Identifying Opportunities to Increase HIV Testing among Mexican Migrants: A Call to Step Up Efforts in Health Care and Detention Settings

HIV testing and counseling is a critical component of HIV prevention efforts and core element of current “treatment as prevention” strategies. Mobility, low education and income, and limited access to health care put Latino migrants at higher risk for HIV and represent barriers for adequate levels of HIV testing in this population. We examined correlates of, and missed opportunities to increase, HIV testing for circular Mexican migrants in the U.S. We used data from a probability-based survey of returning Mexican migrants (N=1161) conducted in the border city of Tijuana, Mexico. We estimated last 12-months rates of HIV testing and the percentage of migrants who received other health care services or were detained in an immigration center, jail, or prison for 30 or more days in the U.S., but were not tested for HIV. Twenty-two percent of migrants received HIV testing in the last 12 months. In general, utilization of other health care services or detention for 30 or more days in the U.S. was a significant predictor of last 12-months HIV testing. Despite this association, we found evidence of missed opportunities to promote testing in healthcare and/or correctional or immigration detention centers. About 27.6% of migrants received other health care and/or were detained at least 30 days but not tested for HIV. Health care systems, jails and detention centers play an important role in increasing access to HIV testing among circular migrants, but there is room for improvement. Policies to offer opt-out, confidential HIV testing and counseling to Mexican migrants in these settings on a routine and ethical manner need to be designed and pilot tested. These policies could increase knowledge of HIV status, facilitate engagement in HIV treatment among a highly mobile population, and contribute to decrease incidence of HIV in the host and receiving communities.     

HIV and Latino migrant workers in the USA

Abstract

Migrant workers from Latin America are an essential source of economic development in the US agricultural industry. A majority of migrants are from Mexico and are undocumented and they represent a vulnerable and marginalized group in American society. There is a growing concern for HIV disease in the migrant community. The HIV prevalence rate among migrants is higher than the average rates in USA and in countries of Latin America. There are many behavioural, social, cultural, and health care risk factors and barriers that place migrants at increased risk for HIV infection. Many migrant workers contract HIV while working and living in the USA, which has contributed to rising HIV infection rates in Mexico. In order to prevent an increasing epidemic of HIV disease in Latino migrant workers, there is an urgent call for new and improved health care policies at the international, federal, state, and local levels.     

Informational returnees: deportation,digital media,and the making of a transnational cybertariat in the Mexican call center industry

In recent years, the US government has intensified the deportation of undocumented Mexican migrants, some of them with long life trajectories in the USA. With weak family networks in their communities of origin and sometimes none at all, many deportees choose to stay in cities along the US-Mexico border, joining the army of underpaid, low-skilled, and informal urban workers. Some take advantage of their transnational experience to earn a better income; within this context, the call center industry is an economic sector that profits from the language facility and sociocultural skills deported populations bring with them from their years spent living in the USA. This paper addresses the working conditions among call center workers in Mexico, with a focus in Tijuana City in the Mexican Northwest. In particular, I explore how migration, deportation, and call center labor produces what I call informational return, a process in which the convergence of culture, deportation, and digital media plays a key role in the constitution of a transnational digital worker.     

Performing the Nation: Unauthorized Mexican Migration and the Politics of Language Use and the Body along the US–Mexico Border

ABSTRACT

Given the harsh environment for Mexican migrants in the US state of Arizona, migrants must think carefully about instantiating their identities in White public space through clothing, bodily movements, and language. This article explores the ways some unauthorized Mexican migrants in Arizona perform belonging to the USA by performing Chicano. Performing Chicano means passing as a US citizen, and migrants’ well-being can depend upon the recognition of those performances. Other unauthorized migrants perform the Supermexicana, to pass as Mexicans who are shopping in the USA, and need to hide the fact that they clandestinely live there. This article examines how some migrants perform a commitment to the USA in public while privately disavowing it, and how others perform a commitment to Mexico that they simply cannot have. This analysis argues that the experiences of unauthorized migrants in the USA can be productively seen through the lens of national performativity.     

