Migration, Bisexuality and HIV: Presentation at Needs Assessment Committee of the NYC HIV Planning Council

1. Migration, Bisexuality and HIV: Presentation at Needs Assessment Committee of the NYC HIV Planning Council Miguel Muñoz-Laboy, DrPH Associate Professor Dept. of Sociomedical Sciences March 24, 2010

2. Guiding questions • What are the lessons learned from your research with Latino MSM and formerly incarcerated Latino immigrants especially as relates to HIV? • What are barriers encountered with reaching those HIV infected and linking them to and sustaining them in care and treatment for HIV? • What strategies or practices seem to work best in linking them to and sustaining them in care for HIV? • What health literacy issues arise in working with this targeted population?  How might they be resolved?

3. Organization of today’s presentation • Sources of information – brief overview of research studies • Answering questions for the meeting – we are going to present strategies (tips) and discuss the barriers behind the strategies.

4. Sources of Information

5. Study 1: Bisexually active Latino men (1998 – 2001) • General research question: Explore the organization of sexual practices of bisexually active Latino men • Methods: Ethnographic observations, life-history interviews (n=20) • Sample characteristics – Migration Status: 60% • Funding source: Supplement to NIMH 2-P50-MH43520-06 (Center PI: A. Erhardt; PI Study: Alex Carballo-Dieguez) • Relevant publication: Muñoz-Laboy, M. Beyond ‘MSM’: Sexual desire among bisexually-active Latino men in New York City. Sexualities, 7 (1): 55-80, 2004.

6. Study 2: Latino MSM and MSMW HIV Optimism (2001-2003) • General research question: Examine the relationship between HIV optimism and sexual risk practices of Latino MSM and MSWM • Methods: Self-administered survey • Sample characteristics Migration Status: 65%; Bisexual Status: 15%; HIV + or unknown: 30% • Funding source: GMHC, NIMH T32MH19139 (PI: A. Erhardt) and CGSH (CU) • Relevant publications: Muñoz-Laboy, M., Castellanos, D. & Westacott, R. (2005). Sexual risk behavior, viral load and perceptions of HIV transmission among homosexually active Latino men: An exploratory study. AIDS Care 17 (1): 33-45; Muñoz-Laboy, M., & Dodge, B. (2007). Which bisexual Latino men are at highest HIV/STI risk? An exploratory analysis. American Journal of Public Health, 97 (6): 1102-1106.

7. Study 3: Mexican migrant workers and HIV (2005-07) • General research question: Identify the situational and contextual factors of HIV/STI risk among married Mexican migrant works • Methods: Ethnographic observations, structured interviews (n=50); life-history interviews with high and low risk (n=10) • Sample characteristics – Migration status: 100%; Bisexual status: 8% • Funding source: Supplement NICHD 1 R01 HD041724-01A1 (PI: J. Hirsch) • Relevant publication: Muñoz-Laboy, M. Hirsch, J. & Quispe-Lazaro, A. (2009). Loneliness as a Sexual Risk Factor for Mexican Male Workers. American Journal of Public Health, AJPH published March 19, 2009, 10.2105/AJPH.2007.122283

8. Study 4: Familial factors to sexual risks of adolescent male and female Latino(a) bisexuals (2007-2008) • General research question: Explore the role of family relations in facilitating or preventing HIV/STI and unintended pregnancy risk among bisexual male and female youth of Latino ancestry • Methods: In-depth interviews (n=25) • Sample characteristics – Migration Status: 20% • Funding source: Columbia University Pilot Project Funds for Diversity in Science • Relevant publications: Muñoz-Laboy, M. (2008). Familism, sexual regulation and risk among bisexual Latino men. Archives of Sexual Behavior. 37 (5): 37 (5): 773-82; Muñoz-Laboy, M., Sririam, V., Weinstein, H. & Vasquez del Aguila, E. (2009). Familism, Religion and Sexual Regulation among Latino(a) Bisexual Youth. Culture, Health and Sexuality, 11 (3): 331–344.

9. Study 5 (Ongoing): Network factors of risk among formerly incarcerated Latino men (2009-2011) • General research question: Identify network determinants of alcohol/marijuana use and HIV/STI risk among formerly incarcerated Latino men and their network ties • Methods: • Pilot study from 2006-2008 (n=20 life histories); • Stage 1 (Oct. 09 – Jan. 10) In-depth interviews (FILM n=30; Support n=30) • Stage 2 (Feb. – Dec. 10) Survey (FILM n=200; Support n=200) • Stage 3 (Sept. – Dec. 10) Clique interviews (n=8) + life histories (n=10) • Stage 4 (Jan. – April. 11) Intervention strategies design + Planning group • Funding source: NIMH 1 RC1 MH088636-01 (PI: M. Muñoz-Laboy)

10. Study 6 (Ongoing): Gender, Power and HIV risk among Latino men (2009-2013) • General research question: Identify the sexual markets, situational and contextual risk factors of Latino bisexually active men • Methods: • Component 1: Mapping out geographies of risk • Ethnographic observations and key informant interviews (2 years) • Recent migrant communities (NJ) and Latino enclaves (NY) • Component 2: Determinants of HIV/STI and un. pregnancy risk (n=160) • In-depth interviews sexual market utilization • Self-administered computer-based survey • Component 3: Intervention strategies design • Community planning group • Intervention mapping approach • Funding source: NICHD 1R01HD056948-01A2 (PI: M. Muñoz-Laboy)

11. Prevention and Care Strategies for Bisexual Latinos- Latinos in the general population- FILM- Migrant workers

12. Strategies for Bisexual Youth and Adults (1) • Keep in mind that Latino bisexual youth and adults are most often not closeted or repressed gays or lesbians. • Promote open dialogues of sexuality and celebrate the diversity of sexual experiences. • Facilitate frank discussions of the richness of bisexual diversity. • Design HIV prevention efforts to match the diversity of bisexual Latino youth and adults.

13. Strategies for Bisexual Youth and Adults (2) • Address HIV/STI risk regardless of assumptions about identity. • Create a comfortable environment where bisexual Latinos can discuss issues that have real implications for sexual risk. • Integrate family, religion and work into HIV prevention messages and discussions.

14. Strategies for Bisexual Youth and Adults (3) • Address reproductive health issues for bisexuals interested in forming families. • Provide cultural sensitivity training regarding bisexuality and sexual diversity to health care providers and agency staff including receptionists, intake personnel and security officers. • Provide workshops in both Spanish and English specifically for bisexual Latinos on family relations, parenthood and sexual communication. • Provide support groups (in person and online) targeted to diverse bisexual Latino groups (e.g., youth, adults, elderly, single and married parents) in both Spanish and English.

15. Sustaining Bisexual Latinos in Care

16. Potential constrains to HIV Care (HIV + MSMW)

17. Questions in terms of factors affecting HIV Care (HIV+ MSMW) • Concurrent partnership structure • Marital status • Visible vs. invisible support • Social-community organizing as mode of engagement

18. Thanks! Miguel Muñoz-Laboy, DrPH Associate Professor Dept. of Sociomedical Sciences mam172@columbia.edu