By Alison Davis
February 26, 2010
Mario De la Rosa, Ph.D.
Jesús Sanchez, Ph.D.
America celebrates its rich diversity, but as a nation we remain riddled with the serious problem of disparities in health outcomes, often for diseases that are mostly preventable. For Latinos, HIV/AIDS is a striking and alarming example of such disparities, say Dr. Mario De La Rosa and Dr. Jesús Sanchez, a pair of social scientists who are tackling the problem in Miami-Dade County, Fla.
The Problem: Over the past 15 years, medical research has made remarkable strides in confronting the HIV/AIDS epidemic. In fact, for many people the discovery and development of new drugs has turned HIV infection from a death sentence into a chronic disease.
But the picture is not so rosy for those who do not have access to these life-saving medications. Worse, language and cultural barriers often block effective prevention messages from reaching people at risk. Latinos, the fastest-growing ethnic minority group in the United States, have been hit especially hard. According to the most recent U.S. census data, the rate of new HIV infections among Hispanics/Latinos is more than double that of whites.
Finding a Solution: Drs. De La Rosa and Sanchez, who lead a team of researchers at Florida International University's National Center on Minority Health and Health Disparities, focus on HIV risk behavior and substance abuse — two intertwined problems — in recent Latino immigrants. Among such immigrants, one group that is often overlooked, says Dr. Sanchez, is farm workers, who come to America with limited education and resources and a culture vastly different from our own. In their homelands of Central and South America, he adds, people don't talk openly about their sex lives, and the stigma of a disease that is often tied to sexual behavior or intravenous drug use is a huge problem.
As a result, many of these people don't know about effective preventive measures like using a condom or about the importance of HIV testing and safe sex. Drug use and visits to prostitutes by Latino men who come to this country alone often bring HIV back to spouses in their home countries, and the cycle continues.
When Drs. Sanchez and De La Rosa first started their research a few years ago, they learned quickly that it would be tough going. The scientists did not know much about the farm worker community, but they did know the community was wary of "helicopter researchers" who — as the locals see it — "fly in and out" after collecting data.
"We knew right away that we needed to partner with the community," says Dr. De La Rosa. "Our first step was to gain trust, and we knew we'd have to earn it."
Community-based participatory research is a vital avenue for addressing health disparities, explains Dr. De La Rosa, but it's difficult. Success means bringing researchers and community members together, both for work and for play. Dr. Sanchez says he enjoys attending community members' holiday events and offering support and guidance. These efforts have a direct impact on moving forward with the researchers' goal of improving Latino health.
"Community members don't believe in findings they don't participate in," says Dr. Sanchez, adding that they need to know that their worries and fears are heard.
"Bronchitis, asthma and cancer are the number-one concerns for farm workers exposed daily to agricultural pesticides. HIV/AIDS isn't necessarily on their radar screen."
How This Funding Helps: For the past several years, Drs. De La Rosa and Sanchez have used NIH funding to conduct research on HIV/AIDS and substance abuse affecting Latinos in Miami. They have completed all data collection and are planning to begin analyzing that data soon.
The new Recovery Act funding provides a chance to substantially extend the Center's reach by training community members in HIV testing and awareness of preventive measures. Lay health advisers will learn how to conduct surveys, to collect and report data, and to communicate important health information to friends and family in their local area.
"This funding is so important because it gives us resources to do things that take a lot of time and effort," says Dr. Sanchez. "Community-based participatory research is a vital part of making a real difference in the battle against HIV/AIDS."
After Two Years … A key goal of the project is to create a self-sustaining research unit that lives well beyond the infusion of funds from the Recovery Act. According to Dr. De La Rosa, after two years the goal is that community researchers will have an established linkage with the Miami Department of Health: a win-win situation in which public health officials can stay on top of the spread of disease and locals can be current with the latest research updates and other health information.
Dr. De La Rosa and Dr. Sanchez say that they will have succeeded when they have created a stable research community in which community members apply successfully for research funding, recruit health workers from within, and spread the message about healthy behaviors among themselves. Building a strong community foundation not only helps to stem the spread of diseases like HIV/AIDS, but by promoting independence it also sustains the overall health of the community.
"Querido Jesús — Muchas gracias de nuevo por toda su ayuda," one participant thanked Dr. Sanchez for all he's done for their community.
Recovery Act Investment: The project "Center for Substance Use and AIDS Research on Latinos in the United States" received $600,000 for fiscal 2009, funded by the National Center on Minority Health and Health Disparities.