmental services and campaigns targeted to the Latino population
due to the lack of transportation. The California Department of Public Health Office of AIDS
has made efforts to meet the transportation needs of the farm workers in Northern CA to provide
HIV related services.29 Improving the accessibility to available services by meeting
transportation needs should be effective for HIV prevention as well as treatment. A number of
national, state, or regional organizations share the same goal of HIV/AIDS prevention and
treatment. It is important that these organizations make efforts to collaborate. Lack of
6. transportation and geographical isolation may cause food insecurity in this group. Governmental
food and nutrition programs such as Supplemental Nutrition Assistance Program and Special
Supplemental Nutrition Program for Women, Infants, and Children from the United States
Department of Agriculture30 are important in supporting the Latino population of the San
Joaquin Valley who are at high risk of HIV infection or are already infected with HIV.
HIV/AIDS is the major public health problem among the Latino population in the US.1,2,3
California has the largest Latino population in the US and is also the state in which more than 1/3
of US farm-workers reside. About two thirds are Latinos, mostly from Mexico, and many appear
to be undocumented immigrants.6,8,9,10,11 The San Joaquin Valley, which consists of farming
communities, suffers from high unemployment rates.12 Latino population in these communities
is at risk of HIV infection and also of not getting treated due to barriers such as income, alien
status, health insurance, language and transportation. Maintaining proper nutritional status and
viral load by ART are important for patients with HIV infection to maintain immune function
and limit disease progression since no cure exists for the infection.4 The presence of early
intervention affects morbidity and mortality.4 Certain lifestyle behaviors such as unprotected sex
and drug-use increase risk of HIV infection.23 Patients with HIV infection can benefits from
modifying their lifestyle to include behaviors such as exercising.24,25,26 A wide range of
organizations from the national to regional offer a variety of programs,27,28,29 In order to deliver
healthcare services and educational opportunities for HIV prevention and treatment to the rural
Latino population in the San Joaquin Valley, it is important to understand their needs such as
transportation. Different organizations involved in treatment and prevention also need to make
efforts to collaborate to work together effectively.
1. HIV: Overview. U.S. Department of Health and Human Services. Office of Disease
Prevention and Health Promotion. Healthy People 2020. Washington, DC. Web site.
September 18, 2013.
2. CDC Fact Sheet: HIV among Latinos. Centers for Disease Control and Prevention. Web site.
http://www.cdc.gov/hiv/pdf/risk_latino.pdf. Published November 2011. Accessed September 17,
3. CDC Fact Sheet: New HIV Infections in the United States. Centers for Disease Control and
Prevention. Web site. http://www.cdc.gov/hiv/pdf/statistics_basics_factsheet.pdf. Published
December 2012. Accessed September 17, 2013.
4. American Dietetics Association. Position of the American Dietetic Association: Nutrition
Intervention and Human Immunodeficiency Virus Infection. J Am Diet Assoc.
5. CDC Report: Effective HIV Surveillance among Asian Americans and Native Hawaiians and
Other Pacific Islanders. Web site.
Published April 2013. Accessed September 17, 2013.
6. Brown A and Lopez MH. Mapping the Latino Population, By State, County and City. Pew
Research Center: Hispanic Trends Project. Web site. http://www.pewhispanic.org/2013/08/29/iiranking-latino-populations-in-the-states/. Posted August 2013. Accessed September 18, 2013.
7. State & County QuickFacts: California. U.S. Dept of Commerce United States Census Bureau.
Web site. http://quickfacts.census.gov/qfd/states/06000.html. Published June 2013. Accessed
September 20, 2013.
8. Hill L, Hayes J. Just the Facts: Undocumented Immigrants. Public Policy Institute of
California. Web site.
http://www.ppic.org/content/pubs/jtf/JTF_UndocumentedImmigrantsJTF.pdf. Posted February
2013. Accessed September 16, 2013.
9. The California Farm Labor Force: Overview and Trends from the National Agricultural
Workers Survey. Aguirre International, Burlingame, California. Web site.
http://agcenter.ucdavis.edu/AgDoc/CalifFarmLaborForceNAWS.pdf. Published June 2005.
Accessed September 20, 2013.
10. California's Agricultural Employment, 2008. State of California Employment Development
Department. Web site. http://www.calmis.ca.gov/file/agric/ca-ag-profile.pdf. Accessed
September 17, 2013.
