Although Latino women face higher barriers to HIV care than their male counterparts, a willingness to use support services may be a reason they fare equally well.
Latino and Hispanic people bear a disproportionate share of the HIV burden in the United States compared with their non-Hispanic fellow citizens. However, although Latino men and women fare similarly when it comes to viral suppression, the obstacles they face on the path to achieving that goal are not all the same.
A team of investigators at the US Centers for Disease Control and Prevention (CDC) conducted a study that analyzed various characteristics of Hispanic and Latino patients receiving care for HIV. The subjects were part of the Medical Monitoring Project (MMP), a collaborative effort between the CDC, government agencies, and local health departments designed to shed light on how people with HIV manage their illness and whether they receive proper care. For this study, CDC investigators looked at Hispanic and Latino people living with HIV who were surveilled by the MMP in 2013 and 2014, including 1774 men and 577 women.
One of the most startling differences between the men and women in this study was the percentage living in poverty. A full 78% of the Hispanic/Latino women lived in poverty, compared with 54% of the men. Women were significantly less likely to have had schooling beyond high school (only 28% vs 47% of men) and to be employed (29% vs 48% of men). A higher percentage of women reported difficulty speaking English (38% vs 21% of men), with more women requiring the services of an interpreter (27% of women vs 16% of men). Slightly more than one-third of women received help with transportation, while only 21% of men did, and 44% of women received meal services compared with 26% of men. Only 14% of women had private health insurance, compared with 22% of the men.
However, despite women’s many disadvantages, no significant differences were seen between the men and women in the study when it came to receiving prescriptions for antiretroviral therapy (95% of the women and 96% of the men) and maintaining levels of viral suppression (68% of the women and 73% of the men). How is it, then, that the women in the study did about as well as the men?
“Latina women with HIV [are] more likely to live in a household with at least 1 child under 18 years of age and less likely to be employed than Latino men with HIV, perhaps because they are more likely to be caretakers for children,” Ruthie Luna-Gierke, MPH, an epidemiologist in the CDC’s Division of HIV/AIDS Prevention and an author of the study, told Contagion®.
“Additionally, among those living outside of Puerto Rico, Latina women with HIV were more likely to report not speaking English well, which may limit their employment opportunities. These language barriers may also be tied to the findings that Latina women with HIV were less likely to have more than a high school education.
“Given these obstacles, Latina women with HIV may still be achieving similar health outcomes as Latino men with HIV due in part to women’s higher use of patient support services such as assistance with translation, transportation, and meals,” Dr. Luna-Gierke continued. “Some antiretroviral regimens require food, [and] so a lack of food might lead to nonadherence. Additionally, the lack of transportation might pose barriers to attending medical appointments and obtaining medications. [Although] Latina women were less likely to report speaking English well, their higher use of interpreter services might have mitigated the negative consequences of this potential barrier.”
Previous studies have revealed that Hispanic and Latino people of both genders fare significantly worse than non-Hispanic white people when it comes to HIV and AIDS. The US Department of Health and Human Services’ Office of Minority Health states that Hispanic men are 3 times as likely as white men to have either HIV or AIDS. Hispanic women are 4 times as likely as white women to have AIDS. And both Hispanic men and women are much more likely to die of these infections than their white counterparts. Also problematic is that many Latino and Hispanic people with HIV are unaware that they have the infection.
Dr. Luna-Gierke stressed that clinicians should be aware of potential barriers faced by Latino and Hispanic patients that may prevent them from taking full advantage of HIV treatment—such as language difficulties, transportation challenges, and food insecurity—and should assist them in getting access to vital support services.