Hector Hugo GonzalezAccording to the Centers for Disease Control and Prevention (CDC), in 2018 Hispanics/Latinos accounted for more than 1 in 4 new HIV diagnoses in the United States, despite making up only 18% of the population. Latinos are disproportionately impacted by HIV in part due to cultural and socioeconomic factors including lack of access to healthcare, language barriers, immigration status, discrimination, and stigma. Since 2003, the Latino Commission on AIDS, with the help of the Hispanic Federation, has designated October 15 as National Latinx AIDS Awareness Day (NLAAD), sponsoring events and activities to promote HIV prevention and awareness among the Latino community. (NLAAD), sponsoring events and activities to promote HIV prevention and awareness among the Latino community.
Among many distinctions, Hector Hugo Gonzalez was the first Mexican-American registered nurse to earn a doctorate in the United States, and he served as director of the National Association of Hispanic Nurses. Gonzalez is professor and chairman emeritus at San Antonio College. We spoke with him about nursing, building trust among Latinos in the U.S. healthcare system, and how to stem the tide of HIV diagnoses in Hispanic communities.
Recruit and train Hispanics to be the promotors of information about HIV.How did you find your way to the nursing profession?
Shortly after I finished high school, I found work as an elevator operator in a hospital. In the old days, you needed an operator. All kinds of people got in the elevator: patients, family, doctors, nurses. After about two years observing all these people, I thought, “Nurses seem to be the happiest in this bunch, and the patients like them.” So, I looked into nursing schools, and I was able to go with the generous help of a friend.
“People helping people” has been a theme throughout your life and nursing career. Can you elaborate?
When I was young, I had no idea that I had the potential to go places. But I always worked hard. As a kid I used to shine shoes, and I shined the best shoes you ever saw. Regardless of what I was doing, when I worked hard people helped me. That has been especially true in my nursing career: helping patients and colleagues, and others helping me. Over the years, so many people have helped me and I’ve developed quite a love for the nursing profession.
Latinos experience high levels of mistrust of the U.S. healthcare system. What can be done to increase trust among the Hispanic/Latino community?
Recruit and train Hispanics to be the promotors of information about HIV. Hispanics who live in the barrio would be more effective than “outsiders.” Train curanderos (native healers), hueseros (bone and muscle specialists), parteras (midwives), and other alternative care providers. These folks have built-in trust with the Hispanic community. Use them as a bridge toward mainstream providers.
The CDC estimates that of the approximately 38,000 new HIV diagnoses in 2018 in the U.S., 21% were Hispanic/Latino gay and bisexual men. Why do you think the rates are so high?
There is an unspoken agreement that sex is not discussed in families: a code of silence.There are many variables including language, customs, socioeconomic status, perceptions of established and folk medicine, and perceptions of sexual practices. There is an unspoken agreement that sex is not discussed in families: a code of silence. And mental illness, sex work, and gay sexual orientation are viewed as castigos de dios, or punishments from God. They are deemed unacceptable and vigorously dealt with in ways that are often dangerous to those members of society. This drives gay individuals to develop “secret” lives. Thus questions about HIV and its prevention and treatment go unasked. There is a lack of information among the Hispanic community to address this problem. The adage saber es poder—knowledge is power—becomes no saber es no poder, or no knowledge is no power.
What can be done to slow the spread of HIV among the Latino community?
Education, education, and more education about HIV conveyed through public service announcements, TV, radio, and printed media with Hispanic audiences. Display posters in homeless shelters, shopping mall restrooms, mom and pop stores, playgrounds, parks, gyms, schools—anywhere Hispanics congregate. Make condoms available in bar restrooms. Information should be communicated in English, Spanish, and Spanglish. With teenagers—who comprise a large number of HIV diagnoses—the old ABC (Abstinence, Be faithful, and Condoms) approach has had limited success. Use more realistic methods that recognize and address their emerging sexual drives. And because cultural beliefs hinder discussion of sexual health, schools or community agencies should take on a greater role teaching about HIV.