Immigration and HIV/AIDS in the New York Metropolitan Area

A pilot test of an infographic-based health communication intervention to enhance patient education among Latino persons with HIV

OBJECTIVE

To pilot test an infographic-based health communication intervention that our team rigorously designed and explore whether its implementation leads to better health outcomes among Latino persons with HIV (PWH).

MATERIALS AND METHODS

Latino PWH (N = 30) living in New York City received the intervention during health education sessions at 3 study visits that occurred approximately 3 months apart. At each visit, participants completed baseline or follow-up assessments and laboratory data were extracted from patient charts. We assessed 6 outcomes (HIV-related knowledge, self-efficacy to manage HIV, adherence to antiretroviral therapy, CD4 count, viral load, and current and overall health status) selected according to a conceptual model that describes pathways through which communication influences health outcomes. We assessed changes in outcomes over time using quantile and generalized linear regression models controlling for the coronavirus disease 2019 (COVID-19) research pause and new patient status (new/established) at the time of enrollment.

RESULTS

Most participants were male (60%) and Spanish-speaking (60%); 40% of participants identified as Mixed Race/Mestizo, 13.3% as Black, 13.3% as White, and 33.3% as "other" race. Outcome measures generally improved after the second intervention exposure. Following the third intervention exposure (after the COVID-19 research pause), only the improvements in HIV-related knowledge and current health status were statistically significant.

DISCUSSION AND CONCLUSION

Our infographic-based health communication intervention may lead to better health outcomes among Latino PWH, but larger trials are needed to establish efficacy. From this work, we contribute suggestions for effective infographic use for patient-provider communication to enhance patient education in clinical settings.

Lack of full citizenship rights linked to heightened client condom refusal among im/migrant sex workers in Metro Vancouver (2010-2018)

In Canada, im/migrant sex workers face stigma, health access barriers, and overlapping marginalisation, with end-demand law reforms in 2014 postulated to exacerbate these inequities. Yet, little quantitative evidence on how immigration status shapes HIV/STI risk exists. Drawing on community-based longitudinal cohort data (AESHA, 2010-2018), we used multivariable confounder models with logistic regression to model (1) the independent effect of precarious immigration status (any status revocable under criminal charges: permanent residency/temporary residency/undocumented) on client condom refusal, and (2) the moderating effect of precarious status on the relationship between condom refusal and exposure to end-demand law reform (2015-2018). Over this 8-year study involving 758 sex workers in Metro Vancouver, 16.0% were im/migrants, of whom 57% had precarious immigration status at baseline. 16.5% of participants experienced client condom refusal. Precarious immigration was associated with increased odds of facing condom refusal (adjusted odds ratio [AOR] 2.53, 95% confidence interval [CI] 1.37-4.68), and these odds were heightened post-end-demand law reforms (AOR 4.35, 95%CI 1.21-15.66). Our findings suggest that lack of citizenship rights may enhance barriers to safer sex negotiation and increase HIV/STI risk among sex workers, highlighting the need for sex work and immigration policy reforms.

La desesperación in Latino migrant day laborers and its role in alcohol and substance-related sexual risk

The purpose of this study was to better understand the relation between psychological distress and alcohol and substance related sexual risk in Latino migrant day laborers (LMDLs). In addition to examining the roles of depression and anxiety, it was also necessary to examine the role of desesperación, a popular Latino idiom of distress frequently expressed by LMDLs in response to the thwarting of major migration related life goals such as traveling to the U.S. in search of work to support families, projects and purchases in country of origin. Given the structural vulnerability of LMDLs to under-employment and frequent unemployment, LMDLs also refer to desesperación as a prelude to problem drinking, substance use, and sexual risk taking. Hence we developed and validated a scale of desesperación for LMDLs to explore this culturally relevant construct of psychological distress in this unique population of Latinos. Based on a cross sectional survey of 344 LMDLs, this study found that the dissatisfaction subscale of desesperación predicted alcohol-related sexual risk taking, while depression predicted substance-related sexual risk taking. These findings are discussed including implications of preventing alcohol and substance related sexual risk taking in LMDLs.