8. 11. Farm Labor: Background. United States Department of Agriculture. Web site.
http://www.ers.usda.gov/topics/farm-economy/farm-labor/background.aspx. Posted February,
2013. Accessed September 17, 2013.
12. News Release: Unemployment in the San Joaquin Valley by County - December 2012.
Bureau of Labor Statistics U.S. Department of Labor. Web site.
http://www.bls.gov/ro9/lausjoaq.pdf. Published December, 2012. Accessed September 20, 2013.
13. HIV/AIDS Surveillance in California. California Department of Public Health: Office of
AIDS. Web site.
http://www.cdph.ca.gov/data/statistics/Documents/SSSemiAnnualRptJune2013.pdf. Posted June
2013. Accessed September 18, 2013.
14. HIV: Objectives. U.S. Department of Health and Human Services. Office of Disease
Prevention and Health Promotion. Healthy People 2020. Washington, DC. Web site.
Accessed September 18, 2013.
15. Expanded Testing Program Overview. Centers for Disease Control and Prevention. Web site.
http://www.cdc.gov/hiv/pdf/policies_HIV-ETP.pdf. Posted April 2013. Accessed September 18,
16. HIV Testing. Centers for Disease Control and Prevention. Web site.
http://www.cdc.gov/hiv/testing/index.html. Accessed September 18, 2013.
17. Branson B. Current HIV epidemiology and revised recommendations for HIV testing in
health-care settings. J Med Virol. 2007;79(1):S6-S10.
18. Morbidity and Mortality Weekly Report: Detection of Acute HIV Infection in Two
Evaluations of a New HIV Diagnostic Testing Algorithm — United States, 2011–2013. Center
for Disease Control and Prevention. Published June 2013. Accessed September 17, 2013.
19. The AIDSinfo fact sheet: HIV and Its Treatment. AIDSInfo, a service of the U.S. Department
of Health and Human Services (HHS).
http://aidsinfo.nih.gov/contentfiles/HIVandItsTreatment_cbrochure_en.pdf. Published August
2012. Accessed September 18, 2013.
20. REASONS/RAZONES HIV Testing campaign. Centers for Disease Control and Prevention.
Web site. http://www.cdc.gov/features/REASONS-RAZONES/. Posted June 2013. Accessed
September 21, 2013.
21. M S Hirsch. Initiating Therapy: When to Start, What to Use. J Infect Dis. 2008;197:S252-60.
22. Loonam CR, Mullen A. Nutrition and the HIV-associated lipodystrophy syndrome. Nutr Res
9. 23. MedlinePlus: HIV infection. National Institutes of Health. Web site.
http://www.nlm.nih.gov/medlineplus/ency/article/000602.htm. Posted May 2012. Accessed
September 20, 2013.
24. Evidence Analysis Library: Is there evidence that physical activity benefits people with HIV
infection? Academy of Nutrition and Dietetics. Web site.
November 2007. Accessed September 19, 2013.
25. Little JP, Phillips SM. Resistance exercise and nutrition to counteract muscle wasting. Appl
Physiol Nutr Metab. 2009;34(5):817-28.
26. Evidence Analysis Library: What is the evidence to support lifestyle interventions for the
treatment of hyperlipidemia in people with HIV infection? Academy of Nutrition and Dietetics.
Web site. http://andevidencelibrary.com/evidence.cfm?evidence_summary_id=250640.
Accessed September 19, 2013.
27. About Act Against AIDS™. About Act Against AIDS™ Web site.
http://www.cdc.gov/actagainstaids/about/. Accessed September 20, 2013.
28. AETC Mission and History: Program Background and Goals. The AIDS Education and
Training Centers National Resource Center. Web site. http://aidsetc.org/. Accessed September 20,
29. Entre Familia: Addressing the Interconnected Issues of California’s Latinos and HIV in
Education, Prevention, and Treatment. The Latino Advisory Board for the State of California,
California Department of Public Health Office of AIDS. Web site.
http://www.cdph.ca.gov/programs/aids/Documents/LABRptEntreFamilia.pdf. Published April
2009. Accessed September 17, 2013.
30. Programs and Services. Food and Nutrition Service, United States Department of Agriculture
(USDA). Web Page. http://www.fns.usda.gov/programs-and-services. Accessed September 21,