Behavioral Health Services for Latinx in the South


Assessing utilization of mental health and substance use services among Latinx living with HIV or at high risk for HIV in the Deep South

Background

In 2019 Latinos constituted 18% of the US population, up from 16% in 2010, with 26% growth in  in the Southern states between 2010 and 2019.1  For instance, the Hispanic population grew 20% in Alabama, 22% in Georgia, 27% in Louisiana, 22% in Mississippi, 27% in North Carolina, 30% in South Carolina, and 34% in Tennessee.2 Many of the factors that contribute to the South’s overall disproportionate HIV burden also apply to Latinos, including poverty, rural isolation, cultural conservatism, and stigma. Additional factors impacting Latinos include socioeconomic barriers to accessing healthcare, anti-immigrant policies, lack of culturally and linguistically appropriate services, and social and structural racism.

Mental illness and substance use have been clearly identified with heightened HIV risk as well as poor HIV treatment adherence.3-6 Furthermore, there is considerable evidence of high levels of mental illness and substance abuse among Latinx.7,8 Nonetheless, utilization of existing behavioral health services is less than optimal among Latinx communities.8-10 A variety of factors are associated with lack of access and/or utilization,11-20 including limited availability of services or insurance coverage, limited English proficiency, stigmatization of mental illness and substance use, family and community views on behavioral health, and lack of social support to engage in services.

Project Description

Building on previous assessments and with guidance from a community advisory committee, LCOA will partner with community-based organizations to conduct regional surveys and focus groups on needs, availability, utilization, and appropriateness of mental health and substance use services among Latinx living with and at high risk for HIV in 7 Deep South states – Alabama, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee. 

This mixed-method assessment among Latinx and service providers will provide up-to-date information to (a) increase awareness on the mental health and substance use service needs of Latinx in the Deep South living with HIV or at high risk for HIV; (b) inform strategies to increase expertise among organizations serving Latinx communities; (c) guide/inform community leaders and health advocates to advocate for enhancement of behavioral health services; and (d) inform public health policies to address social and structural determinants that may hinder provision and utilization of mental health and substance use services.

We will strive to disseminate the findings of this assessment to community leaders, service providers, and public health officials throughout the 7 states as well as nationally to support action steps to enhance utilization and provision of culturally and linguistically appropriate behavioral services to the Latinx communities in the Southern US.

For more information, contact Judith Montenegro at jmontenegro@latinoaids.org or Daniel Castellanos at dcastellanos@latinoaids.org.


 

References

 

1.         Noe-Bustamante L, Lopez MH, Krogstad JM. U.S. Hispanic population surpassed 60 million in 2019, but growth has slowed. Pew Research Center. https://www.pewresearch.org/fact-tank/2020/07/07/u-s-hispanic-population-surpassed-60-million-in-2019-but-growth-has-slowed/. Published 2020. Accessed 3/1/2021, 2021.

2.         Noe-Bustamante L, Lopez MH, Krogstad JM. Hispanics have accounted for more than half of total U.S. population growth since 2010. Pew Research Center. https://www.pewresearch.org/fact-tank/2020/07/10/hispanics-have-accounted-for-more-than-half-of-total-u-s-population-growth-since-2010/. Published 2020. Accessed 3/1/2021, 2021.

3.         Gonzalez A, Barinas J, O’Cleirigh C. Substance use: impact on adherence and HIV medical treatment. Current HIV/AIDS Reports. 2011;8(4):223.

4.         Hinkin CH, Hardy DJ, Mason KI, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS (London, England). 2004;18(Suppl 1):S19.

5.         Berg CJ, Michelson SE, Safren SA. Behavioral aspects of HIV care: adherence, depression, substance use, and HIV-transmission behaviors. Infectious Disease Clinics of North America. 2007;21(1):181-200.

6.         Walkup J, Blank MB, Gonzalez JS, et al. The impact of mental health and substance abuse factors on HIV prevention and treatment. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2008;47:S15-S19.

7.         Villalobos BT, Bridges AJ. Prevalence of substance use disorders among Latinos in the United States: An empirical review update. Journal of Latina/o psychology. 2018;6(3):204.

8.         Alegria M, Canino G, Ríos R, et al. Mental health care for Latinos: Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino Whites. Psychiatric services. 2002;53(12):1547-1555.

9.         Guerrero EG, Marsh JC, Khachikian T, Amaro H, Vega WA. Disparities in Latino substance use, service use, and treatment: Implications for culturally and evidence-based interventions under health care reform. Drug and alcohol dependence. 2013;133(3):805-813.

10.       Keyes KM, Martins S, Hatzenbuehler ML, Blanco C, Bates L, Hasin DS. Mental health service utilization for psychiatric disorders among Latinos living in the United States: the role of ethnic subgroup, ethnic identity, and language/social preferences. Social psychiatry and psychiatric epidemiology. 2012;47(3):383-394.

11.       Cabassa LJ, Lester R, Zayas LH. “It’s like being in a labyrinth:” Hispanic immigrants’ perceptions of depression and attitudes toward treatments. Journal of Immigrant and Minority Health. 2007;9(1):1.

12.       Cooper LA, Gonzales JJ, Gallo JJ, et al. The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients. Medical care. 2003:479-489.

13.       Jimenez DE, Bartels SJ, Cardenas V, Dhaliwal SS, Alegría M. Cultural beliefs and mental health treatment preferences of ethnically diverse older adult consumers in primary care. The American Journal of Geriatric Psychiatry. 2012;20(6):533-542.

14.       Kim G, Loi CXA, Chiriboga DA, Jang Y, Parmelee P, Allen RS. Limited English proficiency as a barrier to mental health service use: A study of Latino and Asian immigrants with psychiatric disorders. Journal of psychiatric research. 2011;45(1):104-110.

15.       Kouyoumdjian H, Zamboanga BL, Hansen DJ. Barriers to community mental health services for Latinos: Treatment considerations. Clinical Psychology: Science and Practice. 2003;10(4):394-422.

16.       Pinedo M, Zemore S, Rogers S. Understanding barriers to specialty substance abuse treatment among Latinos. Journal of substance abuse treatment. 2018;94:1-8.

17.       Rastogi M, Massey-Hastings N, Wieling E. Barriers to seeking mental health services in the Latino/a community: A qualitative analysis. Journal of Systemic Therapies. 2012;31(4):1-17.

18.       Uebelacker LA, Marootian BA, Pirraglia PA, et al. Barriers and facilitators of treatment for depression in a Latino community: A focus group study. Community mental health journal. 2012;48(1):114-126.

19.       Villalobos BT, Bridges AJ, Anastasia EA, Ojeda CA, Hernandez Rodriguez J, Gomez D. Effects of language concordance and interpreter use on therapeutic alliance in Spanish-speaking integrated behavioral health care patients. Psychological Services. 2016;13(1):49.

20.       Zemore SE, Mulia N, Ye Y, Borges G, Greenfield TK. Gender, acculturation, and other barriers to alcohol treatment utilization among Latinos in three National Alcohol Surveys. Journal of substance abuse treatment. 2009;36(4):446-456.