HIV in Latinx Communities

Despite over 50 million Latinx people living in the United States—and it being the fastest growing ethnic group in the United States—this group continues to be misunderstood, underrepresented, marginalized, and stigmatized.

Unfortunately, when it comes to HIV, all of these are phenomena that put people at risk for HIV acquisition as well as poor HIV outcomes after diagnosis. Latinx people on the whole have more barriers to care and worse care options than their white counterparts, meaning that they lag behind the average outcomes and standards for success set for care in the United States.

Let’s take a closer look at the statistics around HIV/AIDS among Latinx people in the U.S., as well as the factors that make HIV more of a danger to Latinx people than their white peers.

HIV Among Latinx People in the U.S.: By the Numbers

Before we can get into the nitty gritty of what the U.S. HIV epidemic looks like for an ethnic group as varied and diverse as Latinx people, it’s important to take a high-level look at the story the data show.

• Of the 1.2 million people living with HIV in the U.S., more than 250,000 are Latinx, which is about 22%. Latinx people are about 16.7% of the U.S. population, meaning they are overburdened by the U.S. HIV epidemic.

• While they are about one-fifth of the U.S. population living with HIV, they are about a quarter (26%) of new HIV infections.

• Latinx people have the second-highest rate of new HIV infections per 100,000 adults among all racial groups—behind only Black Americans.

• Latinx people are between two and three times more likely to be diagnosed with HIV than white people in their lifetime.

Unfortunately, the number of Latinx people being diagnosed with HIV has been going up. From 2010 to 2016, the number of Latinx Americans being diagnosed with HIV has gone up 6%.

However, that uptick is more complicated when you break down the numbers.

HIV diagnoses have gone up 18% among Latinx gay and bisexual men, by far the largest piece of the pie in Latinx diagnoses. But diagnoses have gone down in every other demographic:

• The number of diagnoses among Latinx men due to injection drug use has gone down 39%.

• The number of diagnoses among Latinx men due to male-male sexual contact and injection drug use is down 21%.

• The number of diagnoses among Latinx men who had heterosexual contact was down 17%.

• The number of diagnoses among Latinx women due to heterosexual sex was down 20%.

• The number of diagnoses among Latinx women due to injection drug use was down 25%.

HIV Prevention and Transmission Routes Among Latinx People

Of the Latinx people diagnosed annually with HIV, about 90% are men. Of those, about 88% are gay or bisexual men.

In 2017, 86% of Latinx people diagnosed with HIV reported acquiring it through male-male sexual contact, 7% acquired HIV through heterosexual contact, 4% through injection drug use, and 3% reported both male-male sexual contact and injection drug use as possible ways they were exposed to HIV.

Of the 38,700 people diagnosed with HIV in 2017, Latinx gay and bisexual men comprised the second-largest group of new diagnoses in terms of number. The number-one group was Black gay and bisexual men (9,807) followed by Latinx gay and bisexual men (7,436).

Latinx People and the HIV Continuum of Care

According to the Centers for Disease Control and Prevention (CDC), Latinx people lag behind non-Latinx white people at all stages of the HIV care continuum, meaning fewer know their status, get into care, are virally suppressed, and see a doctor regularly.

Of all Latinx people living with HIV in the U.S.:

• 84% have been diagnosed.
• Only 59% are receiving any form of care.
• 50% are virally suppressed.
• 49% see a doctor regularly.

Latinx people lag behind when it comes to pre-exposure prophylaxis (PrEP) use, as well. Of people who use PrEP in the United States, 69% are white, and only 11% are Latinx.

What are some of the reasons behind these numbers? Latinx people face a number of barriers to quality health care in the United States.

• Stigma: intra-community stigma about speaking to health care professionals or talking about sex or drug use can deter people from seeking help.

• High prevalence of sexually transmitted infections (STIs): Due to a lack of cultural competence among medical providers, Latinx people seek medical care less often than other ethnic groups, which means STIs may go undiagnosed, leaving the door open for an HIV infection.

• Socioeconomic factors: Poverty, racial discrimination, and lack of access to health care all increase HIV risk.

Geographic Diversity of HIV Among Latinx People

While Latinx Americans are diverse in many ways—including race and country of origin—they also deal with different epidemics depending on where they live, as well. Eighty-six percent of Latinx people living with HIV came from 10 states at the end of 2010, with New York and California at the top of the list. While Washington, D.C. has a relatively low number of Latinx residents, it has a high HIV rate. The rate among Latinx people in D.C. is four times the rate among Latinx people elsewhere.

Additionally, by the end of 2009, 10 metro areas accounted for 61% of Latinx Americans living with HIV, including New York City, Los Angeles, and Miami. Latinx people born in the U.S. accounted for about 48% of Latinx U.S. residents diagnosed with HIV in 2011, followed by Latinx Americans born in Mexico (20%) and Puerto Rico (15%). As of 2017, Latinx residents born outside the U.S. accounted for one-third of all new HIV infections in Latinx people.

