Latinx and HIV: Risk Gap, Effects, Know Your Status - Verywell Health

HIV, human immunodeficiency syndrome, affects every community differently, and, in the United States, people of color are disproportionately affected. This is true of the Latinx community, which accounts for 24% of all new HIV infections despite representing only 18% of the U.S. population.

Compared to Whites in the United States, Hispanic/Latinx people are four times more likely to get HIV and two to three times more likely to die as a result of the disease. Higher rates of poverty, unequal access to healthcare, and racism largely account for the disparity.

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Despite significant reductions in the rates of infections since 2015, rates remain high among Latinx men who have sex with men (MSM), who account for nearly nine of every 10 new infections among Latinx men.

Aggressive interventions by the federal government aim to reverse this trend by 2030, with hopes of cutting the HIV infection rate among Latinx people by no less than 72%.

Latinx Communities and HIV

HIV is not distributed equally in Latinx communities. Some groups are affected more than others. Geographically, over 80% of infections are in 10 states or territories where Latinx populations are densely clustered, chief of which are New York, California, Florida, Puerto Rico, and Texas.

Among the key factors driving the epidemic in Latinx communities are higher rates of poverty and lower rates of English proficiency. Both not only limit a person's access to healthcare but also affect the ways that some Latinx people utilize healthcare.

According to a 2020 study published in the journal PLoS One, 16.7% of Latinx people living with HIV are wholly unaware of their HIV status compared to 11.5% of Whites. Of those who are diagnosed, only 71% receive HIV treatment and only two of every three people on treatment are able to control the infection with HIV drugs.

This accounts in large part for why Latinx people are four times more likely to develop AIDS than White people and why they are twice as likely to die from HIV-associated illnesses than White people.

Conversely, counties with stronger community resources and cohesion, measured through proxies such as diminished housing problems and greater social association rates, and those with larger proportion of non-Latinx-White than Latinx population, experience lower disparities.

Other social factors contribute to an increased risk of HIV in Latinx communities. At a time when America's views on immigration are especially volatile, Latinx people will sometimes avoid public healthcare when their right or their family's right to U.S. residency, work, schooling, and federal health coverage is questioned.

Men Who Have Sex With Men

Latinx men who have sex with men (MSM) account for nine of every 10 new HIV infections in Latinx men.

Beyond the physiological vulnerability to HIV (risk based on behaviors that lead to a higher transmission rate) that all MSM share, Latinx MSM are faced with other sociocultural barriers that discourage them from seeking HIV testing or treatment.

Chief among these is HIV-related stigma. This not only includes negative attitudes about people with HIV in general (in which they may be labeled as "sexually promiscuous") but also homophobia, which places MSM at risk of abandonment, discrimination, and medical bias.

The discrimination that Latinx MSM feel within their own community is further compounded by racism from outside of their community. This is called dual marginalization. Research has shown that this translates to higher rates of injecting drug use among Latinx MSM. It is a phenomenon that differs dramatically from Black MSM, who are less likely to inject drugs.

Even compared to White MSM, Latinx MSM are more likely to get HIV from shared needles—due not only to the lack of clean-needle exchanges and drug-treatment programs but also because injecting drug use tends to start at an earlier age in Latinx communities.

Recap

Men who have sex with men (MSM) account for the majority of HIV infections in Latinx communities. Higher rates of poverty, stigma, homophobia, racism, and injecting drug use contribute to the disparity in infection rates.

Latinx Women

Although the rate of HIV is declining among Latinx women, they are still twice as likely to get HIV as their heterosexual male counterparts. In 2018, the Centers for Disease Control and  Prevention (CDC) reported that 1,108 Latinx women were newly diagnosed with HIV compared to 620 heterosexual Latinx men.

While physiological vulnerabilities in women largely account for this disparity—given that heterosexual women, in general, are twice as likely to get HIV as heterosexual men—they don't explain why Latinx women are far more likely to die from HIV.

According to the CDC, Latinx women with HIV are at a threefold increased risk of death from HIV compared to their White female counterparts. By comparison, Latinx men with HIV are twice as likely to die from HIV than their White male counterparts.

Among the reasons for this, Latinx women are more likely than Latinx men to:

• Live in poverty (78% vs. 54%)
• Report not speaking English well (38% vs. 21%)
• Require an interpreter (27% vs. 16%)
• Lack transportation (35% vs. 21%)
• Require food assistance (44% vs. 26%)

These socioeconomic factors are further complicated by traditional gender roles that can limit a woman's ability to protect herself. Compared to White and Black women, for example, Latinx women are far less likely to negotiate safer sex out of fear that doing so will label them "unfaithful" or "promiscuous."

