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Diagnoses and Prevalence of HIV Infection Among Hispanics or Latinos — United States, 2008–2013

Latinos are now the largest minority group in America. At some point in life, 1 in 36 Hispanic/Latino men will be diagnosed with HIV, as will 1 in 106 Hispanic/Latina women (1).


Diagnoses and Prevalence of HIV Infection Among Hispanics or Latinos — United States, 2008–2013

Weekly

October 9, 2015 / 64(39);1097-103

Kristen Mahle Gray, MPH1Eduardo E Valverde, DrPH1Tian Tang, MS2Azfar-e-Alam Siddiqi, MD, PhD1H. Irene Hall, PhD1

Hispanics or Latinos* represent about 17% of the total U.S. population and are disproportionately affected by human immunodeficiency virus (HIV) infection in the United States (1,2). In 2013, the rate of HIV diagnosis among Hispanics or Latinos (18.7) was nearly three times that of non-Hispanic whites (6.6) (1). To better characterize HIV infection among Hispanics or Latinos aged ≥13 years in the United States, CDC analyzed data from the National HIV Surveillance System (NHSS). During 2008–2013, the rate of diagnoses of HIV infection among adult and adolescent Hispanics or Latinos decreased from 28.3 per 100,000 population in 2008 to 24.3 in 2013 (estimated annual percentage change [EAPC] = -3.6); however, the number of diagnoses among males with infection attributed to male-to-male sexual contact increased 16%, from 6,141 in 2008 to 7,098 in 2013 (EAPC = 3.0). In 2013, the rate of diagnosis of HIV infection among males (41.3) was six times the rate among females (6.8). During 2008–2013, behavioral risk factors for HIV infection among Hispanics or Latino differed among males and females and by place of birth. Among Hispanic or Latino males born in Puerto Rico, the proportion of HIV infections attributed to injection drug use (24.9%) was greater than among those born elsewhere. Among HIV-infected Hispanic or Latino females, those born in the United States (21.2%) and Puerto Rico (20.5%) had a greater proportion of HIV infections attributed to injection drug use than those born elsewhere. Additional interventions and public health strategies to further decrease the rates of HIV among the Hispanic or Latino population are needed.

Data from NHSS reported to CDC from the early 1980s through December 2014 were used to determine the numbers and rates of diagnosis of HIV infection among Hispanics or Latinos aged ≥13 years (adults and adolescents) during 2008–2013 and prevalence in 2012, by selected characteristics. The numerator for each rate was the estimated number of diagnoses of HIV infection by diagnosis year. Appropriate subpopulations from the census or postcensus data from the U.S. Census Bureau were used for the denominator (2). Rates of infection by HIV transmission categories (male-to-male sexual contact, injection drug use, male-to-male sexual contact and injection drug use, heterosexual contact, or other) could not be calculated because the U.S. Census does not collect the data needed for the denominators. In calculating the EAPC in rates, populations were treated as actual populations and not samples, because the standard deviation of these populations was not available from the U.S. Census. Data from NHSS were also used to ascertain 1) HIV diagnoses in 2013 among Hispanics or Latinos by place of birth and transmission category, and 2) the numbers and rates of Hispanics or Latinos living with diagnosed HIV infection at year-end 2012 by area of residence at diagnosis. Birthplace information was available for 83.7% of Hispanics or Latinos in this analysis. Data were statistically adjusted for reporting delays and missing HIV transmission categories (3).

During 2008–2013, a total of 276,633 adults and adolescents received a diagnosis of HIV infection in the 50 states and the District of Columbia. Of these, 57,406 (20.8%) were Hispanics or Latinos. A decline was observed in the rates of diagnosis per 100,000 population among Hispanic or Latino adults and adolescents, from 28.3 per 100,000 population in 2008 to 24.3 in 2013 (EAPC = -3.6) (Table 1). During 2008–2013, the HIV diagnosis rate decreased among Hispanic or Latino males from 45.0 per 100,000 to 41.3 (EAPC = -2.0) and among females from 10.1 per 100,000 to 6.8 (EAPC = -9.6). The rates remained stable or decreased among all age groups, with the largest decline among persons aged 35–44 years (39.6 per 100,000 to 29.5 [EAPC = -6.8]). Among Hispanic or Latino males with infection attributed to male-to-male sexual contact, the number of HIV diagnoses increased 16% (EAPC = 3.0), whereas diagnoses decreased in other transmission categories (Figure). Among Hispanic or Latino females, the estimated number of HIV diagnoses decreased in persons with infection attributed to injection drug use or heterosexual contact. The largest declines in males (EAPC = -8.6) and females (EAPC = -11.8) were observed among those with infection attributed to injection drug use (Table 1).

In 2013, the HIV diagnosis rate per 100,000 population among males (41.3) was more than six times the rate among females (6.8). By age group, the highest rate of HIV diagnosis (40.1) among Hispanics or Latinos occurred among persons aged 25–34 years. By transmission category, the largest number of HIV diagnoses occurred among males with infection attributed to male-to-male sexual contact (7,098 [82.8%]), and among females with infection attributed to heterosexual contact (1,194 [87.2%]) (Table 1). The estimated rate of diagnosis for 2013 ranged from 2.3 in Idaho to 90.1 in the District of Columbia (Table 2).

