Hector was working hard in class to please his immigrant parents when the 17-year-old was struck down with a fever.
Unable to keep food or liquids down, he spent two weeks on the couch of his family home in the Bronx. It took several doctors and numerous tests before blood work indicated he had HIV. His viral load had soared to near-fatal levels.
Exhausted, lying in a hospital bed, he simultaneously had to confront his diagnosis and the question of whether to tell his parents he was gay and sexually active.
“I thought: let me just die,’” Hector, who did not want his real name public, told the Guardian. “Let me just close my eyes and hear the beep.
“Then, when my mom came in, it was: let me jump out the window.”
There has been immense progress in curbing the HIV/Aids epidemic in the US, but clinicians fear Hector and Latino youngsters like him are being left behind.
HIV infections and new HIV diagnoses have been decreasing in the US overall, but for Latinos both are increasing, according to the Centers for Disease Control and Prevention (CDC). This increase is largely among gay and bisexual men who are under 30 in the country’s youngest and largest minority group.
“I call it the invisible epidemic,” Vincent Guilamo-Ramos, a clinician and researcher at New York University, explained over coffee at a Dominican restaurant in the Bronx, where he was raised.
The restaurant sits near Montefiore medical center, a hospital system home to America’s first adolescent-focused HIV/Aids center, where Hector and others like him get clinical care as well as social support to deal with the life-altering nature of the infection and the impact it has on families.
“These are major obstacles to ending the epidemic,” Guilamo-Ramos said. “And I think when all those things play out, they disproportionately impact people who are black, brown, poor, undocumented, new arrivals, Spanish-speaking.”
Donald Trump recently said he hoped to eradicate Aids in the next 10 years. In November 2018, the UK was on target to meet a UN goal of succeeding in diagnosing and effectively treating more than 90% of people with the virus. That same month, the New York governor, Andrew Cuomo, said the state was on track to meet its goal to end the Aids epidemic by the end of 2020.
But those goals fail to illustrate the different ways ways individual communities experience the epidemic.
In the US, the black, gay and bisexual male population has the highest risk of HIV infection. The next population with the highest risk is Latinos, and a particularly worrisome sign for that population is that infections are increasing among its young people.
Health interventions, like the HIV prevention drug Prep, are also not reaching these populations. Latinos are only 13% of Prep users while 73% of Prep users are white.
“Whatever strategy the Trump administration comes up with, it’s going to have to grapple with who in fact is disproportionately impacted by HIV/Aids: it’s brown and black, it’s disadvantaged,” said Guilamo-Ramos, who directs the Center for Latino Adolescent and Family Health (CLAFH) at NYU’s Silver School of Social Work.
These new HIV diagnoses among Latinos were concentrated primarily in Florida, Texas, California, Arizona, Illinois and Puerto Rico, according to the CDC.
They were also concentrated in the Bronx – even though young Latinos there do not show any less safe sexual behaviors than their non-Latino peers.
Compared to national averages, Bronx youngsters are less sexually active, have had fewer lifetime sexual partners and are more likely to have been tested for HIV, according to the CDC.
But compared with the four other New York City boroughs, the Bronx has the worst poverty, housing instability, life expectancy and exposure to community violence.
Guilamo-Ramos said it was as if there were two pools filled with sharks – one with many more sharks than the other.
In one pool, a person who swims across is less likely to get bitten, and if they do get bitten there is much more of a response from the community. In the other pool, not only is there a greater chance of someone being bitten by a shark, they also linger in the pool longer waiting for help.
Guilamo-Ramos is developing programs that show getting the community involved can go a long way towards helping people swimming in the shark-infested pool.
He has developed two programs for high-risk communities in the Bronx, Families Talking Together (FTT) and Fathers Raising Responsible Men (FRRM), which both rely on families to talk together about sexual health and to link healthcare to career, educational and social services.
“Young people want more from their parents than just ‘no’, [don’t have sex],” Guilamo-Ramos said.
That was true of Hector, who was born and raised in the Bronx by his Mexican family.
Hector, who is now 19, first heard about HIV/Aids in a health class at school, then never learned about it again. The only other time he would hear references to it was when LGBT people were shown on television – and his parents would make comments about how all “homos” were infected.
Despite the hateful rhetoric that had flowed through Hector’s home, when a doctor told him his sweating and fevers were caused by HIV and he would need a support system to help him through treatment, he was quick to allow the doctor to tell his mom what was going on.
She hadn’t known he was gay, and when Hector confirmed he was, she did not tell his father or anyone else in the family.
“Support for youth is essential because if you don’t have support your life is over – that’s how it felt for me,” he said.Hector, who has taken a break from university to deal with depression, is clear-headed about how his parents’ homophobia is their issue, not his. He has worked hard to educate them while also caring for himself and looking after his needs.
One point of hope for the Bronx: the US health department named it as one of 48 counties it is targeting in its plan to end HIV/Aids.
This good news comes after years of the Trump administration implementing policies that target both the LGBT and Latino communities. In the very same State of the Union speech in which Trump made the HIV/Aids announcement, he also spent a considerable amount of time railing against immigrants.
Guillermo Chacon, the president of the Latino Commission on Aids, said the Latino LGBT community was further stigmatized by these conflicting messages and by actions like the ban on transgender people serving in the military.
“It doesn’t help when at the highest level government, somebody said: ‘We don’t want any more trans in the army,’” Chacon said, in an interview at the Oasis Latino LGBTS Wellness Center in Manhattan. The center welcomes everyone (S is for straight) but specifically targets the Latino community.
Chacon continued: “The signal you send is that it’s OK to reject people who are different from you.”