Applying Ecological Positive Youth Development Theory to Address Co-Occurring Health Disparities Among Immigrant Latino Youth

This article outlines the theory and resulting approach employed in a multilevel, integrated, collaborative community intervention called Adelante, implemented by a university-community partnership in a Latino immigrant community to address co-occurring health disparities of substance abuse, sex risk, and interpersonal violence among youth. The basis for the intervention is a social-ecological interpretation of positive youth development theory, which focuses on changes in the person environment context and community assets as a preventive mechanism. This approach is viewed as appropriate for a community facing multiple barriers to health equity. The article describes the translation of this positive youth development model to practice, including the design of the intervention, intervention components, and the protocol for evaluation. The Adelante intervention is intended to reduce health disparities and, in addition, to add a broader community model to the evidence base.

[Social determinants of health associated to the human immunodeficiency virus of indigenous women in north Oaxaca, México]

The vulnerability to the human immunodeficiency virus (HIV) infection may increase based on specific social determinants of health, which can also affect the lack of adherence to a safe sexual behavior and access to antiretroviral treatment in indigenous women. Consequently, it is necessary to review, through a documentary study, what are those determinants in the case of a group of indigenous women from the North of Oaxaca and how these aspects affect those women, as well as the important role of nursing for the best approach. Social determinants are classified into 3 levels: macro (socioeconomic status, income, migration and education), meso (culture, gender and access to health services) and micro (lifestyles and adoption of safe sex). Indigenous women with limited resources become easy targets of HIV by engaging in risky sexual behaviors inadvertently. The nurse is a key professional who can influence behaviors of women through effective interventions that help foster self-confidence and empowerment, using the resources that the person possesses.

Foreign-Born Persons Diagnosed with HIV: Where are They From and Where Were They Infected?

We sought to calculate rates of HIV diagnoses by area of birth among foreign-born persons in a high-incidence US city with many immigrants, and determine probable place of HIV acquisition. Data from the New York City HIV surveillance registry and American Community Survey were used to calculate HIV diagnosis rates by area of birth and determine probable place of HIV acquisition among foreign-born diagnosed in 2006-2012. HIV diagnosis rates varied by area of birth and were highest among African-born persons; absolute numbers were highest among Caribbean-born persons. Probable place of acquisition was a foreign country for 23 % (from 9 % among Middle Easterners to 43 % among Africans), US for 61 % (from 34 % among Africans to 76 % among South Americans), and not possible to estimate for 16 %. HIV prevention and testing initiatives should take into account variability by foreign area of birth in HIV diagnosis rates and place of acquisition.

Sending-country violence and receiving-country discrimination: effects on the health of Colombian refugees in Ecuador

This study explored factors affecting the health and well being of recent refugees from Colombia in Ecuador. Data collection focused on how sending-country violence and structural violence in a new environment affect immigrant health vulnerability and risk behaviors. A qualitative approach included ethnographic observation, media content analysis, focus groups, and individual interviews with refugees (N = 137). The focus groups (5) provided perspectives on the research domains by sex workers; drug users; male and female refugees; and service providers. Social and economic marginalization are impacting the health and well being of this growing refugee population. Data illustrate how stigma and discrimination affect food and housing security, employment and health services, and shape vulnerabilities and health risks in a new receiving environment. Widespread discrimination in Ecuador reflects fears, misunderstanding, and stereotypes about Colombian refugees. For this displaced population, the sequelae of violence, combined with survival needs and lack of support and protections, shape new risks to health and well-being.

HIV risky sexual behaviors and HIV infection among immigrants: a cross-sectional study in Lisbon, Portugal

This study aimed to examine risky sexual behavior, its associated factors and HIV infection among immigrants. A participatory cross-sectional survey was conducted with 1187 immigrants at the National Immigrant Support Centre, in Lisbon (52.2% female; 34.0% Africans, 33.8% Brazilians, 32.2% Eastern Europeans). About 38% of participants reported ≥ 2 sexual partners in the previous year, 16.2% both regular and occasional sexual partners (last 12 months), 33.1% inconsistent condom use with occasional partners, and 64% no condom use in the last sexual intercourse. Unprotected sex in the last sexual intercourse was more likely among women, Africans, those older, with elementary education, those married and those who didn't receive free condoms in the previous year. No condom use was less likely among those having only occasional sexual partners and both regular and occasional sexual partners. One third of participants had never been tested for HIV. Those never tested reported more frequently inconsistent condom use than those ever tested. Overall, 2.0% reported being HIV positive (2.5% of men; 4.4% of Africans); 4.3% admitted having a STI in previous year. HIV-positive immigrants reported high-risk sexual behaviors. Tailored interventions to promote awareness of HIV serostatus among immigrants as well as culturally adapted risk reduction strategies should be strengthened.

