Latino AIDS immigrants in the Western Gulf states: a different population and the need for innovative prevention strategies

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.

Evaluating the impact of immigration policies on health status among undocumented immigrants: a systematic review

Over the past two decades, new anti-immigration policies and laws have emerged to address the migration of undocumented immigrants. A systematic review of the literature was conducted to assess and understand how these immigration policies and laws may affect both access to health services and health outcomes among undocumented immigrants. Eight databases were used to conduct this review, which returned 325 papers that were assessed for validity based on specified inclusion criteria. Forty critically appraised articles were selected for analysis; thirty articles related to access to health services, and ten related to health outcomes. The articles showed a direct relationship between anti-immigration policies and their effects on access to health services. In addition, as a result of these policies, undocumented immigrants were impacted by mental health outcomes, including depression, anxiety, and post-traumatic stress disorder. Action items were presented, including the promotion of cultural diversity training and the development of innovative strategies to support safety-net health care facilities serving vulnerable populations.

Community-Based Research among Marginalized HIV Populations: Issues of Support, Resources, and Empowerment

A research question was posed to us by a local HIV-resource organization interested in exploring the educational and service needs of those unreached. In order to properly address this inquiry, we developed a community-based participatory research by training peer-led volunteers to facilitate focus-group discussions within Aboriginal and refugees participants following an interview guide. We gathered Aboriginal people and refugees separated into three focus groups each, enrolling a total of 41 self-identified HIV-positive, 38 males. The discussions were tape recorded upon consent and lasted between 59 and 118 minutes. We analyzed the thematic information collected interactively through constant comparison. The qualitative data leading to categories, codes, and themes formed the basis for the spatial representation of a conceptual mapping. Both groups shared similar struggles in living with HIV and in properly accessing local nonmedical HIV resources and discussed their concerns towards the need for empowerment and support to take control of their health.

A randomized controlled trial of a culturally congruent intervention to increase condom use and HIV testing among heterosexually active immigrant Latino men

This randomized controlled trial tested the efficacy of an HIV prevention intervention to increase condom use and HIV testing among Spanish-speaking, heterosexually active immigrant Latino men. A community-based participatory research partnership developed the intervention and selected the study design. Following baseline data collection, 142 immigrant Latino men were randomized to the HIV prevention intervention or the cancer education intervention. Three-month follow-up data were collected from 139 participants, for a 98% retention rate. Mean age of participants was 31.6 years and 60% reported being from Mexico. Adjusting for baseline behaviors, relative to their peers in the cancer education comparison, participants in the HIV prevention intervention were more likely to report consistent condom use and receiving an HIV test. Community-based interventions for immigrant Latino men that are built on state of the art prevention science and developed in partnership with community members can greatly enhance preventive behaviors and may reduce HIV infection.

A Cultural Perspective on Sexual Health: HIV Positive and Negative Monolingual Hispanic Women in South Florida

This study explored feelings and attitudes with regard to HIV and sexual health among 82 monolingual Spanish-speaking, HIV-positive (n = 30) and at-risk women (n = 52), participating in the NOW en Español Project-a cognitive behavioral sexual risk-reduction intervention in Miami, Florida. Hispanic cultural values and beliefs, such as machismo, marianismo, and sexual silence, emerged throughout the intervention as important determinants of sexual behavior. Recommendations for integrating these culture-specific issues in sexual health interventions for Hispanic women are provided.

Trends in disability and disability-free life expectancy among elderly people in Spain: 1986-1999

BACKGROUND

This paper examines recent trends in the prevalence of disability and disability-free life expectancy in the population aged 65 years and older in Spain.

METHODS

Data were drawn from two National Disability, Impairment and Handicap Surveys conducted in 1986 and 1999. Only severe disability was studied, and disabilities overcome through use of external technical aids were included.

RESULTS

In the period 1986--1999, a relative annual decline of 3.7% in overall disability was observed for men. The decline was somewhat less marked in women, participants aged 75 years and older, and those with the lowest educational level. In men, there was a relative annual decline of just over 3% in walking and hearing disabilities, of under 1% in seeing and cognitive disabilities, and a slight rise in self-care disability. Trends among women were similar, though self-care disability rose by 1.78%. In the period 1986--1999, total and disability-free life expectancy rose across all age groups in both sexes. Among men aged 65 years, the proportion of life expectancy with disability fell from 42.1% in 1986 to 21.6% in 1999; the comparable figures for women were 49.8% in 1986 and 30.6% in 1999. Indeed, a reduction in life expectancy with disability was observed even among persons aged 80 years and older.

