HIV testing behaviors among undocumented Central American immigrant women in Houston, Texas

Testing, Inequities and Vulnerability of Adolescents to Sexually Transmitted Infections

Sexually transmitted infections (STIs) should form part of the comprehensive healthcare agenda for adolescents and young people (A&Y) and testing plays a strategic role in STI prevention. However, little attention has been paid to the social and programmatic obstacles to this practice among A&Y. The aim of this study is to describe the prevalence of testing for syphilis and HIV reported by a group of A&Y, analyzing its relationship with variables potentially indicative of inequities related to vulnerability to STIs. This was a cross-sectional survey applied to students at public high schools in three cities in the state of São Paulo, Brazil. The responses of 369 young people who reported having started sexual life were analyzed. The analysis included description of the frequencies of demographic and socioeconomic variables and their associations with testing for syphilis and HIV through the chi-square test. The concentration index (CI) was also calculated, with construction of the respective concentration curve for the associated variables. Positive associations were found between occurrence of testing and living in homes with up to three inhabitants, living in a marital situation with a regular or committed partnership, previous use of primary care services and previous use of hospitals or emergency services. The concentration curve for testing STIs showed significant contributions from the associated variables. The findings indicated that situations of inequity need to be addressed in order to reduce A&Y's vulnerability to STIs.

Pre- and Post-immigration HIV Testing Behaviors among Young Adult Recent Latino Immigrants in Miami-Dade County, Florida

HIV testing early in the immigration process can facilitate timely linkage to HIV prevention and treatment services for immigrants. This study aims to determine the prevalence of self-report HIV testing pre- and post-immigration and the associations between pre-immigration HIV sexual risk behaviors, access to healthcare post-immigration, and HIV testing post-immigration among young adult recent Latino immigrants. Cross-sectional data from 504 recent Latino immigrants aged 18 to 34 who immigrated to Miami-Dade County, Florida during the 12 months before assessment were analyzed using robust Poisson regression models. We found that 23.8% of participants reported HIV testing post-immigration and 56.7% reported HIV testing pre-immigration. The prevalence ratio for post-immigration HIV testing was higher for participants that had health insurance (adjusted prevalence ratio [aPR]: 1.70, 95% confidence interval [CI]: 1.21-2.38) and a regular doctor or healthcare provider after immigration (aPR: 1.43, 95% CI 1.03-2.00), and post-immigration HIV testing was higher for participants that had ever been tested for HIV before immigration (aPR: 2.41, 95% CI 1.68-3.45). Also, the prevalence ratio was lower for those who engaged in condomless sex in the three months prior to immigration (aPR: 0.65, 95% 0.47-0.90). These findings suggest that addressing barriers to healthcare and prevention services for young adult recent Latino immigrants is needed to scale-up HIV testing in this population early in the immigration process.

Chronic Pain and Psychological Distress Among Undocumented Latinx Immigrants in the USA

BACKGROUND

Undocumented immigration is often accompanied by multiple and complex stressors, which over time may increase the risk for chronic pain.

OBJECTIVE

This study aimed to identify the prevalence of chronic pain and its association with psychological distress among undocumented Latinx immigrants in the USA.

DESIGN/PARTICIPANTS

We used respondent-driven sampling to collect and analyze data from clinical interviews with 254 undocumented Latinx immigrants, enabling inference to a population of 22,000.

MAIN MEASURES

Chronic pain was assessed using the World Health Organization Composite International Diagnostic Interview (CIDI) Chronic Conditions Module. For all analyses, inferential statistics accounted for design effects and sample weights to produce weighted estimates. We conducted logistic regression analyses to assess the association between chronic pain and psychological distress after controlling for age, years in the USA, and history of trauma.

RESULTS

A total of 28% of undocumented Latinx immigrants reported having chronic pain, and 20% of those had clinically significant psychological distress. Significant differences in the prevalence of chronic pain were reported across age groups, years in the USA, and trauma history. After controlling for relevant covariates, chronic pain was significantly associated with psychological distress (OR = 1.06, 95% CI [1.02, 1.09]), age (OR = 1.05, 95% CI [1.02; 1.09]), and history of trauma (OR = 1.10 per additional traumatic event, 95% CI [1.02; 1.19]; C-statistic = 0.79).

