Cultural Competence in a Group Intervention Designed for Latino Patients Living with HIV/AIDS

Article excerpt

Although antiretroviral therapy (ART) has altered the course of the HIV/AIDS epidemic, addressing the social and psychological comorbidities that face patients living with HIV/AIDS (PLWH) remains vital. Since the epidemic's earliest days, social workers have been critical contributors to the teams of professionals dedicated to meeting the multifaceted needs of PLWH (Chachkes, Ehrlich, Eisen, & Moynihan, 2003; Dando & Finlon, 2003). In particular, social work interventions with groups aimed at the general population of HIV-infected patients (Turner, 2003; Wiener, 2003; Willinger, 2003) and those targeting specific subgroups of patients (Smiley, 2004; Wiener, 2003) have proven successful in achieving this goal. Given the significant rate at which HIV/AIDS is infiltrating the Latino population in the United States (Centers for Disease Control and Prevention [CDC], 2004), it is imperative that interventions be developed to address the needs of this subgroup specifically (Mason, Marks, Simoni, Ruiz, & Richardson, 1995; Van Servellen et al., 2003; Zambrana, Cornelius, Boykin, & Lopez, 2004). Doing so demands that treatment and prevention efforts be rooted in cultural competence because of culture's direct impact on both the risk of HIV infection within this population (VanOss-Marin, 2003) and individual patient's experience of illness and disease (Mason et al., 1995).

LITERATURE REVIEW

The Latino Population's Vulnerability to HIV/AIDS

The CDC (2004) reported HIV/AIDS poses a sizable threat to the Latino population, with Latinos accounting for 20 percent of the new AIDS diagnoses in the United States in 2002. During the same year, in a comparison of an racial and ethnic groups, Latinos accounted for the second highest rate of AIDS diagnosis (26.0 cases per 100,000 people), second to African Americans (76.4/100,000) (CDC, 2004). HIV/AIDS is the fourth leading cause of death for Latina women ages 25 to 44, whereas Latino men have case rates that are three times higher than those of non-Latino white men (Zambrana et al., 2004). Multiple factors contribute to the Latino community's vulnerability to HIV/AIDS, including poor access to health care, delays in seeking health care services, linguistic barriers, and factors related to this ethnic group's perception of and behavior around sexual roles, practices, and education (Van Servellen et al., 2003; Zambrana et al., 2004).

The plethora of medical and psychosocial issues (that is, stigma, disclosure, social isolation, adherence to complex APT regimens, safer sex practices, and so forth) that confront Latino PLWH are not unique to this population. However, these issues, when viewed in a cultural context, do take on a distinctive quality and have unique ramifications for these patients and, in some cases, for the Latino community as a whole. For example, within Latino culture, HIV/AIDS and the behaviors associated with infection remain highly stigmatized (Van Servellen, 2003); in particular, homophobia is widespread (Galanti, 2003; VanOss-Marin, 2003). This reality influences the rate of HIV/AIDS diagnosis within the Latino community, causes many Latino gay men to remain secretive about their sexuality and refrain from or delay seeking treatment for HIV/AIDS, and can cause extreme social isolation for Latino PLWH (Galanti, 2003; Van Servellen et al., 2003). Although this is but one example of how cultural views influence a community's and patients' perception and experience of HIV/AIDS, it highlights the power of culture and underscores the need for social workers and other practitioners to appreciate culture as a means of delivering appropriate services to the Latino community (McQuiston & Flaskerud, 2003; Van Servellen et al., 2003; Zambrana et al., 2004).

Culturally Competent Practice

The need for social workers to use culturally competent practice is underscored by the socioeconomic and ethnic diversity of the United States (Lu, Lure, & Chen 2001; Lum, 1986; Matthews & Peterman, 1998). …