Differences in Characteristics and Clinical Outcomes…

Discussion

Compared with men, more Hispanic/Latina women with HIV infection in care faced socioeconomic and language-related challenges than did men; however, they had similar prevalences of ART prescription and viral suppression. Hispanic/Latina women used ancillary services at higher rates than did Hispanic/Latino men, perhaps mitigating the effects of the noted challenges on their clinical outcomes.

The poverty rate among Hispanics or Latinos in the United States is approximately twice that of non-Hispanic whites, and women live in poverty at higher rates than do men (4). This study found that 78% of Hispanic/Latina women receiving HIV care lived at or below the federal household poverty level, compared with 54% of men. Poverty is known to affect management of HIV infection and is a paramount concern affecting all stages of the HIV care continuum (5). Some ART regimens require food; thus, lack of food might lead to nonadherence. Lack of transportation might pose barriers to attending medical appointments and obtaining medications. Women’s higher receipt of meal and transportation services might have helped alleviate the negative consequences of food insecurity and lack of transportation on their clinical outcomes.

Among racial and ethnic groups in the United States, Hispanics/Latinos are the group least likely to have any health insurance coverage (6). In this study, 22% of Hispanic/Latino men and 14% of Hispanic/Latina women had any private health insurance. However, 72% of Hispanic/Latina women and 54% of men relied on public insurance only. Taken together, 87% of women and 76% of men had some type of coverage. The higher coverage among women might also have contributed to similar clinical outcomes between men and women. Moreover, the Ryan White HIV/AIDS Program provides comprehensive care as well as support services for persons living with HIV infection who have no insurance or are underinsured and is associated with improved clinical outcomes among persons in poverty (7).

Overall, 38% of women and 21% of men reported not speaking English well, which can affect ability to understand a provider’s instructions and ability to navigate the health care system (8). In addition, the language barrier might prevent care providers from understanding the patient and could lead to missed opportunities to provide needed support or direction. Bilingual providers or interpreter services might have mitigated linguistic barriers.

Lower levels of substance abuse might also have contributed to better clinical outcomes among Hispanic/Latina women receiving HIV care. Persons who use drugs have been found to have lower levels of adherence (9) and, therefore, lower levels of sustained viral suppression, which is critical to reducing morbidity and mortality and preventing transmission to others.

Hispanics/Latinos in HIV care still have higher levels of unmet need for services when compared with other populations (10). Although no disparities between men and women in sustained viral suppression among Hispanics/Latinos were identified, levels are still lower than those found among non-Hispanic whites (3) and lower than the national prevention goal of at least 80% viral suppression for persons with diagnosed HIV infection.

Through partnerships that use a high-impact approach to advancing national HIV prevention goals, CDC works to improve health outcomes and reduce HIV transmission among all Americans. CDC provides support and assistance to health departments and community-based organizations deliver effective interventions to decrease HIV incidence among Hispanic/Latinos, improve their health outcomes, and reduce transmission. CDC also raises awareness about HIV among Hispanics/Latinos through Partnering and Communicating Together to Act Against AIDS (PACT),* which includes the National Hispanic Medical Association and is part of the larger Act Against AIDS initiative.

The findings in this report are subject to at least three limitations. First, the results might not be applicable to Hispanic/Latinos living with HIV infection who are not receiving medical care. Second, behavioral characteristics are self-reported and thus, might be subject to measurement error as well as reporting and social desirability biases. Finally, data were adjusted to minimize nonresponse bias based on known characteristics of sampled facilities and patients; however, the possibility of residual nonresponse bias exists.

Hispanic/Latino men and women with HIV-infection in care differ from one another in their behavioral and sociodemographic characteristics. Hispanic/Latina women receiving HIV care face more socioeconomic and language-related challenges than do men. However, rates of ART prescription and sustained viral suppression did not differ between Hispanic/Latino men and women, perhaps reflecting Hispanic/Latina women’s greater use of ancillary services. It is important for providers to be cognizant of the challenges faced by this population and assist with access to needed ancillary services. Although the lack of disparity in viral suppression among Hispanic/Latino men and women in HIV care is encouraging, work still remains to decrease ethnic disparities and attain national prevention goals among this population.