HIV: The exact origin of the virus in humans is unclear. Scientists surmise that it jumped from an animal population, probably African monkeys or chimpanzees, to humans via a bite or meat. The first case documented in humans dates from 1959. The virus was isolated by Luc Montagnier of France's Pasteur Institute in 1983. It went through several name changes before the official name, human immunodeficiency virus, was agreed upon.
HIV is not transmitted by casual contact; transmission requires a direct exchange of body fluids, such as blood or blood products, breast milk, semen, or vaginal secretions, most commonly as a result of sexual activity or the sharing of needles among drug users. Such a transmission may also occur from mother to baby during pregnancy or at birth. Saliva, tears, urine, feces, and sweat do not appear to transmit the virus.
By the end of 2002 it was estimated that 42 million people were infected with HIV worldwide, the great majority in Third World countries; some 25 million had died from AIDS. The disease in sub-Saharan Africa, which has been especially hard hit, in the main has been transmitted heterosexually and has been exacerbated by civil wars and refugee problems and less restrictive local mores with regard to sex. Some 29 million people were infected with HIV in this region, where, in many countries, the prevalence of AIDS has lowered the life expectancy. The epidemic also has manifested itself in Asia (especially in India, China, Myanmar, Thailand, and Cambodia) and Latin America.
In the United States, the demographics of AIDS have changed over time. In the 1980s it was seen mainly in homosexual and bisexual men and was one of the spurs to the gay-rights movement , as activists lobbied for research and treatment monies and began education and prevention programs. Also in the early years, before careful screening of blood products was deemed necessary, the virus was contracted by an estimated 9,000 hemophiliacs and a small number of people were infected by surgical or emergency blood transfusions. Before long, however, the majority of new HIV infections were seen in drug users who contracted the disease from shared needles or unprotected sex. A large proportion of infected women are drug users or partners of drug users. Nearly a third of the infants born to HIV-infected women are infected with the virus. (Some of these infants test positive for AIDS only because of the mother's antibodies and later test negative.)
Although, the main thrust of HIV/AIDS may no longer related solely to the gay population; it remains a significant problem among Hispanic and Black homosexual men.
Federal health officials say the majority of gay and bisexual men with AIDS are black or Hispanic, a dramatic shift from a decade ago when the disease was predominantly seen in whites in the gay community.
In a new survey, the Centers for Disease Control and Prevention in
Atlanta found that in 1998, 52 percent of AIDS cases among homosexual
and bisexual men were black or Hispanic, compared to 31 percent in
1989. In the same period, the percentage of homosexuals with AIDS who
were white dropped to 48 percent from 69 percent.
Helene D. Gayle, director of the CDC's National Center for HIV, STD
and TB Prevention, says, "The face of AIDS among gay and bisexual men is changing." Perhaps the most astonishing change though, is the steady increase of Hispanic/Latino homosexuals who are becoming HIV positive.
LATINOSTATISTICS
HIV/AIDS in 2005
• Hispanics/Latinos accounted for 18% of the 37,331 new HIV/AIDS diagnoses in 33 states with long-term, confidential name-based HIV reporting.
• For Hispanic/Latino men living with HIV/AIDS, the most common exposures were sexual contact with other men, injection drug use, and high-risk heterosexual contact. For Hispanic/Latina women living with HIV/AIDS, the most common exposures were high-risk heterosexual contact and injection drug use [2]
• HIV testing rates were slightly higher among Hispanics/Latinos than among persons of other races or ethnicities except blacks. A 2002 study showed that 50% of Hispanics/Latinos aged 15–44 had been tested and that 18% had been tested during the past year.
Race/ethnicity of persons (including children) with HIV/AIDS diagnosed during 2005
AIDS in 2005
• AIDS in 2005 Hispanics/Latinos accounted for 19% of the 40,608 new diagnoses in the 50 states and the District of Columbia.
• The 78,054 Hispanics/Latinos living with AIDS accounted for 19% of all people living with AIDS in the 50 states and the District of Columbia.
