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A Community Assessment of Nutritional Needs/Status of HIV/AIDS among Latinos in the San Joaquin Valley of California
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A Community Assessment of Nutritional Needs/Status of HIV/AIDS among Latinos in the San Joaquin Valley of California


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  • 1. A Community Assessment of Nutritional Needs/Status of HIV/AIDS among Latinos in the San Joaquin Valley of California Kayoko Zahn
  • 2. Introduction 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. Background 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 Nutrition 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 Lifestyle 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 Educational programs 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 Recommendations 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. Conclusions 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.
  • 7. References 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. Accessed September 18, 2013. 2. CDC Fact Sheet: HIV among Latinos. Centers for Disease Control and Prevention. Web site. Published November 2011. Accessed September 17, 2013. 3. CDC Fact Sheet: New HIV Infections in the United States. Centers for Disease Control and Prevention. Web site. 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. 2010;110(7):1105-1119. 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. Posted August 2013. Accessed September 18, 2013. 7. State & County QuickFacts: California. U.S. Dept of Commerce United States Census Bureau. Web site. Published June 2013. Accessed September 20, 2013. 8. Hill L, Hayes J. Just the Facts: Undocumented Immigrants. Public Policy Institute of California. Web site. 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. Published June 2005. Accessed September 20, 2013. 10. California's Agricultural Employment, 2008. State of California Employment Development Department. Web site. Accessed September 17, 2013.
  • 8. 11. Farm Labor: Background. United States Department of Agriculture. Web site. 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. Published December, 2012. Accessed September 20, 2013. 13. HIV/AIDS Surveillance in California. California Department of Public Health: Office of AIDS. Web site. 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. Posted April 2013. Accessed September 18, 2013. 16. HIV Testing. Centers for Disease Control and Prevention. Web site. 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). Published August 2012. Accessed September 18, 2013. 20. REASONS/RAZONES HIV Testing campaign. Centers for Disease Control and Prevention. Web site. 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 Rev. 2012;25(2):267-87.
  • 9. 23. MedlinePlus: HIV infection. National Institutes of Health. Web site. 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. Posted 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. Accessed September 19, 2013. 27. About Act Against AIDS™. About Act Against AIDS™ Web site. Accessed September 20, 2013. 28. AETC Mission and History: Program Background and Goals. The AIDS Education and Training Centers National Resource Center. Web site. Accessed September 20, 2013. 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. Published April 2009. Accessed September 17, 2013. 30. Programs and Services. Food and Nutrition Service, United States Department of Agriculture (USDA). Web Page. Accessed September 21, 2013.