HIV/STI Risk Among Male Mexican Immigrants in Dallas, Texas: Findings from a Pilot Study

Rates of HIV and STIs are higher among Latinos than the general U.S. population. A number of factors place Latino immigrants at particularly high risk. 128 male Mexican immigrants in Dallas, Texas completed personal interviews. We measured the prevalence of HIV/STI risk factors and identified sociodemographic and behavioral characteristics associated with higher risk. 9% of the total sample had 3 or more sexual partners in the past year. 5% had sex with a commercial sex worker (CSW). 11% had sex with another man. 11% had a previous STI diagnosis. Risk behaviors and STI history were more prevalent among men who had used illegal drugs or frequently consumed alcohol (18% of the sample) than among others. The overall prevalence of HIV/STI risk factors in this population was moderate. However, men who drank alcohol frequently and used illegal drugs were more likely than others to report engaging in behaviors that put them at risk for acquiring HIV/STI.     

Sexual Orientation Disparities in Sexually Transmitted Infections: Examining the Intersection Between Sexual Identity and Sexual Behavior

The terms MSM (men who have sex with men) and WSW (women who have sex with women) have been used with increasing frequency in the public health literature to examine sexual orientation disparities in sexual health. These categories, however, do not allow researchers to examine potential differences in sexually transmitted infection (STI) risk by sexual orientation identity. Using data from the National Longitudinal Survey of Adolescent Health, this study investigated the relationship between self-reported STIs and both sexual orientation identity and sexual behaviors. Additionally, this study examined the mediating role of victimization and STI risk behaviors on the relationship between sexual orientation and self-reported STIs. STI risk was found to be elevated among heterosexual-WSW and bisexual women, whether they reported same-sex partners or not, whereas gay-identified WSW were less likely to report an STI compared to heterosexual women with opposite sex relationships only. Among males, heterosexual-identified MSM did not have a greater likelihood of reporting an STI diagnosis; rather, STI risk was concentrated among gay and bisexual identified men who reported both male and female sexual partners. STI risk behaviors mediated the STI disparities among both males and females, and victimization partially mediated STI disparities among female participants. These results suggest that relying solely on behavior-based categories, such as MSM and WSW, may mischaracterize STI disparities by sexual orientation.     

Typologies of Sexual Health Vulnerability Predicting STI Preventive Behaviors Among Latinx Adults in the U.S.: A Latent Class Analysis Approach

Vulnerability to poor sexual health among U.S. Latinx populations is poorly understood, despite high STI rates. We examined how vulnerability typologies differ in their STI preventive behaviors. Using data from the 2016 National Health Interview Survey, we performed latent class analysis to test the association between sexual health vulnerability and HIV testing, hepatitis testing or vaccination, and HPV vaccination from a subsample of Latinx adults. Three classes emerged: Under-Employed Females with Health Care Access, Slightly Under-Employed Females with Some Health Care Access, and Employed Males without Health Care Access. Slightly Under-Employed Females with Some Health Care Access were associated with lack of HIV testing, hepatitis B and C testing, and HPV vaccination. Employed Males without Health Care Access were associated with lack of HIV testing and HPV vaccination. Sexual health vulnerability may be associated with certain STI preventive behaviors, which can inform and refine sexual health promotion programming.

     

Routine Physical Examination and Forgone Health Care among Latino Adolescent Immigrants in the United States

Knowledge concerning patterns of health care utilization among Latino-adolescent immigrants is needed to develop culturally-appropriate programs. The objectives of this study were to estimate the annual prevalence of having had a routine physical exam and episodes of adolescents’ not seeking health care when they thought they should (forgone health care) among Latino adolescents by immigrant-generational status. Cross-sectional analysis of data from Latino adolescents in Wave I of the National Longitudinal Adolescent Health Study. First-generation immigrants who had lived in the U.S. ≤ 5 years were less likely to receive routine care than third-generation immigrants (39.0% vs. 54.9%). This disparity decreased after adjustment for insurance status, parental education and poverty among Mexican origin adolescents. On average, 16.0% of first-generation immigrants who had lived in the U.S. ≤ 5 years and 22.5% of third-generation immigrants reported forgoing health care. After adjustment for age, insurance status, parental education and routine care, recent arrivals were less likely than third-generation immigrants to forgo health care. Recent arrivals were less likely to receive a routine physical exam and to forgo care than third-generation immigrants. Future studies should explore the effect of acculturation on knowledge, beliefs and perceptions about health, illness and care-seeking behaviors.     

