Xavier Ramirez earned a Bachelor of Arts in Latina/Latino Studies and a Bachelor of Social Work from the University of Illinois at Urbana-Champaign in 2015. Then, he received a Master of Arts in Social Service Administration from the University of Chicago in 2017. Xavier is currently a perinatal case manager at Pediatric Aids Chicago Prevention Initiative (PACPI) with the University of Chicago where he works with pregnant women who are HIV-positive.
What led you to work as a community health worker?
A lot of my family didn’t speak English growing up. My mom’s mother in law had several health conditions and her niece had down syndrome. It always fell on my mom to go with them to receive any type of health services because she was the only English-speaking family member. I was a kid at the time and I remember seeing her do this work a lot. I was fully aware that if she was not there, or had work, her family could not attend the appointments. My siblings and four of our cousins would tag along. I remember the feeling of having support from family members and understanding the value of that.
When my brother was 17 he had his first child. My sister-in-law was 16 at the time. I spent a lot of my childhood learning about maternal and child health. My sister-in-law had severe postpartum depression, which led to my interest in working with babies and women. I also had several peers in high school who had children. My exposure to young families made me interested in sexual health. The lack of accurate sexual health education caused more hardship and issues with young pregnant women. Young women and men were very confused because they did not understand how their bodies worked, how their menstrual cycle worked, or how their bodies were going to change. I remember doing a lot of Googling because of the shame around sexual health. Folks would say, “sirves para abrir las patas, pero no para educarte”. There was this idea that “you did this to yourself, so now you are on your own to figure it out.” This perpetuated a lack of support and understanding for young people in my life who were trying to navigate a complicated part of their life. This left them to feel like they had zero support from the adults in their life.
Because of these experiences, it motivated me to work with women and children. I feel that because I am male, it has confused people and caused many to discredit my work. Often, I hear hospital staff add the disclaimer that a male is the social worker. I am fully aware that I will never experience pregnancy and childbirth, but I am invested in the well-being of the women. More than anything, I have found that the women I work with want to be listened to and heard. They want their experiences validated within the health system that often functions to silence them and further their oppression.
Because I am a gay male who is Latino, many folks assume that when I work around issues of HIV, I must be working with men that have sex with men. However, I think it is important to note that men have a role in maternal and child health and that it is important that we are invested in this field.
What are the biggest barriers for your clients?
There are a lot of barriers and they differ for every client. The clients that come to mind have been treated as if they were uneducated and incapable of understanding the complexity of HIV and pregnancy. It is insulting in a lot of different ways, especially when a provider explains things in a condescending manner. You hear the big names in healthcare that have solid reputations, so you have high expectations regarding patient care. However, when you see situations where a language barrier is used to degrade a women’s intelligence, it is discouraging. In my experience, women are more than capable of understanding how to manage their care. We need to do better when thinking about how these women are treated and serviced within healthcare systems, so they can receive appropriate information. This is the only way to ensure that they can make positive, health decisions for themselves and their children.
HIV and women are not often discussed outside of the “HIV world” because of the stigma. I am not sure how common it is to know the health implications for HIV-positive, pregnant women or what infant transmission looks like. Lack of common knowledge leads to poor judgments and ideologies around whether HIV-positive women should be allowed to reproduce. This leads to mistreatment and blaming of women who are pregnant. There is fear about acknowledging HIV status, so people tend to avoid disclose of their status to their support system. As women tend to rely on additional social support during pregnancy, it is challenging because they feel isolated and alone. Women end up experiencing additional stress about disclosing their HIV status.
Additionally, society is quick to offer opinions about what women should and should not doing during pregnancy, especially women who are HIV-positive. Their family and others are extra attentive during pregnancy and after, so I find my clients finding creative ways to account for the extra medication needed to manage HIV. That stigma of saying “I am positive and that the baby is exposed” is incredibly stressful. The mom is doing everything in their power to protect her child, but it very hard when motherhood is isolating.
I also want to note that power dynamics in relationships are real. Domestic violence is real. Housing insecurity is real. All of these factors, and many more impact the mother’s ability to care for her own health and the health of their child.
What motivates you to be a community health worker?
The fact that there is still so much work to do motivates me. It is frustrating, but it speaks to the fact of how necessary it is we do this work. I want people to know the importance of on the ground work. For me, I have removed myself from academia and research because those on the ground are the first to notice a social phenomenon. At some point, I want to go back to academia, but I know these experiences are foundational.
I sometimes feel that people dismiss community work because it is thought that anyone can provide direct services. However, that is not true. Being a community worker requires you to have a high level of empathy and understanding, more than I can convey through text. There is a need to understand all competing forces that exist in someone’s life. For example, understanding that people must choose between paying their rent, electric, or food. Some people are so far removed from the experiences of their clients, that they can’t comprehend unequal or unequitable access to resources. I have been in spaces when someone says, “What is SNAP?” making me wonder how someone working with low-income communities is not knowledgeable about programs and systems impacting their clients. I would like to see a workforce that is more knowledgeable about the day to day struggles that poor communities face and I think it would increase our capacity to do health equity work.
What advice would you give to someone interested in becoming a community health worker?
If you are interested in becoming a community health worker, it is critical that you learn cultural humility. I grew up in the city of Chicago and many of my clients are in the suburbs. I realized that for clients in suburban communities, transportation is more of an obstacle than for people in the city. This was a learning experience for me. I would love to see cultural humility embedded into training and academic curriculum, so everyone has a baseline understanding of how to work with communities from different cultural, racial, religious, and income backgrounds.
You should also accept that you will never know everything. You will need to acknowledge that your job will make you feel unconformable. It is a human instinct to pull away from uncomfortable situations. In my work, there are many times when an answer is not clean cut and there is grey area. You may be pushed into situations that are completely unfamiliar to you and you need to challenge yourself to take on difficult scenarios.