Working With Groups: Latino Patients Living With HIV/AIDS The support group discussed here was created to address the unique needs of a vulnerable population receiving services at an outpatient interdisciplinary comprehensive care center. The center’s mission was to provide medical and psychosocial services to adult patients living with HIV/AIDS (PLWH). Both patients and providers at the center expressed a need for a group to address the needs of the center’s Latino population. At the time the group was created, 36% of the center’s population identified as Latino, and 25% of this cohort identified Spanish as their primary language. The purpose of the group was twofold: 1) to reduce the social isolation felt by Latino patients at the center and 2) to create a culturally sensitive environment where Latino patients could explore common medical and psychosocial issues faced by PLWH within a cultural context. Planning for the group consisted of 1) defining a format for the group, 2) recruiting appropriate members, and 3) building an appropriate group composition. When considering the format of the group, I thought about structure, time, place, and language. The group was designated a closed group in that new patients were not admitted once the initial membership was determined. The group was held in the center’s conference room, which was furnished with comfortable seating around a large conference table so that members were visible to each other during group sessions. The group met once a week for 90-minute sessions during which 60 minutes were spent on open discussion and the last 30 minutes were spent on having lunch. Given the importance of food in the Latino culture, I thought members would appreciate the opportunity to share a meal with their peers. I decided to designate the group as Spanish-speaking so that all sessions were held in Spanish. This offered members not only a sense of comfort and an opportunity to explore issues in their native tongue, but it also addressed the language barrier that often isolates Latino PLWH. I used several strategies to recruit members. I hung flyers throughout the center, and I informed my colleagues about the group during interdisciplinary staff meetings. Referrals ultimately came from physicians, social workers, and even administrative staff who had developed relationships with patients at the center. When considering group composition, I focused on creating balance in group size and the characteristics of individual members. I worked to create a group with enough members so that discussions would be fruitful and differing opinions could be presented, but at the same time, individual members would have an opportunity to discuss their unique feelings, thoughts, and opinions. When it came to member characteristics, I strove to create a balance between homogeneity and heterogeneity across such domains as age, sex, sexual orientation, socioecono ...

1. Working With Groups: Latino Patients Living With
HIV/AIDS
The support group discussed here was created to address the
unique needs of a vulnerable
population receiving services at an outpatient interdisciplinary
comprehensive care center. The
center’s mission was to provide medical and psychosocial
services to adult patients living with
HIV/AIDS (PLWH). Both patients and providers at the center
expressed a need for a group to
address the needs of the center’s Latino population. At the time
the group was created, 36% of the
center’s population identified as Latino, and 25% of this cohort
identified Spanish as their primary
language. The purpose of the group was twofold: 1) to reduce
the social isolation felt by Latino
patients at the center and 2) to create a culturally sensitive
environment where Latino patients
could explore common medical and psychosocial issues faced
by PLWH within a cultural context.
Planning for the group consisted of 1) defining a format for the

2. group, 2) recruiting appropriate
members, and 3) building an appropriate group composition.
When considering the format of the
group, I thought about structure, time, place, and language. The
group was designated a closed
group in that new patients were not admitted once the initial
membership was determined. The
group was held in the center’s conference room, which was
furnished with comfortable seating
around a large conference table so that members were visible to
each other during group sessions.
The group met once a week for 90-minute sessions during which
60 minutes were spent on open
discussion and the last 30 minutes were spent on having lunch.
Given the importance of food in
the Latino culture, I thought members would appreciate the
opportunity to share a meal with their
peers. I decided to designate the group as Spanish-speaking so
that all sessions were held in
Spanish. This offered members not only a sense of comfort and
an opportunity to explore issues
in their native tongue, but it also addressed the language barrier
that often isolates Latino PLWH.
I used several strategies to recruit members. I hung flyers

3. throughout the center, and I informed
my colleagues about the group during interdisciplinary staff
meetings. Referrals ultimately came
from physicians, social workers, and even administrative staff
who had developed
relationships with patients at the center. When considering
group composition, I focused on
creating balance in group size and the characteristics of
individual members. I worked to create a
group with enough members so that discussions would be
fruitful and differing opinions could be
presented, but at the same time, individual members would have
an opportunity to discuss their
unique feelings, thoughts, and opinions. When it came to
member characteristics, I strove to create
a balance between homogeneity and heterogeneity across such
domains as age, sex, sexual
orientation, socioeconomic status, etc. The goal was to create a
group where no member felt
isolated by uniqueness while simultaneously promoting
diversity between members. Prior to being
admitted to the group, potential members were
interviewed/screened in person or by phone. The
focus of these interviews was to 1) assess the patient’s ability to

4. communicate in Spanish, 2)
describe the purpose of the group, 3) discuss individual
expectations for the group, and 4) answer
questions about group process and function. A total of 15
patients were referred. Four declined to
participate before the group started and two did not show up
after the first session. Of the remaining
nine members, three were women and six were men. All of the
men had a significant history of
intravenous drug use (IVDU). Two of the men identified as gay,
one identified as bisexual, and
three considered themselves to be heterosexual. All of the
women were heterosexual, identified a
risk factor of unprotected heterosexual sex, and denied a history
of IVDU. Members’ ages ranged
from 36 to 60.
The group ran successfully for 18 months. Throughout the life
of the group, several recurrent
themes were discussed, including 1) stigma of HIV and
homosexuality, 2) disclosure of HIV status,
3) safer sex practices, 4) adherence to HIV treatment, and 5) the
doctor–patient relationship. Each

5. of these themes was discussed within a cultural context giving
light to issues such as
familialism, collectivism, simpatia, machismo (gender roles),
and Latino culture’s tendency to
rely on a folk model of medicine.
As in most groups, certain members adopted roles within the
group. For example, Anna, a 46-
year-old female member, adopted the role of the “silent
member.” She repeatedly came to sessions
and sat in silence, only responding when she was prompted by
direct questions from me or other
members. The challenge with Anna was that as this behavior
continued, other members tended to
ignore her and leave her out of the discussion. In turn, it
became my role to try to engage Anna as
much as possible and draw her into the discussion. Another
example is Diego, a 60-year-old male,
who adopted the role of the “help-rejecting complainer.”
Throughout group sessions, Diego
repeatedly presented a problem or issue and engaged the entire
group by asking for help. When
members responded with suggestions or solutions, he came up
with a myriad of excuses why none
of them would work. I will admit I was not successful at

6. altering Diego’s behavior in any way. I
attempted to point out the pattern, and I tried to ask other
members how it felt to constantly have
their input rejected, but nothing seemed to work. Group
members did express frustration and
boredom with Diego. This was manifested in their body
language and during group sessions when
Diego was not present. When members spoke about Diego in his
absence, I always encouraged
them to bring these issues to his attention when he was present,
but members were not able to do
this because they were fearful of hurting his feelings.
Ultimately, the group served as an arena for mutual support and
commonality. Group members
forged relationships with peers with whom they would not have
had contact in the absence of the
group. They also had the opportunity to reflect on their illness
and personal experiences within a
safe and culturally sensitive environment. While a scientific
evaluation of the group was not
performed, I witnessed and members reported positive outcomes
from the experience.