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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