Comparing knowledge and perceived risk related to the human papilloma virus among Australian women of diverse sexual orientations

Objectives : The study compared levels of awareness of human papilloma virus (HPV) as a sexually transmissible infection (STI) between women of different sexual orientations. It also examined self-reported risk factors for HPV infection, perceived level of personal risk, and willingness to have the HPV vaccine.
Methods : Recruitment occurred through community sampling and data was collected using a self-completion questionnaire.
Results : A convenience sample of 349 women completed the questionnaire in early 2007, 309 were sexually active; 47.6% had lifetime sexual partners of both genders, 26.9% had only male partners, and 25.5% had only female partners. Women with partners of both genders were more likely to have ever had a pap test but were also more likely to report an abnormal result (OR 3.19) than women with only male partners. Only 68% of the sample had heard of HPV and women with partners of both genders were significantly more likely to be aware than women with only male partners (OR 2.56). Forty-four per cent did not know how HPV was transmitted and less than half correctly identified HPV-associated clinical problems, with no differences according to gender of partners. The majority of women had risk factors for HPV, however, few felt personally at risk.
Conclusions : The very low personal risk perception for HPV, particularly among women who have female and male sexual partners, suggests the need for targeted education for this group regarding HPV transmission and prevention.
Implications : Health promotion regarding HPV should be broadened to specifically include information about HPV as an STI between women.     

A model of health care provider decision making about HPV vaccination in adolescent males

IntroductionIn the U.S., HPV vaccination of adolescent males remains low, despite the recommendation for routine vaccination. Although research has highlighted that health care provider (HCP) recommendation is very influential in HPV vaccine uptake, research on this topic in the male population is lacking. Accordingly, we used a qualitative approach to identify HCP knowledge, attitudes, and behaviors regarding adolescent male HPV vaccination, one year, after routine vaccination of adolescent males was recommended.MethodA total of 20 U.S. pediatric HCPs participated in 20–30 min interviews about knowledge, attitudes, and practices regarding male HPV vaccination. Interviews were audio-recorded, transcribed and, analyzed using inductive content analysis.ResultsThe providers had been in practice for 1–35 years, 75% were female, and 75% were White. Opinions on HPV vaccination were shaped by knowledge/perception of the risks and benefits of vaccination. Although all providers frequently offered HPV vaccine to male patients, the strength and content of the offer varied greatly. Vaccination opinions determined what issues were emphasized in the vaccine offer (e.g., stressing herd immunity, discussing prevention of genital warts), while adolescent age influenced if and how they pitched their vaccine offer (e.g., HPV as a STI). Most providers agreed with the ACIP recommendations, however, several expressed that providers’ preexisting opinions might remain unchanged despite the recommendations. Consistent with the literature on determinants of HPV vaccination, providers believed that their own recommendation was a major factor in a family's decision to vaccinate. Barriers to vaccination included the “newness” and sexual nature of the vaccine, lack of insurance coverage, and the vaccine not being mandated.ConclusionsProviders’ opinions about, and approaches to offering, HPV vaccination to males were highly variable. Interventions designed to improve male HPV vaccination should focus on helping providers to routinely recommend the vaccine to all of their eligible patients, both males and females.     

Immigration and Sexual Partner Risk Among Latino Adolescents in San Francisco

Sexual partner characteristics increase risk for adverse reproductive health outcomes. Evidence is limited regarding whether choice of sexual partners among Latino adolescents changes with U.S. acculturation/adaptation. We used generalized estimating equations to assess the associations between immigrant generation (recent immigrant, 1.5 [immigrated prior to adolescence], 2nd and 3rd) and sexual partner risk in a prospective cohort study of 411 Latino adolescents aged 14–19. We examined three measures of partner risk and mediating effects of family influence (familism and parental monitoring). The odds of reporting a partner with frequent substance use increased with increasing immigrant generation (odds ratios (OR) [reference = recent immigrants]: 2.3, 3.4, and 5.6) as did having a partner who was in a gang/incarcerated (OR [reference = recent immigrants]: 2.4, 3.6, and 5.7). Though the odds of having high-risk partners decreased with higher parental monitoring, neither family influence measure mediated these relationships. Findings underscore the need for a prevention focus on partner choice with attention to increased risk with increasing U.S. generation.     

