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A GROWING CONCERN: LATINAS, HIV/AIDS AND OTHER STDS

With the Hispanic population in the United States at an estimated 41 million and rising, mounting health challenges facing this community must be addressed. Specifically, increasing numbers of Hispanics are being diagnosed with human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS) and other sexually transmitted diseases (STDs).

THE CRISIS AMONG LATINAS

The Centers for Disease Control and Prevention (CDC) estimates that approximately 19 million new STD infections occur every year, almost half of them among young people ages 15 to 24. These estimates include 40,000 new cases of HIV infection. Of the more than 900,000 AIDS cases reported to CDC through 2004, 18% were among Hispanic adults and adolescents. Hispanics are more likely to have full-blown AIDS within one year of their HIV diagnosis and are more likely to die faster (within 18 months of diagnosis) when compared to all other racial/ethnic groups.

Hispanic women are also disproportionately affected by HIV/AIDS. In 2004, Latinas had an HIV/AIDS infection rate of 16.3 per 100,000 in the 33 states with confidential name-based reporting, while the infection rate among non-Hispanic white females was 3.2 per 100,000. HIV/AIDS is now one of the leading causes of death for Hispanic women aged 35-44.

In addition to HIV/AIDS, other STDs affect the Hispanic community in general and Latinas in particular. Chlamydia is the most commonly reported bacterial STD in the United States and occurs in an estimated 2.8 million Americans each year. According to CDC, reported chlamydia rates among Hispanics were three times those among non-Hispanic whites in 2004. With Hispanic women, the rate of chlamydia among them in the United States was 3.1 times higher than the rate among non-Hispanic white females (705.8 and 226.6 per 100,000, respectively) and 3.8 times higher than the rate among Hispanic men (705.8 and 183.4 per 100,000 respectively). The gender difference is partly because women are far more likely to be screened for STDs than men. Hispanics, in general, also had higher reported rates of gonorrhea and primary and secondary (P & S) syphilis when compared to non-Hispanic whites.

FACTS

In 2004:

· Hispanic females ages 20 to 24 had the highest chlamydia rate (2,924.4), followed by Hispanic females ages 15 to 19 (2,810.1) and Hispanic females ages 25 to 29 (1,363.2).
· The rate of reported gonorrhea among Hispanic females (78.2) was almost twice that of non-Hispanic white females (40.0).
· The rate of congenital syphilis (i.e., transmission from mother to child) among infants of Hispanic mothers (16.2 per 100,000 live births) was almost 10 times more than that of infants of non-Hispanic white mothers (1.7 per 100,000 live births); and
· In the 33 states with confidential name-based reporting, Hispanic females had an HIV/AIDS infection rate of 16.3 per 100,000, which is five times higher than the infection rate among non-Hispanic white females (3.2 per 100,000).

(Source: Centers for Disease Control and Prevention, Sexually Transmitted Disease Surveillance, 2004)

THE NEED FOR SCREENING

CDC recommends that patients be offered HIV testing in health care settings regardless of lifestyle or risk factor in an effort to make testing a routine part of medical care. Some states already have taken action to make testing more routine. In Illinois, the legislature passed a law this year that mandates HIV testing for all newborns if the mother’s status is unknown. Getting people tested for HIV is important, since it is estimated that of the almost 1 million Americans now infected, one-quarter of them are unaware of their infection.

CDC also recommends routine screening for some STDs since many of the infections have few symptoms, are easily treated with antibiotics and can result in severe health consequences if left untreated. Some STDs can even make it easier for a person to acquire HIV if exposed. Up to 50 percent of untreated chlamydia and gonorrhea in women results in pelvic inflammatory disease (PID), which can lead to chronic pelvic pain, ectopic pregnancy and infertility. CDC and other professional health organizations recommend all sexually active women age 25 and younger be screened annually for chlamydia. Screening pregnant women for syphilis is recommended to prevent transmission to the infant (congenital syphilis), which can cause stillbirth, death soon after birth, physical deformity and neurological complications in children who survive.

