Clinical Considerations for Undocumented Latina Immigrants with HIV

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Clinical Considerations for Undocumented Latina
Immigrants with HIV

• Columbia University School of Social Work
• Clinical Grand Rounds
• September 26, 2007
• Rosa Bramble Weed, LCSW,CASAC

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HIV IN Latin America

• Epidemic in Latin America has been overshadowed
  by the more severe problems in sub-Saharan
  Africa, the large population in Asia .
• There is an estimated 2 million people with
  HIV/AIDS
• Half of those living with HIV/AIDS reside in
  the four largest countries Brazil, Mexico,
  Colombia and Argentina.

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Latin America

• Haiti, Guyana, Belize and Trinidad have a high
  prevalence of the epidemic.
• Currently the virus is moving from high risk
  groups to the general population in Honduras,
  Guatemala and El Salvador.
• Central America is the most vulnerable for
  the spread of HIV Peter Piot, UNAIDS, Central
  America

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Latinos in The United States

• 40 Million Latinos Residing in the US
• Latino population has increased by 58
• The largest group in the United States after
  whites

By 2050, one out of every four women in the
United States will be Latina 19 Million or 48
of the total US Latino population
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Immigrants and HIV

• 25 Years Later-Changing Face of HIV/AIDS
• Men Who Have Sex With Men (MSM)
• Increase among Heterosexual transmission
• Increase among Latinas
• Cultural Factors Sexuality, Machismo,
  Marianismo, Perception of Risks and Belief
  Systems
• Wait longer to access treatment

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Immigrants and HIV in New York City

• More than one-third of New York Citys Population
  is foreign-born, and 6,082 immigrants living with
  AIDS reside in New York City
• The origin of immigrants living AIDS in NYC
  includes 119 countries around the world.
• Three regions represent 66 of the cases
• Caribbean (40)
• Central America (13)
• South America (12)

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New HIV Diagnoses in NYC, 2004Region of birth
among foreign-born
Almost 60 of foreign-born persons newly
diagnosed with HIV in NYC were born in Africa or
the Caribbean/West Indies.
Excludes Puerto Rico and the US Virgin
Islands.As reported to the New York City
Department of Health and Mental Hygiene by
September 30, 2005.
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New HIV Diagnoses in NYC, 2004 By gender
of new HIV diagnoses
Among the foreign-born, two-thirds of new HIV
diagnoses were in men, similar to the
distribution among non-foreign-born persons.
As reported to the New York City Department of
Health and Mental Hygiene by September 30, 2005.
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New HIV Diagnoses in NYC, 2004 By transmission
risk (males only)
of all new HIV diagnoses in males
with a known risk factor
Among foreign-born males, 58 had a risk of MSM,
lower than among non-foreign-born males.
As reported to the New York City Department of
Health and Mental Hygiene by September 30, 2005.
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New HIV Diagnoses in NYC, 2004 By transmission
risk (females only)
of all new HIV diagnoses in females
with a known risk factor
Among foreign-born females, 92 had heterosexual
risk, higher than among non-foreign-born females.

As reported to the New York City Department of
Health and Mental Hygiene by September 30, 2005.
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Impact of HIV in Latinas

• Latina women account for 34 of the female
  population (U.S. Bureau of Census,2001), yet they
  represent 18 of the cumulative cases of AIDS
  (CDC,2004).
• The AIDS case rate of Latinas (12.4 per 100,000)
  is much higher than for White women (2.0 per
  100,000) (CDC,2003)

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Challenges for Undocumented Latina
Living with HIV

• Lack of Access to Services
• Fear of immigration/Deportation
• Fear of governmental agencies
• Housing
• Poverty/Financial Stressors
• Lack of Medical Insurance
• Seek treatment in later stages
• Language barrier
• Intimate Partner Violence

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Impact of HIV and Intimate Partner Violence (IPV)
in Latinas

• Latina women account for 34 of the incidence of
  IPV in the United States
• (Bureau of Justice Statistics,2000)
• The rate of Hispanic pattern of abuse was 54
  greater than in non-Hispanic Whites
• As a group, Hispanics display one of the highest
  rates of partner violence.

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HIV as a form of Intimate Partner
Violence

• Violence limits women ability to negotiate safer
  sex
• Intentional Transmission of virus by infected
  partner
• Fear of leaving the relationship
• Threat of Deportation by perpetrator-

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Clinical Considerations in Treatment

• Stigma as experienced by Women
• Isolation
• Verguenza/Shame
• Depression
• Nervios/Nerves
• Trauma
• Disclosure
• Long Distance Disclosure with children and family

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Clinical Guidelines for Latinas with
HIVBiopsychosocial Assessment

• Medical History/Adherence
• Country of Origin
• Immigration Status
• History of Trauma of Migration
• Trauma assessment PTSD
• Support Network
• Assessment of internalized stigma
• Children and families in native countries

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Treatment Guidelines for Latinas living
with HIV

• Familiasmo Confianza y Respeto
• Creating a safe place, confidential and
  consistency
• Individual Interventions
• Affirmations
• Relaxation/Breathing
• Visualization
• Trauma Treatment
• Listening to their story
• Marias Story

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Group Interventions for
Latinas with HIV

• Life in Harmony Dance movement facilitates
  reconnection with body in a balanced way
• Bio-musica, cultural dance- The use of body as
  vehicle of healing
• Cuentos/Stories narrative of hope and
  transformation

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Community Intervention

• Celebraciones- cumpleanos, pinatas,
• Retreats-Annual retreat for women
• Celebrating the Feminine Spirit
• Connect and heal with inner work as yoga
• Art and Traditional African Drum

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Healing and Transformation to Empowerment

• EN LA UNION ESTA LA FUERZA!
• Training in advocacy
• Collective ownership
• Clients demanding their rights in Advisory board
• Participation in Citywide level of policy
• Sharing of information and resources
• I have learned I have a voice, We have a
  voice and it must be heard. Maria

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Give Women back the POWER

• Gender Inequality needs to be combated around the
  globe which includes
• END GENDER VIOLENCE!
• Womens Rights to property and protecion of law

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Recommendations

• There is need for HIV prevention to be culturally
  appropriate
• Voces Latinas Model for prevention for Immigrant
  Latinas
• Increase for Spanish speaking staff
• There is a need for increased legal services and
  collaboration of legal services and mental health
  services.
• Improved housing opportunities
• Additional supportive services such as mental
  health, food and nutrition, drug and substance
  abuse services, ESL, domestic violence programs
  and emergency assistance
• Funding for Retreats for Latinas
• Recruitment of Bilingual/Culturally Competent
  Clinicians

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• Each life is of equal value, whether gay or
  straight, sex trade worker or stay at home mom,
  black or white, mestizo native rich or poor
• Melinda Gates
• XVI International AIDS Conference Toronto Canada
  2006

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• Work with our communities let us embrace our
  social work commitment
• to human rights, respect
• and human dignity
• Rosa Bramble Weed
• Positive
  Life Program
• Child Center
  of New York
• 67-14
  41st Avenue
• Woodside
  NY 11377
• 
  718-458-4243 ex 213
• Email rosaweed_at_childcenterny.
  org

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References

• New York City of Mental Health and Mental Hygiene
• Moreno, Claudia. The Relalationship Between
  Culture, Gender, Structural Factors, Abuse,
  Trauma and HIV/AIDS for Latinas. Qualitative
  Health Research
• http//qhr.sagepub.com/cgi/content/abstract/17
  /3/340