Recap

Latinx women are not only twice as likely to get HIV as heterosexual Latinx men but also more likely to die as a result of the disease. Higher rates of poverty, lower rates of English proficiency, and traditional gender roles contribute to this disparity.

Comparison to Other Racial/Ethnic Groups

The features of the HIV epidemic in Latinx communities are similar to those of other racial/ethnic groups. Even so, there are some features that stand apart from other groups.

Among them:

• Age of diagnosis: Latinx people tend to get HIV at an earlier age than other racial/ethnic groups, with a higher percentage occurring between the ages of 13 and 24.
• AIDS diagnoses: Compared to Black and White people, Latinx people are more likely to delay testing until they have AIDS. In total, 21% of Latinx people will be diagnosed with AIDS at the time of their first test. The only group with a higher rate is Asians at 25%.
• Living with HIV: Latinx people represent 23% of the 1.1 million people living with HIV in the United States. Black people, who account for 13% of the population, represent the lion's share of infections at 41%, while White people, who account for 60% of the population, represent 26% of the total HIV population.
• New HIV infections: The rate of new infections among Latinx people is the second highest of any racial/ethnic group. In 2019, 10,200 Latinx people were newly diagnosed with HIV compared to 14,300 Black people and 8,600 White people.
• Viral suppression: Roughly six of every 10 Latinx people with HIV are able to sustain an undetectable viral load while on HIV therapy. This is similar to what is seen in Black populations. By contrast, seven of every 10 White people or Asians with HIV are able to achieve viral suppression.

Contributing Factors

Health disparities among Latinx people with HIV are pervasive. While poverty and racism are overriding themes among all people of color, there are other factors that contribute to disparities in infection rates in Latinx populations specifically.

Poverty

The rate of poverty in Latinx people is more than twice that of White people in the United States (15.7% vs. 7.3%). This factor alone directly influences the rate of diagnosis, treatment, and prevention in Latinx communities and helps fuel the HIV epidemic.

High levels of unemployment, the inability to find safe and secure housing, and problems with transportation and food security make it difficult for people with HIV to remain in consistent care. Research has shown that Latinx people are, in fact, more likely to seek medical care following an HIV diagnosis but less likely to remain in care over the long term.

Lack of Health Insurance

Poverty also translates to lower rates of health insurance coverage. According to the League of United Latin American Citizens, Latinx people are three times less likely to have health insurance compared to the general population.

The risk is especially high among people who earn less than $25,000 per year, 27% of whom will have no health coverage of any sort. In the U.S. states that refused Medicaid expansion eligibility, which would have covered more people of low income, the uninsured rate among Latinx people is reported to be as high as 38%.

Location

In addition to poverty, living in a rural area increases healthcare disparities in Latinx people. Although the HIV infection rate may be lower compared to urban areas, language barriers paired with fewer HIV-specific services lead to higher rates of late-stage diagnoses.

Adding to the concerns, Latinx people are more likely to live in rural settings than either White or Black people. Studies have shown that this dynamic alone increases the risk of late HIV diagnoses by 129%.

Cultural Stigma

HIV prevention strategies in Latinx communities are frequently undermined by cultural attitudes or beliefs that keep Latinx people from not only getting tested or treated but also using condoms and other preventive strategies.

Studies have shown that Latinx women, in particular, will avoid getting tested for fear that a positive diagnosis will "bring shame to the family" or place them at risk of abandonment—cutting them off both emotionally and financially.

Traditional roles among men, such as "machismo" (strong masculine pride) or being "strong and silent," similarly prevent at-risk individuals from seeking treatment until late-stage symptoms develop.

Even in urban communities where same-sex relationships are more widely accepted, Latinx MSM reported homophobia and the loss of support from family and friends as the main barriers to getting an HIV test. Doing so may force them to "come out of the closet" or "go into hiding" if they do, in fact, test positive.

Recap

Poverty, a lack of health insurance, stigma, language barriers, and a rural location are just some of the sociocultural factors that contribute to higher rates of infection in Latinx communities.

HIV Symptoms in Latinx Communities

The symptoms of HIV are no different in Latinx people than in any other racial/ethnic group. What is different is the rate of late diagnoses in which Latinx people often delay testing until their immune system is severely compromised or a potentially life-threatening opportunistic infection (infections that are more likely in people with a compromised immune system) like tuberculosis, histoplasmosis, or toxoplasmosis develops.

