National Latinx AIDS Awareness Day and the Continuum of Care

by Roberto Katz

According to the Center for Disease Control and Prevention (CDC), the National Latinx AIDS Awareness Day (NLAAD) is observed each year on October 15 to increase awareness of the impact of HIV/AIDS on the Hispanic/Latino population in the United States. The NLAAD campaign promotes HIV testing and prevention and provides information on access to care to Hispanic/Latino communities across the nation. The need to spread awareness is becoming more urgent given the concerning numbers the Latinx community is facing when it comes to the rates of HIV transmission.  Indeed, the numbers reveal that 1 in 5 new diagnoses in the United States in 2017 were among Latinx, gay and bisexual men. HIV diagnoses among these men increased by 12% from 2012-2016. This increase happens while we see a decline in other demographic groups. Furthermore, the findings from a recent survey by ViiV Healthcare shows that 186,900 Hispanic/Latino gay and bisexual men are living with HIV in the U.S. (2018). Also, 80% of new diagnoses among Hispanics/ Latinos were among gay and bisexual men, and that 1 in 3 Hispanic/Latino gay and bisexual men were not virally suppressed. Finally, the survey states that 1 in 5 newly diagnosed Hispanic/Latino gay and bisexual men were diagnosed late, meaning with HIV and AIDS concurrently. When we look at the local picture, the concern increases. From 2010 to 2014, 84% of the increase in diagnoses observed among Latinx gay and bisexual men nationally was attributed to diagnoses in Puerto Rico, Arizona, California, Florida, Illinois, New York, and Texas. Looking more specifically at Central Florida, the date shared the Florida Department of Health for the counties of Orange, Osceola, Seminole, and Lake communicate that between 2014 and 2018 HIV diagnoses increased 75% for Hispanic/Latino MSM (men having sex with men), and 112% for Hispanic/Latina females. Furthermore, MSM accounted for 77% of Hispanics that received an HIV diagnosis in 2017.

These numbers raise compelling questions regarding the ability of the different organizations to reach the Latinx community. Also, it generates questions about accessibility, availability, and affordability of medical care and preventing care for this subset of the population. A way to organize these questions is by looking at the ‘Continuum of Care.’ The Continuum reflects the series of steps a person living with HIV (PLWH) takes from the initial diagnosis to being retained in care and achieving a very low level of HIV in the body (viral suppression). A PLWH with a suppressed viral load is highly unlikely to transmit the virus to others.  In Florida, in 2017, out of 100% of Hispanics that were diagnosed with HIV, only 74% connected with care. This means that 26% of them were not in care. Also, only 69% of the diagnosed people were retained in care. As a result, only 65% of them were virally suppressed. What happened with the 26% who did not reach care? What happened with those who reached care, but were not retained? “National Latinx AIDS Awareness Day” Continuum of Care reveals a cascade where a lot of people are missed in the process. As a member of the ‘HIV and Latinx Community Task Force’ in Central Florida, I have expressed the need to determine and address the reasons for the cascade in the continuum. It is essential to understand why people avoid and/or drop from treatment and preventive care.

When it comes to our Latinx clients, this cascade in the continuum of care makes sense. There are several identifiable barriers to treatment and preventive services. This includes poor access to housing, education, reliable transportation, insurance coverage, services in their language (when applicable), and culturally competent care. However, there are also non-material barriers such as discrimination due to stigmas related to the transmission of HIV, homophobia, transphobia, racism, and the anti-immigrant discourse in society. In this respect, the community of providers along with local governments has a tall challenge ahead.

The survey done by ViiV offered five insights that can help us to address the continuum of care:

1. Family and community are central to patient’s lives and identities, shaping their health and wellness for better or worse.

2. Interruptions in care happen for many reasons beyond men’s control.

3. Anti-immigrant sentiment and anti-immigrant laws have a powerful effect on a patient’s health.

4. Patients want diverse and responsive care that reflects their needs, identity, and language.

5. Resilience is activated through networks and services by and for the Latinx community, especially youth.

These insights prompt the need to develop an integrated approach when it comes to reaching, intaking, and retaining patients in treatment and prevention. In this respect, assessing needs comprehensively, and connecting consumers with resources tailored to meet those needs is crucial. It requires the participation of professionals from several areas of expertise, and grassroots leadership to mobilize the community. These changes are critical for the National Latinx AIDS Awareness Day strategy to be effective.

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