Transcript Educational Equity Intiative (EEI)

Welcome to the Acción Mutua
web-seminar on Understanding Latinas
and their HIV-related risks
Before we begin, a little about our format…
•Presentation by seminar speaker (approx. 30 min.)
•Followed by question and answer session
(approx. 30 min.)
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•Questions submitted prior to the web seminar will be
addressed first during the Q&A
•For questions that arise during the presentation, click on
the “hand” button and type your question or wait to be
called on to ask your question over the phone
Acción Mutua is a capacity building
assistance (CBA) program of AIDS
Project Los Angeles in collaboration
with the César E. Chávez Institute of
San Francisco State University
Funded by the Centers for Disease Control
and Prevention
Understanding Latinas and their HIVrelated risks when planning and
implementing HIV prevention programs
Dr. Rita M. Meléndez
Assistant Professor
Human Sexuality Studies
Research Associate
Center for Research on
Gender and Sexuality
San Francisco State University
Presentation Overview
• Who are Latinas?
• Facts on Latinas and HIV
• Why are Latinas at risk?
– Tips for agencies
• Building on the strengths of Latinas
Who are Latinas?
Who are Latinas?
• Diversity
– Ethnicity, color, language, SES
– Different partners
• Women and men
• Steady and casual
• Partners in US and outside the US
• In jail out of jail
• Partners who use and do not use
drugs
Facts on Latinas and HIV
Facts on Latinas and HIV
• In 2002, HIV/AIDS was the 4th
leading cause of death among
Latinas aged 35 to 44
• 25% of all Latinos infected with
HIV are women
• Most Latinas (75%) are infected
through sex with an HIV-positive
male partner
Official numbers surrounding
HIV rates for Latinas are
underestimated
• Latinas may not know they are
infected
• Barriers to health care and HIV tests:
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–
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–
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Work and family obligations
Language
Immigration
Transportation
Low risk by providers and Latinas
Agencies have a unique
opportunity to provide services
for Latinas that can stop the
spread of HIV among them.
Why are Latinas at risk?
Why are Latinas at risk?
• Vaginal lining exposes women
to HIV from HIV-positive male
partners
• Anal sex not often discussed
and increases HIV risk
Contextual and Individual Risk
Contextual
factors
Individual
risk
HIV
Why are Latinas at risk?
• Larger social factors provide a
context for risk to emerge
– Unsafe sex is common
– HIV follows social patterns
– Location is important!
• Health care
• Drug use
Contextual factors of HIV risk
• Social dynamics between
women and men
• Abuse
• Access to care
• Substance use
Contextual factors of HIV risk
• Social dynamics between
women and men
• Abuse
• Access to care
• Substance use
Social dynamics
between women and men
• Traditional gender roles
– Women are expected to be
passive in sexual situations
– Men are expected to be active in
sexual situations
• Some women put their partner’s
needs above their own
Talking to partners
about condoms
• Difficulties negotiating:
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–
–
–
Not wanting to argue
Fear of abuse
Fear partner will leave
Survival
“Monogamy” is a risk factor
• Condom negotiation is difficult
in long-term relationships
• Women can become infected
by a long-term partner
– Women feel safe in relationship
– Do not expect (or discuss with)
their partner other sexual partners
– Providers not aware of risk
Helping clients in
approaching a partner
• Women need many options
– Help women make a plan beforehand
• What to say
• When to start conversation
– Provide assertive role playing or training
– Provide strategies for women (i.e.
condoms vs. the pill - “my doctor says…”)
– Provide creative solutions
Tips for approaching a partner
“I would not like my husband to
cheat on me, but I tell him, “The
day you want to have sex with
another woman, you better wear
‘el gorrito’ (condom)”
Gonzalez-Lopez, G. (2005). Erotic Journeys: Mexican immigrants and their sex lives.
Berkeley: University of California Press.
