HIV/AIDS and the Latino/Hispanic Population Providing HIV Services to the Latino/Hispanic Population

Culture What is culture? ▫Culture is learned behavior and beliefs What are some examples of different cultures that you encounter in your daily life?

My first day on the job A.I felt confident and knew where and what I should be doing B.I felt unsure of where I should be and what I should be doing but was confident I would learn what was expected C.I felt terrified and knew I would never get it

Most Latinos are A.Here illegally B.Here legally C.I don’t know

Latinos A.choose not to learn English B.try to learn English

Cultural bias has an important effect on clinical decision-making? True False

What evidence we have that it is in fact true? In the study, "The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization," it was found that physicians referred hypothetical white male, black male, and white female patients (videotaped actors who presented with the same symptoms of cardiac disease) for cardiac catheterization at the same rates (90.6%) but were significantly less likely to recommend catheterization procedures for black female (78.8%) patients exhibiting the same symptoms. (Schulman 1999; Schwartz 1999).

Why is it important to know the answer to these questions?

American Cultural Diversity Diversity ▫Is the South different from the North? ▫Why do you think they are different?

Latino Cultural Diversity Where do Latinos come from?

Latino Cultural Similarities Generalizations not Stereotypes ▫Familismo  The importance and influence of family ▫Machismo  Male as the head of the family ▫Confianza  Trust ▫Fatalismo  Lack of control of one’s life ▫Curanderismo  Spiritual and herbal remedies ▫Space  Lack of space ▫Cordial  Sometimes to a fault

Nationally Latinos make up 15% of the population in the United States but account for 17% of new infections and 18% of those living with HIV/AIDS HIV and Latinos 17% 35% 66% 45% 12% 15% New HIV InfectionsUS Population White, Non-Hispanic Black, Non-Hispanic Hispanic Asian/Pacific Islander 2%5% American Indian/ Alaska Native 1%

HIV and Latinos Locally ▫Latinos are 3.1% of the population and account for 3 % of those living with HIV/AIDS ▫Less than half of Latinos have ever been tested

HIV and Latinos Risk FactorsBarriers to Care Familismo Machismo Fatalismo Stigma Limited condom use Lack of knowledge about HIV High rate of STIs Test late Access to care Religion Fear of deportation Language

Communicating Recognition Respect Self-Awareness Empathy Generalize don’t Stereotype Address

Latino Cultural Similarities Generalizations not Stereotypes ▫Familismo  The importance and influence of family ▫Machismo  Male as the head of the family ▫Confianza  Trust ▫Fatalismo  Lack of control of one’s life ▫Curanderismo  Spiritual and herbal remedies ▫Space  Lack of space ▫Cordial  Sometimes to a fault

Case Study Maria is a 42-year-old Hispanic woman who reports to a clinic for her HIV test results. Maria’s primary language is Spanish, and she does not speak or read English. During the initial appointment, Maria met with Melissa, an HIV counselor, and Ana, the only certified interpreter at the clinic. When Melissa scheduled a follow- up appointment for Maria for this week, she knew that Ana was starting maternity leave and would not be available when Maria returned for her HIV test result. After much discussion, Maria, Melissa, and Ana decided that Maria would bring her older sister, Cristina, to the follow-up appointment to translate and to help with communication. Maria identified Cristina as a “safe and supportive” person and stated that “her English is pretty good.” During the follow-up appointment, Melissa shares the HIV test results with both Maria and Cristina. As Melissa informs Cristina that her sister has tested positive for HIV, Cristina begins to cry. She translates the results to Maria, who also begins to cry.

Couple HIV/AIDS awareness with other health topics whenever possible. Events

Why should I make adjustments? The burden is on us Health care providers are respected