Health and Lifestyle

Febuary 1, 2001

Hermanos de Luna Y Sol

An Empowerment HIV Prevention Program for Spanish-Speaking Latino Gay/Bisexual Men.

Latino gay/bisexual men in the U.S. have been highly and disproportionately affected by the AIDS epidemic. The program "Hermanos de Luna y Sol" (HLS) was designed as a culturally appropriate HIV risk-reduction intervention that targets immigrants, Spanish-speaking gay/bisexual men in the San Francisco, CA Mission district.

HIV Risk Factors for Latino Gay/Bisexual Men

As overlapping members of two high-risk groups ("Latinos" and "men who have sex with men"), Latino gay/bisexual men in the U.S. have been highly and disproportionately affected by the AIDS epidemic.

During 1990, death rates (per 100,000) for HIV-related causes were 22.2 for Latinos compared to 8.7 for Whites. By June 1994, 17% of all diagnosed AIDS cases in the country were Latino, an ethnic group that constitutes only about 9% of the U.S. population.

Similarly, since the very beginning of the HIV epidemic, "men who have sex with men" (MSM) have carried the largest and most disproportionate share of AIDS cases in the nation; as of June 1994, 65% of all male diagnosed AIDS cases in the U.S. have been among MSM. By June 1994, a total of 29,432 AIDS cases have been diagnosed among Hispanic/Latino "men who have sex with men;" Latino MSM thus constitute 52% of all reported Latino male AIDS cases in the nation.

The number of diagnosed AIDS cases in the nation continues to increase at a faster and disproportionate rate among Latino than White men who have sex with men. For example, by March 1993, a total of 21,021 AIDS cases had been diagnosed in Latino MSM; by June 1994, 15 months later, the number of diagnosed Latino MSM AIDS cases had risen to 29,432. Thus, in the 15 months between March 1993 and June 1994, AIDS diagnosed cases increased about 40% among Latino gay/bisexual men. This large percentage increase should be examined in comparison to a much slower -- though also painfully dramatic -- 29% increase of AIDS cases in non-Latino White MSM during the same time period.

The numbers are even more striking when they are examined for cities with a high concentration of Latinos and homosexuals. In San Francisco, CA, for example, the number of Latino AIDS cases diagnosed annually increased from 168 cases diagnosed in 1989 to 334 diagnosed in 1992; approximately 80% of these cases are Latino gay and bisexual men.

This unfortunate increase in AIDS cases among Latino gay/bisexual men stands in contrast to the slower, though also unfortunate, increase of cases for non-Latino Whites in the city during the same time period (an increase from 1533 cases in 1989 to 2239 in 1992; of these cases, 87% are gay/bisexual males). In other words, the number of yearly reported AIDS cases in the city increased 99% for Latinos, while only 46% for non-Latino Whites within the same four-year period.

Research Findings About Gay/Bisexual Latino men

For clearly established biological reasons, and confirmed by clear epidemiological findings, anal intercourse without condoms (i.e. "unprotected") is recognized as one of the most efficient routes for the transmission of HIV. Unfortunately, behavioral studies done to date converge on the finding that Latino gay/bisexual men have had enormous difficulties adjusting to condom use and adopting less risky forms of sexual behavior. In fact, five studies that have measured rates of unprotected anal intercourse in gay/bisexual men show that Latinos had the highest rates of unprotected anal intercourse when compared to samples of non-Latino Whites, African-Americans, or men from other minority groups.

Of special concern is that risk behavior occurs in the presence of substantial knowledge about modes of HIV transmission and means of prevention, as well as in the presence of relatively strong intentions to practice safer sex.

According to qualitative research conducted by Dr. Rafael M. Diaz in San Francisco's Mission district, Latino gay/bisexual men are having serious difficulties in the enactment of safer sex intentions. Well-aware of the risks involved, and aware of the discrepancy between their HIV knowledge, intentions, and behavior, Latino gay men helplessly confess not understanding why this is the case. The situation is further complicated by the frequent use of drugs/alcohol during sex, increased anonymous encounters in public sex environments, and situations of financial dependence leading to prostitution and/or sexual relations with men of unequal power and status.

Diaz's research suggest that sexual self-regulation among Latino gay men is jeopardized by a host of complex socio-cultural factors -- such as machismo, homophobia, sexual silence, family disruption, poverty and racism -- that contribute to

Decreased self-esteem;

Perceptions of low sexual control;

A sense of social isolation; and

Fatalism regarding the inevitability of HIV infection.

The program "Hermanos de Luna y Sol" was designed in collaboration with Dr. Diaz as a model intervention to impact and modify these four important predictors of risky sexual behavior.

Hermanos de Luna y Sol may be found at:

http://www.caps.ucsf.edu/projects/hlsindex.html

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