As World AIDS Day is marked to raise awareness of the global pandemic, Hispanic and Latino communities in the U.S. are in the midst of what one expert described to Newsweek as an "invisible" HIV crisis.
在纪念世界艾滋病日以提高人们对这一全球性流行病的认识之际，西裔和拉丁裔社区正陷入某位专家在《新闻周刊》中所描述的 “隐性” 艾滋病毒危机之中。
Since the virus was identified in 1984, thanks to the tireless efforts of researchers and campaigners, HIV has gone from a mysterious killer to a condition which can easily be stopped from spreading with a few pills. From a peak of 41,699 in 1995, deaths from HIV/AIDS in the U.S. plummeted to 6,456 in 2016. The estimated number of new infections has fallen by 6 percent since 2010, while overall annual new HIV diagnoses in the U.S. dropping by 4 percent between 2012 and 2016.
Earlier this year, President Donald Trump appeared to find such optimism in the condition's decline that he pledged to contain HIV transmission in the U.S. by 2030, after there were 38,700 new infections in 2017.
But among the 58-million-person-strong Hispanic and Latino population in the U.S., the number of people newly infected with the virus spiked by at least an estimated 14 percent between 2010 and 2016, and the rates of new diagnoses climbed by 7 percent between 2012 and 2016.
Marchers on a Gay Pride parade through Manhattan, New York City, carry a banner which reads 'A.I.D.S.: We need research, not hysteria!', June 1983. Barbara Alper/Getty
在纽约曼哈顿举行的同性恋大游/行中，游/行者们举着一面写着 “ 认真研究A.I.D.S.（艾滋病），不要歇斯底里 ！” 的横幅。图片来源：芭芭拉·阿尔伯提供/Getty图片社，一九八三年六月。
According to data cited in an article published last month in the American Journal of Public Health, HIV is responsible for "microepidemics" in Hispanic and Latino communities across all regions of the U.S., with California, Texas, Florida, New York and Puerto Rico accounting for two thirds of this population's new HIV diagnoses in 2016
根据《美国公共卫生杂志》(American Journal of Public Health)上月刊登的某篇文章中引用的数据，艾滋病毒是造成全美所有西裔及拉丁裔社区 “疫情蔓延” 的罪魁祸首2016年，美国加州、德克萨斯州、佛罗里达州、纽约和波多黎各的新增艾滋病毒感染者占美国总人口的三分之二。
Overall, the hardest hit are young, Hipsanic and Latino men who have sex with men, as well as transgender Latina women, and new arrivals to the U.S., according to the authors of the commentary. Professor Vincent Guilamo-Ramos of New York University's Center for Latino Adolescent and Family Health, who co-wrote the commentary, told Newsweek, that while rates of diagnoses and new infections among heterosexual Latinx and Latina females have decreased, estimated new HIV infections have "increased rapidly" among Latinx men who have sex with men.
据几位作者的评论来看，整体受影响最严重的人群集中在年轻人、嬉皮士和与男性发生性关系的拉丁裔男性，以及跨性别的拉丁裔女性，以及刚到美国的新移民。来自纽约大学拉丁裔青少年和家庭健康中心的文森特·吉拉莫-拉莫斯教授也参与撰写了该篇评论，他告诉《新闻周刊》，尽管拉丁裔异性恋者和拉丁裔女性的诊断率和新感染率有所下降，但据估计，在与男性发生性行为的拉丁裔男性中新增艾滋病毒携带者人数 “ 迅速增加 ”。
Around 80 per cent of new HIV cases among the Hispanic and Latino population involve men who have sex with men. In this group, the estimated number of new HIV infections each year has spiked by 30 percent since 2010, and by 68 for those aged between 25 and 34-years-old.
Meanwhile, it is thought one in four transgender Latinas is HIV positive, but the lack of information on this group is stark. As transgender folk have not been a primary focus of research and public health surveillance efforts, the little data available puts estimates of HIV prevalence at between 8 to 60 percent, said Guilamo-Ramos.