Public health officials have made efforts to better educate at-risk Latinx communities about the signs and symptoms of HIV so that people can be treated earlier, when the drugs are most effective.

The early symptoms of HIV, also known as acute seroconversion or acute retroviral syndrome (ARS), may include:

Because the symptoms are relatively nonspecific and tend to resolve within a couple of weeks, people will often mistake ARS for a bad case of flu. Moreover, there are people who will experience no signs or symptoms of infection and never think of getting tested even after a high-risk exposure.

By better understanding the ways that HIV is spread and what symptoms HIV can cause, people can act early and access treatment when needed. Doing so not only increases the odds of living a long, healthy life but also reduces the risk of infecting others.

Know Your Status

The only way to know if you have HIV is to get tested. Even so, around 13% of people living with HIV in the United States remain unaware of their status. Studies suggest that the rate in Latinx communities may be closer to 22%.

Because antiretroviral therapy can extend both the quantity and quality of life of people living with HIV, the U.S. Preventive Services Task Force recommends one-off testing for all Americans ages 15–65 as part of a routine doctor's visit. Those at high risk of infection may require more frequent testing.

Where To Get Tested

Most clinics and doctor's offices can perform an HIV test, some of which can return results in as little as 20 minutes. Even so, it is not uncommon for people to avoid testing at clinics where they may be seen by others in their community. This is especially true in poorer Latinx communities, where options for healthcare may be low and HIV stigma may run high.

In such cases, people can opt for confidential HIV testing outside of their community using the online site locator offered by the Department of Health and Human Services.

Another alternative is to purchase an at-home HIV test available both online and in many drugstores. The saliva-based test has a relatively high level of accuracy but may return a false-negative result if used incorrectly. Even if an at-home test result is positive, it will still require a separate in-office test to confirm the results.

Prevention 

Whether you know your HIV status or not, it is important to practice safe sex by using condoms correctly and consistently, reducing your number of sex partners, and avoiding alcohol and drugs that can impair your judgment.

It is also important to understand your individual risk of HIV, and this is where many within the Latinx community fall short. According to a 2013 study in AIDS Patient Care and STDs, low risk perception is the number one reason that people in Latinx communities avoid HIV testing.

To this end, rather than "guessing" if you are at risk, speak with a doctor or other qualified health professionals to assess your risk of HIV (and to get tested if you haven't already done so).

Even if you are HIV-positive, being placed on fully suppressive antiretroviral therapy reduces your risk of infecting others to zero.

If you are HIV-negative, you may consider taking daily pre-exposure prophylaxis (PrEP) to reduce your risk of getting HIV by as much as 99%.

PrEP Usage in the Latinx Community

According to the CDC, Latinx people are five times less likely to seek PrEP than White people despite being at a higher overall risk of infection.

Diagnosis and Treatment

The diagnosis and treatment of HIV are essential to living a long, healthy life. If diagnosed and treated early, a person with HIV can expect to enjoy a normal to near-normal life expectancy. Starting treatment early also reduces the risk of HIV-associated and non-HIV-associated diseases (like cancer) by up to 72%.

Diagnosis

HIV is diagnosed with an HIV test performed either in a medical facility (point-of-care testing, which doesn't have to go to a lab) or at home. There are several types of tests to choose from that require either a saliva or blood sample.

Options for HIV testing include:

• Rapid point-of-care tests (saliva based)
• Standard point-of-care tests (blood based)
• Rapid at-home tests (saliva based)
• Mail-in HIV tests (requiring a blood drop)
• Nucleic acid tests (blood based)

Although approved HIV tests boast a high level of accuracy, blood-based tests are more accurate than saliva-based tests, and in-office tests are more accurate than at-home tests.

Treatment

HIV is treated with antiretroviral drugs. There is no other form of treatment for HIV infection. The drugs do not cure HIV, but they do keep the virus in check and prevent the disease from progressing.

The drugs are prescribed in combination and work by blocking various stages in the life cycle of the virus. Without the means to complete its life cycle, the virus cannot make copies of itself, and the viral load will drop to undetectable levels where it can do the body little harm.

Today, many antiretroviral drugs are combined into fixed-dose tablets, some of which require only one pill per day. However, for the drugs to work, you need to take them consistently—ideally every day—to keep the virus fully suppressed.

Some studies have shown that HIV drug adherence rates among Latinx and White people are more or less equal. With that said, adherence levels tend to be low in Latinx people who are poor, are younger, have depression, or use drugs. These factors largely account for the reason more Latinx people are less likely to remain in care compared to White people.

