We Can Stop HIV

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Can We Talk About HIV? Si, Se Puede
The CDC looks for new strategies to reach Latinos
by Larry Buhl

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Harm reduction professionals understand the importance of getting people to talk about a disease in order to significantly reduce infections. But what if social norms dictate that the target group doesn’t want to talk about it?

HIV outreach coordinators around the country have been grappling with this conundrum for decades. But now they have a ton of government dollars to help in their efforts.

In September, the Centers for Disease Control and Prevention (CDC) launched the We Can Stop HIV One Conversation at a Time campaign. It’s a national, bilingual communication campaign that encourages Latinos to talk openly about HIV with their families and friends.

It’s not the CDC’s first foray into cultural-specific outreach. In fact, the campaign falls under a larger umbrella at the agency called Act Against AIDS, a portfolio of ten campaigns that have the goal of risk reduction for men and women of color.

We Can Stop HIV One Conversation at a Time is the first CDC campaign by and for U.S. Latinos. The campaign is reaching out to Latinos through online, print media, transit, and billboard advertising, as well as social media outreach, and will present its messages in English and Spanish. Partnerships with leading Latino-serving media outlets and organizations will help amplify bilingual campaign messages.

The campaign was launched in September at the People en Español Festival in San Antonio, Texas, and will continue to be promoted at a variety of community events over the next year. Event cities include Los Angeles, Houston, Miami, Chicago, and San Juan. The campaign’s New York City event on September 4 was hosted in conjunction with MTV Tr3s, the network’s Latino-focused channel.

Just as one HIV/AIDS message won’t work for all Americans, one message won’t work for all Latinos, either. Latinos in the U.S. are a diverse group, segmented by age, geography, acculturation, language preference, and country of origin. It is hard to get agreement among the populations about which designation is better: Hispanic or Latino (for purposes of this article, it’s Latino).

What is common to many Latino groups is a higher barrier to openly discussing HIV/AIDS, according to Nick De Luca, prevention communication branch chief at HIV/AIDS prevention at CDC.

“To develop the campaign, we did extensive research with over 300 Hispanic/Latinos across the U.S. as well as twenty agencies that work with Hispanic/Latinos,” he tells A&U. They reached out to all age groups and represent all parts of Latino communities in the U.S. The goal, De Luca says, was to find out exactly why many were reticent about talking about HIV/AIDS, and sometimes about sexuality in general.

“There was a strong effort to address some of the cultural issues that we identified through our research. We found that Hispanic/Latinos in the U.S. generally don’t talk enough with family and with friends about HIV, even though they discuss many other topics. We heard that some cultural norms in the community, as well as sexual stigma, could lead to what we call ‘sexual silence.’ And that prevents them from having lifesaving conversations.”

One way to more effectively encourage Latinos to talk about sex and sexual roles is to appreciate how many Latinos, generally older ones, see distinct gender roles, machismo and marianismo, where men make decisions and women defer. Deftly reframing these roles so that women can, for example, feel free to ask men to use condoms, can be a key way to reduce risk of HIV and other STDs, experts agree.

And De Luca says that We Can Stop HIV One Conversation at a Time doesn’t pull any punches about what’s at stake. “We talk about how anyone can get it regardless of gender or age or marital status and how it affects more Latinos than you think. If current trends continue, one in fifty Latinos will be infected with HIV. Right now more than 220,000 Latinos are estimated to be living with the virus. Latinos make up sixteen percent of the U.S. population and account for just over twenty percent of new HIV infections each year.”

De Luca points to another statistic: A recent study by the CDC found that only about half of Latinos have talked with friends and family about HIV in the past year, and another found that even when Latinos are ready to talk about HIV, many do not have the information they need to have these life-saving conversations with loved ones.

Culturally Appropriate Intervention
Programs in the CDC’s Act Against AIDS initiative are only part of U.S. governmental efforts to reach out to Latinos/Latinas and other groups in the oneconversation_poster_peer_ad_a_english

fight against HIV/AIDS.

HRSA has been funding a variety of initiatives, including Culturally Appropriate Interventions of Outreach, Access and Retention Among Hispanic/Latino Populations, as part of its Special Programs of National Significance (SPNS).

The initiative’s ten demonstration sites are now in the beginning stages of designing, implementing, and evaluating new methods to identify Latinos who are at high risk or living with HIV, and improve their access to and retention in quality HIV primary care. The ten grantee organizations will develop pilot programs that can be used around the country.

Two of the ten grantees are in Los Angeles, AIDS Project Los Angeles (APLA) and Bienestar. Jeff Bailey, director of client services at APLA, tells A&U that they are in the first phase: identifying HIV-positive men of Mexican origin (the five-year grant APLA received specified “Mexico”) who are not engaged in primary medical care.

“We’re using social media, community partners, the Mexican consulate and some non-traditional sources, like freestanding community clinics in Mexican-American neighborhoods to find [these men],” Bailey says.

Once the men are identified, the program will be launched as part of the Los Angeles AIDS Walk on October 12, with 100 Latino men leading the walk. There will also be an event in L.A. as part of Dia de los Muertos, at Hollywood Forever Cemetery on November 1.

Finding the men is one roadblock, getting them to be out and proud about their status is another. And all of these roadblocks are erected, at first, by silence. As with getting Latinos—especially Latino men—to talk openly about sexuality and HIV, there are cultural barriers to bringing them in to be treated—or even tested—for HIV, Bailey says.

“First there is the stigma with HIV and men who have sex with men,” Bailey says. “For some, there are beliefs that there are treatment options other than Western medicine that are preferable. There’s the comfort level of going into a clinic. In other words, they don’t want to be seen by neighbors going into a clinic that handles HIV cases. And some undocumented men believe that they’re ineligible for care in the U.S.”

Bailey adds that isolation is one of the biggest problems. “Men often will not want to talk with family, and they can’t or won’t build a support system around this (HIV) issue.” But Bailey and his teams are finding the men, and he fully expects to get them talking about the issue one conversation at a time.

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Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His podcast on employment issues, “Labor Pains,” can be found at www.laborpainspodcast.com.