Latinos and HIV—an epidemic waiting to burst?

David Munar of AIDS Foundation of Chicago gives the deal

Interview by Enid Vázquez

David Munar, a first generation Colombian American, was speaking at the 2005 National Conference on Latinos and AIDS, held in Chicago in July. As Associate Director of the AIDS Foundation of Chicago, an advocacy and services organization providing national leadership, Munar knows the statistics well—but he also works closely with communities affected by HIV.

Why should Latinos not be complacent? At last accounting, it’s true that they are affected by HIV out of proportion to their numbers in the U.S. population, but that the gap is not as large as it is in the African American community.

For the 32 states that report HIV diagnoses,

• Blacks made up 51% of all new diagnoses in 2000–2003, but only 13% of the population for those states

• Latinos made up 15% of the diagnoses for those states, but only 11% of the population

Those states do not include New York and California, two states with large numbers of Latinos and large numbers of people with HIV.

“There’s really no comparison with HIV in the Black community and the Latino community. It’s much worse in the Black community,” said Munar. “It’s much higher on every level—incidence, cases, etc. The proportion of Latinos with HIV/AIDS is a little closer to our population in the country. So some people think it’s on par and therefore not a problem. We have to really check that assumption. There’s more to it.

“We’re not as affected by HIV/AIDS as African Americans, and we have to work hard to keep it that way.”

Here’s one expert’s take, in a one-on-one interview.

Young people

Our population is predominantly young. One in 10 of the total population in the U.S. is a young Latino. That’s a startling statistic. That’s a call for prevention. It gives us the chance to rally around our youth.

The CDC [U.S. Centers for Disease Control and Prevention], says that half of new infections are among young people under 25. A third of U.S. Latinos are under 25—we are at greater risk for HIV.

We have the largest youth population of any other racial and ethnic group, and have the highest teenage pregnancy rate of any racial and ethnic group. So our young people are getting busy, and our young people are very vulnerable to HIV.

Diversity

We have 26 different nationalities and no race. We are White, Black, Native American, Asian, and sometimes all in one. One prevention message won’t fit all.

Health care

Latinos have less access to healthcare, so we’re at greater risk of a catastrophic AIDS effect. Of all the racial and ethnic groups, Latinos have the highest rate of no health insurance. This is not news to our community. Most Latinos know someone who doesn’t have health insurance or doesn’t have it themselves.

It’s a recipe for disaster when you combine it with a chronic disease like HIV. It makes the Ryan White Care Act an important safety net. That’s why you see so many health fairs in community settings. This is health care for millions of Latinos—the parks, the libraries. This is where they have their cholesterol checked. [I told David I saw a flyer for a health fair at a large furniture store in my barrio!]

Doctor, doctor

Another problem is that we don’t question our doctor’s recommendations. We don’t know how to be involved and empowered health consumers. This is not about a language barrier. In surveys, Latinos rank highest in saying they leave the doctor’s office without understanding what the doctor said or getting all their questions answered. The highest rate is among non-English speakers. We don’t want to be in an uncomfortable situation and say we don’t agree, or we don’t understand. We’d rather be seen as polite.

Immigration

It’s true that we don’t have the incidence rate of the African American community, and for that we should be thankful. But at the same time, I believe it’s very likely that we’re undercounted. Two in five Latinos are foreign born, in common with Asian/Pacific Islanders. There’s discrimination, and there are large barriers of not knowing how things work. So everything adds up to lack of access to health care. So we’re not testing and those who are testing are not coming in to care.

Uncomfortable conversations

We have to figure out ways to talk to our young people, our mothers, and our aunts. In the AIDS community, we talk to each other a lot, but at the end of the day, what good does it do if we don’t talk to our families, especially our young people? We have to have uncomfortable conversations.

I’m not saying put a sign on the lawn—“Talk to me about AIDS.” But we have to go out of our comfort zone. Women are better at this, men suck at it. Women have the Tupperware model of health parties, where they learn about asthma, heart disease, pregnancy and STDs [sexually transmitted diseases], what to do if your child has a fever.

Risk groups

MSM, IDUs, women—our risk groups are just like the rest of the epidemic, but people may not tell you about their behaviors.

MSM [men who have sex with men, who may not identify as gay] are part of our community. They’re at high risk of HIV and other problems. At the root is stigma and homophobia. That really stands out as a group that’s highly affected.

As a community, we need to look at what we can do to support and nurture our MSM, especially our youth. It’s not about pitting one group against another.

What is HIV?

Stigma in general is so big in our community. We don’t really pay attention to health, especially prevention. There’s a stigma around HIV, but it’s a disease. We need to break down the stigma and get to it as a disease. There’s a real need for health assertiveness.

Not just a test

What scares me is the misunderstanding there is around HIV. One of the pastors in a Black church told us about a conversation she had with a young man—and we’re very lucky to have a pastor talking about this subject. She asked him if he had been tested and he said yes, he was negative. She asked him when he was tested, and he said four years ago. She asked him if he had been at risk in that time and needed to get tested again. He was puzzled—why test again?

There’s such an emphasis on “get tested, get tested,” and we don’t emphasize behaviors. We need to talk about them.

People have to be careful to say it’s not just testing, but an on-going risk assessment and on-going testing and on-going awareness. It’s a commitment to being aware and being open to risk discussion. It’s tough, I know it’s very tough. We can talk about pregnancy. It doesn’t affect MSM but our communities can talk about it. And sex—men, women, and teens are having it.

The youth will lead

This is where young people can break new ground. “I know my HIV status, do you?” “I have HIV—how does that make you feel?” Candidness. You see some in online chat rooms.

The next generation is always pushing the older one. I have a lot of faith that they can lead us in this new reality. It’s their future and their bodies. And it’s their lives and the lives of their children.

The Blacks vs. the browns?

We’re so racially divided. There’s so much distrust and so much pain. There’s racial tension in AIDS and we don’t talk about it. There’s a lot of distrust. People say, “Why are we only getting 11% of the money when we’re 12% of the population?” When we advocated for the African American [HIV/AIDS] Response Act, lots of people said, “Well, what are you doing for Latinos?” We have to make sure our response is constructive, and not paralyzing us, not splintering us.

AIDS advocates need to not fall into that trap. “I’m not Black, so it’s not my problem.” “You’re not Black, so you don’t understand.” I think we have to move beyond that “gay White male disease, now a Black/Latino disease.” The blame game is the only focus there. The world is full of “if onlys.” When are we going to own it?

Phill Wilson (see page 36) says it most eloquently: If you think it’s a conspiracy, fine. What are we going to do to survive? If it’s man-made, then we have more of a need to make sure we survive.

There’s always a temptation to say, “Who’s doing this to us? The Anglo? The gringo?” Well, what are we going to do for us? We have to move forward. Blame is going to distract us from doing the work that needs to be done.

We have to follow the epidemic, absolutely. But sometimes a lot of energy is wasted on who’s doing this to us. That’s a very defeatist attitude. For people who hate us, that’s exactly what they want—divide and conquer.