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Geographic Differences in HIV Infection Among Hispanics or Latinos — 46 States and Puerto Rico, 2010

In the United States, Hispanics or Latinos are disproportionately affected by infection with human immunodeficiency virus (HIV). In 2010, new diagnoses of HIV infection among Hispanics or Latinos occurred at an annual rate that was 2.8 times that of non-Hispanic whites (20.4 versus 7.3 per 100,000 persons) (1). To further assess HIV infection among Hispanics or Latinos in the United States, CDC analyzed the geographic distribution of new diagnoses in 2010 in 46 states and Puerto Rico and the characteristics of those diagnosed. The results of this analysis determined that a lower percentage of infections were attributed to male-to-male sexual contact in Puerto Rico than in the 46 states (36.1% versus 66.5%) and a higher percentage were attributed to heterosexual contact (40.7% versus 22.0%) or injection-drug use (IDU) (20.4% versus 8.6%). In the 46 states, the rate of new diagnoses of HIV infection among Hispanics or Latinos in the Northeast Census region in 2010 (55.0 per 100,000 persons) was more than twice as high as in other regions, and a higher percentage of those with a new HIV diagnosis were born in Puerto Rico or had their HIV infection attributed to IDU, compared with other regions. Geographic differences in HIV infection among Hispanics or Latinos should be addressed with HIV testing, prevention, and treatment efforts tailored to specific communities.

Data were analyzed for Hispanics or Latinos* with newly diagnosed HIV infection in 2010 who were aged ≥13 years at HIV diagnosis and for those living with a diagnosis of HIV infection who were aged ≥13 years at the end of 2009. The data were reported to CDC through June 2011 by Puerto Rico, which represented 98.1% of Hispanics or Latinos diagnosed with HIV infection in five U.S. dependent areas in 2010, and the 46 states. All of these reporting areas have had confidential, name-based HIV infection reporting since at least January 2007. The numbers and percentages of HIV diagnoses in 2010 among Hispanic or Latino adolescents and adults in each U.S. Census region§ and Puerto Rico were calculated by sex, age group, transmission category, residence at diagnosis, and place of birth. The number of diagnoses of HIV infection was adjusted for reporting delay but not for incomplete reporting. Multiple imputation was used to assign a transmission category to those cases missing risk information (2,3). The number of persons living with a diagnosis of HIV infection (prevalence of diagnosed HIV infection) was further adjusted to account for the delay in reporting of deaths among persons with HIV. Where possible, rates per 100,000 persons were calculated based on postcensal estimates of Hispanic populations from the U.S. Census Bureau (4).

New Diagnoses of HIV Infection

In 2010, an estimated total of 10,731 Hispanics or Latinos were newly diagnosed with HIV infection in 46 states (9,620 [89.6%]) and Puerto Rico (1,111 [10.4%]) (Table 1). By category, 83.2% were males, 63.4% were men who had sex with men, and 86.4% were urban residents; infection was most common (32.4%) among persons aged 25–34 years. Among the 8,966 (83.6%) cases with birthplace data available, 54.4% of new diagnoses were in persons born outside of the 50 states and the District of Columbia; the highest percentages were from Mexico (19.4%) and Puerto Rico (15.8%). Compared with new diagnoses of HIV infection among Hispanics or Latinos in the 46 states, lower percentages of diagnoses in Hispanics or Latinos in Puerto Rico were among males (75.3% versus 84.1%), men who had sex with men (36.1% versus 66.5%), and urban residents(69.8% versus 88.3%); higher percentages were among those aged ≥45 years (35.5% versus 22.0%) or with a diagnosis attributed to heterosexual contact (40.7% versus 22.0%) or IDU (20.4% versus 8.6%).

