Dr. Vincent Guilamo-Ramos is the vice-chair of the board of directors of the Latino Commission on AIDS, and director and founder of the Center for Latino Adolescent and Family Health and the co-chair of the Ending the HIV Epidemic working group for the HIV Medicine Association, which produces this blog. Today, on National Latinx AIDS Awareness Day, observed every Oct.15 since 2003 to raise awareness of the HIV pandemic’s impact on U.S. Hispanic/Latino communities across the United States, he talks to Science Speaks about the state of progress and continuing gaps in HIV prevention, treatment and care services for Latinx populations, and barriers to services.
Are the advances in prevention, treatment and tracking HIV that have enabled plans to end HIV as an epidemic in the United States reaching and making a difference in incidence, prevalence and outcomes in Latinx communities?
Yes, but not anywhere near what we know is possible. We’ve seen substantial progress overall in the fight against HIV in the U.S. with annual infections dropping by more than half since the 1980s. At the same time, an invisible Latinx HIV crisis continues. While estimated new infections are decreasing overall, there has been a 6% increase among Latinx individuals since 2014.
A closer look at the demographic breakdown of new infections shows where access to essential services is still a problem. While we have seen decreases in new HIV diagnoses and estimated new infections among heterosexual Latinx since 2014, estimated annual HIV infections have increased by 6% for Latinx gay and bisexual men, with a 21% increase for Latinx gay and bisexual men ages 25-34.
Available data suggest that at least one in three Latinx individuals newly diagnosed with HIV in 2018 was born outside the continental U.S., showing the increased vulnerability of Latinx immigrant communities. With place-of-birth data only available for about two-thirds of the new HIV diagnoses among Latinx individuals recorded by the Centers for Disease Control and Prevention, the proportion could be much larger than one in three.
In addition, substance use and mental health conditions have the potential to interfere with engagement, retention and adherence to HIV prevention and treatment, and HIV diagnoses among Latinx injection drug users increased by 6% since 2016 alone. So while populations most at risk in Latinx communities include men who have sex with men, immigrants, individuals with mental health conditions and people with substance use disorders, the existing HIV prevalence among these groups then increases the risk of exposure to the virus across the community.
Why are these populations affected to such a disproportionate extent?
We know that stigma has been a significant barrier to knowledge of risks, to essential health services and specifically to HIV treatment and prevention from the beginning of the HIV pandemic. When stigma and discrimination are associated with intersecting marginalized identities – because of homophobia, transphobia, racism, xenophobia, social exclusion and lack of opportunity linked to socioeconomic status – added to HIV stigma, the barriers are multiplied.
At the same time, health systems, school systems and social services remain inadequately aligned with the cultural, linguistic, and social needs of Latinx people at risk and living with HIV.
As a result, services don’t reach the people who need them most. Latinx remain the most uninsured and underinsured population in the United States. In spite of high HIV prevalence in Latinx communities more than half of Latinx people in the United States have never been tested for the virus.
Latinx individuals account for approximately 25% of new HIV infections, but only for 13% of PrEP users. In New York City, where I practice, three times as many Latinx people are diagnosed with HIV annually than White, but about four times as many White people are on PrEP than Latinx.
For those who are infected, available services too often fail to meet cultural and linguistic needs as well as provide gender-affirming care. Among Latinx estimated to be living with HIV, more than 1 in 3 are not engaged in HIV care and only half achieve viral suppression.
What needs to happen for the advances in HIV prevention and care to reach all of the people who need them and end HIV as an epidemic in America?
Targeted responses to the unique needs of Latinx people at risk and living with HIV, including gay and bisexual Latinx men, transgender Latinas, recent Latinx immigrants, and Latinx people with mental health conditions and or substance use disorders will be essential.
To do that, we need to build and increase historically neglected partnerships between community-based organizations, behavioral health services, religious organizations and families. These partnerships are essential to developing responses that are informed as well as culturally and linguistically competent. That, in turn, will help to identify outcomes and factors related to achieving them. We could consider PrEP access and uptake a priority. A holistic behavioral response would then examine and address both awareness and knowledge of PrEP as well as access to HIV services and barriers to those services.
The first step to all of that remains recognizing that all progress has not been shared equally — and that is what National Latinx AIDS Awareness Day reminds us to do.
Dr. Vincent Guilamo-Ramos is a professor at New York University and trained as a clinical social worker and nurse practitioner specializing in the health of adolescent and young adults. Dr. Guilamo-Ramos is certified by the American Academy of HIV Medicine as an HIV specialist and board-certified HIV/AIDS nurse. In addition, Dr. Guilamo-Ramos is a member of PACHA and an HHS treatment guidelines member. He also serves as the vice-chair of the board of directors of the Latino Commission on AIDS, director and founder of the Center for Latino Adolescent and Family Health. He is a member of the HIV Medicine Association, which produces this blog, and co-chair of HIVMA’s Ending the HIV Epidemic Working Group.