• Of the rates of diagnoses for adults and adolescents in all racial and ethnic groups, the second highest was the rate for Hispanics/Latinos. The highest rate was that for blacks (68.7 cases per 100,000 persons), followed by the rates for Hispanics/Latinos (24.0/100,000), American Indians and Alaska Natives (9.3/100,000), whites (6.9/100,000), and Asians and Pacific Islanders (4.3/100,000).
• Although Hispanics/Latinos made up only about 13% of the population of the United States [4], they accounted for 16% (155,179) of the estimated 952,629 AIDS cases diagnosed since the beginning of the epidemic.
• By the end of 2005, an estimated 77,125 Hispanics/Latinos with AIDS had died.
• Of persons whose diagnosis of AIDS had been made during 1997–2004, a smaller proportion of Hispanics/Latinos (74%), compared with whites (75%) and Asians/Pacific Islanders (81%), were alive after 9 years. However, the proportion of surviving Hispanics/Latinos was larger than the proportions of surviving American Indians and Alaska Natives (67%) and blacks (66%).
The method of transmission of Latino’s also is astonishing, as the main method is through homosexual activity. This comes at a time when white homosexual Americans have learned preventative techniques and stopped their upward curve of disease and mortality.
Transmission categories for Hispanic/Latino adults and adolescents living with HIV/AIDS, 2005
RISK FACTORS AND BARRIERS TO PREVENTION
A number of cultural, socioeconomic, and health-related factors contribute to the HIV epidemic in the US Hispanic/Latino community. Research shows that behavioral risk factors for HIV infection differ by country of birth. Data suggest that Hispanics/Latinos born in Puerto Rico are more likely than other Hispanics/Latinos to contract HIV as a result of injection drug use and high-risk heterosexual contact (Table) [2]. By contrast, sexual contact with other men is the primary cause of HIV infections among Hispanic/Latino men born in Central or South America, Cuba, Mexico, or the United States.
Sexual Risk Factors
Hispanic/Latina women are most likely to be infected with HIV as a result of sex with men. In a study of heterosexual Hispanics/Latinos in the United States, 16% had sexual risk factors for HIV infection, including multiple sex partners or partners with risk factors for HIV infection.
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 because they fear emotional or physical abuse or the withdrawal of financial support. An assessment of HIV risk behaviors among men who have sex with men (MSM) in the southeastern United States found that Hispanic/Latino and African American men were more likely than white men to report inconsistent condom use during anal sex with multiple partners and that Hispanic/Latino men were more likely to have never been tested for HIV. However, in a study of heterosexual Hispanic/Latino men, consistent recent condom use and intentions to use condoms during the next month were associated with positive attitudes about condom use, perception that one’s partner had a positive view of condom use, and greater participation in decision making about condom use.
Substance Use
Injection drug use continues to be a significant risk factor for Hispanics/Latinos, particularly among those living in Puerto Rico. Drug users in Puerto Rico are more likely to share syringes, cotton, and rinse water and to inject more frequently than Hispanic/Latino drug users on the US mainland. Sharing syringes is not the only HIV risk factor related to substance abuse. Both casual and chronic substance users are more likely to engage in risky sex behaviors, such as unprotected sex, when they are under the influence of drugs or alcohol.
Sexually Transmitted Diseases
In 2005, the rate of chlamydial infection among Hispanics/Latinos was about 3 times the rate for whites (459.0/100,000 compared with 152.1/100,000 whites). The rates of gonorrhea and syphilis among Hispanics/Latinos were about twice the rates among whites: gonorrhea—74.8/100,000 Hispanics/Latinos compared with 35.2/100,000 whites; syphilis—3.3/100,000 Hispanics/Latinos compared with 1.8/100,000 whites. Partly because of physical changes caused by sexually transmitted diseases (STDs), including genital lesions, which can serve as an entry point for HIV, the presence of certain STDs can increase one’s chances of contracting HIV 3- to 5-fold.