CONCLUSION

Among undocumented Latinx immigrants, chronic pain is significantly associated with psychological distress, older age, and trauma history. Given that undocumented immigrants have restricted access to healthcare and are at high risk for chronic pain, developing alternatives to facilitate access to chronic pain interventions and risk-reduction prevention are needed.

'I think they might just go to the doctor': qualitatively examining the (un)acceptability of newer HIV testing approaches among Vietnamese-born migrants in greater-Brisbane, Queensland, Australia

Background In high-income countries (HICs), migrants often have higher rates of late diagnosis of HIV than the host population. Timely HIV testing has significant implications for HIV prevention and management. Newer HIV testing approaches, namely provider-initiated testing and counselling (PITC), HIV rapid testing (HIV RT) and HIV self-testing (HIV ST), aim to reach those populations most at risk and, particularly, those who have not previously tested for HIV.

METHODS

This study used semi-structured interviews to examine the (un)acceptability, barriers and facilitators to newer HIV testing approaches (i.e. PITC, HIV RT and HIV ST) among Vietnamese-born migrants (n = 10) in greater-Brisbane, Queensland, Australia.

RESULTS

Vietnamese-born migrants had mixed perspectives on the (un)acceptability of newer HIV testing approaches. PITC was largely viewed by participants as a facilitator to HIV testing for Vietnamese-born migrants. Likewise, HIV RT (undertaken by a doctor in a medical setting, as opposed to a trained community member in a community setting) was generally considered to facilitate HIV testing. HIV ST was largely not considered acceptable to Vietnamese-born migrants and they would prefer to go to a doctor for HIV testing. Several factors were identified that either facilitate or act as barriers to newer HIV testing approaches, including privacy; cost of (accessing) HIV testing; comfort and convenience; healthcare provider relationship; risk perception; symptoms; and technical and emotional support.

CONCLUSIONS

There is a need to understand migrants' HIV testing preferences if poorer HIV-related outcomes are to be overcome. The findings from this study show a preference for doctor-centred HIV testing, due to enhanced privacy, accuracy and support.

Factors associated with access to HIV testing among international students in Japanese language schools in Tokyo

Japan has been recognized for its excellent universal health coverage system. However, the migrant population faces many barriers in accessing health services in Japan. Japan hosts around 260,000 international students, mostly from developing countries. Among them, language school students tripled from 2011 to 2017, against the backdrop of labor shortage in Japan. Most of these students are also engaged as cheap laborers and are vulnerable populations with poor access to health services. Several socio-economic and behavioral factors may increase their vulnerability to HIV and prevent them from accessing HIV testing in Japan. We examined the factors associated with access to HIV testing among international students in language schools in Tokyo. We conducted a cross-sectional study among international students studying in Japanese language schools in Tokyo. We collected data from 769 Chinese, Vietnamese, and Nepalese students using a self-administered questionnaire. We measured their access to HIV testing through questions on their knowledge of where to receive HIV testing and utilization of HIV testing. Bivariate and multivariable logistic regression models were used to analyze the data. Nepalese students were less likely to know where to receive HIV testing in Japan than Chinese students (AOR = 0.12, 95% CI 0.01–0.96). Students who did not need Japanese language interpreters during visits to health facilities were more likely to know where to receive HIV testing (AOR = 1.93, 95% CI 1.14–3.25). Students who did not have knowledge of free and anonymous HIV testing in Japan were also less likely to know where to receive HIV testing in Japan (AOR = 0.18, 95% CI 0.08–0.42). Students who did not have knowledge of free and anonymous HIV testing (OR = 0.05, 95% CI 0.02–0.10) and who had not utilized HIV testing in their home country (OR = 0.12, 95% CI 0.06–0.27) were less likely to utilize HIV testing in Japan. Factors associated with access to HIV testing among Japanese language school students in Tokyo are nationality, need for Japanese language interpreters, perceived access to doctors/health workers, utilization of HIV testing in the home country, and knowledge of free and anonymous HIV testing. These findings may help to design interventions for improving access to HIV testing among international students in Japan.

