Health Care System Falls Short for the Aging HIV-Positive Latino Population

As a result of the availability and efficacy of antiretroviral treatments, patients with HIV are living longer than ever, which has lead to a different set of challenges. Concerns surrounding long-term health care, comorbidities, management of everyday tasks, and financial difficulties are bubbling to the surface.

Among this aging patient population, the Latino community in particular have several factors that make them more vulnerable to HIV/AIDS.

In a first of its kind study conducted by the Latino Commission on AIDS and the Hispanic Health Network, investigators highlighted disparities in the quality of life between aging Latinos and non-Latinos, especially those who do not speak English.

Although Hispanics/Latinos represent only 18% of the population in the United States, they accounted for approximately 24% of new HIV diagnoses in 2015. Compared with non-Latino white individuals, the risk of infection only increases as Latinos age. In 2015, Latinos aged 50 to 54 years had an HIV diagnosis rate that was more than twice the rate of their white non-Hispanic counterparts.

Despite the figures, this population is often forgotten. Research that includes robust samples of Latinos are lacking, and those available only gather information from English speakers, according to the report.

“The few existing surveys of older adults with HIV/AIDS gathered information from small samples of Latinos and only those that could speak and write in English,” the authors wrote. “Thus, they have ignored the many others who are linguistically isolated due to their inability to communicate or read in English. These individuals, who mainly speak Spanish, are often forgotten by researchers, health planners, and policy analysts; their voices, experiences, and needs are at times not recognized or validated.”

In the report titled Olvidados, or the “forgotten ones,” the authors delved into the health needs of the aging HIV-positive Latino population, and the social and structural factors that perpetuated HIV-related disparities and comorbidities among this population.

A total of 157 HIV-positive Hispanics/Latinos, aged 50 to 80 years, were included in the study. Most of the respondents were foreign-born and an overwhelming majority were very low income, according to the report. Ninety-one percent of the respondents lived on less than $20,000 per year.

Key findings from the report were as follows:

• The survey confirmed that low socioeconomic and status and education levels among respondents are well-known factors associated with poor health outcomes.
• Most participants responded that they are insured, have a provider, and are virally suppressed. However, an average of 1 of 4 participants reported being less than satisfied with some aspect of their provider’s care. Provider satisfaction has been shown to be crucial in engaging and maintaining individuals in care, and significantly increases optimal health outcomes, according to the report
• A significant proportion of respondents were not being counseled by their providers during their visits regarding any health concerns, screenings, and comorbidity risks. On average, approximately 40% of respondents reported that their providers asked about related health issues within the last 6 months, such as substance use, cancer, sexually transmitted infections, violence, and mental health.
• Some level of difficulty with treatment adherence was reported in 1 of 3 respondents. The authors noted that the finding warrants further exploration and explanation.
• Discussions between the providers and respondents related to sexual health were relatively infrequent, despite 43% who indicated some sexual activity within the last 3 months.
• A relatively low frequency of substance use was reported, with 12% who indicated they were in recovery. However, the authors noted that respondents may have understated such problems because of social-desirability bias. Additionally, provider conversations related to substance use were also low.

Focus group discussions were also conducted, allowing the authors to gain further insight into the challenges and concerns older Latinos are facing. Obstacles included fear and mistrust, experience of comorbidities, and access to care challenges. According to the report, these obstacles only complicate patient adherence and management of adverse events and increases the likelihood of social isolation, which can exacerbate depression, increase stress, and cause further harm to the immune system.

An analysis of the discussions highlighted what “helps/works” to achieve optimal health outcomes and overall wellbeing. The facilitators included a strong relationship with providers; high social capital; sex-positivity; work/volunteer engagement; and affordable and sustainable housing.

To address the challenges the aging HIV-positive Latino community faces, the Latino Commission on AIDS and the Hispanic Health Network recommend an increase in culturally sensitive and responsive services; sexual education and sexual wellness initiatives; more capacity building and training; integrating mental and behavioral health into HIV and aging; more research; a focus on prevention and treatment efforts; and increasing patient access to health care.