A Comparison of the Relative Risks of Substance Abuse, Mental Health Conditions, and HIV Opportunistic Infections on Survival Between HIV Positive U.S. Born Hispanics and Foreign-Born Hispanics in Houston, Texas 1990 – 2001

Objective To examine the behavioral risk factors and survival profile of human immunodeficiency virus (HIV) infection of U.S. born Hispanics in comparison to Foreign-born Hispanics with respect to basic demographic characteristics in Houston, and factors associated with early mortality. Method We analyzed from the Adult and Adolescent Spectrum HIV Diseases Project (1990–2001) of a cohort of 876 patients of Hispanic origin. Incidence densities were calculated using first episode of mental health conditions and opportunistic diseases, and were expressed as incidence rate per 100 person-years. Patients who developed one condition were still considered at risk for other conditions. The statistical analysis was performed using Multivariate, Kaplan-Meier, Log Rank test, and Cox proportional regression analysis. Results There was significantly increased relative risks of substance abuse and mental health conditions among U.S. born Hispanics compared to Foreign-born Hispanics: substance abuse (RR=2.0, 95% [CI]:1.8–2.2); mental health conditions (RR=1.4, 95% [CI]:1.3–1.5). By Kaplan Meier analysis early death was associated with U.S. Born Hispanics (log rank test p = .0015). A Cox proportional regression analysis, in which gender, age, and social risk factors were introduced as controls, drug/alcohol abuse were shown to be predictors to a less favorable survival experience (Hazard Ratio [HR] = 1.3, 95% [CI] : 1.1 – 1.6). Conclusion The findings of this study lend support to other investigations which have suggested that factors such as acculturation, coupled with a loss of support systems, may explain a negative survival outcome for U.S. born Hispanics in comparison to those that are foreign-born.