By Fia Curley, Writer/Editor, OMHRC
In the nation's capital, 6 percent of Hispanic residents are living with HIV, according to the D.C. Health Department 2011 HIV/AIDS Hepatitis and TB Epidemiology annual report. The report also found that men accounted for less than half of the District's residents, but almost three-quarters of people living with HIV. Despite these trends and challenges, Nestor Rocha, bureau chief for prevention and intervention services at the D.C. Health Department, remains hopeful, convinced an AIDS-free generation is possible amid the changing landscape of HIV prevention, intervention and treatment.
OMH: When you look at HIV/AIDS in the District's Hispanic community, what is most alarming to you? What emerging trends are changing the way you work?
Nestor Rocha: The significant majority of the total number of all cases is males over females and the chief mode of transmission remains men having sex with men. And that particular aspect is probably what augments the stigma issue and the barriers to accessing services even more. Also, the population is also aging. Our largest (HIV) prevalence rates are really in the 40-year-old and up age group.
OMH: What efforts is the D.C. Department of Health engaged in to address the issue of HIV/AIDS in the Latino community?
Rocha: We support a large network of programs and many of them serve Latino communities. La Clinica del Pueblo, recognized by the Centers for Disease Control, is a major player, providing a variety of services from regular care to HIV screening and counseling. We have also targeted seniors in a number of ways, working to develop an advisory board for older adults, and we just finished our last round of RFAs in which we have created one intervention for addressing the older adult community that we hope will reach Latinos, but it's not specifically designed for Latinos just yet.
OMH: How does Hispanic/Latino culture impact health for District residents?
Rocha: As a Latino, the biggest challenge to me is the cultural barriers built around Latino communities that serve as a protective layer. Our personal behaviors with respect to treatment are very different than in the United States. We come from societies where you get treatment until you feel better or as long as supplies last. Let's say with antibiotics that you have to take for 10 days – if you feel better by day five, you may think there's no point in continuing taking the medicine for the next five days. So that really has an impact on people's ability to remain healthy.
OMH: How do you embrace "cultural proficiency" in prevention, intervention and treatment?
Rocha: Cultural proficiency becomes more critical when you're talking about direct services – it's not just about someone who speaks the language, but who has the experience of being Latino, having migrated to the country and understanding the struggles a Latino may have with respect to residency or legal status in the country, and being able to address the issue in such a way that people can relate. When the practitioner speaks Spanish but does not have that background or experience, it can really turn someone away and have the opposite effect.
OMH: What do you foresee for future prevention efforts regarding HIV?
Rocha: This is an interesting time to discuss prevention because in 2010, the White House released their National HIV/AIDS Strategy and that has prompted many federal agencies to participate in this effort. There's a shift to refocus efforts to become more impactful so that we're not talking about preventing infections but about averting infections. We need to reach out to and educate those who are HIV positive on how to avoid infecting others. Additionally, we're focusing a lot of our efforts on biomedical interventions and clinical efforts that are much more geared toward that approach. For example, it is now known that an undetectable viral load significantly reduces the ability of a HIV-infected individual to infect someone else. Nationwide programs are being geared more toward this treatment-as-prevention approach.
OMH: You said that you believe that an AIDS-free generation is possible? How will we realize that vision?
Rocha: I definitely see us winning the battle where incidence cases will be seldom and immediately engaged. There's a widespread effort to really reach the younger population; they're all becoming more aware. One of the concerns is that younger generations are getting a lot more information, but I think there's a lot of misinformation that we still need to undo and address, but that's an ongoing process. I definitely foresee having the opportunity to reduce the number of cases and be able to say we have absolute control over the epidemic.