Here As I Am
To Improve Healthcare, a listening initiative interviewed Latinx men affected by HIV
by Hank Trout
On September 15, 2020, ViiV Healthcare released its 36-page report, “Here As I Am: A Listening Initiative with Latinx Gay and Bisexual Men Affected by HIV,” a project of ViiV’s Positive Action for Latinx Men initiative. Collaborators included Memria, MPact Global Action for Gay Men’s Health and Rights, and the Latino Commission on AIDS.
The project stemmed from Latinx community leaders’ and advocates’ call for more community-led programs, services, and policies that center on gay, bisexual, queer, and trans Latinx men. The Listening Initiative examined how social, political, and economic forces affect the health and wellbeing of those men, especially their ability to access preventive care and HIV treatment. Using data from 2016 and 2018, they established this background: there are some 186,900 Hispanic/Latinx gay and bisexual men living with HIV in the U.S., one in three of whom have not achieved viral suppression; nearly 80% of new HIV diagnoses (7,996) were of Hispanic/Latinx men; one in five of those men were diagnosed late, meaning that they were diagnosed with HIV and AIDS concurrently. With this information, ViiV and its partners conducted the ten-month Listening Initiative in eleven cities across the U.S. and Puerto Rico.
The Listening Initiative relied upon local community advisors to gather groups of eight to twenty-five Latinx men for two-to-three-hour discussion sessions, conducted in both Spanish and English; they also set up recording booths at twelve locations for participants to tell their own stories, and conducted individual and group interviews with service providers and community leaders at forty-one community-based organizations.
The Listening Initiative led to five specific conclusions:
Family and community are central to men’s lives and identities, shaping their health and wellness for better or worse. The men reported that although sometimes their families and communities can provide them with support and love as they struggle with their HIV diagnosis, families can also be a source of stigma, rejection, or even violence due to their religious beliefs and outmoded notions of “machismo.”
Interruptions in care happen for many reasons beyond men’s control. Many factors complicate HIV-positive Latinx men’s ability to access prevention and treatment. These include class disparities such as housing and income instability, employment barriers, and for immigrants, integrating into a new city. Many of these men reported working several jobs at the same time, making it difficult to access clinic care; those who could find the time found that clinics often are not open on weekends or evenings when those men can be available. They also reported a lack of information available in their own language.
Anti-immigrant sentiment and laws have a powerful effect on men’s health. HIV-positive undocumented immigrant Latinx men reported great fear of being deported if they attempt to access care; even documented immigrants expressed fear due to ICE raids in their “safe spaces” such a clinics, churches, and study groups. Both groups reported incidents of discrimination in health care settings. The ongoing debate around immigrants’ place in U.S. society spreads fear, ostracism, discrimination and violence against HIV-positive Latinx men.
Latinx men want diverse and responsive care that reflects their needs, identity and language. These men expressed the need for care providers they could identify with culturally. Spanish-speaking men said they prefer a Spanish-speaking provider; having sex-positive gay, bi, and trans people on providers’ staff, who are knowledgeable about sexual orientations, HIV, and PrEP, can lead to better engagement in care. Having providers need who use language-appropriate information materials also improves health outcomes; lack thereof has the opposite effect.
Resilience is activated through networks and services by and for Latinx men, especially youth. There is a dearth of organizations dedicated to Latinx men’s health; in many of the cities engaged in the Listening Initiative, there were few or no organizations centered on Latinx men’s health. In those cities, often a single organization—or even just one individual—is prepared to meet the needs of this community.
The researchers propose myriad solutions to these problems, including: creating safer spaces where Latinx men can create a supportive network of “chosen family”; engaging Latinx men’s families in discussions of healthcare needs; offering mobile, locally tailored, and culturally competent services; locating legal, mental health, and housing services in the same spaces as healthcare clinics; providing training for healthcare providers so they can offer affirming care; including the Latinx community in resources, hiring, and outreach; supporting Latinx-led organizations and networks; and connecting leaders across generations to provide leadership, practical opportunities, guidance and mentorship in grant-writing, budgeting, and program design, implementation, and evaluation.
The researchers conclude, “The findings presented here are only one part of ViiV Healthcare’s listening strategy to find and fuel solutions that make a difference in the lives of Latinx men living with and affected by HIV.”
To listen to the men interviewed, log on to: https://viivhealthcare.com/en-us/positive-action-for-latinx-men/.
Hank Trout, Senior Editor, edited Drummer, Malebox, and Folsom magazines in the early 1980s. A long-term survivor of HIV/AIDS (diagnosed in 1989), he is a forty-year resident of San Francisco, where he lives with his husband Rick. Follow him on Twitter @HankTroutWriter.