The following is an introduction to the Latinos in the Deep South initiative, which developed the toolkit, and on whose experience the toolkit’s framework is based, as well as an attempt at characterizing emerging populations.

The Commission started the Latinos in the Deep South initiative in 2007 in recognition of the rapid increase of Latino populations in U.S. Southern states. Latinos in the Deep South focused initially in seven states: Louisiana, Mississippi, Alabama, Tennessee, Georgia, South Carolina and North Carolina. Within the first two years, the Commission conducted roundtables in each state to collect data and begin the process of bringing health departments and service providers together to look at HIV programs that focus on this emerging population. With foundation support, the Commission’s Latinos in the Deep South initiative successfully produced a report that highlighted challenges, successes, partners and agenda building processes to move forward on providing a continuum of HIV education, prevention, testing and treatment to Latinos across the region.

The main findings of the two-year investigation were:

• Throughout the region HIV infection and AIDS cases are rising at an alarming rate among Latino populations while prevention education lags behind. Access to HIV-related medical care is complicated by fear, stigma and, for the undocumented, a variety of administrative, practical and legal obstacles.
• Latinos often discover they are HIV-positive only at a late stage of infection as a result of serious illness or through pre-natal screening. In many communities pregnancy-related care is the main avenue for detecting cases of HIV among Latinos, including men.
• Many Latinos in the South, especially recent immigrants, do not have access to health care and are not reached by health promotion activities.
• AIDS prevention and service organizations throughout the region are making efforts to establish contact with Latino communities even without Spanish speaking employees.
• The high level of transience among the Latino and immigrant communities complicates attempts to carry out traditional HIV prevention initiatives based on peer-to-peer education.
• The increasing visibility of anti-immigrant sentiment makes Latinos distrustful of health departments and medical providers, which weakens campaigns to promote public health.
• Medical care for those infected with HIV is often available; however, undocumented clients have additional burdens in managing the disease.
• The lack of trained bilingual professional staff inhibits prevention initiatives and delivery of care; the few bilingual workers now in the field are overstretched and expected to fulfill too many roles.
• A well-organized and -marketed commercial sex industry generates a risk environment both for immigrant men and for the sex workers providing the services.
• High birth rates among Latinos have led to a massive increase in Spanish-speaking public school enrollment, which makes more urgent the need for appropriate educational programs for parents and for Latino adolescents in the region.
• Interventions targeting gay Latinos or other Latino men who have sex with men are rare in the South.

Since then, the program has evolved into different branches: capacity building assistance (CBA), community-based participatory research (CBPR), and community organizing. These have grown organically in response to the various needs in the region. The Commission recognizes that the HIV service infrastructure is not as well developed in the U.S. South as in the original national epicenters of the epidemic. This complicates service delivery for Latinos – who, in some states, are highly migratory. In other states, where there are more established Latino communities, services are still mitigated by the availability of bilingual and culturally appropriate services. In most regions, the local partners recognized that ongoing community assessments, development of coalitions of service providers, and non-traditional partners are integral to meeting the need for Latinos in the region.

As a CBA program, the Commission has supported the growth, strategic planning and actions of coalitions and organizations serving the local Latino populations across the South. While community organizing is important, infrastructure issues remain a challenge in the region. As a CDC-funded CBA provider, the Commission has been heavily involved in coalitions and activities in the original seven states and expanded to include Kentucky, Florida, New Mexico and Arkansas. The Commission recognizes that the lessons learned and best practices developed within the original seven states have relevance to other regions that have emerging Latino populations

In CBPR, the Commission recognizes that academic researchers, health departments and service providers all have to stretch to meet in common ground to meet the data collection, intervention design and policy development to effectively service Latinos in this area. With the support of the Office of AIDS Research, the Commission has convened CBPR summits in Alabama, Arizona, North Carolina, Missouri and Tennessee. These have involved over 200 elected officials, researchers, health department representatives, service providers and community members.

The community organizing function of the Latinos in the Deep South Program emerged specifically to encourage, enhance and act on policy issues in the Southern states. One of the key elements has been a distance-based learning initiative called the Dennis deLeon Sustainable Leadership Institute, which completed its first cohort in 2011. The Institute was named after the Commission’s visionary founder, Dennis deLeon, who believed in a just society, especially for those living with HIV/AIDS. As an attorney, Dennis understood that policy and service providers have an obligation to the local community. The Dennis deLeon Sustainable Leadership Institute is conducted through webinars and local projects that are tailored to each participant and location. The Institute focuses on how to identify problems and affect real policy change. In the past, this has meant a focus on AIDS stigma, HIV criminalization, HIV funding, anti-immigration sentiment and syringe access.

The Commission recognizes that HIV sero-incidence is increasing in the Southern states, along with the number of Latino populations moving into the regions. The tables below indicate the sero-prevalence of states and metropolitan statistical areas (MSAs) next to the sero-incidence of MSAs in the U.S. in one year. Whereas those states and locales with long-time epidemics clearly maintain a majority of HIV cases, the data clearly points to an increase in the rate of new infections, as nine of the top ten sero-incidence rates occur in Southern states.

Through these three branches, the Latinos in the Deep South Program provokes and encourages real change to occur at a local level. The combination of factors requires a multi-pronged response – including CBA, CBPR and grassroots community organizing. The Commission is proud to share these lessons learned and best practices, and hopes to illustrate how these can be replicable in other regions and sustainable in the South.