Exploring migratory dynamics on HIV transmission: the case of Mexicans in New York City and Puebla, Mexico

Migration and population movement are increasingly viewed as important factors associated with HIV transmission risk. With growing awareness of the potential impact of migration on HIV transmission, several perspectives have emerged that posit differing dynamics of risk. We considered available data on the role of migration on HIV transmission among Mexican migrants in New York City and Puebla, Mexico. Specifically, we examined 3 distinct models of migratory dynamics of HIV transmission-namely, the structural model, the local contextual model, and the interplay model. In doing so, we reframed current public health perspectives on the role of migration on HIV transmission.

Risk perception and vulnerability to STIs and HIV/AIDS among immigrant Latin-American women in Canada

This paper describes the migratory experiences of Latin American migrant women living in Canada, their perceptions of the risk of HIV, AIDS and other sexually transmitted infections (STIs) and barriers to accessing healthcare services. We conducted 25 in-depth interviews with Latin American migrant women living in Montreal, Canada. The majority of participants were permanent residents and refugee status claimants. Women's experiences in Canada were characterised by uncertainty, deception and fraud, separation from their families and feelings of discrimination. Women's risk perception of HIV/AIDS/STIs involved relations of gender inequalities of power. Women who did not perceive themselves to be at risk were those who had a stable partner who they felt they could trust. The majority of women reported difficulties in accessing sexual and reproductive health services. Women's vulnerability to HIV/AIDS/STIs was determined by: experiences during their lifecourse; their migratory status, which was associated with sexual abuse, abuse at work, language barriers and lack of social support networks; and their ability to access health services. The provision of health services to this population must focus on sexual and reproductive health needs and should do so from a multicultural perspective that takes into account the changes associated with the migration process.

HIV/AIDS health care challenges for cross-country migrants in low- and middle-income countries: a scoping review

Introduction

HIV/AIDS has been one of the world’s most important health challenges in recent history. The global solidarity in responding to HIV/AIDS through the provision of antiretroviral therapy (ART) and encouraging early screening has been proved successful in saving lives of infected populations in past decades. However, there remain several challenges, one of which is how HIV/AIDS policies keep pace with the growing speed and diversity of migration flows. This study therefore aimed to examine the nature and the extent of HIV/AIDS health services, barriers to care, and epidemic burdens among cross-country migrants in low-and middle-income countries.

Methods

A scoping review was undertaken by gathering evidence from electronic databases and gray literature from the websites of relevant international initiatives. The articles were reviewed according to the defined themes: epidemic burdens of HIV/AIDS, barriers to health services and HIV/AIDS risks, and the operational management of the current health systems for HIV/AIDS.

Results

Of the 437 articles selected for an initial screening, 35 were read in full and mapped with the defined research questions. A high HIV/AIDS infection rate was a major concern among cross-country migrants in many regions, in particular sub-Saharan Africa. Despite a large number of studies reported in Africa, fewer studies were found in Asia and Latin America. Barriers of access to HIV/AIDS services comprised inadequate management of guidelines and referral systems, discriminatory attitudes, language differences, unstable legal status, and financial hardship. Though health systems management varied across countries, international partners consistently played a critical role in providing support for HIV/AIDS services to uninsured migrants and refugees.

Conclusion

It was evident that HIV/AIDS health care problems for migrants were a major concern in many developing nations. However, there was little evidence suggesting if the current health systems effectively addressed those problems or if such management would sustainably function if support from global partners was withdrawn. More in-depth studies were recommended to further explore those knowledge gaps.

Genetic diversity and linkage disequilibrium in the chemokine receptor CCR2-CCR5 region among individuals and populations

BACKGROUND

Chemokine receptors CCR2 and CCR5 play a key role in immune and inflammatory responses and have been associated with several diseases, including AIDS. In order to comprehend health disparities it is important to understand the nature of genetic variation in specific genes of interest in different populations. Current studies of the CCR2 and CCR5 receptor genes are primarily focused on the CCR5-Δ32, and CCR2-V64I SNPs.

METHODS

Sanger sequencing was used to sequence the regions containing 16 SNPs in the adjacent CCR2 and CCR5 genes (including CCR5-Δ32, and CCR2-V64I) in 249 subjects of African, European and Hispanic ancestry. Linkage disequilibrium (LD) and haplotypes were determined using Haploview.

