Pregnancy, HIV and Latinos.
Kenneth Dominguez, M.D., M.P.H.
Dr. Ken Dominguez, epidemiologist for the Centers for Disease Control and Prevention (CDC) and Captain in the U.S. Public Health Service
Pregnancy, HIV and Latinos.
In 2008, Latinos accounted for just 15 percent of the population but they comprised 19 percent of newly diagnosed cases of HIV and AIDS, and had 3 fold higher rates of diagnoses of HIV compared to white nonhispanics, statistics that Dr. Ken Dominguez, an epidemiologist for the Centers for Disease Control and Prevention (CDC) and Captain in the U.S. Public Health Service specializing in preventing the spread of HIV/AIDS, knows all too well.
"The epidemic has additional complications for Latinos. Limited access to health care, cultural barriers, stigma, and legal issues make it difficult to battle the rise of HIV/AIDS," says Dominguez. "Language barriers play a big role in terms of quality of care, being able to clearly communicate with your patients."
Passionate to help address some of these issues for Latinos, Dominguez joined the outreach efforts for One Test. Two Lives. to help increase awareness of the importance of testing women for HIV early in pregnancy among providers who are not regularly testing their patients. Since 1995, CDC has recommended all pregnant women be tested for HIV and, if infected, get treatment for themselves to improve their health and to prevent passing the virus to their infant.
We discovered that a primary factor for a woman's acceptance of HIV testing was the strength of the provider's recommendation to get tested. If the provider said, 'this was important, please get tested,' the patient was more likely to accept it."
--Ken Dominguez, on the importance testing for HIV during pregnancy
"The One Test. Two Lives. campaign offers important information to both health care providers and patients on the benefits of early prenatal care and HIV testing to prevent transmitting the virus from mother to child," said Dominguez. "All of the educational materials are available in Spanish, which is critical to reach Latinos."
Continues Dominguez, "The brochures and fact sheets available in the One Test. Two Lives. provider resource kit are effective tools that enable physicians to communicate about universal voluntary prenatal testing for HIV to their patients."
In addition to his work with One Test. Two Lives., Dominguez has worked with a perinatal HIV prevention program for Latinas in South Carolina called "Empowering Latinas to Lash out against HIV/STIs" (ELLAs). The program, interviews Spanish-speaking health care providers to determine any perceived barriers to counseling and administering an HIV test to pregnant Latinas in South Carolina. It also explores where Latina women get their HIV information and possible barriers related to their decision to seek early prenatal care and to take the HIV test during pregnancy.
Dominguez has been involved in HIV issues since he first came to CDC in 1991, when he conducted research to study the rate of new HIV-infections in pregnant women in the CDC –Belle Glade Study, near Lake Okochobee, in Palm Beach County, Florida.
In 1993, Dominguez became involved with mother-to-child HIV transmission efforts through CDC's "Perinatal Guidelines Evaluation Project "– a four-city study to determine if physicians were following guidelines for HIV screening and antiretroviral therapy (ARV) treatment.
Along with additional research, these guidelines were a precursor for CDC's current recommendation for opt-out HIV screening, which offers routine HIV screening for all patients unless they decline. Says Dominguez, "With opt-out, you get very strong provider recommendation because the physician is saying 'we'll test you unless you say no.'"
More recently in 2008, he and colleagues from St. Jude's Hospital in Memphis, TN, and University of Miami, in Miami, FL, were the first to publish a case series which documented prechewing of food by caregivers as a novel mode of mother-to-child HIV transmission and recommends health care providers ask pregnant women about this practice and warn against it if one is HIV-infected. Dominguez emphasizes, "This represents yet another important reason why a pregnant woman would want to know her HIV status."
He also coauthored a recent report in March 2011, in CDC's Morbidy and Mortality Weekly Report describing the prevalence of prechewing among caregivers of HIV-exposed children in pediatric HIV clinics in the U.S.