Welcome to the Acción Mutua web-seminar Latino Immigrant Day Laborers & HIV

1. Welcome to the Acción Mutua web-seminarLatino Immigrant Day Laborers & HIV Before we begin, a little about our format • Presentation by seminar speaker ≈ 40 min • Question and answer session ≈ 20 min • Press *6 on your telephone keypad to mute your line • If you are experiencing difficulty with your phone connection, dial *0 for the conferencing service operator • Questions submitted prior to the web seminar will be addressed first • For questions that arise during the presentation, please click on the “hand” icon button and type your question

2. Acción Mutua is a capacity building assistance (CBA) program of AIDS Project Los Angeles in collaboration with the César E. Chávez Institute of San Francisco State University Funded by the Centers for Disease Control and Prevention

3. Latino Immigrant Day Laborers & HIV Paula Worby, DrPH, MPH Associate Director Multicultural Institute paula@mionline.org

4. Focus of today’s presentation Learning Objectives • Who are day laborers • Direct HIV risks • Background factors affecting risk • Maximizing assets for prevention

5. The reason I came to the U.S. was to look for a better life… but once you’re here, there are all kinds of problems like loneliness, depression, separation from your family. One can fall into depression and when… depressed, then you resort to alcoholism and drugs…and then you get more problems… You can forget the reason you came here in the first place… Organista, Alvarado, Balblutin-Burnham, Worby and Martinez (2006)

6. Who are day laborers Recent immigrants from different countries Construction, painting and landscaping Higher hourly wages but irregular work Some move on, others are permanent 117,000 to 260,000 workers seek work daily PHOTO/MEGAN MCCALL, Daily Californian 2001

7. Who are day laborers • Almost exclusively male (98%) • Majority without work authorization (75%) • All low-income National Day Labor Study 2004-2005 (sampling of 264 sites in 20 states)

8. Who are day laborers • Diverse • countries of origin • time in U.S. • ages • education • community involvement • work skills • other languages/indigenous identity National Day Labor Study 2004-2005 (sampling of 264 sites in 20 states)

9. County of origin

10. Years of residence in the U.S.

11. Age range Source: National Day Labor Study; personal communication Enriquez-Haass, 2007

12. Mapping HIV risk DIRECT RISK (unsafe sex & IDU) • MEDIATORS GREATER CONTEXT

13. Context matters…. Photo: Erik Oeverndiek/San Mateo Daily Journal

14. Greater Context (the Setup) • Discrimination (undervalued) • Loneliness, sadness (far from home) • Financial hardships (overwhelming debts) • Limited housing options • Difficult, painful, dangerous work • Pressure to not fail family • Lack of English imposes limits Desesperación

15. Vulnerability… “There are guys who lose morale, you understand? The only thing they do is drink, smoke marihuana. Why? To forget, you know, to forget a little while that they have problems because everyone has a bunch of problems—pay the rent, pay the bills, send money to Mexico” Worby (2002)

16. …and resilience “You can get to the point where you don’t have anything, not even to eat...you feel so desperate, so upset. You walk along and don’t know what to do you are so desperate. Then later, you find some friend who helps you and it makes you think, you feel so good again...” Organista (2002 unpublished)

17. “Desesperación” • Need intimacy, pleasure, distraction • Male bonding and avoiding boredom(drinking and seeking sex) • Can’t escape negative peers • Desperate measures to get cash • Pathways to the “fall into vice” (“caerse en vicio”)

18. “Because there is a lot of—what would you say—a lot of vices. It’s very easy to buy cigarettes here, a beer or whatever, cocaine, heroin. This is what I’ve observed and really that is why I say that life [in the U.S.] is very nice but it is very dangerous…” Worby (2002)

19. Mediating influences (the causes) • Which sex partners • Control & expectations about protection (condoms) • Alcohol and/or drug use with sex • Injection drug use

20. Sexual contact with women • Sex workers’ availability • Men arriving single or separated • Men with partners or families at home • Challenges to remain faithful despite good intentions • History of non-monogamy • Estrangement over time

21. “The problem is that at times you have to have relations with a prostitute because, what are you going to do? You can’t flirt with someone because here before you know it they’ll want to have the police after you. It is really different, you know?” Organista, Alvarado, Balblutin-Burnham, Worby and Martinez (2006)

22. Sexual contact between men • Stigmatized and hidden • Not determined by sexual identity • Migrating away from cultural norms • New chances to explore • Survival sex (money for sex)

23. “My friends had homosexual friends, but they had them only so they could give them oral sex, not to have sexual relations…” Gonzalez-Lopez (2005)

24. Alcohol and drug use • Not everyone drinks • Heavy drinking & weekend binging • Alcohol goes with sex “to relax” • Marijuana versus hard drug use

25. Condom use • Low or inconsistent use • Assuming which women are ‘clean’ • Condoms for- ‘other’ partners (not for main partner) • Men picking up men at day laborer sites • STD history

26. “I did use [condoms], but only a few times …90% but not 100% and wouldn’t use any with a woman that I knew. The risk was when I got drunk; I wouldn’t use any.”

27. Injection drug use • Heavy drug use ≠ regular at day labor • But some drug users are former day laborers Providers can ask about: • Injections used in self medical care

28. Direct risk (the result) • MEDIATORS • Alcohol/drugs with sex? • Which sex partners? • Control over encounters? DIRECT RISK (Unsafe sex & IDU) • GREATER CONTEXT • Harsh living/working conditions • Loneliness, desesperación,discrimination • Distance from family & community • Few options for romantic partners

29. Positive approaches Building on day laborers’ individual strengths and community assets Photo: Multicultural Institute 2008

30. Tips for agencies Reinforcing what already works: • Staying well is best way to help families • Communicating back home • Obtaining safe work safely • Finding decent housing & housemates • Health, legal, and educational services that match needs

31. Photo: Multicultural Institute 2008

32. Tips for agencies Reinforcing what works for communities: • Mutual helping • Peer information networks • Hometown and family networks • Working through trusted organizations • Connecting through cultural and sports activities, church communities

33. Photo: Multicultural Institute 2007

34. Tips for agencies Service delivery in general: • Sensitivity and language skills • of all staff • Bring services to workers instead of bringing workers to services

35. Service delivery in general (cont.) • Flexible requirements & scheduling • Limited usefulness of most written materials • Mix it up! stories, movies, skits, music triggers for discussion

36. Photo: Multicultural Institute 2007

37. HIV prevention education • Address common fears and misunderstandings as a given • Peer influence vs. influential “experts” • Good intentions vs. actual behaviors • Assume sexual activity but reaffirm those with other choices

38. Photo: Multicultural Institute 2005

39. iGracias ~ Thank You! Questions & Answers

40. Thanks for Your Participation For more information or to learn how to receive CBA services, contact us at: 213.201.1345 www.accionmutua.org