Why Are Hispanic/Latino Men 4 Times More Likely to Get HIV Than White Men?
Amid the coronavirus pandemic, the hope and promise for a healthier tomorrow might feel reminiscent of another virus — one that ravaged the LGBTQ community in the 1980s and beyond. But in the years since HIV transmission was at its height, has HIV/AIDS started to feel like a bygone disease despite a death toll that has soared over 32 million people worldwide? In the United States, it depends on who you ask. And if you're part of the Latinx community, the answer is complicated.
Toward the end of 2019, The New York Times trumpeted a promising headline: "New York Says End of AIDS Epidemic Is Near." The optimistic article sourced the Center for Disease Control (CDC)'s 2010-2016 findings, that rates of infection among gay and bisexual men have remained stable, and that, per Governor Andrew Cuomo, New York is on track to end the AIDS epidemic in the state by the end of 2020.
But while most demographics have experienced a trend-setting decrease in infection rates, the CDC noted that for Hispanic/Latino men, "the annual number of HIV infections in 2016, compared with 2010, increased," and that during those years, the infection rates for this demographic were "4.3 times that for white males."
With extensive and varied work, healthcare advocates and community leaders are spearheading efforts across the country to tackle HIV prevention and awareness for the Latinx community. But for many, it's still an uphill battle.
"I will say I'm proud to be there for them," says Danny Ochoa of his community. A gay man living with HIV, Ochoa is a Prevention Intervention Specialist in the Community Health Department at Gay Men's Health Crisis (GMHC). A leader in HIV/AIDS prevention, care and advocacy, GMHC's mission has evolved since its 1982 founding to recognize the importance of inclusion and diversity and has now become a haven for the urban queer Latinx populations. This resource can be just as vital as hospitals and medical centers.
BREAKING BARRIERS
"I believe that the biggest barrier for a healthy community is the stigma associated with HIV, followed by homophobia, transphobia and xenophobia," says Luciano Reberte, a gay man living with HIV and Program Director at the Latino Commission on AIDS in New York City. The reason Latinx populations have experienced an uptick in HIV infection rates, as Reberte sees it, is multifaceted. Other contributing factors include the "lack of access to medical insurance for the immigrant community and prevention services, limited access to mental health services, communication and language barriers, housing, among many others," suggests Reberte. "We need to address the impact of social determinants of health."
The healthcare gap ripples throughout minority communities. Combine two underserved groups such as LGBTQ and Latinx and the issues compound. Advocates must be adept at understanding how to reach those in need.
"A lot plays into this reality; it's socioeconomics," says Eric Holzapfel, Deputy Director at Entre Hermanos. As Seattle's leading organization that promotes health and well-being in the LGBTQ Latinx community, Entre Hermanos has been strategically analyzing ways to bridge the gap in health disparity among Latinx populations in a city where Latinos make up 6.6percent of the population but almost 15 percent of its HIV cases.
"We try and inform our outreach methods through research. What are the dating apps that young people are using? What radio station should we be on? We get that information through in-depth interviews and focus groups to make sure we are staying current," says Holzapfel, who then uses that data to reach content consumers that span generations. "La GranD [99.3] is the only Spanish FM station in western Washington, so it's an important outreach tool — we have a hour-long program on Sundays. Similar to dating apps, they charge a fee. We make investments in those tools to carry out our work."
"We've been working for many years on prevention at Entre Hermanos — we hand out condom kits, information about where to get testing and also how to correctly use a condom, where to get PrEP," says Martha Zuniga, Entre Hermanos' Prevention and Care Program Manager.
But working within the confines of larger systems can make for seemingly insurmountable obstacles. "The most important thing is lack of access to the healthcare system," Zuniga adds. "There's an increase in infection, and we can see it in the testing." At the same time, Zuniga notes, "People who have to work two or three shifts or jobs on the same day don't have time to see a doctor."
A TEXAS CASE STUDY
Even if Latinx people do have time to seek medical help, concerns may multiply once inside the doctor's office. "It's very hard for the Latino community to go to official spaces, the HRA [Human Resources Administration], in general," says Ochoa. Medical facilities require identification, which may be unsettling for undocumented patients. Also, forms are often only offered in English. In such instances, access and fear render many Latinos unwilling to seek professional help.
"Urban areas like Dallas have had this [infection] increase; I think language has a lot to do with it," says JP Cano, the Prevention Services Manager at Resource Center, a Dallas-based nonprofit that builds community among LGBTQ people and those with HIV. Cano has been with Resource Center for 11 years and understands how its location affects its culture and those it serves. "We live in a part of the south, close to Mexico, so we have a lot of immigrants," he says. "They don't speak the language; they don't have access to a lot of information others will have as quickly." The data confirms Ochoa's observations. According to the Texas Department of Health Services, male and Hispanic Texans are most likely to test late in their HIV infection.
Commonly searched online HIV/AIDS resources — websites like healthline.com or WebMD — do not provide Spanish language content. It is an essential part of Resource Center's work that materials be offered in Spanish, especially in a city like Dallas, where Cano estimates that among those who get tested at Resource Center, "probably 35 to 40 percent" are Hispanic/Latino. "We also provide outreach in bars and bathhouses, and we get a lot of visitors from outside of Dallas for that," he adds.
