Sex, drugs and HIV: an ethnographic approach

Drug Treatment Needs of Hispanic Drug Users in Long Beach, California

The objective of this study is to investigate differences between Hispanic and non-Hispanic drug users in Long Beach, CA, with respect to drug use, HIV risk behaviors, and drug treatment experience and to explore the dissimilarities between Hispanic drug users who identify their family origin as Mexican American compared to those who identify their family origin as Mexican. We recruited 1,728 drug users into an HIV risk reduction intervention; of these, 404 were Hispanic. The Risk Behavior Assessment (RBA) was used to collect information on demographics, drug and sex risk behaviors, and drug treatment experience. Hispanic drug users are significantly more likely to inject drugs than non-Hispanic drug users and were found to have a higher mean number of injections in the last 30 days. Hispanic drug users were more likely to have taken part in drug treatment programs, specifically methadone detoxification and maintenance programs. Self-identified Mexican drug users were less likely to have ever attended a drug treatment program than were Mexican-American drug users. Greater availability of drug treatment programs for monolingual and bilingual Hispanic injectors is needed.

HIV-Related Behaviors among Recently Immigrated and Undocumented Latinas

HIV/AIDS research, prevention, and intervention efforts have widened in recent years to include minorities and women, partly in response to the rise of infection among these groups [1]. However, conventional research methods (i.e., random community samples) are likely to exclude more marginalized groups such as undocumented immigrants. We conducted ethnographic interviews of twenty-one recently immigrated and undocumented Latinas regarding their HIV-related risk behaviors, partners risk behaviors, HIV knowledge and attitudes, and sexual communication and decision making. Findings indicated low rates of risk behaviors. However, condom use was also low, and partners' behavior appeared to pose a risk. The immigration process, often necessitating periods of separation, may prohibit women from having accurate knowledge about partners' risk behaviors. Interviews were conducted at community agencies where respondents were recruited and at respondents' home in Los Angeles County. Findings suggest the importance of considering the effects of immigration, acculturation, and gender and relationship dynamics when examining risk in this population.

Alcohol Use and Problem Drinking Among Male Mexican and Central American Im/migrant Laborers

This review addresses a growing concern regarding alcohol use in adult male Latino im/migrant laborers in the United States. The review draws from alcohol studies focusing on “Hispanic” populations, and from health behavior studies of Latino im/migrant laborers, research that includes alcohol use. Specifically, this review addresses (a) alcohol consumption and drinking patterns among Mexican and Central American im/migrant laborers, and (b) health and social consequences of alcohol use. After reviewing more than 200 articles, 30 studies meeting key criteria were selected for review. Survey data show lower alcohol use in Latino im/migrants as compared with U.S. Latino and non-Latino populations, but also a relation between problem drinking and acculturation. Ethnographic research reveals heavy drinking and negative health and social consequences in a significant number of Latino im/migrant laborers. How structural-environmental and culture-based factors combine to influence problem drinking in the United States is discussed along with recommendations for future research.

Sex with sex workers among latino day laborers in Suburban Maryland

Using the structural-environmental conceptual framework, this study employed mixed methods to address the question of whether sex with female sex workers contributes to HIV risk among male immigrant Latino day laborers in suburban Maryland. Because contextual factors can greatly affect HIV risk for both sex workers and their clients, this study investigated the organizational structure of sex work, factors that predicted men's hiring of sex workers, sexual behaviors performed with sex workers, and the use of condoms. Qualitative research was conducted to inform the development of a quantitative survey, but also provided crucial descriptions about the motivations, locations, arrangements, and sexual activities related to sex work. Key informant interviews (N = 10), in-depth interviews with day laborers (N = 10) and Latina female sex workers (N = 4), and two focus groups with day laborers (N = 11) were conducted, and a quantitative survey administered via Audio-enhanced Computer-assisted Self-interviewing (N = 174). Condom use was nearly universal in encounters with female sex workers, thus indicating that the sex workers were not an important source of HIV transmission in this context. Logistic regression was performed to test a model predicting sex with sex workers. Latino day laborers who reported more immigrant stress and who did not have a partner in the U.S. were more likely to have had sex with a sex worker, as were men who reported binge drinking. Structural and social conditions influenced the hiring of sex workers. Further research is warranted to better understand the interrelationships among these circumstances and to inform the development of programs to address them.