HIV Among Latinx Women

Cisgender Latinx women face myriad specific challenges when it comes to HIV prevention and care, challenges that differ greatly from those of cisgender Latinx men.

A 2018 study of Latinx people living with HIV by the CDC that included 1,774 men and 577 women quantified some of the many differences that can put Latinx women at increased risk for HIV. Of the women surveyed, 78% lived in poverty, compared to 54% of men. Latinx women also had much lower levels of schooling beyond high school—only 28% of Latinas had any college education versus 47% of men. They were also less likely to have employment (29% of Latinas versus 48% of men).

Language barriers among Latinx women also contribute to health disparities among Latinas. Latinx women had a higher percentage of respondents who had trouble speaking English (38% versus 21%). This means that Latinx women living with HIV will have more problems navigating the health care system. Language barriers might require an interpreter, which is a high barrier that not every health care provider can provide and makes for worse health outcomes. The language barrier can mean that providers are unable to understand patients or communicate to the patient effectively.

More than a third of Latinas needed help with transportation, meaning they were dependent on others, compared to 21% of Latinx men. Only 14% of the women surveyed had private health insurance, compared to 22% of men.

The HIV diagnosis rate among Latinx women is about three times the rate of white women. Given all of these additional burdens and challenges, it’s no surprise that Latinx women shoulder an unfair burden in the United States’ HIV epidemic.

• In 2013, Latinx women comprised 15% of the number of women diagnosed with HIV, which is about on par with the percentage of women in the United States who identify as Latina.

• Of those diagnosed with HIV, about 86% obtained HIV through heterosexual sex, a higher rate than white women (74%) and lower than but comparable to Black women (90%).

• Injection drug use is the second most common mode of HIV transmission for adult and adolescent Latinx women at 13%.

• Latinx women have a higher rate of concurrent AIDS diagnoses (about 4.4 per 100,000 women) than white women (1.1 per 100,000), though much lower than Black women (25 per 100,000).

HIV Risk Factors for Latinx Women

Several factors can determine risk for Latinx women, including where they were born (country of origin, within or outside the United States), length of time living in the United States, immigration status and generation, level of education attained, and household income.

Many Latinx women, due to cultural norms, prioritize the health of their family over their personal health. This means some women delay primary care, including sexual and reproductive health care, until there’s an emergency.

HIV Among Gay and Bisexual Latinx Men

About 20% of all people diagnosed with HIV in the United States every year are Latinx gay and bisexual men. About two-thirds of these Latinx gay and bisexual men are between the ages of 13 and 34.

As stated before, while many groups among Latinx people have seen their HIV diagnosis rates drop in recent years, gay and bisexual men have seen an uptick. That may not be all bad news: Higher rates do mean that there is an uptick in testing among gay and bisexual men, but there’s still a long way to go to improve outcomes for this population.

The CDC estimates that, while more testing may have led to an uptick in diagnoses, there is still more testing needed among Latinx men. Among all Latino men, 20% are unaware of their infection. Among Latinx young men aged 13 to 24, 44% are unaware of their infection.

Latinx gay and bisexual men also face challenges to HIV testing and care, including:

• A lack of health insurance (Latinx people have the highest uninsured rate in the country among all ethnic groups).
• Language barriers (as in the challenges outlined above for Latinx women).
• Mistrust of the health care system.

HIV Risk Factors for Gay and Bisexual Latinx Men

Behind some of these specific problems for Latinx gay and bisexual men is the reality that they are living at the nexus of several societal biases, including anti-Latinx racism and homophobia, both of which can cause psychological distress.

One study of Latinx gay men living in New York and Los Angeles found that 40% of participants reported experiencing both racism and homophobia in the past year. Across those surveyed, researchers found that low self-esteem and decreased levels of social support were associated with sexual behaviors that have an inherently higher HIV risk, especially unprotected anal sex.

Men who had both homophobic and racist experiences in the past year were more likely than men who reported neither to engage in unprotected anal sex as a bottom. These same men were also more likely to be binge drinkers.

Acculturation also plays a role in HIV risk. Acculturation is the level to which a person has adopted values of a mainstream society—in this case, the level to which non-U.S.-born Latinx U.S. residents identify with their home culture or American culture. Acculturation and its impact on HIV rates can vary widely by a Latinx person’s country of origin, the flow of Latinx people from other countries into the U.S., and the nature of how HIV spreads within specific areas of the U.S.

This is why there’s no single “Latinx HIV epidemic” in the U.S.: It varies from community to community. For instance, HIV prevalence is higher among U.S.-born Latinx people in San Francisco, while in Chicago, the opposite is true.

Other sociocultural factors that can lead to a higher HIV prevalence include small sexual networks and intimate partner violence.

Several studies among Black gay and bisexual men have shown that HIV can be a cyclical problem in the community, as, due to multiple societal factors, Black gay and bisexual men have a higher rate of HIV and also have smaller sexual networks than non-Black gay men that disproportionately include other Black gay and bisexual men. Similarly, Latino gay and bisexual networks are relatively small and often include a pool of people where HIV rates are high.

