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Stigma Remains an Obstacle to Treatment
Counselors Say Fears Are Common Among Recent Latino Immigrants

By Brittney Johnson
Washington Post Staff Writer
Tuesday, August 5, 2008

Many patients still duck around the corner and wait for Metrobuses to pass so they can run unseen into one of the Whitman-Walker clinics -- the area's largest nongovernmental providers of HIV/AIDS services, according to Justin Goforth, director of Whitman-Walker's medical adherence unit.

More than 20 years into the HIV/AIDS epidemic, stigma is still a major barrier to getting tested and treated, Goforth said.

"If we could freely talk about [HIV] like we freely talk about someone with diabetes or cancer, people would get the support that is so important to health care," he said.

Perhaps nowhere is the shame greater and the support more lacking, disease counselors say, than among recent Latino immigrants. Deep cultural beliefs (for example, that women who insist on condom use are promiscuous, and that men who are sick are weak or not manly) and religious values (that sex outside marriage is wrong) discourage open talk about sexually transmitted diseases, they explain. Now, they say, the public health challenge posed by such beliefs is compounded by anti-immigrant sentiment and local legislation targeting those living in the country illegally.

Fearful area residents are putting off testing longer and traveling farther from home to get it following widely publicized campaigns in some Virginia counties to deport undocumented immigrants.

Undocumented Latinos "know that if [government officials] find out they are [HIV-]positive, their chance of changing their immigration status is almost zero," said Miguel Mejia, Whitman-Walker's Latino care coordinator. Last week President Bush approved a measure that could allow HIV-positive persons to enter the country or obtain legal residency; current law prohibits this. The decision now rests with the Department of Health and Human Services.

Public health workers in Virginia are not permitted to ask patients about their immigration status. But patients' fears to the contrary have been fueled by new laws in Loudoun and Prince William counties that allow police to ask anyone for immigration papers and direct jail officials to report all foreign-born inmates to federal immigration authorities.

"We have to get the word out through the grapevine that what's going on at the local level for immigration enforcement does not impact your access to HIV services," said Sue Rowland, executive director of Virginia Organizations Responding to AIDS, a nonprofit umbrella group that advocates for people living with HIV/AIDS.

Last year Rowland and other members of the Northern Virginia HIV Consortium compiled a question-and-answer sheet to help people understand their right to access HIV services, regardless of local measures that bar illegal immigrants from receiving other social services. But last week the document was still not available in Spanish or online.

According to the Virginia Department of Health, "Citizenship and immigration status shall not be included as a factor in VDH eligibility requirements."

Spokesmen for the Loudoun and Prince William health departments said they can't tell whether fewer undocumented people are seeking HIV/AIDS services.

At Whitman-Walker's Northern Virginia clinic, however, Goforth said, he has noticed an increase in undocumented residents who say they feel safer there than at government clinics. Dilcia Molina, a psychologist at La Clinica del Pueblo, a District clinic that primarily serves Latinos, said she sees about three patients a week from Virginia seeking HIV services in the District for the same reason.

District health officials, meanwhile, are trying to reassure Latino patients.

"In D.C. we try to send the message that those fears [of arrest for seeking health services] are unfounded. Our health response has nothing to do with immigration," said Shannon Hader, director of HIV/AIDS Administration for the D.C. Department of Health.

But health experts say fear perpetuates a dangerous culture of silence.

According to the D.C. health department, Latinos make up 8 percent of the District's population and 5 percent of all diagnosed AIDS cases -- a rate Hader suspects would be higher if more Latinos were tested. Nationwide, Latinos make up 15 percent of the population and 19 percent of diagnosed AIDS cases, according to the Kaiser Family Foundation.

Goforth said the taboo against discussing STDs is also costly.

"I have seen clients die from full-blown AIDS in a house full of their entire family and no one knew they were positive," Goforth said.

His job is to incorporate patients' treatment plans into their daily lives, which can be a challenge. Many who test positive are unlikely to take their medicine as prescribed or keep doctors' appointments because they are trying to hide their HIV from their families, he said. Many immigrants, he said, still consider HIV/AIDS a death sentence. Without medication, it can be.

"They don't know about modern treatment," Goforth said. "If you don't know that, you're back to the beginning of the epidemic when people thought, 'Why should we get tested if we are just going to get sick and die?' "

To give hope to his most vulnerable clients, Goforth tells his story.

"I tell them I have been HIV-positive for 16 years," he said. "They look at me and say, 'He looks like a normal healthy guy. He's got a good job and is just living a life.' "

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