RESULTS

The data revealed large differences in allele frequencies of several SNPs and LD patterns among the ethnic groups, including SNPs that were restricted to Africans or Europeans. Seven known CCR5 haplotypes and six novel CCR2 haplotypes were identified. A rare case of an HIV+ subject with the CCR5-Δ32/Δ32 was identified.

CONCLUSIONS

These data demonstrate a LD between CCR2 and CCR5 at several loci and provide new information about CCR2 that contributes to our understanding of its population-specific genetic variability. The data indicate that in addition to CCR5-Δ32 and CCR2-V64I, other SNPs and haplotypes may be important genetic determinants of disease and should be investigated.

HIV risk perception and distribution of HIV risk among African, Caribbean and other Black people in a Canadian city: mixed methods results from the BLACCH study

Background

African, Caribbean and other Black (ACB) people are a priority group for HIV prevention in Canada, but little is known about the epidemiology of HIV risk in this population. This paper helps fill the knowledge gap by: presenting service providers’ and ACB people’s perceptions about HIV risk in ACB populations; describing the distribution of HIV risk behaviours among ACB people according to markers of social status and position; and comparing results from these two analyses.

Methods

The Black, African and Caribbean Canadian Health (BLACCH) Study is a mixed methods study that used semi-structured interviews and a cross-sectional quantitative questionnaire to collect information about HIV and health from 188 ACB people in London, Ontario, Canada. Qualitative content analysis was used to identify interview themes, and weighted bivariate statistical analyses were performed on the quantitative data. Behaviours related to HIV risk were stratified by sex, poverty status, immigration experience and employment status.

Results

Community members perceived that they were at low risk for HIV and mainly focused on sexual risks. They called for more information about HIV in Canada and culturally appropriate HIV services. Service providers cited marital infidelity and cultural and religious attitudes about condoms as barriers to women protecting themselves. They mentioned cultural norms, beliefs about masculinity and underrepresentation of heterosexual ACB men at AIDS service organizations as barriers to men protecting themselves. There were few statistically significant differences in risk behaviours reported by men and women. Those living in poverty were more likely to abstain from sex (p = 0.006) and use condoms (p = 0.027) in the past year. Those living in Canada longer reported higher prevalences of forced sex (p < 0.001), mixing alcohol or drugs with sex (p = 0.001) and past STI diagnoses (p = 0.032). Stable employment was associated with higher prevalences of not using condoms in the past year (p = 0.005) and past STI diagnoses (p = 0.018).

Conclusions

The results show that perceptions about ACB people’s HIV risk differ from actual risk, and those with higher social standing might be at greater risk. Furthermore, the social determinants of health are important factors in the epidemiology of HIV among ACB people.

Emotions and cognitions as correlates of early adolescent sexual behavior among Dominican youth in the United States and Dominican Republic

The present study examined cognitive and emotional correlates of sexual decision-making among three groups of Dominican adolescents: (a) Dominican youth who were born and raised in New York City, (b) Dominican youth who recently immigrated to New York City from the Dominican Republic, and (c) Dominican adolescents who were born and currently reside in the Dominican Republic. Data were collected via self-administered questionnaires from Dominican mother-adolescent dyads in New York City (n = 1,008) and the Dominican Republic (n = 213). Across groups, positive emotion constructs were consistently among the most important correlates of intentions to engage in sexual intercourse while issues related to STIs and HIV showed the lowest correlations. Interestingly, positive correlations with intentions to engage in intercourse were found among Dominican-residing males, as were positive correlations with intentions among Dominican-residing females. The implications for HIV prevention programs for Dominican youth are discussed.

HIV among immigrants living in high-income countries: a realist review of evidence to guide targeted approaches to behavioural HIV prevention

BACKGROUND

Immigrants from developing and middle-income countries are an emerging priority in HIV prevention in high-income countries. This may be explained in part by accelerating international migration and population mobility. However, it may also be due to the vulnerabilities of immigrants including social exclusion along with socioeconomic, cultural and language barriers to HIV prevention. Contemporary thinking on effective HIV prevention stresses the need for targeted approaches that adapt HIV prevention interventions according to the cultural context and population being addressed. This review of evidence sought to generate insights into targeted approaches in this emerging area of HIV prevention.

