The Impact of Acculturation on Utilization of HIV Prevention Services and Access to Care Among an at-Risk Hispanic Population
January 7, 2010
In 2006, Hispanics constituted 14 percent of the US population but 22 percent of new HIV/AIDS cases. In addition, 32 percent of Hispanics who test HIV-positive are diagnosed with AIDS only one month later. Compared with non-Hispanic whites, Hispanics with HIV are more likely to be co-infected with hepatitis C.
"A few studies have shown that less acculturated Hispanics, as defined by limited English proficiency and fewer than five years in the United States, are less likely than more acculturated Hispanics to get tested for HIV," the authors noted. They hypothesized that low acculturation levels represent "an important barrier to the use of HIV preventive health care services and access to care among Hispanics at risk for HIV in Los Angeles County." For the current study, 600 Hispanics were recruited from STD clinics, community-based organizations, and needle-exchange programs in the county.
Among the participants, 55 percent were female; 49 percent were ages 17-34; 45 percent reported less than a high school education; 37 percent reported annual income of less than $10,000; 54 percent reported having no health insurance; 12 percent were men who have sex with men; 10 percent reported engaging in injection drug use in the past 30 days; 38 percent were born in the United States; and 75 percent spoke primarily Spanish.
In their analysis of information collected from participants, the researchers found that low levels of acculturation were significantly associated with having fewer HIV tests (odds ratio [OR] 1.98, 95 percent confidence interval [CI] 1.24, 3.15), no hepatitis C test (OR 2.61, 95 percent CI 1.77, 3.84), testing positive for HIV (OR 2.67, 95 percent CI 1.04, 6.83), and low levels of access to care (ß=0.06; p<.05). Documented participants were significantly more likely than undocumented persons to receive HIV tests and hepatitis C tests and to have health insurance.
"Our findings suggest that lower levels of acculturation are associated with greater risk for HIV infections," as well as with a lack of hepatitis C testing, the authors wrote. "Thus, increasing access to HIV testing and health care services is crucial for improving HIV detection, quality of care, and HIV-related health outcomes among US Hispanics."
Noting that large-scale studies of the topic are needed, the authors concluded: "The development of prevention programs targeting an at-risk Hispanic population might include an emphasis on outreach efforts to monolingual Spanish speakers and the undocumented, as well as providing education and advocacy on behalf of this population to assist in navigating the US health care system, and providing access to Spanish language hotlines and confidential HIV testing and counseling sites. Programs directed at health care providers are also needed to educate providers about the role of acculturation, its effects in key areas that limit access to services, and strategies to tailor services to Hispanic people based on acculturation levels."
Journal of Health Care for the Poor & Underserved
11.2009; Vol. 20: P. 996-1011; Janni J. Kinsler, Ph.D.; Sung-Jae Lee, M.P.H., Ph.D.; Jennifer N. Sayles, M.D., M.P.H.; Peter A. Newman, Ph.D.; Allison Diamant, M.D., M.P.H.; William Cunningham, M.D., M.P.H.