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HIV/AIDS: Hispanic/Latino Disparities and Policy Recommendations …

HIV/AIDS: Hispanic/Latino Disparities and Policy Recommendations

Daniel Santibanez, MPH, Department of Public Health, University of North Florida

Donna T. Jones, MS, RD, LD/N, Medical Nutrition Therapy of Florida, Inc.

July 22, 2005 - UNF Hispanic Health Issues Seminar

This is part 6 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.

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  • 1. HIV/AIDS: Hispanic/Latino Disparities and Policy Recommendations Daniel Santibanez, MPH Department of Public Health University of North Florida Donna T. Jones, MS, RD, LD/N MNT Services, Inc. This is part 6 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department. For more information or register for the seminars, please call 620-1289.
  • 2. HIV/AIDS Defined
    • What causes AIDS ?
    • AIDS is the most serious form of an illness caused by a virus called the Human Immunodefiency Virus (HIV). In general, the body attacks and disables the immune system. Over time, with a damaged immune system, the body loses its ability to combat a variety of illnesses, called opportunistic infections (OI’s) or conditions. Challenges by these OI’s and conditions further challenges the immune system.
    • The gradual destruction of the immune system, doesn’t happen the same in everyone. Some can remain well for up to 10-15 years without experiencing the first serious symptoms, while others the destruction of the immune system is very rapid, only a few years.
  • 3. The Culprit’s Mug-Shot
  • 4. From Project Inform. For more information, contact the National HIV/AIDS Treatment Hotline, 800-822-7422, or visit our website, www.projectinform.org
  • 5. Indicator Conditions for Case Definition of AIDS
    • Candidiasis of bronchi, trachea, or lungs
    • Candidiasis, esophageal
    • Cervical cancer, invasive
    • Coccidioidomycosis, disseminated or extrapulmonary
    • Cryptococcosis, extrapulmonary
    • Cryptosporidiosis, chronic intestinal
    • Cytomegalovirus disease (other than liver, spleen, or lymph nodes)
    • Encephalopathy, HIV-related
    • Herpes simplex, chronic ulcer(s) or bronchitis, pneumonitis, or esophagitis
    • Histoplasmosis, disseminated or extrapulmonary
    • Isosporiasis, chronic intestinal
    • Lymphoma, Burkitt's
    • Kaposi's sarcoma
    • Lymphoma, immunoblastic
    • Lymphoma, primary (in brain)
    • Mycobacterium avium complex or M. kansasii , disseminated or extrapulmonary
    • Mycobacteriumtuberculosis , any site
    • Pneumocystis carinii pneumonia
    • Pneumonia, recurrent
    • Progressive multifocal leukoencephalopathy
    • Salmonella septicemia, recurrent
    • Toxoplasmosis of brain
    • Wasting syndrome, HIV-related
  • 6. Classification system for HIV infection
  • 7. Infection Control/Prevention
    • Abstinence
    • Condoms:
      • Latex or polyurethane condoms
      • Female condoms
    • MTCT: Viramune or AZT Tx during childbirth, avoid breast feeding
      • The transmission of HIV from mother to child is responsible for over 90% of infections among children under the age of 15
    • Using sterile needles for IVDU
    • Universal Precautions for healthcare workers
  • 8. Global approximates 14,000 new HIV infections a day in 2003
    • More than 95% are in low and middle income countries
    • Almost 2000 are in children under 15 years of age
    • About 12,000 are in persons aged 15 to 49 years, of whom:
      • almost 50% are women
      • about 50% are 15–24 year olds
  • 9. The AIDS pandemic Adults and children living with HIV/AIDS, end 2002 North America 980,000 Caribbean 440,000 Latin America 1,500,000 North Africa & Middle East 550,000 Sub-Saharan Africa 29,400,000 East Asia & Pacific 1,200,000 S & SE Asia 6,000,000 Australia & New Zealand 15,000 Western Europe 570,000 Eastern Europe & Central Asia 1,200,000 2001-02 increase Source: UNAIDS 3.4% 4.8% 5.6% 11.1% 13.2% 13.5% 15.8% 17.8% 20.8% 29.0%