Differential effects of migration and deportation on HIV infection among male and female injection drug users in Tijuana, Mexico

HIV prevalence is rising, especially among high risk females in Tijuana, Baja California, a Mexico-US border city situated on major migration and drug trafficking routes. We compared factors associated with HIV infection among male and female injection drug users (IDUs) in Tijuana in an effort to inform HIV prevention and treatment programs. IDUs aged > or = 18 years were recruited using respondent-driven sampling and underwent testing for HIV, syphilis and structured interviews. Logistic regression identified correlates of HIV infection, stratified by gender. Among 1056 IDUs, most were Mexican-born but 67% were born outside Tijuana. Reasons for moving to Tijuana included deportation from the US (56% for males, 29% for females), and looking for work/better life (34% for females, 15% for males). HIV prevalence was higher in females versus males (10.2% vs. 3.5%, p = 0.001). Among females (N = 158), factors independently associated with higher HIV prevalence included younger age, lifetime syphilis infection and living in Tijuana for longer durations. Among males (N = 898), factors independently associated with higher HIV prevalence were syphilis titers consistent with active infection, being arrested for having 'track-marks', having larger numbers of recent injection partners and living in Tijuana for shorter durations. An interaction between gender and number of years lived in Tijuana regressed on HIV infection was significant (p = 0.03). Upon further analysis, deportation from the U.S. explained the association between shorter duration lived in Tijuana and HIV infection among males; odds of HIV infection were four-fold higher among male injectors deported from the US, compared to other males, adjusting for all other significant correlates (p = 0.002). Geographic mobility has a profound influence on Tijuana's evolving HIV epidemic, and its impact is significantly modified by gender. Future studies are needed to elucidate the context of mobility and HIV acquisition in this region, and whether US immigration policies adversely affect HIV risk.     

Methylation: a regulator of HIV-1 replication?

Pakistan, the second most populous Muslim nation in the world, has started to finally experience and confront the HIV/AIDS epidemic. The country had been relatively safe from any indigenous HIV cases for around two decades, with most of the infections being attributable to deported HIV positive migrants from the Gulf States. However, the virus finally seems to have found a home-base, as evidenced by the recent HIV outbreaks among the injection drug user community. Extremely high-risk behavior has also been documented among Hijras (sex workers) and long-distance truck drivers. The weak government response coupled with the extremely distressing social demographics of this South-Asian republic also helps to compound the problem. The time is ripe now to prepare in advance, to take the appropriate measures to curtail further spread of the disease. If this opportunity is not utilized right now, little if at all could be done later.     

The context of return migration: challenges of mixed-status families in Mexico's schools

As a result of US immigration and enforcement policies, Mexico has experienced the arrival of mixed-status families coming from the USA. We examine these families’ experiences of return to central Mexico through the lens of a ‘context of return’, by focusing on how the Mexican government, particularly schools, has received returned migrants. Based on in-depth interviews with thirteen mixed-status families who returned to Mexico in 2005–2010, we show how the citizenship and legal status of the various family members determine their incorporation in Mexico. As these legal statuses are shaped by both the US context of reception and the Mexican context of return, we argue that the two contexts are intimately related and shape the contours of the families and their incorporation upon their return.     

Formulation and validation of a composite migration history score for epidemiological research in Mexican American women

This research developed a composite migration history score, using data on birth places of subjects, and their parents and grand parents, and the length of residence in US from 390 overweight Mexican American women. The derived migration history score is validated through a factor analysis of the nine dimensional migration history variables. The importance of this methodology of defining migration history score for epidemiological research is discussed in the context of studying the role of migration-related health behavior changes and their consequent impact on risks of untoward health outcomes in migrants.     

SHOULD RAPID TESTS FOR HIV INFECTION NOW BE MANDATORY DURING PREGNANCY? GLOBAL DIFFERENCES IN SCARCITY AND A DILEMMA OF TECHNOLOGICAL ADVANCE

Since testing for HIV infection became possible in 1985, testing of pregnant women has been conducted primarily on a voluntary, 'opt-in' basis. Faden, Geller and Powers, Bayer, Wilfert, and McKenna, among others, have suggested that with the development of more reliable testing and more effective therapy to reduce maternal-fetal transmission, testing should become either routine with 'opt-out' provisions or mandatory. We ask, in the light of the new rapid tests for HIV, such as OraQuick, and the development of antiretroviral treatment that can reduce maternal-fetal transmission rates to <2%, whether that time is now. Illustrating our argument with cases from the United States (US), Kenya, Peru, and an undocumented Mexican worker in the US, we show that when testing is accompanied by assured multi-drug therapy for the mother, the argument for opt-out or mandatory testing for HIV in pregnancy is strong, but that it is problematic where testing is accompanied by adverse events such as spousal abuse or by inadequate intrapartum or follow-up treatment. The difference is not a 'double standard', but reflects the presence of conflicts between the health interests of the mother and the fetus--conflicts that would be abrogated by the assurance of adequate, continuing multi-drug therapy. In light of these conflicts, where they still occur, careful processes of informed consent are appropriate, rather than opt-out or mandatory testing.     

