Acculturation, sexual behaviors, and health care access among Hispanic and non-Hispanic white adolescents and young adults in the United States, 2006-2010

Barriers and facilitators to utilizing HIV prevention and treatment services among migrant youth globally: A scoping review

Both migrants and young people experience disproportionately high rates of HIV acquisition and poor access to HIV prevention and treatment services. To develop effective interventions and reach epidemic control, it is necessary to understand the barriers and facilitators to accessing HIV services among migrant youth. We conducted a scoping review to identify these factors for migrant youth ages 15-24, globally. We conducted a PRISMA-concordant scoping review using keyword searches in PUBMED and Web of Science for peer-reviewed primary literature published between January 2012 and October 2022. We included studies that investigated barriers and facilitators to accessing services for migrant youth participants. We used the Socio-Ecological Model as an analytical framework. The 20 studies meeting the inclusion criteria spanned 10 countries, of which 80% (n = 16) were low- and middle-income countries. Study methods included were quantitative (40%), qualitative (55%), and mixed methods (5%). Six studies included refugee youth (30%), 6 included migrant worker youth (30%), 3 included immigrant youth (15%), 2 included rural migrant youth (10%), and 1 included immigrants and refugees. The remainder represented unspecified migrant youth populations (10%). At the individual level, education level and fear of infection acted as barriers and facilitators to HIV services. At the relationship level, social support and power in relationships acted as barriers and facilitators to HIV services. At the community level, barriers to HIV services included discrimination and stigma, while community and religious outreach efforts facilitated access to HIV services. At the structural level, barriers to HIV services included stigmatizing social norms, lack of health insurance, and legal barriers. Migrant youth face significant, unique barriers to accessing HIV services. However, facilitators exist that can be leveraged to enable access. Future implementation science research, enabling policies, and adapted programmatic interventions should prioritize migrant youth as a distinctive sub-population to receive targeted HIV services.

HIV knowledge, sexual practices, condom use and its associated factors among international students in one province of China: a cross-sectional study

OBJECTIVE

China has seen an increasing number of international students in recent years, mostly from Africa and Asia. However, little is known about these students' HIV knowledge, sexual practices and potential HIV risk. This study aimed to describe HIV-related risk among international students.

DESIGN

An online cross-sectional survey.

SETTING

10 universities situated in one province of China.

PARTICIPANTS

617 international students filled out the questionnaire and 607 international students were included in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Socio-demographic and programme-related characteristics, HIV-related knowledge, sexual practices and other HIV/sexually transmitted infection-related variables. Logistic regression analyses were performed to examine factors associated with inconsistent condom use among international students.

RESULT

The results showed that in total, only 51.6% (313/607) of international students had adequate HIV-related knowledge, and 64.9% (394/607) reported not receiving any HIV related education or training while studying in China. Moreover, 32.3% (196/607) reported having penetrative sex including oral, vaginal and anal sex during the period in which they studied in China and among them. The proportions of inconsistent condom use in vaginal and oral intercourse while studying in China were 52.6% (50/95) and 79.5% (35/44), respectively, with casual partners, and 60% (80/129) and 91.2% (52/57) with regular partners, respectively. Female gender, being married and having multiple sexual partners were associated with inconsistent condom use.

CONCLUSION

The present study indicated that international students in one province of China have suboptimal HIV-related knowledge, significant unprotected sex, less HIV testing and less safe sex education, which highlights an urgent need to provide HIV education and related health services to international students in China.

Subjective culture and HIV preventive behaviour among young Latin Americans: a systematic review

Given high levels of new HIV infection globally, calls have been made for greater attention to the cultural variables that hinder prevention and testing. However, no reviews exist to systematise the findings. This study aimed to identify the cultural variables associated with three HIV preventive behaviours (condom use, HIV testing behaviour, and injection drug use with non-shared or sterilised syringes) among young Latin Americans. A systematic review was conducted guided by PRISMA-P criteria, on five databases (Web of Science, Scopus, PubMed, Medline and Scielo), which identified 2474 articles. Scientific articles and empirical studies that addressed cultural variables and HIV preventive behaviours among young people aged 15-24 years of age using Latin American samples were selected, with 37 articles being included in the final review. Six key cultural variables: the importance of female virginity; the role of trust in the couple's relationship; the disorienting effects of romantic love; the role of subjective norms; the importance of decision-making norms; and impulse control beliefs. Gender norms provide a framework for understanding sexual decision-making among young Latin Americans. Although young people have begun to adopt more egalitarian views of gender norms, deep-rooted beliefs about gender, sexuality and relationships continue to impact on HIV prevention behaviour.

Experiences of health service literacy and access amongst Australian young adults from migrant backgrounds

ISSUE ADDRESSED

We currently know very little about the attitudes of young adult Australians from migrant backgrounds towards health service utilisation. This qualitative study aimed to explore their experiences of accessing health services and identify barriers and facilitators to health service utilisation.

