Strengthening HIV approaches to reach Denver Latino populations

A mix of cultural and social factors is hindering programs in the Denver area to prevent Latino men who have sex with men from becoming infected with HIV. That finding emerged from a series of interviews and focus group discussions in late 2009 with 54 members of the Latino MSM community in Denver.

The research was conducted in English and Spanish by JSI Research & Training Institute, Inc. for the Colorado Department of Public Health and Environment (CDPHE). In a 62-page report on the study, JSI noted that the "social alienation" felt by many of the interviewees indicates that the phenomenon is hindering HIV-prevention initiatives.

According to the study, the Latino MSM community sees itself as stigmatized by other Latinos because of homophobic religious and cultural views, yet at the same time it is isolated from the mainstream gay and non-Latino populations.

Perceiving themselves as isolated and ignored, a majority of the interviewees "lacked a shared faith" that others would meet their needs, as the report puts it. The sum of those experiences "contributes to a feeling of mistrust of institutions," the report said.

The report, HIV Prevention Needs Among Hispanic/Latino Men Who Have Sex with Men in the Denver Metro Area, identified a chain of events that result from feelings of isolation. The outcome can be emotional distress, which leads to alcohol and drug abuse in some cases, and can produce an extreme desire for sexual intimacy to compensate for the lack of social connection. A further consequence too often is impulsive decision-making and unprotected sex.

Although other studies commissioned by the CDPHE reached a similar conclusion, JSI's provided a "thick and vivid description of the contextual lives" of the Latino MSM community and showed how those conditions impacted HIV risk and prevention, the report notes.

Recent Latino MSM immigrants to the United States are most at risk, particularly if they lack legal immigration status. The newcomers tend to be so preoccupied with finding and maintaining a job and, in the case of illegal immigrants, avoiding detection by immigration authorities, that health issues, including HIV is "not a priority" for them, explains Arman Lorz, JSI's coordinator for the Denver project. For example, undocumented immigrants are likely to avoid having an HIV test for fear that registering at a health center might expose their (undocumented) status.

Even where immigration status is not an issue, there is "social alienation" among the Latino MSM population because of the typically low tolerance for their sexual orientation within the wider Latino community, some focus group participants indicated. The alienation results from "being gay within a strict and uncompromising religious upbringing predominant in Latino cultures," the report found.

JSI staff worked in conjunction with the CDPHE on all phases of the project. For conceptualizing and evaluating guidance, JSI formed a 10-member project advisory group of Latino MSM community members living in the Denver area. To recruit  study participants, JSI created a flyer in English and Spanish, 500 of which were distributed at key locations in Denver.

In light of its study, JSI recommends an HIV prevention approach that is comprehensive and holistic, reflecting Latino MSM life and culture. The report suggests a series of specific steps that the CDPHE might take to strengthen HIV-prevention outreach to the Latino MSM community. Among the recommendations: Tailor HIV-prevention messages for the Latino MSM community, evoking themes that convey family support, for instance; offer a full range of confidential services, including educational, substance abuse and employment programs in a safe location; and provide quick, low-cost or free HIV testing at a general health care site rather than one limited to HIV testing.