Among the 46 states, a higher percentage of Hispanics or Latinos with new diagnoses resided in the South (35.4%), followed by the West (32.1%), Northeast (26.3%), and Midwest (6.2%). Characteristics of Hispanics or Latinos with a new diagnosis of HIV infection in 2010 differed regionally. Compared with other regions, the Northeast had the lowest percentage of diagnoses in males (76.7%) and in rural residents** (1.3%), whereas the South had the highest percentage in rural residents (6.0%). Although male-to-male sexual contact was the predominant transmission category for HIV infection overall (66.5%), a lower percentage of HIV infections were attributed to male-to-male sexual contact in the Northeast (52.5%). More infections were attributed to IDU in the Northeast than elsewhere (15.8% versus <8.8% in the other regions). In 2010, 48.7% of the Hispanics or Latinos in the 46 states with a diagnosis of HIV infection attributed to IDU lived in the Northeast. Among Hispanics or Latinos with new diagnoses of HIV infection who were born outside of the 50 states and the District of Columbia, Puerto Rico was the most common birthplace in the Northeast (10.6%) and Mexico in all other regions (>18.6%).

In 2010, the overall rate of new diagnoses of HIV infection among Hispanics or Latinos in 46 states was 27.6 per 100,000 persons. The rate in the Northeast (55.0) was more than twice that of any other region (Table 2).

Prevalence Rate of Diagnosed HIV Infection

At the end of 2009, the overall prevalence rate of diagnosed HIV infection among Hispanics or Latinos was 432.3 per 100,000 persons. The prevalence rate of diagnosed HIV infection in the Northeast (1,252.6) was 3.8 times that in the South, the region with the next highest rate (333.7). Four of the five states with the highest prevalence rates of diagnosed HIV infection per 100,000 Hispanics or Latinos at the end of 2009 were in the Northeast (Figure).

Reported by

Qian An, MS, Angela Hernandez, MD, Joseph Prejean, PhD, Emilio J. German, MS, Horace Thompson, H. Irene Hall, PhD, Div of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Corresponding contributor: Qian An, qan@cdc.gov, 404-639-8523.

Editorial Note

The burden of HIV infection among Hispanics or Latinos differs between the 46 states and Puerto Rico. In 2010, Hispanics or Latinos with new diagnoses of HIV infection in Puerto Rico were more likely to have HIV infection attributed to IDU or heterosexual contact and were older than those with new diagnoses in the 46 states. Within the 46 states, the Northeast region accounted for an estimated 13.9% of the Hispanic or Latino population in 2010 (5) but 26.3% of new diagnoses of HIV infection. During the study period, the highest rate of new diagnoses of HIV infection and the highest prevalence rate of diagnosed HIV infection in Hispanics or Latinos were in the Northeast. The disproportionately high percentage of Hispanics or Latinos living with a diagnosis of HIV infection might pose a greater risk for HIV transmission for Hispanics or Latinos in the Northeast than in other regions (6).

Unlike the South and West regions, where Hispanics or Latinos tend to be of Mexican and Central American descent, 34.9% of Hispanics or Latinos in the Northeast are of Puerto Rican origin (5). Hispanics or Latinos in the Northeast are more likely to acquire HIV infection through IDU than Hispanics or Latinos in other regions, which might, in part, reflect an influence of the epidemiology of HIV transmission in Puerto Rico (7).

The South region had the second highest rate of new HIV diagnoses among Hispanics or Latinos. In the past 10 years, the South has experienced the largest percentage growth in the Hispanic or Latino population, possibly as a result of increased migration (5). Hispanic or Latino migrants in this region tend to be young, unaccompanied males. Studies have suggested that this population might be entering social surroundings with increased risks for HIV infection in their new environment (8).

The findings in this report are subject to at least three limitations. First, results are based on data from 46 states and Puerto Rico. However, these areas represent approximately 91.2% of reported acquired immunodeficiency syndrome (AIDS) diagnoses in the United States and the dependent areas, and states with high proportions of Hispanics or Latinos were included. Second, data were adjusted for reporting delay but not incomplete reporting, and statistical adjustment of data might have introduced uncertainties into estimates of diagnoses of HIV infections or of the number of persons living with a diagnosis of HIV infection. Finally, birthplace data were missing for 16.4% of Hispanics or Latinos newly diagnosed with HIV infection in 2010. Additionally, birthplace does not indicate where a person became HIV infected.

