Disparities in access to HIV prevention among men of Mexican descent living in the Midwestern United States.

Men of Mexican descent (MMD) in the U.S. are disproportionately affected by HIV. Understanding MMD's access to HIV prevention is necessary to reduce their transmission rates. We explored disparities in access to HIV prevention among MMD of different assimilation status, healthcare access, and sexual risk behavior. 322 Midwestern MMD completed a survey assessing their access to passive interventions (e.g., lectures), interactive interventions (e.g., counseling), HIV testing, media information, and information from the Internet. 64% MMD had received passive interventions, 36% interactive interventions, 42% HIV testing, 41% information from media, and 12% from the Internet. MMD who were less assimilated to the U.S., had lower healthcare access, and were at risk for HIV, were less likely to have accessed prevention interventions but more likely to have received media information. Access to HIV prevention among Midwestern MMD is tied to their assimilation and healthcare access. Findings have implications for developing strategies of intervention delivery.

Intentions to seek and accept an HIV test among men of Mexican descent in the Midwestern USA.

In the USA, a high proportion of men of Mexican descent (MMD) test for HIV late in the course of the infection and miss opportunities for prevention. Given the need to promote timely HIV testing among MMD, we studied how MMD's motivations and previous experiences with disease prevention influence their intentions to seek (i.e., client-initiated HIV testing) and accept (i.e., provider-initiated HIV testing) an HIV test. We conducted a survey (N=302) at a large Mexican festival in the Midwestern USA. We elicited MMD's sexual risk behavior, social norms and culturally supported HIV testing expectations, previous experiences with disease prevention, and their intentions to seek and accept a free HIV test. Forty-one percent of MMD intended to actively seek an HIV test and 70% said they would accept it from a provider. Multivariate analyses indicated that MMD's intentions to seek and intentions to accept an HIV test were stronger when they expected desirable outcomes of an HIV test, including benefits for their family and community. Whereas MMD's intentions to actively seek an HIV test were stronger when they had more previous experiences with disease prevention and normative support, their intentions to accept an HIV test from a provider were stronger when they expected less negative outcomes from testing for HIV (e.g., stigma). Provider-initiated HIV testing may improve HIV testing access, particularly among MMD with lower experience and support. However, efforts to promote provider-initiated HIV testing among MMD should challenge negative HIV testing expectations and associate HIV testing with positive outcomes.

Predictors of HIV sexual risk behaviors in a community sample of injection drug-using men and women.

Injection risk practices and unprotected sex between injection drug users (IDUs) and their sexual partners are responsible for a high proportion of AIDS cases and new HIV infections in the United States. The purpose of this study was to investigate the links between drug use behaviors and psychosocial factors with high-risk sexual behaviors among male and female IDUs. Understanding the determinants of sexual risk practices among drug users can lead to the development of more effective programs to prevent sexual HIV and STD transmission. This study enrolled a community sample of 101 IDUs (males = 65, females = 36), primarily African American and unemployed, who injected drugs and had unprotected sex in the past 3 months. The sample was categorized into highest sexual risk (multiple partners and intercourse without condoms) and lower sexual risk subgroups. Univariate analyses showed that IDUs at highest sexual risk had lower sexual risk reduction self-efficacy (p =.01) and were more likely to be African American (p =.02). Drug users at highest sexual risk also used noninjected cocaine and crack more frequently (p =.05), were less likely to inject heroin (p =.04), and tended to more often inject cocaine (p =.05). IDUs at highest sexual risk also tended to more often use crack and methamphetamines. Logistic regression analyses showed that injecting cocaine or crack, sexual risk reduction self-efficacy, and race were independent predictors of sexual risk behavior levels. Sexual risk reduction programs for this population are needed, with HIV prevention programs tailored to specific IDU risk reduction needs.