The effect of migration on HIV high-risk behaviors among Mexican migrants

BACKGROUND

Previous studies have shown an association between Mexican migration to the United States and an increased frequency of HIV high-risk behaviors among male Mexican migrants. However, the individual level change in these behaviors after migration has not been quantified.

OBJECTIVE

To estimate the change in HIV high-risk behaviors among Mexican migrants after migration to the United States.

METHODS

A case-crossover study was embedded in the California-Mexico Epidemiological Surveillance Pilot, a targeted, venue-based, sampling survey. We implemented the study from July to November 2005, studying 458 Mexican migrants at sites in rural and urban areas in Fresno County and San Diego County and directly comparing individual HIV high-risk behaviors before and after migration.

RESULTS

After migration, there were increases in the odds of male migrants engaging in sex with a sex worker [odds ratio (OR) = 2.64, P < 0.0001], sex while under the influence of drugs or alcohol (OR = 5.00, P < 0.0001), performing sex work (OR = 6.00, P = 0.070), and sex with a male partner (OR = 13.00, P = 0.001). Those male Mexican migrant subgroups at particularly elevated risk were those in the United States for more than 5 years, those from the youngest age cohort (18-29 years old), or those frequenting high-risk behavior venues and male work venues.

CONCLUSIONS

Our results show that Mexican migrant men were significantly more likely to engage in several HIV high-risk behaviors after migration to the United States. However, a smaller proportion of men reported low condom use after migration, indicating increased adoption of some prevention methods. Our results also identified subgroups of Mexican migrants at elevated risk who should be targeted for HIV prevention interventions.

Does Powerlessness Explain Elevated HIV Risk Amongst Tajik Labor Migrants? An Ethnographic Study

To investigate the role of powerlessness in elevated HIV risk among labor migrants, we compared internal verses external male migrant workers from Tajikistan using minimally structured interviews and focused field observations. The sample included 30 male labor migrants who traveled to work in Regar, Tajikistan (internal labor migrants), and 30 who traveled to work in Moscow, Russia (external labor migrants). Though powerlessness did not appear to account for whether labor migrants engaged in more HIV risk behaviors, the harsh living and working conditions of external labor migration impacted how the migrants manifested these HIV risks by amplifying group masculine norms and behaviors. Progress in preventing HIV infection amid the difficult social conditions of labor migration is contingent upon adequate conceptualization of how such conditions impact HIV risk behaviors.

HIV and Mexican migrant workers in the United States: a review applying the vulnerable populations conceptual model

Mexican migrant workers residing in the United States are a vulnerable population at high risk for HIV infection. This article critically appraises the published data surrounding HIV prevalence in this vulnerable group, as seen through the lens of the Vulnerable Populations Conceptual Model. This model demonstrates how exposure to risk and resource availability affect health status. The health status of Mexican migrants in the United States is compromised by a number of factors that increase risk of HIV: limited access to health services, multiple sexual partners, low rates of condom use, men having sex with men, and lay injection practices. Migration from Mexico to the United States has increased the prevalence of HIV in rural Mexico, making this an issue of urgent binational concern. This review highlights the implications for further nursing research, practice, and policy.

A randomized controlled trial to test an HIV-prevention intervention for Latino gay and bisexual men: lessons learned

At the time of this writing, no randomized controlled trial (RCT) of an intervention to reduce unsafe sex among Latino gay and bisexual men (LGBM) had been published. We report the results of an RCT conducted in New York City in which 180 LGBM were assigned either to an intervention developed specifically for this population or to a wait-list control group. The intervention was based on empowerment theory and used factors identified in prior research as determinants of unsafe sex. By eligibility criteria, all men had engaged in unprotected anal intercourse (UAI) within two months of the baseline assessment. At first (two months) and second (six months later) follow-up assessments, approximately half of the men in the experimental group reported no UAI. Yet, a similar proportion of the control group also reported no UAI. Baseline data indicate that although the men had been the subject of social oppression and sexual prejudice (homophobia), they did not feel disempowered, externally controlled or fatalistic, and they reported self-efficacy and intentionality to enact safer sex. Lessons learned are discussed, as well as notes of caution for future research employing a similar conceptual framework.

