Many times, Latino patients and caregivers seek a friendly and warm approach to care. Simpatia guides Latinos' desire to maintain patient-provider relationships that are rooted in respect and politeness. Often, this results in the feeling that they cannot ask questions or cast doubt on a health care provider's opinions.
In a group in Brooklyn, a Latino man with HIV told of going to his doctor with cold symptoms. The doctor recommended he go to the local pharmacy and just buy an over-the-counter cold remedy. But at the pharmacy, he was frustrated that his doctor had not written down exactly which medicine to buy. "There are so many different medicines. How am I supposed to know which will interact with my other meds? He just should have told me what I needed." He left the store without any medicine. Not wanting to question his doctor's orders or seem disrespectful, he never discussed it with his doctor.
A limited ability to speak English can prevent Latinos from seeking care to the same degree that a lack of health insurance can. In addition, English-speaking Latinos seek more preventive services than those who do not speak English. The lack of Latino health care providers may keep away Latinos who prefer to have providers who speak their language and share their culture. Some facilities have bilingual staff and interpreters, but without appropriate training on interpretation techniques and medical terminology, miscommunication can lead to medical errors. Family members, especially children, and untrained staff should not be used as interpreters when relaying sensitive medical information such as HIV test results. Regional Spanish translation is necessary to accommodate for differences in terminology.
The reading level of materials for Latinos must also be checked for each target audience. Latinos face enormous educational barriers and many have literacy problems. Without attention to literacy level in both Spanish and English, HIV materials will be of little or no use to a large percentage of Latinos.
Networking with Spanish-language radio and television stations has been an effective way of communicating important prevention information to Latino communities. In order to maximize exposure to culturally appropriate HIV prevention education, health care organizations should attempt to reach households where Spanish or an indigenous language is the only language spoken.
Latinos are the largest group of uninsured and underinsured people in the U.S. and are twice as likely to lack health insurance as the overall U.S. population. These rates have remained high due to immigration status, economic barriers, educational status, and employers who do not offer benefits to low-wage-earning Latinos. According to a 2011 Kaiser Family Foundation study, Latinos are more likely than whites to obtain health care through public clinics or emergency rooms, and to lack a regular source of health care. This may explain why Latinos are likely to learn their HIV status later in the disease process than whites.
The lack of culturally appropriate health care, little targeted HIV education, economic difficulties, fear of deportation, and a perceived low HIV risk combine to leave Latinos at high risk of HIV. Although the time between untreated HIV infection to an AIDS diagnosis is generally agreed to be 10 to 12 years, 65% of Latinos are diagnosed with AIDS within one year of their HIV diagnosis, meaning they have been unknowingly living with HIV for many years. They also have lower CD4 cell counts and higher viral loads when first tested for HIV.
Since HIV has long been associated with gay men and injection drug users, health care providers are less likely to recommend HIV testing to married Latinas, who make up an increasing share of women with AIDS. One way to encourage HIV testing among Latinos is to frame it as a prevention method that will benefit not only the patient but the entire family. Slogans such as "Protege tu familia: Hazte la prueba" or "Protect your family: Get tested" can be strong motivators for Latinos who do not identify with groups they feel are at risk for HIV.
To communicate with patients from different cultures, providers must be able to respond to their cultural expectations. So, in addition to collecting information on a patient's health problems, every provider should ask about a patient's cultural background. In The Latino Patient, Nilda Chong proposes using the GREET model when working with Latinos:
R easons for Immigrating
E xtended or Nuclear Family
E thnic Behavior
T ime in the U.S.
This model provides an opportunity to collect cultural information while demonstrating interest in the lives of their Latino patients, establishing confianza (trust).
Health care providers should remember that Latinos are diverse. They must not stereotype but rather treat each Latino patient as unique, with the respect each deserves. The process of becoming culturally competent is a continual learning process, and each interaction is an opportunity for learning.
According to the National Minority AIDS Education and Training Center, providers can offer culturally sensitive care to Latinos with HIV if they:
Providers must remain mindful of the many factors that contribute to HIV risk among Latinos and the impact that cultural and gender expectations have. The HIV epidemic among Latinos presents important challenges to community leaders, patients, health care providers, policymakers, researchers, and public health officials. A holistic approach to address HIV is extremely important if we are to reduce HIV and treatment differences among Latinos, and improve health care and health status for all.
Luis Scaccabarrozzi is Director of HIV Health Literacy Programs at ACRIA.
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