HIV/AIDS: Hispanic/Latino Disparities and Policy Recommendations Daniel Santibanez, MPH, Department of Public Health, University of North Florida Donna T. Jones, MS, RD, LD/N, Medical Nutrition Therapy of Florida, Inc. July 22, 2005 - UNF Hispanic Health Issues Seminar This is part 6 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.

1. HIV/AIDS: Hispanic/Latino Disparities and Policy Recommendations Daniel Santibanez, MPH Department of Public Health University of North Florida Donna T. Jones, MS, RD, LD/N MNT Services, Inc. This is part 6 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department. For more information or register for the seminars, please call 620-1289.

3. The Culprit’s Mug-Shot

4. From Project Inform. For more information, contact the National HIV/AIDS Treatment Hotline, 800-822-7422, or visit our website, www.projectinform.org

6. Classification system for HIV infection

9. The AIDS pandemic Adults and children living with HIV/AIDS, end 2002 North America 980,000 Caribbean 440,000 Latin America 1,500,000 North Africa & Middle East 550,000 Sub-Saharan Africa 29,400,000 East Asia & Pacific 1,200,000 S & SE Asia 6,000,000 Australia & New Zealand 15,000 Western Europe 570,000 Eastern Europe & Central Asia 1,200,000 2001-02 increase Source: UNAIDS 3.4% 4.8% 5.6% 11.1% 13.2% 13.5% 15.8% 17.8% 20.8% 29.0%

15. Age-sex-adjusted percentage of adults aged 18+ who had ever been tested for HIV, January - June 2002 * Estimates are age-sex-adusted to the 2000 U.S. standard population using five age groups: 18-24 years, 25-34 years, 35-44 years, 45-64 years, and 65 years and over 46.7 - 51.7 49.2 Black, non-Hisp 31.4 - 33.4 32.4 White, non-Hisp 33.2 - 37.6 35.4 Hispanic 95% confidence interval Percent* Race/Ethnicity

19. AIDS Cases by Race/Ethnicity 3,026 196 American Indian/Alaska Native 7,166 497 Asian/Pacific Islander 172,993 8,757 Hispanic 368,169 21,304 Black, not Hispanic 376,834 12,222 White, not Hispanic Cumulative Estimated # of AIDS cases, through 2003 Estimated # of AIDS Cases in 2003 Race or Ethnicity

24. Top 10 AIDS Reported Cases by State/Territory Maryland 26,918 North Carolina 1,083 Georgia 27,915 New Jersey 1,516 Puerto Rico 28,301 Maryland 1,570 Pennsylvania 29,988 Illinois 1,730 Illinois 30,139 Pennsylvania 1,895 New Jersey 46,703 Georgia 1,907 Texas 62,983 Texas 3,379 Florida 94,725 Florida 4,666 California 133,292 California 5,903 New York 162,446 New York 6,684 State/Territory # of Cumulative AIDS cases through 2003 State/Territory # of AIDS Cases in 2003

25. Cumulative Adult AIDS Cases Through May 2002 (N=87,682) Comment: The epidemic in Florida has spread out to suburban and rural areas from urban epicenters in Miami-Dade, Broward, Palm Beach, Hillsborough, St. Petersburg, Orange, and Duval counties. Though 55% of the 87,000 AIDS cases are known to have died, the cumulative numbers remind us of the overall burden of the epidemic on the community. Characterized by race/ethnicity, sex, and mode of exposure, it becomes apparent that HIV/AIDS in Florida consists of multiple overlapping, but somewhat distinct, epidemics. Source: HIV/AIDS Reporting System (HARS). CUMULATIVE CASES 0 to 500 501 to 2500 2501 to 5000 Over 5000 6 780 9 50 5 541 42 8384 28 487 1345 70 19 88 126 306 25400 36 145 8 14 71 100 80 664 59 26 33 213 27 1180 30 64 180 122 5014 18 15 79 550 4969 1337 804 328 13790 574 193 266 167 4402 314 1232 112 840 1466 113 1033 268 178 40 1440 13 791 3491

28. Cumulative Effects of HIV Infection and AIDS (through 2002) Although Hispanics make up only about 14% of the population of the U.S. and Puerto Rico, they accounted for 20% of the more than 886,500 AIDS cases diagnosed since the beginning of the epidemic By the end of 2002, nearly 88,000 Hispanics had died with AIDS

29. AIDS in 2002 The 76,052 Hispanics living with AIDS accounted for 20% of all people in the United States living with AIDS

30. HIV/AIDS in 2002 From 1999 - 2002, the number of new HIV/AIDS cases increased 26% among Hispanics in 30 surveillance areas

32. Research shows that Hispanics born in different countries have different behavioral risk factors for HIV/AIDS Data suggest that Hispanics born in Puerto Rico are more likely than other Hispanics to contract HIV as a result of injection drug use By contrast, sexual contact with other men is the primary cause of HIV infections among men born in Mexico

33. Risk Factors and Barriers to Infection Heterosexual Risk Denial Substance Abuse Poverty Sexually Transmitted Diseases

40. Many clients did not have access to medical services back home, and need to be educated about the U.S. system as well as basic medical issues. For example, case managers at La Clinica del Pueblo in Washington D.C. spend a great deal of time with clients addressing questions like: “ What is a prescription? A refill?” “How do you take the medications?” La Clinica del Pueblo receives Title I and Title II funds to serve Hispanic men whose exposure category is men who have sex with men. Fewer than 10 percent of La Clinica clients speak fluent English

41. “ Clients are accustomed to going to the emergency room for drugs when they feel bad. The idea of taking medications when they feel okay is foreign. These individuals don’t understand drug resistance, or their need to see a doctor. In Mexico, individuals get drugs from pharmacists without ever seeing a physician” Barbara Aranda-Naranjo of the South Texas AIDS Center for Children and Families in San Antonio

42. “ You don’t talk about your disease! You never, in the Hispanic culture, talk about anything where someone will lose face. It is very difficult for these women to be honest with their physician; they think it is safer if no one finds out they are sick.” Barbara Aranda-Naranjo of the South Texas AIDS Center for Children and Families in San Antonio Reluctance to even discuss health problems also is a factor

58. Thank You! Daniel Santibanez [email_address] This is part 6 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department. For more information or register for the seminars, please call 620-1289.