Policies of containment: immigration in the era of AIDS

Has Pandemic Threat Stoked Xenophobia? How COVID-19 Influences California Voters' Attitudes toward Diversity and Immigration

Sociological theory and historical precedent suggest that pandemics engender scapegoating of outgroups, but fail to specify how the ethnoracial boundaries defining outgroups are drawn. Using a survey experiment that primed half of the respondents (California registered voters) with questions about COVID-19 during April 2020, we ask how the pandemic influenced attitudes toward immigration, diversity and affect toward Asian Americans. In the aggregate, the COVID prime did not affect attitudes toward immigrants, but did reduce support for policies opening a pathway to citizenship for undocumented immigrants and reduced appreciation of California's diversity. Respondents reported rarely feeling anger or fear toward Asian Americans, and rates were unaffected by the COVID prime. A non-experimental comparison between attitudes toward immigrants in September 2019 and April 2020 found a positive change, driven by change among Asian-American and Latino respondents. The results provide selective support for the proposition that pandemics engender xenophobia. At least in April 2020 in California, increased bias crimes against Asian Americans more likely reflected politicians' authorization of scapegoating than broad-based racial antagonism.

Vexing, Veiled, and Inequitable: Social Distancing and the "Rights" Divide in the Age of COVID-19

Although unprecedented in scope and beyond all our life experiences, sweeping social distancing measures are not without historical precedent. Historically, racism, stigma, and discrimination resulted in grossly inequitable application of disease containment measures. But history also provides examples in which broad measures enjoyed remarkable public support. When it comes to COVID-19, blame and division continue to shape containment responses. But the COVID-19 pandemic also resonates with moments in which there was broad social support for containment precisely because lockdowns or stay at home orders are, on the surface, remarkably equitable. Yet even in a context in which a majority of Americans support social distancing, small but coordinated conservative groups are challenging social distancing as a matter of individual rights. In sharp contrast, vulnerable populations, who bear the heaviest burden of disease, have claimed a right to social distancing as a matter of protection.

HIV Testing Among Black and Hispanic Immigrants in the United States

Late presentation is common among black and Hispanic US immigrants living with HIV. Little is known about HIV testing in this population because data are aggregated into racial and ethnic categories without regard to nativity. This study was undertaken to determine HIV testing patterns in these populations. We used data from the National Health Interview Survey (2007-2010), a nationally representative source of HIV testing data disaggregated by nativity. The sample consisted of 10,397 immigrants (83.9% Hispanic white, 13.1% non-Hispanic black, and 3.0% Hispanic black). The majority of participants were from the Caribbean, Central America, and Mexico (81.5%). Hispanic white immigrants were least likely to have undergone testing compared with non-Hispanic and Hispanic black immigrants (46.7% vs. 70.5% and 65.8%). Among immigrants with known risk factors or prior STDs, 59.2% and 74.8% reported previous HIV testing. Immigrants who had not recently talked to a healthcare provider were less likely to report testing: Hispanic white (AOR 0.65, 95% CI 0.58-0.72), non-Hispanic black (AOR 0.64, 95% CI 0.48-0.85), and Hispanic black (AOR 0.26, 95% CI 0.14-0.48). Only 17.2% of all immigrants intended to undergo HIV testing in the 12 months following participation in the survey. Among all three racial and ethnic groups, immigrants who reported a history of prior STDs were more likely to intend to test for HIV in the future. Many black and Hispanic immigrants to the United States have not undergone HIV testing. Interventions to increase access to HIV testing and awareness of transmission risk should be developed.

