Initial acculturation and HIV risk among new Hispanic immigrants

Center for Drug Use and HIV Research, Institute for AIDS Research, National Development and Research Institutes Inc., New York, NY, USA.
Journal of the National Medical Association (Impact Factor: 0.96). 08/2005; 97(7 Suppl):32S-37S.
Source: PubMed


Research on the initial stage of acculturation of new immigrants is crucial for identifying AIDS prevention policies and priorities for this vulnerable population.
This study employed an exploratory approach and qualitative data collection methods to identify and describe social and behavioral factors influencing risk for HIV infection among recent Hispanic immigrants (<3 years in the United States). Immigrants from Guatemala, El Salvador, Honduras, the Dominican Republic and Mexico were interviewed in urban, suburban and semirural settings in the New York Metropolitan Area. Data were collected through ethnographic fieldwork, in-depth interviews (N=51), focus groups (N=11; total number of participants=86) and individual interviews with health and social service providers (N=26).
Initial stages of acculturation for immigrants reflect both retention and change in attitudes and behaviors involving their mental health, gender role norms, social and sexual behavior, and alcohol and other drug use. Current living environments may introduce conditions affecting HIV risk and prevention, while sustained connections to countries of origin may support retention of attitudes and behaviors with positive and negative risk implications.
Specific epidemiological, environmental, economic, social and psychosocial factors are identified that provide the context for risk and prevention. The challenges and opportunities faced by these new communities must be distinguished from those of more acculturated immigrant populations if culturally appropriate interventions are to be developed.

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Available from: Carlos Decena, Jan 15, 2014
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    • "The evidence from views studies to support this mechanism was almost equally divided among sound, moderate, partial and no evidence, indicating that this mechanism was seen as less important by immigrants themselves in terms of culturally appropriate HIV prevention. Studies with sound or moderate evidence for ‘embeddedness’ usually reported that social networks were ethnically stratified with immigrants’ primary social interactions being with other co-ethnics [115,170] or other ethnicities related by language in the case of Latinos in the USA [131,148] or region of birth in the case of African-born immigrants in the UK [116,143,145]. These social networks were also stratified in other ways such as the ethnic stratification of gay male bars reported in three North American cities and the ethnic stratification of commercial sex work between Latino and Asian sex workers in the USA [130,142]. "
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    ABSTRACT: Background Immigrants from developing and middle-income countries are an emerging priority in HIV prevention in high-income countries. This may be explained in part by accelerating international migration and population mobility. However, it may also be due to the vulnerabilities of immigrants including social exclusion along with socioeconomic, cultural and language barriers to HIV prevention. Contemporary thinking on effective HIV prevention stresses the need for targeted approaches that adapt HIV prevention interventions according to the cultural context and population being addressed. This review of evidence sought to generate insights into targeted approaches in this emerging area of HIV prevention. Methods We undertook a realist review to answer the research question: ‘How are HIV prevention interventions in high-income countries adapted to suit immigrants’ needs?’ A key goal was to uncover underlying theories or mechanisms operating in behavioural HIV prevention interventions with immigrants, to uncover explanations as how and why they work (or not) for particular groups in particular contexts, and thus to refine the underlying theories. The realist review mapped seven initial mechanisms underlying culturally appropriate HIV prevention with immigrants. Evidence from intervention studies and qualitative studies found in systematic searches was then used to test and refine these seven mechanisms. Results Thirty-four intervention studies and 40 qualitative studies contributed to the analysis and synthesis of evidence. The strongest evidence supported the role of ‘consonance’ mechanisms, indicating the pivotal need to incorporate cultural values into the intervention content. Moderate evidence was found to support the role of three other mechanisms – ‘understanding’, ‘specificity’ and ‘embeddedness’ – which indicated that using the language of immigrants, usually the ‘mother tongue’, targeting (in terms of ethnicity) and the use of settings were also critical elements in culturally appropriate HIV prevention. There was mixed evidence for the roles of ‘authenticity’ and ‘framing’ mechanisms and only partial evidence to support role of ‘endorsement’ mechanisms. Conclusions This realist review contributes to the explanatory framework of behavioural HIV prevention among immigrants living in high-income countries and, in particular, builds a greater understanding of the suite of mechanisms that underpin adaptations of interventions by the cultural context and population being targeted.
    Full-text · Article · Nov 2012 · Systematic Reviews
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    • "Racial/ethnic underrepresentation also existed in this study. Shedlin, Decena, and Oliver-Velez (2005) studied acculturation among new immigrants and found that language was a key obstacle in their lives. Therefore, in the case of Hispanics, eliminating language and cultural barriers could increase participation in clinical trials (Allen et al., 2001). "
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    ABSTRACT: Underrepresentation of HIV-infected Hispanics and African Americans in clinical trials seriously limits our understanding of the benefits and risks of treatment in these populations. This qualitative study examined factors that racial/ethnic minority patients consider when making decisions regarding research participation. A total of 35 HIV-infected Hispanic and African American patients enrolled in clinical research protocols at the National Institutes of Health were recruited to participate in focus groups and in-depth interviews. The sample included mostly male participants (n = 22), had a mean age of 45, had nearly equal representation of race/ethnicity, and were diagnosed 2 to 22 years earlier. Baseline questionnaires included demographics and measures of social support and acculturation. Interviewers had similar racial/ethnic, cultural, and linguistic backgrounds as the participants. Four major themes related to the decisions of participants to enroll in clinical trials emerged, which are as follows: enhancers, barriers, beliefs, and psychosocial context. Results may help researchers develop strategies to facilitate inclusion of HIV-infected Hispanics and African Americans into clinical trials.
    Preview · Article · Jul 2011 · The Journal of the Association of Nurses in AIDS Care: JANAC
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    • "According to DiClemente et al. (2002), these elements imply greater protection in sexual relations. Therefore, immigrant adolescents are more vulnerable because they have weaker social networks, especially in their first stage of acculturation (Shedlin et al., 2005). "
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    ABSTRACT: La adaptación conductual y la discriminación percibida son dos de las variables psicosociales más estudiadas en relación al VIH. Por ello, el objetivo de esta investigación es analizar si estas variables pueden predecir las conductas sexuales de riesgo para el VIH en función de las diferencias culturales y de género. La muestra estuvo compuesta por 815 adolescentes de entre 14 y 19 años residentes en España, de los que el 56,2% eran autóctonos españoles y el 47,8% restante inmigrantes latinoamericanos. Los resultados muestran que los adolescentes latinoamericanos, los de mayor edad y los que se encuentran menos adaptados emiten más conductas sexuales de riesgo para el VIH. Además, según el origen, los adolescentes latinos muestran más discriminación percibida que los autóctonos y menos adaptación social. En función del género, entre los autóctonos las mujeres se encuentran más adaptadas en el ámbito escolar y en el social y entre los latinoamericanos los varones muestran mayor adaptación personal y menor adaptación escolar que las mujeres. En la discusión se analizan y comentan los resultados obtenidos y se resalta la necesidad de tener en cuenta las diferencias culturales y de género a la hora de elaborar programas de prevención para el VIH/sida.
    Preview · Article · Jan 2011 · International Journal of Clinical and Health Psychology
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