Effective Engagement of Local Latinx Communities in Ending the HIV Epidemic Planning Process: San Francisco County
By Angel Fabian
In December 2019, MPact’s Fijate Bien Program published HIV Planning Councils – Implications for Latinx Gay and Bisexual Men as part of a series of technical briefs expanding the national advocacy on addressing the disparities of new HIV infections and poor access to HIV prevention, care and treatment for Latinx gay and bisexual men. Following the stated recommendations, during the past six months, Fijate Bien has been providing technical assistance (TA) and capacity building (CB) support to Cause Data Collective (CDC), a San Francisco based research and health policy consultant group. Through a competitive RFP process, CDC was awarded funding to enact the Latinx Community Engagement for the San Francisco Ending the HIV/HCV/STI Epidemics Plan (ETE).
The current federal administration created the Ending the HIV Epidemics (EHE) initiative which aims to reduce new HIV infections in the U.S. by 90% by 2030. In 2019, funding to support the creation of local and regional initiative plans was made available to the 57 entities (including Washington DC, San Juan, PR, 7 states and 48 counties). This funding highlighted the importance of community engagement and requires entities to document the level of community engagement enacted in the development of their EHE plans.
The TA/CB provided by the Fijate Bien program has centered around a Community Empowerment framework, that is data driven and responsive to local community needs. The 2018 Epidemiology Report Issued by SFDPH showed that Latino MSM diagnosis surpassed that of white MSM for that year. Underscoring the importance of recalibrating prevention efforts to this population. This report also highlights that from 2009 -2018 rectal gonorrhea continues to increase in the general MSM population. Similarly, there has been an increase in syphilis among the general MSM population living with HIV, further highlighting the need to expand how prevention services may not reaching those most at need. Although data from this report shows methamphetamine use has remained relatively stable since 2009, anecdotally we know that the use of this substance is increasing across the Latinx community. Furthermore, HIV cases among cis-gendered Latinas accounted for 26% of all women diagnosed with HIV and Latinx accounted for 36% of young adults (under 25) living with HIV. Although community members continue to voice concerns about the under-reporting of trans Latina women, they currently account for 38% of the total trans women HIV cases. Of great concern, Latinx overall accounted for more than one-third of the newly diagnosed HIV cases in San Francisco.
The Latinx Community Engagement project first assembled an Engagement Core that captured the racial, linguistic, and socioeconomic diversity of San Francisco’s Latinx community and ETE’s target audiences in relation to the epidemiological findings outlined above. The preliminary draft of the ETE plan was reviewed and information was synthesized and translated to share with Latinx community members. Initially, the engagement consisted of extensive outreach and in-reach by the Engagement Core to reach Latinx community members currently not engaged in HIV/HCV/STI services and invite them to group discussions with compensation.
Stay at Home Orders due to COVID19 forced this community engagement piece to transfer to virtual platforms. Fortunately, the project leader’s connections that had been forged over the years allowed for the effective outreach and involvement of community gate keepers, clients/patients and service providers to involve in the process. A first round of virtual focus groups and one-on-one interviews have been performed and initial findings have been shared with the SFPHD ETE Planning Group. These recommendations will be incorporated into the plan and a second round of feedback will be performed prior to the final plan being submitted to CDC & HRSA in the fall.
Initial findings include:
- Many respondents mentioned that Latinx is a very broad and diverse category. To capture and overcome some of the most important barriers to HIV/HCV/STI diagnosis and treatment, we need to break it down. Participants noted that the current plan should provide information and intervention plans based on the following situations: Immigration / Citizenship Status and Languages spoken.
- Integrated services are critical to avoid some of the barriers to HIV/HCV/STI treatment in Latinx communities. The more the branding and offering of services focus on helping Latinx people support their families and communities, the more successful it will be.
- Housing assistance should be part of the integrated services around HIV/HCV/STIs. A person who advises people how to get on a waiting list for housing, rental assistance, and dealing with landlord-tenant disputes, would be especially helpful.
- Monolingual Latinx people who do not speak English need services in their own language. Medical providers do not speak their language cannot convey information to them about treatment, risks, or affordability.
- Many undocumented Latinx people do not know they can get services, or don’t know they can get them without their information being shared with ICE.
- Languages spoken. While Spanish is fairly well-represented, Brazilian Portuguese and indigenous languages of Central America, especially Mayan languages, are needed in more healthcare settings.
- Confidentiality and privacy within the community need to be emphasized as part of health services. The burden of proof for testing information not being used against Latinx people lies with the DPH. Services have to spell out that information is confidential and will not fall into the wrong hands.
- This has to be really clear, especially when it comes to the fourth pillar: Molecular Surveillance. Every time this is mentioned to folks red flags come up. DPH needs to spell out the advantageous of how this is going to identify clusters that need whose viral loads are going up and not punish or single out individuals. Avoid the word surveillance at all costs and be transparent about what these things do and what they don’t do.
We look forward to continue sharing learned lessons with regional and national partners as EHE Initiative plans are completed and implemented in local Latinx communities.
For more information please contact Angel Fabian, Fijate Bien, Advocacy Coordinator firstname.lastname@example.org.
Contributions by Jorge Sanchez, Ethnographer at San Francisco State University; Amanda Halperin, Investigator; & Ray Ney Soares, Consultant