The effect of new drug approvals on HIV mortality in the US, 1987–1998

After increasing steadily from 1987 to 1995, the number of US deaths caused by human immunodeficiency virus (HIV) declined sharply from 1995 to 1998. We analyse aggregate data to consider the hypothesis that this decline was due to a rapid increase in the number of drugs available to treat HIV. The evidence suggests that new drugs played a key role in the post-1995 decline in HIV mortality. The annual number of HIV deaths is estimated to have been reduced by over 6000, on average, by an additional HIV drug approval. The social return to HIV drug innovation appears to be extremely large.     

Five myths about AIDS that have misdirected research and treatment

A number of widely repeated and factually incorrect myths have pervaded the AIDS research literature, misdirecting research and treatment. Five of the most outstanding are: 1) that all risk groups develop AIDS at the same rate following HIV infection; 2) that there are no true seroreversions following HIV infection; 3) that antibody is protective against HIV infection; 4) that the only way to treat AIDS effectively is through retroviral therapies; and 5) that since HIV is so highly correlated with AIDS incidence, it must be the sole necessary and sufficient cause of AIDS. A huge body of research, reviewed in this paper, demonstrates the falsity of these myths. 1) The average number of years between HIV infection and AIDS is greater than 20 years for mild hemophiliacs, 14 years for transfussion severe hemophiliacs, 10 years for old severe hemophiliacs, 10 years for homosexual men, 6 years for transfusion patients of all ages, 2 years for transplant patients, and 6 months for perinatally infected infants. These differences can only be explained in terms of risk-group associated cofactors. 2) Seroreversions are common. Between 10 and 20 percent of HIV-seronegative people in high risk groups have T-cell immunity to HIV, and may have had one or more verified positive HIV antibody tests in the past. 3) Antibody, far from being protective against HIV, appears to be highly diagnostic of loss of immune regulation of HIV, and some evidence of antibody-enhancement of infection exists. 4) Non-retroviral treatments of HIV infection, including safer sex practices, elimination of drug use, high nutrient diets, and limited reexposure to HIV and its cofactors have proven to be effective means of preventing or delaying onset of AIDS. 5) Many immunosuppressive factors, including drug use, multiple concurrent infections, and exposure to alloantigens, are as highly correlated with AIDS risk groups as HIV. These data are more consistent with AIDS being a multifactorial or synergistic disease than a monofactorial one.     

The Silk Road Health Project: How Mobility and Migration Status Influence HIV Risks among Male Migrant Workers in Central Asia

Objectives

We examined whether mobility, migrant status, and risk environments are associated with sexually transmitted infections (STIs) and HIV risk behaviors (e.g. sex trading, multiple partners, and unprotected sex).

Methods

We used Respondent Driven Sampling (RDS) to recruit external male migrant market vendors from Kyrgyzstan, Uzbekistan, and Tajikistan as well internal migrant and non-migrant market vendors from Kazakhstan. We conducted multivariate logistic regressions to examine the effects of mobility combined with the interaction between mobility and migration status on STIs and sexual risk behaviors, when controlling for risk environment characteristics.

Results

Mobility was associated with increased risk for biologically-confirmed STIs, sex trading, and unprotected sex among non-migrants, but not among internal or external migrants. Condom use rates were low among all three groups, particularly external migrants. Risk environment factors of low-income status, debt, homelessness, and limited access to medical care were associated with unprotected sex among external migrants.

Conclusion

Study findings underscore the role mobility and risk environments play in shaping HIV/STI risks. They highlight the need to consider mobility in the context of migration status and other risk environment factors in developing effective prevention strategies for this population.     

