HIV/AIDS Among Hispanics in the United States

The United States has a large and growing Hispanic population that is heavily affected by the HIV/AIDS epidemic. In 2000, Hispanics represented 13% of the U.S. population (including residents of Puerto Rico), but accounted for 19% of the total number of new U.S. AIDS cases reported that year (8,173 of 42,156 cases). The AIDS incidence rate per 100,000 population (the number of new cases of a disease that occur during a specific time period) among Hispanics in 2000 was 22.5, more than 3 times the rate for whites (6.6), but lower than the rate for African Americans (58.1).

Hispanics in the United States include a diverse mixture of ethnic groups and cultures. As shown in the chart at left, HIV exposure risks for U.S.-born Hispanics and Hispanics born in other countries vary greatly, indicating a need for specifically targeted prevention efforts (Table 19, HIV/AIDS Surveillance Report, 2000 Year-end Edition, Vol. 12, No. 2).

Historical Trends in AIDS Cases Among Hispanics in the U.S.

Between 1993 and 1999, the number of persons living with AIDS increased, as a result of the 1993 expanded AIDS case definition and, more recently, improved survival among those who have benefited from the new combination drug therapies. During that period, the characteristics of persons living with AIDS were changing, reflecting an expansion of the epidemic, particularly in minority populations. In 1993, 18% of those estimated to be living with AIDS were Hispanic, while in 1999, 20% were Hispanic. In comparison, non-Hispanic whites represented 46% of people estimated to be living with AIDS in 1993, but only 38% in 1999.

Cumulatively, males account for the largest proportion (81%) of AIDS cases reported among Hispanics in the United States, although the proportion of cases among females is rising. Females represent 19% of cumulative AIDS cases among Hispanics, but account for 23% of cases reported in 2000 alone. Sixty percent of Hispanics reported with AIDS in 2000 were born in the U.S.; of those, 42% were born in Puerto Rico.

From the beginning of the epidemic through December 2000, 114,019 Hispanic men have been reported with AIDS in the United States. Of these cases, men who have sex with men (MSM) represent 42%, injection drug users (IDUs) account for 35%, and 6% of cases were due to heterosexual contact. About 7% of cases were among Hispanic men who both had sex with men and injected drugs. Among men born in Puerto Rico, however, injection drug use accounts for a significantly higher proportion of cases than male-male sex.

For adult and adolescent Hispanic women, heterosexual contact accounts for the largest proportion (47%) of cumulative AIDS cases, most of which are linked to sex with an injection drug user. Injection drug use accounts for an additional 40% of AIDS cases among U.S. Hispanic women.

Building Better Prevention Programs for Hispanics

While race and ethnicity alone are not risk factors for HIV infection, underlying social and economic conditions (such as language or cultural diversity, higher rates of poverty and substance abuse, or limited access to or use of health care) may increase the risk for infection in some Hispanic American communities.

• Transmission related to substance abuse continues to be a significant problem among Hispanics living in the United States, especially among those of Puerto Rican origin. Studies of patients in drug treatment centers find HIV prevalence among Hispanics to be substantially higher in some regions of the country, particularly the Northeast and Midwest. Comprehensive programs for drug users must provide the information, skills, and support necessary to reduce both injection-related and sexual risks. In addition, HIV prevention and treatment, substance abuse prevention, and sexually transmitted disease treatment and prevention services must be better integrated to take advantage of the multiple opportunities for intervention.

• Prevention messages must be tailored to the affected communities. Hispanic populations need interventions that (1) are consistent with their values and beliefs and (2) include skills-building activities to facilitate changes in sexual behavior. Further, because the HIV/AIDS epidemic among Hispanics living in the U.S. reflects to a large extent the exposure modes and cultural modes of the individuals’ birthplaces, an understanding of these behaviors and differences is important in targeting prevention efforts. For example, some high-risk behaviors associated with drug abuse (such as use of shooting galleries) may be more predominant among Puerto Rico-born Hispanics than among other Hispanics. Therefore, for these populations, prevention strategies should emphasize (1) preventing and treating substance abuse and (2) decreasing needle-sharing and the use of shooting galleries. For Hispanics born in Mexico, Cuba, and Central and South America, CDC data indicate that male-male sex is the primary mode of HIV transmission. Messages targeted to these populations must be based on an understanding of their cultural attitudes toward homosexuality and bisexuality, which may be different from those of other populations at high risk for infection.

To improve prevention programs in Hispanic communities across the United States, in addition to addressing underlying social and economic conditions, we must apply the lessons we have already learned about the design of culturally appropriate HIV prevention efforts for each Hispanic population.

For more information...

CDC National AIDS Hotline:
1-800-342-AIDS
Spanish: 1-800-344-SIDA
Deaf: 1-800-243-7889

CDC National Prevention Information Network:
P.O. Box 6003
Rockville, Maryland 20849-6003
1-800-458-5231

Internet Resources:
NCHSTP: http://www.cdc.gov/nchstp/od/nchstp.html
DHAP: http://www.cdc.gov/hiv
NPIN: http://www.cdcnpin.org