HIV/AIDS Prevention in Migrant Workers

1. HIV/AIDS Prevention in Migrant Workers H. Virginia McCoy, Ph.D

2. Disclosures of Financial Relationships This speaker has no significant financial relationships with commercial entities to disclose. This speaker will not discuss off-label use or investigational product during the program. This slide set has been peer-reviewed to ensure that there are no conflicts of interest represented in the presentation.

3. Immokalee, Florida Immokalee

4. Migrant Workers in US • > 9 million people in U.S. - migrant workers (MWs) • About 70% are Hispanic • Concentrated in 6 states: • Texas • Florida • Washington • California • Oregon • North Carolina

5. MW Challenges • Limited education • Lack of access to health care • Poverty-related low wages • Obstacles with different culture and language • Chronic underemployment • Constant mobility • Substandard housing • Hazardous working conditions

6. MW and HIV Risk • Behaviors that increase HIV risk found among MWs: • Exposure to multiple sex partners • Sexual episodes without a condom • Alcohol and drug abuse • The seroprevalence rate of HIV infection among MWs - 2.6 to 13%

7. Timeline • NIAAA grant#: R01 AA015810 • Start of project: Sept. 30, 2005 • Intake and 3M, 6M and 12M f/u • End of project: Dec. 30, 2010

8. Aims of the Study To assess: • The effectiveness of P.E.E.R v/s H.E.A.L.T.H.Y in reducing HIV risk behaviors • Whether Social Influence, Attitude-Motivation-Skill, & Stage of Change mediate each intervention • If factors like gender, acculturation, and abuse history moderate the relationship b/w intervention and HIV risk behavior

9. Theoretical Model

10. Baseline Demographics

11. Sexual Risk - VEE Sexual risk measured by Vaginal Episode Equivalent or VEE index VEE  =  1 x # of unprotected vaginal sex acts + 2 x # of unprotected anal sex acts + 0.1 x # of unprotected oral sex acts (Susser, Desvarieux, & Wittkowski, 1998)

12. HIV Risk Behavior (VEE or Vaginal Episode Equivalent is a measure of HIV risk behavior. Higher the VEE higher the risk.)

13. Factors Related to Sexual Risk Behavior Following factors are related to sexual risk behavior (measured as VEE) • Alcohol use • Drug (Marijuana and Crack/ Cocaine) use • Social support

14. Condom Use During Vaginal Sex

15. Lessons from the Fields: A Migrant HIV Prevention Project McCoy HV, Hlaing WM, Ergon-Rowe E, Samuels D, Malow R. Lessons from the fields: a migrant HIV prevention project. Public Health Rep. 2009 Nov-Dec;124(6):790-6.

16. Lessons from the Fields: A Migrant HIV Prevention Project Objective: • To discuss and elucidate the lessons learned in the pilot-testing and intervention adaptation phase of MW study during the first years of the research grant • The lessons from the field in the early stages of intervention adaptation and pilot testing should help other researchers in their design and implementation of community research trials among migrant workers

17. Lessons from the Fields: A Migrant HIV Prevention Project Method: • The lessons from the focus groups and meetings, as well as individual interviews and focus groups with field and intervention staff and a review of project documents were used to obtain information for this study

18. Lessons from the Fields: A Migrant HIV Prevention Project Findings: • It is very important to establish and maintain trust between outreach staff and the migrant community • Always be aware of cultural nuances and practices that might create challenges to the research process, and the interaction of these factors with poverty • Have flexibility in recruitment and intervention

19. The Impact of Ethnic Identity on Changes in High Risk HIV Behaviors in Sexually Active Migrant Workers Shehadeh, N., McCoy, H.V., Rubens, M., Batra, A., Renfrew, R., and Winter, K. (2012). The Impact of Ethnic Identity on Changes in High Risk HIV Behaviors in Sexually Active Migrant Workers. Journal of Immigrant and Minority Health, 14(1), 100-106.

20. The Impact of Ethnic Identity on Changes in High Risk HIV Behaviors in Sexually Active Migrant Workers • Objective: • Examines associations between Ethnic Identity (EI) in African American and Hispanic MWs and short-term changes in high-risk sexual behaviors.

21. The Impact of Ethnic Identity on Changes in High Risk HIV Behaviors in Sexually Active Migrant Workers Methods: • Baseline and 3-month follow-up data was collected and analyzed. • The Multigroup Ethnic Identity Measure (MEIM) was used to assess ethnic identity. (A high ethnic identity score indicates the level of comfort one has with their ethnic group.)

22. The Impact of Ethnic Identity on Changes in High Risk HIV Behaviors in Sexually Active Migrant Workers Findings: • Females had higher levels of positive behavior change. • Lower ethnic identity was associated with higher levels of positive change in relation to HIV/AIDS risk behavior. Among Hispanics, education was negatively correlated with ethnic identity. • Education was a predictor of behavior change.

