PERSPECTIVE ON AIDS : A Woman-to-Woman Call to Arms : Latinas account for 20% of female HIV cases. They need prevention methods that allow for cultural differences.

As I complete my service as U.S. surgeon general--the first woman, and the first American of Hispanic descent to hold that office--one of my greatest hopes is that the Latinas of this country begin to envision the future from a more realistic, assertive and proactive stance--without straying too far from the cultural norms that guide us, but not blindfolded by today’s inescapable realities.

Many health-related challenges facing Latinas are laden at times with cultural contradiction. We are expected to retain our pride without lingering at the altar of personal ambition, to transform without transgressing, to integrate without imposing.

We are also expected to share the best of our heritage and the best of our traditions, without forgetting our community’s unique values and mores, as we struggle each day to become part of mainstream society.

If all this were not enough, we are expected to take care of our families first and ourselves second, as we have done, lovingly and willingly, for centuries.

But no challenge that we face as Hispanic women is greater than the one that is robbing so many of us and our children of life: the fearsome epidemic of HIV/AIDS.

When I look at the numbers, I am very concerned about mi gente. Although we make up approximately 9% of the total U.S. population, 17% of all reported cases of AIDS are found in Latinos. Similarly, Hispanic women account for 20% of the 32,477 cases of AIDS in women. And Hispanic children account for one-fourth of all American children with AIDS.

Sad to say, women are bearing the brunt of infection, while continuing to bear the burden of caring for their families as well.

In light of these statistics, all women--especially Latinas--must work to foster a common agenda aimed at protecting them, their families and communities, from HIV infection.

To start, we must advocate a comprehensive health-care system relevant to women’s needs--a system where prevention, intervention and treatment programs are planned through the eyes of women, account for their socioeconomic realities and give them the ability, power and support to survive and succeed.

We must also develop preventive messages that are sensitive to women’s realities. For some Latinas, shame, guilt, fear of abandonment and rejection are more powerful realities than fear of a disease they lack the means, or knowledge, of preventing.

In light of our cultural realities, we must press for new prevention technologies geared toward women, especially Latinas, who are at high risk. We need methods that we can use independently, without having to compromise our health or, as sometimes may be the case, without having to seek permission from our male partners.

We need a method of protection that is affordable, easy to use, odorless, stainless, and unobtrusive--a technology that women can use to control the risk of infection for HIV and sexually transmitted diseases while preserving their relationships, and, as some Latinas often request, one that also allows for conception, should that be wished.

If we are to achieve any of these goals, we must, above all else, foster an open dialogue with men, one that holds men equally accountable for protecting and upholding the life of their family members but also respects Hispanic men’s traditional role as the head of the family.

In the presence of AIDS, which affects us all, we must begin to put an end to the gender war. It’s not “your man” or “your woman” who is at fault here; it’s the HIV virus.

I urge women everywhere to get involved, get informed and get in charge. It’s time we begin to think about ourselves first, for once. That is not selfish of us; to the contrary, it is absolutely life-affirming.

Let’s help one another to put all the guilt and blame and self-doubts aside, embrace the truth and tell one and all: When the health of a woman collapses, the health of the family collapses as well.

However, let’s also keep in mind that all Latinas cannot be reached in similar ways. As we move ahead with our efforts in education, prevention and treatment, we must be keenly aware of both our united and separate realities.

After all, how can a woman really ask for safe sex or control sexual practices when she is economically dependent on her partner? How can we expect her to speak up, and risk abandonment, when the one who abuses, neglects and infects also supports the family? And how can we expect women to take care of themselves if the system is unfriendly, the services are not amenable or unavailable, the data on women is incomplete, the research is narrow and the findings are irrelevant to women’s social needs and the state of their disease?

We Hispanic women must not be too proud to ask for help, to learn more about ourselves and our relationships and to speak to one another--men and women alike. This will not be easy, for in doing so, we might reveal the naked core that is so preciously guarded by our honor. But honor is not meant to imperil us; it is to sustain us.

In the future, care and prevention will be intricately related. By caring for the infected as well as the affected, closing the gaps between the haves and the have-nots and spurring women everywhere, especially those infected with the virus, to enlightenment and action, we will all reap the rewards of a health-care system in which women, for once, can take a well-deserved center stage.