1. HIV and AIDS Among Latinos: Implications for Prevention and Care Presentation By: Miguelina Maldonado Director of Government Relations & Public Policy National Minority AIDS Council May 25, 2000 The Ninth Statewide HIV/AIDS Policy Conference New York State Department of Health AIDS Institute New York City Department of Health

2. Diversity, Unity, Change….. For Survival The epidemic of HIV/AIDS in New York State has always been diverse. People of color (POC) were disproportionately impacted early on in the course of the epidemic. Unity is required to address HIV/AIDS complacency and the increasing burden of HIV among POC. Policy change is required to support a more proactive and effective response to HIV/AIDS among diverse groups of POC.

3. Global Epidemic AIDS is a global pandemic that is impacting the developing world and people of color most dramatically. Worldwide there were 33.4 million persons estimated to be living with HIV/AIDS as of the end of 1998. 95% resided in developing countries. The Caribbean shows some of the highest rates of HIV in the world outside of Africa. Latin America accounted for 1.4 million adults and children estimated to be living with HIV/AIDS by the end of 1998.

4. Disparities in Health Among Ethnic and Racial Minorities Persist The health of the United States population has improved significantly over the last 50 years. Ethnic and racial minority groups still continue to lag behind the white population, experiencing substantial disparities in health outcomes on many significant indicators.

5. Disparities: HIV/AIDS in the United States The disparities in health experienced by ethnic and racial minority groups are particularly evident in the case of HIV/AIDS Ethnic and racial minority groups in the U.S. make up 24% of the U.S. population. In 1998, they represented 67% of the new AIDS cases.

6. HIV/AIDS Disproportionately Impacts Latinos The Latino population is the second ethnic/racial minority group, most highly impacted by HIV/AIDS in the United States (U.S.). The Latino population is also one of the fastest growing populations in the country. Between 1980 and 1990 the Latino population grew by 53%. By the year 2030 it is projected that Latinos will total 65.6 million and make up 19% of the U.S. population.

7. Cumulative and New AIDS Cases As of December 1998 CDC reported 688,200 cumulative AIDS cases in the United States. Latinos accounted for 124,841 cases or 18% of the total AIDS cases reported through 1998. A total of 48,266 new AIDS cases were reported in the U.S. Latinos accounted for 9,650 or 20% of these new AIDS cases yet accounted for only 13% of the total population.

8. AIDS Cases Per 100,000 Population 1998: By Gender and Age Latinos have the second highest AIDS case rate per 100,000 population, among adults and adolescents (37.8) --- approximately 3.8 times the rate among (9.9) whites. Latino Males:AIDS case rate of 58.2--over three and quarter (3.27) times the rate for white (17.8) males. Latino Females: AIDS case rate of 16.6, almost seven (6.9) times the rate for white (2.4) females. Latino Children: less than 13 years of age AIDS case rate was 0.9 or 4.5 times the rate for white (0.2) children.

9. Latino AIDS Cases Per 100,000 Population 1998: By Region By region, the Latino AIDS case rate was highest in the mid-Atlantic, Northeast and Southeast regions of the country. New York State leads the nation with an AIDS case rate of 137.3 per 100,000 Latino population. Followed by Washington, DC (120.9), Connecticut (96.6), Pennsylvania (89.7), Massachusetts (85.9), Rhode Island (79.3), Delaware (62.5), Puerto Rico (58.3) and Florida (48.3).

10. AIDS Mortality 1998 Cumulative total of 410,800 deaths due to AIDS through December 1998 --- approximately 60% of the total persons diagnosed with AIDS since the beginning of the epidemic. 70,934 cumulative deaths due to AIDS were reported among Latinos accounting for: – 17% of the total U.S. deaths, and – 57% of the 124,841 cumulative cases of AIDS reported among Latinos.

11. Disparities Persist Despite Advances Ethnic and racial minorities continue to lag behind whites. Between 1996 and 1997 the deaths due to AIDS dropped 45% overall compared to 54% for whites, 44% for Latinos and 38% for African Americans. The AIDS mortality rate is still declining but far more slowly. From 1997 to 1998, the AIDS death rates declined by 21% for Latinos compared to 20% overall, 22% for whites and 17% for African Americans.

12. Latino Death Rates: 4 Times the White Death Rates The rate of AIDS deaths per 100,000 population for Latinos was 3.7 times that of whites. – CDC data reported in August 1999 indicates that AIDS deaths per 100,000 population were 12.24 for Latinos compared to 3.32 for whites and 32.46 for African Americans.

13. Latino AIDS Cases by Gender, 1998 Latino males make up 82% of the cumulative adult/adolescent AIDS cases reported among Latinos, while females make up 18% of the cases. Males made up 78% and females made up 22% of the new adult/adolescent AIDS cases reported among Latinos in 1998.