Negative Acculturation in Sleep Duration Among Mexican Immigrants and Mexican Americans

Negative acculturation, the increase in high-risk profiles as immigrants live longer in the U.S., is found for a range of health behaviors and outcomes among Latino populations. Yet it has never been explored with regard to sleep duration. Using the National Health Interview Survey, we investigate Mexican immigrant and U.S.-born Mexican-American sleep durations. U.S.-born Mexican Americans are around 40% (P < 0.05) more likely to be short sleepers than Mexican immigrants after adjusting for demographic characteristics. These relationships are attenuated with the addition of health behavior variables (OR = 1.25, n.s.). This is explained because U.S.-born Mexican Americans have higher rates of smoking and stress levels, both of which are associated with increased risks of short sleeping. Because chronic partial sleep deprivation may increase health risks directly and indirectly through impaired judgment, sleep may be a mechanism through which health disparities between Mexican immigrants and U.S.-born Mexican Americans emerge.     

Factors Associated with Perceived Susceptibility to Cervical Cancer Among Latina Immigrants in Alabama

To examine factors associated with perceived susceptibility to cervical cancer among Latina immigrants in two counties in Alabama. Datasets from two anonymous cross-sectional surveys from two studies were combined for these analyses. The total sample size was 743 women. Participants’ average age was 30 ± 6.8 years and they were mainly from Mexico (89.2%). Almost 36% of the participants did not perceive themselves as being susceptible to cervical cancer, 33.9% did not know if they were susceptible, and 30.4% perceived themselves as susceptible. Educational attainment, thinking they may have been exposed to an STI in the past, thinking they may be at risk of HPV currently, having had a Pap smear within the last year, and having a relative with cancer were significantly associated with perceived susceptibility to cervical cancer in the multinomial logistic regression. Greater knowledge about cervical cancer risk factors reduced the uncertainty about perceived susceptibility. Perceived susceptibility to cervical cancer seems to be influenced more importantly by the current or past perception of HPV/STI exposure, and by having a relative with cancer. This finding is critical in the development of interventions that are tailored to Latina immigrants as well as efforts to educate providers in a state where Latino immigration is a recent phenomenon.     

A syphilis outbreak in remote Australia: epidemiology and strategies for control

This paper describes the epidemiology of a syphilis outbreak in remote Australia, and explores contributing factors and control strategies. Between 1 August 2000 and 31 January 2002, 74 cases of early syphilis (42 female, 32 male) were identified in 73 Kimberley residents. Syphilis rates in age groups 10-19 and 20-29 years were 583 and 439 per 100000 person years respectively. Factors contributing to the outbreak included incompleteness of sexually transmitted infection (STI) clinical management, untimely contact tracing, staffing and management issues, and poor community knowledge about STIs. Outbreak control strategies addressed factors that could be influenced by changes in health service delivery, and focused on providing education and support to health staff, and efforts to increase community knowledge about sexual health. Although some improvements have occurred, the outbreak is still continuing. Until open and honest discussion and a collaborative approach is taken toward STI problems affecting Indigenous Australians, outbreaks such as this will continue to occur.     

Does Selective Migration Explain the Hispanic Paradox? A Comparative Analysis of Mexicans in the U.S. and Mexico

Latino immigrants, particularly Mexican, have some health advantages over U.S.-born Mexicans and Whites. Because of their lower socioeconomic status, this phenomenon has been called the epidemiologic “Hispanic Paradox.” While cultural theories have dominated explanations for the Paradox, the role of selective migration has been inadequately addressed. This study is among the few to combine Mexican and U.S. data to examine health selectivity in activity limitation, self-rated health, and chronic conditions among Mexican immigrants, ages 18 and over. Drawing on theories of selective migration, this study tested the “healthy migrant” and “salmon-bias” hypotheses by comparing the health of Mexican immigrants in the U.S. to non-migrants in Mexico, and to return migrants in Mexico. Results suggest that there are both healthy migrant and salmon-bias effects in activity limitation, but not other health aspects. In fact, consistent with prior research, immigrants are negatively selected on self-rated health. Future research should consider the complexities of migrants’ health profiles and examine selection mechanisms alongside other factors such as acculturation.     