Miles over mind: Transnational death and its association with psychological distress among undocumented Mexican immigrants

Objective: This study examined the association between transnational death and psychological distress among undocumented Mexican immigrants. The Minority Stress Model and a disenfranchised grief perspective were used as frameworks for this study.Method: Respondent driven sampling (RDS) was used to collect data from clinical interviews with 248 undocumented Mexican immigrants residing near the US-Mexico border.Results: After controlling for relevant covariates, experiencing transnational death was a significant predictor of clinically significant distress in this at-risk population.Conclusions: Our findings underscore the need to contextualize transnational death among undocumented immigrants from a perspective of disenfranchised grief that requires the development of contextually and culturally sensitive interventions aimed at addressing the high prevalence of transnational death and its associated distress in this marginalized population.

HIV Testing Among Foreign-Born Men and Women in the United States: Results from a Nationally Representative Cross-Sectional Survey

HIV disproportionately affects the foreign-born population in the United States. This analysis describes the prevalence of ever-testing for HIV among foreign-born individuals residing in the United States. Data from a national health survey of the civilian, non-institutionalized population was used to describe prevalence of ever-testing for HIV among foreign-born individuals by birth place. Multivariate logistic-regression procedures were used to determine factors associated with ever-testing for HIV among foreign-born men and women. The prevalence of ever-testing for HIV among foreign-born individuals varied by region of birth ranging from 31 to 67%. Factors related to ever-testing for HIV varied by gender. Efforts need to continue in order to improve HIV testing rates among Asian foreign-born individuals, lower educated foreign-born and foreign-born gay/bisexual men. Health care providers can play an important role by counseling new arrivals regarding the importance of testing for HIV and practicing HIV risk reduction activities.

Respondent driven sampling in a biomonitoring study of refugees from Burma in Buffalo, New York who eat Great Lakes fish

BACKGROUND

Refugees from Burma who consume fish caught from local waterbodies have increased risk of exposure to environmental contaminants. We used respondent driven sampling (RDS) to sample this hard-to-reach population for the first Biomonitoring of Great Lakes Populations program. In the current study, we examined the interview data and assessed the effectiveness of RDS to sample the unique population.

METHODS

In 2013, we used RDS to sample 205 Burmese refugees and immigrants residing in Buffalo, New York who consumed fish caught from Great Lakes waters. RDS-adjusted population estimates of sociodemographic characteristics, residential history, fish consumption related behaviors, and awareness of fish advisories were obtained. We also examined sample homophily and equilibrium to assess how well the RDS assumptions were met in the study.

RESULTS

Our sample was diverse with respect to sex, age, years residing in Buffalo, years lived in a refugee camp, education, employment, and fish consumption behaviors, and each of these variables reached equilibrium by the end of recruitment. Burmese refugees in Buffalo consumed Great Lakes fish throughout the year; a majority of them consumed the fish more than two times per week during summer, and about one third ate local fish more than once per week in winter. An estimated 60% of Burmese refugees in Buffalo had heard about local fish advisories.

CONCLUSIONS

RDS has the potential to be an effective methodology for sampling refugees and immigrants in conducting biomonitoring and environmental exposure assessment. Due to high fish consumption and limited awareness and knowledge of fish advisories, some refugee and immigrant populations are more susceptible to environmental contaminants. Increased awareness on local fish advisories is needed among these populations.

HIV Risk Behaviors Among Latina Women Tested for HIV in Florida by Country of Birth, 2012

Latina women in the United States (US) are disproportionately affected by human immunodeficiency virus (HIV) infection. Data are limited on the risk differences in HIV among Latinas by country of birth. This paper describes the risk behaviors among Latina women tested for HIV at public sites in Florida. Multivariate logistic regression was used to assess the demographic characteristics associated with the report of specific risk behaviors. Results indicate that foreign-born Latina women were 54 % less likely to report partner risk [95 % confidence interval (CI) 0.40, 0.54] than US-born Latina women. Reported risk behaviors varied by race/ethnicity, US-born versus foreign-born status, and by Latina country of origin. Knowledge of these differences can aid in targeting HIV prevention messaging, program decision-making, and allocation of resources, corresponding to the central approach of High Impact Prevention and the National HIV/AIDS Strategy.