Análisis comparativo de las percepciones sobre el VIH/SIDA de varones homosexuales y bisexuales colombianos, con experiencia migratoria o sin la misma

<p>Realizar una comparación de las percepciones sobre el VIH/Sida que tienen los varones homosexuales y bisexuales colombianos que residen en el Eje Cafetero colombiano frente a aquellos varones que han migrado a España, permitiendo indagar si estas percepciones influyen en la vulnerabilidad social de los implicados, la cual está determinada por aspectos tales como las desigualdades que pueden resultar del desconocimiento de la diversidad cultural y sexual de las personas que se encuentran inmersas en un proceso migratorio.</p><p class="Default"><strong>Métodos</strong> La investigación es de carácter transnacional (Colombia-España) y se realizó a través de entrevistas en profundidad a varones mayores de edad residentes en las comunidades autónomas de Madrid, Cataluña, Valencia y Andalucía en España y los departamentos de Caldas, Quindío, Risaralda y Valle del Cauca en Colombia, en un periodo de tiempo comprendido entre los años 2011 y 2013; en total se realizaron 87 entrevistas en ambos países.</p><p class="Default"><strong>Conclusión</strong> La relación entre la migración y la sexualidad debe plantearse desde una visión integral que permita enriquecer su comprensión, tanto a la sociedad de origen como al país de acogida al considerar sus aspectos sociales y culturales. Es indispensable que cualquier programa de promoción y prevención en salud que pretenda influir en los comportamientos sociales, tenga en cuenta las especificidades de las personas, para evitar así las generalizaciones y la instrumentalización de estas, reconociéndolas y visibilizándolas como sujetos de pleno derecho que opinan, hablan y participan.</p>

HIV/AIDS among African-born residents in the United States

The number of African-born residents living in the United States (US) increased by more than 750 % between 1980 and 2009. HIV diagnosis rates in this population are six times higher than estimated incidence in the general US population. African-immigrants with HIV are also diagnosed at later stages of infection than US-born residents, but they paradoxically have lower mortality after diagnosis. There are higher rates of HIV among women, higher rates of heterosexual transmission, and lower rates of injection-drug-use-associated transmission among African-born residents in the US relative to the general US population. Despite this distinct epidemiologic profile, surveillance reports often group African-born residents with US-born Blacks. The high rates of HIV among African-born residents in the US combined with increasing immigration and incomplete surveillance data highlight the need for more accurate epidemiologic data along with appropriate HIV service programs.

[Cost-benefit analysis: HIV/AIDS prevention in migrants in Central America]

OBJECTIVE

To quantify the costs and benefits of three HIV prevention interventions in migrants in Central America: voluntary counseling and testing, treatment of sexually transmitted infections, and condom distribution.

MATERIALS AND METHODS

The methods were: a) identification and quantification of costs; b) quantification of benefits, defined as the potential savings in antiretroviral treatment of HIV cases prevented; and c) estimation of the cost-benefit ratio.

RESULTS

The model estimated that 9, 21 and 8 cases of HIV were prevented by voluntary counseling and testing, treatment for sexually transmitted infections and condom distribution per 10 000 migrants, respectively. In Panama, condom distribution and treatment for sexually transmitted infections had a return of US$131/USD and US$69.8/USD. Returns in El Salvador were US$2.0/USD and US$42.3/USD in voluntary counseling and testing and condom distribution, respectively.

CONCLUSION

The potential savings on prevention have a large variation between countries. Nevertheless, the cost-benefit estimates suggest that the HIV prevention programs in Central America can potentially result in monetary savings in the long run.

Going North: Mexican migrants and their vulnerability to HIV

BACKGROUND

Mexican migrants are at higher risk for HIV than Mexicans who do not migrate to the United States. Migration to the United States was the driving factor of the early Mexican HIV epidemic, and it is likely that it continues to strongly influence incidence. An overview of migration of Mexicans to the United States identifies many pervasive environmental and structural factors as well as risk behaviors that render migrants vulnerable to HIV infection. However, published studies sampling Mexicans while in the United States suggest a relatively low prevalence of HIV among the general migrant population. To better understand this apparent paradox, we sought to identify any demographic variables among Mexicans while in Mexico that may indicate that migrants have or acquire resources that have a protective effect from their vulnerability due to migration.

METHODS

A California-Mexico binational collaboration project, with a respondent-driven sample with population-based quotas, was conducted in five Mexican states from December 2004 to January 2005, in areas with a high index of migration to the United States. We compared demographic and behavior variables of Mexicans with a history of migration to the United States in the past 12 months to nonmigrant Mexicans living in the same community.

