The goals of the National HIV/AIDS Strategy are to reduce new human immunodeficiency
virus (HIV) infections, increase access to care and improve health outcomes for persons
living with HIV, and reduce HIV-related health disparities (1). In July 2013, by presidential
executive order, the HIV Care Continuum Initiative was established, focusing on accelerating
federal efforts to increase HIV testing, care, and treatment (2). Hispanics or Latinos*
are disproportionately affected by HIV infection; the annual rate of HIV diagnosis
among Hispanics or Latinos is approximately three times that of non-Hispanic whites
(3). To achieve the goals of the National HIV/AIDS Strategy, and to be consistent
with the HIV Care Continuum Initiative, Hispanics or Latinos living with HIV infection
need improved levels of care and viral suppression (4–6). Achieving these goals calls
for 85% of Hispanics or Latinos with diagnosed HIV to be linked to care, 80% to be
retained in care, and the proportion with an undetectable viral load (VL) to increase
20% by 2015 (1). Analysis of data from the National HIV Surveillance System (NHSS)†
and the Medical Monitoring Project (MMP)§ regarding progress along the HIV care continuum
during 2010 for Hispanics or Latinos with diagnosed HIV infection indicated that 80.3%
of HIV-diagnosed Hispanics or Latinos were linked to care, 54.4% were retained in
care, 44.4% were prescribed antiretroviral therapy (ART), and 36.9% had achieved viral
suppression (VL result of ≤200 copies/mL). Among Hispanic or Latino males and females,
the percentages that were linked to care, were prescribed ART, and had achieved viral
suppression were similar; however, the percentage retained in care was lower among
males compared with females. The levels of linkage to care and viral suppression were
lower among Hispanics or Latinos with HIV infection attributed to injection drug use
than among those with HIV infection attributed to heterosexual or male-to-male sexual
contact. These data demonstrate the need for implementation of interventions and public
health strategies that increase linkage to care, retention in care, and consistent
ART among Hispanics or Latinos, particularly Hispanics or Latinos who inject drugs.
Data from NHSS for 2010 reported to CDC through December 2012 were used to determine
the numbers of Hispanics or Latinos aged ≥13 years newly diagnosed with HIV and living
with diagnosed HIV and the numbers and percentages linked to care and retained in
care. Nineteen jurisdictions met the criteria for the collection and reporting of
CD4+ T-lymphocyte (CD4) and VL test results,¶ which are the data needed to assess
linkage and retention in care. Linkage to care** was calculated among Hispanics or
Latinos with new HIV diagnoses during 2010 who resided in any of the 19 jurisdictions
at diagnosis. Retention in care†† was assessed among Hispanics or Latinos with HIV
diagnosed by December 31, 2009, who resided in any of the 19 jurisdictions at the
time of diagnosis, and were alive on December 31, 2010, (i.e., persons living with
diagnosed HIV). Data were statistically adjusted for missing HIV transmission categories
(3).
Data from MMP were used to estimate ART prescription§§ and viral suppression¶¶ among
Hispanics or Latinos aged ≥18 years using methods that have been described previously
(5). The MMP values are weighted national estimates of the numbers of Hispanics or
Latinos who received medical care during January–April 2010 and had documentation
of ART prescription and viral suppression. Percentages were calculated among Hispanics
or Latinos whose HIV infection was diagnosed by December 31, 2009, and who were alive
on December 31, 2010, in the United States and Puerto Rico (denominators were based
on NHSS data). Data analyses were limited to 2010, the most recent year data were
available for persons living with HIV infection.