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  • 15. Age-sex-adjusted percentage of adults aged 18+ who had ever been tested for HIV, January - June 2002 * Estimates are age-sex-adusted to the 2000 U.S. standard population using five age groups: 18-24 years, 25-34 years, 35-44 years, 45-64 years, and 65 years and over 46.7 - 51.7 49.2 Black, non-Hisp 31.4 - 33.4 32.4 White, non-Hisp 33.2 - 37.6 35.4 Hispanic 95% confidence interval Percent* Race/Ethnicity
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  • 19. AIDS Cases by Race/Ethnicity 3,026 196 American Indian/Alaska Native 7,166 497 Asian/Pacific Islander 172,993 8,757 Hispanic 368,169 21,304 Black, not Hispanic 376,834 12,222 White, not Hispanic Cumulative Estimated # of AIDS cases, through 2003 Estimated # of AIDS Cases in 2003 Race or Ethnicity
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  • 24. Top 10 AIDS Reported Cases by State/Territory Maryland 26,918 North Carolina 1,083 Georgia 27,915 New Jersey 1,516 Puerto Rico 28,301 Maryland 1,570 Pennsylvania 29,988 Illinois 1,730 Illinois 30,139 Pennsylvania 1,895 New Jersey 46,703 Georgia 1,907 Texas 62,983 Texas 3,379 Florida 94,725 Florida 4,666 California 133,292 California 5,903 New York 162,446 New York 6,684 State/Territory # of Cumulative AIDS cases through 2003 State/Territory # of AIDS Cases in 2003
  • 25. Cumulative Adult AIDS Cases Through May 2002 (N=87,682) Comment: The epidemic in Florida has spread out to suburban and rural areas from urban epicenters in Miami-Dade, Broward, Palm Beach, Hillsborough, St. Petersburg, Orange, and Duval counties. Though 55% of the 87,000 AIDS cases are known to have died, the cumulative numbers remind us of the overall burden of the epidemic on the community. Characterized by race/ethnicity, sex, and mode of exposure, it becomes apparent that HIV/AIDS in Florida consists of multiple overlapping, but somewhat distinct, epidemics. Source: HIV/AIDS Reporting System (HARS). CUMULATIVE CASES 0 to 500 501 to 2500 2501 to 5000 Over 5000 6 780 9 50 5 541 42 8384 28 487 1345 70 19 88 126 306 25400 36 145 8 14 71 100 80 664 59 26 33 213 27 1180 30 64 180 122 5014 18 15 79 550 4969 1337 804 328 13790 574 193 266 167 4402 314 1232 112 840 1466 113 1033 268 178 40 1440 13 791 3491
  • 26. Overview Through May 2002
    • Florida U.S.
    • Reported
    • AIDS Cases 87,682 822,920
    • HIV Cases 25,761 182,851
    • Estimated
    • HIV Prevalence 95,000 850,000-950,000
    • Whites 30,200 ---
    • Blacks 49,100 ---
    • Hispanics 15,200 ---
    • Others 500 ---
    • Estimated Percent
    • Aware of Serostatus 75% 75%
    • Estimated Annual
    • HIV Incidence 4,000 40,000
  • 27. HIV/AIDS epidemic is a serious threat to the Hispanic/Latino community
    • In addition to being a population seriously affected by HIV, Hispanics continue to face challenges in accessing health care, prevention services, and treatment
    • In 2001, HIV/AIDS was the third leading cause of death among Hispanics men aged 35-44 and the fourth leading cause of death among Hispanic women in the same age group
  • 28. Cumulative Effects of HIV Infection and AIDS (through 2002) Although Hispanics make up only about 14% of the population of the U.S. and Puerto Rico, they accounted for 20% of the more than 886,500 AIDS cases diagnosed since the beginning of the epidemic By the end of 2002, nearly 88,000 Hispanics had died with AIDS
  • 29. AIDS in 2002 The 76,052 Hispanics living with AIDS accounted for 20% of all people in the United States living with AIDS
  • 30. HIV/AIDS in 2002 From 1999 - 2002, the number of new HIV/AIDS cases increased 26% among Hispanics in 30 surveillance areas
  • 31. Risk Factors and Barriers to Prevention
    • A number of cultural, socioeconomic, and health related factors help drive the HIV epidemic in the Hispanic community
    • Because Hispanic Americans or their parents have emigrated from many Latin countries or regions, there is no single Hispanic culture in the U.S.