HIV transmission category among Hispanics or Latinos varied by place of birth (Table 3). Infection attributed to male-to-male sexual contact accounted for the majority of infection transmissions among males, irrespective of place of birth, ranging from a low of 53.6% among persons born in Puerto Rico to a high of 86.4% among persons born in South America. Hispanic or Latino males born in Puerto Rico had a higher proportion of HIV infections attributed to injection drug use (24.9%) than those born elsewhere, whereas Hispanic or Latino females born in the United States (21.2%) and Puerto Rico (20.5%) had a higher proportion of HIV infections attributed to injection drug use than those born elsewhere. A smaller proportion of Hispanic or Latino males born in the United States (6.6%) had infection attributed to heterosexual contact compared with male Hispanics or Latinos born elsewhere. A smaller proportion of Hispanic or Latino females born in the United States (78.2%) and Puerto Rico (79.2%) had infection attributed to heterosexual contact compared with female Hispanics or Latinos born elsewhere.

At year-end 2012, an estimated 911,602 adults and adolescents were living with diagnosed HIV infection, and of these, 183,300 (20.1%) were Hispanics or Latinos (Table 2); the rate of persons living with HIV infection among Hispanics or Latinos was estimated at 458.8 per 100,000 population, and the estimated HIV prevalence ranged from 73.6 per 100,000 population in Montana to 1,947.5 in the District of Columbia (Table 2).

Discussion

During 2008–2013, overall diagnoses of HIV infection among adult and adolescent Hispanics or Latinos decreased in the United States. However, decreases have not occurred uniformly because diagnoses of HIV infection among men who have sex with men increased. This increase might have resulted from increased incidence of HIV infection, an increase in HIV testing among Hispanic or Latino men who have sex with men, or a combination of both of these factors (4).

An estimated 43% of Hispanics or Latinos who received an HIV diagnosis were not born in the United States or Puerto Rico (a U.S. territory), and among these Hispanic or Latino immigrants, 66% were men who have sex with men. The large proportion of HIV diagnoses in the United States among Hispanics or Latinos who are immigrants is important to consider when developing HIV prevention interventions, given that approximately 40% of Hispanic or Latino immigrants do not speak English well or at all (5) and because certain socioeconomic factors, such as limited access to health care, lack of health insurance, and poverty, might be at play (6).

Findings from this report also confirm earlier findings that Hispanics or Latinos are not a homogenous group, and risk factors differ by place of birth (7,8). The majority of males born in Puerto Rico with infection diagnosed during 2008–2013 had infections attributed to male-to-male sexual contact, highlighting a change in HIV transmission patterns, which until recently indicated that the most common HIV transmission category among men in Puerto Rico was injection drug use (9). Still, a much larger proportion of Hispanic or Latino males born in Puerto Rico reported infection attributed to injection drug use compared with Hispanic or Latino males born elsewhere. HIV care providers working in communities where Puerto Ricans reside should be mindful of a recent report indicating that levels of linkage to care, retention in care, prescription of antiretroviral therapy, and viral suppression were lower among Hispanics or Latinos with HIV infection attributed to injection drug use than among those with infection attributed to male-to-male sexual contact and heterosexual contact (10).

The findings in this report are subject to at least two limitations. First, misclassification of Hispanics or Latinos as members of other races/ethnicities might have resulted in underestimation of the number of Hispanics or Latinos overall and of Hispanic or Latino subgroups. Second, birthplace information was missing for 16% of Hispanics or Latinos in this analysis. Depending on the distribution of birthplaces for persons with missing information, transmission category prevalence for certain subgroups might have been larger or smaller.

The disproportionate rate of HIV infection among Hispanics or Latinos and the disparities found within this population indicate that much work still needs to be done to reach Hispanics or Latinos at high risk for acquiring or transmitting HIV infection. CDC and its partners are pursuing a high-impact prevention approach to maximize the effectiveness of current HIV prevention methods. Example activities include providing technical assistance to health departments and community-based organizations to deliver effective prevention interventions to Hispanics or Latinos, and supporting testing projects and campaigns that focus on Hispanics or Latinos, such as Reasons, which encourages HIV testing among Hispanic or Latino men who have sex with men. CDC funds health departments across the United States and its territories for core HIV prevention activities, including activities for Hispanics or Latinos, and supports projects to optimize care outcomes, such as the Care and Prevention in the United States demonstration project, which promotes increased testing and linkage to, retention in, and reengagement in care for racial and ethnic minorities living with HIV (6).

1Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; 2ICF International, Atlanta, Georgia.

Corresponding author: Kristen Mahle Gray, kgray1@cdc.gov, 404-639-2050.