RESULTS

A total of 1539 migrants and 1236 nonmigrants were recruited from five Mexican states. Migrants (men and women) reported more HIV risk behavior than nonmigrants in the past 12 months. Migrants reported more sexual partners and noninjected drug use. Migrants reported higher condom use during vaginal sex and were more likely to have taken an HIV test.

CONCLUSION

Though migrants reported higher HIV-related risk behaviors, they also reported higher condom use. Migrants were more likely to have accessed an HIV test indicating an opportunity for a prevention intervention. More binational collaborations are needed to research the different levels of vulnerability among Mexican migrants and actual acquisition of HIV infection. In addition, more research is needed to identify protective factors for HIV prevention interventions among Mexican migrant communities in Mexico and in the United States.

Invisible Americans: Migration, Transnationalism, and the Politics of Difference in HIV/AIDS Research

Using the scholarship on transnationalism and citizenship, this paper examines the politics of difference in HIV/AIDS prevention programmes in the United States and their impact on Haitian migrants and immigrants. It finds that there is a tremendous amount of complex movement of knowledge production and expertise among various constituents who work in the field of HIV/AIDS, and these individuals circulate ideas and technologies of HIV/AIDS across different fields in multiple ways. Through these circulations, information about HIV/AIDS becomes entangled in the debates about relevant knowledge bases, and as a result, questions over culture and modernity. This paper traces how such discourses become framed under the rubric of risk and difference and operate at the level of situated experience. Through ethnographic fieldwork observations and interviews, this paper argues that notions of individual responsibility in HIV/AIDS risk management often become inseparable from notions of racial, ethnic and immigrant identity.

Unconditional hospitality: HIV, ethics and the refugee 'problem'

Refugees, as forced migrants, have suffered displacement under conditions not of their own choosing. In 2000 there were thought to be 22 million refugees of whom 6 million were HIV positive. While the New Zealand government has accepted a number of HIV positive refugees from sub-Saharan Africa, this hospitality is under threat due to negative public and political opinion. Epidemic conditions raise the social stakes attached to sexual exchanges, contagion becomes a major figure in social relationships and social production, and the fears of the contagious nature of those 'just off the plane' connect refugees to an equally deep-seated fear of racial miscegenation. Jacques Derrida's notion of unconditional hospitality is a dream of a democracy which would have a cosmopolitan form. This means that one cannot decide in advance which refugees one might choose to resettle. This paper will use Derrida's notion of unconditional hospitality to emphasise the fragility of HIV positive refugees' position, caught between becoming newly made New Zealand subjects while at the same time having that subjecthood threatened. For Derrida, both ethics and politics demand both an action and a need for a thoughtful response (a questioning without limit).

Policies of inclusion: immigrants, disease, dependency, and American immigration policy at the dawn and dusk of the 20th century

The racial politics of immigration have punctuated national discussions about immigration at different periods in US history, particularly when concerns about losing an American way of life or American population have coincided with concerns about infectious diseases. Nevertheless, the main theme running through American immigration policy is one of inclusion. The United States has historically been a nation reliant on immigrant labor and, accordingly, the most consequential public policies regarding immigration have responded to disease and its economic burdens by seeking to control the behavior of immigrants within our borders rather than excluding immigrants at our borders.

Mobile populations and HIV/AIDS in Central America and Mexico: research for action

OBJECTIVE

To present a multi-centre study that analyses the socioeconomic, cultural and political contexts that give rise to population mobility, and its relationship to vulnerability to sexually transmitted infections (STI)/HIV/AIDS, in order to provide information that can be used to design appropriate and focused interventions.

METHODS

In each of 11 transit stations (border towns, port cities, areas where mobile populations congregate) in Central America and Mexico, a household survey of the local population was conducted to analyse demographic, socioeconomic characteristics, and information known and opinions held about HIV/AIDS and mobile populations. In-depth interviews with key informants, community members and mobile populations were held to ascertain knowledge about prevention and transmission of STI/HIV/AIDS. Likewise, an ethnographic study was undertaken to identify interactions between local and mobile populations.

