Latinos and HIV/AIDS

1. Latinos and HIV/AIDS Elena Rios, MD, MSPH President & CEO National Hispanic Medical Association

6. Midwest AIDS Prevention Project (MAPP) • Dedicated to providing high-quality, innovative, evidence-based health education, harm reduction and disease prevention programming and promoting tolerance and understanding, healthy lifestyles, and health services for all people in the region, including those living HIV/AIDS. • Audiences targeted have included teens, college students, gays and lesbians, women, people of color, health care workers, church groups, HIV outreach workers, Latino, Asian, and Arabic communities, and others.

9. Youth and HIV/AIDS • Latino youth exhibit high levels of sexual risk behavior and are at increased risk due to their lack of perceived vulnerability • HIV infections in 13-19-year-old Latino males was among Men having Sex with Men (50%) • 13- to 19-year-old Latina females, however, heterosexual contact accounted for 50% of the new and cumulative cases of HIV infection.

10. Latino Issues and AIDS • Latinos with HIV/AIDS more likely to be publicly insured or uninsured • Insurance status can also vary at the time of HIV diagnosis • Immigration issue ---inadmissability of HIV/AIDS policy being questioned by – could be done by Congress or Administration by visa waiver option

11. Latino Issues and AIDS • Diagnosis at later stages of disease leads to lesser survival • Unawareness of risk or disease leads to increased transmission to others • Hispanics twice as likely to have STDs compared to Caucasians (gonorrhea, syphilis) and 3x for chlamydial infection –increasing likelihood of HIV transmission • Low income challenges • Stigma in families, denial, mistrust of health system • Strong family ties – US and Mexico, mainland and Puerto Rico

12. Cultural Competence • Latino culture – variable by subgroup, but strong and family oriented • Health care system not attuned to cultural competence • Language services needed to respect culture • Staff training, organizational commitment in cultural competence is needed for the non-Latino health care systems, providers

13. Financing • Medicaid – largest funder • Health Insurance • Ryan White CARE Act • IOM 2005 Report: “Public Financing & Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White” – patchwork of services, ineffective approach to managing the epidemic

14. Federal Trends • CDC 2006 – all Americans age 13-64 to be tested for HIV as part of routine medical care, since so many unaware of their status and take steps to treatment if they are aware • CDC funding rapid HIV tests • Ethical dilemma: Goal to increase from 75 %– 95% persons knowing they are infected will require more resources than available at CDC

15. Minority AIDS Initiative • US Department of Health and Human Services Office of Minority Health grants and coordinates activities • HIV/AIDS Policy Office • NIH/NIAAID/NCMHD – Strategic Plans for Disparities • AHRQ – Annual Health Disparities Report • CDC and HRSA and SAMHSA

16. Minority AIDS Initiative • Became authorized in the Ryan White CARE Act this year • Targets minority communities: • Technical assistance and infrastructure • Access to prevention and care • Build community linkages for HIV prevention/care • Congressional Tri Caucus – Disparities Bill; Health Care Summit – July 20-21, San Diego

17. Recommendations • Systemic approach needed to reduce poverty : housing, jobs, immigration reform, language and stress with acculturation, prison population • Mind –body : need to focus on improving quality of life for Latinos w/HIV/AIDS • Reduce discrimination and stigma with MSM • Reduce injection drug use factor – treatment programs, needle exchange programs

18. Recommendations • Community Leadership • Capacity building of CBOs in our communities • Advocacy to Legislators on need for expansion of programs targeted to Latinos • Cultural Competence Curriculum in medical education, CME • Research and Clinical Trials – Latino inclusion

19. Latino Physicians Issues • There is a need for more Latino physicians with growth of Latinos with HIV/AIDS • Latino physicians are 5% of the total physicians in the U.S. –and there is a physician shortage • HCOP and COE programs (Title VII, PHS Act) recruit Latino students to medicine but need support from Congress and White House to continue • Health Professions Diversity is a national priority especially at this time of MD shortage, baby boomer increasing demand –need for political leadership

20. National Hispanic Medical Association • Est. in 1994 in Washington, DC with mission to improve health of Hispanics & other underserved in the U.S. • NHMA Leadership Fellowship Program • NHMA Council of Medical Societies • Advocacy with Congressional Hispanic Caucus • Annual Conference – April 17-20th, 2008, Hilton Towers Hotel, Washington, DC • www.HispanicHealth.info; www.nhmamd.org

21. NHMA Council of Medical Societies – States • Arizona Latino Medical Association • California Latino Medical Association • Arkansas Latin American Medical Assoc • Illinois Hispanic Medical Assoc • New Mexico Hispanic Physician Assoc • Spanish Amer Med-Dent Assoc of NY • Hispanic Amer Assoc of Louisiana

22. Medical Societies - Other • El Paso • San Antonio • Houston • Memphis • Rochester • Bolivian - American • Columbian - American • Peruvian - American • Dominican - American • Salvadoran – American and Puerto Rico

23. National Hispanic Health Professionals Leadership Network • NHMA Council of Medical Societies • NHMA Physician Fellows Leadership Network • NHMA Resident Leadership Network • National Association of Hispanic Nurses (NAHN) • Hispanic Dental Association (HAD) • National Hispanic Mental Health Assoc • National Latino Forum of Health Executives • Latino Caucus of American Public Health Assoc • Latino Section of American Dietetic Association • OMH Regional Offices & Contacts • Hispanic-Serving Health Professions Schools • Hablamos Juntos

24. National Hispanic Health Foundation • NHMA’s 501c3 Foundation • Affiliated with the Robert F. Wagner Graduate School of Public Service, New York University • Research Training and White Papers on Hispanic health policy • Scholarships for Hispanic health professional students • www.nhmafoundation.org or at www.nyu.edu