Entre Hermanos distributes Spanish-language materials at local restaurants and bars, and Resource Center ensures that Spanish is used in digital spheres as well. "We do ads on dating apps like Grindr and Scruff," Cano says, adding that content information is limited, but keywords like "testing," "PrEP," and the phone number and website are included. "We always add 'Se habla espa�ol.' We continue with an effort to provide Spanish ads, but the budget can be limited."
With a 44 percent increase in people living with HIV in Dallas County since 2008, organizations like Resource Center must continue to reach those at risk.
LOCAL ORGANIZATIONS TAKE THE LEAD
The CDC figures note, "among all Hispanics/Latinos; males accounted for 89.5 percent of HIV infections, most of which (88.3 percent) were attributed to male-to-male sexual contact." The collected data ends in 2016, just before Donald Trump took office. As a new period of research begins, those within and who advocate for the Latinx community fear that the country's current administration might signal more severe statistics.
"We're not getting any favors from the hate rhetoric from the Trump administration or ICE raids or fear-sewing," Holzapfel says. "That doesn't help us in encouraging people to be out and comfortable but also seek care whenever they feel necessary."
"There's a lot of people who don't want to get medical assistance because of the Public Charge issue," Zuniga says, referencing the 2019 rule that restricts certain immigrants from obtaining Green Cards. The controversial basis for that rule is that immigrants may require more public services to keep their lives afloat.
"Of course, this rule comes at a time of relentless hardship for immigrant families in the U.S. as a result of policies put forth by this Administration that harms their health and safety," stated Mark Del Monte, CEO and Executive Vice President of the American Academy of Pediatrics in an interview with Salud America!
These concerns have not stopped groups from mobilizing; some organizations in smaller cities are enhancing their Latinx outreach.
"At Charlotte Pride, we had noticed there was no organization in our city doing specific or dedicated outreach or services for LGBTQ Latinx people," says Matt Comer, the Communications Director of North Carolina's Charlotte Pride. "Charlotte Latinx Pride is one of our first community programs outside of our annual festival and parade. It was begun several years ago to begin providing outreach opportunities for the LGBTQ Latinx community in Charlotte."
In New York, the Latino Commission Against AIDS is buzzing with activity. "The largest social messaging campaign that we have is National Latinx AIDS Awareness Day," says vice president and director of health policy and advocacy Luis Scaccabarrozzi. "Many believe that this is a government-developed campaign, but it is a homegrown initiative."
Other programs that stretch beyond or enrich the New York and LGBTQ communities include the Latino Religious Leadership Program and Poder Latino, "the longest-running and largest Latino HIV-positive informational group in New York City," says Scaccabarrozzi.
Their work extends regionally as well. Jos� A. Romero is living with HIV and works in Durham, North Carolina, with Latinos in the South. "It's not hard to travel in the South and be in a resource-impoverished area," Romero notes.
And even when folks can find resources, they still might be turned away. "Lots of hospitals are far from where the need is," Romero says, adding "many in the South practice religious and moral exemptions. A hospital does not need to provide sexual health care if a provider is Christian. It creates unnecessary barriers to care."
Latino Commission on AIDS is also pivoting its actions during this COVID period. "At this moment, we're developing other efforts around telehealth and tele-consult," Scaccabarrozzi says as the organization looks into "virtual programming and exploring the possibility of doing more than on-site testing."
Entre Hermanos is similarly adjusting to these social-distancing times. "Due to the special circumstances, now we are sending condoms by mail," Zuniga says. "We also are doing HIV and STI testing by appointment at the office."
A SENSE OF COMMUNITY
Without a support system, mentors or resources, many in the LGBTQ Latinx community may feel they're swimming against the current.
"In the United States, we are a minority of a minority of a minority," Ochoa says, explaining how being an immigrant compounded with being sexually outside the norm can make assimilation and acceptance even more difficult.
It doesn't help that some religious institutions shun those seeking fellowship. Fifty-five percent of the U.S. Latinx population identifies as Catholic, and the Catholic church has been slow to welcome the queer community.
Jomil Luna, a gay man living with HIV in New Jersey, has noticed this faith-based ostracizing. "Sometimes people do not seek resources due to lack of knowledge, lack of support, fear of ridicule or abandonment from their family or religious communities," he said.
"There are two persons, besides the parents, who have the same importance: the doctor and the priest, so yes, when a priest says, '[HIV] is a punishment because what they are doing is a sin because of his sexual orientation,' the stigma will be forever," Zuniga says.
As such, it is vital to foster welcoming havens. "We must continue to advocate, educate, and motive others to learn more," Luna says.
"I've been with Entre Hermanos for the last 15 years, and the community knows me," Zuniga adds. "We've been creating this big family they trust, and they want to just talk to someone who knows them for a long time or short time, and they can recommend us to their friends."
This sense of outreach and trust, community and service — and the ability to financially support these critical efforts — have the most significant impact on sexual education and health.
"The one piece that will need to shift to tackle these stubborn numbers is deeper investments into the Latinx community around prevention and support," says Holzapfel. "We know that once they get plugged into our services or get on PrEP or medical case management, the results are a 180, so it's just that question of how much engagement can we do and how many clients can we serve? Once they're through the door, the success is in the numbers."