Of the 2,992 Hispanics or Latinos with HIV infection diagnosed during 2010 in the
19 jurisdictions, 2,402 (80.3%) were linked to care ≤3 months after HIV diagnosis
(Table 1). Among males and females, 80.2% and 80.7%, respectively, were linked to
care. The percentage of linkage to care was similar across age categories, with persons
aged 13–24 years having the lowest percentage linked to care (78.7%) and persons aged
45–54 years having the highest percentage linked to care (81.9%). By transmission
category, the lowest percentage of linkage to care was among males and females with
infection attributed to injection drug use (76.5% and 78.6%, respectively), whereas
the highest percentage of linkage to care was among males and females with infection
attributed to heterosexual contact (82.9% and 81.0%, respectively).
Among 70,213 Hispanics or Latinos aged ≥13 years residing in the 19 jurisdictions
at HIV diagnosis and reported living at the end of 2010, 54.4% were retained in care
(Table 2). Of these, males (52.7%) had a 7% lower percentage retained in care compared
with females (59.7%). By age group, the percentage retained in care was similar, with
persons aged 25–34 years having the lowest percentage retained in care (52.2%) and
persons aged 45–54 years having the highest percentage retained in care (55.7%). By
transmission category, the lowest percentage retained in care was among males with
infection attributed to injection drug use (47.6%), and the highest percentage was
among females with infection attributed to heterosexual contact (59.8%).
Of 172,536 Hispanics or Latinos aged ≥18 years living with diagnosed HIV on December
31, 2010, in the United States and Puerto Rico, 76,650 (44.4%) were prescribed ART
(Table 3). Among males and females, 44.0% and 45.7%, respectively, were prescribed
ART. Prevalence of ART prescription was lowest among those aged 25–34 years (36.7%)
and highest among those aged ≥55 years (59.3%). The lowest percentage of ART prescription
by transmission category was among males with infection attributed to injection drug
use (31.0%), and the highest percentage was among females with infection attributed
to heterosexual contact (49.8%).
Of Hispanics or Latinos living with diagnosed HIV in the United States and Puerto
Rico, 36.9% had achieved viral suppression at their most recent test. Males and females
had nearly the same percentage of viral suppression (36.9% and 37.0%, respectively).
Persons aged 25–34 years had the lowest percentage of viral suppression (28.6%), and
persons aged ≥55 years had the highest percentage (54.3%). By transmission category,
females with infection attributed to injection drug use had the lowest percentage
of viral suppression (23.4%), whereas females with infection attributed to heterosexual
contact had the highest percentage (42.6%).
Discussion
The results of the analysis described in this report indicate that, in 2010, among
adult and adolescent Hispanics or Latinos of all age groups and both sexes who were
diagnosed with HIV, 80.3% were linked to care, 54.4% were retained in care, 44.4%
were prescribed ART, and 36.9% had achieved viral suppression. Across the HIV care
continuum, Hispanics or Latinos have higher percentages of linkage to and retention
in care and ART prescription compared with the national population of persons with
HIV, but they have a lower percentage of viral suppression compared with the same
national population (4). Among Hispanics or Latinos, percentages of linkage to and
retention in care are similar across age groups; this similarity by age is not observed
among the national population of persons with HIV or among blacks or African Americans
with HIV (4).
Hispanics or Latinos with HIV infection might not seek, receive, or adhere to HIV
care or achieve viral suppression for reasons including lack of health insurance,
language barriers, geographic differences, and migration patterns (7,8). HIV programs
that focus on care and treatment for Hispanics or Latinos might strengthen efforts
to link and retain persons with HIV in care and promote adherence to medication to
achieve optimal health outcomes. Evidence-based interventions with demonstrated efficacy
in scientific studies and effectiveness in practice settings also might be considered
(9).
Hispanics or Latinos with HIV infection attributed to injection drug use or male-to-male
sexual contact and injection drug use typically had lower levels of linkage to care,
retention in care, ART prescription, and viral suppression than those with HIV infection
attributed to heterosexual or male-to-male sexual contact. In addition to interventions
to ensure that all persons with HIV infection receive optimal care to improve health
outcomes, targeted strategies for Hispanics or Latinos who inject drugs might be needed
to achieve improvements at each step of the continuum. Providing comprehensive prevention
services and referrals to persons who inject drugs, such as those offered by many
syringe exchange programs, can help reduce the spread of HIV. These programs can also
serve as gateways to care and treatment for HIV infection, thus serving as an effective
public health approach for this population (10).