  • 32. Research shows that Hispanics born in different countries have different behavioral risk factors for HIV/AIDS Data suggest that Hispanics born in Puerto Rico are more likely than other Hispanics to contract HIV as a result of injection drug use By contrast, sexual contact with other men is the primary cause of HIV infections among men born in Mexico
  • 33. Risk Factors and Barriers to Infection Heterosexual Risk Denial Substance Abuse Poverty Sexually Transmitted Diseases
  • 34. Poverty
    • Of the Hispanic people with HIV/AIDS interviewed in a multi-site study, 47% of Mexican-born men who have sex with men (MSM) and 59% of Puerto Rican-born MSM had annual incomes of less than $10,000
    A variety of socioeconomic problems associated with poverty, including limited access to high-quality care, directly or indirectly increase the risk for HIV infection
  • 35. Denial
    • Although many Hispanics are increasingly engaged in the fight against HIV/AIDS, some Hispanics have been slow to join the effort
    Many Hispanics MSM identify themselves as heterosexual and, and as a result, may not relate to prevention messages crafted for gay men
  • 36. Heterosexual Risk
    • Some women, including those who suspect that their partners are at risk for HIV infection, may be reluctant to discuss condom use with their partners out of fear of emotional or physical abuse or the withdrawal of financial support
    Hispanic women are most likely to be infected with HIV as a result of sex with men
  • 37. Substance Abuse
    • Both casual and chronic substance users are more likely to engage in high-risk behaviors, such as unprotected sex, when they are under the influence of drugs or alcohol
    Injection drug use continues to be a significant risk factor for Hispanics
  • 38. Sexually Transmitted Diseases
    • Compared with whites, Hispanics are about twice as likely to have gonorrhea or syphilis
    Sexually transmitted infections increase the likelihood of HIV transmission
  • 39. Lack of experience using American medical system
    • In most Central and South American communities, medical services are not always located nearby and pharmacists are permitted to freely dispense many drugs that require prescriptions in the U.S.
    Therefore, people go to see the doctor only when they are very sick
  • 40. Many clients did not have access to medical services back home, and need to be educated about the U.S. system as well as basic medical issues. For example, case managers at La Clinica del Pueblo in Washington D.C. spend a great deal of time with clients addressing questions like: “ What is a prescription? A refill?” “How do you take the medications?” La Clinica del Pueblo receives Title I and Title II funds to serve Hispanic men whose exposure category is men who have sex with men. Fewer than 10 percent of La Clinica clients speak fluent English
  • 41. “ Clients are accustomed to going to the emergency room for drugs when they feel bad. The idea of taking medications when they feel okay is foreign. These individuals don’t understand drug resistance, or their need to see a doctor. In Mexico, individuals get drugs from pharmacists without ever seeing a physician” Barbara Aranda-Naranjo of the South Texas AIDS Center for Children and Families in San Antonio
  • 42. “ You don’t talk about your disease! You never, in the Hispanic culture, talk about anything where someone will lose face. It is very difficult for these women to be honest with their physician; they think it is safer if no one finds out they are sick.” Barbara Aranda-Naranjo of the South Texas AIDS Center for Children and Families in San Antonio Reluctance to even discuss health problems also is a factor
  • 43. Work to improve access to prevention, care, and treatment services for Latinos regardless of their immigration or citizen status
    • Provide additional resources to support services to Latinos, including increased funding to Puerto Rico and states currently experiencing dramatic increases in Latino populations
    • Create, fund, and sustain services tailored to monolingual Spanish speaking and migrant/immigrant Latinos without regard to citizenship states
    • Create and support HIV prevention and care services to Latinos in and transitioning from correctional settings
  • 44. Work to improve access to prevention, care, and treatment services for Latinos regardless of their immigration or citizen status