RESULTS

The transit stations share low educational levels among the local population, few public services, repeated human rights violations, violence, poverty and corrupt authorities. Within this social context, transactional sex, sex for survival, rape and non-professional commercial sex happen in conditions that increase the risk of the transmission of STI/HIV, such as infrequent condom use. Migrant women and sex workers are particularly vulnerable in this context. A wide gap exists between information about STI/HIV transmission and reported prevention practices.

CONCLUSION

Given the conditions that exist in these transit stations, interventions should be multisectoral, sustainable, and should defend the human rights of various groups, including women and people living with HIV/AIDS.

The foreignness of germs: the persistent association of immigrants and disease in American society

During the 20th century the United States witnessed social, political, and economic transformations as well as advancements in medical diagnosis and care. Despite changes in demography, the meaning of citizenship, and the ability to treat and cure acute and chronic diseases, foreigners were consistently associated with germs and contagion. This article explores why, at critical junctures in American history, immigrants have been stigmatized as the etiology of a variety of physical and societal ills. The article analyzes three periods from 1880 to the present and suggests that now, as germs progressively and, often, indiscriminately cross national, social, and economic boundaries through multiple vectors, the mistakes of the past must not be repeated. Protecting the public health in the current era of globalization requires an ecumenical, pragmatic, and historically informed approach to understanding the links between immigration and disease.

AIDS policy modeling for the 21st century: an overview of key issues

Decisions about HIV prevention and treatment programs are based on factors such as program costs and health benefits, social and ethical issues, and political considerations. AIDS policy models--that is, models that evaluate the monetary and non-monetary consequences of decisions about HIV/AIDS interventions--can play a role in helping policy makers make better decisions. This paper provides an overview of the key issues related to developing useful AIDS policy models. We highlight issues of importance for researchers in the field of AIDS policy modeling as well as for policy makers. These include geographic area, setting, target groups, interventions, affordability and effectiveness of interventions, type and time horizon of policy model, and type of economic analysis. This paper is not intended to be an exhaustive review of the AIDS policy modeling literature, although many papers from the literature are discussed as examples; rather, we aim to convey the composition, achievements, and challenges of AIDS policy modeling.

Health of America's newcomers

Newcomer health and health care are policy issues with major outcomes of cost shifting and enormous consequences for newcomers and the community health nurses who promise them care. Newcomers are persons entering U.S. borders who could be asylees, refugees, immigrants, legal or illegal aliens, migrants, international adoptees, and others. Described in this article are the role federalism has played on the interplay among policymakers regarding newcomer health. Also addressed is newcomer health policy, including immigration policies, and newcomer health issues such as infectious diseases and questionable health care. Additional newcomer health issues such as newcomers at high risk for health problems, issues of access to care for newcomers, and welfare reform policies are discussed. Newcomer health and special interest group activities such as those from medicine and nursing are also addressed. Finally, meaningful options and possible solutions for newcomer health care concerns are identified and shared.

Accessing HIV testing and care

With the many recent improvements in the medical management of HIV, the benefits of early detection of the virus have increased. People found to be HIV-positive can be offered immediate referrals for medical care and a comprehensive continuum of services. However, it is estimated that, among the 650,000 to 900,000 seropositive persons in the United States, about one third are unaware of their serostatus. Many of those who are tested for HIV do not return for their results. Among those less likely to return for results are young people and black Americans. Many factors at the individual, system and societal levels negatively impact whether individuals at risk for HIV seek HIV testing in the first place, whether they return for their results, and whether they get appropriate care after they are found to be HIV-positive. Some solutions are offered to improve the identification of new HIV infections. These include social marketing campaigns to encourage individuals to be tested for HIV. Also, more use of the rapid HIV test, which will substantially increase the number of people obtaining their HIV results, is recommended. New computer technologies, such as telemedicine, also have the potential to improve linkages to care for newly diagnosed individuals. In addition, it is essential that HIV care continue to be readily available through the Ryan White Care Act.