Earlier this year, the Center for Disease Control and Prevention reported that in 1998, for the first time since AIDS was discovered nearly 20 years ago, the disease was diagnosed in more Black and Hispanic gay men than in white gays. While AIDS deaths have dropped dramatically among whites, as first reported in 1997, the decline for Hispanics was nearly 50% less than the decline among whites, and the decline for blacks was 65% of the decline for whites. Among women and the young, two groups with increasing infection rates, the vast majority are Hispanic and black.

New York is the nation's capitol in AIDS cases among Latinos. It has the highest rate of Latinos living with AIDS in the United States with 187 per 100,000, whereas the rate among whites is 19 per 100,000.

In its most recent annual survey of AIDS in the Latino community, the NYC Hispanic Federation found that over 45% of Latinos in the state reported knowing someone with AIDS. This is an astonishing figure. Almost half of New York's Latino community has been personally affected by the AIDS epidemic.

It should be no surprise, then, that according to a recent survey by the Harlem Communities Council, Latinos rate AIDS as the greatest health risk facing the communityover cancer and heart disease. What was once considered a gay white diseasean unfathomable, taboo subject in the communityis now something with which most New York Latinos are familiar.

On a national level, according to a 1998 survey by the Kaiser Family Foundation, 35% of Latinos said they personally knew someone who had HIV or AIDS or who had died from AIDS. Half rated AIDS as the nation's most urgent health problem and 52% said that AIDS was a more urgent problem for their local community than it had been a few years before.

Yet, although Latinos know about modes of transmission, understand the health consequences of HIV and AIDS, and feel personally threatened by it, infection rates are still growing among various segments of the population. It seems that the Latino community is still losing ground to the epidemic.

Over the last fifteen years, I have been both personally and professionally involved in learning about HIV/AIDS, exploring ways to communicate effectively about its emotional and physical effects, and working with clients to educate the public about the disease. It has not been easy, but my experience has guided me along the way. I have learned many things about how Latinos in particular deal with HIV and AIDS, but I have also observed that many factors that may seem slightly exaggerated in the Latino community are really common to our society as a whole.

For individuals, issues of shame, guilt, and fear can make it difficult to deal with HIV/AIDS effectively. Lack of adequate information that can be understood easily, the high cost of health care, and the inconvenience, strain, and side effects of medical regimens have also taken their toll on persons living with HIV/AIDS. For a Latino raised with a certain fatalistic view of the world, it is natural to want to give up in this situation. However, the will to live is often stronger than the impulse to surrender to one's fate.. Within a family unit, it is difficult to resolve issues of communication, to talk about sex, and to share deep emotions in any situation; communication is especially difficult when it involves a stigmatized disease like HIV/AIDS. The difficulties are magnified in Latino families that adhere to strict cultural roles, and that obligate all members to demonstrate respect for family authority and to uphold the family's honor. Yet the impact of losing someone close due to HIV/AIDS or of having someone in the family disclose information about HIV/AIDS can have a powerful effect. When a family member asks, as one of my sisters did recently, if she can help distribute information about HIV/AIDS to the younger family members, you know some things can change.

As a community and a society, we have with the inevitable outcome of indifference to the needs of gay men, IV drug users, and prisonersthis indifference has fueled today's healthcare emergency in the Latino and African American communities. Throughout the history of HIV/AIDS, our leaders have also been slow to respond to the epidemic. Much has been accomplished, but we must continue to take the necessary healthcare and educational messages that have made a difference in other affected communities and adapt them so that they can cross cultural lines more effectively.

Roy Cosme, for the last five years, has represented the Latino Commission on AIDS in New York City. He is president of Arcos Communications, a Latino marketing and public relations agency.