Latinos Migrant Workers in the US

Published: 2021-07-10 14:40:05
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There are an estimated 5 million Latinos migrant workers (LMW) in the U.S. (Sanchez, De La Rosa & Serna, 2013). Many LMWs come from disadvantaged backgrounds that compel them to seek work in the U.S., often without legal authorization (Persichino & Ibarra, 2012). The majority of LMWs enter the U.S. alone, possess low levels of education, and lack English language skills (Persichino et al., 2012). Moreover, the annual incomes of LMWs generally fall below the U.S. poverty level (Persichino et al., 2012). Such living, social, and environmental conditions place LMWs at increased risk of morbidity and mortality. Namely, LMWs face notable disparities related to HIV transmission and sequential HIV/AIDS health outcomes. Problem Statement Prevalence of HIV Among Latino Migrant Workers The exact HIV prevalence rate among LMWs is difficult to assess on account of barriers to testing and the constant mobility of the LMW community (Persichino et al., 2012). Moreover, there are no existing studies that compare prevalence rates of LMWs and non-migrant worker Latino immigrants or that of U.S. born Latinos (Sanchez et al., 2013; Persichino et al., 2012).Howbeit, estimates place the HIV prevalence rate among LMWs to be as low as 2.6% and as high as 13% (Persichino et al., 2012). Moreover, according to Persichino et al. (2012), the HIV prevalence rate among LMWs is at least “four to eight times higher than the estimated HIV prevalence rates in the U.S.” (p. 122). In addition, LMWs are more likely to contract HIV while living and working in the U.S. compared to their home countries (Persichino et al., 2012). The Meaning and Significance of HIV Among Latino Migrant Workers HIV is generally heavily stigmatized within the LMW community, which has been spurred by several misconceptions regarding the condition. Namely, many LMWs believe that HIV can only be contracted by gay men and drug users, groups that are generally stigmatized in the Latino community (Persichino et al., 2012). It is also common for Latinos to believe that an HIV diagnosis is a death knell (Sanchez et al., 2013). These factors deter many infected LMWs from disclosing their HIV status with medical professionals, family members, and others in their community, and can affect their treatment seeking practices (Persichino et al., 2012). Moreover, many LMWs experience social isolation due to their mobile and clandestine lifestyles, which make them reluctant to disclose their status for fear of further isolation and abandonment (Kissinger et al., 2012). In fact, many HIV-infected LMWs report having been ostracized by others in their community after receiving their diagnosis (Persichino et al., 2012). Literature Review Risk Factors that Affect the Incidence of HIV Among Latino Migrant Workers As a vulnerable and increasingly large ethnic minority group in the U.S., LMWs often experience socioeconomic adversity and discrimination, as well as health care barriers incited by immigration status and limited English-language skills (Sánchez, Silva-Suarez, Serna & De La Rosa, 2012).In addition to several other behavioral, social and cultural risk factors, these confounding characteristics contribute to the increased rate of HIV transmission that LMWs confront while living and working in the U.S. (Persichino et al., 2012). Behavioral risk factors. Many Latino migrant women travel without the protection or support of their families during their journeys into, and residence in, the U.S. (Persichino et al., 2012). As such, they are at increased risk for sexual violence subjection, and thus HIV exposure (Persichino et al., 2012). Latino migrant men are more likely than women to travel alone; separated from their sexual partners and family, they are more likely to engage in risky sexual behavior (Persichino et al., 2012). Additionally, many LMWs frequent the localities that surround the U.S.-Mexico border, which contain high rates of commercial sex work and intravenous drug use and, wherefore, high rates of HIV transmission (Persichino et al., 2012). The most common forms of HIV transmission among male LMWs are sexual contact with other men and commercial sex workers whereas HIV transmission among female LMWs typically occurs through heterosexual contact (Centers for Disease Control and Prevention [CDC], 2018). Upon arrival to the U.S., the rate of LMWs that have multiple sexual partners increases (Kissinger et al., 2012). Even so, rates of safe sex practice among male LMWs decreases, which increases rates of HIV exposure (CDC, 2018). Namely, the rate of condom usage among male LMWs decreases by 16.3% (from 81.4% to 65.1%) following entry to the U.S. (Kissinger et al., 2012). Furthermore, female LMWs are generally averse to using condoms as it is widely viewed that condom usage is characteristic of promiscuous women (CDC, 2018). Because work opportunities for LMWs are inconstant and at times scarce, some LMWs are compelled to seek or accept work in the sex trade (Sanchez et al., 2013). Many sex industry workers refrain from using condoms for greater earnings, increasing the risk of HIV transmission (Sangaramoorthy & Kroeger, 2013).In fact, in one study that surveyed 159 female LMWs working in the sex trade, 75% reported never having used condoms (Sangaramoorthy et al., 2013). In addition, many LMWs obtain work as day laborers, which requires them to stand near storefronts or on street corners; such conditions induce solicitations for sex, which some LMWs accept (Galvan, Ortiz, Martínez & Bing, 2008). In fact, in a study that surveyed 450 LMWs at six sites occupied by