Contextual factors of HIV risk
• Social dynamics between women and
men
• Abuse
• Access to care
• Substance use
Two types of abuse
placing women at risk
Forced sex
•15% of Latina
high school
students reported
being forced to
have sex
Intimate partner
violence (IPV)
1 in 4 women
experience some
form of IPV
Forced sex and HIV
“He had been drinking and he had
had a bad day...and [sex] was his
release. He said, 'Let's go to bed now.'
I said, 'No, I'm not in the mood.' He
said, 'Yes, you are.' Before I knew it, he
took off my clothes and he was on top
of me. If felt like [I was] being raped…”
Davila, Y.R. and Brackley, M.H.(1999). Mexican and Mexican American women in a battered
women’s shelter: barriers to condom negotiation for HIV/AIDS prevention. Issues in Mental
Health Nursing. 20, 333-355.
Consequences of forced sex
• Direct risk for HIV
• Indirect risk for HIV
– Long-term effects of abuse may
lead to abusive relationships in
future, inability to negotiate safer
sex
Intimate Partner Violence
• Higher rates of HIV infection
among women who report past
abuse
– History of abuse
• Cycle of abuse
– Economic (support) dependence
– Difficulty negotiating safer sex
– Difficulty refusing sex
Tips for clients in approaching
an abusive partner
• Women in abusive relationships need
to protect themselves against HIV
• Ask clients to:
– Stay calm, repeat in your mind what you
want to say, stay on point
– Solve problem together
– Change subject if your partner becomes
angry and you fear what he will do
– Remove yourself from the scene if you
feel you are in physical danger
Contextual factors of HIV risk
• Social dynamics between women and
men
• Abuse
• Access to care
• Substance use
Importance of accessing care
• Women need check-ups for STIs
and HIV
• Women with untreated STIs are
up to 10 times more likely to
become infected with HIV
Difficulty accessing care
• Inability to pay
• Language barriers
• Work schedules
• Transportation difficulties
• Risk perceptions
• Male health providers
Tips for agencies
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Provide health services in Spanish
Encourage check-ups (referrals)
Encourage mothers to get care
Make sure Latinas are aware of risks
Provide childcare
Provide transportation services
Consider mobile clinics
Contextual factors of HIV risk
• Social dynamics between women and
men
• Abuse
• Access to care
• Substance use
Substance Abuse and HIV
• Use alcohol or recreational
drugs that increase risky
behaviors
• Partners who use drugs
– Risky sex and/or share needles
• Latinas may inject drugs
– Sharing needles can be a source
of intimacy
Substance Abuse and HIV
“I did not do it consciously. I did it
after a party. I was kind of drunk
and I was not completely aware. I
think I drank alcohol to feel more
encouraged….”
Gonzalez-Lopez, G. (2005). Erotic Journeys: Mexican immigrants and their sex lives. Berkeley:
University of California Press.
Tips for agencies dealing with
substance abuse
• Based on your capacity, provide
referrals or services for substance use
• Make sure Latinas understand the
HIV risks associated with alcohol and
drug use
• Dealing with substance abuse offers
opportunities to address safer sex
practices
What can we do?
Building on strengths
Family
Support
Female role
models
Social
Support
Economic
selfsufficiency
Understanding Risk
in Prevention Work
• Create prevention programs for
and by Latinas
• Build solidarity among women of
color
• Provide different solutions
– No one solution will work for all
iGracias ~ Thank You!
Questions & Answers
For more
information
or to learn
how to
receive
CBA
services,
contact us
at:
www.accionmutua.org
213.201.1345
Future Acción Mutua web seminars:
Program Evaluation (overview)
November 16, 2006
Machismo, Sexism: Is there a difference?
Mid December, TBA
Latina Transgenders & HIV Risk
January 18, 2007
Program Evaluation
January 25, 2007 (overview)
February 27, 2007 (part two – process evaluation)
March 27, 2007 (part three – outcome monitoring)
Web seminars in development:
Latino Immigration & HIV
Social Marketing & Promotional Materials Development
At Risk Latino Youth
Gang Affiliation, Incarceration and HIV
Crystal Meth 101