STD Quarterly

Help Latino patients break through barriers

Almost one-fifth of new HIV infections are Latinos

What is your facility doing to reach out with HIV prevention messages to the Latino community? Know this: While Latinos represent approximately 14% of the U.S. population, they account for almost one-fifth (19%) of the 40,000 new HIV infections estimated to occur in the United States each year.1

The Washington, DC-based National Alliance of State and Territorial AIDS Directors (NASTAD) has just issued a publication, Addressing HIV/AIDS . . . Latino Perspectives and Policy Recommendations, to help develop strategies in combating the AIDS epidemic in the Latino population. (Review the free publication at the organization’s web site, www.nastad.org. Click on "Publications," "HIV prevention," "Reports," then the publication title: Addressing HIV/AIDS . . . Latino Perspectives and Policy Recommendations.)

Little insurance, no documentation

Health care providers face many challenges in working with Latino communities, observes Alberto Santana, MS, NASTAD’s HIV prevention program manager. Latinos are underinsured or not insured at all, and many are undocumented and afraid to access care because of fear of deportation, racism, and stigma, he says.

"Latinos are diverse ethnically, racially, and socially; and because of this diversity, programs and health care services need to be tailored to meet the needs of the person being served," Santana states. "Language barriers also are a challenge faced by health care providers, and a health care provider may miss important information or misdiagnose a person because of this barrier." (Review the following Contraceptive Technology Update articles for assistance in overcoming such barriers: "Meeting the challenge of caring for Hispanic women," December 1999, p. 141; "Break down barriers to gynecologic care," January 2002, p. 6; and "Reach diverse audiences with appropriate facts," January 2002, p. 8.)

Understanding the issues of health care access and diversity are important in shaping, refining, and implementing service delivery models that are innovative, culturally competent, and meet patients’ needs, he asserts.

Overcome the hurdles

Latinos, particularly women, will not seek treatment for themselves because the family comes first, says Monica Nuño, program specialist in the education department at AIDS Project Los Angeles (APLA) and co-author of the NASTAD publication. The publication offers a comprehensive literature review of research pertaining to Latino health care.

"Women have so many outside issues that are so much more important that getting treatment itself, such as food and transportation," she says. "We found that those things had to be met before their priorities for treatment."

Patient information should be available in Spanish and English with careful consideration to the literacy levels of the target audience, says Nuño. See if educational materials can be developed first in Spanish when possible; literal translations of English materials may not get the desired message across to Latino patients, she notes.

APLA produces a quarterly publication, Impacto!, which is written entirely in Spanish and is aimed at HIV-positive Latinos, says Nuño. The publication contains treatment information that is helpful for Latino patients, she notes. (Obtain the publication for free at the organization’s web site, www.apla.org; click on "Español," then the publication title: Impacto!)

When it comes to HIV testing, studies indicate that Latinos may be more likely to be tested late for HIV in their illness, either presenting with a diagnosis of AIDS at the time of testing or developing AIDS within one year of testing positive.1

According to a 2001 study, when Latino patients finally seek out medical assistance, they report several barriers to receiving competent care, including such factors as providers not listening to everything said, not fully understanding their providers, and not asking questions during their visit.2

The report concludes that Latinos have greater difficulty in communicating with their providers, as compared to other racial/ethnic groups.2

"Latinos come into care with very high expectations," observes Nuño. "Once they get there, they have expectations that they are going to be cured immediately."

Collaboration is key

Collaborate with colleagues in getting the message out on health care access for Latinos. NASTAD has organized the Latino Advisory Committee, which includes AIDS directors and HIV/AIDS program staff from state health departments and health departments in cities directly funded by the Atlanta-based Centers for Disease Control and Prevention to conduct prevention activities, says Santana.

The committee bridges programmatic concerns with current policy challenges and provides guidance to NASTAD staff to create initiatives in support of prevention and care services for Latino communities throughout the United States, he notes.

APLA has worked to engage Latinos within the communities, working in collaboration with other agencies and those familiar with that particular population, says Nuño. By working with smaller organizations that have direct impact with Latino citizens, the organization is better able to meet the individual needs of Latino patients, she says.

Research shows that television is the No. 1 source of HIV/AIDS information for Latinos, followed by radio and billboards.3 Collaboration with other agencies may be one way to cost-share and get prevention messages on the television. Nuño suggests that seeking to educate through public awareness campaigns also may be effective.

"Go into the television studios, and talk to those people," she advocates. "Target them to show how important raising awareness is for this community."

References

1. Kaiser Family Foundation. Latinos and HIV/AIDS. Menlo Park, CA; July 2003.

2. Kaiser Family Foundation. Latinos and AIDS. Menlo Park CA; 2001.

3. Kaiser Family Foundation. National Survey of Latinos on HIV/AIDS. Menlo Park CA; 1997.