As for those born outside the U.S., they made up at least one in three new HIV diagnoses in Hispanic and Latino communities in 2017. Guilamo-Ramos stressed it is thought the majority of these people caught the virus after arriving in the U.S..
"These trends are very alarming and a strong public health response is sorely needed," said Guilamo-Ramos, who has devoted his career to preventing and improving the treatment of HIV/AIDS among Latino and African American youth, among other things.
毕生致力于预防和改善拉丁裔和非洲裔美国青年艾滋病患者的治疗及其他工作的吉拉莫-拉莫斯说， “ 该疾病的发展趋势令人倍感担忧，必须立即实施强有力的公共卫生应对措施加以遏制。”
The authors of the commentary suggested the president's aim to tackle transmission by the end of the next decade is misaligned with his other policies. The Trump administration's "restrictive policies on civil liberties, particularly for immigrants and sexual—and gender-identity minorities, erode access to health and social services for key populations affected by the Hispanic/Latino HIV epidemic and do not align with the declared targets to reduce HIV prevention and treatment disparities," they wrote.
这篇评论的作者认为，该总统所设定的在未来十年末解决病毒传播问题的目标与其推行的其他政策相冲突。具体来说，特朗普政府 “ 限制公民，尤其是移民者和性别认同少数群体的自由 ” 不仅导致受西裔/拉丁裔艾滋病毒流行影响的关键人群获得卫生和社会服务的机会减少，而且与其公开呼吁减少艾滋病毒预防和治疗差异的目标相悖。
There is no simple answer to this complex issue, said Guilamo-Ramos. Hispanic and Latino communities face a lack of access to healthcare, with only 45 percent of those aged 19 to 64 fully insured in 2018 according to the Commonwealth Fund. And the help available isn't always culturally or linguistically appropriate.
吉拉莫-拉莫斯说： “ 这个问题太过复杂，以至于目前还无法给出简单的答案。根据联邦基金 ( Commonwealth Fund ) 的数据，西裔和拉丁裔社区存在缺乏医疗保障的问题，2018年，在19岁至64岁的人群中，只有45%的人拿到全额保险。此外该机构所提供的援助受文化或语言差异的影响有时反而适得其反。
New arrivals, for instance, often face significant access obstacles to health and social services, such as lack of health insurance, language barriers, poverty, and immigration status. Trans people may be put off from seeking help, fearing doctors may not be trained to be sensitive to their gender identities.
As a result, worrying patterns emerge. More than half of Latinx people in the U.S. have never been tested for HIV, according to Guilamo-Ramos, eventhough current federal guidelines recommend annual testing as part of routine primary care. And Latinx people account for approximately 25 percent of new HIV infections, but making up only for 13 percent of Pre-Exposure Prophylaxis (PrEP) users, he added. If taken as prescribed, the once daily pill is effective in preventing HIV infections.
结果，令人担忧的情况出现了。据吉拉莫-拉莫斯说，美国有一半以上的拉丁裔人从未接受过艾滋病毒检测，尽管目前的联邦指导方针建议将年度检测作为日常初级保健的一部分。他补充说，艾滋病毒新感染人群中拉丁裔约占25%，而他们中接受暴露前预防治疗 ( PrEP ) 的感染者仅占服用该药物总人数的13%。如果按照医嘱每日服用一次，这种药片可以有效预防艾滋病毒感染。
A stock image shows PrEP pills, a once daily pill that prevents HIV. Getty
When individuals are diagnosed, they're not always getting the right treatment, or taking drugs which prevent the virus being passed on, in what is known as viral suppression.
Among Latinx folk estimated to be living with HIV, more than one in three are not receiving care, and less than half achieve viral suppression, said Guilamo-Ramos. "Of those that do in fact achieve viral suppression, maintaining sustained viral suppression—continuous viral suppression through ongoing uptake of HIV treatment—is challenging."
