The results of these analyses suggest that Hispanics testing at publicly funded HIV CT sites, compared to non-Hispanic whites, had a higher percentage of previously undiagnosed HIV infections and experienced delays in receiving test results. The percentage of previously undiagnosed HIV infections among Hispanics overall and Hispanics from Puerto Rico were 1.5 and 4.0 times as high as among non-Hispanic whites. The percentages of previously undiagnosed HIV infection among Hispanic MSM and IDUs were 8.4 and 3.6 times as high as the percentage among Hispanic heterosexuals. Although a higher percentage of tests among Hispanics was conducted in clinical settings, the percentage of tests identifying previously undiagnosed HIV infections was higher in non-clinical settings, which underscores the importance of testing in both clinical and non-clinical settings. These findings suggest that CT programs should better target their services to increase testing among Hispanics, especially Hispanic MSM and IDUs.

To increase the number of persons in clinical settings who know their HIV status, CDC issued HIV testing recommendations in 2006 to make HIV testing a routine part of medical care in clinical settings; to encourage repeat HIV testing at least annually for those at high risk for HIV infection, such as MSM and IDUs; and to promote rapid testing, which is likely to minimize the number of persons who fail to return for their results or who experience delays in receiving their results (7). CDC is currently updating guidelines for HIV testing in non-clinical settings (8). In communities heavily impacted by HIV, both clinical and non-clinical service providers should encourage HIV testing among Hispanics and ensure that test results are promptly received.

Challenges of providing HIV testing and prevention services to Hispanics can include lack of health insurance, immigration status, migration patterns, language barriers, discrimination, stigma associated with homosexuality and injection drug use, poverty, low level of education, and the cultural and socioeconomic heterogeneity of Hispanics (1,2,9). In addition, behavioral risk factors for HIV infection, diagnosis trends, time to AIDS, and AIDS survival vary by place of birth (1,2). Beyond expanding testing, conducting effective HIV behavioral interventions that are risk-specific and culturally relevant for Hispanics are also needed. Several evidence-based behavioral interventions have been identified in the scientific literature that explicitly target Hispanics (10). To date, only a few are currently available as a package with training through CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project, but others are currently being packaged and many other available intervention packages may be appropriate provided they are adapted to address specific cultural issues and local needs (11).

The findings in this report are subject to at least four limitations. First, the data are test-level, as opposed to client-level, so it is not possible to link the results of repeat tests for the same person. Second, several variables had missing data. Third, CT data are from many but not all health departments providing publicly funded CT and thus are not necessarily representative of all publicly funded or privately funded HIV testing sites. Fourth, although previous findings have documented differences among Hispanics by place of birth (1,2), this analysis was not able to explain why some Hispanic sub-populations (e.g., tests of persons from Puerto Rico) had higher percentages of previously undiagnosed HIV infections. Further analyses and research will be needed to better understand these differences.

Because Hispanics are disproportionately affected by HIV/AIDS, as shown in our results and other reports (3-6), are a heterogeneous community (2,9), and constitute the largest and fastest-growing minority group in the United States (9,12), CDC established an internal executive committee in 2007 to develop a comprehensive HIV prevention plan of action aimed at decreasing HIV/AIDS morbidity and mortality among Hispanics. Increasing the number of Hispanics who know their HIV status will be one of the top priorities included in this plan. Additional efforts and improved strategies are needed to increase HIV testing among Hispanics and identify previously undiagnosed HIV infected persons early so that they may benefit from appropriate clinical, medical, prevention, and social services. For example, the use of social networks among Hispanics may be an effective strategy to recruit persons for testing and identify new HIV diagnoses (13). Furthermore, effective and culturally competent HIV prevention strategies, including testing, that are widely and readily accessible to Hispanics and to their distinct sub-populations are critically needed to reduce the HIV/AIDS disparities within the Hispanic population.

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