METHODS

We undertook a realist review to answer the research question: 'How are HIV prevention interventions in high-income countries adapted to suit immigrants' needs?' A key goal was to uncover underlying theories or mechanisms operating in behavioural HIV prevention interventions with immigrants, to uncover explanations as how and why they work (or not) for particular groups in particular contexts, and thus to refine the underlying theories. The realist review mapped seven initial mechanisms underlying culturally appropriate HIV prevention with immigrants. Evidence from intervention studies and qualitative studies found in systematic searches was then used to test and refine these seven mechanisms.

RESULTS

Thirty-four intervention studies and 40 qualitative studies contributed to the analysis and synthesis of evidence. The strongest evidence supported the role of 'consonance' mechanisms, indicating the pivotal need to incorporate cultural values into the intervention content. Moderate evidence was found to support the role of three other mechanisms - 'understanding', 'specificity' and 'embeddedness' - which indicated that using the language of immigrants, usually the 'mother tongue', targeting (in terms of ethnicity) and the use of settings were also critical elements in culturally appropriate HIV prevention. There was mixed evidence for the roles of 'authenticity' and 'framing' mechanisms and only partial evidence to support role of 'endorsement' mechanisms.

CONCLUSIONS

This realist review contributes to the explanatory framework of behavioural HIV prevention among immigrants living in high-income countries and, in particular, builds a greater understanding of the suite of mechanisms that underpin adaptations of interventions by the cultural context and population being targeted.

Research participant recruitment in Hispanic communities: lessons learned

Hidden/special populations such as new immigrants are hard-to-reach due to issues such as stigma, discrimination, fear of immigration authorities, and cultural norms. Such factors can affect the recruitment of participants for behavioral research, especially research which addresses stigmatizing conditions such as HIV/AIDS. This research involved a qualitative approach and methods. The study identified contextual factors as well as attitudes, experiences and beliefs affecting HIV risk among recent Hispanic immigrants in New York. During the course of this research, challenges to participant recruitment were identified which were related to the environments, characteristics of the populations, and the sensitive nature of the topic to be studied. Strategies including exploratory fieldwork and sensitivity to participants' fear of "the system" were effective in recruiting individuals from this population. The authors discuss the strategies which facilitated recruitment of research subjects from these new Hispanic immigrant communities and the importance of behavioral research among these vulnerable communities.

Sexual risk behavior among HIV-positive patients at an urban clinic in Santiago, Dominican Republic

More than 1% of adults in the Dominican Republic are HIV-infected and most infections are acquired sexually. We studied sexual risk behaviors in a group of HIV-positive patients treated in Santiago, Dominican Republic. Interviews were conducted with 129 participants seen in May 2006 at one of the country's largest public hospital HIV clinics. Questions included demographics, sexual history, condom use, and focused on patients' last sexual encounter. Most patients (72.4%) had been sexually active since their HIV diagnosis. Following their diagnosis, 72.8% of sexually active patients used condoms more frequently, 21.7% used condoms with the same frequency, and 5.4% used condoms less often. The most common reason cited for not using a condom after HIV diagnosis differed by gender; men cited decreased sexual pleasure (70.0%) and women reported that their partner had refused to use a condom (71.8%). Sexually active patients who believed that their partner did not have HIV were much more likely to report using a condom at their last sexual encounter than those who did not know their partner's HIV status (odds ratio [OR] = 16.9). HIV-positive patients reported using condoms more frequently following their HIV diagnosis and were more likely to use a condom if they believed their partner did not have HIV. Increased HIV testing may lead to reduced sexual risk behavior in the Dominican Republic.

HIV risk and prevention among Hispanic immigrants in New York: the salience of diversity

The importance of identifying differences in HIV risk between Hispanic subgroups is the focus of this article. Data are drawn from two New York?based HIV-related studies: among Puerto Rican drug users and among new immigrants from Central America, the Dominican Republic, and Mexico. Results indicated that intercultural individuals (i.e., those involved in both Puerto Rican and mainland cultures) were less risky in terms of injection- and sex-related risk behaviors and that geographic and other contextual factors, along with cultural norms, influence risk behaviors for immigrants. Both studies indicate the need to differentiate subgroup factors affecting HIV risk and prevention behaviors to develop appropriate and effective community-based interventions. The study's limitations are noted.