The National HIV/AIDS Strategy calls for intensified HIV prevention efforts in communities where HIV infection is most heavily concentrated, including Hispanic or Latino communities (9). The findings in this report suggest that HIV intervention efforts should be tailored to the characteristics and needs of the Hispanic or Latino population in different geographic areas. Regionally specific HIV prevention efforts should be used to increase early diagnosis and linkage to care for Hispanics or Latinos. CDC's high-impact prevention approach, a combination of scientifically proven, cost-effective, and scalable interventions (e.g., biomedical interventions, HIV testing and linkage to care, and individual and small group interventions), could be used in high-risk Hispanic or Latino populations, particularly injection-drug users in the Northeast and Puerto Rico, persons in rural areas, and recent immigrants to the South.

Acknowledgment

Sandra Miranda De Leon, MPH, HIV Surveillance Program, Puerto Rico Dept of Health.

References

  1. CDC. HIV surveillance report, 2010. Vol. 22. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://www.cdc.gov/hiv/topics/surveillance/resources/reports. Accessed October 5, 2012.
  2. Song R, Hall HI, Frey R. Uncertainties associated with incidence estimates of HIV/AIDS diagnoses adjusted for reporting delay and risk redistribution. Stat Med 2005;24:453–64.
  3. Harrison KM, Kajese T, Hall HI, Song R. Risk factor redistribution of the national HIV/AIDS surveillance data: an alternative approach. Public Health Rep 2008;123:618–27.
  4. US Census Bureau. Population estimates: current estimates data. July 1, 2010. Washington, DC: US Census Bureau; 2012. Available at http://www.census.gov/popest/data/index.html. Accessed October 5, 2012.
  5. US Census Bureau. The Hispanic population: 2010. Washington, DC: US Census Bureau; 2011. Available at http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf. Accessed October 5, 2012.
  6. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011;365:493–505.
  7. Diaz T, Buehler JW, Castro KG, et al. AIDS trends among Hispanics in the United States. Am J Public Health 1993;83:504–9.
  8. Painter TM. Connecting the dots: when the risks of HIV/STD infection appear high but the burden of infection is not known—the case of male Latino migrants in the southern United States. AIDS Behav 2008;12:213–26.
  9. Office of National AIDS Policy. National HIV/AIDS strategy. Washington, DC: Office of National AIDS Policy; 2010. Available at http://www.whitehouse.gov/administration/eop/onap/nhas. Accessed October 10, 2012.

* Hispanics or Latinos might be of any race.

The five U.S. dependent areas are American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands.

§ Northeast: Connecticut, Maine, New Hampshire, New Jersey, New York, Pennsylvania, and Rhode Island; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.

Residents of metropolitan areas with ≥500,000 population.

** Residents of nonmetropolitan areas with <50,000 population.


What is already known on this topic?

In the United States, Hispanics or Latinos are disproportionately affected by human immunodeficiency virus (HIV) infection. For example, in 2010, new diagnoses of HIV infection among Hispanics or Latinos occurred at an annual rate that was 2.8 times that of non-Hispanic whites.

What is added by this report?

In 2010, Hispanics or Latinos with a new diagnosis of HIV infection in the Northeast and Puerto Rico were more likely to have HIV infection attributed to injection-drug use than in other regions. Within the 46 states, the Northeast region had the highest rate of new HIV diagnoses among Hispanics or Latinos in 2010 and the highest prevalence rate of diagnosed HIV infection at the end of 2009.

What are the implications for public health practice?

HIV interventions should be tailored to the differing needs of populations in different geographic areas. Regionally specific HIV prevention efforts should be used to increase early diagnosis and linkage to care for Hispanics or Latinos. CDC's high-impact prevention approach could be used in high-risk Hispanic or Latino populations, particularly injection-drug users in the Northeast and Puerto Rico, those in rural areas, and recent immigrants to the South.


TABLE 1. Estimated number* and percentage of new diagnoses of HIV infection among Hispanics or Latinos aged ≥13 years, by U.S. Census region§ and selected characteristics — 46 states and Puerto Rico, 2010

Characteristic

Northeast

Midwest

South

West

Subtotal

Puerto Rico

Total

No.

%

No.

%

No.

%

No.

%

No.

%

No.

%

No.

