With the news earlier this month that a baby born with HIV may be suppressing the virus, it is markedly apparent that the HIV/AIDS epidemic in the United States has reached a turning point. New HIV infections among the general population are declining, and we possess the prevention tools and strategies to begin envisioning an "AIDS-free generation."
But while many consider HIV/AIDS a manageable disease, rates of infection remain unacceptably high among certain at-risk populations in the country, particularly Latinos. According to the Centers for Disease Control, Latinos have nearly triple the rate of new HIV diagnoses compared with whites, a more rapid progression to an AIDS diagnosis, and double the rate of AIDS-related deaths.
Recently, the CDC highlighted large gaps along the continuum of HIV/AIDS care for Latinos. Of the 220,400 U.S. Latinos infected with HIV, only 80 percent are aware of their status, 67 percent are linked to care following a positive diagnosis, and just 37 percent are retained in care. In total, only 26 percent of HIV-positive Latinos achieve viral suppression -- the point when the virus is no longer detected in the blood.
With fewer Latinos and African-Americans engaged in each stage of care compared with whites, the current HIV/AIDS system of care is clearly not working well for some.
The Latino HIV gap is not solely accounted for by individual behavior. However, it reflects multiple influences and historical inequities that make Latinos more likely to be exposed to HIV and less likely to treat it. For example, in New York, Latinos statewide are six times more likely to be living with HIV than are whites. With high clustering among Latinos by geographic area, Latinos are more likely to be exposed to HIV by virtue of their neighborhood.
The most recent CDC data also show that people aged 20 to 24 have the highest rate of new HIV diagnoses, suggesting that HIV is concentrated by age as well as neighborhood. As Latinos are a largely young minority group -- with 41 percent of the collective Nassau, Suffolk and Westchester populations younger than 25 -- Latino youth are particularly at risk.
With 33 percent of Latinos uninsured nationally, lack of insurance poses a significant barrier to regular testing and treatment. Latino immigrants are also more likely to delay HIV testing and care due to language barriers and fear of deportation.
Thus the challenge is to link communities in need with the powerful tools we know can save lives and reduce new infections.
While the Obama administration has made strides in addressing disparities in the nation's HIV epidemic through the creation of the National HIV/AIDS Strategy and the Affordable Care Act, his second term will require renewed focus on the full implementation of these efforts, and the streamlining of services between prevention and care. Barriers to prevention and treatment must be addressed with targeted efforts to link Latinos with effective combinations of biomedical, behavioral and environmental interventions. This is critical for the metropolitan area, which has more than 4 million Latino residents and among the highest rates of of HIV/AIDS.
We do have powerful tools, but we need a renewed commitment to better connect them to communities of need. Only then can we make an AIDS-free generation a reality for everyone.
Vincent Guilamo-Ramos is a professor of social work and co-director of the Center for Latino Adolescent and Family Health at New York University's Silver School of Social Work. Katharine McCarthy is a research scientist with the center.