By Dr. Vincent Guilamo-Ramos and Dr. Barbara Taylor
In February 2019, the federal government updated national HIV goals to end the epidemic in the U.S. by 2030. Those goals appeared to be coming into reach because of significant overall progress in the fight against HIV, with deaths attributed to HIV across the U.S. decreasing by approximately 4% from 2014 to 2018 and estimated new infections decreasing by 7%, reflecting improving access to prevention, treatment and care.
But as noted here on National Latinx AIDS Awareness Day, that progress has not been shared equally. During that same time period, deaths attributed to the virus among Latinx individuals increased and new HIV infections are up by 6%.
The Latinx HIV epidemic is clustered in eight geographic areas with seven states – New York, Texas, California, Florida, Illinois, Arizona, New Jersey – and Puerto Rico accounting for roughly eight of 10 new HIV diagnoses and 9 in 10 HIV deaths among Latinx individuals. The Ending the HIV Epidemic initiative has recognized the need to target hot spots – states and counties across the country that account for the great majority of new HIV infections – as well as to determine the impacts of the U.S. HIV epidemic on specific populations.
This recognition is critical to turning around the overlooked HIV epidemic among Latinx populations and communities. Beyond these geographic priority areas in the Latinx HIV epidemic, there are also high transmission clusters throughout the U.S. in which HIV transmission rates are 5 to 33 times the national average. Young Latinx men who have sex with men below the age of 30 are disproportionately represented in these high transmission clusters.
Common disparity drivers characterize these clusters, including inadequate reach of HIV prevention and treatment services in Latinx communities. HIV-related stigma, homophobia/transphobia, discrimination, racism, lack of insurance, poverty, inequality of opportunity, knowledge gaps regarding HIV and risk, lack of culturally appropriate services and mistrust of healthcare system, also need to be considered when responding to the HIV prevention and treatment needs of diverse Latinx communities. It is also critical to recognize demographic and social differences across geographic hotspots in the Latinx HIV epidemic and develop context-appropriate interventions.
Zooming in on New York City highlights a large but also largely overlooked crisis. Roughly one in three people (29%) in NYC identifies as Latinx. At the same time, the city is home to one of the most diverse Latinx communities in the U.S., with a Latinx population primarily represented by residents from Puerto Rico and the Dominican Republic. Latinx residents account for more than a third (36%) of all new HIV diagnoses in New York City, and the city accounts for nearly four of every five new HIV diagnoses among Latinx residents of New York state. While a 20% decrease in annual HIV diagnoses among Latinx in New York City from 2014 to 2018 represented an impressive drop, the decrease among non-Latinx residents was more than 30%. Latinx youth aged 13 to 29 represent roughly two in every five (39%) diagnoses among Latinx in NYC.
Zooming in closer still to one of New York’s five boroughs highlights the weight of inequities.
Home to the poorest congressional district in the continental U.S., the Bronx performs the worst compared to all four other NYC boroughs in adult educational attainment, poverty, rent burden, teen births, elementary school absenteeism, jail incarceration, assault hospitalizations, self-reported health, and life expectancy. The Bronx also accounts for more than 20% of all new HIV diagnoses and nearly 30% of all new HIV diagnoses among Latinx residents in the city. From 2014 to 2018, new HIV diagnoses in the Bronx only decreased by 11%, while decreasing by roughly 30% for NYC as a whole. Among Latinx in the Bronx, new diagnoses only decreased by approximately 8%, demonstrating the need for Latinx focused community-specific interventions and outreach.
Zooming in on Texas highlights the weight of structural barriers to care that include lack of health coverage. While roughly two in every five people (39.7%) in Texas identify as Latinx, Latinx Texans experience higher rates of uninsurance (28%) when compared with their Latinx counterparts nationally (15%). In addition to that barrier to health, Latinx residents of Texas face additional structural challenges worse than their national counterparts, resulting in lower educational attainment and higher poverty, rent burden, teen birth, and repeat teen birth rates.
In 2018, over 40% of new HIV diagnoses in Texas were among Latinx residents. From 2014 to 2018, the number of new HIV diagnoses for Latinx increased by 4%, compared to an overall increase of 1.3% statewide, and decreases in diagnoses among Latinx in some other states, including New York. In 2018, Latinx men who have sex with men accounted for approximately 76% of HIV diagnoses among Latinx Texans, as well as nearly half of all new HIV diagnoses among men who have sex with men in the state. Latinx youth aged 15 to 29 represented approximately 45% of new HIV diagnoses among Latinx in Texas in 2018.
The takeaways from both places must inform plans and strategies to end HIV as an American epidemic. Latinx populations comprise the largest racial/ethnic minority group, making up 18% of the U.S. population – and their number is expected to double by 2060. Important demographic and social differences across geographic hotspots in the Latinx HIV epidemic need to be considered when responding to the HIV prevention and treatment needs of diverse Latinx communities. Lack of access to care, including HIV prevention and treatment, and HIV-related stigma are key barriers to care for Latinx individuals, particularly in the U.S. South, where the number of new diagnoses are rising.
If left unaddressed, persistent HIV disparities among Latinx communities in the United States represent a significant challenge to national goals for ending the HIV epidemic by 2030. We must work in collaboration with Latinx communities to provide expanded opportunities for HIV education, prevention, and care in these diverse communities, and to address the structural barriers to achieving health experienced by many Latinx populations.
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 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. 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.
Dr. Barbara Taylor is an Associate Professor of Infectious Diseases and the Assistant Dean for the MD/MPH Program at UT Health San Antonio. During the COVID-19 pandemic, she has served as the Chair of the City of San Antonio/Bexar County Health Transition Team and she currently serves as Co-Chair of the San Antonio Metropolitan Health District’s COVID-19 Community Response Coalition, which works to support pandemic response efforts and provide community guidance. Dr. Taylor conducts research to improve health outcomes for those living with or at risk for HIV, with a specific focus on Latinx populations.