%

Sex

Male

1,943

76.7

501

84.2

2,858

84.0

2,785

90.2

8,087

84.1

837

75.3

8,924

83.2

Female

591

23.3

95

16.0

546

16.0

302

9.8

1,534

15.9

274

24.7

1,807

16.8

Age group at diagnosis (yrs)

13–24

457

18.0

118

19.8

628

18.4

576

18.7

1,779

18.5

136

12.2

1,916

17.9

25–34

748

29.5

219

36.8

1,104

32.4

1,113

36.1

3,184

33.1

298

26.8

3,482

32.4

35–44

680

26.8

165

27.7

904

26.6

798

25.9

2,547

26.5

283

25.5

2,831

26.4

45–54

422

16.7

62

10.4

555

16.3

429

13.9

1,468

15.3

250

22.5

1,718

16.0

≥55

226

8.9

31

5.2

213

6.3

170

5.5

640

6.7

144

13.0

785

7.3

Transmission category

Males

Male-to-male sexual contact

1,331

52.5

397

66.7

2,297

67.5

2,374

76.9

6,399

66.5

401

36.1

6,800

63.4

Injection-drug use

305

12.0

39

6.6

144

4.2

144

4.7

632

6.6

200

18.0

833

7.8

Male-to-male sexual contact and injection-drug use

55

2.2

16

2.7

82

2.4

126

4.1

279

2.9

31

2.8

310

2.9

Heterosexual contact

251

9.9

48

8.1

333

9.8

139

4.5

771

8.0

205

18.5

975

9.1

Other**

1

0.0

1

0.2

2

0.1

2

0.1

6

0.1

5

0.0

Females

Injection-drug use

96

3.8

13

2.2

50

1.5

32

1.0

191

2.0

27

2.4

217

2.0

Heterosexual contact

495

19.5

82

13.8

496

14.6

270

8.7

1,343

14.0

247

22.2

1,588

14.8

Other**

1

0.0

0

0.0

1

0.0

1

0.0

3

0.0

2

0.0

Residence area at diagnosis

Urban††

2,362

93.2

473

79.5

2,831

83.2

2,829

91.6

8,495

88.3

775

69.8

9,270

86.4

Suburban§§

115

4.5

60

10.1

340

10.0

204

6.6

719

7.5

233

21.0

952

8.9

Rural¶¶

33

1.3

33

5.5

205

6.0

46

1.5

317

3.3

29

2.6

346

3.2

Unknown

25

1.0

29

4.9

28

0.8

8

0.3

90

0.9

74

6.7

164

1.5

Place of birth

50 states and DC

1,178

55.7

178

44.1

1,407

50.5

1,296

50.3

4,059

51.5

32

2.9

4,090

45.6

Central America

140

6.6

41

10.1

295

10.6

230

8.9

706

9.0

3

0.3

709

7.9

Cuba

28

1.3

2

0.5

200

7.2

17

0.7

247

3.1

247

2.8

Mexico

153

7.2

136

33.7

517

18.6

932

36.2

1,738

22.1

2

0.2

1,740

19.4

Puerto Rico

224

10.6

21

5.2

145

5.2

16

0.6

406

5.2

1,009

90.8

1,416

15.8

South America

163

7.7

17

4.2

157

5.6

52

2.0

389

4.9

6

0.5

395

4.4

Other

229

10.8

9

2.2

65

2.3

33

1.3

336

4.3

34

3.1

369

4.1

Overall***

2,534

100.0

595

100.0

3,404

100.0

3,087

100.0

9,620

100.0

1,111

100.0

10,731

100.0

* Estimates resulted from statistical adjustment that accounted for reporting delays and missing risk-factor information, but not for incomplete reporting.

Hispanics or Latinos might be of any race.

§ Northeast: Connecticut, Maine, New Hampshire, New Jersey, New York, Pennsylvania, and Rhode Island; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.

Heterosexual contact with a person known to have, or to be at high risk for HIV infection.

** Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.

†† Metropolitan area of ≥500,000 population.

§§ Metropolitan area of 50,000–499,999 population.

¶¶ Nonmetropolitan area of <50,000 population.

*** Because column totals for estimated numbers were calculated independently of the values for the subpopulations, the values in each column might not sum to the column total.


