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Prevention Challenges
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En español

Image of Hispanic mother and father holding small girl.A number of cultural, socioeconomic, and health-related factors contribute to the HIV epidemic in the US Hispanic/Latino community. Research shows that behavioral risk factors for HIV infection differ by country of birth. Data suggest that Hispanics/Latinos born in Puerto Rico are more likely than other Hispanics/Latinos to contract HIV as a result of injection drug use or high-risk heterosexual contact (Table) [3]. By contrast, sexual contact with other men is the primary cause of HIV infections among Hispanic/Latino men born in Central or South America, Cuba, Mexico, or the United States [3].

Transmission categories and country of birth of Hispanics/Latinos with AIDS diagnosed in the United States during 2006

 

Central/
South America
(n = 814)
%

Cuba
(n = 145)
%

Mexico
(n = 1,334)
%

Puerto Rico
(n = 1,346)
%

United States
(n = 2,608)
%

Male-to-male sexual contact

49

62

59

18

45

Injection drug use

10

9

10

40

22

Male-to-male sexual contact and injection drug use

3

4

4

5

6

High-risk heterosexual contact

36

24

26

36

25

Othera

1

0

1

1

2

aIncludes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.

Sexual Risk Factors

Image of older Hispanic male/female couple.Hispanic/Latina women are most likely to be infected with HIV as a result of sex with men [3]. In a study of heterosexual Hispanics/Latinos in the United States, 16% had sexual risk factors for HIV infection, including multiple sex partners or partners with risk factors for HIV infection [6]. Some women, including those who suspect that their partners are at risk for HIV infection, may be reluctant to discuss condom use with their partners because they fear emotional or physical abuse or the withdrawal of financial support [7]. An assessment of HIV risk behaviors among men who have sex with men (MSM) in the southeastern US found that Hispanic/Latino and African American men were more likely than white men to report inconsistent condom use during anal sex with multiple partners and that Hispanic/Latino men were more likely to have never been tested for HIV infection [8]. However, in a study of heterosexual Hispanic/Latino men, consistent recent condom use and intentions to use condoms during the next month were associated with positive attitudes about condom use, perception that one’s partner had a positive view of condom use, and greater participation in decision making about condom use [9].

Substance Use

Injection drug use continues to be a significant risk factor for Hispanics/Latinos, particularly among those living in Puerto Rico [3]. Drug users in Puerto Rico are more likely to share syringes, cotton, and rinse water and to inject more frequently than Hispanic/Latino drug users on the US mainland [10]. Sharing syringes is not the only HIV risk factor related to substance abuse. Both casual and chronic substance users are more likely to engage in risky sex behaviors, such as unprotected sex, when they are under the influence of drugs or alcohol [11].

Sexually Transmitted Diseases

In 2006, the rate of chlamydial infection for Hispanics/Latinos (477/100,000) was about 3 times the rate for whites (not Hispanic/Latino) (153/100,000) [12]. The rates of gonorrhea and syphilis for Hispanics/Latinos were about twice the rates among whites: gonorrhea—77/100,000 Hispanics/Latinos compared with 37/100,000 whites; syphilis—4/100,000 Hispanics/Latinos compared with 2/100,000 whites. Partly because of the physical changes caused by sexually transmitted diseases (STDs), including genital lesions, which can serve as an entry point for HIV, the presence of certain STDs can increase one’s chances of contracting HIV 3- to 5-fold [13].

Hispanic/Latino Cultural Beliefs: Risk and Protective Factors

Image of two young Hispanic men having coffee.Research has shown that Hispanic/Latino cultural concepts of masculinity and femininity, thus the social norms of sexuality, have created double standards and power inequalities that have been linked to HIV risk and protective behaviors [14]. For some Hispanic/Latino men, the traditional gender role of machismo has positive implications for HIV prevention, such as strength and protection of the family [15]. However, proving masculinity through power and dominance can lead both straight and gay Hispanic/Latino men to engage in risky sex behavior, such as sex with multiple partners [16], unprotected sex with women or men [16, 17], or sexual coercion [18]. Familismo, or a strong commitment to family, can be a strong incentive for some Hispanic/Latino men to reduce unprotected sex with casual partners. Familismo can also be a source of conflict for Hispanic/Latino men who have sex with men (MSM), whose families may have a negative view of homosexuality [19]. Further, many Hispanic/Latino MSM identify themselves as heterosexual and, as a result, may not relate to prevention messages crafted for gay men [20, 21].

For some Hispanic/Latina women, the traditional gender roles—marianismo, in which women are expected to be pure and to acquiesce to men’s desires [22] and simpatía, in which the importance of nonconfrontational relationships is emphasized [23]—, combined with sexual silence impede the discussion of sexual issues and the negotiation of sexual safety with male partners [24]. In one study, Hispanic/Latina women’s denial of personal risk for HIV infection was associated with a lack of information about how to avoid risky behaviors [22].

Greater acculturation into the US culture has been associated with the adoption of several health-protective behaviors among Hispanics/Latinos, including communicating with partners about sexual safety [25] and disclosing positive HIV serostatus [26]. However, high levels of acculturation have also been associated with an increase in behaviors that are risk factors for HIV infection [16]. In one study, highly acculturated HIV-positive Hispanic/Latino men were more likely to use drugs before sex, which increased unsafe sexual behavior [27]. For Hispanic/Latina women, those who were more highly acculturated were more likely to inject drugs and to have had a greater number of sex partners [25].

Because of the diversity of Hispanic/Latino people and cultures in the United States, the above-mentioned research on Hispanic/Latino cultural beliefs and HIV risk behaviors does not apply to all individuals or groups of Hispanic/Latino origin.

Socioeconomic Issues

Image of older Hispanic woman with younf Hispanic girls, reading at a table.More than 1 in 5 (21.9%) Hispanics/Latinos live in poverty [28]. Various socioeconomic problems associated with poverty, including a lack of formal education, unemployment, inadequate health insurance, and limited access to high-quality health care, can directly or indirectly increase the risk for HIV infection. Hispanics/Latinos are more likely than whites (not Hispanic/Latino) to receive a diagnosis later in the course of HIV infection (even when they already have AIDS), suggesting that they are not accessing testing or health care services through which HIV infection could be diagnosed at an earlier stage [29, 30].

The migration patterns, social structure, language barriers, and lack of access to regular health care among transient Hispanic/Latino immigrants can affect awareness and hinder access to HIV/AIDS prevention and care [31, 32]. Recent immigrants face additional challenges, such as social isolation and lack of information about HIV/AIDS, which can further increase their risk for exposure to HIV [16]. Thus, transient and recent Hispanic/Latino immigrants need linguistically and culturally appropriate HIV prevention services.

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Last Modified: October 6, 2008
Last Reviewed: October 6, 2008
Content Source:
Divisions of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

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