HIV & Immigrant CommunitiesImpact on Asians & Latinos

Sneha Jacob, M.D., M.S.South Asian Total Health InitiativeRobert Wood Johnson Medical School

The names and photos in the

following presentation are not

the actual names and photographs of the patients discussed, but rather fictional names and stock

photo images taken from the Internet

Carlos

50 year old Mexican man, non English speaking

Unable to find a job to support his family in Mexico so he crossed the border by foot into Texas in 2003

Found his way to NJ where he worked as a dishwasher at an Indian restaurant and sends money home to support his two daughters

http://www.nytimes.com/2010/07/10/us/10enforce.html?pagewanted=all

Carlos

Had to stop working this past September due to difficulty breathing

Admitted to the hospital where he was found to have AIDS and to be in heart failure due to a rare heart valve infection

Started on HIV treatment in JanuaryBack to work at another Indian restaurant in March

http://www.sciencedaily.com/articles/m/mitral_valve.htm

Immigration Reform

Immigrants and access to Medical Care

Undocumented immigrants: not eligible for federally funded public health insurance programs, including Medicare, Medicaid and the Child Health Insurance Program (CHIP) Exception: emergency care

Legal noncitizens (i.e. permanent residents)-- limited access to employer-based health coverage and restrictions: not eligible for Medicaid and SCHIP for the first 5 years

non-citizens (legal and undocumented) are far more likely to be uninsured than citizens (47% vs. 15%)

Latino Immigrants & Health Insurance Coverage

Latino Commission on AIDS: http://www.latinoaids.org/hivlatinos.php

Immigrants with HIV/AIDS and access to Medical Care HIV drug coverage

AIDS Drug Assistance Program (ADAP) New Jersey= ADDP

Ryan White Federal Government Funding for HIV positive individuals

Federally Qualified Health Centers (FQHCs) and Migrant Health Cen ters – funded by the federal Health Resources and Ser vices

Administration (HRSA).

The HIV Ban- U.S. & Abroad

US Public Health Service List of “Dangerous and

Contagious Diseases”

1987 Reagan Administration: AIDS was added to that list

Department of Health and Human Services (DHHS)  in

late 2009, published regulations to

remove HIV from the list of “communicable diseases of

public health significance,” in effect on January 4, 2010 

45 countries still deport, detain or deny entry to

people solely because they are HIV positive.

http://ghalegroup.com/blog/2010/04/30/china-ends-travel-ban-on-visitors-with-hiv-and-aids/

Countries with Regulations

restricting Entry

BahamasBrunei

Equatorial GuineaIranIraq

JordanPapua New Guinea

QatarRussia

SingaporeSolomon Islands

SudanUnited Arab Emirates (UAE)

Yemen

U.S Public Health Service

List

“Communicable diseases of public health significance”

active tuberculosis,

infectious syphilis,

chancroid,

gonorrhea,

granuloma inguinale,

lymphogranuloma venereum,

Hansen's disease (leprosy)

The Immigration Act of 1990

What is HIV? AIDS?HIV is a Virus that weakens

your immune system

Causes AIDS- Acquired Immune Deficiency Syndrome.

HIV becomes AIDS when the immune system becomes severely weakened

AIDS results in severe illness (infections, cancers) that cause death

Can HIV/AIDS be Treated?HIV/AIDS cannot be cured

but it CAN be treated Antiretroviral Therapy,

the treatment for HIV/AIDS can allow people to live with HIV and be healthy on as little as one pill a day

The earlier one is diagnosed, the earlier treatment can be started, & the longer they can live

How do we test for HIV?

HIV tests check for antibodies - immune system produces in reaction to HIV infection

Rapid tests –preliminary results in as little as 20 minutes.

How does the HIV Test Work?Tests blood or a sample of cells

from inside cheek for antibodies to the virus.

Most people develop antibodies to the HIV virus within 3-6 months of infection.

If this test is positive lab technicians run 2 more tests; results can take from a few days to 2 weeks

Who Should be tested for HIV?Current CDC Recommendations

ALL individuals ages 13 to 64 be tested for HIV at least once in their lifetime

Yearly testing if high risk of infection:

unprotected sex with >1 partner or with an anonymous partner

A man who has sex with men

Use of intravenous (IV) drugs

Diagnosis of tuberculosis, STD, hepatitis, or syphilis

Gabriella44 year old woman

came to the hospital with heavy bleeding, concerned she was

having a miscarriage

Tested positive for HIV

Crossed the border from Honduras via

Guatemala and Mexico in 2004,

leaving her mother and 3 sons behind

http://213project-mwecas.blogspot.com

Gabriella

One of her sons, 19 years old was killed by guerillas in

Honduras last year

Sending her earnings as a housekeeper to help her sons

cross the border however they were caught and detained in Guatemala

Had to stop her HIV medications because her

insurance lapsed -unable to read the application that came by mail in English

https://www.russellsage.org/publications/crossing-border

HIV and Latino Immigrants

Latinos constitute a rapidly expanding proportion of People Living With HIV/AIDS in the U.S.