Black-white disparities during an epidemic: Life expectancy and lifespan disparity in the US, 1980–2000

Covid-19 has demonstrated again that epidemics can affect minorities more than the population in general. We consider one of the last major epidemics in the United States: HIV/AIDS from ca. 1980–2000. We calculate life expectancy and lifespan disparity (a measure of variance in age at death) for thirty US states, finding noticeable differences both between states and between the black and white communities. Lifespan disparity allows us to examine distributional effects, and, using decomposition methods, we find that for six states lifespan disparity for blacks increased between 1980 and 1990, while life expectancy increased less than for whites. We find that we can attribute most of this to the impact of HIV/AIDS.     

Melanin and HIV in sub-Saharan Africa

HIV is common in sub-Saharan Africa. Sexually transmitted bacterial and fungal infections increase the chance of HIV infection. Melanin can prevent the penetration of skin and mucus membranes by microorganisms, and soluble melanin can inhibit HIV replication. We suggest that melanin may reduce the incidence of HIV infection through venereally acquired skin lesions, thus reducing the risk of sero-conversion and slow the progress to AIDS. Indigenous sub-Saharan peoples are highly melanized, but there is pigment variation between populations. We show that skin reflectance, a negative correlate of melanin, is positively associated with adult rate of HIV in sub-Saharan countries. There is no such relationship in populations outside sub-Saharan Africa. We suggest that melanin concentration in black people may correlate with resistance to HIV infection.     

Focus: Sex and Gender Health: Beyond the Pap Smear: Gender-responsive HIV Care for Women

Women comprise nearly one-quarter of all people living with human immunodeficiency virus (HIV) in the U.S. and 20 percent of incident annual cases. Though women overall are more likely than men to be diagnosed with HIV and engage in care, they are as unlikely to successfully achieve viral suppression with antiretroviral therapy, suggesting gender-based disparities that should be addressed by gender-responsive policies and programs. Using the socioecological model of health and syndemics theory, we comprehensively reviewed published literature to evaluate reasons for and ways to address gender differences in HIV risk and treatment. We discuss the biologic, sociocultural, interpersonal, and behavioral contexts of HIV risk that affect women, comprehensive healthcare for women with HIV that includes pregnancy planning or prevention, and policy implications.     

Global South cosmopolitans: the opening and closing of the USA–Mexico border for Mexican tourists

The US government has simultaneously increased efforts to close its border to unauthorized migrants, and opened the border to increasing flows of tourists from Mexico. In this paper I focus on the experiences of Mexican tourists who are able to freely cross the USA–Mexico border with US visas, given that their unique status as tourists from Mexico is an important element to consider because it organizes their daily lives, their moral understandings, and their experiences across the USA–Mexico border. I show how Global South cosmopolitans from Mexico benefit from class privilege in Mexico, but become legally vulnerable in the USA due to their racialization as Mexicans and lack of citizenship rights. This paper draws on ethnographic data and in-depth interviews collected in the border town of Mexicali, Baja California, Mexico between July 2009 and August 2010.     

Conservation on International Boundaries: The Impact of Security Barriers on Selected Terrestrial Mammals in Four Protected Areas in Arizona,USA

Several thousand terrestrial protected areas (PAs) lie on international boundaries. Because international boundaries can be focal points for trade, illegal activity and development, such PAs can be vulnerable to a range of anthropogenic threats. There is an increasing trend towards the erection of international boundary infrastructure (including fences, barriers and ditches) in many parts of the world, which may reduce the risk of these anthropogenic threats to some PAs. However this may restrict home range and access to resources for some native species. We sought to understand the impacts of these two different types of threat by using camera traps to measure the activity level of humans, native and invasive mammals in four US PAs on the Mexican international boundary. Comparisons were made between treatment areas with barriers and those without. Results showed that puma and coati were more likely to appear in treatment areas without barriers, whereas humans were not observed more frequently in one treatment area over another. The suggestion is that the intermittent fencing present in this part of the world does affect some native species, but does not necessarily restrict the movement of humans (including illegal migrants), who may negatively impact native species.     