References

  1. CDC. Diagnoses of HIV infection in the United States and dependent areas, 2013. HIV Surveillance Report 2015(25). Available athttp://www.cdc.gov/hiv/library/reports/surveillance/2013/surveillance_report_vol_25.html.
  2. US Census Bureau. Population estimates. Available at http://www.census.gov/popest/dataExternal Web Site Icon.
  3. Harrison KM, Kajese T, Hall HI, Song R. Risk factor redistribution of the national HIV/AIDS surveillance data: an alternative approach. Public Health Rep 2008;123:618–27.
  4. Johnson AS, Hall HI, Hu X, Lansky A, Holtgrave DR, Mermin J. Trends in diagnoses of HIV infection in the United States, 2002–2011. JAMA 2014;312:432–4.
  5. US Census Bureau. American Community Survey, 2012. English-speaking ability of the foreign-born population in the United States. Available athttps://www.census.gov/content/dam/Census/library/publications/2014/acs/acs-26.pdf Adobe PDF fileExternal Web Site Icon.
  6. CDC. HIV among Latinos. Available at http://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/index.html.
  7. CDC. HIV/AIDS among Hispanics—United States, 2001–2005. MMWR Morb Mortal Wkly Rep 2007;56:1052–7.
  8. Espinoza L, Hall HI, Hu X. Diagnoses of HIV infection among Hispanics/Latinos in 40 states and Puerto Rico, 2006–2009. J Acquir Immune Defic Syndr 2012;60:205–13.
  9. CDC. Incidence and diagnoses of HIV infection—Puerto Rico, 2006. MMWR Morb Mortal Wkly Rep 2009;58:589–91.
  10. CDC. Hispanics or Latinos living with diagnosed HIV: progress along the continuum of HIV care—United States, 2010. MMWR Morb Mortal Wkly Rep 2014;63:886–90.

* Hispanics or Latinos can be of any race.


Summary

What is already known on this topic?

Hispanics or Latinos represent about 17% of the total U.S. population and are disproportionately affected by human immunodeficiency virus (HIV) infection in the United States. In 2013, the rate of HIV diagnosis among Hispanics or Latinos (18.7 per 100,000) was nearly three times that of non-Hispanic whites (6.6).

What is added by this report?

During 2008–2013, the overall rate of the diagnoses of HIV infection among adult and adolescent Hispanics or Latinos decreased (from 28.3 per 100,000 in 2008 to 24.3 in 2013; estimated annual percentage change [EAPC] = -3.6); however, diagnoses of HIV infection among males with infection attributed to male-to-male sexual contact increased (EAPC = 3.0).

What are the implications for public health practice?

The higher rate of HIV infection among Hispanics or Latinos indicates that much work still needs to be done to reach Hispanics or Latinos at high risk for acquiring or transmitting HIV infection. Targeted strategies for Hispanic or Latino subpopulations, such as men who have sex with men and persons who inject drugs, present prevention challenges and warrant expanded efforts.


TABLE 1. Diagnoses of HIV infection* among adult and adolescent Hispanics or Latinos, by selected characteristics — United States, 2008–2013

Characteristic

2008

2009

2010

2011

2012

2013

EAPC§

p-value

95% CI

No.

Est. no.

Rate

No.

Est. no.

Rate

No.

Est. no.

Rate

No.

Est. no.

Rate

No.

Est. no.

Rate

No.

Est. no.

Rate

Sex

Female

1,656

1,686

10.1

1,588

1,623

9.5

1,429

1,479

7.9

1,297

1,362

7.1

1,180

1,266

6.4

1,227

1,370

6.8

-9.6

<.0001

(-11.1 to -8.1)

Male

7,967

8,106

45.0

7,773

7,949

42.8

7,565

7,819

40.6

7,566

7,914

40.0

7,743

8,264

40.8

7,748

8,568

41.3

-2.0

<.0001

(-2.7 to -1.3)

Age group at diagnosis (yrs)

13–24

1,660

1,690

18.1

1,665

1,701

17.8

1,733

1,789

16.8

1,717

1,794

16.6

1,843

1,963

17.9

1,729

1,901

17.0

-1.0

0.16

(-2.4 to 0.4)

25–34

3,243

3,300

41.0

3,151

3,224

39.4

3,027

3,129

37.0

2,978

3,115

36.4

3,106

3,315

38.3

3,171

3,514

40.1

-1.1

0.052

(-2.1 to 0.0)

35–44

2,686

2,732

39.6

2,597

2,655

37.6

2,340

2,419

33.0

2,234

2,341

31.3

2,071

2,213

28.9

2,074

2,295

29.5

-6.8

<.0001

(-8.0 to -5.6)

45–54

1,495

1,521

30.9

1,355

1,385

26.8

1,322

1,368

24.8

1,373

1,438

25.2

1,333

1,424

24.2

1,382

1,535

25.2

-4.2

<.0001

(-5.8 to -2.7)

55–64

417

425

15.1

442

453

15.1

451

466

14.3

423

441

12.8

432

465

12.8

494

551

14.4

-2.7

0.061

(-5.5 to 0.1)

≥65

122

125

4.8

151

154

5.6

121

126

4.5

138

147

4.9

138

149

4.7

125

141

4.2

-2.7

0.308

(-7.6 to 2.5)