BARRIERS TO PREVENTION
Latinas confront several obstacles when it comes to preventing HIV and seeking treatment once infected. One obstacle is that a majority of the approaches used to prevent HIV infection have been based on models used with men who have sex with men. Also, depending on levels of acculturation, Latinas do not view themselves as a “risk group,” and believe that being married, or in what they believe to be a monogamous relationship, protects them from infection. Hispanic women are most likely to be infected with HIV as a result of sex with men. Some women, including those who suspect that their partners are at risk for HIV infection, may be reluctant to discuss condom use with their partners out of fear of emotional or physical abuse and/or the withdrawal of financial support.
The role of women in Hispanic families also makes it harder for them to get the help they need in regard to the prevention and treatment of HIV/AIDS and other STDs. For many Latinas, personal health is not considered as high of a priority as the health of their family. As a result, some women choose to focus on HIV/AIDS and other STDs only when the infection impacts the care of their family. Living in poverty, which can limit a woman’s access to quality care, can also lead to a delay in being tested for STDs and inadequate treatment once diagnosed. Other factors, such as lack of health insurance, low education, fear and distrust of health care providers, language barriers, and anti-immigrant attitudes also may play a role in whether Latinas access health care.

FEDERAL PREVENTION EFFORTS
The Department of Health and Human Services is the federal agency that plays a key role in the prevention and treatment of HIV/AIDS and other STDs. Federal health agencies recommend policies, set screening and treatment guidelines, provide funds for research, finance health services and provide technical assistance. For example, most HIV/AIDS funding goes to medical treatment, which comes mainly from the Health Resources and Services Administration (HRSA) through the Ryan White Comprehensive AIDS Resources Emergency Act (RWCA). Some additional services provided by federal health agencies include special programs aimed at Hispanic and other racial and ethnic minority populations. A few of the programs directed toward these populations include:
· Minority AIDS Initiative (MAI): Since Fiscal Year 1999, CDC has received funds through the MAI to finance HIV prevention services for racial and ethnic minority communities disproportionately affected by HIV/AIDS, particularly in African-American and Hispanic/Latino populations. Examples of MAI programs focused on Hispanics include a community-based free health clinic offering bilingual, bi-cultural HIV/AIDS programs in Washington, D.C.; one-on-one interventions for transgender people in various California urban areas; and a food bank in East Los Angeles that serves people living with HIV/AIDS.
· National HIV/AIDS Partnership (NHAP): In 2002 and 2003, CDC provided seed money for this public-private partnership. NHAP focuses on implementing a strong public health coalition and effective communications campaign to address linkages to HIV prevention, testing, and treatment services in racial and ethnic minority communities. Although federal funding began the program, it now relies on partners for funding. The partners provide spokespersons, financial support and their expertise for a variety of projects.
· Infertility Prevention Program (IPP): Since untreated chlamydia and gonorrhea are the most important preventable causes of infertility and potentially fatal tubal pregnancy, CDC and the Office of Population Affairs support the IPP. It funds chlamydia screening and treatment services for low-income, sexually active women attending family planning, STD and other women’s health care clinics.
· Syphilis Elimination Effort (SEE): Launched by CDC in 1999, the National Plan to Eliminate Syphilis began when infectious syphilis was at an all-time low and limited primarily to heterosexual minority populations, particularly African-Americans. Since implementation of the plan, there have been significant declines in syphilis rates among African-Americans, women and newborns. In order to sustain these elimination efforts and to carry out innovative solutions to the resurgence of syphilis among men who have sex with men (MSM), in May 2006 CDC released an update of the plan, Together We Can: The National Plan to Eliminate Syphilis from the United States.
Though specific programs addressing HIV/AIDS and other STDs among minorities have been important treatment and prevention tools in the Hispanic community, more general strategies may also prove useful. With emerging evidence that the U.S. HIV epidemic is increasingly affecting populations with the highest rates of curable STDs, the CDC/HRSA Advisory Committee on HIV and STD Prevention and Treatment (CHAC) has recommended that states and local governments pay particular attention to funding general population programs that include:
· Early detection and treatment of curable STDs;
· Expanding screening and treatment programs where a high prevalence of STDs has facilitated HIV transmission; and
· Private and public sector partners taking joint responsibility for implementing strategies to address HIV and STD prevention programs.
Early detection and treatment of STDs should be only one component of a comprehensive HIV prevention program, which also must include a range of social, behavioral and medical interventions. These are all areas where local and state governments and the private sector can participate.
Risk Factors and Barriers to Prevention for Hispanic Women
· Recognition of Partners’ Risk -- Some women may be unaware of their male partners’ risk for STD and HIV infection, such as unprotected sex with multiple partners, sex with men or injection drug use.
· Sexual Inequality in Relationships with Men -- Some women may not insist on condom use because they fear that their partners will physically abuse or leave them.
· Socioeconomic Issues -- Nearly one in five Hispanics live in poverty. Problems associated with poverty, including limited access to high-quality health care and higher levels of substance use, can directly or indirectly increase HIV and other STD risks.
· Gender- and culturally-appropriate strategies: Many current efforts fail to incorporate gender and culturally-specific approaches. Prevention efforts must be better tailored to meet the needs of Latinas.
· Women’s roles: For many Latinas, personal health is not considered as high a priority as the health of family members. Hispanic women may neglect their own health care to take care of children, spouses or other relatives.

