HIV in International Communities

1. Migrant Farmworkers’ Risks of HIV/STI Infection and Developing Approaches for Reducing Their Risks HIV in International Communities

2. Stephanie Zamora, RN • Family Nurse Practitioner-Board Certified • United Medical Centers, Eagle Pass, TX • Primary clinician for Ryan White Program – Uvalde TGA • Speaker for National Minority AIDS Council • AETC Texas AI/AN Network • No financial disclosures HIV in International Communities

3. OBJECTIVES • 1. Recognize statistical disparities of HIV/AIDS among ethnic classes, including migrant farm workers, in the United States • 2. Identify risk factors for HIV/AIDS in international communities. • 3. Describe strategies to reduce transmission of HIV and STI in these groups. HIV in international communities

4. Epidemiology

5. U.S. Census Demographics – Population Estimates 2007

6. 78% of all farm workers are foreign born • 75% born in Mexico • 2% from Central America • 1% elsewhere • 79% male, 21% female • Median education level was 6th grade, however 3% reported having never attended school. Migrant Farm Worker Demographics National Agriculture Workers Survey, (2005)

16. Data on farm workers is limited • Estimates of 2.6% to 13% infection rates • No exact rates, but could be as high as 10 times the national average • Studies on prevalance • Jones et al (1992) – 13% seropositivity rate among 198 migrant farm workers tested in a SC camp. • Lyons (1992) – 3.2% among 554 were positive for HIV. 8x higher than the national seroprevalance rate of 0.4%. Statistical trends of Hiv/STI among migrant farm workers in U.S. National Center for Farmworker Health, 2009

17. Sanchez et al (2004) cited 3 studies of Mexican migrant farmworkers in California from 1991-2004: • Carrier & Magana (1991) Orange County – • N=50, 0% prevalence • Ruiz et al (1997) 5 Northern California Counties • N=173, 0% prevalence • Bowser et al (2004) North San Diego County • No testing – 70% had sex with a sex worker with 23% reporting condom use • Behavior intervention on condom use Statistical Trends

18. Martinez-Donate et al (2005) • Estimate prevalence of HIV and risk factors among Mexican migrants travelling through San Diego-Tijuana. • Probability survey of 1429 subjects and HIV testing of 1041 subjects from April – December 2002. • Despite risk factors, no positive tests • Highlights need for early HIV prevention for Mexican migrant workers. Statistical trends Martinez-Donate (2005)

19. Risk factors

20. Risk factors • Mobility • Barriers to healthcare • Culture • Language • Geography • Discrimination • Isolation • Psychosocial factors • Poverty • Lack of insurance • Underemployment • Substandard housing • Sexual Behaviors • Sex workers • Multiple partners • Condom use Sanchez, 2004

21. Interferes with accurate epidemiological studies. • Difficult to establish health care home • In Mexico: • Prevalence of HIV relatively low • Recent data – 30% HIV in Mexico related to migrants • In Africa: • Mobile populations played a role in the initial spread of HIV/AIDS in sub-saharan Africa • These populations then spread the virus to families in their homelands in other parts of Africa mobility Sanchez, 2005 /Brummer, 2002

22. Culture • Lack of communication/culture of silence • Machismo/Stigma • Beliefs about disease transmission, especially HIV • Language • 90% speak or read little or no English • Education levels • Low understanding of risks associated with HIV/AIDS • Geography • Often rural, remote locations • Transportation issues Barriers to Healthcare

23. Isolation • Far from families and social networks • Contributes to depression and anxiety • Loneliness • Residency/immigration status • Psychosocial factors • Acculturation • Fear of job loss and deportation discrimination Gonzalez, 2008

24. Low wages • 2000 median annual income $6250 – US worker was $42,000 • Limited or no health insurance • Underemployment • Substandard Housing • Overcrowded • Structural defects • Lacking in basics • Residency/immigration status • Disenfranchised population poverty Gonzalez, 2008

25. Multiple partners • Condom use • Sex worker contact • Needle sharing • “Migrant Paradox” • Low levels of HIV in setting of high risk behavior. • Demonstrates need for primary prevention Sexual behaviors

26. strategies

27. Common elements of successful programs • Trust building and peer leadership • Attention to survival needs • Location, transportation, and availability • Cultural competence • Linguistically appropriate services • Outreach and case management • Population-specific outreach and education • Inter-state and bi-national coordination and linkage • Skills building • Combating stigma and discrimination New York State Department of Health, 2007

28. Farmworker Justice • Providing AIDS prevention efforts since 1998 • HIV prevention programs • Popular Opinion Leader (POL) • Young Latino Promotores (YLP) • MPoderoso • Promotores de Salud • Technical assistance with HIV • National capacity building assistance provider • Poder Sano strategies

29. Hombres Preparados • An HIV/AIDS awareness program for solo Latino male migrant farmworkers • Lessons that take 1-2 days and can be presented by a lay health worker (promotora) • Provided by National Center for Farmworker Health • For more information: • http://ncfh.org/?pid=56 strategies

30. New York State HIV Prevention and Primary Care Initiative • Funds 5 agencies in New York state to address HIV prevention • 1 Migrant health project • 2 Community health centers • 1 county health department • 1 community based health center Strategies

31. Southern California Border HIV/AIDS project • Mission: to improve HIV/AIDS outreach, primary care services, & international linkages to care for people living in and working in the San Diego area. • UMBAST • AETC border steering team • Capacity building and support along US – Mexico border • Resources for international linkage of care strategies

32. National Center for Farmworker Health, Inc. (2009). HIV/AIDS Farmworker Fact Sheet. • Jones, J. et al (1992). HIV-Related Characteristics of Migrant Workers in Rural South Carolina. Migrant Health Newsline, Clinical Supplement, p. 4. • Lyons, M. (1992). Study Yields HIV Prevalence for New Jersey Farmworkers. Migrant Health Newsline, Clinical Supplement pp 1-2. References

33. National Agriculture Workers Survey (2001-2002), Washington, DC: US Department of Labor, 2005. Martinez-Donate. A.P. et al (2005). HIV infection in mobile populations: the case of Mexican migrants to the United States. Rev Panam Salud Publica. 2005; 17(1): 26-9. References

34. Thank you!!!!

35. Sanchez, M.A. (2004). The Epidemiology of HIV Among Mexican Migrants and Recent Immigrants in California and Mexico. Journal of Acquired Immune Deficiency Syndrome, Vol. 34.4, pp206. • Brummer, D. (2002). Labour Migration and HIV/AIDS in Southern Africa. International Organization for Migration Regional Office for Southern Africa. p2 references

36. Gonzalez, E. (2008). Migrant farm workers: our nation’s invisible population. Prairie View A&M Cooperative Extension Program. • New York State Dept. of Health (2007). Migrant and seasonal farmworkers: health care access and HIV/AIDS in this population. • Farmworker justice website: • http://www.farmworkerjustice.org/hiv-prevention references