To help overcome this, simpler medications are being developed that don't require the same levels of drug adherence. This includes a new drug called Cabenuva (cabotegravir + rilpivirine) that requires only two injections once monthly to keep the virus fully in check.

Recap

HIV can only be diagnosed with an HIV test. If a person tests positive for HIV, antiretroviral drugs can be prescribed to control the virus and prevent the disease from progressing.

HIV Latinx Community Resources

There is no one-size-fits-all solution for preventing the spread of HIV. Different communities require different approaches, and the Latinx community is no exception.

In its effort to curb HIV transmission in the United States, the federal government announced a bold new plan in 2019 called Ending the HIV Epidemic in the U.S. (EHE). The initiative seeks to reduce the number of new infections by 75% by 2025, and by at least 90% by 2030.

In order to do this within the Latinx community, public health officials aim to increase access to HIV-specific medical care, reduce HIV stigma and misinformation, and tailor services and education to Spanish-language speakers, among other things.

There are some resources already in place for Latinx communities. Chief among them is National Latinx AIDS Awareness Day, an annual event scheduled every October 15 that aims to raise awareness about HIV and encourage prevention and treatment of HIV in Latinx communities.

Other resources include:

• InfoSIDA: The Spanish-language version of HIV.gov operated by the Department of Health and Human Services that offers easy-to-understand information about HIV
• Latino Commission on AIDS: A nonprofit organization offering services, programs, and training both in Spanish and English
• Latinos Unidos Contra el Sida: A nonprofit organization providing HIV education and support services to people living with or at risk of HIV (including access to at-home HIV test kits)
• Obtenga Cobertura Para Una Vida Sana: A Spanish-language guide offering advice on how to access health insurance, including the federally funded AIDS Drug Assistance Program (ADAP)
• Somos > AIDS: A Spanish-language version of the public information campaign Greater Than AIDS offering information and resources covering all aspects of HIV, including a list of state HIV hotlines with Spanish-language operators
  

Summary

People in the Latinx community are at an increased risk of HIV for various reasons. Not only are they more likely to get HIV compared to White people, but they are at greater risk of death due to delayed diagnosis and treatment. Poverty, cultural stigma, language barriers, and a lack of access to healthcare all contribute to the grim statistics.

Although HIV infection rates are in decline in Latinx communities, men who have sex with men (MSM) remain disproportionately affected and account for most new infections. Latinx women also remain at an exponentially greater risk of infection and death than their heterosexual male counterparts.

To counteract these statistics, widespread testing and treatment are needed, along with services tailored to Spanish-language speakers. Moreover, education is needed to change cultural misconceptions about HIV and reduce the stigma that keeps many Latinx people from seeking the treatment and care they need.

A Word From Verywell

Despite a greater understanding of HIV in many communities, people living with HIV remain frequent targets of bias and discrimination. If you are living with HIV, there are laws in place to protect you from discrimination and several avenues to redress them irrespective of the language you speak.

If faced with bias or discrimination from a healthcare provider, you can file a complaint with the Office for Civil Rights of the Department of Health and Human Services at 800-368-1019. Language assistance services are available.

You can also file a complaint with the Office of Fair Housing and Equal Opportunity in matters of housing discrimination at 800-669-9777. Request a Spanish-language interpreter if needed.

Complaints about workplace discrimination can be addressed to Equal Employment Opportunity Commission (EEOC) at 800-669-4000. Spanish-language interpreters are also available.

Frequently Asked Questions

• The overall rate of HIV is relatively low in Mexico, with roughly 0.3% of the population affected. With that said, the rate is higher in at-risk groups like incarcerated people (2%), commercial sex workers (7%), transgender people (17%), and men who have sex with men (17%).

• Free testing sites can be found using the online locator offered by the Department of Health and Human Services. Your local health department may also offer free HIV testing as well as your campus health center if you are a college student. Free testing is often available from Planned Parenthood, as well.

• HIV preexposure prophylaxis (PrEP), involving a daily dose of the HIV drug Truvada (tenofovir disoproxil fumarate and emtricitabine) or Descovy (tenofovir alafenamide fumarate and emtricitabine), can reduce the risk of getting HIV in gay and bisexual men by up to 99%. On the other hand, if you have HIV, having an undetectable viral load reduces the odds of infecting others to zero.

• It may be difficult to disclose your HIV status, but doing so allows your partner to make an informed choice about having sex and may help encourage safer sex practices. By educating yourself about HIV, you can educate others and reduce the fear and misconceptions surrounding the disease.

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