By Tony Vera, Committee on Latino Affairs
The extent of the medical and public health challenges posed to meaningful HIV/AIDS prevention and treatment in New York City is, in great part, a by-product of the city's historic demographic pattern of socioeconomic disadvantage. As it affects Latinos and People of Color, the epidemic has been taking an ominous turn over the past two decades, that being the mainstreaming of HIV/AIDS within the heterosexual population, and most notably women.
According to HRSA Care ACTION (April, 1999), four out of every five cases for which heterosexual contact was the exposure category (1997-98) were among men of color. Injection drug use (IDU) was nearly three times more likely to be the exposure category for Latino and Black males than in White males. Despite this fact, few prevention programs target male injection drug users, and fewer still target men whose risk factor is heterosexual contact. For heterosexual women with AIDS in NYC, the rate has grown from 25% of all women with AIDS in 1986 to 39% in 1998; in the same period the proportion of IV-drug using women has declined from 68% to 45% (NYCDOH, 1999).
Latina women of childbearing age constitute a major segment of an invisible
but continuously growing population of HIV-infected women of color, representing a heterogenous group whose disenfranchised status binds them to a common and tragic outcome. Eighty-one percent of AIDS cases reported among females in the U.S. during the year ending June 30, 1998 were among women of color. Women of color are sicker at the time of diagnosis, and die nearly five times more quickly than do white males with HIV/AIDS (Dalton, 1989). As the leading cause of death among Latinas between ages 25 and 34, AIDS is projected to become the leading cause of death among minority women of childbearing age in the 21st century (Chu, Buehler, & Berkelman, 1990).
According to the New York State Department of Health, the top three means of transmission of the AIDS virus for Latino men in the state are:
For Latina women, the top two means of transmission are:
The high proportion of AIDS prevalence among Latinos and African Americans in New York City has been increasing since 1996 when Latinos and African Americans made up 70.1% of the cumulative AIDS cases and increasing to 76% in 1998. This is due to shifting epidemiological trend of lower AIDS prevalence among white MSM and increasing HIV infection among African American and Latino women, and injecting drug users1. Latinos account for 25% of NYC's population, but they represent 31% of adults with AIDS.2
The international dimensions of HIV/AIDS will likely continue to shape the future morbidity and mortality trends among New York City's Latino community. More than two-thirds (67%) of the world's AIDS cases are tragically confined to the Sub-Saharan region of the African continent. Nevertheless, the United States, and New York City in particular, will be more impacted by the devastating spread of HIV/AIDS in Latin America and the Caribbean. It is not clear how and to what extent the impacted Latino population is changing in New York City. It is known, however, that in 1998 Latin American and the Caribbean countries reported 1.73 million adults and children living with HIV/AIDS compared with 890,000 in North America. While the adult prevalence rate of Latin America (0.57%) is not much higher than that of North America (0.56%), the Caribbean region (1.96%) is second only to the Sub-Saharan region (8.0%) in global prevalence. (World Health Organization)
Looking more closely at the Spanish-speaking world of Latin America, one will observe that the Central American region is at a greater public health disadvantage in responding to the epidemic. Prevention efforts and access to treatment and antiretroviral medications are far more limited in Central American countries such as Guatemala or Honduras, where prevalence rates are among the highest in the region, than in South American countries such as Argentina with more extensive service networks and resources.3
The disparities in prevention, treatment and access to services are correlates of the relative economic and social instabilities Latin American countries suffer. The poverty and/or government inspired violence in Latin American and Caribbean societies also drive much of the documented and undocumented immigrant flow into New York City. It should, therefore, not be surprising that the increase in the rate of AIDS between 1998 and 1999 would be so alarmingly high in communities such as Washington Heights where Dominicans predominate. As illustrated below, East Harlem with a strong Puerto Rican presence and observable growth of Mexicans and Central Americans has a much higher rate of AIDS than Washington Heights but with much lower, but significant, growth rates. Most alarming is the 82% increase in rates between 1998 and 1999 among women residing in Washington Heights.
Call for a Latino social work response.
Latino social workers are providing services to Latinos living with HIV/AIDS in various service settings, including medical care, prevention & education, advocacy, social policy, counseling, and case management. We are challenged to understand and respond to the increasing complexity of AIDS morbidity, immigration patterns, changes in medical treatment anticipated with forced Medicaid managed care for AIDS patients, and the segmentation of poverty among Latino nationalities. It should go without saying that Latino social workers have an important contribution to make in shaping solutions to the prevention and treatment barriers that are affecting New York City's Latino communities.
2 AIDS in New York City, AIDS Surveillance Update, First Quarter 1999, page 8.
3 AIDS epidemic update: December 1999. UNAIDS, World Health Organization.
(May 2000)
1 AIDS in Boroughs & Neighborhoods of New York City. New York City Department of Health, Office of AIDS Surveillance, Volume 2, 1998.