METHODS

Semi-structured interviews were conducted with young people aged between 18-24 and living in Greater Western Sydney. Interview questions focused on facilitators and barriers to health service access. NVivo 11 was used to facilitate thematic analysis of the interviews.

RESULTS

Twenty-five young adults between 18-24 years from migrant backgrounds participated. Twenty semi-structured individual interviews and one group interview with five participants were conducted. Analysis identified themes relating to health literacy, cultural factors and quality of care and showed the importance of families, the education system and service outreach in facilitating access.

CONCLUSIONS

Findings indicate that more effective delivery of health services information in education, positive engagement between service-providers and service-users, and age-appropriate, culturally considerate health promotion strategies are needed to overcome barriers to health services accessibility. SO WHAT?: The results show the importance of families and communities, the education system and health service outreach in facilitating health service access for young people from migrant backgrounds. The paper highlights the need for more effective health promotion strategies targeting this group, their families and communities. To increase access, health promotion practitioners need to actively reach out to families and young people from migrant backgrounds through education and community-relevant forums.

Disparities in Use of Subspecialty Concussion Care Based on Ethnicity

Concussion is common and subspecialty care can be essential to ensure recovery. However, barriers may exist to accessing care. This study aimed to assess disparities in subspecialty concussion care related to ethnicity, limited English proficiency (LEP), and insurance status. We utilized logistic regression to analyze 2010-2015 administrative data from four Sports Medicine clinics, comparing odds of being seen for concussion to odds of being seen for fracture by ethnicity, insurance type, and interpreter usage, controlling for demographic factors. ICD-9 codes were used to identify concussion and fracture. Our final sample contained 25,294 subjects: 5621 with concussion and 19,673 with fracture. In bivariate analysis, youth seen for concussion had 83% lower odds of being Hispanic compared with youth seen for fracture (95%CI: 75-92%). Due to interactions between ethnicity and interpreter use, we utilized a stratified multivariate model as our final model. Youth with concussion had 1.8× greater odds of having private insurance compared with youth with fracture (Hispanic OR 1.8, 95% CI 1.5-2.3; Non-Hispanic OR 1.8, 95% CI 1.7-2.0). Youth with concussion also had greater odds of not using an interpreter, though the strength of this association was weaker for Hispanic youth compared with non-Hispanic youth (Hispanic OR 1.68, 95% CI 1.30-2.17; Non-Hispanic OR 4.36, 95% CI 3.00-6.35). Age and sex were included as covariates. In conclusion, our analysis suggests disparities in subspecialty concussion care for Hispanic youth, as well as for individuals with LEP and non-private insurance. Further research should explore means for improving access to concussion care for all youth.

Diminished Health Returns of Educational Attainment Among Immigrant Adults in the United States

Objectives: Marginalization-related diminished returns (MDRs) refer to weaker health effects of educational attainment for socially marginalized groups compared to the socially privileged groups. Most of the existing literature on MDRs, however, has focused on marginalization due to race, ethnicity, and sexual orientation. Thus, very limited information exists on MDRs of educational attainment among immigrant populations in the United States. Aims: Building on the MDRs framework and using a nationally representative sample of US adults, we compared immigrant and native-born adults for the effects of educational attainment on psychological distress, self-rated health (SRH), and chronic diseases (CDs). Methods: The 2015 National Health Interview Survey (NHIS) has enrolled 33,672 individuals who were either immigrant (n = 6,225; 18.5%) or native born (n = 27,429; 81.5%). The independent variable (IV) was educational attainment, which was treated as a categorical variable. The dependent variables included psychological distress, SRH, and CDs, all of which were dichotomous variables. Age, gender, race, ethnicity, and region were confounders. Immigration (nativity status) was the moderator. Results: Higher educational attainment was associated with lower odds of psychological distress, poor SRH, and CDs. However, immigration showed a significant statistical interaction with college graduation on all outcomes, which were suggestive of smaller protective effects of college graduation on psychological distress, poor SRH, and CDs for immigrant than native-born adults. Conclusions: In the US, the associations between educational attainment and psychological distress, SRH, and CDs are all weaker for immigrant than native-born adults. To prevent health disparities, it is essential to decompose health inequalities that are due to low educational attainment from those that are due to diminished returns of educational attainment (i.e., MDRs). There is a need to help highly educated immigrant adults secure positive health outcomes, similar to their native-born counterparts. Such changes may require bold and innovative economic, public, and social policies that help immigrant adults to more effectively mobilize their educational attainment to secure tangible outcomes. Elimination of health disparities in the US requires efforts that go beyond equalizing access to education.