23. The Impact of Ethnic Identity on Changes in High Risk HIV Behaviors in Sexually Active Migrant Workers Summary of Direct Logistic Regression Analysis Predicting Vaginal Episode Equivalent (VEE) Change for Full Sample * p < .05

24. Newcomer Status As A Protective Factor Among Hispanic Migrant Workers For HIV Risk McCoy, H. V., Shehadeh, N., Rubens, M., & Navarro, C. (2012). Newcomer Status As A Protective Factor Among Hispanic Migrant Workers For HIV Risk. Unpublished manuscript, Florida International University, Miami, Fl.

25. Newcomer Status As A Protective Factor Among Hispanic Migrant Workers For HIV Risk • Objectives: • Examine associations between length of time and HIV risk behaviors among Hispanic migrant workers.

26. Newcomer Status As A Protective Factor Among Hispanic Migrant Workers For HIV Risk Methods: • Analyses on Hispanic males and females (n = 255) • Examine relationship between HIV risk behaviors (alcohol use) and attitudes with length of stay in Immokalee (newcomers v. long-timers). • Regression equations were utilized to analyze the relationship between HIV risk behaviors (alcohol use) and attitudes with length of stay in Immokalee (newcomers v. long-timers).

27. Newcomer Status As A Protective Factor Among Hispanic Migrant Workers For HIV Risk Findings: Newcomers were more likely: • Lower levels of education • Were more likely to be born outside the U.S. • Had significantly higher condom use (t = -2.382, p = .018) • Fewer episodes of unprotected vaginal acts (t = 3.004, p =.030) • Newcomers consumed less alcohol and had greater intentions to use condoms

28. Newcomer Status As A Protective Factor Among Hispanic Migrant Workers For HIV Risk Findings: • Support the “Healthy Migrant” Effect • Literature suggests that there is an association with length of time immigrants are in the US and decreases in health outcomes. Examples are: • Low birth weight • Adolescent risk behaviors • Depression • Anxiety

29. Newcomer Status: Hierarchical Linear Regression Predicting Behavioral Intentions to use Condoms Note: EI=ethnic identity. All Sexual acts and consumption of alcohol and illegal substances refer to the last 30 days.*p ≤ 0.05

30. Effects of Alcohol on Sexual Risk McCoy, H. V., Shehadeh, N., & Rubens, M. (2012). Effects of Alcohol on Sexual Risk among Migrant and Seasonal Workers in Immokalee, Florida. Unpublished manuscript, Florida International University, Miami, Fl.

31. Effects of Alcohol on Sexual Risk • Objective: • To examine if changes in alcohol use and sexual risk behaviors among migrant workers post-intervention (12M).

32. Effects of Alcohol on Sexual Risk Methods: • Analyses on Hispanic and African American MWs (N = 431) • Examined relationship between alcohol use and sexual risk measured by VEE • Linear Mixed Model (LMM) with repeated measures was utilized to analyze the relationship between VEE and demographic variables, behavioral intention, alcohol use, self-efficacy, social support, condom use skills etc.

33. Effects of Alcohol on Sexual Risk Findings: Reduction in VEE was predicted by: • Gender (Male) • Ethnicity (African American) • Language (English) • Alcohol use • Behavioral intention • Self efficacy

34. Behavior Change in 12 M

35. Hispanic Female Migrant Workers and Change In HIV Sexual Risk McCoy, V. H., Shehadeh, N. & Balakrishnan Rubens, M. (2012). Hispanic Female Migrant Workers and Change In HIV Sexual Risk. Poster session at the International AIDS Conference, Washington D.C., United States.

36. Hispanic Female Migrant Workers and Change In HIV Sexual Risk • Objective: • Examines MW ethnic groups by gender and changes in their sexual risks following participation in a community-based intervention.

37. Hispanic Female Migrant Workers and Change In HIV Sexual Risk The HIV risk behaviors analyzed: • VEE • lifetime abuse • unprotected vaginal acts • condom use

38. Hispanic Female Migrant Workers and Change In HIV Sexual Risk The MW sample: • African American/ Black males (26%, n=71) • African American/ Black females (17%, n=45) • Hispanic males (45%, n=121) • Hispanic females (13%, n=34)

39. Hispanic Female Migrant Workers and Change In HIV Sexual Risk Hispanic females: • Had the highest sexual risk scores (F=3.350, p=.02) • Highest incidences of lifetime abuse (emotional, physical, and sexual) (F=25.224, p<.001) • Highest number of unprotected vaginal acts (F=3.680, p=.013) • Least likely to have used condoms (F=5.139, p=.002) • Hispanic females benefited the most in reducing their sexual risk over the intervention period (F=2.882, p=.037)

40. Females Change More Post-Intervention Changes in Sexual Risk after Participation in Intervention (n=270)

41. Manuscripts and Abstracts • Thirteen abstracts and presentations at national and international conferences • Two manuscripts published • Five manuscripts in the works

42. Miami Research Team

43. Immokalee Research Team

44. Thank You!