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;12:153- 164.

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-rr- 03

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!!!!