HIV Counseling and Testing Among Hispanics at CDC-Funded Sites in the United States, 2007

摘要

Objectives. We sought to determine whether Hispanic–White HIV testing disparities exist and to identify characteristics associated with newly diagnosed HIV among Hispanics. Methods. We used 2007 HIV Counseling and Testing System data to compare test-level records of Hispanics and non-Hispanic Whites, and we conducted a multivariate logistic regression analysis to identify characteristics associated with newly diagnosed HIV. Results. Relative to Whites, Hispanics were more likely to have had a positive HIV test result (1.2% versus 0.8%), to have newly diagnosed HIV (0.8% versus 0.6%), and to have test results returned and receive posttest counseling more than 2 weeks after testing (24.3% versus 21.5%). Newly diagnosed HIV among Hispanics was most strongly associated with being a man who has sex with men (MSM; adjusted odds ratio [AOR] = 6.8; 95% confidence interval [CI] = 6.1, 7.6), being both an MSM and an injection drug user (AOR = 3.7; 95% CI = 2.6, 5.3), and being aged 40 to 49 years (AOR = 6.4; 95% CI = 4.9, 8.2). Conclusions. Hispanic–White disparities exist with respect to rates of positive HIV test results and late return of results. HIV prevention strategies such as rapid testing should focus on Hispanic MSM. Hispanics are the largest and fastest-growing minority population in the United States. 1 In 2007, Hispanics accounted for 15% 1 of the US population, a percentage that is expected to double by 2050. 2 Although researchers and public health practitioners commonly consider Hispanics a single, homogeneous group, Hispanics are heterogeneous 3 given that they differ according to cultural heritage, socioeconomic status, national origin, health care use, and self-identification (e.g., ethnic group or mixed race). 3 – 5 Hispanics are affected by disparities. 4 – 6 The Centers for Disease Control and Prevention (CDC) defines disparity as a quantity that separates a group from a specified reference point on a particular measure of health expressed in terms of a rate, percentage, proportion, mean, or some other quantitative measure. 7 Eliminating disparities, which is a main goal of Healthy People 2010 , 8 is a challenge in the Hispanic community because Hispanics are heterogeneous and adversely affected by sociocultural (e.g., stigma, homophobia), socioeconomic (e.g., poverty, lack of health insurance, low educational levels), and political (e.g., illegal immigration) factors. 3 , 9 In 2007, the median income of Hispanic households was $38 679 (versus $54 920 for non-Hispanic White households), 10 and 22% of Hispanics lived below the poverty threshold (versus 8% of non-Hispanic Whites). 10 In that same year, 61% of Hispanics aged 25 years and older had at least a high school education (versus 87% of non-Hispanic Whites), 11 and 33% of Hispanics younger than age 65 years lacked health insurance coverage (versus 17% of non-Hispanic Whites). 12 In the United States, several HIV/AIDS disparities among Hispanics exist in the areas of morbidity, mortality, and HIV testing. In 2007, Hispanics accounted for 15% (45.5 million) of the estimated US population, 1 as mentioned, but 18% (7484) of the estimated number of diagnosed cases of HIV/AIDS. 13 CDC estimates that the HIV incidence rate in 2006 was 2.5 times higher among Hispanics than it was among non-Hispanic Whites (29.3 versus 11.5 cases per 100 000 population). 13 – 15 In 2005, 4.7 deaths per 100 000 population were attributed to HIV among Hispanics, as compared with 2.2 deaths per 100 000 population among non-Hispanic Whites. 16 Although a national household survey in 2006 showed that the rate of HIV testing in the preceding 12 months was higher among Hispanics (13%) than among non-Hispanic Whites (8%), 17 Hispanics are diagnosed late with HIV more frequently than non-Hispanic Whites. 13 , 18 , 19 According to CDC data, the percentage of Hispanics diagnosed with AIDS within a year of their HIV diagnosis is higher than the percentage among non-Hispanic Whites (41% versus 34%), 13 and Hispanics are twice as likely as non-Hispanic Whites to be tested late in their infection. 18 In addition, Hispanics diagnosed with HIV have a higher percentage of initial CD4 counts below 200 than non-Hispanic Whites (34% versus 30%). 19 We analyzed 2007 data from the national HIV Counseling and Testing System (CTS) in an effort to determine whether Hispanic–White HIV testing disparities exist. We also sought to identify characteristics associated with newly diagnosed HIV among Hispanics.