We Need Culturally Appropriate Resources When Latinas Experience Intimate Partner Violence - The "Invisible Crisis"

By: Veronica Bucher, Claudia Bernedo, Alejandra Siles, Karla Alvarado, Kamila A. Alexander

When Dr. Kamila A. Alexander began working as a Spanish-proficient public health nurse in Baltimore, Maryland in 2001, she found that resources for Latinas* were few and far between. At that time, there were approximately 10,000 Latinxs living in Baltimore City. She still recalls one patient in particular: a Latina, monolingual mother of two who tested positive for HIV after experiencing sexual violence. This diagnosis occurred within a health care system that was in no way designed to meet her needs. Unfortunately, the Latinas Saludables Research Study team, led by Dr. Alexander, still sees some of the same gaps in care. In 2020, the population of Latinxs in Baltimore has expanded to nearly 35,000, warranting more attention now than ever before.

Sexual and reproductive health inequities experienced by Latinas in the U.S. are unjust and can have detrimental consequences to families. Since 2010, HIV incidence overall in the U.S. has decreased six percent; nevertheless, the general Latinx population has seen a 14 percent increase during the same time period. Moreover, 88 percent of new HIV diagnoses in Latinas in the U.S. are the result of heterosexual contact. This significant yet underrecognized trend has been described as “the invisible crisis.” Intimate partner violence (IPV) and reproductive coercion (RC) disproportionately affects Latinas and can exacerbate risks for HIV and unintended pregnancies due to forced and condomless sex, threats, and coercion to engage in sexual activity, or sabotage of birth control methods.

Latinas face a lack of culturally appropriate health care and IPV services. For example, in a recent community assessment of the Baltimore metropolitan area, the Healthy Relationships Team, also led by Dr. Alexander, found that only one out of six community-based organizations were equipped to provide Spanish-language IPV services. Language barriers and mistrust of health care might impact effective use of services, especially among Latinas experiencing IPV who might be unaware of their risks for acquiring HIV. Compared to the general population, Latinx people are less aware of their HIV-positive status, use pre-exposure prophylaxis (PrEP) less, and receive HIV care at significantly lower rates. In one interview conducted by the Latinas Saludables Research Study team, a Baltimore-based provider stated that they perceived “Up to 98 or 99 percent of the Latina people we interviewed didn’t know what PrEP was.” In fact, in 2015, PrEP was indicated for use by 300,000 Latinxs in the U.S., but only 3 percent filled their prescriptions. In another interview, one provider acknowledged the lack of culturally-appropriate education about PrEP saying, “I think it’s just the education… I know there’s very few organizations that focus on the Spanish/Latin community, so I think that they’re not aware of it.” Providers must recognize, contextualize, and address these issues to provide optimal care.

Call to Action

How can we act against two intersecting, invisible epidemics to improve the health of Latinas? This year’s theme of Hispanic Heritage Month is focused on the service and contributions of Latinxs to the U.S. However, if these overlapping epidemics, IPV, RC, and risks for HIV, are not adequately addressed, the ability of individuals and families to continue contributing to our nation is woefully undercutting a broader vision for achieving health equity.

To better address these crises, the Latinas Saludables Research Study, funded by the JHU Center for AIDS Research and led by Dr. Alexander, is exploring factors that influence the availability and acceptability of PrEP and contraceptives among Latinas who have experienced IPV. To examine these factors, we are taking a two-fold approach. First, we are interviewing local health care and social services providers to examine how systems of care currently support Latinas and their families. Second, in partnership with House of Ruth Maryland, we are administering a culturally and linguistically appropriate survey (developed by Latinx-identifying future nurses) for Latinas in our community.