day laborers in Los Angeles, California, 38% of respondents reported having been solicited for sex at least once, of which 9.4% reported having accepted such solicitations (Galvan et al., 2008). Of those LMWs that reported having accepted a solicitation for sex, few reported having used condoms during the sexual exchange (Galvan et al., 2008). LMWs are more likely to experiment with drugs while in the U.S. (Sanchez et al., 2013). Moreover, many migrant workers rely on substances to cope with the stress-inducing factors that typify the migrant experience (Sanchez et al., 2013). Alcohol is the most widely used substance while weed and crack cocaine are the highest used illicit drugs among LMWs (Sanchez et al., 2012). Male LMWs report higher consumption and more frequent use of substances than females (Ford, King, Nerenberg & Rojo, 2001). At any rate, substance use increases LMWs’ risk of engaging in unprotected sexual contact with multiple partners, which increases the risk of HIV transmission (Ford, et al., 2001). Fortunately, according to Fernández et al. (2005), rates of illegal injection drug use among LMWs are relatively low. However, among LMWs it is common practice to intravenously administer products such as vitamins and painkillers, particularly among those from Mexico where sterile needles are available at most pharmacies without a prescription (Fernández et al., 2005). However, in the U.S., sterile needles are not as easily accessible as regulations vary by state; as such, many migrants share unclean needles, which increases the risk of HIV transmission (Persichino et al., 2012). Social and cultural risk factors.Many LMWs have limited health literacy skills (Sanchez et al., 2013). As a result, it is common for LMWs to possess an understanding of HIV/AIDS that is marked by several misconceptions, rendering many LMWs unaware of their risk (Persichino et al., 2012). For example, one survey indicated that approximately 43.8% of LMWs believe that HIV can be transmitted by mosquitoes while “37.5% believe that transmission is possible through the use of public bathrooms and kissing” (Persichino et al., 2012, p. 124). Researchers of another study found that of respondents surveyed, 25% believed that HIV is a problem that is “exclusive to the homosexual population and those who use drugs” (Persichino et al., 2012, p. 124). Further, researchers of this study also found that 20% of respondents believed that AIDS could be caused by an HIV test (Persichino et al., 2012). Topics regarding sex and sexuality are generally regarded as shameful in Latino culture. As a result, many LMWs are reluctant to disclose their sexual histories particularly if they have had multiple sexual partners or have engaged in homosexual contact or sex with commercial sex workers (Galvan et al., 2008). To this end, many LMWs refrain from discussing such topics with medical professionals and avoid seeking sexual health care services (CDC, 2018). Moreover, HIV is generally perceived as a disease that is endemic to gay men, which contributes to the stigma surrounding the virus (CDC, 2018).In fact, according to Persichino et al. (2012), “stigma and homophobia in the Latino culture are major barriers to gaining HIV education, testing, and medical care” as many Latinos fear that seeking such services may demonstrate to others that they are HIV-infected or gay (p. 124). For these reasons, although LMWs who engage in homosexual contact face one of the highest risks of HIV infection, many are reluctant to disclose their sexual orientation or HIV status for fear of ostracization (Persichino et al., 2012). Access and health care barriers. LMWs face restrictions in employment, income, and health insurance which limits access to quality health care. In fact, fewer than 20% of LMWs have employer-provided health insurance (Solorio, Currier, & Cunningham, 2004). Additionally, many LMWs are ineligible for government-funded health coverage for factors such as immigration status (Solorio et al., 2004). Many health care providers also lack culturally and linguistically competent services which serve as an access barrier for LMWs (Ford, et al., 2001). Furthermore, the constant mobility of LMWs affects access to health care services and renders many LMWs unaware of the affordable health care services or migrant-serving clinics that may exist in their area (Solorio et al., 2004). One study estimated that a mere 18% of LMWs have received services from health clinics aimed at serving this population (Solorio et al., 2004).As a result of these barriers, many LMWs resort to treating themselves with the use of natural or herbal remedies and over-the-counter medication when they fall ill (Solorio et al., 2004). As such, an HIV-infected LMW may not be diagnosed until “additional, AIDS-defining disorders manifest and infections develop, thus placing the patient at higher risk of morbidity, mortality, and transmission” (Persichino et al., 2012, p. 125). Further, given the lack of HIV specialty clinics and health care providers that are equipped to serve the unique needs of the LMW population, many HIV-infected LMWs are left without quality care (Ford, et al., 2001). Intersectional Identities and Systems of Oppression LMWs possess many intersecting identity markers that relate to their social position as an ethnic minority group and immigrant community. In light of such intersectional identities, LMWs bear the brunt of structural racism and xenophobia – systems of oppression that pervade the issue of immigration in the U.S. and influence the day-to-day experiences of LMWs.These conditions play a significant role in producing health disparities among LMWs – specifically, by affecting their access to quality health care (Viruell-Fuentes, Miranda & Abdulrahim, 2012). For example, Latino immigrants are more likely to experience discrimination compared to U.S.