Trends in Sexual Risk Behaviors Among Hispanic/Latino Men Who Have Sex with Men - 19 Urban Areas, 2011-2017

Correct and consistent condom use and human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) are protective against sexual transmission of HIV (1,2). The incidence of HIV infection among Hispanic/Latino men who have sex with men (MSM) in the United States is increasing (3). HIV risk among Hispanic/Latino MSM differs based on their place of birth and years of U.S. residence (4). Data from CDC's National HIV Behavioral Surveillance (NHBS)* for 2011-2017 were analyzed to assess changes in sexual risk behaviors among Hispanic/Latino MSM by place of birth and years of U.S. residence. Overall, condomless anal sex during the previous 12 months increased from 63% in 2011 to 74% in 2017, and PrEP use during the previous 12 months increased from 3% in 2014 to 24% in 2017. Regardless of place of birth, nearly 75% of Hispanic/Latino MSM reported condomless anal sex during 2017. However, because of PrEP use, <60% of non-U.S.-born Hispanic/Latino MSM and <50% of U.S.-born Hispanic/Latino MSM reported unprotected anal sex (condomless anal sex and no PrEP use) during 2017. Results indicate that PrEP can be a vital tool for reducing HIV transmission among Hispanic/Latino MSM, especially those who have condomless anal sex. Interventions to prevent HIV acquisition, including increasing PrEP uptake, could address cultural and linguistic needs of Hispanic/Latino MSM, as well as other barriers to prevention of HIV infection typically faced by all MSM.

Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

OBJECTIVES

Social determinants of health (SDHs) are the complex, structural, and societal factors that are responsible for most health inequities. Since 2003, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has researched how SDHs place communities at risk for communicable diseases and poor adolescent health. We described the frequency and types of SDHs discussed in articles authored by NCHHSTP.

METHODS

We used the MEDLINE/PubMed search engine to systematically review the frequency and type of SDHs that appeared in peer-reviewed publications available in PubMed from January 1, 2009, through December 31, 2014, with a NCHHSTP affiliation. We chose search terms to identify articles with a focus on the following SDH categories: income and employment, housing and homelessness, education and schooling, stigma or discrimination, social or community context, health and health care, and neighborhood or built environment. We classified articles based on the depth of topic coverage as "substantial" (ie, one of ≤3 foci of the article) or "minimal" (ie, one of ≥4 foci of the article).

RESULTS

Of 862 articles authored by NCHHSTP, 366 (42%) addressed the SDH factors of interest. Some articles addressed >1 SDH factor (366 articles appeared 568 times across the 7 categories examined), and we examined them for each category that they addressed. Most articles that addressed SDHs (449/568 articles; 79%) had a minimal SDH focus. SDH categories that were most represented in the literature were health and health care (190/568 articles; 33%) and education and schooling (118/568 articles; 21%).

CONCLUSIONS

This assessment serves as a baseline measurement of inclusion of SDH topics from NCHHSTP authors in the literature and creates a methodology that can be used in future assessments of this topic.

Risky sexual behavior of foreign and native-born women in emerging adulthood: The long reach of mother-daughter relationships in adolescence

Parents' influence on young adult sexual behavior receives little attention compared to influence on adolescent behavior. Yet effective parenting should have lasting effects. Even fewer studies examine parents' influence on sexual behavior of both foreign and native-born young adults. Using the National Longitudinal Study of Adolescent to Adult Health (Add Health) Waves I (1994-95) and III (2001-02), we examine longitudinal associations among mother-daughter relationship quality and nativity during adolescence and young adults' risky sexual behaviors of condom use at last intercourse, number of sexual partners, and STI diagnoses (N = 4460). Women, 18-26 years old, who had good mother-adolescent daughter relationships have fewer partners and STIs in the past year. Second generation women have worse mother-adolescent daughter relationships, compared to third generation. Relationship quality does not explain associations between nativity and risky behavior. Lasting associations between relationship quality and risk behaviors suggest that reproductive health interventions should enhance mother-adolescent relationships.

Cultural influences on HIV testing among Latino youth

Young Latinos aged 13-24 years in the USA are disproportionately impacted upon by HIV. Despite the elevated risk, lower rates of HIV testing have been documented among Latino youth relative to other racial/ethnic groups. The objective of the current study was to examine the influence of acculturation and cultural values on HIV testing among Latino youth. The study consisted of 51 sexually experienced young Latinos aged 13-16 years from a major city in the Southeastern USA. Participants completed a survey on HIV testing history, cultural orientation and Latino cultural values. Results indicate that 21.6% of the young people had been tested for HIV. The number of times tested ranged from one to four (M = 1.9 ± 1.0). HIV testing was associated with US American cultural orientation and familism (and emphasis on strong family commitment, family support and emotional closeness). Participants with greater orientation to US American culture were more likely, whereas those who endorsed higher familism value were less likely, to have had an HIV test. For participants scoring high on familism, the desire to maintain family honour may serve as a deterrent to testing. Incorporating culturally relevant strategies, such as promoting sexual communication and conversations on HIV prevention within the family, may enhance testing and narrow the gap in HIV infection between Latino youth and other ethnic groups.