Hispanic / Latino
Cultural History & Beliefs
Latino ethnicity is comprised of individuals of Indigenous, African, Anglo, European, Asian, and Middle Eastern descent. Most of those who live in America are of Mexican, Puerto Rican, Cuban, Central or South American descent. The cultures vary significantly by country of origin. Differences in immigration experiences, history, rural or urban, and cultural norms and expressions are definitive factors in shaping their lives. Although three out of five Latinos living in the United States were born here, most face cultural and language barriers that complicate their ability to negotiate systems effectively. Family, religion, spirituality, familial respect, and adherence to traditional gender roles have been important to their survival and significantly impact the manner in which HIV/AIDS is addressed.
State of HIV/AIDS
The U.S. Centers for Disease Control and Prevention estimates that today more than one million Americans are infected with HIV (1). Unfortunately, about 300,000 are unaware that they are positive and another 225,000 are not receiving appropriate care, even though they are aware of their status (1, 2). Over half a million people have died of AIDS in the U.S., and 88,000 of them were of Latin descent (3). In fact, Latinos have the second highest rate for all racial and ethnic groups reporting in the nation of persons living with AIDS (76,000 persons or 20.0 per 100,000. Between 1999 and 2003, the estimated number of new AIDS cases and the number of persons who died from AIDS among Latinos increased significantly (3). In the 35 to 44 year old age cohort, HIV/AIDS has become the third leading cause of death among Latino men and fourth leading cause of death among Latino women (3). In the US and Puerto Rico, Latinos make up only 14% of the population but account for 18% (almost 164,000) of the 886,500 AIDS cases diagnosed since the beginning of the epidemic (3). Survival, particularly at more than 48 months after diagnosis, was greater among Latinos, non-Latino whites, and Asian/Pacific Islanders than among non-Latino blacks. Mode of transmission of HIV differs by country of origin in the Latino community for both men and women (3).
Patient Barriers to Care
Declines in overall AIDS mortality in the United States may be generating perceptions that it is under control. HIV/AIDS rates are still a major public health concern for Latinos. Providing appropriate prevention and treatment interventions have been hindered by both real and perceived gaps in the current health care system. Researchers have found an association between education/, literacy, service provision and patient adherence. Patients with lower education or literacy levels were less likely to receive state-of-the-art treatment. Those who do were more likely to miss medication schedules because they were confused by stringent protocols required when using potent HIV/AIDS drugs. Many were challenged by the circumstances in which they are forced to live. For Latinos, these problems are compounded by the fact that they are a very diverse people whose language, dialect, culture and concerns differ significantly. Hence, key issues for clinicians to know include:
- Availability of quality health services in their communities
- Economic hardship
- Stigmatization associated with disease or weakness
- Cultural avoidance of discussing issues related to sexual behavior, alcohol or drug use
- Privacy and honor
- Distrust of American health care system
- Language difficulty
- Citizenship status
Provider Challenges to Delivering Care
The sensitivity of health care professionals should extends beyond minimally meeting cultural or language needs. Providers must create discreet environments where learning, understanding and respect can occur. AIDS is a disease that impacts the lives of individuals, families and communities. Providers must learn more about the knowledge, beliefs, and health seeking behaviors and attitudes of the communities they serve. Country of origin has a great deal to do with acceptable and unacceptable behaviors, particularly those behaviors associated with HIV transmission. Health care professionals who fail to understand these cultural differences are less likely to gain their patients’ trust or agreement to administer an HIV test.
Providers also must be aware of the effect of poverty and resulting crime in communities of color. Many men who are positive have contracted the virus while imprisoned. Providers must take accurate personal histories on the men, women and adolescents they treat so every patient can be afforded the proper care and counseling needed.
Communities have a responsibility as well. Collaboration with health care professionals is essential. While traditional therapies may be preferred, they must be augmented by mainstream therapies, including nutrition therapy.
NMAETC Recommendations for Clinical Delivery
- Create an environment that is inviting, friendly and respectful.
- Understand patients feel more comfortable when they are able to view artwork and materials that reflect their cultures.
- Use easy to understand language when discussing health concepts.
- Use the population’s native language, when possible, and provide translation services for offices where language is not spoken by staff members.
- Do not assume that people with limited English-speaking proficiency cannot understand what you are saying. Many can but are hesitant to acknowledge it.
- Be open to patients bringing family members to the appointments, but use discretion when delivering HIV diagnosis.
- Where possible, make child care available.
- Structure programs to meet all patients’ mental, physical, nutrition and social service needs.
- Have flexible office hours and locations, where possible.
Data Sources: Hispanic/Latino
- Glynn M., Rhodes P., Estimated HIV prevalence in the United States at the end of 2003. National Prevention Conference; June 2005; Atlanta. Abstract 595.
- Fleming, P.L., et al., “HIV Prevalence in the United States, 2000,” 9th Annual Conference on Retroviruses & Opportunistic Infections, Feb. 24-8, 2002, Seattle, WA, Abstract 11.
- Centers for Disease Control & Prevention, HIV/AIDS Surveillance Report, 2002,14; 1-40.