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The Philadelphia Inquirer
AIDS Risk For Latinas Climbs Still Rates Have Been On The Rise Since 1990
Cultural Factors Can Hurt
By Marina Walker
December 2, 2002
Nancy Santiago, 44, of Kensington, a native of Puerto Rico and the mother of five children and grandmother of six, learned last year she had contracted the AIDS virus from her boyfriend.
Juana Rodriguez, 51, also from Puerto Rico, took care of her boyfriend until 1993, when he died of AIDS in her apartment in North Philadelphia. A few months later she learned she was HIV-positive, too.
Maria Nieves, 47, was infected by her last partner, a man from El Salvador, whom she met in Philadelphia and dated for five years.
The experiences of these women illustrate the risk faced by Latino women in the Philadelphia area and the United States who make up a growing share of new AIDS cases among Hispanics.
While the overall number of new AIDS cases in the United States has been declining since the mid-1990s, the proportion of new cases that occur among Latino women is rising.
Their risk is significantly higher than that of white women, though much lower than that of African American women.
In 2001, women made up 23 percent - 1,894 people - of the new Latino AIDS cases in the United States, up from 15 percent - 730 people - in 1990, the Centers for Disease Control and Prevention reported.
In 2000, AIDS was the fourth-leading cause of death for Latinas age 35 to 44 in the United States (after cancer, accidents and heart disease), compared with the ninth-leading cause for white women, according to the CDC. Although Latinas make up only about 13 percent of the female population of the United States, they have accounted for 21 percent of all AIDS deaths among women since the beginning of the epidemic in 1981. Of the 67,557 women who have died of AIDS, 14,236 have been Hispanic.
"In Philadelphia, Latinas have been disproportionately affected by HIV/AIDS," said David Acosta, coordinator of prevention programs at AIDS Activities Coordinating Office, in the city Department of Public Health.
Many of the women are middle-aged, infected by husbands or boyfriends who are bisexual or intravenous drug users.
"Poverty, traditional gender-role beliefs, sexual coercion, sexual abuse, and difficulties talking about sex may all contribute to these findings," said Barbara Marin, guest researcher at CDC's National Center for HIV, STD and TB prevention.
The CDC estimates that Latinas represent 18 percent of new HIV infections among women in the United States.
"Latinas are a group at risk in Pennsylvania," Joseph Pease, director of the division of HIV/AIDS at the Department of Health said. "We are testing programs in order to find the best way to target them."
New programs are aimed at helping Latinas overcome cultural factors that make them especially vulnerable to infection.
"In the Latino culture, talking about sex is still taboo," said Waleska Maldonado, director of Esfuerzo, a program at the Hispanic organization Congreso that reaches nearly 10,000 Hispanics a year with HIV/AIDS prevention and care services in North Philadelphia.
Experts say the message must reach Latino men, especially intravenous drug users and gay and bisexual men.
"We need to reach men with a consistent preventive message. And empower Latinas," said Cynthia Gomez, codirector for the Center of AIDS Prevention Studies, University of California at San Francisco. "Otherwise, we are going to lose our women. They are going to sacrifice themselves, as it is happening in Africa."
Throughout the region, counselors are trying to reach Latinas in places where they feel comfortable. They organize "house parties" where women can ask questions about AIDS and how they can protect themselves, including abstinence.
In North Philadelphia, an area where many Hispanics live, counselors go to nightclubs to distribute condoms and offer saliva testing for HIV. They also visit Hispanics working at mushroom farms in Kennett Square, Chester County.
In New Jersey, programs offer day care for children so their HIV-infected mothers can go to the doctor.
The message changes depending on the age of the women. Middle-aged women often assume they aren't at risk because they have been married for many years.
At Temple Hospital, doctors said they were seeing more HIV cases among middle-aged Latinas infected by long-term partners or husbands.
"We have many 35-to-40-year-old, lifelong-faithful HIV widows. The shock for these women is tremendous," said Ellen Tedaldi, professor of medicine at Temple.
In New Jersey, women 35 and older made up 45 percent of all HIV infection cases among Latino women between 1996 and 2000.
Often, women don't know their partners are unfaithful. Sometimes, they tolerate it because they are economically dependent.
A study conducted in California among Latino women found that only 41 percent of the participants had ever used a condom.
"In Latino culture, a woman that asks for safe sex can be considered a loose woman," said Gomez, the University of California researcher.
"Latinas are soft and too emotional. That makes us a target," said Nancy Santiago, who said she was infected with HIV by her boyfriend, who was an intravenous drug user.
"I trusted him," Santiago said of the man she dated for a year, and who disappeared after she was diagnosed. "That's why I didn't ask him to use condoms."
Santiago was shocked when she learned she had been infected, and tried to commit suicide. She was hospitalized for a month.
"This is my story. It's full of hurt, anger and betrayal. And still there is love in it," wrote Santiago when she left the hospital in July.
Those words are now the first paragraph of a book she wants to publish. She also wants to help other women by advocating for a Pennsylvania law, similar to those in some other states, that makes it a crime to knowingly infect others with HIV.
Latina immigrants new to sexual freedom in the United States may engage in risky sexual behavior, making them vulnerable to infection, experts say.
Maria Nieves, 47, got the virus through her last partner, whom she dated for five years.
She arrived from Puerto Rico when she was 9 and started having sex at 13. Soon she became an alcoholic.
"I was very ignorant, I never had safe sex," said Nieves, who learned last year that she was HIV-positive.
Nieves, who has overcome her alcohol addiction, has become an advocate for Action AIDS, Pennsylvania's largest AIDS service organization.
She spoke recently on HIV prevention to medical students at Villanova University.
"I don't want my children to commit the same mistake. So I talk to them about prevention and sex with love," she told the students.
"It's not knowing that kills."