Why are Latino gay and bisexual men at risk?

Seventeen percent of all AIDS cases in the United States are among Latinos, although Latinos constitute only about nine percent of the population. Of these cases, forty percent are among gay and bisexual men, and cultural and political barriers make some of these men harder to reach. Prevention interventions that target locations where high-risk sex occurs, such as parks, are likely to be successful. Campaigns accessing the general population in the work place, at community gatherings, and at churches may avoid grouping individuals as homosexual, while still reaching at-risk men. Intervention strategies should aim at exploring homophobia, sexual discomfort, and gender issues. Interventions that foster community building among Latino men and provide a forum for exploring prevention issues are also needed. Growth of an organized Latino gay and bisexual community will be critical not only in sustaining individual development, but also in challenging established Latino and Anglo norms that make these men outsiders.     

Antiretroviral treatment considerations in Latino patients

Latinos in the United States have been disproportionately affected by HIV, with a higher rate of infection, later diagnosis, and a higher death rate than Caucasians. Complicating the issue is that "Latino" is a broad term that encompasses diverse ethnic and racial groups, requiring a targeted approach to prevention and management of HIV infection. This article explores the demographics of HIV infection among Latinos in the United States, discusses cultural beliefs among Latinos that have an impact on prevention and access to care, and reviews strategies for managing HIV infection in this population.     

Challenges and strategies in recruiting, interviewing, and retaining recent Latino immigrants in substance abuse and HIV epidemiologic studies

The growth of immigrant populations in the United States over the past 20 years has increased the need to enhance understanding about the risk factors that influence their substance abuse and HIV risk behaviors. Today, Latinos account for the largest majority of immigrants gaining entry into the United States. As the largest and fastest growing minority subgroup in the United States, they bear a disproportionate burden of disease and death compared to non-Latinos. Latinos are confronted with escalating HIV and substance-abuse problems, particularly Latinos between the ages of 18-34. This paper is based on our longitudinal study on the drug using and HIV risk behaviors of 527 recent Latino immigrants between the ages of 18-34 who have lived in the United States less than 1 year. The data collection activities of this study have provided insights in identifying, recruiting, interviewing, and retaining Latinos in community-based studies. Strategies, such as utilizing a combination of translation techniques, ensured the development and implementation of culturally appropriate questionnaires. Respondent-driven sampling facilitated identifying participants. Establishing rapport and trust was critical for interviewing, and maintaining a tracking protocol was most important for retention. The lessons learned from this study can guide substance abuse and HIV researchers when recruiting, interviewing, and retaining recent Latino immigrants in future epidemiologic studies.     

Using community-based participatory research to develop an intervention to reduce HIV and STD infections among Latino men.

Although the Latino community living in the United States has been disproportionately affected by the intersecting epidemics of HIV and sexually transmitted diseases (STDs), the development, implementation, and evaluation of HIV and STD prevention interventions designed to reduce infection among Latinos lags behind prevention efforts targeting other communities. HoMBReS: Hombres Manteniendo Bienestar y Relaciones Saludables is a sexual risk reduction intervention designed to reduce HIV and STD infection among recently arrived, non-English-speaking Latino men who are members of a multicounty Latino soccer league in central North Carolina, a region of the United States with both the fastest growing Latino population and disproportionate HIV and STD infection rates. HoMBReS was developed in partnership with the local Latino community using community-based participatory research (CBPR). We describe (a) the CBPR partnership history and further expansion; (b) the development of the intervention through the integration of collected formative data, theoretical considerations, and findings from the scientific literature; and (c) lessons learned while using a CBPR approach to develop HoMBReS.     

Ethnic Enclaves and Type II Diabetes: a Focus on Latino/Hispanic Americans

Diabetes disproportionately impacts the Latino population and while individual traditional risk factors are key, additional external factors, such as neighborhoods, may also affect diabetes rates. This review examines the role of living in an ethnic enclave, a neighborhood with a high Latino concentration, on diabetes and its risk factors for the Latino population in the United States (U.S.). Studies fail to find an association between living in an ethnic enclave and diabetes, despite research demonstrating that enclaves have a protective effect on other health outcomes for Latinos. When considering diabetes risk factors, the associations with ethnic enclaves are mixed. For Latinos, living in an ethnic enclave is associated with healthier diets and increased physical inactivity, while data are mixed for obesity prevalence. More research is needed to determine what aspects of an ethnic enclave have a protective effect against diabetes among Latinos.     