Transmission category

Male adult and adolescent

Male-to-male sexual contact

4,929

6,141

4,924

6,172

5,046

6,233

5,224

6,405

5,452

6,874

5,410

7,098

3.0

<.0001

(2.2 to 4.0)

Injection drug use

449

674

367

584

322

529

291

478

237

436

238

452

-8.6

<.001

(-12.8 to -4.2)

Male-to-male sexual contact and injection drug use

330

408

272

351

253

329

228

301

240

320

199

278

-6.6

<.01

(-11.1 to -1.9)

Heterosexual contact

677

872

640

833

556

722

551

724

459

624

518

731

-5.2

<.01

(-8.3 to -2.0)

Other**

1,582

11

1,570

9

1,388

6

1,272

7

1,355

9

1,383

10

-1.5

0.94

(-34.4 to 47.7)

Female adult and adolescent

Injection drug use

191

297

164

275

96

191

100

194

97

180

78

167

-11.8

<.01

(-18.2 to -4.9)

Heterosexual contact

883

1,384

820

1,342

762

1,283

635

1,162

577

1,076

580

1,194

-4.5

<.0001

(-6.4 to -2.4)

Other**

582

5

604

6

571

4

562

6

506

9

569

9

13.9

0.532

(-24.3 to 71.4)

Area of residence††

Urban

8,546

8,697

31.2

8,332

8,520

29.7

7,997

8,267

27.2

7,815

8,177

26.3

7,945

8,480

26.6

7,913

8,759

26.8

-3.5

<.0001

(-4.2 to -2.9)

Suburban

776

789

17.5

713

728

15.7

681

703

13.7

714

748

14.1

666

708

13.0

699

770

13.8

-5.3

<.0001

(-7.4 to -3.2)

Rural

270

273

12.0

281

286

12.2

287

295

11.7

297

308

11.9

273

291

11.0

335

368

13.6

0.5

0.754

(-2.8 to 4.0)

Unknown

31

33

35

38

29

33

37

44

39

50

28

41

Total§§

9,623

9,792

28.3

9,361

9,573

26.8

8,994

9,298

24.4

8,863

9,276

23.8

8,923

9,529

23.9

8,975

9,938

24.3

-3.6

<.0001

(-4.2 to -3.0)

Abbreviations: CI = confidence interval; EAPC = estimated annual percentage change; Est. = estimated; HIV = human immunodeficiency virus.

* Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis.

Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing risk-factor information but not for incomplete reporting. Rates are per 100,000 population. Rates are not calculated by transmission category because of the lack of denominator data.

§ EAPC is based on rates with the exception of transmission category, which is based on the estimated number of diagnoses.

Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.

** Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.

†† Urban: population of ≥500,000. Suburban: population of 50,000– 499,999. Rural: nonmetropolitan area.

§§ Because column totals for estimated numbers were calculated independently of the values for the subpopulations, the values in each column might not sum to the column total.



TABLE 2. Diagnoses of HIV infection* in 2013, and persons living with diagnosed HIV infection at year-end 2012, among adult and adolescent Hispanics or Latinos, by area of residence — United States

Area of residence

Diagnoses of HIV infection, 2013

Living with HIV infection, year-end 2012

No.

Est. no.

Rate

No.

Est. no.