"One Scar Too Many:" The Associations Between Traumatic Events and Psychological Distress Among Undocumented Mexican Immigrants

Undocumented immigration often presents with multiple stressors and contextual challenges, which may diminish mental health. This study is the first to provide population-based estimates for the prevalence of traumatic events and its association to clinically significant psychological distress among undocumented Mexican immigrants in the United States. This cross-sectional study used respondent-driven sampling to obtain and analyze data from clinical interviews with 248 undocumented Mexican immigrants residing in high-risk neighborhoods near the California-Mexico border. Overall, 82.7% of participants reported a history of traumatic events, with 47.0% of these meeting the criteria for clinically significant psychological distress. After controlling for relevant covariates, having experienced material deprivation, odds ratio (OR) = 2.26, 95% CI [1.18, 4.31], p = .013, and bodily injury, OR = 2.96, 95% CI [1.50, 5.83], p = .002, and not having a history of deportation, OR = 0.36, 95% CI [0.17, 0.79], p = .011, were associated with clinically significant psychological distress. These results support the need to revisit health and immigration policies and to devise solutions grounded in empirical evidence aimed at preventing the negative effects of trauma and psychological distress in this population.

Community Health Advocate-Identified Enablers of HIV Testing for Latina Immigrant Women

This study aims to identify enablers or facilitators of HIV testing among Latina immigrant women through qualitative interviews with five community health advocates (CHAs). CHAs act as cultural bridges between Latinos and service providers. We employed a single case-study design using the PEN-3 model as a conceptual framework for situating HIV testing behaviors within cultural and structural contexts of Latina immigrant women's lives. A cross-case analysis of themes revealed that intrinsic enablers of HIV testing included individual trust, confidentiality, intergenerational family participation, and peers. The extrinsic enablers were local community outreach, bicultural/bilingual testing staff, service location and mass media outlets. These results have implications for the cultural competency of health and social service providers, instituting and revising HIV testing outreach interventions, and the earlier identification of women who may have been infected. They offer important insights for promoting other health behaviors among the Latino communities.

HIV Testing Among Black and Hispanic Immigrants in the United States

Late presentation is common among black and Hispanic US immigrants living with HIV. Little is known about HIV testing in this population because data are aggregated into racial and ethnic categories without regard to nativity. This study was undertaken to determine HIV testing patterns in these populations. We used data from the National Health Interview Survey (2007-2010), a nationally representative source of HIV testing data disaggregated by nativity. The sample consisted of 10,397 immigrants (83.9% Hispanic white, 13.1% non-Hispanic black, and 3.0% Hispanic black). The majority of participants were from the Caribbean, Central America, and Mexico (81.5%). Hispanic white immigrants were least likely to have undergone testing compared with non-Hispanic and Hispanic black immigrants (46.7% vs. 70.5% and 65.8%). Among immigrants with known risk factors or prior STDs, 59.2% and 74.8% reported previous HIV testing. Immigrants who had not recently talked to a healthcare provider were less likely to report testing: Hispanic white (AOR 0.65, 95% CI 0.58-0.72), non-Hispanic black (AOR 0.64, 95% CI 0.48-0.85), and Hispanic black (AOR 0.26, 95% CI 0.14-0.48). Only 17.2% of all immigrants intended to undergo HIV testing in the 12 months following participation in the survey. Among all three racial and ethnic groups, immigrants who reported a history of prior STDs were more likely to intend to test for HIV in the future. Many black and Hispanic immigrants to the United States have not undergone HIV testing. Interventions to increase access to HIV testing and awareness of transmission risk should be developed.

Barriers and Facilitators to HIV Testing in Migrants in High-Income Countries: A Systematic Review

Migrants, particularly from low- and middle-income countries, are at a heightened risk of adverse HIV outcomes. HIV testing may improve these outcomes. We reviewed and synthesised studies into migrants and HIV testing (outcome variable), published between January 1997 and April 2014. Papers using quantitative, qualitative and mixed methods designs, and samples with adult (≥18 years) migrants from low- and middle-income countries in high-income countries were included in the paper. Of 3155 papers retrieved, 31 met the inclusion criteria and are included in the review. A large number of barriers and facilitators to HIV testing were identified across the individual, social and structural levels. A number of study design and methodological issues, however, inhibited a comprehensive synthesis. There is no doubt that addressing HIV testing in migrants in high-income countries is complex; however, it has important implications for individual, community and population health, and a strong, empirically based response is warranted.

