Transcript Slide 1

Latinos and HIV:
Cultural Issues that
affect care
Bernie Vazquez
Thomas Street Health Center
Houston, Texas.
Objectives
Define culture and its effect on
medical care and treatment.
 Gain knowledge of cultural issues
that may affect medical care and
adherence with Latino patients.
 Build skills to improve the
provision of culturally sensitive
services to Latinos.

Culture


Most social scientists today view
culture as consisting primarily of
the symbolic, ideational, and
intangible aspects of human
societies. People within a culture
usually interpret the meaning of
symbols, artifacts, and behaviors in
the same or in similar ways.
Banks, J.A., Banks, & McGee, C. A. (1989). Multicultural
education. Needham Heights, MA: Allyn & Bacon.
Culture and Health
Culture can be thought of as
an integrated pattern of
learned beliefs and
behaviors that are shared
among a group of people.
This is how WE do this…
My Mom used to say….
Culture and Health
Beliefs and behaviors include
styles of communication, ways
of interacting, views on roles
and relationships, values,
practices, and customs.
“Nobody talks to me like that”
“This is HOW I talk”
Culture and Health

"Culture is the shared
knowledge and schemes
created by a set of people for
perceiving, interpreting,
expressing, and responding to
the social realities around
them" (p. 9).
Lederach, J.P. (1995). Preparing for peace: Conflict
transformation across cultures. Syracuse, NY: Syracuse
University
Culture and Health
Beyond cultures of
origin, people are
influenced by the many
group cultures to which
they belong.
(Example: Latinos
infected with HIV…)

Culture and Health

These can include kinship
networks; ethnic, gender, or
sexual orientation identity
groups; religious affiliations;
social classes; geographic
regions; occupation; and
disability.
Culture and Health
These variables
influence us in many
ways and are reflected
in what we think about
health care and the
people who provide it.
 “I like only Latino
Doctors”
 “I would prefer to have
a male doctor”

Ethnocentrism
Ethnocentrism is the
tendency to believe that
one's ethnic or cultural
group is centrally
important, and that all
other groups are
measured in relation to
one's own.
 “The medicine in my
country is better”
 “They send me medicine
from my country”

Ethnocentric
Ethnocentric people may
also adopt a new
culture, repudiating
their birth culture,
considering that the
adopted culture is
somehow superior to
the birth culture .
 “ I only like American
doctors”

Familism
Familism - the higher
importance of the family to the
individual.
 “My children come first”
 “Let me ask my …first”

Sexual Discomfort


Sexuality appears to be even
more intensely private and
personal in Latino culture than
in non-Latino white culture.
Sexual issues are often not
discussed even between sexual
partners.
Burgos NM, Diaz Perez YI. An exploration of human
sexuality and the Puerto Rican culture. J Soc Work
Hum Sexuality 1986;4:135-150.
Sexual Discomfort


In traditional Latino culture,
the "good" woman is not
supposed to know about
sex, so it is inappropriate for
her to bring up subjects like
AIDS and condoms.
Pavich E. A Chicano perspective on Mexican culture and
sexuality. J Soc Work Hum Sexuality 1986;4:47-65.
Respeto

Respeto" requires maintaining
one's sense of personal integrity
in interactions with others. By
implication, a person receiving
medical or drug treatment must
feel that he or she is treated
with respect and valued, or
treatment will be rejected.
Marin B, Marin G, Juarez R. Differences between Hispanics and nonHispanics
in willingness to provide AIDS prevention advice. Hisp J Behav Sci 1990;12:153164.
Respeto

Another dimension of
"respeto" is that often
patients will not
question an authority,
even if they do not
understand something
that is said.

Marin BV, Marin G, Juarez R. Differences
between Hispanics and Non Hispanics in
willingness to provide AIDS prevention
advice. Hisp J Behav Sci 1990;12:153-164.
Simpatia
Simpatia - the act of being
polite; respectful not
confrontational
 “I don’t want to bother the
doctor”
 “ They will get mad if I tell
them”

Triandis HC, Marin G, Lisansky J, et al. Simpatia as a
cultural script of Hispanics. J Pers Soc Psychol
1984;47:1363-1375.
Marianismo

"Marianismo" comes from the Virgin
Mary (or "Maria"). It is the supposed
ideal of true femininity –i.e. being
modest, virtuous, and sexually
abstinent until marriage—and then
being faithful and subordinate to their
husbands. Evelyn P. Stevens, "Marianismo: la otra cara
del machismo en Latino-América"; in: Ann Pescatelo, Hembra
y macho en Latino-América: Ensaios., Edición Diana, México
1977, p.123.
Marianismo
In traditional Latino culture, the
"good" woman is not supposed to
know about sex, so it is
inappropriate for her to bring up
subjects like AIDS and condoms.
 “ Women always suffer”
 “That happens when you play
with men”
 “That is a woman’s curse”

Machismo

In some communities the
satisfaction and wellbeing of
the male family members
is a priority. In terms of
machismo, males have an
“expansive and almost
uncontrollable” sexual
appetite, and it is their right
to satisfy that desire in the
ways they choose . Pavich E. A Chicano
perspective on Mexican culture and sexuality. J Soc
Work Hum Sexuality 1986;4:47-65.
Machismo
In contrast, female sexuality
is seen as an object over
which the male has control.
 Females are expected to
have only one sexual partner,
none before or outside of
marriage .
 Extramarital affairs are the
primary way in which males
prove their masculinity

Homophobia

One impact of homophobia is
that many men who have sex
with men, particularly young
and minority men, do not
disclose their sexual orientation
in order to avoid social
isolation, discrimination, abuse,
and violence.
Barbara Van Oss Marín, PhD, University of
California San Francisco
 Cynthia A. Gómez, PhD, University of
California San Francisco
 http://hivinsite.ucsf.edu/InSite?page=pr-rr03

Homophobia
The fear of rejection by
friends and family can be
a strong reason not to
reveal HIV status or risk
factors…
 This includes not
disclosing risk behavior
to doctors or counselors.

Providing Culturally Appropriate
HIV-Related Services

It is critical that service
providers ask questions to
assure that medical
information and behavior
change messages have
been correctly
understood. (i.e. simpatia,
respeto)
Providing Culturally Appropriate
HIV-Related Services

Latinos may be more
likely to trust and
cooperate with
someone with whom
they have had pleasant
conversations, often
referred to as "la platica"
by Mexican Americans.
Providing Culturally Appropriate
HIV-Related Services
Provide culturally sensitive
material.
 Respect and value cultural
characteristics
 Cultural strengths such as
strong family orientation can
be used to encourage safe
sexual and drug behaviors.

Providing Culturally Appropriate
HIV-Related Services

Agencies and Service
Providers offer
multicultural services
and have staff that can
help not only providing
the language but the
sensitivity training .
Providing Culturally Appropriate
HIV-Related Services

Latinos have a different
perception of time. A
hurried pace or focus on
saving time on the part of a
caregiver may be seen as
rudeness, because in Latino
culture, time is not as
important as interpersonal
relationships.
Providing Culturally Appropriate
HIV-Related Services
Cultural strengths such as
strong family orientation
can be used to encourage
safe sexual and drug
behaviors.
 Greater understanding of
and respect for Latino
culture will lead to better
HIV prevention efforts.

Principles of cultural competence




Define culture broadly.
Value clients’ cultural
beliefs.
Recognize complexity in
language interpretation.
Facilitate learning and
collaboration between
providers and patients.
Muchas Gracias!!!!