Socio-cultural factors that affect HIV prevention among Latinas

October 15th is National Latino AIDS Awareness Day (NLAAD). This day gives us theperfect opportunity to talk about HIV and encourage HIV testing within the Latino community. According to the U.S. Centers for Disease Control and Prevention (CDC), Latinos represent only 15% of the total U.S. population but account for 18% of all new HIV infections. Among the Latino community, men make up the vast majority of new HIV infections (76%) which mayincrease the rate of HIV among Latinas. Seventy percent of Latinas living withHIV/AIDS were infected through heterosexual contact. Could one of your Latina clients be one of them?

This month, we encourage you to reach out to Latina clients and provide them with more information about the HIV/AIDS epidemic. Bring up HIV testing as part of routine healthcare visits in order to normalize the topic and remove the stigma that is often associated with it.

Risk factors and barriers to keep in mind:

A number of cultural, socioeconomic, and health-related factors contribute to the HIV epidemic among Latinas. Depending on their age, education and background, Latinas face barriers that prevent them from getting tested. Some of these barriers include:.

• Sex and sexuality are taboo. Most Latino families do not talk about sex openly. As a result, sex is not a topic women feel they can bring up and discuss, even with a healthcare provider, Some Latinas believe that they should not know about or talk to men about sex because it suggests promiscuity. Latinas are more likely to ask a trusted female friend about sex than a relative, but may still be embarrassed to ask direct or specific questions about sexually transmitted infections.
• Stigma. Many Latinos believe the myth that HIV only affects people who commit acts considered to be immoral such as promiscuity, prostitution and homosexuality. As a result, Latinas who consider themselves to be in monogamous, socially accepted relationships, will not consider that they are at risk for infection.
• Machismo/Marianismo. Traditionally Latina women are expected to be submissive, pure, sexually naïve and not question male authority. This tradition creates a huge obstacle for Latinas and prevents them from questioning their partners about past sexual history and negotiating safer sex, including condom use. Asking a partner to use a condom could be interpreted by the partner as the woman being unfaithful or it could suggest a lack of respect of her partner by questioning his actions. The fear of violence as a result of requesting condom use makes it even more difficult for women to ask for this protection.
• Fatalism. This refers to a belief in Latino culture that life’s course is set and one cannot do anything to alter this course. Not all Latinos believe this, but for those who do, it can be a barrier to getting tested or using protection.
• Incomplete information about HIV/AIDS. National and state campaigns about HIV/AIDS are raising awareness about this epidemic; however, many Latinas still do not have all the facts. A study by the National Council of La Raza found that Latinos did not recall campaigns targeted to their community. In small focus groups organized in the Triangle by the North Carolina Healthy Start Foundation, many participants believed that HIV and AIDS were the same. They did not make a distinction between the virus and the disease. A result of this confusion is that Latinas think that if you have HIV you will die soon and ignore the fact that with appropriate treatment a person can live with HIV without developing AIDS.
  Women in the focus groups also shared misinformation about how HIV is transmitted. Kissing a person with HIV was mentioned as one way a person could become infected. Other misconceptions revolved around the appearance of someone who has HIV. Participants shared that if someone looks healthy, well dressed and attractive then they are unlikely to be infected.
• Lack of health insurance. More than 60% of Latinas in North Carolina lack health insurance. Latinas may avoid testing if they think the test will cost money and they cannot afford it or if they are unsure about the cost of treatment if they are HIV-positive.
• Immigration status. The fear of deportation for undocumented immigrants can prevent Latinas from seeking services, including HIV counseling and testing. Testing is not related to immigration status.
• Confidentiality. Using an interpreter to discuss the topic of HIV, provide counseling or give test results, can be worrisome to Latinas.  For many Latinas, having a third party involved in this process might create distrust and hesitation because it is one more person who knows. Some Latinas may feel more embarrassed having someone else, aside from the provider, know the results or that they even sought out a test. In some communities, this interpreter could be someone they know personally, adding a level of embarrassment.

Recommendations

It is important to remember that not all of the barriers mentioned above will apply to all of your Latina clients. Try to learn more about the client and offer a tailored message based on each client’s situation.

• Encourage all your Latina clients to get tested for HIV. Explain that the test is offered to everyone. Keep a list of the places and dates of free testing in your area in case your client declines testing at your site. For more details visit www.hivtest.org
• Stress confidentiality. Inform your clients that testing is confidential or direct your client to someone who can provide this information. Let them know that getting tested is not related to their immigration status.
• Make every opportunity count. Don’t wait for Latinas to approach you to talk about HIV. Emphasize the importance of safe sex and early detection. Take advantage of any opportunity to encourage mothers to get checked for HIV even when they are just bringing their children in for care. Always remember that waiting for the next consultation can be too late.
• Make sure Latinas are aware of their risks. If you don’t speak Spanish use illustrations. Visit our webpage www.mamasana.org to find our recent HIV brochure VIH Una Realidad (http://www.nchealthystart.org/catalog/prepregnancy.htm#a10s). 
• Tell pregnant women about the HIV testing law. If your client is pregnant, inform her that in North Carolina the law states that a pregnant woman will be tested for HIV at one of her prenatal checkups, at delivery or when the baby is born. Encourage her to get tested at the first opportunity to decrease the risk of transmission to her child.
• Set up mobile clinics. Find locations near schools, parks and community centers with bilingual volunteers and free HIV screenings.
• Refer clients to free screenings. Find out what local health fairs are offering free screenings so that you may refer your Latino clients.
• Familiarize yourself with options in your community for covering treatment of HIV. Uninsured clients will have lots of questions. For more information visit http://www.epi.state.nc.us/epi/hiv/services.html
• Promote HIV prevention. Go to the Web site of NLAAD http://www.nlaad.org/ to find out about local events or how to organize an HIV prevention event in your area.