HIV rates among Latinx men who have sex with men (MSM) are on the rise. Yet, until recently, little national attention has been paid to the issue. As anti-immigration sentiments and policies in the U.S. have certainly increased in recent years, is this having an impact on Latinx gay and bisexual men's vulnerability to HIV? While we don't know whether a direct correlation exists, providers and advocacy groups claim that the fear of deportation and the stigma associated with immigration may be driving people away from getting tested or accessing care.
According to the Centers for Disease Control and Prevention (CDC), although new HIV diagnoses among MSM held steady from 2010 to 2014, those among Latinx MSM increased by 13%. In 2015, over 9,000 Latinx people were diagnosed, and nearly 80% of these were among MSM. The CDC has estimated that if such rates persist, one in four Latinx gay and bisexual men will have HIV in their lifetimes.
Despite these alarming statistics, no particularly strong efforts have been made nationally to determine their cause. According to James Frencher, M.D., a resident physician with University of California at San Francisco (UCSF), one of the main reasons why gay and bisexual Latinx men are facing an increase in HIV infections has to do with "cultural factors and the effect of fear engendered in migrant communities of color."
Frencher says that a large number of Latinx MSM face challenges in getting tested, and, if they are HIV positive, in being connected to care. "The most common reasons are not being able to take time off work, lack of insurance, and fear of deportation when entering these institutions," he says. He notes that about 30% of his patients at his previous clinical site in Queens, New York City, were undocumented immigrants and, consequently, many were hesitant to see a doctor "because of the fear of [U.S. Immigration and Customs Enforcement (ICE)] raiding the hospital."
Related: The U.S. Has Allowed Back an HIV-Positive Mexican Immigrant Who Was Wrongly Deported. But Why Did This Happen at All?
Though we lack the data to prove a direct correlation between the fear of deportation and risk of HIV, Frencher's anecdotal evidence is revealing. During the period of increased HIV diagnoses for Latinx MSM (2010-2014), deportations under Obama's presidency were at an all-time high.
The situation under President Trump has certainly made things worse. Since his candidacy, Trump has tied his "America First" rhetoric to policies that would mean deporting more immigrants from the U.S., and he has reportedly referred to Haitian immigrants as "all having AIDS" and to Mexican immigrants as "murders and rapists."
President Trump has not just used anti-immigrant rhetoric, he's also pursuing anti-immigrant policies. He continues to press for a physical wall along the Mexico border and to pursue immigration and visa bans for specific countries -- most of which have thus far been blocked in federal courts. What is the impact of all this on immigrants seeking care for HIV?
Frencher says that, in his experience, many undocumented immigrants tend to see a doctor only if their symptoms get worse, and even then, many of his patients ask whether they will be able to go to work the following day. "People are afraid to stay in hospitals for long periods of time because they become easy targets for ICE," he explained. Thus, people are not checking in with doctors as often as they should, nor do they have the opportunity to miss work because they lack the health benefits afforded to others, because the Affordable Care Act prevents undocumented immigrants from accessing Medicaid expansion coverage or even unsubsidized marketplace plans.
Accessing health care is challenging for all undocumented immigrants, but a particular set of conditions are driving HIV infections among Latinx MSM.
The William's Institute at the University of California, Los Angeles, estimated in 2013 that there are about 267,000 undocumented LGBT migrants living in the U.S., and it noted that "LGBT undocumented immigrants are more likely to be male and younger." An estimated 71% of these LGBT undocumented immigrants are Hispanic/Latinx. Another study showed that most Latinx MSM are HIV negative when they arrive in the U.S., and they have lower HIV rates than those who have been U.S. residents for five years or longer or are U.S. born. But, after they arrive, if they are in environments hostile to immigrants, lack health care access, and fear that health care visits will be sites for discrimination and deportation, their risk factors seem to increase over time.
However, not only the larger context of anti-immigrant sentiments and fear of deportation may be impacting the health of Latinx MSM. Luciano Reberte, LEAD program manager at the Latino Commission on AIDS, affirms that "migrants are prone to receive a late HIV diagnosis and lack medical insurance." But, he also notes an "increase in the use of club [party] drugs," making it easier for people to contract the virus when their their judgment is impaired. He stresses that many people partaking in risky sexual behavior in tandem with party drugs are doing so because of depression and a lack of self-esteem. "They are putting their bodies at risk and participating in precarious sexual activities because they are dealing with pain, such as family rejection or the fear of coming out as gay or queer," says Reberte.
The Latino Commission on AIDS is working to find solutions. It recently launched its own three-city study (New York, Los Angeles, and Miami) to identify the needs of Latinx MSM and improve their outcomes along the HIV care continuum. It is also looking to the CDC to help address these concerns. It has spearheaded a call to action, signed by nearly 100 national and local advocacy groups, to press for a CDC-led consultation with Latinx leaders to further address the HIV rates in Latinx communities.
Luis Scaccabarrozzi, vice-president of Latino Commission on AIDS, who helped prompt the call to action, says that while Latinx MSM HIV rates are of major concern, cisgender women and transgender women of color are also being included in the organization's advocacy. While addressing rising HIV rates among Latinx people will require additional resources, he notes that the Trump administration and GOP-led Congress will likely not want to fund anything that has to do with the assistance of people who are "foreign born and who have no legal status."
While a meeting with the CDC has not yet been scheduled, the CDC acknowledges that more work needs to be done.
"[The] CDC has worked with state and local partners for many years to reach Latino gay and bisexual men, but given the numbers, we may not yet have reached them as effectively as black gay and bisexual men for a number of reasons," says Elizabeth Davenport, CDC spokesperson. "In part, this may reflect the more severe burden and longer history combatting HIV among black gay and bisexual men."