Download Latinos/as and HIV/AIDS

Latinos and HIV/AIDS:
Deconstructing Risk Factors, Cultural
Norms, and Resiliency
Creciendo Juntos
HIV/AIDS Services Group
Virginia HIV/AIDS Resource Consultation Group
Thursday, November 13, 2008
Charlottesville, VA
PRESENTATION OUTLINE
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Introductions
Objectives
Epidemiologic profile
and survey data
Analyzing risk factors
Cultural norms that
oppress
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Structural racism as a
barrier to HIV
prevention
Resiliency for change
Community organizing
for health justice
LEARNING OBJECTIVES
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Upon completion of the session, participants will be
able to:
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Identify trends for HIV/AIDS rates within the Latino
community.
Understand risk taking behavior identified at a local level.
Determine the extent that culture, context, structural
barriers and resiliency impact risk taking behavior.
Discuss what can be organized locally.
NATIONAL TRENDS
HIV/AIDS EPIDEMIC
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Although Latinos/as represent approximately 15% of
the US population, they account for 19% of the
AIDS cases diagnosed in 2006 (CDC).
Latinos account for 17% of new HIV infections
(9,700 of 56,300 total new infections).
Among women, Latinas account for 16% of new
HIV infections and their HIV incidence rate is nearly
four times the rate for white women (CDC, 2008).
HIV/AIDS EPIDEMIC
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HIV was the sixth leading cause of death for
Latinos ages 25-44 in 2006.
In 2006, 54 percent of Latinos reported
having been tested for HIV, higher than the
overall population (45%) (Kaiser, 2006).
Latinos born in the US account for 34% of
estimated AIDS cases among Latinos in 2006,
followed by Latinos born in Puerto Rico
(17%) and Mexico (17%) (CDC, 2008).
HIV/AIDS TRENDS
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Estimated AIDS prevalence among Latinos is
clustered in a handful of states, with ten states
accounting for 90 percent of Latinos
estimated to be living with AIDS.
During the early 1990s, important new
advances were made in the treatment of the
HIV disease . The number of new AIDS cases
and deaths declined among all racial groups,
but not at the same rate.
HIV/AIDS TRENDS
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AIDS cases among Latinos declined by 56
percent between 1993 and 2001, compared to
a 73 percent decline among whites.
Estimated deaths among Latinos with AIDS
declined by 63 percent between 1993 and
2001 compared to an 80 percent drop for
whites.
HIV/AIDS TRENDS
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Studies indicate that Latinos may be more likely to
be tested for HIV late in their illness-that is, to be
diagnosed with AIDS at the time of their first HIV
test or to develop AIDS within one year of testing
positive (42%).
Nearly a quarter of Latinos named HIV as the most
urgent health problem facing the nation and many
believe (39%) that the US is making progress against
the epidemic (Kaiser, 2006).
HIV/AIDS TRENDS
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Of those who self-identified as HIV positive, nearly
half were unconnected to medical care.
Four main reasons given for not receiving medical
care, regardless of HIV status, were they can’t
afford care (27%), they do not need medical services
(17%), they can’t get transportation (6%), and not
knowing where to go (5%). (HCSUS, 2000).
Latinos with HIV/AIDS more likely to be uninsured
or be publicly insured (50% on Medicaid).
HIV/AIDS Epidemiologic
Profile Conclusions
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Diagnosed AIDS cases by year show a decreasing
trend for the last eight years.
The number of newly diagnosed HIV/AIDS cases
stayed the same for the last four years.
There is still a significant disparity among ethnic
groups related to class, access to health care, and
testing practices.
Women are playing a more important role in the
profile, although men still lead the epidemic.
LOCAL EPIDEMIC
RURAL REALITY:
A CASE STUDY IN VIRGINIA
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The Latino population tripled between 1990 and
2006.
Latinos represent 6% of the population but 8% of the
HIV/AIDS cases.
The rate of AIDS diagnosis was higher (30 in
100,000) than the national average (24 in 100,000).
Sixty-two percent of the reported HIV/AIDS Latino
cases are in Northern Virginia (VDH, 2006).
VCU STUDY
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Between 1999 to 2000, the Survey and Evaluation
Research Laboratory conducted a study on HIV and
AIDS with Latino men in rural areas of Virginia on
behalf of the HIV Community Planning Committee.
