Dismantling Structural Barriers to HIV Prevention, Care and Treatment for Latinx Gay and Bisexual Men | Fijate Bien Program

by Angel Fabian

Angel Fabian is the Advocacy Coordinator for MPact’s Fijate Bien program, which is a new advocacy initiative focused on the HIV prevention needs of Latinx gay and bisexual men in the United States. Below, Angel describes his story of how he got involved in this critical work and tells us more about what we can expect to see from Fijate Bien.

In the mid 90s, I had the honor of meeting a young immigrant activist, Miguelito, who had been diagnosed with multiple STIs including an AIDS diagnosis at the age of 17.

When he was first diagnosed, he went into a deep depression and declined medical and support services.  He had been thrown out of his home in Mexico as a child after being found messing around with another boy by one of his brothers. He then fled to Mexico City and faced homelessness and engaged in survival sex, somehow eventually migrating to the US.

When I reconnected with him by chance out in the community around the same time, we had a long talk, some laughs and a good cry.  From that point on he was ready to continue living, started accessing services and began educating his own family and raising community awareness about HIV and challenges face by LGBT people.  His life was cut short from devastating bout with Toxoplasmosis at age 21.

His legacy of perseverance, lightness, passion and tenacity still reminds me to continue taking care of myself and to honor the life stories fueling the advocacy work I do.

In the United States (U.S.) and its territories, in 2017, the majority (70%) of diagnosed HIV infections in Latinx men were among gay and bisexual men and other men who have sex with men (67% MSM and 3% MSM/IDU).  In the same year, 26% of all new HIV diagnoses were in the Latinx community; of those, 78% were among Latinx gay and bisexual men (75% MSM and 3% MSM/IDU).  Between 2012-2016, new HIV diagnoses among Latinx gay and bisexual men and other men who have sex with men increased 12%; the greatest increase occurred in men between the ages of 25 to 34 (a 22% increase).  Although Latinx gay and bisexual men would benfit from biomedical interventions such as PrEP, only a small percentage of these men have accessed this medication.[1]

Geographically, rising diagnoses of HIV among Latinx gay and bisexual men are mainly localized in seven jurisdictions.  From 2010-2014, 84% of the increase in HIV diagnoses among Latinx gay and bisexual men was in six states –  Arizona, California, Florida, Illinois, New York, and Texas – and Puerto Rico.[2] Moreover, statistically significant increases were observed in the following jurisdictions within each of the states: (1) Phoenix; (2) California jurisdictions other than Los Angeles, San Francisco, San Diego, Oakland and Sacramento; (3) Miami, Tampa, and Florida jurisdictions other than Miami, Fort Lauderdale, West Palm Beach, Orlando, Tampa, and Jacksonville; (4) Chicago; (5) San Antonio and Texas jurisdictions other than Houston, Dallas, Fort Worth, Austin, San Antonio, and El Paso.

In 2015, among all U.S. Latinx living with HIV, only 59% received HIV medical care, 49% were retained in HIV care, and 50% had a suppressed viral load.[3] Access to HIV care and treatment services is seriously compromised for Latinx gay and bisexual men by stigma, homophobia, and discrimination.

If current trends continue, 1 in 5 Latinx gay and bisexual men will be diagnosed with HIV during their lifetimes.[4]

MPact’s Fijate Bien project has begun working with national, regional and local partners to advocate for solutions to address these disparities. Starting on the US national level, we are working with public health officials, funders, long-term and recent AIDS activists and community members to break down the structural barriers faced by Latinx gay and bisexual men which include:

  • The historic underfunding and lack of resources for Latinx gay and bisexual men programs and organizations who are working to provide services Latinx gay and bisexual men often facing crisis situations.
  • Raids by US Immigration and Customs Enforcement (ICE) and fear of changes to the Public Charge rule which frequently deter Latinx communities from accessing HIV prevention, treatment and care services due to fear of deportation and/or having negative impact on their residency and citizenship processes.
  • Low uptake and retention in biomedical prevention, such as PrEP.
  • Lack of targets or indicators in the National HIV/AIDS Strategy addressing the HIV Crisis among Latinx gay and bisexual men and other men who have sex with men.
  • Attacks on the Affordable Care Act, Medicaid expansion and Ryan White Reauthorization. These programs allow Latinx gay and bisexual men to access to life-saving medication, to continue living meaningful lives and allow them to prevent further infections.
  • Cultural/linguistic competency barriers that prevent Spanish-speaking individuals to participate in planning councils and resource allocation groups
  • Limited opportunities for present and future leadership development in the movement

Beyond all these structural barriers, we need to work to connect this issue to other struggles that impact Latinx gay and bisexual men such as mental health, substance use, homelessness, lack of transportation, unemployment and engagement in survival sex.

I am an immigrant, curander@, two-spirit/queer, Zapotec@/Xican@ activist and organizer. My life experiences have enabled me to connect, advocate with/for, uplift and celebrate community members from all walks of life. I have taken a nontraditional path academically and professionally that has allowed me to stay connected, if only through social media, to the continued struggles and the amazing activism impacting marginalized communities in the US and internationally.   My continued commitment is to aid in the dismantling of systems of oppression, that in many ways contribute to disparities in access to health services.

The Fijate Bien program is working to support advocacy efforts that are designed to address the barriers to HIV prevention and treatment services for Latinx gay men in the United States.  Our plan begins by establishing partnerships between advocates in the US and advocates globally to foster multi-lateral exchange, innovation, coordination and scale-up interventions aimed at improving HIV service access.  Through this, we aim to strengthen organizational and strategic capacity necessary for ensuring unobstructed HIV testing, prevention, treatment, care and support for Latinx gay and bisexual men in the United States.

Through this position, I continue to learn, grow, contribute and advocate with/for Latinx gay, bisexual, and queer men around issues of HIV/AIDS and health disparities from an intersectional framework at a regional, national and international level.  I look forward to reconnecting with colleagues and forging new relationships along the way.

[1] HIV prevention pill not reaching most Americans who could benefit – especially people of color. https://www.hiv.gov/blog/hiv-prevention-pill-not-reaching-most-americans-who-could-benefit-especially-people-color March 6, 2018.

[2] McCree DH, Walker T, DiNenno E, et al. A programmatic approach to address increasing HIV diagnoses among Hispanic/Latino MSM, 2010-2014. Preventive Medicine. 2018;114:64-71.

[3] Centers for Disease Control and Prevention. HIV Surveillance Report, 2017; vol. 29. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html.  Published November 2018.

[4] Hess KL, Hu X, Lansky A, et al. Lifetime risk of a diagnosis of HIV infection in the United States