Sexual Health and Language Dominance Among Hispanic/Latino Women and Men: Analysis of a Nationally Representative Sample

This study assessed the prevalence of sexual behaviors among a nationally representative sample of Latino men and women in the United States (US) (N = 432) including Spanish language data collection. Prior studies of sexual health among US Latinos have consisted of convenience samples, and focused mainly on assessing risk behaviors. We consider a broader range of sexual behaviors, subjective sexual experiences (e.g. pleasure and arousal), and STI testing behaviors. Analyses by language dominance and gender indicate a higher variability in sexual behaviors for English-dominant participants and a link between overall STI testing to regular medical examinations, especially women. Higher rates of pleasure, orgasms and arousal was reported by Spanish-dominant men and women, relative to the English-dominant group. Results represent a nuanced examination of internal differentiation among US Latinos and provides applicable data for reducing sexual health disparities in this population.     

未婚流动人群对性和生育健康的态度

目的了解惠州市流动人群的性及生育健康态度,评价该人群的生育健康需求。方法以匿名问卷调查方式收集资料进行统计分析。结果70．8％(944／1 333)的男性,67．5％(900／1 333)的女性在工作单位从未接受过生育健康教育,26．0％～28．0％的人偶尔接受过生育健康教育,3．0％(40／1 333)男性与4．0％(53／1 333)女性经常接受生育健康教育。女性性观念较男性相对保守和谨慎一些,女性较男性在性行为中有较强的自我保护意识,二者比较,差异有显著性(P<0．001)。结论提出积极可行的干预建议,可提高流动人群的自我保健意识,促进该人群的生育健康。     

Sexual practices,identities and health among women who have sex with women in Lesotho – a mixed-methods study

Despite the high prevalence of HIV and STIs among women in Africa and the growing literature on HIV and STIs among women who have sex with women, research on the sexual health of women who have sex with women in Africa is scant. This study used mixed methods to describe sexual identity, practices and health among women who have sex with women in Lesotho. Most respondents (48%) described themselves as lesbian, 29% as bisexual and 23% as heterosexual. Almost half (45%) had disclosed their same-sex attraction to family, but only 25% had done so with healthcare workers. A total of 8% reported having HIV. Self-reported HIV was associated with having three or more male partners, having male and female partners at the same time and having a history of STIs. Gender norms, the criminalisation of homosexuality, varied knowledge of, and access to, safer-sex strategies, and mixed experiences of HIV/STI testing and sexual healthcare provided social and structural contexts for HIV- and STI-related vulnerability.     

Family and cultural influences on cervical cancer screening among immigrant Latinas in Miami-Dade County,USA

Cervical cancer disproportionately affects minorities, immigrants and low-income women in the USA, with disparities greatest among Latino immigrants. We examined barriers and facilitators to cervical cancer screening practices among a group of immigrant Latino women in Florida, USA. Between January and May 2013, six focus group discussions, involving 35 participants, were conducted among Hispanic women in Miami to explore their knowledge, beliefs about cervical cancer and facilitators and barriers to cervical cancer screening using a theoretical framework. The data showed that family support, especially from female relatives, was an important facilitator of screening and treatment. Women, however, reported prioritising family health over their own, and some expressed fatalistic beliefs about cancer. Major obstacles to receiving a Pap smear included fear that it might result in removal of the uterus, discomfort about being seen by a male doctor and concern that testing might stigmatise them as being sexually promiscuous or having a sexually transmitted disease. Targeted education on cancer and prevention is critically needed in this population. Efforts should focus on women of all ages since younger women often turn to older female relatives for advice.     

Changes in income inequality and the health of immigrants

Research suggests that income inequality is inversely associated with health. This association has been documented in studies that utilize variation in income inequality across countries or across time from a single country. The primary criticism of these approaches is their inability to account for potential confounders that are associated with income inequality. This paper uses variation in individual experiences of income inequality among immigrants within the United States (U.S.) to evaluate whether individuals who moved from countries with greater income inequality than the U.S. have better health than those who migrated from countries with less income in equality than the U.S. Utilizing individual-level (March Current Population Survey) and country-level data (the United Nations Human Development Reports), we show that among immigrants who have resided in the U.S. between 6 and 20 years, self-reported health is more favorable for the immigrants in the former category (i.e., greater income inequality) than those in the latter (i.e., lower income inequality). Results also show that self-reported health is better among immigrants from more developed countries and those who have more years of education, are male, and are married.     

