PERSPECTIVE ON AIDS : HIV in Latinos? Absolutamente Si : The rate of infection among Latinos is higher than in the general population, and cultural factors hamper control.

As Surgeon General of the United States, I am concerned with the health of all Americans. As a Hispanic woman, I have a special concern for the health of my own community. And as I look at the health of Hispanics in the United States today, I see many signs of hope and progress. But I also see difficult problems and challenges. The most worrisome is HIV infection and AIDS.

We have learned many things about AIDS in the more than 10 years since it was first reported, but what the relentless increase in cases and deaths has especially taught us is that HIV and AIDS infect and kill without discretion or distinction.

So is AIDS a problem for Hispanic communities? Absolutamente si.

As of November, more than 200,000 people had been been diagnosed with AIDS, and more than 130,000 people had died. More than 33,000 of the diagnosed AIDS cases were Hispanic. Hispanics are only 8% of the U.S. population, but account for more than 16% of reported AIDS cases.

Certain kinds of behavior, including intravenous drug use and unprotected sex, are known to spread HIV. Are they present in the Hispanic community? Absolutamente si.

Transmission of the virus through heterosexual contact is three times more common among Hispanics than among whites. Sexually transmitted diseases such as syphilis and gonorrhea also occur disproportionately among Hispanics, indicating a high rate of unprotected sex.

Similarly, according to the National Institute on Drug Abuse, while 22% of AIDS cases overall are attributable to injection drug use, the percentage increases to 40% among Hispanics.

Why is this happening? The reasons are complex, but they include denial, misconception, fear and a poor understanding of HIV. Many Hispanics lack even the most basic information about the transmission of HIV. Some mistakenly believe that a cure for AIDS is available, or that you can tell who has AIDS by the way a person looks. In a recent survey of more than 1,000 minority women, 75% of Hispanic women felt they were at no risk of acquiring HIV; this despite the fact that Hispanic women account for more than 20% of cases among women. A recent study done in Los Angeles on low-income Hispanic males infected with HIV found that more than half of those who were sexually active kept their infection secret from their partners.

Our community also denies and rejects homosexuality. Whether we accept the lifestyle or not, we cannot afford to turn our backs on these, our brothers and sisters. We must also remember that 10% of reported heterosexual AIDS cases have occurred among women who had sexual contact with a bisexual man.

If we are to stop this disease from killing more and more of our families, friends and children, then we must break the bonds of denial, fear and ignorance.

We cannot assume that all Hispanics can be reached in similar ways. Knowledge gained among one group can and should be applied to others, but we must have a clear and sensitive understanding of the history, cultural traditions, religion and economic realities of each community in order to be effective.

Hispanic women need information about how HIV infection is spread and how they can protect themselves, but the information must reflect their realities. For example, we have been telling sexually active women that abstinence works, and for those who cannot abstain that they should change the rules and make sure that their men wear condoms. But in our culture, is this a feasible alternative? And women have been hearing that monogamous sex with one uninfected partner is safe--but will a Hispanic woman be able to demand and receive from her partner a truly monogamous relationship?

The issue of women and AIDS goes to the heart of how we, as women, are going to live our lives. Too many of us take care of our families and not ourselves. We must do both.

We must start by persuading our communities that AIDS is a family issue--and that difficult matters such as sexual behavior, the use of alcohol and other drugs--even homosexuality--must be discussed in a family setting that respects the values and traditions of our heritage.

The issue of AIDS in the Hispanic community is much broader than the epidemic itself. If we are to stop it, then everyone in the community must see a role for himself or herself in fighting the spread of the epidemic and caring for those who are ill. It cannot be "us versus them." We are all a family. We are not here to judge, we are here to help.

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