1. 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.) **************************************************** Please press *6 on your telephone keypad to mute your line (to un-mute your line, press *6 again) If you are experiencing difficulty with your phone connection, dial *0 for the conferencing service operator 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

2. 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

3. Understanding Latinas and their HIV- related 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

4. Presentation Overview Who are Latinas? Facts on Latinas and HIV Why are Latinas at risk? –Tips for agencies Building on the strengths of Latinas

5. Who are Latinas?

6. 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

7. Facts on Latinas and HIV

8. In 2002, HIV/AIDS was the 4 th 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

9. Official numbers surrounding HIV rates for Latinas are underestimated Latinas may not know they are infected Barriers to health care and HIV tests: –Work and family obligations –Language –Immigration –Transportation –Low risk by providers and Latinas

10. Agencies have a unique opportunity to provide services for Latinas that can stop the spread of HIV among them.

11. Why are Latinas at risk?

12. Vaginal lining exposes women to HIV from HIV-positive male partners Anal sex not often discussed and increases HIV risk

13. Contextual and Individual Risk Contextual factors Individual risk HIV

14. 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

15. Contextual factors of HIV risk Social dynamics between women and men Abuse Access to care Substance use

16. Contextual factors of HIV risk Social dynamics between women and men Abuse Access to care Substance use

17. 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

18. Talking to partners about condoms Difficulties negotiating: –Not wanting to argue –Fear of abuse –Fear partner will leave –Survival

19. “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

20. 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

21. 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.

22. Contextual factors of HIV risk Social dynamics between women and men Abuse Access to care Substance use

23. Two types of abuse placing women at risk Forced sex Intimate partner violence (IPV) 15% of Latina high school students reported being forced to have sex 1 in 4 women experience some form of IPV

24. 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.

25. 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

26. 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

27. 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

28. Contextual factors of HIV risk Social dynamics between women and men Abuse Access to care Substance use

29. 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

30. Difficulty accessing care Inability to pay Language barriers Work schedules Transportation difficulties Risk perceptions Male health providers

31. Tips for agencies 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

32. Contextual factors of HIV risk Social dynamics between women and men Abuse Access to care Substance use

33. 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

34. 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.

35. 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

36. What can we do?

37. Building on strengths Social Support Family Support Economic self- sufficiency Female role models

38. 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

39. Questions & Answers iGracias ~ Thank You!

40. 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 For more information or to learn how to receive CBA services, contact us at: 213.201.1345 www.accionmutua.org