14. Latino AIDS Cases by Gender & Mode of Exposure, 1998 Among Latino males, the leading exposure category for AIDS is men who have sex with men (43% of the cumulative cases and 36% of the new AIDS cases reported in 1998). Among Latinas, heterosexual transmission is the leading exposure category cumulative AIDS cases (47% of the cumulative cases and 44% of the new AIDS cases reported in 1998).

15. Latino AIDS Cases by Birth Place, 1998 Latinos born in the United States make up the greatest proportion of the new cases AIDS cases (29%), closely followed by those born in Puerto Rico who make up 27% of the cases. Latinos born in Mexico, account for 10% of the new AIDS cases, those born in Central/South America (7%), and those born in Cuba (2%). Latinos born in other locations account for 2.2% of the new AIDS cases, and 22% of the new AIDS cases are among Latinos whose place of birth is unknown.

16. Latino AIDS Cases by Birth Place & Mode of Exposure, 1998 Injecting drug use: Puerto Rican-born (46%) U.S.-born (28%) Latinos Men who have sex with men: Mexican-born (48%) U.S.-born (37%) Central/South American-born (36%) Cuban-born (34%). Heterosexual contact: Puerto Rican-born (25%) U.S.-born (12%) Central/South American-born (17%)Mexican-born (11% ) Cuban-born (8%) No reported or identified risk: Cuban-born (47%) Mexican-born (29%) Central/South American-born (40%) U.S.-born (18%) Puerto Rican-born (11%)

17. Cumulative AIDS in New York State, 1999 People of color are disproportionately impacted by HIV/AIDS in NYS POC make up 33% of the total New York State population and over 72% of the cumulative AIDS cases reported through December 31, 1999. Latinos make up 13% of the state population and account for 30% of the cumulative AIDS cases in New York State. AIDS cases among Latinos have increased significantly from 1985 (24%) to 1999 (30%).

18. Latino AIDS Cases in NYS: By Gender & Mode of Exposure Latinos make up 35% of the AIDS cases reported among men Latinas make up 31% of the AIDS cases reported among females Injection Drug Use, MSM and heterosexual sex are the primary exposure categories in NYS.

19. NYS: Latino AIDS Cases By Gender & Exposure Category Males: IDUs 64% MSM28% Heterosexual 7% Other0.7% Females: IDUs52% Heterosexual47% Other1.6%

20. NYS: Mortality AIDS Case Mortality Rates: – Despite decreases over time POC reflect the highest AIDS mortality rates Total AIDS case mortality rates declined dramatically from 38% in 1995 to 17% in 1997.

21. NYS: Mortality and People of Color Among POC AIDS case mortality rates declined by over 50% from 1995 to 1997 Among Latinos AIDS case mortality rates declined from 38% in 1995 to 15% in 1997 AIDS case mortality rates decreased among African Americans from 41% in 1995 to 19% in 1997 Among whites AIDS case mortality rates decreased from 34% in 1995 to 14% in 1997

22. Recommendations: HIV Prevention Expand and fully fund culturally competent, language appropriate tailored and intensive HIV interventions for diverse Latino sub-populations, delivered by and for Latinos. Outreach and engagement of immigrant and migrant populations. Greater focus of prevention efforts addressing the unique needs of Latino youth, gay men and women. Expansion and integration of drug prevention, drug treatment and harm reduction strategies to address the intersection of HIV and substance abuse, addressing injection and non-injection drug use.

23. Recommendations: HIV Prevention Support the sustainability of Latino community-based organizations providing HIV related services through capacity building and infrastructure development. Fund tailored Latino prevention initiatives to be delivered by and for Latinos. Develop and implement Latino leadership initiatives that include civic and faith based leaders. Develop and implement a tailored, multi-level Latino focused campaign to dispel stigma and promote the importance of knowing one’s HIV status.

24. Recommendations: HIV Care Develop and implement educational programs for Latino clinical providers and other health care providers on state of the at HIV care and disease management. Develop, expand and enhance Latino focused treatment education and adherence support programs that are peer led. Expand the pool of bilingual/bicultural Latino HIV related health and social service, and mental health providers through educational programs and incentives.

25. References Joint United Nations Program on HIV/AIDS (UNAIDS), “The UNAIDS Report, A Joint Response to AIDS in Action”, Geneva, Switzerland: 1999, p.17. Centers for Disease Control and Prevention HIV/AIDS Surveillance Report, Year-end edition, Vol. 10, No. 2, December 1998. New York State Department of Health, AIDS Institute, AIDS Surveillance Report, 1998. New York State Department of Health, AIDS Institute, About the AIDS Institute 2000, May 2000.