Barriers to health care for undocumented immigrants: a literature review

With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations, to discrimination and fear of deportation. This paper is aimed at reviewing the literature on barriers to health care for undocumented immigrants and identifying strategies that have or could be used to address these barriers. To address study questions, we conducted a literature review of published articles from the last 10 years in PubMed using three main concepts: immigrants, undocumented, and access to health care. The search yielded 341 articles of which 66 met study criteria. With regard to barriers, we identified barriers in the policy arena focused on issues related to law and policy including limitations to access and type of health care. These varied widely across countries but ultimately impacted the type and amount of health care any undocumented immigrant could receive. Within the health system, barriers included bureaucratic obstacles including paperwork and registration systems. The alternative care available (safety net) was generally limited and overwhelmed. Finally, there was evidence of widespread discriminatory practices within the health care system itself. The individual level focused on the immigrant’s fear of deportation, stigma, and lack of capital (both social and financial) to obtain services. Recommendations identified in the papers reviewed included advocating for policy change to increase access to health care for undocumented immigrants, providing novel insurance options, expanding safety net services, training providers to better care for immigrant populations, and educating undocumented immigrants on navigating the system. There are numerous barriers to health care for undocumented immigrants. These vary by country and frequently change. Despite concerns that access to health care attracts immigrants, data demonstrates that people generally do not migrate to obtain health care. Solutions are needed that provide for noncitizens’ health care.

HIV testing practices among Latina women at risk of getting infected: a five-year follow-up of a community sample in South Florida

Latinos are more likely to delay HIV testing, present to care with an AIDS defining illness, and die within one year of learning their HIV-positive status than non-Latino blacks and whites. For this paper, we explore the role of partner-relationship characteristics and health behaviors, in predicting HIV testing among Latina adult women who engaged in risky sexual behaviors (i.e., unprotected vaginal and/or anal sex). Data from a convenience sample of 168 Latina adult women who engaged in risky sexual behavior in the year prior to assessment were analyzed for this paper. Rates and predictors of HIV testing among this sample were assessed after a five-year follow-up. Descriptive and analytical estimates include incidence rates and adjusted odds ratios (AOR) from multilevel models. At five-year follow-up, 63.7% (n = 107) women reported having been tested for HIV, of whom 12.2% (n = 13) were women who never tested before. Main reasons for not having been tested at follow-up included: low risk perception (62.1%) and trusting their partner(s)/being in a monogamous relationship/knowing their partner's HIV status (17.2%). Predictors of HIV testing included: age (AOR: 0.96; 95% CI = 0.92-0.99), provider endorsement of HIV testing (AOR: 4.59; 95% CI = 1.77-11.95), poor quality of their romantic relationships (AOR: 1.12; 95% CI = 1.03-1.26), and knowing the HIV sero-status of sexual partner (AOR: 3.61; 95% CI = 1.46-8.95). This study characterizes a group of Latina women at high risk for HIV infection and their HIV testing behaviors. Our findings underscore the need of increasing access to quality health-care services and HIV behavioral interventions, and to strengthen the adherence to HIV/sexually transmitted disease testing recommendations and guidelines among local health-care providers serving the Latino community in South Florida.

Barriers to HIV Testing in Black Immigrants to the U.S

BACKGROUND

Late HIV testing is common among immigrants from sub Saharan Africa and the Caribbean. Since 2010, HIV testing is no longer a required component of immigrant screening examinations or mandatory for immigrants seeking long term residence in the US. Thus, barriers to HIV testing must be addressed.

METHODS

Five hundred and fifty-five (555) immigrants completed a barriers-to-HIV testing scale. Univariate and multivariate linear regression were performed to examine predictors of barriers.

