Foreign- and U.S.-Born Individuals with HIV Have Different Demographic and Risk Profiles

D. Hollander

First published online:

| DOI: https://doi.org/10.1363/4427312

In 46 states and five territories that have well‐established HIV surveillance, 16% of new diagnoses in 2007–2010 were in individuals born outside the United States, and these individuals differed significantly from their U.S.‐born counterparts.1 Notably, higher proportions of the former than of the latter were Hispanic or Asian, and acquired HIV through heterosexual contact. Of the more than 30,000 persons from outside the United States who received an HIV diagnosis during the study period, the largest number (roughly 7,000) came from Mexico, which is the country of origin of the largest number of immigrants in the country.

Reports of HIV diagnoses, including data on infected individuals’ demographic and clinical characteristics, are routinely collected by state and local health departments, which in turn send them to the Centers for Disease Control and Prevention (CDC). Analysts used data from states and territories that had been reporting HIV diagnoses to the CDC for at least four years to examine the demographic and risk profiles of infected individuals who were born outside the United States. They imputed missing values on key variables, and used chi‐square tests to compare data on this population and U.S.‐born infected individuals.

In all, 191,697 cases of HIV were reported to the CDC during the study period—30,995 (16%) of them among foreign‐born persons. The four states that reported the largest numbers of legal immigrants in 2007–2010 (California, Florida, New York and Texas) also reported the largest numbers of HIV diagnoses.

The majority of both foreign‐ and U.S.‐born individuals who received diagnoses were male; the proportion differed modestly but significantly between the two groups (77% vs. 74%). More substantial differences were apparent by race and ethnicity: Some 58% of those born outside the United States were Hispanic, and 28% were black; by comparison, these proportions were 15% and 49%, respectively, among those who were U.S.‐born. Foreign‐born individuals made up 3% of whites who received a diagnosis, but substantially higher proportions of blacks (10%), Hispanics (42%) and Asians (64%). On average, both foreign‐ and U.S.‐born individuals were about 37 years old at the time of diagnosis.

In 39% of cases, HIV diagnoses among foreign‐born persons were attributable to heterosexual contact; the proportion was 27% among those born in the United States. Seventy‐one percent of foreign‐born infected males acquired HIV through sexual contact with a male, and 21% acquired infection through heterosexual contact, compared with 75% and 12%, respectively, of U.S.‐born males. Among women, 92% of infections in the foreign‐born population, and 81% in the U.S.‐born population, were attributable to heterosexual contact.

Foreign‐born infected individuals came from 186 countries; the largest numbers were from Mexico (7,311), Haiti (2,140), Cuba (988), El Salvador (908) and the Dominican Republic (898). By world region, Central America topped the list (accounting for 41% of foreign‐born persons who received an HIV diagnosis), followed by the Caribbean (22%), Africa (15%), Asia (8%) and South America (8%); a variety of other regions accounted for small proportions of this population. Mode of HIV transmission differed considerably by foreign‐born individuals’ region of birth. For example, two‐thirds or more of those from Asia, Central America and South America were men who have sex with men, compared with one‐third of those from the Caribbean and fewer than one in five of those born in Africa. Women who were infected by a male partner made up about half of infected individuals who were born in Africa and one in five of those from Asia.

The analysts point out that their study is limited because the data lack information from states with high levels of infection and large immigrant populations (Maryland and Massachusetts), and do not permit assessment of when and where individuals became infected. At the same time, they note that foreign‐born persons living in the United States comprise "multiple groups with different demographic characteristics, community networks, resources, and patterns of risk behaviors." They conclude that their findings underscore the "many clinical and public health challenges" of the diverse population of immigrants infected with HIV.—D. Hollander