Moving Towards an AIDS-Free Generation

An AIDS free generation was recognized as a tenable possibility at the 19th International AIDS Conference in Washington, D.C., last month. Prominent scientists and policy makers argued that we are at a critical juncture in the fight to end the HIV pandemic. HIV-preventative interventions have been developed that rely on a combination of biomedical, behavioral and structural approaches to reducing HIV transmission, and if widely implemented and tailored to specific groups disproportionately impacted by HIV, could result in what Secretary of State Hillary Clinton termed "an AIDS-free generation."

The Obama administration's National HIV/AIDS Strategy for the United States specifically calls for a focus on the "groups and communities where the most cases of new infections are occurring." These groups are disadvantaged, ethnic minorities. Latinos constitute the largest, youngest and fastest growing ethnic minority group in the nation -- they accounted for over half of the country's growth in the past decade. In 2010, Latinos accounted for nearly 22 percent of diagnoses of HIV infection in the U.S. while representing 16 percent of the total population. Furthermore, the most recent CDC data indicates that the highest rate of new HIV diagnoses occurs among young adults 20-24 years old; within this group, Latinos are disproportionately affected. Given that approximately 50 percent of Latinos are under the age of 25, Latino youth must be a priority if the hope of an AIDS-free generation is to become a reality.

Critical to HIV prevention and improving the survival of HIV-infected persons requires involvement in healthcare -- testing, linking people to care, staying in care, getting on antiretroviral therapy and suppressing viral load. This "treatment cascade," in which each step is contingent upon the maintenance of the prior, has proven to be difficult to achieve for most and particularly difficult for Latinos.

Among Latinos, 20 percent of HIV infected individuals are undiagnosed, representing a missed opportunity for secondary HIV prevention and linkage to care. In fact, Latinos are the last to be tested for HIV compared to other ethnic minority groups, meaning they are more likely to become aware of infection at the most severe stage of the disease. For HIV-positive individuals, achieving viral suppression maintains health and reduces the chances of transmission to uninfected sexual and drug partners. Undiagnosed HIV-positive individuals are more likely to transmit HIV to others, compared to individuals who know their HIV positive status. These health disparities are rooted in long-term inequities in American society: Barriers related to language, lack of health care, undocumented status and poverty all contribute to the challenges in accessing and maintaining Latinos in HIV treatment and care.

Never before was it imaginable that as a global community our prevention science could provide us with strong evidence that we can end HIV/AIDS. Reaching this goal is in part a question of setting priorities, focusing on most at-risk populations, and implementing evidence-informed prevention strategies. While the HIV epidemic has disproportionately impacted the Latino community in our country, an adequate response has been sorely lacking, and ending AIDS will be impossible if Latinos are not part of the solution.

Vincent Guilamo-Ramos, PhD, is a professor and co-director of the Center for Latino Adolescent and Family Health, Silver School of Social Work at New York University. Jane J. Lee is a research scientist with CLAFH.