We’ve achieved many victories in the battle against HIV/AIDS, especially with the arrival of PrEP, but Latino gay and bisexual men aren’t reaping the benefits.
Though new infection rates have decreased 10% overall from 2010 to 2014, the rate among Latino MSM (men who have sex with men) actually increased 14%. (African-Americans are still the largest sector of people living with HIV, but new infection rates among black MSM have stabilized.)
Why are Latino men being left behind?
A lack of education and awareness, limited access to health services and testing, and systemic socioeconomic obstacles all play a major role, of course—as they do for many demographics affected by HIV. But experts point to a cluster of factors at play within the Latinx community in particular.
One is a language barrier: “[Some organizations] don’t have Spanish-speaking people to take their phone calls, or make sure they’re directed to where they need to go,” says Moises Agosto, treatment director at the National Minority AIDS Council. “For Latinos who are monolingual… it will be so problematic that they give up.”
Agosto says these barriers have been here “for a long time,” and include an aversion to health care systems among immigrants and the undocumented for fear of reprisals or deportation. “This administration has been so loud about not supporting immigrant rights, this has made the problem worse.”
A more generalized resistance to seeking treatment among the Latinx community often acts in combination with homophobia, according to Leandro Rodriguez, director of programs at the Latino Commission on AIDS. “You only go to the doctor if you’re really, really sick,” he says of cultural attitudes. Add that to the taboo of men having sex with men in a culture that values hypermasculinity, and “you’re mixing those two dynamics, talking to [a provider] about both sexual behavior and health. It’s been very, very challenging.”
These factors also help explain why Latino men have been slow to adopt PrEP as a prevention strategy: In a study of new PrEP prescriptions issued between 2012 and 2015, whites accounted for 74% of users, Latinos just 12%, and African Americans 10%.
Again, cultural attitudes and stereotypes come into play: “The thought is, ‘If I start taking PrEP, would that mean that I’m a PrEP whore?” says Rodriguez. “Am I actually validating what’s expected of me?’”
The challenges for HIV-positive men to take daily antiretrovirals are much the same: In part due to late diagnoses, treatment and viral-suppression rates are also lower among Latino MSM. Just 58% of Latinos diagnosed with HIV have suppressed viral loads, compared to 65% of whites, according to the CDC’s most recent statistics.
Those in treatment might not even come out as positive right away, says Rodriguez, meaning they lack the benefits of a good support system. (Some may even hide their medication from roommates and family.)
Substance abuse, including alcohol and crystal meth, is also a hindrance to daily adherence, in addition to upping risk of infection from sex or intravenous drug use. In a 2015 study of substance abuse among minority MSM, Latino men were most likely to drink heavily, and were nearly twice as likely to have injected drugs over the past six months than other minority groups.
So what’s being done to curb the disturbing trend?
Rodriguez points to the success of Oasis, which has provided information, referrals and testing for LGBT (and straight) Latinx in New York since April 2016.
“Instead of just pushing the message out, we decided it was best to first create a safe space, where the Latino community can congregate and not feel intimidated, and from there start the discussion.”
Removing HIV/AIDS from the name was key, he says: “We hear from our clients, ‘If I go to your agency, people will think I have HIV or AIDS.’ There’s still that stigma.”
Oasis has seen high engagement rates with the community, and workshops and conversations at the center have fueled better insights into Latino MSMs’ sexual lives. This year the center successfully identified 26 HIV-positive patients and connected them with treatment plans within 30 days.
Rodriguez also points to the CDC’s Every Day Every Dose app, which has proven especially effective with young people heavily engaged with social media. The app offers daily reminders and tracking for patients taking antiretrovirals as treatment or prevention. These strategies have proven effective in places like New York, but rural areas, including those with migrant communities, pose a different challenge.
“You can’t have a one-size-fits-all kind of solution,” Agosto says, “’Latino MSM’ is a very heterogenous group.”
The National Minority AIDS Council cultivates interactions tailored to local needs, Agosto says. “We need a more frontline kind of approach, having community health workers who can go to people’s houses.” That strategy has been highly effective in countries like Kenya, where door-to-door campaigns have led to a dramatic increase in the number of people getting tested.
“Leadership voices from those particular communities provide intelligence and feedback that the government needs to develop actual interventions [and] policies,” adds Agosto.
Access to and awareness of PrEP remains a top priority across the board. It’s a conversation Rodriguez would like to see start happening in schools, similar to how conversations about the HPV vaccine are becoming more routine. Workshops with Latino MSM from around the country to address PrEP are being planned for the Biomedical HIV Prevention Summit later this month.
“There’s a need for reinvention for MSM of color,” Rodriguez says of HIV treatment and prevention. “We’ve acknowledged the need and we’re all preparing to address it as aggressively as we can. That’s comforting.”
Logo will be host a special World AIDS Day panel on Facebook Live on December 1 at 12pm.