HIV Prevention Among Mexican Migrants at Different Migration Phases: Exposure to Prevention Messages and Association With Testing Behaviors

The next phases of the Migrante Project: Study protocol to expand an observatory of migrant health on the Mexico-U.S. border

Background

Mexican migrants traveling across the Mexico-United States (U.S.) border region represent a large, highly mobile, and socially vulnerable subset of Mexican nationals. Population-level health data for this group is hard to obtain given their geographic dispersion, mobility, and largely unauthorized status in the U.S. Over the last 14 years, the Migrante Project has implemented a unique migration framework and novel methodological approach to generate population-level estimates of disease burden and healthcare access for migrants traversing the Mexico-U.S. border. This paper describes the rationale and history of the Migrante Project and the protocol for the next phases of the project.

Methods/design

In the next phases, two probability, face-to-face surveys of Mexican migrant flows will be conducted at key crossing points in Tijuana, Ciudad Juarez, and Matamoros (N = 1,200 each). Both survey waves will obtain data on demographics, migration history, health status, health care access, COVID-19 history, and from biometric tests. In addition, the first survey will focus on non-communicable disease (NCD), while the second will dive deeper into mental health and substance use. The project will also pilot test the feasibility of a longitudinal dimension with 90 survey respondents that will be re-interviewed by phone 6 months after completing the face-to-face baseline survey.

Discussion

Interview and biometric data from the Migrante project will help to characterize health care access and health status and identify variations in NCD-related outcomes, mental health, and substance use across migration phases. The results will also set the basis for a future longitudinal extension of this migrant health observatory. Analyses of previous Migrante data, paired with data from these upcoming phases, can shed light on the impact of health care and immigration policies on migrants' health and inform policy and programmatic responses to improve migrant health in sending, transit, and receiving communities.

Cumulative Stress and Trauma from the Migration Process as Barriers to HIV Testing: A Qualitative Study of Latino Immigrants

Immigrants are at increased risk for late HIV testing; however, there is limited understanding of how migration to the United States shapes HIV testing behaviors. This study examined the relationship between the migration process and HIV testing among Latino immigrants. Semi-structured, in-depth interviews were conducted in March and April 2017 with 34 Latino immigrants in New York City. Grounded theory guided analysis of the qualitative data. Results indicated that Latino immigrants experienced cumulative stress and trauma throughout the migration process that contributed to significant emotional and psychological consequences. Stress and trauma accumulated from the migration process posed barriers to HIV testing as Latino immigrants sought to avoid activities perceived as stressful, including learning one's HIV status. Targeted interventions that ameliorate the stressful effects of migration may facilitate preventive health behaviors among Latino immigrants.

HIV-positive migrants' experience of living in Sweden

Background: There is a limited knowledge of the impact of being human immunodeficiency virus (HIV)-positive on migrants living in Sweden. It is therefore important to gain a general awareness of this issue in order to maintain the wellbeing of this vulnerable group of patients and to develop an adequate social support network.Objective: The aim of this study was to explore HIV-positive migrants' experiences of their life situations, living in Sweden.Method: A qualitative, exploratory study was performed using semi-structured interviews with 14 HIV-positive migrants, aged 29-55 years, and analyzed with qualitative content analysis. The participants were recruited from three clinics for infectious diseases in western Sweden.Results: The results are presented in the following three categories: ´Vulnerability in social relationships', 'Fear of disclosure", and 'Resilience'. The results illustrated the participants' experiences of vulnerability in their social relationships, fear of disclosing HIV status, feeling lonely and stigmatized, and lacking social network and support. Furthermore, the results illustrated participants' challenges in finding a partner, due to their fear of being recognized because of their HIV-infection. However, the result indicated participants' struggling for a normal life with integrity, and that their need to look positively at life.Conclusions: In the actual study loneliness, fear of disclosure, perceived stigma, and the lack of a social network had significant impact on the life situations of the HIV positive migrants. Fear of disclosure and the challenge of finding a partner and friends were the main obstacles. It is crucial to increase access for these patients to supporting networks that will promote their empowerment and trust.

Complex Patterns Across the Migration Process and Associated HIV Testing and Risk Behaviors among Latino Immigrants

BACKGROUND

Migrants are at elevated risk for adverse HIV-related outcomes. Yet, there is limited understanding about the complexity of the migration process and the different migration experiences that may influence HIV testing and risk behaviors. This study examined whether patterns in immigrants' migration experience were associated with HIV risk and preventive behaviors.

METHODS

Surveys were conducted with Latino immigrant adults (n = 306) in New York City during the spring of 2017. Informed by formative interviews, variables were developed to assess the migration process and document information about Latino immigrants' experiences during six particular stages of migration (pre-departure, travel, destination, interception, return, and settlement). We conducted a Latent Class Analysis (LCA) to detect patterns in the migration experience among participants and examined the associations between the latent classes and HIV testing and risk behaviors.