Hispanic/Latino Cultural Beliefs: Risk and Protective Factors
Research has shown that Hispanic/Latino cultural concepts of masculinity and femininity, and thus the social norms of sexuality, have created double standards and power inequalities that have been linked to HIV risk and protective behaviors. For some Hispanic/Latino men, the traditional gender role of machismo has positive implications for HIV prevention, such as strength and protection of the family. However, proving masculinity through power and dominance can lead both straight and gay Hispanic/Latino men to engage in risky sex behavior, such as sex with multiple partners, unprotected sex with women or men, or sexual coercion. Familismo, or a strong commitment to family, can be a strong incentive for some Hispanic/Latino men to reduce unprotected sex with casual partners. Familismo can also be a source of conflict for Hispanic/Latino men who have sex with men (MSM), whose families may have a negative view of homosexuality. Further, many Hispanic/Latino MSM identify themselves as heterosexual and, as a result, may not relate to prevention messages crafted for gay men.
For some Hispanic/Latina women, the traditional gender roles—marianismo, in which women are expected to be pure and to acquiesce to men’s desires, and simpatía, in which the importance of nonconfrontational relationships is emphasized—combined with sexual silence impede the discussion of sexual issues and the negotiation of sexual safety with male partners. In one study, Hispanic/Latina women’s denial of personal risk for HIV infection was associated with a lack of information about how to avoid risky behaviors.
Greater acculturation into the US culture has been associated with the adoption of several health-protective behaviors among Hispanics/Latinos, including communicating with partners about sexual safety and disclosing positive HIV serostatus. However, high levels of acculturation have also been associated with increased HIV risk behaviors among Hispanic/Latino(a) men and women. In one study, highly acculturated HIV-positive Hispanic/Latino men were more likely to use drugs before sex, which increased unsafe sexual behavior. For Hispanic/Latina women, those who were more highly acculturated were more likely to inject drugs and to have had a greater number of sex partners.
Because of the diversity of Hispanic/Latino people and culture in the United States, the above-mentioned research on Hispanic/Latino cultural beliefs and HIV risk behaviors does not apply to all individuals or groups of Hispanic/Latino origin.
Socioeconomic Issues
More than 1 in 5 (21.9%) Hispanics/Latinos live in poverty. Various socioeconomic problems associated with poverty, including a lack of formal education, unemployment, inadequate health insurance, and limited access to high-quality health care, can directly or indirectly increase the risk for HIV infection. Hispanics/Latinos are more likely than whites (not Hispanic/Latino) to be given a diagnosis during the late stages of HIV infection, or when they already have AIDS, suggesting that they are not accessing testing or health care services through which HIV infection could be diagnosed at an earlier stage.
The migration patterns, social structure, language barriers, and lack of access to regular health care among transient Hispanic/Latino immigrants can affect awareness and hinder access to HIV/AIDS prevention and care. Recent immigrants face additional challenges, such as social isolation and lack of information about HIV/AIDS, which can further increase their risk for exposure to HIV. Thus, transient and recent Hispanic/Latino immigrants need linguistically and culturally appropriate HIV prevention services.
PREVENTION
Populations of minority races and ethnicities continue to be disproportionately affected by the HIV epidemic. New recommendations advise routine HIV screening for adults, adolescents, and pregnant women in health care settings in the United States. They also recommend reducing barriers to HIV testing.
Initiative comprises 4 strategies:
• making HIV testing a routine part of medical care,
• implementing new models for diagnosing HIV infections outside medical settings,
• preventing new infections by working with HIV-infected persons and their partners, and
• further decreasing perinatal (mother to unborn baby) HIV transmission.
It is important to evaluate the effectiveness of HIV prevention interventions for the US Hispanic/Latino population. Research shows that HIV prevention efforts can reduce risk behaviors and increase protective behaviors among Hispanics/Latinos at risk for HIV infection. One systematic review found that HIV prevention interventions for Hispanics/Latinos increased the use of condoms and reduced the number of acts of unprotected sex, the number of sex partners, the frequency of injection drug use, and the acquisition of STD infections.
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