吉拉莫-拉莫斯说，据估计，携带艾滋病毒的拉丁裔人中，超过三分之一的人没有得到治疗，成功实现病毒抑制的患者不到一半。 “ 对于那些确实具备病毒抑制功能的药物来说，维持持续性药效，也就是通过持续接受艾滋病毒治疗以达到抑制病毒的长期效果——是一项具有挑战性的任务。”
"Take PrEP in New York City for example," he said. The latest data from the NYC Department of Health and Mental Hygiene showed the number of annual HIV diagnoses among Latinx has decreased by 10 percent from 2017 to 2018 "which is an impressive achievement," he said. But at the same time, the decrease among white people has been over 30 percent in only one year.
“ 以纽约市接受暴露前预防治疗的情况为例，” 他说。纽约市卫生和心理卫生部的最新数据显示，2018年被诊断出感染艾滋病毒的人数较2017年下降了10%， “ 这一成就令人印象深刻， ” 他说。但与此同时，在仅仅一年内，白人的艾滋病感染率直接减少了30%。
"This disparity can in large part be explained by who is using PrEP. Latinx account for about three times as many new HIV diagnoses in NYC than Whites, but there are about four times as many Whites on PrEP than Latinx. If we do not manage to understand how we can make these tools accessible in an equal way, we are inadvertently exacerbating disparities," Guilamo-Ramos said.
“ 这种差异在很大程度上可以归因于PrEP治疗的接受者。在纽约市，拉丁裔人群中感染艾滋病毒的人数是白人的三倍，但接受PrEP治疗的拉丁裔人数只占同类白人的四分之一。 ” 如果不能就如何确保全美在获取治疗服务上的平等机会达成共识，那么我们实际在无意中加剧了这种不平等现象，” 吉拉莫-拉莫斯说。
He added: "More interventions that are designed specifically for the needs of Latinx populations at greatest risk of HIV are sorely needed."
"The reasons for using or not being on PrEP may be very different among adu/lt urban white men who have sex with men (MSM) than among recently immigrated young Latinx MSM living along the U.S.-Mexico border. Therefore, an intervention designed and tested with one population may not work as intended with another. There has been a tendency to apply interventions developed and tested for non-Latinx to Latinx populations."
Compounding these factors is a stigma towards the virus present across American society, which renders the Hispanic/Latino HIV Crisis "largely invisible," Guilamo-Ramos said.
吉拉莫-拉莫斯说，导致这些因素趋于复杂化的根源是美国社会对于该病毒的耻辱感，正是这种耻辱感，西裔和拉丁裔所面临的艾滋病毒危机才得以 “ 成功隐藏 ”。
"Frequently, Latinx at risk and living with HIV experience stigma and discrimination linked to intersectional marginalized identities, including homo-/transphobia, racism/xenophobia, HIV-related stigma, as well as social exclusion and lack of opportunity due to limited socioeconomic status," he said.
他说： “ 感染艾滋病毒的拉丁裔高危人群和艾滋病毒携带者经常由于边缘化交叉身份的相关因素而受到羞辱和歧视，包括对同性恋/跨性别者的恐惧、种族主义/仇外心理、以艾滋病毒为耻的心理，以及社会排斥和由于社会经济地位低下而缺乏机会。”
But Guilamo-Ramos has hope the situation can improve. First, more research on the underlying drivers of increasing HIV infections among Latinx in the United States is desperately needed, focusing in particular on understanding why tools to prevent and treat the virus do not adequately reach those in greatest need, he said. The methods designed to confront HIV which emerge must then be made culturally and linguistically appropriate.
Guilamo-Ramos, who has worked for two decades on understanding how families can help combat the spread of HIV, knows individuals outside of the traditional healthcare setting can play a vital part. Programs he has developed include the Families Talking Together and Fathers Raising Responsible Men, both supported by the Department of Health.
"We try to give parents the tools they need to effectively communicate with their adolescents about important issues such as becoming sexually active, using condoms and contraception, and seeking out sexual and reproductive health services," he said.
Moving forward, Guilamo-Ramos hopes the American Journal of Public Health article will inform the national responsse to an "important public health emergency by accelerating the roll out of existing tools for HIV prevention and treatment in Latinx communities" and by better aligning health and social service systems with the unique needs of Hispanc and Latino populations in greatest need of effective HIV prevention and treatment.