-born Latinos due, in part, to factors such as immigration status and limited English-language skills; such experiences can deter LMWs from seeking health care (Viruell-Fuentes et al., 2012). Some studies also postulate a strong association between “higher levels of perceived discrimination” and negative health outcomes (p. 2101). In fact, the risk of negative health outcomes among immigrants rises as their length of residence in the U.S. increases; this is in keeping with other studies that have shown “prolonged exposure to the racialized structure of the U.S.” to be an inciting factor that causes deleterious health effects among U.S.-born ethnic minority groups (Viruell-Fuentes et al., 2012).Furthermore, immigrant communities are typically geographically segregated in locales that lack resources and have increased exposure to environmental risk factors and limited access to care, factors that contribute to disparities in health care access and negative health outcomes among LMWs (Viruell-Fuentes et al., 2012). Other studies have also shown that female LMWs, compared to male LMWs, experience less access barriers to HIV/AIDS-related health care because females are more likely to seek and receive prevention and wellness services related to their sexual and reproductive health (Sanchez et al., 2012). Researchers attribute this disparity to the perceived social norm that renders the sexual health of males less important than that of females (Sanchez et al., 2012). These conditions demonstrate that male LMWs face a disparity with regard to HIV/AIDS-related health care access and highlight the influence that intersectional identity factors related to gender and sex have in shaping HIV/AIDS health outcomes among LMWs (Sanchez et al., 2012).The Impact of HIV and Its Sequelae Many LMWs with HIV are at risk of developing mental health problems elicited by the social isolation and marginalization that they experience (Persichino et al., 2012). In addition, the sexual partners and spouses of HIV-infected LMWs are at increased risk of contracting HIV; LMWs with HIV also risk transmitting the virus to their children (Persichino et al., 2012). Maintaining the health and well-being of LMWs is also vital as many act as the main source of income for their families; as a result, the HIV/AIDS health outcomes of LMWs can also affect the livelihood of those who rely on the financial support that LMWs often provide. Such disparities that exist within the LMW community can also increase the risk of HIV transmission within the larger Latino community that resides in the U.S as well as in countries in Latin American (Persichino et al., 2012). In fact, studies have shown that the increased rate of HIV transmission among LMWs has contributed to rising HIV infection rates in Mexico; as such, continued HIV transmission can lead to a widespread epidemic (Persichino et al., 2012).Recommendations for Social Worker Assessment and Intervention When assessing LMWs it is important for social workers to utilize a culturally sensitive approach that considers the generally stigmatizing perceptions that the LMW community possesses regarding HIV/AIDS (Ford, et al., 2001). Such an approach should be used to guide social worker inquiries into matters related to the sexual health and sexual history of LMWs (Ford, et al., 2001). Social workers should also stress their legally-binding confidentiality practices as a way to mitigate anxieties regarding public exposure that LMWs may experience (Ford, et al., 2001). With regard to intervention approaches, social workers can implement STI risk-reduction and stigma-minimization strategies related to sexual health topics through psychoeducation and community education (Ford, et al., 2001). In addition, it is vital to cultivate awareness among LMWs regarding health care providers that are culturally and linguistically competent, as well as physically and economically accessible to this population in order to mitigate access barriers (Ford, et al., 2001).Recommendations for Macro Assessment and Intervention In light of the discriminatory experiences that many LMWs face, healthcare providers must provide services that are culturally and linguistically competent (Ford, et al., 2001). Such providers must also be willing to provide care to patients regardless of immigration status to alleviate the health disparities that exist for those who are undocumented (Ford, et al., 2001). Mobile clinics should be utilized to provide necessary preventative care and health screenings to LMWs and can address issues related to health care access barriers and continuity of care (Fernández et al., 2005). Additionally, transportation services should be made available to LMWs in rural areas that are unable to travel long distances for specialized treatment (Ford, et al., 2001). Fernández et al. (2005) argues that cultivating the health of LMWs is imperative to the vitality of the U.S. economy as the economic contributions of this community are paramount. As such, policy-level changes and regulations should be enacted to protect the health of LMWs. Namely, institutional incentives should be put in place to entice qualified and skilled healthcare providers to serve the LMW community (Ford, et al., 2001). In addition, government programs that fund public health services should broaden their eligibility criteria to expand health care coverage and provide adequate services to LMWs (Ford, et al., 2001).

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