The Effects of Problem Drinking and Sexual Risk Among Mexican Migrant Workers on Their Community of Origin

Although the financial remittances sent by male Mexican migrant workers residing in the United States can result in higher standards of living for their families and home communities, out-migration may lead to increased migrant problem drinking and sexual risk behaviors, which may in turn impact these same communities of origin. Based on semi-structured interviewing (n=60) and participant observation in a migrant sending community in central Mexico and a receiving community in the Northeastern United States, this paper explores the effects of out-migration on HIV risk and problem drinking among United States-based migrants from a small agricultural community in the Mexican state of Puebla. We argue that problem drinking and risky sexual behaviors among these migrant workers have had significant consequences for their home community in terms of diminished remittances, the introduction of HIV and other sexually transmitted infections, and loss of husbands or kinsmen to automobile accidents. Moreover, although rumor and gossip between the two communities serve as a form of social control, they may also contribute to increased problem drinking and sexual risk.

Between tradition and change: condom use with primary sexual partners among Mexican migrants

The frequency of male Mexico-US migration has been associated with increased HIV risk for sexual partners awaiting their return in Mexico. This study examined the association between sexual partner characteristics and condom use among a sample of 354 male migrants from two Mexican municipalities. Migrants were interviewed about their past year's sex practices. Results indicated that migrants were more likely to use condoms with their non-spousal partners, partners with less education than the migrant, and partners with higher employment status. Condom use was greater among younger migrants and residents of the more densely populated municipality. Findings suggest the coexistence of a traditional cultural orientation that does not support condom use and another one that does provided the sex partner is formally employed. Prevention programs must strengthen the structural conditions fostering greater equality between the sexes and adapt their approaches for different population density, age and partner types.

Connecting the dots: when the risks of HIV/STD infection appear high but the burden of infection is not known--the case of male Latino migrants in the southern United States

Between 1990 and 2000, the number of Latinos in Alabama, Arkansas, Georgia, North Carolina, South Carolina, and Tennessee, states that had no or small Latino populations in 1990, increased by more than 300% on average. Several of these states (referred to as rapid growth states) have high AIDS/STD case rates. Compared to Latinos in states with well-established Latino populations and Latinos nationwide, those in rapid growth states are more often males, young, foreign-born, and recent arrivals who travel without females. The typical Latino in rapid growth states is a young male migrant. Although these migrants may be at risk of HIV/STD infection, little is known about the risk factors that affect them. To clarify this picture, a database search was conducted to identify studies of HIV/STD infection and/or risk factors among rural and urban-based Latino migrants in the six rapid growth states. This qualitative review examines ten studies that were conducted in Alabama, Georgia, North Carolina, and South Carolina. Five of the studies screened for HIV and/or syphilis infection and provide some information on risk factors; five studies describe risk factors only. Most of those studies that describe risk factors provide evidence that male Latino migrants in rural and urban settings of rapid growth states are vulnerable to HIV/STD infection through heterosexual contacts. However, many of the studies fail to provide sufficient information on other risk factors, and all but one of the studies that screened migrants for HIV or STD infection were conducted between 1988 and 1991. There is an urgent need for updated information on HIV/STD infection and the social-behavioral and situational risk factors that affect male Latino migrants in rapid growth states of the South.

Using theatrical presentations as a means of disseminating knowledge of HIV/AIDS risk factors to migrant farmworkers: an evaluation of the effectiveness of the Infórmate program

Previous research has suggested that Mexican migrant farmworkers are at elevated risk for contracting HIV/AIDS and that they are in need of receiving HIV/AIDS-related education. The present study evaluated the impact of the Infórmate adolescent theater program on HIV/AIDS knowledge and attitudes among farmworker audience members of various ages. Audience members from 7 migrant farmworker camps completed a self-administered questionnaire before and after they observed the Infórmate performance. Paired-samples t-tests and McNemar tests indicated an increase in knowlege in "modes of HIV transmission," "body fluids that can transmit HIV," and items assessing HIV/AIDS "myths." In addition, a greater percentage of farmworkers at posttest reported that they believed that condoms should always be used during sex. The overall findings from this study suggest that theater can be an effective medium for increasing HIV/AIDS-related knowledge among migrant farmworkers. However, it is suggested that, because some farmworkers held false beliefs regarding modes of HIV transmission after viewing the theater program, theater used in combination with other prevention activities may provide for a more comprehensive educational experience.