Dissecting complex diseases in complex populations: asthma in latino americans

Asthma is a common but complex respiratory ailment; current data indicate that interaction of genetic and environmental factors lead to its clinical expression. In the United States, asthma prevalence, morbidity, and mortality vary widely among different Latino ethnic groups. The prevalence of asthma is highest in Puerto Ricans, intermediate in Dominicans and Cubans, and lowest in Mexicans and Central Americans. Independently, known socioeconomic, environmental, and genetic differences do not fully account for this observation. One potential explanation is that there may be unique and ethnic-specific gene-environment interactions that can differentially modify risk for asthma in Latino ethnic groups. These gene-environment interactions can be tested using genetic ancestry as a surrogate for genetic risk factors. Latinos are admixed and share varying proportions of African, Native American, and European ancestry. Most Latinos are unaware of their precise ancestry and report their ancestry based on the national origin of their family and their physical appearance. The unavailability of precise ancestry and the genetic complexity among Latinos may complicate asthma research studies in this population. On the other hand, precisely because of this rich mixture of ancestry, Latinos present a unique opportunity to disentangle the clinical, social, environmental, and genetic underpinnings of population differences in asthma prevalence, severity, and bronchodilator drug responsiveness.     

Diabetes in the hispanic or latino population: Genes,environment, culture,and more

The Hispanic or Latino population is the largest minority group in the United States, currently representing 13.7% of the total U.S. population. Hispanics or Latinos usually suffer from higher rates of type 2 diabetes, obesity, metabolic syndrome, and their multiple vascular complications. Inadequate nutrition and reduced physical activity in the setting of an increased genetic predisposition to type 2 diabetes have contributed to the inexorable rise in metabolic abnormalities in Hispanics in the United States, which now affect many children and adolescents. It is evident that multiple medical, cultural, and socioeconomic factors influence the development of diabetes, its course, and its consequences. Our health care system is barely prepared to face the challenge of managing diabetes in this high-risk group. Culturally oriented clinical care, education, outreach and research programs are needed to better identify the challenges to create opportunities to improve the lives of Hispanics or Latinos with diabetes or at risk for the disease.     

Latino Older Adults and Mental Health: A Review and Commentary

Latinos are the largest and fastest growing minority population in the United States, and within that, the proportion of elderly Latinos is also increasing at a very rapid rate. This is due to an increase in longevity and improved health care. Depression and other mental health disorders are common in this group, yet few services exist at present that are culturally appropriate and that have been found, in randomized trials, to be effective with them. Part of the reason for this lag in research and development of clinical services is due to the multiple barriers to seeking and receiving mental health services that exist in Latino communities. This article reviews these barriers as well as existing programs that address them and therefore hold promise as mental health interventions. Although there is an increasing amount of research on older adults in this country, Latino older adults still remain underrepresented in research and underserved clinically. This article also highlights the need to increase appropriate normative data for valid testing, and emphasizes a call for more culturally competent and bilingual clinicians.     

Chapter 2: Brief Overview of Latino Demographics in the Twenty-First Century

SUMMARY

The Latino population in the United States has grown substantially in the past twenty years. It is expected that by the year 2050, Latinos will comprise twenty-four percent of the total U.S. population. The growth of the Latino population poses many challenges for alcohol-related services. The increasing diversity of the population changes the framework for culturally competent services.     

Avoiding the looming Latino/Hispanic cardiovascular health crisis: a call to action

Cardiovascular disease (CVD) is the leading cause of death among the largest and fastest growing ethnic minority in the United States, Latinos/Hispanics. To review recent findings on the prevalence of CVD, CVD risk factors, and related illnesses in the US Latino/Hispanic population, an extensive PubMed and Internet literature search for studies published from January 1995 to July 2005 was conducted, using a combination of search terms. Data validity was assessed based on the quality of the source and a consensus of the authors on perceived validity. The review found limitations in current research as well as treatment methods and options for Latino/Hispanic persons at risk for developing CVD and related illnesses. Because of these limitations and the large public health concern, additional research is required to fully determine the best predictors of CVD and diabetes in Latino/Hispanic patients. A combined effort of health-influencing and health-governing bodies is needed on all levels to address the CVD problem in the Latino/Hispanic population.     