Rate

Alabama

14

15

10.6

317

315

231.9

Alaska

2

2

6.2

65

66

196.4

Arizona

252

259

17.3

3,719

3,714

254.7

Arkansas

19

24

16.5

281

288

208.0

California

1,947

2,198

19.5

38,917

39,623

358.3

Colorado

96

98

12.0

2,282

2,279

284.8

Connecticut

92

103

25.7

3,333

3,373

865.3

Delaware

9

10

17.1

232

235

414.8

District of Columbia

42

47

90.1

967

989

1,947.5

Florida

1,266

1,299

34.4

20,518

20,478

559.8

Georgia

160

249

38.2

2,323

2,423

377.8

Hawaii

13

14

14.7

227

230

244.4

Idaho

3

3

2.3

113

113

87.6

Illinois

345

405

25.6

5,829

5,997

385.7

Indiana

49

51

17.0

730

731

253.5

Iowa

9

9

7.8

181

181

161.0

Kansas

30

32

14.0

427

427

193.8

Kentucky

19

19

19.1

328

328

333.2

Louisiana

62

64

38.1

777

774

478.1

Maine

2

2

15.6

57

58

427.3

Maryland

79

103

25.7

1,548

1,609

417.1

Massachusetts

203

297

55.5

4,397

4,623

895.9

Michigan

38

39

11.7

711

709

217.7

Minnesota

29

30

15.9

664

663

363.4

Mississippi

13

13

20.5

230

229

364.7

Missouri

19

19

11.7

615

614

381.4

Montana

1

1

4.2

17

17

73.6

Nebraska

14

14

11.1

246

246

199.2

Nevada

139

143

25.0

1,643

1,640

295.3

New Hampshire

3

3

10.8

148

149

500.8

New Jersey

395

469

35.6

9,405

9,587

745.5

New Mexico

80

82

10.7

1,244

1,242

163.8

New York

1,178

1,277

44.5

42,838

42,844

1,518.0

North Carolina

124

127

20.9

1,728

1,728

293.1

North Dakota

2

2

14.0

10

10

81.3

Ohio

60

62

22.1

997

996

369.2

Oklahoma

24

30

11.5

478

490

198.6

Oregon

46

51

14.8

691

705

210.1

Pennsylvania

179

185

31.0

4,929

4,902

850.0

Rhode Island

19

21

19.6

537

548

524.8

South Carolina

40

41

22.5

577

576

321.9

South Dakota

4

4

20.5

18

18

99.5

Tennessee

39

40

18.2

658

658

302.9

Texas

1,582

1,738

22.9

21,201

21,617

291.7

Utah

19

19

7.1

480

479

181.1

Vermont

1

1

13.5

24

24

304.1

Virginia

90

93

17.3

1,630

1,599

308.9

Washington

78

80

13.5

1,398

1,397

245.3

West Virginia

6

7

34.3

57

58

309.8

Wisconsin

38

39

15.4

663

662

268.5

Wyoming

2

2

4.9

38

38

94.1

Total§

8,975

9,938

24.3

181,443

183,300

458.8

Abbreviation: HIV = human immunodeficiency virus.

* Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis.

Estimated numbers resulted from statistical adjustment that accounted for reporting delays but not for incomplete reporting. Rates are per 100,000 population.

§ Because column totals for estimated numbers were calculated independently of the values for the subpopulations, the values in each column might not sum to the column total.


TABLE 3. Diagnoses of HIV infection* among adult and adolescent Hispanics or Latinos, by transmission category and place of birth — United States, 2008–2013

Characteristic

Central America

Cuba

Mexico

Puerto Rico

South America

No.

Est. no.§

%

No.

Est. no.§

%

No.

Est. no.§

%

No.

Est. no.§

%

No.

Est. no.§

%

Transmission category

Male adult and adolescent

Male-to-male sexual contact

1,835

2,604

74.6

1,169

1,242

82.4

5,466

6,997

80.2

812

978

53.6

1,859

2,070

86.4

Injection drug use

64

158

4.5

27

38

2.5

261

411

4.7

380

456

24.9

19

51

2.1

Male-to-male sexual contact and injection drug use

61

99

2.8

25

28

1.9

233

323

3.7

83

93

5.1

39

47

2.0

Heterosexual contact**

451

625

17.9

166

197

13.1

673

984

11.3

215

295

16.1

164

225

9.4

Other††

921

5

0.1

95

2

0.1

1,701

7

0.1

248

4

0.2

224

1

0.0

Subtotal

3,332

3,491

100.0

1,482

1,507

100.0

8,334

8,722

100.0

1,738

1,826

100.0

2,305

2,395

100.0

Female adult or adolescent

Injection drug use

14

55

6.2

4

6

5.3

33

65

5.8

99

128

20.5

10

22

7.0

Heterosexual contact**

435

828

93.5

82

109

93.5

631

1,051

93.9

300

495

79.2

184

286

92.3

Other††

394

3

0.4

29

1

1.1

405

3

0.3

191

2

0.3

103

2

0.7

Subtotal

843

886

100.0

115

117

100.0

1,069

1,119

100.0

590

624

100.0

297

310

100.0

Total§§

4,175

4,377

100.0

1,597

1,624

100.0

9,403

9,840

100.0

2,328

2,450

100.0

2,602

2,704

100.0


TABLE 3. (Continued) Diagnoses of HIV infection* among adult and adolescent Hispanics or Latinos, by transmission category and place of birth — United States, 2008–2013

Characteristic

United States

Other

Unknown

Total

No.

Est. no.§

%

No.

Est. no.§

%

No.

Est. no.§

%

No.

Est. no.§¶

%

Transmission category

Male adult and adolescent

Male-to-male sexual contact

14,623

17,345

81.6

748

977

70.8

4,473

6,709

83.5

30,985

38,923

80.1

Injection drug use

905

1,404

6.6

28

95

6.9

220

541

6.7

1,904

3,154

6.5

Male-to-male sexual contact and injection drug use

887

1,089

5.1

37

48

3.5

157

260

3.2

1,522

1,987

4.1

Heterosexual contact**

1,189

1,402

6.6

167

258

18.7

376

520

6.5

3,401

4,506

9.3

Other††

2,668

26

0.1

341

2

0.2

2,352

5

0.1

8,550

52

0.1

Subtotal

20,272

21,266

100.0

1,321

1,380

100.0

7,578

8,035

100.0

46,362

48,620

100.0

Female adult or adolescent

Injection drug use

497

795

21.2

11

40

6.2

58

194

14.6

726

1,305

14.8

Heterosexual contact**

1,850

2,938

78.2

314

598

93.6

461

1,137

85.2

4,257

7,442

84.7

Other††

1,253

23

0.6

282

1

0.1

737

3

0.3

3,394

39

0.4

Subtotal

3,600

3,757

100.0

607

639

100.0

1,256

1,334

100.0

8,377

8,786

100.0

Total§§

23,872

25,022

100.0

1,928

2,019

100.0

8,834

9,369

100.0

54,739

57,406

100.0

Abbreviations: Est. = estimated; HIV = human immunodeficiency virus.

* Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis.

Places of birth other than those specified.

§ Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing risk-factor information but not for incomplete reporting.

Entries include persons whose place of birth is not among those listed and persons whose place of birth is unknown.

** Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.

†† Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.

§§ Because column totals for estimated numbers were calculated independently of the values for the subpopulations, the values in each column might not sum to the column total.



Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. 

References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.


All MMWR HTML versions of articles are electronic conversions from typeset documents. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (http://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.

 


Geographic Differences in HIV Infection Among Hispanics or Latinos—46 States and Puerto Rico, 2010 
From CDC's MMWR Weekly October 12, 2012; / 61(40);805-810

Estimated Lifetime Risk for Diagnosis of HIV Infection Among Hispanics/Latinos—37 States and Puerto Rico, 2007 
From CDC’s MMWR Weekly; October 15, 2010 / 59(40);1297-1301

Lo que deben saber los padres sobre la infección de la tuberculosis en los niñosExternal Web Site Policy
From the New Jersey Medical School Global Tuberculosis InstituteExternal Web Site Policy

Addressing HIV/AIDS Latino Perspectives and Policy RecommendationsExternal Web Site Policy (PDF) 
This document provides recommendations on how to develop programs and policies to effectively address the AIDS epidemic among Latinos. The report also encourages the development of Latino leadership and expertise inside of health departments at the state and local levels and within Federal agencies at the national level.

Resources from the Hispanic/Latino Consultation April 1-2, 2008
From CDC

Ethnographic Guides
From CDC's Division of Tuberculosis Elimination

Replicating Effective Programs Plus: ¡Cuídate!—A Culturally-Based Program to Reduce HIV Sexual Risk Behavior among Latino Youth 
From CDC's Division of HIV/AIDS Prevention

HIV/AIDS Among Hispanics 
Fact sheet from the Divisions of HIV/AIDS Prevention of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention En Español

The State of Latinos in HIV Prevention Community Planning (PDF) 
Report from the Divisions of HIV/AIDS Prevention of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Systemic Review of HIV Behavioral Prevention Research in Latinos
From HIV InSite

Be Safe: A Cultural Competency Model for Latinos
From the AIDS Education and Training Center National Multicultural Center

Hispanic/Latino Fact Sheet
From the AIDS Education and Training Center National Multicultural Center

Latinos and HIV/AIDS
From the Henry J. Kaiser Family Foundation



Hispanics or Latinos Rate of HIV diagnosis 3x that of non-Hispanic whites

Hispanics or Latinos Rate of HIV diagnosis 3x that of non-Hispanic whites




Diagnoses and Prevalence of HIV Infection Among Hispanics or Latinos — United States, 2008–2013


Weekly

October 9, 2015 / 64(39);1097-103



Kristen Mahle Gray, MPH1; Eduardo E Valverde, DrPH1; Tian Tang, MS2; Azfar-e-Alam Siddiqi, MD, PhD1; H. Irene Hall, PhD1

Hispanics or Latinos* represent about 17% of the total U.S. population and are disproportionately affected by human immunodeficiency virus (HIV) infection in the United States (1,2). In 2013, the rate of HIV diagnosis among Hispanics or Latinos (18.7) was nearly three times that of non-Hispanic whites (6.6) (1). To better characterize HIV infection among Hispanics or Latinos aged ≥13 years in the United States, CDC analyzed data from the National HIV Surveillance System (NHSS). During 2008–2013, the rate of diagnoses of HIV infection among adult and adolescent Hispanics or Latinos decreased from 28.3 per 100,000 population in 2008 to 24.3 in 2013 (estimated annual percentage change [EAPC] = -3.6); however, the number of diagnoses among males with infection attributed to male-to-male sexual contact increased 16%, from 6,141 in 2008 to 7,098 in 2013 (EAPC = 3.0). In 2013, the rate of diagnosis of HIV infection among males (41.3) was six times the rate among females (6.8). During 2008–2013, behavioral risk factors for HIV infection among Hispanics or Latino differed among males and females and by place of birth. Among Hispanic or Latino males born in Puerto Rico, the proportion of HIV infections attributed to injection drug use (24.9%) was greater than among those born elsewhere. Among HIV-infected Hispanic or Latino females, those born in the United States (21.2%) and Puerto Rico (20.5%) had a greater proportion of HIV infections attributed to injection drug use than those born elsewhere. Additional interventions and public health strategies to further decrease the rates of HIV among the Hispanic or Latino population are needed.