Predictors of HIV transmission among migrant and marginally housed Latinos

This study examined predictors of HIV-related sexual risk taking in a high risk and understudied convenience sample of 366 predominantly Mexican, migrant adults without stable housing. The sample included 27% men who have sex with men, 28% injectors of illegal drugs, and 21% sex workers. Hierarchical regression analysis showed that sexual risk taking was predicted by low condom self-efficacy, high-risk behavior, and being female. Interestingly, those who engaged in the highest-risk behaviors were more likely to use condoms consistently during sex, although they carried condoms less.

The Epidemiology of HIV Among Mexican Migrants and Recent Immigrants in California and Mexico

For Mexican migrants and recent immigrants, the impact of migration from Mexico to California has the potential to lead to an increased risk for HIV infection. Until recently, the prevalence of HIV in Mexico and among Mexican migrants in California appeared to be stable and relatively low. Recent studies have raised new concerns, however, that the HIV epidemic may expand more aggressively among this population in the coming years. Unfortunately, the insufficient amount of data available within recent years makes it difficult to fully assess the potential for rapid spread of the HIV epidemic among this population. Consequently, there is a critical need for an ongoing binational surveillance system to assess prevalence and trends in HIV/STD/TB disease and related risk behaviors among this population both in Calfornia and within this population's states of origin in Mexico. This enhanced epidemiologic surveillance system should provide improved data on the subpopulations at the highest risk for HIV/STD/TB, such as men who have sex with men, and should provide the opportunity to evaluate the impact of migration on the transmission dynamics, risk behaviors, and determinants of behavior on each side of the border. It is essential that this potential threat be assessed and that intervention programs are developed and implemented to combat this possible escalation in the HIV epidemic.

Risk and danger among women-who-prostitute in areas where farmworkers predominate

Based on ethnographic research in three agricultural settings in Florida, this article examines one aspect of risk and danger for female sex workers, that of interpersonal violence, while considering women's responses to a shifting sex trade in areas where farmworkers live and work. Sex work in agricultural areas varies from urban sex work. Women eschew pimps, ask for backup from local men entrenched in street settings, and canvass a wide spatial area rather than remained fixed in space. Oscillating between periods of capital-deficiency (nonseason) and capital-intensification (harvest), women respond to increasing risk and danger by building a clientele of regular customers, refusing risky transactions and referrals, and creating a local infrastructure of sanctuary. Some women also construct schemes to relieve men of their money. These men typically are farmworkers, whose vulnerability and image of low risk for HIV expands the potential for risk and danger found in these settings.

Sexuality, Culture, and Power in HIV/AIDS Research

▪ Abstract  This article examines the development of anthropological research in response to AIDS. During the first decade of the epidemic, most social science research focused on the behavioral correlates of HIV infection among individuals and failed to examine broader social and cultural factors. By the late 1980s, however, pioneering work by anthropologists began to raise the importance of cultural systems in shaping sexual practices relevant to HIV transmission and prevention. Since the start of the 1990s, this emphasis on cultural analysis has taken shape alongside a growing anthropological research focus on structural factors shaping vulnerability to HIV infection. Work on social inequality and the political economy of HIV and AIDS has been especially important. Much current research seeks to integrate both cultural and structural concerns in providing an alternative to more individualistic behavioral research paradigms.

Views of child sexual abuse in two cultural communities: an exploratory study among African Americans and Latinos

This exploratory study investigates knowledge and ideas about child sexual abuse among African Americans and Latinos through focus group discussions. Participants defined and described child sexual abuse, acknowledged that it occurred in their communities, and expressed their sense that family risk factors, risky institutions, and offender propensities were its root causes. Latino participants identified cultural transitions as another contributor. Responses and conversational style differed somewhat by gender and cultural identity. The authors discuss implications for child sexual abuse prevention, intervention, and research.

