San Antonio physicians are being alerted about a rapidly growing cluster of new HIV cases. These infections are being monitored by the Centers for Disease Control.
Stigma about homosexuality and AIDS in the Hispanic community may be part of the problem.
For Joey Garcia, life as a gay teenager in the Rio Grande Valley of Texas was never easy.
"I was 13 years-old when I revealed it to my parents that I was gay. They actually kicked me out of the house," he says.
And it wasn't just his family. Garcia said his lifestyle was often frowned upon by people in the traditional, sometimes macho, often religious Hispanic community.
"There's definitely a lot of stigma," Garcia say. "I see it all the time."
Garcia is 24 now. Four years ago, he attended a Pride event in San Antonio. They offered free HIV tests and so he got one. He'd done it before, and didn't think he had anything to worry about. When the result was positive, he was stunned.
"I ended up not practicing safe sex with one of my partners who was apparently cheating on me at the time," Garcia says. "I was in shock for a little bit. I didn't really know what to say."
Texas, along with California and New York, has the highest number of new cases in the country. In Texas, young Hispanic patients have it particularly rough.
"You are stigmatized because you are a minority. You might be stigmatized because you're gay. And then you're stigmatized again because you're living with HIV," says infectious disease specialist Dr. Barbara Taylor of UT Health San Antonio.
Taylor observed Garcia is part of a new generation of HIV patients cropping up in South Texas. Young, Hispanic men are showing up in HIV clinics in alarming numbers. And, she said, based on surveillance conducted by the CDC, San Antonio is a "hot spot" with a cluster of cases that are related, as in, the viruses are genetically similar.
The CDC has identified 16 clusters in Texas. Six of those are in San Antonio.
Taylor says one called Cluster 51 is in the cross hairs right now. "There are 27 confirmed cases of people who are carrying viruses that are definitely linked," she says.
That means the people in Cluster 51 may be connected in some way, part of a network of new transmission. That intel provides a starting point for intervention.
Concern about this spate of new cases sparked the Director of the San Antonio Metropolitan Health District to send out a letter to physicians this month. It includes a list of the kinds of patients who need testing and encourages doctors to prescribe the HIV prevention drug, known as PrEP or Truvada, to people at high risk.