At a JAMA media briefing during the international AIDS Conference, Professor H. Irene Hall, Ph.D., from the Centers for Disease Control and Prevention in Atlanta presented findings of a new characteristics study of HIV-positive US residents who were born outside the country, which demonstrated that in comparison to HIV positive individuals born in the U.S., Hispanics or Asians are more likely to have contracted the virus, whilst a higher percentage of HIV infections were due to heterosexual contact.

The study is published in the online edition of JAMA. and background information in the article states:

“Persons born outside the United States comprise approximately 13 percent of the total U.S. population and represent a varied group of people, including students, skilled workers, family members of U.S. citizens, undocumented migrants, naturalized citizens, and refugees. Although more than 95 percent of persons with HIV in the world live outside the United States, an understanding of HIV infection in persons born outside but living in the United States allows for both a new perspective on HIV in this country as well as a better understanding of the health status and health education needs of persons born outside the United States.”

The researchers add that language and cultural barriers can present a problem to people who were not born in the U.S. to learn about HIV prevention, access HIV testing, and obtain timely medical care.

The team obtained data from the National HIV Surveillance System to analyze various characteristics of U.S.-born and residents born outside the U.S., including demographic, geographic, and risk factor characteristics of those who were diagnosed with HIV whilst living in 46 U.S. states and 5 U.S. territories from 2007 through 2010. Naturalized citizens and those from U.S. territories were defined as being born outside the United States.

The researchers discovered that during the study period a total of 191,697 people were diagnosed with HIV of which 30,995 people or 16.2% were born outside the United States. California, Florida, New York, and Texas were the four states with the highest numbers of persons born outside the U.S. that were diagnosed with HIV and were found to be the states with the highest number of HIV cases overall. Most HIV cases were diagnosed in men, with 124,863 men or 77.7% of U.S.-born males compared with 22,773 or 73.5% of males born outside the U.S.

The researchers found that the percentage of HIV positive people born outside the U.S., in terms of race and ethnicity, varied by category.

Total number of HIV diagnoses in individuals born in the U.S by race/etnicity:

  • White HIV-positive individuals – 55,574
  • Black HIV-positive individuals – 86, 547
  • Hispanic HIV-positive individuals – 42,431
  • Asian HIV-positive individuals – 3,088

Number and percentage of HIV diagnoses in individuals born outside the U.S by race/ethnicity:

  • White HIV-positive individuals – 1,841 (3.3%)
  • Black HIV-positive individuals – 8,614 (10.0%)
  • Hispanic HIV-positive individuals– 17,913 (42.2%)
  • Asian HIV-positive individuals – 1,987 (64.3%)

The researchers observed that a total of 39.4% of HIV diagnoses in men and women born outside the United States were due to heterosexual contact compared to 27.2% of men and women who were born in the U.S, whilst most of the HIV diagnoses for both males born outside and in the U.S. were in men who had sexual contact with other men.

Evaluations by country or region revealed that from 25,255 HIV-positively diagnosed people, the most common region of birth was Central America, including Mexico with 10,343 individuals or 41%, followed by 5,418 people or 21.5% from the Caribbean, 3656 or 14.5% of Africans, 1,995 or 7.9% of Asians and 1,929 or 7.6% of South Americans.

The researchers highlight that the date of first entry into the U.S. is not collected on the HIV case report form, meaning that it is impossible to know whether the HIV infection occurred before or after the individual emigrated to the U.S.

The researchers conclude: “These findings demonstrate the diversity of the HIV-infected population born outside the United States, presenting many clinical and public health challenges.”

Written by Grace Rattue