Is the Social–Ecological Framework Useful in Understanding Infectious Diseases? The Case of HIV/AIDS

The extraordinary complexity of emerging infectious diseases calls for new paradigms and approaches to understand the casual mechanisms underlying pathogen emergence and to improve disease prevention. An attempt was made to foster interdisciplinary collaboration and stimulate transdisciplinary approaches to improve emerging infectious disease research during and subsequent to a meeting held in March 2005 as part of the US NIH Roadmap initiative “Research Teams of the Future.” The meeting drew on models and theories associated with the idea of humans and nature as interactive, complex systems. Of the three diseases chosen as case studies to represent the wide range of social and ecological emergence factors involved (dengue, leptospirosis, and HIV/AIDS), HIV/AIDS proved especially difficult. This Profile examines the meeting themes with a particular focus on the deliberations of a working group focused on HIV/AIDS. Attention is given to the challenges of bridging different disciplines and perspectives in applying a social-ecological framework to analyze HIV/AIDS and the benefits of reductionistic vs. holistic strategies in responding to the global HIV/AIDS pandemic. The issues raised point to opportunities to significantly deepen understanding of HIV/AIDS as a transdisciplinary problem. Disclaimer: The author is Director of the Research Program at the East–West Center and was chair of the HIV/AIDS mini-symposium. This Profile is based on the important contributions and efforts of all the members of the HIV/AIDS working group. All omissions or misrepresentations are the author’s.     

Gender,Migration and HIV in Rural KwaZulu-Natal,South Africa

Objectives

Research on migration and HIV has largely focused on male migration, often failing to measure HIV risks associated with migration for women. We aimed to establish whether associations between migration and HIV infection differ for women and men, and identify possible mechanisms by which women''s migration contributes to their high infection risk.

Design

Data on socio-demographic characteristics, patterns of migration, sexual behavior and HIV infection status were obtained for a population of 11,677 women aged 15–49 and men aged 15–54, resident members of households within a demographic surveillance area participating in HIV surveillance in 2003–04.

Methods

Logistic regression was conducted to examine whether sex and migration were independently associated with HIV infection in three additive effects models, using measures of recent migration, household presence and migration frequency. Multiplicative effects models were fitted to explore whether the risk of HIV associated with migration differed for males and females. Further modeling and simulations explored whether composition or behavioral differences accounted for observed associations.

Results

Relative to non-migrant males, non-migrant females had higher odds of being HIV-positive (adjusted odds ratio [aOR] = 1.72; 95% confidence interval [1.49–1.99]), but odds were higher for female migrants (aOR = 2.55 [2.07–3.13]). Female migrants also had higher odds of infection relative to female non-migrants (aOR = 1.48 [1.23–1.77]). The association between number of sexual partners over the lifetime and HIV infection was modified by both sex and migrant status: For male non-migrants, each additional partner was associated with 3% higher odds of HIV infection (aOR = 1.03 [1.02–1.05]); for male migrants the association between number of partners and HIV infection was non-significant. Each additional partner increased odds of HIV infection by 22% for female non-migrants (aOR = 1.22 [1.12–1.32]) and 46% for female migrants (aOR = 1.46 [1.25–1.69]).

Conclusions

Higher risk sexual behavior in the context of migration increased women''s likelihood of HIV infection.     

Risk Factors for Visceral Leishmaniasis among Residents and Migrants in Kafta-Humera,Ethiopia

Background

Visceral leishmaniasis is a lethal parasitic disease transmitted by phlebotomine sand flies. The largest focus of VL in Ethiopia is located in the lowland region bordering Sudan, where the epidemiology is complicated by the presence of thousands of seasonal agricultural workers who live under precarious conditions.

Methodology/Principal Findings

We conducted two parallel case-control studies to identify factors associated with VL risk in residents and migrants. The studies were conducted from 2009 to 2011 and included 151 resident cases and 157 migrant cases, with 2 matched controls per case. In multivariable conditional regression models, sleeping under an acacia tree at night (odds ratios (OR) 5.2 [95% confidence interval 1.7–16.4] for residents and 4.7 [1.9–12.0] for migrants), indicators of poverty and lower educational status were associated with increased risk in both populations. Strong protective effects were observed for bed net use (OR 0.24 [0.12–0.48] for net use in the rainy season among residents, OR 0.20 [0.10–0.42] for any net use among migrants). For residents, living in a house with thatch walls conferred 5-fold and sleeping on the ground 3-fold increased risk. Among migrants, the risk associated with HIV status was borderline significant and sleeping near dogs was associated with 7-fold increased risk.

Conclusions/Significance

Preventive strategies should focus on ways to ensure net usage, especially among migrant workers without fixed shelters. More research is needed to understand migration patterns of seasonal labourers and vector bionomics.