WHAT FEDERAL & STATE LEGISLATORS ARE DOING
Hispanic leaders and elected officials at federal and state levels have taken an active role in addressing the rapid growth of HIV/AIDS in the Hispanic community. In 2005, U.S. Representative Hilda Solis (D-CA) and other legislators announced “National Latino AIDS Awareness Day” and held various festivities, workshops and informational sessions as well as HIV testing.
“National Latino AIDS Awareness Day,” which is recognized annually on October 15, the last day of Hispanic Heritage Month, was created by the Latino Commission on AIDS to call for expansion of resources for preventing the spread of HIV infection in Latino communities and to promote activities that raise national, state and local awareness of the expanding HIV/AIDS epidemic in Latino communities. As a result of these efforts, more local and regional Hispanic organizations are convening and participating in similar events and activities. The National Latino Commission on AIDS is a nonprofit membership organization dedicated to improving and expanding health promotion, research, treatment and other services to the Latino community through organizing, education, model program development, capacity building and training. In March 2006, the commission hosted a conference that looked at how HIV transmission has escalated among women and youth in the Latino community.
Federal and state legislators also announced results of a study on Hispanic women and HIV/AIDS -- Las Olvidadas: Latinas and HIV/AIDS, which was released by the Hispanic Federation of New York. The report serves as a call to action, offers an analysis of key factors fueling the HIV/AIDS epidemic among Latinas, and offers policy recommendations and action strategies that states can implement or use as a tool. The policy recommendations include enhancing HIV prevention, testing and counseling strategies; promoting sexuality education and safer sex counseling; developing programs to serve Latina populations; and increasing access to care, supportive services and clinical trials.
Texas State Representative Dora Olivo launched a new initiative in 2006 to better equip her constituency and the community in Fort Bend County, Texas, to address the problem of HIV/AIDS. The newly formed Fort Bend HIV/AIDS Coalition seeks to pool existing resources in the community in an effort to spread awareness about how to prevent HIV/AIDS and the services available to those affected by the disease. The coalition is comprised of a diverse array of community leaders, service providers and experts on the HIV/AIDS pandemic. The coalition aims to make information on HIV/AIDS and other STDs more accessible to those that are disproportionately affected by the disease, primarily Latinos and African-Americans. “Solving the HIV/AIDS dilemma is a global issue that demands local leadership and local action,” Olivo said.

Between 2004 and 2006, the National Association of Latino Elected Officials (NALEO) held a series of seminars and workshops for state legislators to address the crisis of HIV/AIDS. At its Annual National Summit in 2005, the National Hispanic Caucus of State Legislators (NHCSL) held an HIV/AIDS session where the latest data, statistics and trends on treatment and care were presented to state legislators.

WHAT LEGISLATORS CAN DO

If left unchecked, the epidemics of HIV/AIDS and other STDs will continue to claim more victims in the rapidly growing Hispanic population. Although there are obstacles to overcome—such as Latinas’ roles in the family, relationships, poverty and a lack of culturally appropriate tools—these difficulties can be addressed. Legislators can play a vital role in prevention efforts by proposing new legislation, funding high-priority programs and forming collaborative relationships among state prevention efforts to maximize their potential. Legislators can:
· Help form partnerships between state governments and local and faith-based community groups to promote HIV testing, education and outreach programs. Faith-based outreach efforts have been particularly effective at reaching racial and ethnic minority populations.
· Ensure adequate funding for HIV/AIDS and STD prevention programs.
· Promote HIV testing as a part of routine medical care by working with health care providers and by conducting educational and anti-stigma campaigns to encourage the public to be tested.
· Promote routine screening of women for STDs, in accordance with CDC guidance.
· Ensure private health insurance carriers in your state cover the cost of recommended routine STD screening.