Data from NHSS reported to CDC from the early 1980s through December 2014 were used to determine the numbers and rates of diagnosis of HIV infection among Hispanics or Latinos aged ≥13 years (adults and adolescents) during 2008–2013 and prevalence in 2012, by selected characteristics. The numerator for each rate was the estimated number of diagnoses of HIV infection by diagnosis year. Appropriate subpopulations from the census or postcensus data from the U.S. Census Bureau were used for the denominator (2). Rates of infection by HIV transmission categories (male-to-male sexual contact, injection drug use, male-to-male sexual contact and injection drug use, heterosexual contact, or other) could not be calculated because the U.S. Census does not collect the data needed for the denominators. In calculating the EAPC in rates, populations were treated as actual populations and not samples, because the standard deviation of these populations was not available from the U.S. Census. Data from NHSS were also used to ascertain 1) HIV diagnoses in 2013 among Hispanics or Latinos by place of birth and transmission category, and 2) the numbers and rates of Hispanics or Latinos living with diagnosed HIV infection at year-end 2012 by area of residence at diagnosis. Birthplace information was available for 83.7% of Hispanics or Latinos in this analysis. Data were statistically adjusted for reporting delays and missing HIV transmission categories (3).

During 2008–2013, a total of 276,633 adults and adolescents received a diagnosis of HIV infection in the 50 states and the District of Columbia. Of these, 57,406 (20.8%) were Hispanics or Latinos. A decline was observed in the rates of diagnosis per 100,000 population among Hispanic or Latino adults and adolescents, from 28.3 per 100,000 population in 2008 to 24.3 in 2013 (EAPC = -3.6) (Table 1). During 2008–2013, the HIV diagnosis rate decreased among Hispanic or Latino males from 45.0 per 100,000 to 41.3 (EAPC = -2.0) and among females from 10.1 per 100,000 to 6.8 (EAPC = -9.6). The rates remained stable or decreased among all age groups, with the largest decline among persons aged 35–44 years (39.6 per 100,000 to 29.5 [EAPC = -6.8]). Among Hispanic or Latino males with infection attributed to male-to-male sexual contact, the number of HIV diagnoses increased 16% (EAPC = 3.0), whereas diagnoses decreased in other transmission categories (Figure). Among Hispanic or Latino females, the estimated number of HIV diagnoses decreased in persons with infection attributed to injection drug use or heterosexual contact. The largest declines in males (EAPC = -8.6) and females (EAPC = -11.8) were observed among those with infection attributed to injection drug use (Table 1).

In 2013, the HIV diagnosis rate per 100,000 population among males (41.3) was more than six times the rate among females (6.8). By age group, the highest rate of HIV diagnosis (40.1) among Hispanics or Latinos occurred among persons aged 25–34 years. By transmission category, the largest number of HIV diagnoses occurred among males with infection attributed to male-to-male sexual contact (7,098 [82.8%]), and among females with infection attributed to heterosexual contact (1,194 [87.2%]) (Table 1). The estimated rate of diagnosis for 2013 ranged from 2.3 in Idaho to 90.1 in the District of Columbia (Table 2).

HIV transmission category among Hispanics or Latinos varied by place of birth (Table 3). Infection attributed to male-to-male sexual contact accounted for the majority of infection transmissions among males, irrespective of place of birth, ranging from a low of 53.6% among persons born in Puerto Rico to a high of 86.4% among persons born in South America. Hispanic or Latino males born in Puerto Rico had a higher proportion of HIV infections attributed to injection drug use (24.9%) than those born elsewhere, whereas Hispanic or Latino females born in the United States (21.2%) and Puerto Rico (20.5%) had a higher proportion of HIV infections attributed to injection drug use than those born elsewhere. A smaller proportion of Hispanic or Latino males born in the United States (6.6%) had infection attributed to heterosexual contact compared with male Hispanics or Latinos born elsewhere. A smaller proportion of Hispanic or Latino females born in the United States (78.2%) and Puerto Rico (79.2%) had infection attributed to heterosexual contact compared with female Hispanics or Latinos born elsewhere.

At year-end 2012, an estimated 911,602 adults and adolescents were living with diagnosed HIV infection, and of these, 183,300 (20.1%) were Hispanics or Latinos (Table 2); the rate of persons living with HIV infection among Hispanics or Latinos was estimated at 458.8 per 100,000 population, and the estimated HIV prevalence ranged from 73.6 per 100,000 population in Montana to 1,947.5 in the District of Columbia (Table 2).
Discussion

During 2008–2013, overall diagnoses of HIV infection among adult and adolescent Hispanics or Latinos decreased in the United States. However, decreases have not occurred uniformly because diagnoses of HIV infection among men who have sex with men increased. This increase might have resulted from increased incidence of HIV infection, an increase in HIV testing among Hispanic or Latino men who have sex with men, or a combination of both of these factors (4).

An estimated 43% of Hispanics or Latinos who received an HIV diagnosis were not born in the United States or Puerto Rico (a U.S. territory), and among these Hispanic or Latino immigrants, 66% were men who have sex with men. The large proportion of HIV diagnoses in the United States among Hispanics or Latinos who are immigrants is important to consider when developing HIV prevention interventions, given that approximately 40% of Hispanic or Latino immigrants do not speak English well or at all (5) and because certain socioeconomic factors, such as limited access to health care, lack of health insurance, and poverty, might be at play (6).