TABLE 2. Estimated* rate of new diagnoses of HIV infection in 2010 and prevalence rate of diagnosed HIV infection at the end of 2009, among Hispanics or Latinos§ aged ≥13 years, by U.S. Census region — 46 states

Characteristic

Northeast

Midwest

South

West

Total

Rate of new diagnoses of HIV infection in 2010

Prevalence rate of diagnosed HIV infection at the end of 2009

Rate of new diagnoses of HIV infection in 2010

Prevalence rate of diagnosed HIV infection at the end of 2009

Rate of new diagnoses of HIV infection in 2010

Prevalence rate of diagnosed HIV infection at the end of 2009

Rate of new diagnoses of
HIV infection
in 2010

Prevalence rate of diagnosed HIV infection at the end of 2009

Rate of new diagnoses of HIV infection in 2010

Prevalence rate of diagnosed HIV infection at the end of 2009

Sex

Male

83.9

1,744.3

30.1

443.2

44.2

514.3

36.3

482.6

44.7

651.6

Female

25.8

755.6

6.6

120.7

9.3

135.4

4.2

78.6

9.2

194.9

Age group at diagnosis (yrs)

13–24

39.9

211.4

13.5

45.5

20.1

55.9

13.8

40.1

19.1

67.0

25–34

75.0

687.2

28.7

246.4

39.0

289.4

33.0

251.9

40.0

319.3

35–44

75.6

1,817.6

26.1

492.1

36.6

569.9

27.6

521.8

37.0

705.6

45–54

58.9

2,911.9

14.9

611.5

30.9

669.1

20.3

590.1

29.1

949.9

≥55

26.7

1,323.3

7.5

279.7

10.0

242.2

7.6

218.0

11.4

397.4

Residence area at diagnosis

Urban**

55.5

1,247.5

20.7

329.4

30.6

375.2

23.5

324.2

30.6

483.0

Suburban††

47.2

1,001.5

14.3

194.9

18.3

204.0

10.2

139.5

15.9

217.4

Rural§§

31.8

1,577.6

8.5

145.1

16.4

197.6

6.0

95.6

12.7

216.0

Overall¶¶

55.0

1,252.6

19.2

293.5

27.6

333.7

20.9

288.2

27.6

432.3

* Estimates resulted from statistical adjustment that accounted for reporting delays and missing risk-factor information, but not for incomplete reporting.

Per 100,000 persons. Rates for U.S. dependent areas are not provided because U.S. Census information on race/ethnicity for U.S. dependent areas is limited. Rates are not calculated by transmission category and by place of birth because of the lack of denominator data.

§ Hispanics or Latinos can be of any race.

Northeast: Connecticut, Maine, New Hampshire, New Jersey, New York, Pennsylvania, and Rhode Island; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.

** Metropolitan area of ≥500,000 population.

†† Metropolitan area of 50,000–499,999 population.

§§ Nonmetropolitan area of <50,000 population.

¶¶ Because column totals for estimated numbers were calculated independently of the values for the subpopulations, the values in each column might not sum to the column total.


FIGURE. Estimated prevalence rate* of diagnosed HIV infection among Hispanics or Latinos aged ≥13 years at the end of 2009 — 46 states

The figure shows the estimated prevalence rate of diagnosed HIV infection among Hispanics or Latinos aged ≥13 years in 46 states during 2009. At the end of 2009, the overall prevalence rate of diagnosed HIV infection among Hispanics or Latinos was 432.3 per 100,000 persons. The prevalence rate of diagnosed HIV infection in the Northeast (1,252.6) was 3.8 times that in the South, the region with the next highest rate (333.7). Four of the five states with the highest prevalence rates of diagnosed HIV infection per 100,000 Hispanics or Latinos at the end of 2009 were in the Northeast.

* Per 100,000 persons. Estimates resulted from statistical adjustment that accounted for reporting delay and missing risk-factor information, but not for incomplete reporting.

Hispanics or Latinos might be of any race.

Alternate Text: The figure above shows the estimated prevalence rate of diagnosed HIV infection among Hispanics or Latinos aged ≥13 years in 46 states during 2009. At the end of 2009, the overall prevalence rate of diagnosed HIV infection among Hispanics or Latinos was 432.3 per 100,000 persons. The prevalence rate of diagnosed HIV infection in the Northeast (1,252.6) was 3.8 times that in the South, the region with the next highest rate (333.7). Four of the five states with the highest prevalence rates of diagnosed HIV infection per 100,000 Hispanics or Latinos at the end of 2009 were in the Northeast.


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