RESULTS

LCA clustered participants into three migration experience classes: positive experience (50.3%), neutral experience (36.3%), and negative experience (13.4%). The migration classes were significantly associated with sociodemographic variables, including sex, age, and income. Different experiences during the migration process did not influence immigrants' past or current HIV testing or risk behaviors. However, the migration classes were associated with immigrants' future intentions to test for HIV with the positive migration experience class reporting greater intentions to test for HIV in the next 12 months than the negative experience class (aOR, 2.95; 95% CI, 1.21-7.17; p < .05).

CONCLUSION

Results suggest the applicability of a migration experience framework for understanding future HIV risk and preventive behaviors among immigrants.

Vulnerabilities and risks of HIV infection among migrants in the Thane district, India

OBJECTIVES

To explore the vulnerabilities and risks of HIV infection among female migrants compared with male migrants in the Thane district of Maharashtra, India.

STUDY DESIGN

This is a cross-sectional epidemiological study.

METHODS

Data from 35,841 migrants (men 96.2% and women 3.8%) were collected using the web-based 'Migrant Service Delivery System.' The data were then analysed in SPSS, version 23.0. Statistical analysis, including Chi-squared test and multivariate logistic regression, was used to identify factors influencing HIV infection for both male and female migrants.

RESULTS

It was observed that 2.96% of female migrants had HIV infection compared with 0.77% of male migrants. We found that 12.1% of women consumed alcohol compared with 41.9% of men, and access to bars was 1.5% among women and 3.5% in men. We observed an even larger difference between men and women in their previous history of using brothels for sex; only 5.9% of female migrants reported previously having used brothels for sex, compared with 62.9% of male migrants. Approximately 12.3% of married women and 93.6% of married men had sex with someone other than their spouse. We found that 67.0% of married women and 73.9% of married men reported using a condom during their last sexual act compared with 60.9% of unmarried women and 68.1% of unmarried men.

CONCLUSIONS

In Thane, female migrants faced higher vulnerabilities and risks of HIV infection than male migrants. Consequently, innovative strategies are required to address these particular needs of female migrants.

Interventions for Increasing HIV Testing Uptake in Migrants: A Systematic Review of Evidence

Migrants have been identified as being at greater risk for late HIV testing and diagnosis. Late diagnosis is of concern because timely diagnosis and initiation of treatment can both optimise health outcomes and reduce transmission. We reviewed and evaluated interventions that aimed to increase HIV testing uptake in migrant populations. Of 6511 papers retrieved, 10 met the inclusion criteria and were included in the review. Three types of interventions were identified (exposure to HIV prevention messages, HIV education programs, and direct offer of testing). All interventions were based on individual models of behaviour change targeting migrants or GPs. While important, interventions that also address broader health system and structural factors that contribute to late HIV-diagnosis in at-risk members of migrant populations are needed. Integrating PITC into existing primary healthcare settings shows promise of creating an enabling environment within patient-doctor relationships that can encourage HIV testing uptake among migrant populations.

Behavioral and Psychosocial Correlates of HIV Testing Among Male Clients of Female Sex Workers in Tijuana, Mexico

We use data collected from a sample of 400 male clients of female sex workers (FSW) to examine their HIV testing behavior. We present frequencies of HIV testing and used bivariate and multivariable analyses to assess its socio-demographic, behavioral, and psychosocial correlates. We found that the majority (55 %) of male clients of FSW in Tijuana, Mexico had never had an HIV test and the prevalence of HIV testing within the past year was low (9 %). In multivariable analyses, significant correlates of having ever tested for HIV were higher age, higher HIV knowledge score, lower sexual compulsiveness score, lower misogynistic attitudes score, having a condom break during sex with a FSW, and higher frequency of sex with a FSW while she was high. Our findings represent an important starting point for developing effective interventions to address the need to promote HIV testing among this population.

Risk profile and HIV testing outcomes of women undergoing community-based testing in San Diego 2008-2014

Women comprised 19% of new HIV diagnoses in the United States in 2014, with significant racial and ethnic disparities in infection rates. This cross-sectional analysis of women enrolled in a cohort study compares demographics, risk behaviour, and sexually transmitted infections (STI) in those undergoing HIV testing in San Diego County. Data from the most recent screening visit of women undergoing voluntary HIV screening April 2008 –July 2014 was used. HIV diagnosis, risk behaviour and self-reported STIs were compared among women aged ≤24, 25–49, and ≥50, as well as between HIV-infected and uninfected women and between Hispanic and non-Hispanic women. Among the 2535 women included, Hispanic women were less likely than other women to report unprotected vaginal intercourse (p = 0.026) or stimulant drug use (p = 0.026), and more likely to report one or fewer partners (p < 0.0001), but also more likely to report sex with an HIV-infected individual (p = 0.027). New HIV infection was significantly more prevalent among Hispanic women (1.6% vs. 0.2%; p < 0.001). Hispanic women were more likely than other women to be diagnosed with HIV despite significantly lower rates of risk behaviour. Culturally specific risk reduction interventions for Hispanic women should focus on awareness of partner risk and appropriate testing.