Questions 4 & 5

QUESTION 4: How can we increase the rates of HIV testing in the Latino community?

At the Institute for Latinx Health Equity, we approach this question using the “3 As” model.* We ask, “are services Available, Accessible, and Acceptable?”.   I also think a few mini-“a’s” are embedded but very important in the model – awareness (the foundation: knowledge is power!), advocacy (for ourselves, for those we care about, and for our communities), and adherence ( a personal commitment to keeping yourself informed and healthy, in which ever way that works best for you, and your family or loved ones, if you so choose).

QUESTION 5: What’s one thing you wish every Latino knew about HIV/AIDS? 

A few things I wish everybody knew – HIV is very HUMAN– By that, I mean that it is not something that happens to someone because they are “bad” or “deviant” or “dirty”.  It does not happen because individuals or their communities are “careless.”

It is also easily preventable on an individual level, and we are at an age where more and more tools can be used for prevention (such as PrEP, along with condoms, viral suppression, etc.) so that people can decide what is best for oneself.

Finally, HIV/AIDS is treatable – and NOT A DEATH SENTENCE.  With advances in treatment, people with HIV are less likely to transmit the virus to others if the HIV-positive person is taking medication as prescribed, and can live longer, healthier, and have a higher quality of life.  These all ultimately work together for the benefit of the community as a whole.

*Reference: Blankenship KM, Bray SJ, Merson MH.  Structural interventions in public health.  AIDS. 2000 Jun;14 Suppl 1:S11-21.


Questions 2 & 3

QUESTION 2: Do you believe the Latino community faces added difficulties because of language barriers, cultural taboos, or immigration issues? 

Accessible and affordable quality health care services (including sexual and reproductive health, mental health, and primary care services) and education, as well as having culturally-responsive systems of care would go a long way in addressing HIV in Latino communities.

QUESTION 3: What are some of the greatest barriers to identifying and treating HIV/AIDS in the Latino community? 

The greatest barriers in identifying and treating HIV/AIDS in the Latino community are found at the broader social and structural levels of society.  The “basics” are key – having health insurance & being able to access quality health care services that are culturally-responsive in a timely manner.  Stigma and discrimination also play a role – at both the individual and community level.  But stigma and discrimination are also perpetrated by health care providers, educators, law-enforcement officials, and policy-makers.

QUESTION 1: Why are HIV infection rates particularly high among Latinos, particularly Latino males?

It is important to establish a few key elements first – how is HIV transmitted?   HIV is transmitted through blood, semen, and vaginal fluids, as well as from mother to infant (perinatal transmission) via birth or breastfeeding.  “Risky behaviors” include anal, vaginal, and oral sex, and injection substance use.  Things that can be done to reduce the risk of transmission include – using condoms, using pre-exposure prophylaxis (PrEP), suppressing viral load (if HIV positive), knowing your HIV status, getting screening and treatment for  sexually-transmitted infections (STIs), and using sterile injection tools (needles, etc.).   Notice that I did not mention anything as far as gender identity, sexual orientation, or race/ethnicity.

Now to your question: “why are HIV infection rates particularly high among Latinos, particularly Latino males?”   HIV as a virus is transmitted as I said above, and can be prevented as I said above.  Your question, however, points to a health disparity (i.e. certain populations, such as Latino males, experience a disproportionate burden of poor health).  Disparities in HIV (and many other health outcomes) are based on structural inequalities in our society – such as poverty, racism/discrimination, and limited (or lack of) access to quality health care services, educational opportunities, sustainable employment, and housing.  HIV infection rates are disproportionately higher among certain populations.  This is due in part to the fact that, in general, individuals have sex with other individuals in their social networks.  Thus, someone might be at higher risk for HIV in a certain population simply because the prevalence of HIV in that particular network is higher than in other networks.  However, the prevalence was fueled by inequities in the society.

The HIV infection rates among young Latino men who have sex with men (MSM) are disproportionately higher in the United States and territories compared to non-white Hispanic males, as it is for Latinos and Latinas via heterosexual contact. For example: Hispanics/Latinos represent about 17% of the US population, yet accounted for approximately 23% of HIV infections among adults and adolescents in 2013 (Census, 2012; CDC, 2015).

In the US, the leading transmission category for HIV diagnosis among Hispanics/Latinos in 2013 was male-to-male sexual contact, accounting for 72% (7,812) including male-to-male sexual contact and injection drug use (3%; 285). The second highest transmission category was attributed to heterosexual contact among Hispanic/Latino males and females (21%; 2,238). The estimated rate (per 100,000) of HIV infections among Hispanic/Latino males was three times greater (41.8) than for white, non-Hispanic males (13.8) and almost four times greater for Hispanic/Latino females (7.0) than for white, non-Hispanic females (1.8) in 2013 (CDC, 2015).

Next up:

QUESTION 2: Do you believe the Latino community faces added difficulties because of language barriers, cultural taboos, or immigration issues?

–Gabriela S. Betancourt