    • Work to improve the coordination of services within and between states/territories and local jurisdictions
  • 45. Work to improve access to prevention, care, and treatment services for Latinos regardless of their immigration or citizen status
    • Combine Ryan White Care Act and AIDS Drug Assistance Program (RWCA/ADAP) with state and local resources to expand prescription drug and medical services for uninsured Latinos
  • 46. Work to improve access to prevention, care, and treatment services for Latinos regardless of their immigration or citizen status
    • Support increased funding for the National Minority HIV/AIDS initiative (MHAI)
    • In its fourth year, the MHAI is a critical tool in the national efforts to eliminate HIV/AIDS related health disparities among racial and ethnic groups
  • 47. Work to improve access to prevention, care, and treatment services for Latinos regardless of their immigration or citizen status
    • Develop resource allocation methodologies that are consistent with, and that anticipate, local need
    • States, territories, and local health departments should work in close collaboration with planning bodies to ensure that resource allocation are proportionate with systematically demonstrated need
  • 48. Work to improve access to prevention, care, and treatment services for Latinos regardless of their immigration or citizen status
    • Support basic HIV/AIDS educational efforts targeting Latinos
    • Information about HIV/AIDS including modes of exposure, strategies for preventing HIV infection, the natural history of the disease, the importance of early detection and early treatment, and current treatment approaches should be broadly disseminated and constantly updated
  • 49. Work to improve access to prevention, care, and treatment services for Latinos regardless of their immigration or citizen status
    • Create public information and awareness campaigns that educate Latinos about their rights and entitlements as well as the availability and location of services locally
  • 50. Work to improve access to prevention, care, and treatment services for Latinos regardless of their immigration or citizen status
    • Build and support local, community based-capacity
  • 51. Work to improve access to prevention, care, and treatment services for Latinos regardless of their immigration or citizen status
    • Establish and uphold the highest standards for culturally competent care
  • 52. Work to improve access to prevention, care, and treatment services for Latinos regardless of their immigration or citizen status
    • Provide and support cultural competency training
  • 53. Organize and mobilize Latinos
    • Encourage and support coalition work within Latino communities and between Latinos and other people of color
  • 54. Keys for Provider Success
    • Organizations caring for Hispanics living with HIV disease should link clients with programs that help them address their economic circumstances
    • In some populations, linkages to employment services, transportation services, and counseling may be essential
  • 55. Keys for Provider Success
    • Critical is the integration of substance abuse prevention and AIDS treatment, and actively addressing the role of homophobia and marianismo in health care utilization and prevention methods
    The Hispanic cultural attitude of machismo and marianismo reinforces female passivity and male dominance and virility, and can reduce safe sex practices and negatively influence treatment utilization
  • 56. Providers should…
    • Collaborate with organizations that have already established trust with the community to build a network of services
    • Aggressively educate the community about testing the treatment
    • Implement educational campaigns in the preferred language of the population
    • Assure that all case managers and physicians are bi-lingual and bi-cultural
    • Provide translation services
  • 57. Providers should…
    • Help clients access support services including support groups
    • Integrate social services with AIDS treatment in order to help patients comply with regimens, return for appointments, eat nutritiously, and maintain their overall health
    • Recognize that HIV status affects individuals’ legal status and/or desire to normalize their legal status
  • 58. Thank You! Daniel Santibanez [email_address] This is part 6 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department. For more information or register for the seminars, please call 620-1289.