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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