Culture, late testing blamed in growing HIV crisis among Hispanics

Culture, late testing blamed in growing HIV crisis among Hispanics

01:46 PM CDT on Friday, August 8, 2008
BY JESSICA MEYERS / The Dallas Morning News
jmeyers@dallasnews.com

Hispanics in Texas are getting tested for HIV later than any other ethnic group, fueling the spread of infection in a segment of the population already seeing a disproportionate number of cases nationwide.

Texas has more than 8,000 Hispanics living with AIDS — the fourth highest in the nation. Hispanics make up 15 percent of the U.S. population but 22 percent of new HIV/AIDS cases in 2006.


And it may actually be worse than the numbers show. The Centers for Disease Control and Prevention just announced that the annual HIV infection rate is 40 percent higher than previously estimated. Public health officials are calling the rate of Hispanic HIV/AIDS cases a health crisis and made it a major topic during the International AIDS Conference in Mexico City, which wraps up today.


The most alarming statistic in Texas may be that 32 percent of Latinos are diagnosed with AIDS only a month after testing HIV positive, compared with 24 percent each for both blacks and whites.


“This is a pretty significant difference,” said Dr. Sharon Melville, the manager of the HIV/STD Epidemiology and Surveillance Branch for the state. “It’s troubling. They are getting into care late and not getting diagnosed as early and we need to pay attention to that.”


Late detection heightens the risk of spreading the virus unknowingly and delays the opportunity for life-extending drugs.


Hispanics in the United States face a number of unique challenges in combating the disease, including language barriers, limited access to health care, legality issues and cultural mores.


“Hispanics talk about sex with a sense of humor but they’re not so comfortable talking about it seriously,” said Edgar Carmona, the Associate Executive Director of AIDS Interfaith Network in Dallas.


He gives regular AIDS presentations to Hispanics and says he has to warn people in advance about the sensitivity of the subject matter.


“They are not ready to see sex as a mode of getting the disease.”


Condom usage is also rare in a culture with a strong masculine identity and a more conservative Catholic background.


Some in the Hispanic community feel it violates the intimacy of the act and view it as a sign of weakness, Mr. Carmona said.


Dallas County had the highest overall HIV rate in Texas in 2006, and the state recorded almost 2,000 Hispanics living with HIV/AIDS in Dallas last year — up almost 300 cases since 2005.


At least 19 percent of gay Hispanic men under 30 have HIV in Dallas compared with an average of 17 percent in major cities.


AIDS workers say the cultural emphasis on masculinity and privacy leads to a double stigma for gay Hispanic men. Some choose ignorance over humiliation when it comes to confronting HIV.


Martin Robles was one of those men.


He went to the doctor for an infected finger on his left hand that wouldn’t heal. Three weeks later he found out what was wrong.


His immune system was virtually destroyed. The 34-year-old had full-blown AIDS.


“You never think it will affect you,” Mr. Robles, a gay man who came to Dallas from Mexico nine years ago, said in Spanish. “By the time I learned to have safe sex, it was too late.”


He spent 18 days in the hospital, lost his job and left with a $20,000 medical bill. He’s only told his family and close friends that he has the virus.


This culture of silence breeds misunderstandings that, coupled with a failure of government agencies to address the Hispanic AIDS crisis, have fostered its growth, said Guillermo Chacon, the Vice President of the Latino Commission on AIDS. He emphasized a need for more outreach and bilingual services.


“We have been invisible, and I keep reminding people this is a killer in our communities,” he said, especially now that Hispanics have the fastest growing population in the country. The commission released its first Latino/Hispanic Aids Action Agenda this past January, along with a number of community-based organizations and health departments across the country.


Together, they created policy recommendations that include strategies to make treatment more accessible and social marketing about HIV/AIDS in Spanish and English.


Mr. Chacon noted that those efforts need to extend to recent Hispanic immigrants, who must adapt their cultural preconceptions to stop the spread of the disease.


“The idea that Latino gay men only exist in XYZ city is wrong. They are part of our social fabric. These are issues that need to build from families all the way to counties and states,” he said.


Texas, which has the largest recent influx of Hispanic immigrants, faces the added hurdle of infected undocumented workers and a large migrant population that cannot afford regular exams.


“Many of our Hispanic clients are very afraid to enter into the larger system of care because they fear being identified and deported back to their home countries where there is no support system,” said Raeline Nobles, the executive director of Dallas-based AIDS Arms.


Although the number of infected Hispanics has remained relatively steady in recent years, the clinic has had a 4 percent increase in Hispanic clients this year.


Nationwide, the rate of Hispanics with HIV is still only about one third that of blacks.


When AIDS first appeared in the United States, it was seen as a disease affecting white gay men. As the epidemic spread to the rest of the population, it was met with denial by many groups — straight people and blacks among them.


Ms. Nobles said she is seeing that same type of reaction in the Hispanic community today.


But Mr. Carmona with AIDS Interfaith noted the additional cultural factors that distinguish the experience for Latinos.


“The sense of guilt and responsibility is different,” he said, especially since newer immigrants have fewer ties in the states and sometimes spouses back home. Hispanics often feel a deeper loneliness because they can’t communicate with family or friends about their situation, he said.


Max Gutierrez, a gay 57-year old Hispanic Dallas resident who has lived with the disease for more than a decade, says he has found a support network outside of the Hispanic community where he feels better understood. Mr. Gutierrez has watched AIDS slowly destroy more than 20 friends over the years, and says it’s not getting any easier, or any better.


“Our society has fallen into a new wave of complacency when it comes to AIDS,” he said. “It seems to have been swept under the rug or glamorized so that people think it’s under control. Well, it’s not under control.”



BY THE NUMBERS: HIV infections in Hispanics
•32 percent of Hispanics develop AIDS a month after being diagnosed with HIV.


•Hispanics make up 15 percent of the U.S. population but 22 percent of new HIV/AIDS cases in 2006.


•Almost 2,000 Hispanics were living with HIV/AIDS in Dallas last year.


•At least 19 percent of gay Hispanic men under 30 are affected with HIV in Dallas.


•25 percent of people living with HIV don’t know it.


SOURCE: Centers for Disease Control and Prevention