Intimate partner violence among all gay couples in the United States is estimated to be as high as 25% and can lead to greater levels of substance use and depression, as well as a greater number of sexual partners and condomless anal sex.

HIV Among Transgender Latinx People

As with many groups outlined above, transgender Latinx people face severe social stigmas due to both their gender and racial identities. Unfortunately, there is even less data to work with when it comes to transgender Latinx people, as much of the data around transgender people is not disaggregated by race. That in itself is a barrier to care for many transgender Latinx people: They are often invisible, even to researchers.

Nonetheless, there are some data about transgender Latinx people out there that can paint a picture of the epidemic among this particular subgroup. These numbers specifically come from a 2016 study conducted by a group of Latinx transgender women.

In a survey of 129 transgender Latinas in Southern California done by the TransLatina Coalition:

• 49.5% of respondents received health care coverage through Medicaid, Medicare, or Medi-Cal.
• 28% of respondents had no health insurance whatsoever.
• 36% of respondents said they lacked care because of a lack of personal resources.
• 35% said they lacked care because of a lack of trans-sensitive care providers.
• 51% of respondents were currently experiencing anxiety.
• 26% were currently experiencing depression.
• 47% said their mental health needs were not being met because of a lack of personal resources.
• 44% said their mental health needs were not being met because of a lack of support groups.
• 90% of participants said they practice safe sex.
• 32% reported being HIV positive.
• 97% of HIV-positive patients were receiving treatment.

Many of the socioeconomic factors that affect Latinx people and queer people are amplified for transgender Latinx people. This is a prime example of how intersectional identities can amplify health challenges. While many socioeconomic factors affect cisgender Latinx people, transgender Latinx people face far worse outcomes due to being both Latinx and transgender in a racist and transphobic society. For example:

• 57% of survey respondents said they live in less than $10,000 a year.
• 49% did not finish high school; these respondents had received either some high school, elementary school, or no formal education.
• 8.7% of respondents were homeless, while 3.1% lived in a shelter and 3.9% lived in a group home.
  • Of those who lacked housing, 68% said they do not know where to go for shelter that would honor their gender identity.
  • 98% of respondents said housing was essential for their health and stability, with most indicating they lacked housing due to employment discrimination.
• 26% of respondents lacked employment, while 20% had full-time jobs and 20% had part-time work.
• 31% of respondents said the primary place they get their medical care is in the emergency room.

In addition, documentation status affects HIV among all categories of Latinx people and can also be a risk factor for transgender Latina women. Many people migrate from Central America after experiencing discrimination or violence in their country of origin. Those who are able to gain documents reported better control over their sexual relationships, improved access to services, and less risky employment.

According to women who took part in the TransLatina study, documentation status affects three other areas of life that can affect HIV status: their gender expression, their access to services, and relationship power dynamics.

HIV Among Latinx Intravenous Drug Users

Approximately 1 in 10 of new diagnoses among Latinx people are among Latinx drug users, which includes Latinx gay and bisexual men who use drugs and also engage in same-sex sexual contact.

Of all those in the U.S. diagnosed with HIV as a result of intravenous drug use in 2013, Latinx Americans are overrepresented at 25% of cases. Black Americans are extremely overrepresented at 44%, while white Americans are 27% of those diagnosed with HIV due to intravenous drug use.

Latinx Americans born in the U.S. account for 37% of Latinx intravenous-drug-use infections, followed by those born in Puerto Rico (25%), Mexico (9%), Central America (3%) and Cuba (0.5%).

Interactions Between HIV and Other Common Illnesses Among Latinx People

HIV can complicate treatment for other illnesses a person may have. These are often called “comorbidities,” and they’re a problem for many Latinx people living with HIV. Compared to the general public, Latinx Americans have much higher rates of certain chronic conditions that can complicate HIV treatment. For example:

Latinx people are at an elevated risk for developing heart disease and experiencing a stroke, while some subpopulations of Latinx people are more likely to have high cholesterol. Some HIV treatments, as well as the virus itself, can lead to heart disease, meaning Latinx people with HIV must take extra care to monitor their heart health along with their doctor.

Latinx people are more than twice as likely to develop diabetes than non-Hispanic white people. Without proper treatment, diabetes can damage kidneys, eyes, the heart, and nerve systems. Some antiretrovirals have been linked to blood sugar issues, meaning Latinx people on antiretrovirals should also monitor their blood sugar.

Latinx people also have an elevated risk of contracting hepatitis C, a common HIV co-infection. Hepatitis C can cause serious health effects for people living with HIV and can lead to liver problems.

The HIV epidemic is a multi-pronged beast, no matter which way you look at it. As with any illness, social factors are behind the lived realities of people living with or at risk for HIV.

Latinx people have a wealth of diversity in terms of geography, language, cutlure, race, and more. As such, when we talk about Latinx people facing the HIV epidemic, perhaps it’s more appropriate to talk about several different, interconnected HIV epidemics faced by different subcommunities among Latinx people.

Either way, there’s no way that these epidemics can be fought or faced without acknowledging the multiple, interconnected systemic barriers facing Latinx people.