Voluntary HIV Counseling and Testing for Latinos

Latinos make up only about 14% of the population of the United States and Puerto Rico,¹ but as of 2003 they were 20% of all people living with AIDS in the U.S. and accounted for 20% of new AIDS diagnoses.² Latinos are the largest ethnic minority in the U.S., and they come from very diverse backgrounds. This rich diversity also means that HIV risk factors vary, and prevention efforts must be tailored accordingly. For example, of AIDS cases diagnosed in 2003, the main transmission route for Puerto Ricans was injection drug use (39%) and (unprotected) heterosexual sex (39%), for Latinos born in Mexico it was male to male sex (61%) and for those born in Central and South America it was male to male sex (49%) and heterosexual sex (34%).²

Factors to Consider When Promoting and Providing HIV Prevention and Treatment

Language-Appropriate Education

The primary language for 72% of Latinos born outside the U.S. is Spanish, 35% of U.S. born Latinos are bilingual and less than 5% of Latino migrant farm workers report speaking English well.³ Language barriers are greater for individuals who speak languages other than Spanish or English, such as Brazilian immigrants and indigenous groups from Mexico and Guatemala.^3,4

Inadequate Medical Insurance and Care

Latinos are less likely to have health insurance than any other group in the U.S.⁴ Many Latinos work in industries where affordable health insurance is not provided, and many immigrants are excluded from federal safety net programs such as Medicaid.³ Also, many Latinos test late in their illness. According to the CDC, 43% of Latinos were diagnosed with AIDS within one year of testing HIV-positive.⁵

Immigration-Related Issues

Many immigrant men are at high risk for HIV infection as a result of an increased number of female and male sexual partners. In turn, this places their female partners at risk.⁴ According to studies, immigrants face poverty, racism, stigma, extended separation from family and low self-esteem. This can result in stress, depression and anxiety,³ Thereby increasing the prevalence of high risk behaviors and preventing them from seeking services. Economic needs also force some immigrants to exchange sex for money or food.

Cultural and Social Issues

Some Latinos may be reluctant to get tested for HIV and to seek care and treatment for fear of being deported, stigmatized³ or due to their beliefs about AIDS. A study of Latino men who have sex with men (MSM) found that poverty, homophobia and racism were highly correlated with risk taking behavior.³ Additionally, many MSM identify as heterosexual and may not relate to prevention messages directed towards self-identified gay men.¹ Also, some women, even if they suspect their partners of being at risk for HIV infection, may be reluctant to discuss condom use out of fear of emotional and/or physical abuse or the withdrawal of financial support.¹

Suggestions for Effective Services and Campaign Messages

• Provide culturally appropriate education about HIV transmission and living with HIV, and actively address myths.

• Offer services and materials in the language preferred by your target population.

• Incorporate positive cultural values in your services and messages, such as the importance of family unity, perseverance, spirituality, etc.

• Address relevant social issues such as HIV-related stigma, disclosure issues and homophobia.

• Some men who have sex with men identify as heterosexual or may not disclose this behavior. Make sure your services and messages are inclusive of various sexual identities.

• Some individuals don't test or return for results for fear that a positive result will damage their self-image and their family and social relationships.⁶ Counseling staff should be trained to address this issue.

• Encourage immigrants to seek anonymous rather than confidential testing, as an HIV-positive diagnosis can affect their immigration status. HIV-positive immigrants should always consult with an immigration attorney.

• Radio is a popular medium among Latinos and it may help reach migrant and immigrant groups.³

• As you design and implement services, collaborate with trusted agencies, schools, businesses, churches, etc.

• HIV testing and counseling programs should develop protocols to provide medical, mental and social service referrals specific to the populations they served, so as to create a continuum of care.

References

1. CDC, Fact sheet: HIV/AIDS Among Hispanics, November 2004.

2. CDC, HIV/AIDS Surveillance Report, Vol. 15, December 2004.

3. UNIDOS Network, AIDS and Migrants: Solutions and Recommendations, June 2004.

4. NASTAD, Addressing HIV/AIDS ... Latino Perspectives and Policy Recommendations, July 2003.

5. The Henry J. Kaiser Family Foundation, Key Facts: Latinos and HIV/AIDS, February 2005.

6. CDC, Best Practices in Prevention Services for Persons Living with HIV, December 2004.