Challenges faced by the Latinx population are rooted in linguistic, social, cultural, and systemic inequities. We hope what we learn from the Latinas Saludables Research Study will help us to improve HIV, IPV, and unintended pregnancy prevention services offered to Latinas and their families, in order to seek reproductive justice for this population. Though the PrEP Continuum of Care is a well-established framework to implement care for those at risk of contracting HIV, we need more culturally-relevant research and programs developed by and for the Latinx community. With a team comprised of Spanishspeakers and data collectors the majority of whom identify as Latinx, we hope this representation will mitigate potential barriers that may arise due to lack of diversity. Approaches to acknowledge and decrease the impact of systemic racism and stereotyping related to HIV susceptibility and unintended pregnancy among Latinas experiencing IPV can ultimately assure that the contributions of Latinx communities are visible in every facet of our nation.

*The terms “Latinx” and “Hispanic” include heterogeneous subgroups of the U.S. population and refer to individuals whose heritage or country of origin include many different countries. Our team chooses to use the term “Latinx” for gender-inclusive ideas, and “Latina” to specify members of the Latinx population that identify as female. Our team avoids using the term “Hispanic” due to its Eurocentric implications, and failure to recognize the indigenous cultures of each country of origin.

This blog is a part of the “Dialogues in Health Equity” series by the Health Equity Faculty Interest Group. They are committed to decreasing health disparities experienced by local and global communities by promoting social justice and health equity through nursing practice, research, education, and service.

ABOUT THE AUTHORS

Veronica Bucher is a MSN (Entry Into Nursing) candidate at Johns Hopkins School of Nursing. She is currently the Lead Research Assistant for the Latinas Saludables Research Study; in this position, she is exploring the availability and perceptions of pre-exposure prophylaxis (PrEP) for Latina women who have experienced intimate partner violence. Previously, she earned a bachelor’s degree from Cal Poly San Luis Obispo, served as a Peace Corps Volunteer in rural Dominican Republic, and worked as a project manager at a San Francisco-based health tech startup. Her nursing interests include women’s health, immigrant health, and health equity. Her goal is to one day leverage health care data analytics to address racial disparities in women’s health care.

Claudia Bernedo, is a MSN (Entry into Nursing) candidate at the Johns Hopkins School of Nursing. She has dual Bachelor’s degrees in Biology and Psychology and served in the Peace Corps in Belize, promoting health education in a rural village of 3,000 residents and focusing on non-communicable diseases and maternal and child health. She is a board member in the Global Health Interest Group. She joined the Healthy Relationships research team in June, and serves as a research assistant for the Latinas Saludables Research Study and the TANGLED Study. She is originally from Peru, and her passions include social justice, serving the Latinx population, and traveling.

Alejandra Siles, BS, is an MSN (Entry into Nursing) candidate at the Johns Hopkins School of Nursing. She is a Birth Companion and a Research Assistant for the Healthy Relationships research team. Her interests include women’s and Latinx health. As an aspiring nurse practitioner, she hopes to bring health equity to underserved communities, especially Spanish speaking ones.

Karla Alvarado is an MSN (Entry into Nursing) candidate at the Johns Hopkins School of Nursing. Previously, she earned her Bachelor’s degree in Community Health at the University of Maryland. After completing her undergraduate degree, Karla worked as a health educator in Mary’s Center, a community clinic in DC and MD, where she provided bilingual health education to patients of all ages and conditions. This opportunity further developed her passion for immigrant health and public and preventative health. She is currently the president of the Latinx Health Advocacy Group and a bilingual Research Assistant in the Latinas Saludables Research Study, where she hopes to continue advocating and improving services for Latinx Women. She aspires to become a Family Nurse Practitioner and work with underserved communities.

Kamila Alexander, PhD, MPH, RN is an Assistant Professor at Johns Hopkins School of Nursing. She uses health equity and social justice lenses to research the prevention of sexual health outcome disparities and the complex roles that structural determinants such as intimate partner violence, societal gender expectations, and limited economic opportunities play in the experience of intimate human relationships. Dr. Alexander is the co-leader of the Johns Hopkins School of Nursing Health Equity Faculty Interest Group.