Findings from this report also confirm earlier findings that Hispanics or Latinos are not a homogenous group, and risk factors differ by place of birth (7,8). The majority of males born in Puerto Rico with infection diagnosed during 2008–2013 had infections attributed to male-to-male sexual contact, highlighting a change in HIV transmission patterns, which until recently indicated that the most common HIV transmission category among men in Puerto Rico was injection drug use (9). Still, a much larger proportion of Hispanic or Latino males born in Puerto Rico reported infection attributed to injection drug use compared with Hispanic or Latino males born elsewhere. HIV care providers working in communities where Puerto Ricans reside should be mindful of a recent report indicating that levels of linkage to care, retention in care, prescription of antiretroviral therapy, and viral suppression were lower among Hispanics or Latinos with HIV infection attributed to injection drug use than among those with infection attributed to male-to-male sexual contact and heterosexual contact (10).

The findings in this report are subject to at least two limitations. First, misclassification of Hispanics or Latinos as members of other races/ethnicities might have resulted in underestimation of the number of Hispanics or Latinos overall and of Hispanic or Latino subgroups. Second, birthplace information was missing for 16% of Hispanics or Latinos in this analysis. Depending on the distribution of birthplaces for persons with missing information, transmission category prevalence for certain subgroups might have been larger or smaller.

The disproportionate rate of HIV infection among Hispanics or Latinos and the disparities found within this population indicate that much work still needs to be done to reach Hispanics or Latinos at high risk for acquiring or transmitting HIV infection. CDC and its partners are pursuing a high-impact prevention approach to maximize the effectiveness of current HIV prevention methods. Example activities include providing technical assistance to health departments and community-based organizations to deliver effective prevention interventions to Hispanics or Latinos, and supporting testing projects and campaigns that focus on Hispanics or Latinos, such as Reasons, which encourages HIV testing among Hispanic or Latino men who have sex with men. CDC funds health departments across the United States and its territories for core HIV prevention activities, including activities for Hispanics or Latinos, and supports projects to optimize care outcomes, such as the Care and Prevention in the United States demonstration project, which promotes increased testing and linkage to, retention in, and reengagement in care for racial and ethnic minorities living with HIV (6).

1Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; 2ICF International, Atlanta, Georgia.

Corresponding author: Kristen Mahle Gray, kgray1@cdc.gov, 404-639-2050.
References
CDC. Diagnoses of HIV infection in the United States and dependent areas, 2013. HIV Surveillance Report 2015(25). Available athttp://www.cdc.gov/hiv/library/reports/surveillance/2013/surveillance_report_vol_25.html.
US Census Bureau. Population estimates. Available at http://www.census.gov/popest/data.
Harrison KM, Kajese T, Hall HI, Song R. Risk factor redistribution of the national HIV/AIDS surveillance data: an alternative approach. Public Health Rep 2008;123:618–27.
Johnson AS, Hall HI, Hu X, Lansky A, Holtgrave DR, Mermin J. Trends in diagnoses of HIV infection in the United States, 2002–2011. JAMA 2014;312:432–4.
US Census Bureau. American Community Survey, 2012. English-speaking ability of the foreign-born population in the United States. Available athttps://www.census.gov/content/dam/Census/library/publications/2014/acs/acs-26.pdf .
CDC. HIV among Latinos. Available at http://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/index.html.
CDC. HIV/AIDS among Hispanics—United States, 2001–2005. MMWR Morb Mortal Wkly Rep 2007;56:1052–7.
Espinoza L, Hall HI, Hu X. Diagnoses of HIV infection among Hispanics/Latinos in 40 states and Puerto Rico, 2006–2009. J Acquir Immune Defic Syndr 2012;60:205–13.
CDC. Incidence and diagnoses of HIV infection—Puerto Rico, 2006. MMWR Morb Mortal Wkly Rep 2009;58:589–91.
CDC. Hispanics or Latinos living with diagnosed HIV: progress along the continuum of HIV care—United States, 2010. MMWR Morb Mortal Wkly Rep 2014;63:886–90.



* Hispanics or Latinos can be of any race.



Summary

What is already known on this topic?

Hispanics or Latinos represent about 17% of the total U.S. population and are disproportionately affected by human immunodeficiency virus (HIV) infection in the United States. In 2013, the rate of HIV diagnosis among Hispanics or Latinos (18.7 per 100,000) was nearly three times that of non-Hispanic whites (6.6).

What is added by this report?

During 2008–2013, the overall rate of the diagnoses of HIV infection among adult and adolescent Hispanics or Latinos decreased (from 28.3 per 100,000 in 2008 to 24.3 in 2013; estimated annual percentage change [EAPC] = -3.6); however, diagnoses of HIV infection among males with infection attributed to male-to-male sexual contact increased (EAPC = 3.0).

What are the implications for public health practice?

Abbreviations: Est. = estimated; HIV = human immunodeficiency virus.

* Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis.

† Places of birth other than those specified.

§ Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing risk-factor information but not for incomplete reporting.

¶ Entries include persons whose place of birth is not among those listed and persons whose place of birth is unknown.

** Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.

†† Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.

§§ Because column totals for estimated numbers were calculated independently of the values for the subpopulations, the values in each column might not sum to the column total.





Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.


All MMWR HTML versions of articles are electronic conversions from typeset documents. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (http://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
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