Provider Perspectives on Multi-level Barriers and Facilitators to PrEP Access Among Latinx Sexual and Gender Minorities.

Although pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention intervention, inequities in access remain among Latinx sexual and gender minorities (LSGM). There is also a gap in the PrEP literature regarding providers' perspective on access inequities. This qualitative case study sought to explore barriers and facilitators to PrEP engagement in a community-based integrated health center primarily serving Latinx populations in Northern California. We conducted in-depth, semi-structured interviews with providers (9/15) involved in PrEP services and engaged in a constructivist grounded theory analysis consisting of memoing, coding, and identifying salient themes. Three participants worked as medical providers, three as outreach staff, and one each in planning, education, and research. The analysis surfaced four themes: geopolitical differences, culture as barrier, clinic as context, and patient strengths and needs. Participants referenced a lack of resources to promote PrEP, as well as the difficulties of working within an institution that still struggles with cultural and organizational mores that deprioritize sexual health. Another barrier is related to sexual health being positioned outside of patients' immediate needs owing to structural barriers, including poverty, documentation status, and education. Participants, however, observed that peer-based models, which emboldened their decision-making processes, were conducive to better access to PrEP, as well as allowing them to build stronger community ties. These data underscore the need for interventions to help reduce sexual stigma, promote peer support, and ameliorate structural barriers to sexual healthcare among LSGM.

Working and Living Conditions and Psychological Distress in Latino Migrant Day Laborers.

Background. Little research has been conducted on relations between challenging working and living conditions and psychological distress in Latino migrant day laborers (LMDLs), a particularly marginalized Latino population in the United States. Aims. Consistent with a structural-environmental framework of LMDL vulnerability to health and mental health problems, this study tests a model of hypothesized pathways between working and living conditions and multiple forms of psychological distress. Method. Structural equation modeling was used to test the conceptual model with 344 LMDLs who participated in a cross-sectional survey in the San Francisco Bay Area. Results. As hypothesized, results reveal pathways between (1) working and living conditions; (2) working and living conditions and depression, as well as desesperación (desperation), the latter a Latino cultural idiom of distress frequently expressed by LMDLs; and (3) between living conditions and alcohol use. Discussion. Findings increase understanding regarding how challenging working and living conditions contribute to the same, as well as different, forms of psychological distress in LMDLs. Conclusions. Implications for mitigating structural vulnerability to psychological distress can be addressed at multiple social-ecological levels ranging from community-based support for enhancing LMDL employment (e.g., via day labor centers) to expanding the availability of work authorization for undocumented workers.

Cultural and community resources protect Latino migrant day laborers from discrimination-related distress.

OBJECTIVES: The purpose of this study is to test the relationship between discrimination and psychological distress in Latino migrant day laborers (LMDLs), including potential protective factors: access to cultural resources (e.g., festivals, people from one's country of origin), including community services perceived to be culturally competent, and contact with family in country of origin (e.g., phone/text, visits). Findings expand our understanding of discrimination-related psychological distress, in a particularly stigmatized population of Latinos, and how cultural and community resources may help mitigate discrimination-related distress. METHODS: We conducted a cross-sectional survey of 344 LMDLs in the San Francisco Bay Area from February to July 2014. Participants were 46.5% Mexican and 50.7% Central American, 91.9% undocumented, and 40.5 years of age on average (SD = 10.8). Mediation and moderation analyses tested whether protective factors would mitigate discrimination-related distress. RESULTS: Discrimination was related to depression, anxiety, and desesperación, the latter a popular Latino idiom of psychological distress, and this relationship was mediated by access to cultural resources and use of culturally competent community services. CONCLUSIONS: Culturally competent community services, including cultural resources from country of origin, may help mitigate discrimination-related distress in LMDLs. However, such interventions are likely to have diminishing returns unless the structural vulnerability of LMDLs is addressed (e.g., expanding work authorization, sanctuary city ordinances). Implications for future research include developing multilevel measures of LMDL discrimination that include structural factors perceived as discriminatory (i.e., antiloitering city ordinances, immigration control). (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Depression and Risk for Problem Drinking in Latino Migrant Day Laborers.

BACKGROUND: Given the structural vulnerability of Latino migrant day laborers (LMDLs) to unstable and poorly paying work, harsh living conditions and frequent inability to support or even visit families in country of origin, psychological distress is a common response and one frequently implicated in risky outcomes such as problem drinking. OBJECTIVES: The purpose of this study was to examine the relation of three different forms of psychological distress to problem drinking in LMDLs: depression, anxiety, and desesperación, the latter a popular Latino culture-based idiom of psychological distress. METHODS: A cross sectional survey of 344 LMDLs was conducted in the San Francisco Bay Area from January to June of 2014. Independent contributions of depression, anxiety, and desesperación in explaining problem drinking as measured by a modified version of the AUDIT, were assessed using multiple linear regression analysis. RESULTS: Depression was significantly associated with risk for problem drinking while other forms of psychological distress were not. Conclusion/Importance: Findings provide stronger empirical support for the association between depression and problem drinking, a long suspected but under-demonstrated relationship in the literature on LMDLs. Implications for preventing problem drinking as well as mitigating psychological distress more generally for LMDLs are discussed.