Alcohol Use and Abuse Among Latinos

SUMMARY

This paper will identify some of the key barriers for developing a better understanding of the impact of alcohol use and abuse among Latinos in the United States. Examples of culturally competent approaches to better researching and serving Latinos are presented to facilitate service provision to this population.     

Cultural approaches to diabetes self-management programs for the Latino community

The issue of diabetes within the Latino population of the United States is of such magnitude that reviewing previously published studies on culturally oriented diabetes self-management interventions is imperative to further understanding and progress on this matter. The purpose of this revision is to illustrate what has been accomplished to date, analyze the lessons learned, and restate the importance of developing culturally relevant interventions for vulnerable populations.     

Cigarette smoking and quit attempts among Latinos in substance use disorder treatment

Background: Differences in tobacco use behaviors have been identified between Latinos and non-Latino whites in the general US population. Little is known about cigarette smoking and quitting behaviors of Latinos in treatment for substance use disorders (SUDs), who represent two major tobacco-vulnerable groups. Objectives: To compare, in a national sample of persons enrolled in SUD treatment, demographic, drug use, and smoking and quitting prevalence and behaviors between Latinos and non-Latino whites. Methods: We surveyed 777 SUD treatment clients, sampled from 24 clinics selected at random from the National Institute on Drug Abuse Clinical Trials Network (Latino client n = 141; 40% female). We then conducted univariate and multivariate analyses to identify correlates of smoking behaviors by Latino/non-Latino white ethnicity. Results: Latinos’ smoking prevalence resembled that of non-Latino whites (78.7% vs. 77.4%). In regression analyses, Latino smokers (n = 111) tended to smoke fewer cigarettes per day (CPD) than non-Latino white smokers (n = 492); were more often nondaily smokers and menthol smokers; more often reported a smoking quit attempt in the last year; and tended to report higher numbers of past-year quit attempts. Among Latino smokers, those with less education and those reporting opioids as their primary drug of use reported higher CPD. Conclusions: Latinos in SUD treatment are at equally high risk of being current heavy smokers as compared to non-Latino whites in SUD treatment. At the same time, Latinos in SUD treatment exhibit ethnic-specific smoking and quitting behaviors that should be considered when designing smoking interventions for this group.     

Latino Caregivers of Relatives with Alzheimer's Disease

Abstract

This review of the literature discusses the experience of Latinos who provide care to a family member with Alzheimer's Disease and Related Disorders (ADRD). This discussion is imperative in light of the present demographic changes and in light of current findings suggesting that the risk for dementia is significantly higher for Hispanic elderly. All studies reviewed reported that the ADRD Latino caregiver is most likely to be a female caring for her parents or her parents-in-law. Despite the relatively low availability of informal support and the high levels of depression among ADRD Latino caregivers, most studies reported that ADRD Latino caregivers underutilize formal services. The major implications of the present review are that a heterogeneous perspective of the Latino community should be adopted by taking into consideration within group differences. In addition, systematic study of outreach and therapeutic interventions aimed specifically towards ADRD Latino caregivers is recommended.     

Condom use among heterosexual immigrant Latino men in the southeastern United States.

Latinos in the United States have been disproportionately affected by the intersecting epidemics of HIV and sexually transmitted diseases (STDs). We examined correlates of condom use among adult heterosexual Latino men who are members of a large multicounty soccer league in rural North Carolina. Of 222 participants, the mean (+/-SD) age was 29.8 (+/-8.3) years. Approximately 60% reported Mexico as their country of origin, 60% reported Grade 8 or below as their highest level of education, and 50% reported using condoms during their most recent vaginal intercourse episodes. Adjusting for relationship status, multivariable logistic regression identified four correlates of condom use: having sought health care information from family members (adjusted odds ratio [AOR]=3.68; 95% confidence interval [CI]=1.48-9.13); greater knowledge of HIV transmission and prevention (AOR = 2.61; CI = 1.23-5.54); greater condom use self-efficacy (AOR = 4.45; 95% CI = 2.12-9.36); and greater adherence to traditional masculine norms (AOR = 2.10; 95% CI = 1.02-4.33). Our findings underscore the need for innovative and targeted HIV and STD prevention programming among the emerging Latino community in the southeastern United States.     

