Latinos and HIV care in the Southeastern United States: new challenges complicating longstanding problems.

In recent years, Hispanics/Latinos have become the largest immigrant group in the United States. Hispanics/Latinos represent the fastest growing minority group in the United States and have now surpassed 50 million, accounting for approximately 1 of 6 people living in the United States according to the most recent census data. The term ‘‘Latino or Hispanic’’ is applied to a very heterogeneous group from different countries and different cultures, and thus it is not possible to think of this population as a homogeneous group. Nevertheless, of the Hispanics living in the United States, almost 30 million are of Mexican origin. However, while Mexicans have been coming to the United States for centuries, the migration patterns have not remained the same. One relatively recent shift in Mexican immigration has been the places where Mexican immigrants have settled. Whereas traditionally they tended to remain primarily in border states that formerly belonged to Mexico, such as California, Arizona, or Texas, more recently they have increasingly gone to other areas, such as the Midwest and the Southeast, in large part as a result of employment opportunities. As a result, between 1990 and 2000, the Mexican immigrant population in the Southern states grew more than 300% [1]. Hispanics/Latinos as a group tend to have less education and English language proficiency and frequently lack health insurance. At 41.5%, Hispanics are the demographic segment of the adult population in the United States most likely to be uninsured. Another salient feature of Mexican immigrants living in the United States is that approximately half are undocumented and thus further marginalized from the health care system. Of the approximately 46 million uninsured individuals in the United States, about 20% are undocumented and most are Hispanics. Thus, it should come as no surprise that Hispanics/Latinos experience substantial health disparities, because their access to medical care is suboptimal and, when ill, they commonly present late for medical care [2]. Contrary to popular belief, however, undocumented immigrants have lower rates of health care utilization than do native-born Americans and only seek medical care in the United States when an illness worsens or when they have a life-threatening medical emergency [3]. The existing disparities affecting the Hispanic/Latino population in the United States are also present in human immunodeficiency virus (HIV) infection. The Centers for Disease Control and Prevention estimates that the rate of HIV infection among Hispanics is 2.5 times that of whites and that Hispanics are more likely to be ‘‘late HIV testers’’ [4]. In general, it has been shown that HIV disease is diagnosed at a later stage in Hispanics/Latinos and that these patients have lower CD4 cell counts, higher HIV RNA levels, more AIDS-defining opportunistic infections, and longer hospital stays than whites [5, 6]. Latinos have also been shown to have significant delays in initiation of HIV care. Reasons for delay of care include lack of access to transportation, being too sick to go to the doctor, and having 1 or more competing needs on expenditures, such as rent and food costs. The article by Dennis et al in this issue of Clinical Infectious Diseases documents some of the challenges in providing care for HIV-infected Latinos in North Carolina, a state that has experienced a recent and rapid increase in the Latino population [7]. Their findings are Received 19 May 2011; accepted 24 May 2011. Correspondence: Carlos del Rio, MD, Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Rd, Rm 754, Atlanta, GA 30322 ([email protected]). Clinical Infectious Diseases 2011;53(5):488–489 The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. [email protected]. 1058-4838/2011/535-0014$14.00 DOI: 10.1093/cid/cir440