RESOURCES FROM CENTERS FOR DISEASE CONTROL AND PREVENTION:

Division of HIV/AIDS Prevention
http://www.cdc.gov/hiv/aboutDHAP.htm

HIV/AIDS Surveillance Report, 2004
http://www.cdc.gov/hiv/stats/hasrlink.htm

HIV/AIDS Fact Sheets
http://www.cdc.gov/hiv/resources/factsheets/index.htm
http://www.cdc.gov/hiv/resources/factsheets/women.htm

Division of STD Prevention
http://www.cdc.gov/std/default.htm

Sexually Transmitted Disease Surveillance 2004
http://www.cdc.gov/std/stats/

Trends in Reportable Sexually Transmitted Diseases in the United States, 2004: National Surveillance Data for Chlamydia, Gonorrhea, and Syphilis http://www.cdc.gov/std/stats/trends2004.htm

Sexually Transmitted Disease Fact Sheets

http://www.cdc.gov/std/HealthComm/fact_sheets.htm

The National Plan to Eliminate Syphilis from the United States
http://www.cdc.gov/stopsyphilis/plan.htm

OTHER RESOURCES:

American Social Health Association
www.ashastd.org/

Healthy States Initiative
http://www.healthystates.csg.org/

Health Problems in Hispanic American / Latina Women, The National Women’s Health Information Center, U.S. Department of Health and Human Services, Office on Women’s Health http://www.4woman.gov/minority/hispanicamerican/hiv.cfm

Hispanics and Sexually Transmitted Diseases Fact Sheet, American Social Health Association
http://www.ashastd.org/news/hisp.cfm

Las Olvidadas: Latinas and HIV/AIDS
Hispanic Federation and the Latino Commission on AIDS, Washington, DC
http://www.kaisernetwork.org/health_cast/uploaded_files/LAS_OLVIDADAS2_-_Report.pdf
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1527

Latino Coalition Against AIDS
http://www.latinoaidscoalition.org/

Latino Commission on AIDS
http://www.latinoaids.org/about.htm

National Coalition of STD Directors (NCSD)
http://www.ncsddc.org/

National Conference of State Legislators
www.ncsl.org/

National HIV/AIDS Partnership (NHAP)
www.nhap.org

Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2004. Vol 16. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2005. Also available at: http://www.cdc.gov/hiv/stats/hasrlink.htm.
National Council of La Raza. “NCLR President Janet Murgia, U.S. Rep. Hilda Solis, Actress Lupe Ontiveros, and National Experts Convened for Latinas and HIV/AIDS Summit.” Dec. 1, 2005. Accessed from http://www.nclr.org/content/news/detail/35360/.
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2004. Vol 16. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2005. Also available at: http://www.cdc.gov/hiv/stats/hasrlink.htm.
Centers for Disease Control and Prevention. “Surveillance Findings.” Accessed from http://www.cdc.gov/hiv/topics/women/print/surveillance.htm Aug. 31, 2006.
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2004. Atlanta, GA: U.S. Department of Health and Human Services, September 2005.
National Institute of Allergy and Infections Diseases. “HIV Infection and AIDS: An Overview.” Accessed from http://www.niaid.nih.gov/factsheets/hivinf.htm Aug. 30, 2006.
U.S. Census Bureau. “Income Stable, Poverty Up, Numbers of Americans With and Without Health Insurance Rise, Census Bureau Reports.” Accessed from http://www.census.gov/Press-Release/www/releases/archives/income_wealth/002484.html Aug. 31, 2006.

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This article was written by the National Hispanic Caucus of State Legislators (NHCSL. NHCSL) is the preeminent organization representing the interests of 300 Hispanic state legislators from all states, commonwealths, and territories of the United States. Founded in 1989 as a nonpartisan, nonprofit 501(c)3, NHCSL is a catalyst for joint action on issues of common concern, such as health, education, immigration, homeownership and economic development to all segments of the Hispanic community. For more information visit www.nhcsl.org June 2006