AIDS among Minorities

By Isabel M. Estrada Portales

This year we reached a sad landmark: the 25th anniversary of the HIV/AIDS epidemic. On June 5, 1981, the U.S. Centers for Disease Control and Prevention (CDC) issued its first warning about a disease that would become known as AIDS. Twenty five years later a new survey by the Kaiser Family Foundation finds that significant percentages of Americans still think HIV might be spread through kissing, sharing a drinking glass and touching a toilet seat -- 37%, 22% and 16% respectively.

Obviously, this is a renewed call for spreading information and for shouting from the rooftops: GO GET TESTED!

Nearly a decade ago, an AIDS diagnosis was a death sentence for anybody. Today, it doesn't have to be, but ethnic and racial minorities are still lagging behind on testing and treatment, therefore, they have disproportionately high morbidity and mortality rates.

Since the approval in 1995 of the first drug "cocktail" by the Food and Drug Administration for the treatment of HIV, deaths from AIDS have declined by more than 70 percent. However, minorities yet again have not shared equally on this decline, particularly in the last few years.

According to statistics from the CDC, the number of deaths among African Americans with AIDS declined by 7% between 2000 and 2004; compared to a 19% decline among whites over this period.

In the case of Latinos, the picture is mixed. Between 2000 and 2004, AIDS diagnoses among Latinos increased by 8.9%, compared to a 5.5% increase among whites. The number of estimated deaths among Latinos with AIDS increased by 16.9% between 2000 and 2003 compared to a 4.4% decline for whites. On a positive note, there was an 8.7% decrease in Latino deaths from 2003 to 2004.

"The problem is Latinos come late," said Dr. Octavio Vallejo, himself a long-term survivor of HIV. "Compared to other groups, we are lagging behind in receiving treatment for HIV for many reasons. But the reason number one is stigma." Dr. Vallejo is the HIV/AIDS trainer at the UCLA Center for Health Promotion and Disease Prevention and serves on the faculty of the UCLA/Pacific AIDS Education and Training Centers.

"Our people are afraid to be tested for HIV, in a great part because of the perception of the disease. There is a bit of fatalism: "it was my fate, I'm going to die,' but they don't know that now nobody has to die from AIDS," said Dr. Vallejo.

Today there are an estimated 1.039 million to 1.185 million HIV-positive individuals living in the United States-the largest number ever according to the Centers for Disease Control and Prevention- and nearly 20 percent are Latino.

Of the overall number, between 252,000-315,000 people do not know they are infected, and thus are suffering from a lack of treatment, while at the same time, may be unknowingly spreading the virus.

"There is a lack of information, lack of health insurance, there is shame, and the strong homophobic sentiments in the Latino community, where many people still believe AIDS is a 'gay thing,'" said Dr. Vallejo, "and then, of course, the immigration issue. Many Latinos believe that they can't get treatment if they are not legal residents, or don't know that there are free clinics to treat people."

The assumed connection between HIV/AIDS and homosexuality, according to Dr. Vallejo, not only prevents people from getting tested, but also keeps alive the idea that heterosexual promiscuity is safe.

Dr. Vallejo used to work in Mexico in the treatment of HIV/AIDS, and he recalls the horror stories of the people he treated. "We had nothing to treat them with; they came pretty much to die in our hands."

He has continued to work in building bridges in HIV care between the U.S. and Mexico. In March 1994, he received a commendation letter from the White House for his work against AIDS in Mexico and the United States.

"What surprised me when I came was that I found here, among our Latino community, all the problems I saw in Mexico. The same lack of information, the same denial," recalls Dr. Vallejo.

Women's Passive Role is Killing Them, Literally

"If you told them, 'do you know your husband infected you?' They would swear that their husband could not have done that to them. That's still the situation for many here in our community. We have to empower them," he said.

According to Dr. Vallejo, the numbers show that Latino and African American women, who are in monogamous relationships, are bearing the burden of the new HIV infections.

"The chance of transmission from woman to man is lower, although possible. But the transmission from man to woman is twice as likely as is the transmission from man to man. Therefore, it's believed that the high rate of infection among heterosexual and married women is due in great part to their male partners having sex with other men," explained Dr. Vallejo.

Jay Blackwell, Director of the Capacity Development Team with the Office of Minority Health Resource Center (OMHRC), points out the huge impact drug use has in spreading the epidemics among women.

"Sometimes the impact of drug use, particularly in women of color, is overlooked," said Blackwell. "It's the number two cause of infections in heterosexual women. Often the mates of women are active drug users."

In fact, according to CDC, the primary mode of HIV transmission among African American women was heterosexual contact, followed by injection drug use.

CDC statistics also show that in 2002, 50% of the HIV/AIDS diagnoses among Latino men were due to sex with other men.

"Dr. Rafael Díaz did a study and found that the Latino gay population has the worst experiences of homophobia, so much so that around 67% report having adopted a heterosexual persona at least once in their lives. That's a recipe for HIV transmission," said Dr. Vallejo.

Dr. Vallejo comes across a fair amount of criticism for advocating informing women about the problem of homosexuality and bisexuality among men, because, some say, it risks bringing more blame and shame to the gay community.

"The real issue is that women sometimes don't know, and they need to know this is happening, so they can figure out how to stand up for themselves, and seek help," said Dr. Vallejo.

This is something close to Dr. Vallejo's heart because he says the great success story of the AIDS epidemic is the ability to prevent the transmission from mother to child; however, it still happens in the Latino and African American communities. Latinos account for over 20% of AIDS cases due to mother to child transmission, according to the CDC.

In fact, the survey from Kaiser Family Foundation shows that a majority of Americans does not know that a pregnant woman with HIV can take drugs to reduce the risk of her baby being infected (55%), or that having another sexually transmitted disease (STD) may increase a person's risk of getting HIV (56%).

"Many Latinas don't come to prenatal care because they are undocumented. Then, they don't even know they are HIV positive and don't get the preventive treatment that would avoid the transmission to the baby. The earlier the process begins the greater the success," said Dr. Vallejo.

According to Nelson Vergel in Houston, who has lived with HIV since 1983 in Houston and is a community educator and patient advocate, the problem of homophobia brings about the denial.

"Many Latinos learn they are HIV positive when they fall sick, but this makes no sense, because the retrovirals are there and everybody could have access to them. But Latinos don't get tested," said Vergel.

On the other hand, he is also sensitive to the issue of increasing infections in women, and he attributes that to a low use of condoms.

"Our women still see their men get insulted when the word condom is mentioned, but the men are not being faithful and are engaging in very risky behavior that endangers themselves and their partners," concluded Vergel.

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Isabel M. Estrada Portales is the OMHRC Director of Communications.
Comments? Email: iestrada@omhrc.gov