Latinos with AIDS: Where are they from?

Latino Commission on AIDS: http://www.latinoaids.org/hivlatinos.php

How are Latinos becoming infected with HIV?Estimated New HIV Infections

among Latinos, 2010 (CDC)

Heterosexual Women

Heterosexual Men

Injection Drug User (IDU) Women

IDU Men

Men who have sex with Men (MSM)

MSM + IDU

Vidhya

•70 year old woman moved to the US

from India in 2009 after becoming a

widow

•Lives with her 35 year old daughter

and in Central Jersey

•Husband died of kidney failure & diabetes in 2007

 http://www.bolegaindia.com/gossips/Meenal_Patel_will_play_grandmother_in_Alakshmi-gid-13186-gc-16.html

Diagnosed on routine immigration testing in February 2009

History of two blood transfusions in India in 1999 for low hemoglobin

Started on HIV treatment in 2011

HIV and Asian Immigrants

What is the Recorded Rate of HIV Among Asians in the U.S.? (CDC,

2005)Male Adults and Adolescents with HIV in U.S., 2005

What is the Recorded Rate of HIV among Asians in NJ?

Black, non-Hispanic; 49%

Hispanic; 24%

White, non-Hispanic; 25%

Asian/Pac Islander; 1%

n=23,471 males

Why are Asians NOT being tested?

Cultural BarriersLanguage Barriers

Lack of Knowledge about HIVFear & Stigma

New Jersey: Proportion of Asians Tested for HIV

Total Number Asians Tested Under NJ Counseling and Testing Services

1.88 1.850

20

40

60

80

100

2011 2012

Year

Tota

l % T

este

d

Rommel

27 year old Filipino manWorked at Major Network TV station in the I.T. Department in NYC

One day found to have yellow eyes and yellowed skin, fever, stomach pain

Went to the hospital and was found to have HIV and Hepatitis C

 http://fitness.bf-1.com/men_celebrities/michael-copon-a-filipino-making-it-in-hollywood

RommelMigrated to the United States from the Philippines with his family at the age of 5

Injected crystal methamphetamine at parties on the weekends

Has sex with men, yet has not disclosed this sexual orientation to his family

Found to have AIDS at diagnosis and was started on HIV medication right awayhttp://www.thehillscenter.com/addiction/iv-drug-use/

Asians in the U.S. have the highest percent of foreign born

with HIV% HIV Diagnoses in US Among Foreign

Born: Blacks (8614 of 86547) 10% of diagnosesHispanics (17913 of 42431)42% of

diagnosesAsians (1987 of 3088) 64% of diagnoses

#1-Phillipines (449), #2- India (287), #3-VietNam(256), #4- Thailand (190), #5-China (137).

At Diagnosis Asians are more likely to have

Advanced AIDSIn 2004, the proportion of individuals who were found to have AIDS within 1 year after their HIV infection was diagnosed:

37% of Whites 40% of Blacks 41% of American Indians/Alaska Natives43% of Hispanics44% of Asians and Pacific Islanders

What is my role?

Eric B. Chandler Health Center

Federally Qualified Health Center

(FQHC)

Robert Wood Johnson Medical

School(UMDNJ)

New Brunswick, NJ

Eric B. Chandler HIV Clinical Services

450 patients with HIV

6 Different Counties (majority from Middlesex, Hunterdon, Somerset)

276 Men, 170 Women, 4Transgender

42% Black, 17% White, 35% Latino, 3% Asian

50% Heterosexual, 28% MSM, 18% Injection Drug Use, 1% Perinatal (mother to child), 0.4% Transfusion

89% live with a virus that is undetectable (controlled on Antiretroviral Therapy)

Chandler ranks as one of the top in the U.S. among 600+ HIV centers (average viral load suppression rate 72%)

Our Latino Population

130 Latino patients

Puerto Rico, Dominican Republic, Mexico, Guatemala, Honduras, Ecuador, Peru, Paraguay, Brazil, Cuba, Colombia

Risk Factors: 70 Heterosexual 45 Men who have sex with men

(MSM) 14 Injection Drug Use 1 Perinatally infected (at birth)

How are YOU impacted by HIV?

HIV AmongYouth Aged 13-24 in the United States

In 2009, young persons accounted for 39% of all new HIV infections in the US. (persons aged 15–29 comprised 21% of the US population in 2010)

Those aged 20–24 had the highest number and rate of HIV diagnoses of any age group (36.9 new HIV diagnoses/100,000 people).

Thank you

Dr. Dutta, Rutgers University

SATHI South Asian Total Health Initiative Sunanda Gaur, Shrivridhi Shukla

Robert Wood Johnson Medical Center Department of Family Medicine/Internal Medicine

Eric B. Chandler Health Center HIV Team Joy Melendez, Cindy Leon, Betsy Medina, Jessica

Ortiz, Connie Robinson, Kathy Sarnoski, Steve Levin

Questions?

Other Topics…. HIV “Cures” in the News