HIV risks and seroprevalence among Mexican American injection drug users in California

Latinos in the United States are an ethnically diverse group disproportionately affected by HIV/AIDS. We describe HIV seroprevalence, HIV risk behaviors and utilization of health services among Mexican American injection drug users (IDUs) in California (n = 286) and compare them to White (n = 830) and African American (n = 314) IDUs. Study participants were recruited from syringe exchange programs (n = 24) in California. HIV seroprevalence among Mexican Americans (0.5%) was dramatically lower than Whites (5%) and African Americans (8%). Mexican Americans reported fewer sex-related risks than Whites and African Americans though injection-related risks remained high. Compared to Whites, Mexican Americans were more likely to participate in drug treatment during a 6 month period (AOR 1.5, 95% CI 1.1, 2.0) but less likely to receive any health care (AOR 0.6, 95% CI 0.5, 0.8). Exploring cultural and structural factors among Mexican American IDUs may offer new insights into how to maintain low rates of HIV seroprevalence and reduce barriers to health care utilization.

Epidemiology of HIV infection in large urban areas in the United States

Background

While the U.S. HIV epidemic continues to be primarily concentrated in urban area, local epidemiologic profiles may differ and require different approaches in prevention and treatment efforts. We describe the epidemiology of HIV in large urban areas with the highest HIV burden.

Methods/Principal Findings

We used data from national HIV surveillance for 12 metropolitan statistical areas (MSAs) to determine disparities in HIV diagnoses and prevalence and changes over time. Overall, 0.3% to 1% of the MSA populations were living with HIV at the end of 2007. In each MSA, prevalence was >1% among blacks; prevalence was >2% in Miami, New York, and Baltimore. Among Hispanics, prevalence was >1% in New York and Philadelphia. The relative percentage differences in 2007 HIV diagnosis rates, compared to whites, ranged from 239 (San Francisco) to 1239 (Baltimore) for blacks and from 15 (Miami) to 413 (Philadelphia) for Hispanics. The epidemic remains concentrated, with more than 50% of HIV diagnoses in 2007 attributed to male-to-male sexual contact in 7 of the 12 MSAs; heterosexual transmission surpassed or equaled male-to-male sexual transmission in Baltimore, Philadelphia, and Washington, DC. Yet in several MSAs, including Baltimore and Washington, DC, AIDS diagnoses increased among men-who-have sex with men in recent years.

Conclusions/Significance

These data are useful to identify local drivers of the epidemic and to tailor public health efforts for treatment and prevention services for people living with HIV.

[Epidemiology of HIV infection in immigrants in Spain: information sources, characteristics, magnitude and tendencies]

Lately Spain, the proportion of immigrants has increased in both general and HIV-infected populations. Nevertheles, data on the temporal trends of the epidemic in immigrants and on their sociodemographic, epidemiologic and clinical characteristics are scarce and are scattered in various information sources that cover complementary aspects of this issue. The objectives of the present study were to analyze the available information sources that allow the epidemiology of HIV infection in immigrants in Spain to be studied, and to describe the current situation of HIV infection in immigrants, based on the available information sources.

Unappreciated epidemiology: the churn effect in a regional HIV care programme

High levels of geographic mobility in and out of HIV care centres (i.e. the churn effect) can disrupt the continuity of patient care, misalign prevention services, impact local prevalence data perturbing optimal allocation of resources, and contribute to logical challenges in repeated transfer of health records. We report on the clinical, demographic, and administrative impact of high population turnover within HIV populations.

Risk perception and beliefs regarding HIV infection among Ethiopian immigrants

In Ethiopia, approximately 7.5% of the urban population is HIV-positive, and countrywide 1.5 million people are living with HIV. Between 1990 and 2000, immigration into the United States by African-born immigrants increased by 130%. Of this immigrant population, individuals from Ethiopia make up a significant portion. Although there is a rich literature addressing the beliefs regarding HIV and risk perception among some immigrant populations in the United States, few studies target Ethiopian-born residents. Thus, a survey-based study addressing demographics, acculturation, awareness, beliefs and risk perception, attitudes toward susceptibility for infection, and risk behaviors targeted Ethiopian-born residents of San Diego, California. Results indicate a separation between understanding of HIV transmission and personal risk perception for infection in a young, highly educated, predominantly male participant pool. As an initial study of HIV beliefs and risk perception in the immigrant Ethiopian population, our results provide information on specific areas warranting further investigation.