CONCLUSION

From 1986 through 1999, prevalence of severe disability among Spanish elderly persons decreased substantially, and the duration of life with disability was compressed between a later onset and the time of death. Among women, however, self-care disability--the type of disability requiring most social resources for its attention--underwent a sharp rise.

HIV-Related Risk Behavior Among Hispanic Immigrant Men in a Population-Based Household Survey in Low-Income Neighborhoods of Northern California

OBJECTIVES/GOAL

We compared risk behaviors and HIV testing between recent (in the U.S. <5 years) and established (in the U.S. >5 years) Hispanic immigrant men (N = 410).

STUDY

This study was a population-based, cross-sectional survey of HIV/sexually transmitted disease markers and risk behaviors in men age 18 to 35 years residing in low-income census block groups in 3 northern California counties.

RESULTS

Recent immigrants were less likely to currently have a main sexual partner (45.3% vs. 67.2%, P <0.01) and more likely to have ever used commercial sex workers (40.0% vs. 27.6%, P <0.01). Recent immigrants were less likely to receive medical care in the last 6 months (21.2% vs. 31.3%, P = 0.04) or had ever been HIV tested (26.0% vs. 43.3%, P <0.01). Established immigrants more likely reported unprotected sex, hallucinogen or ecstasy use.

CONCLUSIONS

Recent Hispanic immigrants have less stable sexual partnerships and less health-seeking behavior, including HIV testing. Established immigrants report HIV test rates comparable to the national average.

Assessing the HIV/AIDS health services needs of African immigrants to Houston

This study investigated HIV/AIDS knowledge, risk behaviors and perceptions, and access to services among Black immigrants from more than 20 African nations to Houston, Texas, United States. Three hundred nine respondents completed a 98-item self-administered questionnaire on HIV/AIDS knowledge, risk behaviors, access to services, and stigma. Data analysis revealed this population to be highly educated (70.9% had educational attainment levels beyond high school), with a plurality motivated to immigrate to the United States for academic reasons (45.0%). As a group they displayed a high level of knowledge about modes of HIV transmission. Generally, Christian background respondents had higher knowledge than those of Muslim background. Nevertheless, 36.3% reported that they had never used a condom, with the overwhelming majority of respondents reporting low self-perceived risk for contracting HIV (79.5%). These findings, together with the persistent practice of traditional rituals such as body scarring/tattooing by a significant minority (20.1%), a lack of awareness about vertical transmission (16.3% of women; 29.9% of men), and discouraging scores on an HIV stigma perception scale, suggest that a targeted campaign to raise awareness in this population is warranted.

Help-seeking and risk-taking behavior among Black street youth: implications for HIV/AIDS prevention and social policy

This article explores and analyzes the help-seeking and risk-taking behavior of Black urban street youth in Washington, DC, USA and Cape Town, South Africa. The target population of 100 youths came from the streets of Washington, DC and Cape Town, South Africa. Structured face-to-face interviews and direct observation of informal and formal settings where youths congregated were used to gather data. Major findings indicate that the majority received high levels of support from families and friends. In terms of formal systems, social and mental health services are viewed as much less accessible or useful. Youths were knowledgeable about HIV/AIDS but did not translate this into safer sexual practices. Implications for health and social policy are outlined.

New frontiers and challenges in HIV research among older minority populations

Older racial and ethnic minorities are a rapidly growing segment of the population. HIV infection disproportionately affects minorities of all ages, presenting new challenges in research, prevention, and treatment of HIV infection. Cultural characteristics coupled with changing values and age-related beliefs can present some atypical challenges to HIV researchers and clinicians. Family relationships, language barriers, and the psychology of aging complicate these challenges even further. Older minorities also experience certain stigmas that the added burden of HIV infection only exacerbates. Effective research, prevention, and treatment must begin with sensitivity to the varied characteristics of older minorities.