Percentage of Hispanics receiving prompt HIV care below national target

The percentage of Hispanics with HIV in the United States and its territories who are receiving medical care within the first 90 days of their diagnosis is currently below the goal established by the National HIV/AIDS Strategy to link 85% of the population to care. According to CDC researchers, addressing unmet needs for ancillary services in this population may help increase access to HIV care.

“Previous research suggests Hispanics/Latinos are more likely to delay entry into HIV medical care because of unmet transportation, shelter, or food service needs, and to enter into care with more advanced HIV disease than non-Hispanics/Latinos,” Lauren C. Korhonen, MSPH, from the CDC’s Division of HIV/AIDS Prevention of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, and colleagues wrote in MMWR. “Addressing unmet needs for ancillary services among Hispanics/Latinos living with HIV can help reach the National HIV/AIDS Strategy goals of reducing health disparities, increasing access to care, and improving health outcomes for persons living with HIV.”

Although Hispanics represent only 16% of the U.S. population, they accounted for 23% of HIV diagnoses in 2014, according to the CDC. In addition, Hispanics are less likely to receive care (83.9% vs. 87.1%) and achieve viral suppression (54.2% vs. 62%) compared with whites.

To investigate HIV testing services in this population, Shubha Rao, MPH, also from the CDC’s Division of HIV/AIDS Prevention, and colleagues examined 2014 data submitted by 60 CDC-funded health departments and 151 community-based organizations. The researchers found that Hispanics accounted for 22.6% of all CDC-funded HIV test events (n = 3,049,845) conducted in the United States, Puerto Rico and the U.S. Virgin Islands. In this population, men who have sex with men (MSM) accounted most new diagnoses (63.8%) in non-health care settings.

Among those newly diagnosed, 61.1% of Hispanics were linked to care during the first 90 days of their diagnosis and 71% were linked to care within any timeframe. The percentage of Hispanics linked to care within the first 90 days was lower in the South than any other census regions, underscoring the need for enhanced strategies in this area.

“Barriers to accessing and receiving HIV testing among Hispanics/Latinos include lack of health insurance, lower educational status, stigma or fear of discrimination, and fear of disclosing immigration status,” Rao and colleagues wrote. “HIV prevention programs that focus on culturally and linguistically sensitive prevention strategies to increase testing, enhance linkage to HIV care and partner services, and promote community-level risk-reduction services for Hispanics/Latinos might reduce health disparities and HIV transmission.”

In a separate report, Korhonen and colleagues suggested that assisting Hispanics with everyday living services may support retention in HIV care. The researchers assessed data from the Medical Monitoring Project collected from Hispanic adults receiving outpatient HIV care in 2013 and 2014 and discovered that Hispanics of all ages and sexual orientation/behavior reported unmet ancillary needs. The most common unmet needs were for dental care (24%) and eye/vision care (21%).

“These services are essential because many persons living with HIV have oral or eye conditions that require specialized care,” the researchers wrote.

Other unmet needs included food and nutrition services (15%), transportation assistance (9%), and shelter or housing services (8%).

The data revealed that more than 40% of Hispanics with an unmet need for transportation assistance, food or nutrition services, or peer group support did not know how to receive help. Furthermore, 28% needing shelter or housing services, 21% needing transportation services, and 15% needing food or nutrition services were either ineligible, believed themselves to be ineligible or were denied these services. Less than 20% of Hispanics needing dental care or eye/vision care said they did not receive the services due to money/insurance issues.

“In some cases, this might be related to immigration status, because just under 40% of Hispanics/Latinos in HIV care in the United States are foreign born,” Korhonen and colleagues wrote. “In previous research, Hispanic/Latino immigrants living with HIV cited inadequate knowledge about available services as obstacles to receiving HIV care and often held erroneous beliefs about service eligibility for undocumented persons.”

On the contrary, the researchers reported that the Ryan White HIV/AIDS Program, the primary funder of ancillary services, assists all people living with HIV in the U.S. regardless of immigration status.

“Co-locating ancillary services with routine HIV medical care using a medical home model is a hallmark of the program, and might increase access to these services for persons in HIV medical care,” they concluded. – by Stephanie Viguers

References:

Korhonen LC, et al. MMWR Morb Mortal Wkly Rep. 2016;doi:10.15585/mmwr.mm6540a3.

Rao S, et al. MMWR Morb Mortal Wkly Rep. 2016;doi:10.15585/mmwr.mm6540a2.

Disclosures: The researchers report no relevant financial disclosures.