The findings in this report are subject to at least two limitations. First, analyses
based on NHSS data are limited to 19 jurisdictions with complete reporting of all
levels of CD4 and VL test results; data from these areas represent approximately 45%
of all Hispanics or Latinos living with diagnosed HIV on December 31, 2010, in the
United States, and might not be representative of all Hispanics or Latinos in the
United States. Second, certain analyses in this study are based on different populations,
and the results cannot be compared because linkage to care and retention in care were
based on data for persons aged ≥13 years from 19 jurisdictions, whereas ART prescription
and viral suppression were based on weighted estimates of persons receiving care who
were aged ≥18 years from the United States and Puerto Rico.
CDC and its partners are pursuing a high-impact prevention*** approach to advance
the goals of the National HIV/AIDS Strategy and maximize the effectiveness of current
HIV prevention and care methods. Testing is a critical first step of entry into the
HIV continuum of care. CDC supports HIV testing projects and campaigns that focus
on Hispanics or Latinos. One such campaign is Reasons (Razones),††† which is the agency’s
first national effort to encourage HIV testing among Latino gay and bisexual men,
who comprise the majority of Hispanics or Latinos diagnosed with HIV. CDC also supports
multiple projects to optimize outcomes along the continuum of care, such as the HIV
Screening. Standard Care. Testing and Linking African American and Hispanic/Latino
Patients to Care.§§§ campaign, which is a new segment of the Act Against AIDS campaign
tailored to help health care providers improve HIV outcomes among African American
and Hispanic or Latino patients by making HIV testing and linking to care the clinical
standard. Another project is the Care and Prevention in the United States¶¶¶ demonstration
project, which seeks to increase linkage to, retention in, and reengagement in care
for all persons with HIV, including racial and ethnic minorities, with the goal of
reducing HIV-related morbidity and mortality by addressing social, economic, clinical,
and structural factors influencing HIV health outcomes. The results of the analyses
described in this report underscore the need for enhanced linkage to care, retention
in care, and viral suppression for Hispanics or Latinos. Focusing prevention and care
efforts on populations that bear a disproportionate burden of HIV disease could lead
to reductions in HIV incidence and health inequities and help achieve the goals of
the National HIV/AIDS Strategy.
What is already known on this topic?
The 2010 annual rate of human immunodeficiency virus (HIV) diagnosis among Hispanics
or Latinos was approximately three times that of non-Hispanic whites. The percentages
of Hispanics or Latinos linked to care, retained in care, taking antiretroviral medications,
and achieving viral suppression have been lower than those for whites but higher than
for blacks or African Americans.
What is added by this report?
Data from 2010 indicate that 80.3% of HIV-infected Hispanics or Latinos were linked
to care, 54.4% were retained in care, 44.4% were prescribed antiretroviral therapy
(ART), and 36.9% had achieved viral suppression. Among Hispanic or Latino males and
females, the percentages that were linked to care, were prescribed ART, and had achieved
viral suppression were similar; however, the percentage retained in care was lower
among males compared with females. The levels of linkage to care and viral suppression
were lower among Hispanics or Latinos with HIV infection attributed to injection drug
use than among those with HIV infection attributed to heterosexual or male-to-male
sexual contact.
What are the implications for public health practice?
Increasing the proportion of Hispanics or Latinos living with HIV who are receiving
care is critical for achieving the goals of the National HIV/AIDS Strategy to reduce
new infections, improve health outcomes, and decrease health disparities. Among Hispanics
or Latinos, targeted strategies for different groups, such as persons who inject drugs,
might be needed to achieve improvements at each step of the HIV care continuum.