One Voice, Many Messengers
A national health plan will address the diversity of Latinx/Hispanic populations
by Larry Buhl

Next February, as the nation’s attention turns to primary contests that will choose a Democratic nominee for President, Hispanic/Latinx organizations, stakeholders and allies will convene a national health summit to address the health disparities affecting Hispanic and Latinx communities. The theme, “Setting Our Hispanic/Latinx Health Agenda,” is meant to bring a national focus on HIV, viral hepatitis, STIs, substance use and other health conditions that disproportionately impact Hispanic/Latinx communities. The summit, to be held in Washington, D.C., will include national, regional and local healthcare providers, as well as community-based organizations serving Hispanic/Latinx communities across the United States and its territories. It will be just one milestone in a new effort to organize and develop a national agenda and a blueprint for measuring clear health outcomes in Hispanic/Latinx communities.

The timing of the summit is not accidental, according to Guillermo Chacon, president of the Latino Commission on AIDS and founder of the Hispanic Health Network. “We must be proactive on the eve of the presidential elections,” Chacon told A&U. “We want to engage as many as we can to develop health policy agendas.”

It’s not just making HIV/AIDS an issue in the 2020 Presidential election, according to Chacon. It’s about identifying Hispanic and Latinx communities as crucial in the national plan to end HIV/AIDS.

In his State of the Union address in February, 2019, President Trump announced his intention – without specifics – to end HIV by 2030, and that the details would be worked out by the Department of Health and Human Services. But Trump administration’s record on HIV/AIDS issues, has been, in the most generous interpretation, mixed. In requesting $291 million to end HIV/AIDS, the most recent budget calls for a significant cut to PEPFAR (President’s Emergency Plan for AIDS Relief). And as A&U reported in the September issue, there is a lack of clarity over whether the Department of Homeland Security believes that HIV is a reason to separate migrant parents and their children at the border.

The administration’s record on Latinx/Hispanic issues is also far from positive. Trump’s lukewarm denunciation of white supremacy following the massacres in El Paso and Dayton, to his use of “animals” and “illegals” to describe migrants from Central America, have led to a culture of fear and distrust among U.S. Latinos and Hispanics. A recent Pew Research Center survey found Latinos are increasingly worried about their place in the U.S. under Trump than under past administrations. The Pew Research Center showed two-thirds of Hispanics believing Trump’s policies have been harmful to Hispanics, and a majority surveyed say it’s more difficult to live in the U.S. as a Latino in recent years.

Within that context, a Hispanic/Latinx health summit is especially urgent now, community and health advocates say. But the issues with Latinx/Hispanic health predate the current administration. While communities throughout the U.S. have seen a decrease in HIV infection rates, many of the most vulnerable Latino/Hispanic communities have seen an increase in HIV infection rates and other STIs in recent years. As reported by the CDC in 2015, Latino/Hispanics accounted for about one quarter of all new diagnoses of HIV in the United States, despite representing about 18% of the total U.S. population. From 2010 to 2014, the estimated annual HIV infections increased 14% among Latino/Hispanic gay, bisexual, and other men who have sex with men. If current rates persist, one in five Latino gay and bisexual men in the U.S. may be diagnosed with HIV in their lifetimes.
PrEP use among Latinx populations is also much lower than in other groups. About seven in ten new HIV diagnoses in Latinos happens among gay and bisexual men, and less than half of those infected with HIV have achieved viral suppression.

It’s not only HIV/AIDS disproportionately impacting the Latinx/Hispanic communities, and it’s not just gay and bi Latino men and MSMs at risk. The CDC also shows that despite having lower rates of hepatitis C, Hispanics were 40 percent more likely to die from that disease. Latinos show more liver scars than non-Hispanic Whites. Hispanic/Latino health disparities can be observed by an excess mortality from conditions that include diabetes, stomach cancer, liver cancer, cervical cancer, liver disease, homicide, and work-related injuries.
Oscar De La O, President of Bienestar Human Services., in a statement pointed out disparities within disparity. “Many members of our communities are dealing with substance abuse, intimate partner violence, mental health, HIV infection as well as elevated levels of trauma, incarceration, and poverty and therefore these factors should be considered predictors for HIV and Hepatitis C.” Trans Latinx people face another unique set of stigmas and risk factors.

HIV/AIDS experts, advocates for Latinx/Hispanics, and community stakeholders are sounding the alarm. In March, 2018, a letter signed by 160 Latinx organizations was sent to Dr. Eugene McCray, Director of the Division of HIV/AIDS Prevention at CDC. The letter said that “an internal consultation is necessary to coordinate a national response that will mitigate the impact that these new HIV infections will have on our most vulnerable Latino communities.” The letter asked for the start of conversations to “facilitate a better public health response to this serious trend of new HIV infections affecting our communities.”

Some preliminary conversations have taken place since the letter was sent. Last August the first meeting organized by the CDC’s Department of HIV/AIDS Prevention (DHAP) was hosted by the National Hispanic Medical Association in Atlanta. This was followed up by a second meeting in March. Some jurisdictional work has been done in the areas most impacted by HIV among Hispanic/Latinx populations, including, Arizona, Nevada, New York, California, Illinois, Texas, and Washington, D.C.

According to Chacon, these conferences can develop top-down policies and bottom-up messages—and, when appropriate bottom-up policies and top-down messages—to reach the widest number of Latinx/Hispanic people in the U.S. and its territories.

“The messenger matters,” Chacon says. “It’s often said that the Latinx and Hispanic community is monolithic. It is not. There’s a whole galaxy, with people with roots in Puerto Rico, Dominican Republic, Venezuela, Cuba. There’s foreign born, and first and second generation citizens and undocumented, English-speaking and Spanish-speaking.”
Research shows Latinos born in different countries have distinct behavioral risk factors. For example, Latino men born in Puerto Rico are more likely to contract HIV as a result of injection drug use or high risk heterosexual contact. One message, say, on using PrEP, will not work for each of those populations. And beyond crafting messages that will speak to all of these populations, “we need to make the community visible.”

In addition to diversity of origins and economic circumstances, there are other issues that have put Latinx/Hispanic people at greater risk of infection with HIV, hepatitis and STDs, according to Chacon. “Stigma. Fear of disclosing HIV status, or sexuality, which leads to not testing and not seeking prevention and treatment services. There’s also language barriers, low educational attainment for some and fear and mistrust of the medical system.”

Chacon said that individual states and county departments of health throughout the U.S. will need to provide recommendations into the ways prevention and treatment messages can make an impact in various populations, and will be responsible for much of the outreach.

The Latino Commission on AIDS is facilitating the process of developing a national steering committee and a national planning committee.

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Larry Buhl is a multimedia journalist, screenwriter, and novelist living in Los Angeles. Follow him on Twitter @LarryBuhl.