Older Latinos and HIV: Provider Perspectives

Purpose: HIV has increased among older Latinos, primarily through sexual transmission. Latino seniors may be especially reluctant to discuss sex and sexuality, and there is little guidance about how to surmount barriers to communication about sex, sexuality and risk in the literature.

This study explored the perspectives of social workers and case managers (SW&CM) who work with HIV+ older Latinos. The study sought (1) to determine how, and under what conditions, these SW&CM engage in discussion and educational activities regarding sex, sexuality and risk HIV/AIDS. (2) Understand how social and case workers address barriers to discussing or educating older Latinos about sex, sexuality and risk for HIV/AIDS. (3) Document the messages, language and approaches that social and case workers have found most successful for engaging in discussion of sex, sexuality and risk behaviors with Latino Seniors.

Methods: This study utilized a semi-structured interview schedule to conduct in-depth interviews with 40 bilingual SW&CM working with HIV+ Latinos over the age of 50. All respondents had at least 5 HIV+ Latinos over 50 on their caseloads, were fluent in Spanish, and indicated that they spoke with their clients about risk and risk factors in Spanish. The sample contained representatives of nine national origin groups. All interviews were conducted in Spanish, audio-recorded and transcribed verbatim. Transcripts were entered into Atlas.ti. They were read, and then coded using open, free and axial coding techniques, and the constant comparison method. Themes regarding the primary research questions were identified. Researchers explored linkages between codes, generated themes, and mapped relationships.

Results: There were differences in the approaches respondents used to interview Latinos about sex and sexuality. Respondents indicated that both their personal socio-demographic closeness and distance (age, gender, national origin, etc.) could be used to facilitate discussion. Although Latina women are notoriously difficult to interview, respondents indicated a variety of techniques used to engage them in open dialog. Some respondents indicated that once Latina women felt comfortable, they were often more forthcoming than male counterparts.

Respondents also indicated that their knowledge could be critical for establishing a relationship that would lead to open dialog about risk factors. Chief in importance were knowledge of sex and sexuality, and facility with Spanish. Respondents, all of whom lived in Southeast Florida, were familiar with most Spanish regional variations. In most cases they indicated that (a) either cultural similarity or cultural difference could be used as to advantage in establishing open dialog; (b) that they did not usually have to vary their Spanish to adjust to clients from different regions; however (c) they required extensive passive knowledge of Spanish to be able to understand words and expressions their clients used. Respondents also indicated that an understanding of behavioral and cultural antecedents, especially prior to the immigration of their clients was helpful to them in establishing rapport.

Conclusions and Implications: The study is a step in the development language, techniques and tactics that will aid practitioners and researchers who seek to interview, survey or develop materials for older Latinos related to HIV/AIDS.