The main problem in any region heavily affected by AIDS is poverty. If the money exists to do research, then the number of diagnoses will not be high. Poverty, however, is too big of a problem for public health to deal with so in Queens a more realistic approach is to target minority populations with education. More specifically, there is potential in targeting the Hispanic populations because they have a more structured culture such that if a significant impact can be made, then the effects will last.
A general assessment of the situation recognizes a couple of factors among the at-risk populations that include AIDS not being a priority compared to meals (14), the homeless being at risk (15), and someone not at risk coming into contact with an at-risk population (16). The last factor is important to note because the fact is that even if an individual is not part of the at-risk population, sooner or later that person will come into contact with another individual who is at risk.
The potential options would be to either tackle the African American or the Hispanic population. The cause for concern among the Hispanic population exists because study data shows that the number of Hispanics infected is greater than for other racial groups in proportion to total population (17). It would also be an easier task to break down the Hispanic population into groups as opposed to the African American population which is more like a single ethnic group. Taking a more detailed look at the Hispanic population one comes to the realization that it would be prudent to target a few ethnicities as opposed to the entire population. Based on the 2000 census numbers, Puerto Rico and the Dominican Republic were the most populous groups of Hispanics in Queens (18). There is much potential in primarily targeting these two groups because their families came from the Caribbean region which was the second-most affected region behind Africa by AIDS (19). Another subgroup of the Hispanics population to keep in mind are Mexicans. In one study, Mexicans were shown to be less knowledgeable about HIV/AIDS than all other Hispanics combined (20). The difference between the primary mode of transmission between North America and the Caribbean is marked. Whereas the majority of AIDS cases in North American are the result of homosexual activity, in the Caribbean, heterosexual contact is the main cause of AIDS (21).
The main aspect of Hispanic society that needs to be targeted is their culture. Special attention needs to be paid to the way relationships work in their society. When it is fine for men to have multiple partners even though their wives are to remain devoted, it is no wonder that heterosexual risk is so high. In Hispanic society this acceptance of the male being able to sleep around leads to the study that found Hispanic prostitutes having more than twice (15%) as high prevalence rates of HIV antibodies than white and other prostitutes (7%) (22). This number is definitely cause for concern seeing as how it is acceptable for Hispanic men to have multiple partners. A disturbing trend emerged among Hispanic women, with a study showing that they were more likely to have multiple partners than their white counterparts (23). One thing to look forward to is at least prostitutes in general have been increasing their condom use as they perceive their risk to be greater (22). On the other hand, prostitutes may increase their condom use with customers, but they fail to do so with their significant others who may also be at risk for HIV (24). The lack of condom use may either be a perception that their partner is not at risk or the result of a lack of control in the relationship. A way to counteract this problem of consent is to implement spermicides which the prostitute can implement on her own (24).
Some trends that must be noted among the Hispanic population include Hispanic women being more likely to have given birth within a 12 month span as opposed to non-Hispanic women and that only about 60% of Hispanics 25 and older had at least a high school diploma as opposed to about 89% of Whites 25 and older (25). The numbers for having at least a bachelor’s degree were 13% and 30%, respectively (25). The cause for concern is further amplified by a study which showed that on a test of AIDS knowledge, Hispanics scored significantly lower than any other race (26). One question in the study asked whether using condoms during sex lowered the risk of contracting AIDS. About 15% of whites and blacks answered incorrectly as opposed to more than 40% of Hispanics (26). The study also recognized that a potential explanation for the disparity is the comprehension of language (26). Another study confronted this potential problem and called for the Spanish language programs that are adapted for people from the various Spanish speaking countries (27).
Some trends that have been highlighted include one of increasing AIDS cases among foreign-born Hispanics and heterosexual U.S. born Hispanics (28). Such a trend is bothersome and some evidence suggests that most of the foreign-born Hispanics were infected in the U.S. (28). In accordance with these trends, it is obvious that the Hispanic and more specifically Puerto Rican and Dominican populations are in need of assistance.
Another subgroup that needs to be targeted in the prevention plan is that of adolescents especially those from a Hispanic background. The adolescent population is more of a side effect because as the older generations of Hispanics learn and change their behaviors, so will future generations. However, attention still needs to be paid to those who are currently adolescents.
A study in 1988 noted that among adolescents, 71.7% of whites and only 58.3% of Hispanics knew that using condoms during sexual intercourse would lower the risk of AIDS (29). The same study found that Latino adolescents were more than twice as likely to have misconceptions about AIDS as their white counterparts (29). An alternate study found that in general among the Hispanic population, only 28% thought that condoms were very effective in preventing HIV transmission (20).
Programs that are aimed at reducing risky behavior in schools showed some interesting results that could be the foundation of prevention programs. Results show that instruction related to biological issues led to earlier initiation of sexual intercourse, while instruction of AIDS led to later initiation of intercourse (30). Other interesting observations were that the more effective programs outlined behavioral norms and that students need to be able to identify with their peer educators or video instructors (30). It is only natural for the human brain to be more comfortable with what is familiar. The study also confirmed the belief that AIDS education programs lead to somewhat on an increased use of condoms (30).