Collection of data occurred over 18 months with 291
Latino MSM living in rural areas.
Research team: S.L. Jarama, D. Kennamer, J. Honnold, S.
Kennedy, and J. Bradford.
VCU STUDY
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Most Latino MSM (85%) had at least
graduated from high school. About 30
percent had attended some college.
Despite the fairly high educational level of
this group, about half the sample earned less
than $1,500 per month.
About 77 percent of the sample had been
tested.
VCU STUDY
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Most Latino gay men who came out to a
parent experienced a negative reaction from
their mother (60%) and their father (64%).
Only 32 percent reported coming out to their
medical provider.
About seven out of ten of Latino MSM drank
alcohol during sex while one third used drugs
during sex.
VCU STUDY
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A significant proportion (43%) of the sample
did not know the HIV status of their last
sexual partner.
Condom use during anal sex with casual
partners is inconsistent among Latino MSM
(30% = never, or sometimes)
Many of the men tend to have multiple sexual
partners (62%) and reported machista
attitudes.
MACHISMO AS DETERMINANT
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The VCU study found a statistically
significant relationship between machismo
and HIV/STD sexual risk behaviors.
Latino MSM with high machismo values
were over five times more likely to engage in
HIV/STD sexual risk behaviors compared to
those with low machismo values.
In contrast, HIV/STD sexual risk behaviors
were not significantly associated with
acculturation, discrimination, or homophobia.
VCU STUDY CONCLUSIONS
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High machismo values are a significant risk
factor for HIV and STD sexual risk behaviors
in Latino MSM.
Culturally competent messaging and
appropriate skill building opportunities
addressing machismo values should be
incorporated into HIV and STD prevention
programs that target Latino MSM.
A COMPARISON
Nuestras Voces Study:
Study of gay and bisexual men in three urban
settings: Los Angeles, New York, and Miami
conducted by Rafael Diaz.
 Survey questions developed from focus groups
conducted with diverse MSM communities.
 Challenged theoretical assumptions about
individual behavior vs. socio-cultural factors.
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NATIONAL STUDY OF LATINO
GAY AND BISEXUAL MEN
Internalized Psychocultural Factors
Machismo
 Homophobia
 Family Loyalty
 Sexual Silence
 Poverty
 Racism
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Not personal deficits, rather logical outcomes of socialization process of
Latino gay and bisexual men.
Survey Participant Profile
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912 men recruited in 35
gay bars
309 (NYC), 302
(Miami), 301 (LA)
50% less than 30 years
of age
82% self-identified as
gay
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55% college educated
27% unemployed
73% immigrant descent
41% had Latino partners
19% HIV positive
Critical Thinking about Homophobia
Were you ever hit as a child for being thought
of as gay.
 As a child did you hear that being gay is
abnormal?
 As a gay man did you ever pretend to be
heterosexual?
 As a gay/bisexual man did you ever have to
separate yourself from your family?
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Survey Results: Homophobia Indicators
18% were hit as a child
 71% as children heard that gays remained
alone at old age
 91% heard that being gay is abnormal
 64% had to pretend to be heterosexual
 29% separated themselves from their families.
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Racism
Have you experienced discrimination in the
workplace?
 Have you felt sexually objectified?
 Have you experienced police brutality?
 Have you felt uncomfortable in gay white
environments?
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Survey Results: Racism Indicators
15% experienced workplace discrimination
 62% have felt like the target of sexual
objectification
 22% experienced police brutality
 26% have felt uncomfortable in gay white
environments.
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COMPARISON OF RESEARCH
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Both studies suggest culturally-bound
determinants that impact HIV/AIDS risk
taking behavior.
HIV prevention interventions should integrate
messages about racism and hegemonic
masculinity (machismo).
Interventions can’t be reduced to individual
behaviors alone without considering larger
social/cultural context.
DEVELOPING A HEALTH
JUSTICE MODEL FOR
HIV PREVENTION
DEFINING HEALTH JUSTICE
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Definition: Health justice is the
proactive reinforcement of policies,
practices, attitudes and actions (praxis)
that produce equitable power, access,
opportunities, treatment, impacts, and
outcomes for all.
Indicators: Equitable impacts and
outcomes across race is the key
indicator of health justice.