Predictors of condom use in Mexican migrant laborers

The purpose of this study was to explore predictors of condom use with occasional sex partners and regular sex partners, as well as carrying condoms in a new high-risk group for HIV infection, Mexican migrant laborers. This study extends previous findings by (1) exploring additional predictors not previously examined, (2) utilizing a large sample of male and female Mexican migrant laborers, (3) carefully controlling for the effects of various demographic and lifestyle variables related to condom use, and (4) assessing the interactive effects of gender on predictors of condom use. Snowball sampling was used to survey 501 adult Mexican migrant laborers. Results revealed that condom use with occasional sex partners was predicted by carrying condoms and condom self-efficacy and that women were more likely to use condoms with occasional partners when both men and women knew someone with HIV/AIDS. Condom use with regular sex partners was predicted by procondom social norms, less negative attitudes toward condoms, not knowing someone with HIV/AIDS, and condom self-efficacy. Carrying condoms was predicted by procondom social norms, less negative attitudes toward condoms, condom self-efficacy, worry about contracting HIV/AIDS, and women were more likely than men to carry condoms when both men and women were married. Understanding these findings, future research directions, and implications for condom promotion strategies with Mexican migrant laborers are discussed.

Tecatas: an ethnotheoretical look at Mexican American female injecting drug users

Ethnotheory is suggested as a way to study the roles Mexican American female injecting drug users play. It is suggested that ethnotheory extends present theoretical models used to explain and modify female IDUs' behavior; provide insights on female IDUs' roles useful for the development of effective intervention strategies; and suggests a type of ethnographic data collection that uncovers the subject's view of reality. Three detailed ethnographic excerpts from Mexican American female IDUs illustrate how female IDUs manage the array of roles they play and how information gained through ethnotheory is useful in the design of culturally relevant interventions.

Drug use, AIDS knowledge, and HIV risk behaviors of Cuban-, Mexican-, and Puerto-Rican-born drug injectors who are recent entrants into the United States

To date, relatively little research attention has been devoted to the HIV-risky behaviors of persons who are newly arrived in the United States and who use drugs. Data gathered from street-recruited injection drug users (IDUs) recruited in 10 United States cities who were born in Mexico, Cuba, and Puerto Rico and who are recent entrants into the United States suggest that, in comparison to US-born IDUs, Mexican-born subjects are at elevated risk for acquiring and transmitting HIV as a result of sharing needles with friends and running partners; sharing drug injection implements such as cookers, cotton, and rinse water; frequent injection in HIV-risky settings; use of unsterilized needles; and relatively frequent trading of sex for drugs or money. Puerto-Rican-born IDUs were found to inject drugs relatively frequently, and to do so relatively often in high-risk settings in which sterile injecting equipment and cleaning materials often are scarce. These data also show generally lower levels of AIDS knowledge among the in-migrant IDUs than among US-born IDUs. Respondents from each nationality group most often cited television as the source of their most useful and reliable AIDS information, but also tended to regard community outreach workers as a significant source of reliable AIDS and needle cleaning information. The high levels of involvement in HIV-risky behaviors, deficits in knowledge concerning the means of HIV transmission, and relative ease of mobility of the at-risk (for HIV) individuals examined here indicate a need for a comprehensive public health prevention initiative to limit the future spread of HIV. At a minimum, such an undertaking would do well to incorporate group-specific, culturally appropriate behavioral interventions as well as an information campaign.

Two good reasons: women's and men's perspectives on dual contraceptive use

In the US, continued high rates of unintended pregnancy, combined with increases in heterosexual transmission of HIV to women, have sharply magnified concern about the factors leading to or barring the use of contraceptive methods to protect concurrently against both risks. This paper reports on results of focus group research among African-American women participating in a longitudinal study and African-American men who are either partners of the women or are of similar socio-economic status as their partners. We found a high level of agreement between men and women on the issues and problems that both sexes face. People felt that regardless of a woman's use of other contraceptive methods, a condom should always be used for protection. This belief, however, differed markedly from actual practice. Although we attempted to discern the relative salience of concern about pregnancy versus STIs, we conclude that people may not separate these two concerns in their resolve to use two methods. Furthermore, they recognized the need for dual protection, but expected conflict with their partners from using condoms as a second method because of high levels of distrust regarding sexual fidelity. Thus people are caught in a bind: distrust further increases the sense of a need for dual methods, but using condoms exacerbates the problems people have with achieving trust in relationships.