不同性别务工青少年生殖健康状况分析

目的 了解15～24岁不同性别进城务工青少年的性与生殖健康知信行状况及影响因素.方法 采用自编结构式匿名问卷对山东省济南市1 075名15～24岁进城务工青少年进行自填式问卷调查.结果 男性与女性进城务工青少年的性与生殖健康知识水平均较低,尤其流产相关知识,男性得分中位数仅25.0分;35.0%的男性认为只要双方愿意就可以发生婚前性行为,高于女性的16.1%;面对恋人性要求,男性坚持不发生性行为的比例(18.1%)远低于女性(53.1%),差异有统计学意义(χ2=141.704,P<0.001);30.7%的调查对象自我报告发生过性行为,其中男性为40.1%,女性为23.7%,差异有统计学意义(χ2=29.385,P<0.001);不同性别进城务工青少年发生婚前性行为的共同影响因素为年龄、文化程度、对避孕的态度;女性还与对婚前性行为的看法、对恋人性要求的处理方式有关.结论 为进城务工青少年提供性与生殖健康教育及服务时应考虑性别差异.     

A successful guide in understanding Latino immigrant patients: an aid for health care professionals

The recent growth of Latino immigrants in the United States has presented great challenges to the health care system, particularly in "emerging Latino states." An educational DVD was developed to aid professionals in providing culturally competent care to Latino immigrants and better understand their expectations when seeking care, as well as common cultural beliefs and practices. Knowledge and confidence was assessed through pre- and posttest measurements among 515 health care professionals nationwide. Results indicated significant increase (P < .001) in overall knowledge/confidence in Latino cultural beliefs as they relate to health care seeking, differences in health care systems between the United States and Latin America, and barriers to health care. Such multimedia training may be a promising approach to improving health care with Latino immigrants in the United States.     

Factors in the Delayed HIV Presentation of Immigrants in Northern California: Implications for Voluntary Counseling and Testing Programs

To describe the determinants of delayed HIV presentation in one Northern California County, the authors identify persons with an opportunistic infection (OI) at HIV diagnosis. From 2000–2002, a sample of HIV patients attending a public AIDS program (n=391) were identified. Immigrants composed 24% of our sample; 78.7% of immigrants were Hispanic. Immigrants, compared to U.S.-born patients, presented with lower initial CD4+ counts at diagnosis than U.S.-born patients (287 cells/mm³ vs. 333 cells/mm³, p=0.143), were more likely to have an OI at HIV diagnosis (29.8% vs. 17.2%, p=0.009), and were more likely to be hospitalized at HIV diagnosis (20.2% vs. 12.5%, p=0.064). We found only immigrant status was significantly and independently associated with delayed presentation. Interviews with 20 newly HIV diagnosed Hispanic patients suggest lack of knowledge regarding HIV risk, social stigma, secrecy and symptom driven health seeking behavior all contribute to delayed clinical presentation. The main precipitants of HIV testing for immigrants were HIV/AIDS related symptoms and sexually transmitted infection (STI)/HIV diagnosis in a sexual partner. These results support augmentation of STI/HIV voluntary clinical testing and partner notification services along the Mexico-California migrant corridor.     

Ohio Appalachia Public Health Department Personnel: Human Papillomavirus (HPV) Vaccine Availability, and Acceptance and Concerns Among Parents of Male and Female Adolescents

Public health departments (n?=?48) serving the 32 counties of Ohio Appalachia were contacted to determine human papillomavirus (HPV) vaccine availability and to assess patient and parental attitudes, perceived barriers, and decisional differences about vaccination for male and female adolescents. Nurses or nursing supervisors in 46 of 48 health departments agreed to participate with 45 (97.8?%) reporting that HPV vaccines were available for males and females. HPV vaccination barriers reported most frequently were lack of knowledge about the vaccines, concerns about potential side effects, the newness of the HPV vaccines, and parents believing their children were not sexually active or were too young to receive an HPV vaccine. Provider reports of the primary differences in the acceptability of an HPV vaccine among parents of males compared to the parents of females were lack of awareness that an HPV vaccine was available for males, not understanding why the vaccine should be given to males, and fear of vaccination increasing sexual promiscuity among female adolescents. Half of the health departments (n?=?24) reported that parents of females were more receptive toward HPV vaccination, 16 health departments reported no difference in acceptability based on gender of the child, and 5 health departments reported that parents of males were more receptive. This study suggests that there are different informational needs of males and females and parents of male and female children when making an informed decision about HPV vaccination. Findings highlight content to include in strategies to increase HPV vaccination rates among Appalachia Ohio residents.