Loneliness as a sexual risk factor for male Mexican migrant workers

HIV/AIDs risk among migrant workers is often examined through individual determinants with limited consideration of social context. We used data from systematic ethnographic observations, structured interviews (n = 50), and life history interviews (n = 10) to examine the relationship between loneliness and HIV/AIDS risk for recently arrived (within the last 3 years) male Mexican migrant workers in New York City. Higher levels of loneliness were strongly associated with frequency of sexual risk behavior (r = 0.64; P = .008). From our ethnographic observations, we found that loneliness was a dominant element in workers' migration experience and that 2 different kinds of social spaces served as supportive environments for dealing with loneliness: bars or dance clubs and Catholic churches. Loneliness should be addressed as a critical factor in reducing HIV/AIDS risk among Mexican male migrant workers.

They "miss more than anything their normal life back home": masculinity and extramarital sex among Mexican migrants in Atlanta

CONTEXT

Gender has been recognized as a significant influence on sexual health behaviors. Labor migration presents an important context of vulnerability for sexual health. To understand how the context of migration affects risk-related practices, both cultural and social aspects of gender need to be explored.

METHODS

In the quantitative part of a mixed-methods study conducted in 1999 in Atlanta, 187 Mexican migrant men were asked about their demographic characteristics; sexual history; migration motivations; substance use; social support; leisure-time activities; and ideas about masculinity, sexuality and marriage. Multivariate regression analyses were conducted to test the association between these domains and men's number of partners since their arrival in Atlanta.

RESULTS

Number of partners was positively associated with owning a home in Mexico; number of trips back to Mexico; social network size; having had a sex worker as a partner; and going out dancing and to strip clubs on weekends (coefficients, 0.3-4.1). It was negatively associated with age, education, contact with social network members and feeling that sex is tied to emotional intimacy (-0.4 to -1.0).

CONCLUSIONS

Programs must acknowledge and target migrant men's social networks and the spaces in which they may encounter risky sexual situations. Multilevel strategies, such as the development of more health-enhancing community spaces and the promotion of safer sexual practices should form part of comprehensive efforts to reduce sexual risk among migrant men.

Sexual risk behaviour among HIV-positive patients at an urban clinic in Santiago, Dominican Republic

More than one percent of adults in the Dominican Republic are HIV-infected and most infections are acquired sexually. We studied sexual risk behaviours in a group of HIV-positive patients treated in Santiago, Dominican Republic. Interviews were conducted with 129 participants seen in May 2006 at one of the country's largest public hospital HIV clinics. Questions included demographics, sexual history, condom use and focused on patients' last sexual encounter. Most patients (72.4%) had been sexually active since their HIV diagnosis. Following their diagnosis, 72.8% of sexually active patients used condoms more frequently, 21.7% used condoms with the same frequency and 5.4% used condoms less often. The most common reason cited for not using a condom after HIV diagnosis differed by gender; men cited decreased sexual pleasure (70.0%) and women reported that their partner had refused to use a condom (71.8%). Sexually active patients who believed that their partner did not have HIV were much more likely to report using a condom at their last sexual encounter than those who did not know their partner's HIV status (OR=16.9). HIV-positive patients reported using condoms more frequently following their HIV diagnosis and were more likely to use a condom if they believed their partner did not have HIV. Increased HIV testing may lead to reduced sexual risk behaviour in the Dominican Republic.

The sexual experiences of Latino men who have sex with men who migrated to a gay epicentre in the USA

Key informant interviews, in-depth interviews and focus groups were conducted to examine ways in which social context influenced the behavior of Brazilian, Colombian and Dominican men who have sex with men. First, we investigated how the social context in the home country affected motivation for migration. Findings suggest that Latino men who have sex with men frequently reported coming to the USA to escape homo-negativity and to achieve greater sexual freedom. The study also examined how the social context encountered in the early years after migration shaped sexual behavior and risk. A majority of the participants reported easy access to sex partners and frequent sexual encounters. The anonymity of living in a gay epicentre such as New York City, often without social connections from the past, was experienced as liberating and conducive to sexual exploration. Moreover, sex in public venues, such as parks and sex cabins, was readily available to those who do not speak English. The tendency to engage in high levels of sexual activity during the early period after arrival in New York City was particularly evident among younger men. Implications for future programme development are discussed alongside prevention efforts targeting migrants during this critical period.