Crack cocaine use in rural migrant populations: living arrangements and social support

Correlates of crack cocaine use were studied among a targeted sample of migrant workers and their sexual partners (n = 571) in rural Southern Florida. Employment among men and recent drug-user treatment among men and women are positively related to crack use, as is involvement in crime and prostitution. Among women but not men, living with children is negatively related to crack use. Drug use and HIV prevention programs should intervene with individuals and their families and social groups. Migrant workers and their sexual partners also need effective drug-user treatment with long-term relapse prevention services.

Risking for protection: discourses around 'safe sex' among Chilean, Turkish and second-generation Greek women living in Melbourne, Australia

The aim of this study was to identify the ways in which women from Turkish, second-generation Greek and Chilean backgrounds living in Melbourne, Australia, understand risks to their sexual health with a focus on STDs including HIV/AIDS. Data were derived from in-depth qualitative interviews with 20 women from each ethnic group (N = 60). Interviews were guided by a theme list, conducted in the woman's language of preference, tape-recorded and fully transcribed. Transcripts were double coded for key themes and analysed using ethnographic content analysis. The key findings are that for many women, reducing the risk of STDs to protect their physical health introduces risks to their social health and to the well-being of their family and community. Thus, women place priority over the protection of their social health as opposed to their physical health. Despite specific cultural differences in understandings of sexual health risks and illnesses, all women shared gendered commonalities in the ways in which they contextualise STDs within the wider context of social relationships and their everyday life. We conclude by arguing for interventions that specifically take into account social models of risk in STD and HIV/AIDS prevention and we consider the practical implications of this for harm reduction strategies in multicultural societies such as Australia.

Survey of condom-related beliefs, behaviors, and perceived social norms in Mexican migrant laborers

This study reports findings from a survey of condom-related beliefs, behaviors, and perceived social norms in Mexican migrant laborers that live and work in the United States for extended periods of time. Snowball sampling was used to recruit 501 Mexican migrants from five "sending towns" in Jalisco, Mexico, with historically high rates of out-migration to the United States. Results showed that subjects reported few negative beliefs about condom use and high efficacy to use condoms in challenging sexual situations but social norms sanctioning condoms were limited. Results also revealed mixed knowledge of HIV transmission, poor knowledge of condom use, and higher condom use with occasional versus regular sex partners. Forty-four percent of male migrants reported sex with prostitutes while in the U.S., with married men reporting less condoms use with prostitutes than single men. It was concluded that condom promotion efforts with Mexican migrants should concentrate on men to encourage consistent use with occasional sex partners, including prostitutes. AIDS prevention education should be provided with sensitivity to the language needs, limited education, and extreme social and geographic marginality of this highly underresearched Latino population.

Women and AIDS: an analysis of media misrepresentations

A close reading of popular discourses on women and the AIDS epidemic reveals the ways in which such depictions produce and reiterate power-laden notions of normative sexuality. Prostitutes, one frequently depicted 'kind' of woman, are presented as indiscriminate, polluting to men and categorically different from 'normal' women. Other women depicted in AIDS discourses are almost always HIV-positive mothers or pregnant women; these women are usually only of concern insofar as they may infect their babies. The themes of self-control, self-discipline and personal responsibility may also stigmatize women. Such discourses suggest that those who have AIDS are responsible for their own illness. They also deflect attention away from the socioeconomic contexts that may make it more difficult for some to avoid infection, away from the connections between poverty, illness and disempowerment, and away from systematic inequalities that characterize U.S. society.

Knowledge and meaning: the AIDS education campaign in rural northeast Thailand

Nearly 80% of Thailand's population live in the rural sector. To date, these villages have been subject to top-down dissemination of HIV/AIDS education information via the mass media and bureaucratic networks. This report details an ethnographic enquiry into the impact education campaigns are having in one village in Northeast Thailand. It is found that AIDS information is primarily integrated with local conceptions of sexual behaviour and commercial sex. By the early 1990s, heterosexual behaviour is a major mode of HIV transmission in Thailand. Local and international media discourse focuses on the commercial sex industry in describing the spread of the virus. However, the lack of detailed research of sexual practices in Thailand makes accurate projections of HIV transmission difficult and allows unsubstantiated claims to be made concerning typical Thai sexual behaviour. This paper explores the local context in which these practices are found and discusses the meanings villages attached to HIV/AIDS information. Knowledge levels and behaviour change are assessed and it is argued that community based imperatives are essential for effective future campaigning.