National Latinx AIDS Awareness Day (NLAAD) occurs every fall on October 15 in an effort to promote information about and access to HIV testing and treatment focused on the Hispanic and Latinx communities, who are disproportionately impacted by HIV.
The date is important every year, of course. But in 2021, it’s particularly crucial. This June marked 40 years since the first reports of the condition that later became known as HIV.
Over the past four decades, we’ve made huge strides in HIV prevention and treatment. But we’ve also left lots of people behind. We lack progress in eliminating healthcare disparities that hinder access for the communities most disproportionately affected.
“The Latinx community continues to be overrepresented in HIV cases when compared to their percentage of the U.S. population,” says Dr. Richard Jimenez, a faculty member in Walden University’s PhD in Public Health program.
“Awareness campaigns help to ward off complacency and help keep HIV prevention top of mind,” Jimenez adds.
A lack of trust in the medical field — brought on by systemic racism and implicit racial and ethnic bias among healthcare workers — is a major barrier for some Latinx people when it comes to receiving HIV testing, prevention education, and care and maintaining care once it’s available. And that’s why the healthcare system needs to do a better job of becoming culturally competent and meeting people where they are.
“Culturally appropriate, meaningful, and sensitive educational interventions are important for reaching the Latinx community,” Jimenez says. “Members of the community who are marginalized and hard to reach don’t have readily available access to HIV prevention educational interventions or to the health system when services are needed.”
Outreach efforts like NLAAD are only a small part of the larger systemic changes needed to ensure that healthcare and educational programs take initiative to reach these communities.
Another huge barrier to testing and treatment for some people can be fear — and not just regarding their HIV status.
“If they’re undocumented, they have tons of fear of being deported,” explains Tammy Ayala, intensive case manager at EPIC Sexual Health Center in the Tampa, Florida, area. Ayala does outreach in communities with large migrant farmworker populations.
“I tell them, ‘We don’t report people. That’s not what we do here.’” she adds. “I haven’t had a client who is undocumented decline any services. As soon as they know help is available to them, they grab it with open arms. So I know it’s not due to them not wanting help or not wanting care. It’s just that they’re afraid.”
Despite policy statements by the American Medical Association regarding the ethical obligation to treat patients regardless of their immigration status, reports of individuals facing questioning or deportation after seeking medical care can lead to a justified hesitancy to seek care, even for legal immigrants.
Affordability can also be a concern, especially for those who don’t have access to health insurance or who have high out-of-pocket costs. “They don’t understand that there are resources out there for them that are free,” Ayala says.
The U.S. Census Bureau reports that in 2019, “Hispanics comprised 18.7 percent of the total population, but 28.1 percent of the population in poverty.”
And according to the Kaiser Family Foundation (KFF), as of 2019, people under 65 who were Hispanic, Black, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander were less likely to be insured than their white counterparts. KFF’s numbers show that, despite gains as a result of the Affordable Care Act, 20 percent of Hispanic Americans under 65 did not have insurance coverage in 2019.
The Ryan White HIV/AIDS Program is a federally funded program that provides financial help to people with HIV by covering the cost of medications and doctor’s visits related to HIV care.
“Undocumented people also qualify for that,” Ayala says. “So it’s not like they can’t qualify if they don’t have a social security number — whereas with a lot of nonprofit agencies, you have to have it.”
For these immigrant populations and the 67 percent of Hispanic Americans who were born in the United States, cultural and language considerations still affect health care access and outcomes. Acknowledging and incorporating these factors into healthcare programs can help these communities access care.
A big message Ayala wants to get out there for NLAAD is about prevention. Pre-exposure prophylaxis, better known as PrEP, is available to prevent HIV infection. “PrEP is an HIV pill for people who do not have HIV,” she explains.
“Depending on the person and how much they feel their risk level is,” Ayala adds, “they’ll want that pill.” Ayala still educates about safe sex and condom use because, she says, there are still a lot of other STIs out there, not just HIV.
Awareness about PrEP remains a big barrier, though. A report from the Centers for Disease Control and Prevention found that among men who have sex with men, a lower percentage of both Black and of Latinx men than white men had talked about PrEP with their healthcare provider.
“A lot of people don’t know about that pill,” Ayala says of her clients. “They’re shocked every single time.”
PrEP uses a form of combination antiretroviral therapy (cART or ART), which is the gold standard in HIV treatment today. Nowadays, people with HIV can take cART, a combination of several medications. Options include a daily pill and (just approved and coming soon) a longer-acting injectable.
Over time, treatment can bring a person’s viral load down to an undetectable level, also making the infection untransmissible (this is also known as U=U). “Not only are they healthy,” Ayala says, “but they’re not going to be spreading HIV to other people.”
She stresses that cART is not a cure and people must continue to take their medication. But people now live long and healthy lives with HIV. “Whatever dreams you had before HIV,” she says, “you can still have them after.”
So, what can you do for NLAAD? Ayala says, “Get tested. A lot of testing sites are free.” EPIC, for example, does not charge. Ayala says to pass the word around about testing options as well, if possible.
Stigma about HIV can still exist in any community, and that can be a barrier to seeking testing or care or following through with care, Ayala says. Talking openly about HIV can help reduce stigma. Post about awareness on social media and talk with friends and family.
“It all starts with awareness and acknowledging that the problem still exists, that we are being highly impacted, and that we can do something to prevent the problem,” Jimenez adds.