Knowledge, attitudes, and experience regarding HIV/AIDS among older adult inner-city Latinos

Although Latinos, now the largest minority group in the U.S., comprise 13% of the population, they represent 18% of all new HIV and AIDS cases. This disproportionate representation also appears among older adult Latinos. Semi-structured interviews with 45 inner-city Spanish speaking older adult Latinos provide new data regarding HIV/AIDS among this largely ignored but at risk population. Findings indicate that approximately two thirds of the sample ascribed to at least one myth regarding viral transmission (e.g., via mosquito bites; using public toilets) and less than half were aware of age and gender specific risk factors (e.g., increased mortality and side-effects from antiviral medication; greater risk of contracting HIV through intercourse among older women). Women were significantly less likely to have experience with condoms than men, and machismo, lack of perceived risk, and perceived ineffectiveness were identified as potential barriers to condom use. Recommendations are offered for the design of culturally sensitive, primary prevention programs for this older Latino population.     

Epidemiologic data on young men of color who have sex with men

Young men of color who have sex with men (YMSM of color) have been disproportionately affected by the HIV/AIDS epidemic in the United States. Between 2001 and 2006, HIV/AIDS diagnoses increased 93.1% among African-American MSM aged 13-24 and 45.8% among Latino MSM aged 13-24. Many multisite studies have yielded valuable information on the behaviors associated with HIV infection in adolescents, MSM, African-Americans, and Latinos. Studies among adolescents found a high prevalence of risky sexual behaviors, including having multiple partners and unprotected intercourse and frequent substance use. Multisite studies of MSM also found frequent reports of alcohol and drug abuse, and one study found that nearly one-half (48%) of HIV-positive MSM were unaware of their infection. Similarly, two multisite studies of YMSM found high rates of unprotected sex, substance use, and HIV-infection among YMSM of color. Recognizing these challenges, the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA) funded the first multisite study to improve engagement, linkage to HIV care, and retention in care for HIV-positive YMSM of color. The objective of this article is to review the epidemiologic data on HIV-positive YMSM of color from surveillance and multisite studies in order to identify the needs of this population and the gaps in the literature.     

Hepatocellular Carcinoma and Associated Clinical Features in Latino and Caucasian Patients from a Single Center

Introduction and aimHepatocellular carcinoma (HCC) is the most common type of liver cancer in adults and has seen a rapid increase in incidence in the United States. Racial and ethnic differences in HCC incidence have been observed, with Latinos showing the greatest increase over the past four decades, highlighting a concerning health disparity. The goal of the present study was to compare the clinical features at the time of diagnosis of HCC in Latino and Caucasian patients.Material and methodsWe retrospectively screened a total of 556 charts of Latino and Caucasian patients with HCC.ResultsThe mean age of HCC diagnosis was not significantly different between Latinos and Caucasians, but Latinos presented with higher body mass index (BMI). Rates of hypertension, diabetes, and hyperlipidemia were similar in the two groups. The most common etiology of liver disease was alcohol drinking in Latinos, and chronic hepatitis C in Caucasian patients. Non-Alcoholic Steatohepatitis (NASH) was the associated diagnosis in 8.6% of Latinos and 4.7% of Caucasians. Interestingly, alpha-fetoprotein (AFP) levels at time of diagnosis were higher in Latino patients compared to Caucasians, but this difference was evident only in male patients. Multifocal HCC was slightly more frequent in Latinos, but the two groups had similar cancerous vascular invasion. Latino patients also presented with higher rates of both ascites and hepatic encephalopathy.ConclusionLatino and Caucasian patients with HCC present with a different profile of etiologies, but cancer features appear to be more severe in Latinos.