As HIV Rates Fall Nationally, Latinx Communities Remain Disproportionately Impacted. Why?

Bay Curious, KQED’s podcast that explores the Bay Area’s unique local legends, interesting landmarks and uncovered histories, is inviting listeners to take off their headphones and take a walk in a park.

On Nov. 4 and 5, our journalists will take small groups on guided tours of the National AIDS Memorial Grove in Golden Gate Park, where they’ll tell stories about the formation of the memorial, known as The Grove. Along the way, there will be performances reflecting on the people who are remembered in the space.

Overall, according to the Centers for Disease Control and Prevention, human immunodeficiency virus, or HIV, has declined in the United States by 6% since 2010. But there’s been an escalation of new infections — 14% — in the Latinx community, particularly among gay and bisexual men. According to 2019 data from the CDC, Hispanic Americans accounted for almost 30% of new HIV infections while making up only about 18% of the country’s population.

In California, about 40% of residents identify as Hispanic or Latino, according to U.S. Census Bureau data.

Francisco Buchting, vice president of grants, programs and communications at Horizons Foundation, which invests in LGBTQ nonprofits, told KQED there is a stigma about HIV in the Latinx community.

“When HIV first started, it was the ‘gay cancer,’” he said. “Even in the present, it continues — homophobia — in parts of our community.”

In the 1980s, the face of the HIV movement was white, gay men. That, consequently, often left minorities absent from research literature, outreach initiatives and early treatment. In addition to homophobia, the entrenched religious beliefs in the Latinx diaspora contributed to the stigmatization of HIV.

Moral judgments about male same-gender relationships and fears of contagion dominated the public religious response during the first five or six years of the HIV epidemic, according to the National Center for Biotechnology Information. Additionally, the cultural value of machismo may create reluctance to acknowledge risky behaviors such as male-to-male sexual contact or substance misuse, according to the CDC.

Esperanza Macias, policy and communications director with the Instituto Familiar de La Raza, a San Francisco organization that promotes health in the Latino community, said gay Latin men often had to combat living outside of the stereotypes of being a dominant alpha male because they would face harassment and assault.

“A lot of men met in areas that ended up not being safe. That was the only way that they were able to explore their sexuality,” Macias said. “And, unfortunately, it was an unsafe way. And because they weren’t able to share that with their partners, oftentimes, their partners would also get HIV.”

The 2019 CDC data found that both Hispanic men and women were four times as likely to have AIDS — the condition caused by HIV — as compared to white men and women. It also found that Hispanic men were twice as likely to die of HIV infection than non-Hispanic white men, while Hispanic women were three times as likely to die than non-Hispanic white women.

Buchting told KQED that a growing shift in recent decades to abstinence-only sex education in the U.S. and Latin America, fueled by conservatism and religion, complicated HIV prevention efforts.

“I think within the religion piece, especially in the space that I fund internationally, we look at religious fundamentalism as one of the driving forces for this — [the] safe, secure, legal access to comprehensive reproductive rights, including abortion or LGBTI rights,” he added.

Macias, who has worked to teach youth of color about sexually transmitted diseases like HIV, said the push for abstinence messaging wasn’t good for the health of young people who have hormones and are naturally curious.

“It was a matter of exposing people to the concepts and to the importance and recognizing that it was much more a health issue than an issue of religion,” Macias said, referring to sex education. “It was not a tradeoff between promiscuity and other negative characteristics associated with sex education. It was really a matter of being a critical health issue — that it was important for young men and young women.”

Social and economic factors, like poverty, racial discrimination and lack of access to health care, can increase the risks of HIV, according to the CDC. But language barriers, low academic achievement and mistrust of the health care system may also affect the quality of HIV care many Latinos receive.

There are also several studies that indicate HIV-infected undocumented immigrants enter care at a more advanced stage than others.

“If you’re undocumented, you may not be as comfortable responding to surveys for a host of reasons,” Buchting said. “When I was working in HIV in LA, especially a lot of the Latino patients that I saw, they were accessing services much later, compared to the non-Latino patients. And their HIV had progressed to the point that sometimes the first encounter with them was already an AIDS diagnosis as opposed to an HIV infection.”

Undocumented people also face unique barriers to receiving necessary care, including stigmatization, high levels of acculturation stress, and fear of deportation, according to the National Institutes of Health. Many also have very limited access to health care coverage and are ineligible to enroll in federally-funded health care programs like Medicaid and Medicare.

But Buchting said that compared to decades ago, there are now many more treatment options for HIV, which is currently viewed as a chronic medical illness that can be managed. Research on HIV has progressed significantly since the 1980s, he noted, including HIV prevention medication like pre-exposure prophylaxis, commonly known as PrEP, which reduces the risk of HIV from sex by 99%.

“Now, as HIV is evolving and less at the forefront, we’re looking at what other ways [we can] partner,” Macias said about Instituto Familiar de La Raza. “Then, if our focus is not so much on saving the LGBT Latino community from a fatal disease, what can we do to support their wellness now? And I feel like that’s a wonderful thing to witness.”

More than 100,000 Latinos have died since the start of the HIV/AIDS epidemic, according to a 2016 CDC report. Buchting says the work being done at the organizational level is made to honor those who passed.

“We know that, hopefully, one day, there’ll be a cure, but until then, continue to work to help those infected and those that are living with it,” he said. “And try to do as much prevention as we can.”

Guided tours of the National AIDS Memorial Grove in Golden Gate Park are from 1–3 p.m. Nov. 4 and 5. Space is limited. Tickets cost $25. For more information and to register, visit kqed.org.