HEALTH INEQUITY
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Health is more than healthcare
Health is tied to the distribution of resources
Racism and hegemonic masculinity impose
an added health burden
Inequality—economic and political—is bad
for your health
Social policy is health policy
We all pay the price of poor health*
*Adapted from Office of Minority Health & Public Health Policy
DEFINING STRUCTURAL RACISM
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Structural racism is the US is the normalization and
legitimization of an array of dynamics—historical, cultural,
institutional, and interpersonal—that routinely advantage
dominant culture while producing cumulative and chronic
adverse outcomes for people of color.
It is a system of hierarchy and inequity, primarily
characterized by —the preferential treatment, privilege, and
power of dominant culture at the expense of Black, Latino,
Asian, Pacific Islander, Native American, Haitian, Arab, and
other racially oppressed people.
*Based on report by Aspen Institute
STRUCTURAL RACISM
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Indicators/Manifestations: The key indicators of
structural racism are inequalities in power, access,
opportunities, treatment, and policy impact and
outcomes, whether they are intentional or not.
Structural racism is more difficult to locate in a
particular institution because it involves the
reinforcing effects of multiple institutions and
cultural norms, past, and present, continually
reproducing old, and producing new forms of
racism.
STRUCTURAL RACISM
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Impact: Structural racism condemns millions
of people of color to poverty, inadequate
health care, substandard jobs, violence, and
other conditions of oppression.
Scope: Structural racism encompasses the
entire system of a dominant culture, diffused
and infused in all aspects of society, including
our history, culture, politics, economics, and
entire social fabric.
DIFFERENT LEVELS OF RACISM
Individual
Structural
MACRO LEVEL
MICRO LEVEL
Interpersonal
Institutional
Assets for Healthier Practices in
Latino MSM Communities
Family acceptance
 Social and sexual satisfaction
 Social interaction and political activism
 Having a positive gay role model as a young
person
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Sociocultural Predictors of High-Risk Situations
Significant Paths (standardized coefficients)
Resiliency
-.22
Poverty
.34
.27
Social Isolation
& Low
Self-Esteem
.24
Racism
.11
High-Risk
Situations
.18
.23
Homophobia
Test of Model Fit
x 2 = 0.24
p = .89
Variance Explained
Isolation/Self-Esteem, R = .29
Risky Situations, R = .16
WHAT CAN YOU DO?
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Challenge homophobia and HIV stigma that is based on
assumptions about hegemonic masculinity.
Promote a serostatus approach for HIV prevention with
linkages to peer lead interventions that shift power
through mobilization efforts.
Mobilize Latinos to understand intersections of
inequities in health, political, and social conditions.
Don’t only focus on disparities without addressing root
cause of racism and hegemonic masculinity.
Support community level and structural prevention
interventions that integrate elements of health justice
with economic opportunities.
EXPLORING ONE STRATEGY
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Implementing stigma reduction strategies
through social marketing strategies
AIDS-related stigma refers to prejudice,
discounting, discrediting, and discrimination
directed at people perceived to have AIDS or
HIV and at the individuals, groups, and
communities with which they are associated
CHALLENGING STIGMA
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Primary and secondary AIDS stigma
How do you distinguish between internalized and
externalized stigma for HIV prevention and care
services?
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Delays in testing and treatment
Adverse response to results
Media coverage
Abstinence only legislation
Blame behavior
Risk group discourse
CHALLENGING STIGMA
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Instrumental stigma is expressed through an
individual's concern about his or her risks of
contracting HIV through casual contact with
people living with HIV/AIDS.
Symbolic stigma is a vehicle for expressing
religious, political, or other attitudes and
values through one's perception of people
living with HIV/AIDS.
CHALLENGING STIGMA
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Social marketing efforts
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Do personal responsibility messages perpetuate
blame on people living with HIV/AIDS?
How do normalization messages impact a
public’s sense of compassion and exigency for
action?
Social marketing strategies
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Should name root cause
Tie into medical, employment, and housing rights
CLOSING THOUGHTS
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Create a mechanism for getting updates about
population and epidemic shifts
Plan for regular listening sessions with
community stakeholders
Consider health justice framework for HIV
intervention design
Challenge stigma as a means of achieving
health equity
THANK YOU FOR YOUR ATTENTION!
J. Carlos Velázquez, MA
MLAC Co-Chair
◊
Director of Multicultural Marketing
HMA Associates
[email protected]
(202) 342-0676