RESULTS

In multivariate analysis, primary language other than English (β=2.9, p=.04), lower education (β=5.8, p=.03), low income [= below $20K/year] (β=4.6, p=.01), no regular provider (β=5.2, p=.002) and recent immigration (β=5.7, p=.0008) were independently associated with greater barriers. Barriers due to health care access, privacy, fatalism, and anticipated stigma were greater for recent versus longer term immigrants.

DISCUSSION

Immigrants from sub-Saharan Africa and the Caribbean face significant barriers to HIV testing. Interventions to improve access and timely entry into care are needed.

Hispanics/Latinos and the HIV continuum of care in the Southern USA: a qualitative review of the literature, 2002-2013

Hispanics/Latinos are disproportionately affected by HIV infection, but access HIV care less often than non-Hispanic whites in the USA. The majority of new HIV diagnoses among Hispanics/Latinos occur in the southern USA; however, data are lacking regarding factors associated with HIV care access for Hispanics/Latinos in the South. We conducted a qualitative review of peer-reviewed articles using the HIV continuum of care framework to assess HIV care for Hispanics/Latinos in the US South. We identified 13 studies conducted in southern states that were informed by the continuum of care: testing and diagnosis of HIV infection (n = 9); linkage and retention in care (n = 2); and prescription of and adherence to ART (n = 2). Barriers to health care access included stigma, lack of Spanish-speaking health-care providers, and fear of deportation. Facilitators to health care access included provider endorsement of HIV tests and regular health care. Innovative solutions (e.g., patient navigators), tailored strategies (e.g., community outreach) and organizational-level interventions (e.g., increasing provider endorsement of HIV tests) can improve access for Hispanics/Latinos in the South.

Healthcare coverage and use among undocumented Central American immigrant women in Houston, Texas

We investigated the prevalence and correlates of having current healthcare coverage and of having a usual formal source of care among undocumented Central American immigrant women. Participants were recruited using respondent driven sampling. Thirty-five percent of participants had healthcare coverage and 43% had a usual formal source of care. Healthcare coverage was primarily through the local indigent healthcare program and most of those with a usual formal source of care received care at a public healthcare clinic. Having healthcare coverage and having a usual formal source of care were both associated with older age; having a usual formal source of care was also marginally associated with increased time of residence in the US and increased income security. The primary barriers to healthcare use were not having money or insurance, not knowing where to go, and not having transportation. Healthcare interventions may benefit from targeting young and newly arrived immigrants and addressing the structural and belief barriers that impede undocumented immigrant women's use of healthcare services.

Effectiveness of respondent driven sampling to recruit undocumented Central American immigrant women in Houston, Texas for an HIV behavioral survey

Respondent driven sampling (RDS) is widely used for HIV behavioral research among sex workers, drug users, and other hidden populations, but has had limited application in immigrant populations in the U.S. In 2010, we used RDS to recruit undocumented Central American immigrant women in Houston, Texas for an HIV behavioral survey. Beginning with three initial participants we recruited 226 women within 16 weeks. Social networks were dense and participants adopted the recruitment system with reasonable ease. Homophily scores indicated moderate within-group preference by country of origin. However, cross-group recruitment was sufficient to achieve a diverse sample that attained equilibrium for all demographic and sexual behavior characteristics. Overall, RDS was easy to implement, attained a large sample in a relatively short period of time, and reached an otherwise hidden population. Our results suggest that RDS is an effective method for recruiting undocumented Latina immigrants for HIV behavioral surveys.

Prevalence of HIV risk behaviors among undocumented Central American immigrant women in Houston, Texas

Undocumented Central American immigrants in the United States are disproportionately affected by HIV infection. However, epidemiological data on sexual behaviors among undocumented women are sparse and the extent to which behaviors vary by duration of residence in the U.S.is largely unknown. In 2010, we used respondent driven sampling to conduct an HIV behavioral survey among Central American immigrant women residing in Houston, Texas without a valid U.S. visa or residency papers. Here we describe the prevalence of sexual risk behaviors and compare recent (5 years or less in the U.S.) and established immigrants (over 5 years in the U.S.) to elucidate changes in sexual risk behaviors over time. Our data suggest that recent immigrants have less stable sexual partnerships than established immigrants, as they are more likely to have multiple and concurrent sexual partnerships, as well as partnerships of shorter duration.