Living Conditions and Psychological Distress in Latino Migrant Day Laborers: The Role of Cultural and Community Protective Factors.

The purpose of this study was to examine the relationship between typically difficult living conditions and psychological distress in Latino migrant day laborers (LMDLs), with attention to the potentially protective roles of contact with family in country of origin (i.e., communication, sending money, etc.), availability of local culture (i.e., food, music, people from one's country of origin), and utilization of community resources perceived to be culturally competent (i.e., services that are respectful, able to serve Latinos, able to solve problems, in Spanish, etc.). Participants were 344 LMDLs surveyed in the San Francisco Bay Area. As hypothesized: (a) difficult living conditions were related to depression, anxiety, and desesperación [desperation], the latter a popular Latino idiom of psychological distress recently validated on LMDLs; (b) contact with family moderated the relation between difficult living conditions and depression and desesperación but not anxiety and (c) access to local culture, and utilization of community resources, mediated the relation between difficult living conditions and depression and desesperación but not anxiety. Implications for intervening at local and larger levels in order to provide some protection against distress built into the LMDL experience in the United States are discussed.

Qualitative Exploration of an Effective Depression Literacy Fotonovela with at Risk Latina Immigrants.

While depression is prevalent among immigrant Latinas, mental health literacy is low. Culturally tailored health narratives can improve mental health literacy and are now increasingly featured in Spanish language fotonovelas (i.e., booklets in a comic book format with posed photographs and dialogue bubbles). The purpose of this qualitative study is to explore why a depression literacy fotonovela proved effective with Latina immigrants at risk for depression in a quantitative randomized control study. This study is the qualitative companion of the previously published quantitative piece of a mixed methods study, the latter revealing posttest improvements in depression knowledge, self-efficacy to identify the need for treatment, and decreased stigma towards mental health care (Hernandez and Organista in Am J Community Psychol 2013. doi: 10.1007/s10464-013-9587-1 ). Twenty-five immigrant Latinas participated in structured interviews, in the current qualitative study, 3 weeks after participating in the quantitative study. Results suggest depression literacy improved because participants evidenced high recall of the storyline and characters, which they also found appealing (e.g., liked peer and professional support offered to depressed main character). Further, identification with the main character was reflected in participants recalling similar circumstances impacting their mental health. Despite some improvement, stigma related to depression and its treatment remained for some women. Future research for the improvement of health literacy tools is discussed.

Structural vulnerability and problem drinking among Latino migrant day laborers in the San Francisco Bay Area.

Latino migrant day laborers (LMDLs) live under challenging conditions in the San Francisco Bay Area. This study explored day laborer alcohol use guided by a structural vulnerability framework, specifically problem vs. non-problem drinking as perceived by LMDLs and how they cope with or try to avoid problem drinking given their broader environment. The study utilized ethnographic methods including in-depth semi-structured qualitative interviews with 51 LMDLs. Findings revealed the considerable challenge of avoiding problem drinking given socio-environmental factors that influence drinking: impoverished living and working conditions, prolonged separation from home and family, lack of work authorization, consequent distress and negative mood states, and peer pressure to drink. While participants shared strategies to avoid problem drinking, the success of individual-level efforts is limited given the harsh structural environmental factors that define day laborers' daily lives. Discussed are implications for prevention and intervention strategies at the individual, community, national and international levels.

"As Good As It Gets": Undocumented Latino Day Laborers Negotiating Discrimination in San Francisco and Berkeley, California, USA.

Undocumented Latino day laborers in the United States are vulnerable to being arrested and expelled at any time. This social fact shapes their everyday lives in terms of actions taken and strategies deployed to mitigate being confronted, profiled, and possibly incarcerated and deported. While perceptions of threat and bouts of discrimination are routine among undocumented Latino day laborers, their specific nature vary according to multiple social factors and structural forces that differ significantly from locale to locale. The experience of discrimination is often tacitly negotiated through perceptions, decisions, and actions toward avoiding or moderating its ill effects. This essay examines urban undocumented Latino day laborers over a variety of sites in the greater San Francisco Bay Area, which, compared to many metropolitan areas in the U.S. is "as good as it gets" in terms of being socially tolerated and relatively safe from persecution. Nonetheless, tacit negotiations are necessary to withstand or overcome challenges presented by idiosyncratic and ever changing global, national/state, and local dynamics of discrimination. [undocumented Latino laborers, social exclusion, discrimination, tacit negotiation].

New practice model for Latinos in need of social work services.

The practice model described in this article represents a new synthesis of some of the best and most pragmatic models and concepts in the cultural competence literature. The article begins by infusing the ecosystems perspective with Latino-relevant theories and research for enhancing cultural sensitivity, both heightened awareness of the Latino experience and understanding of problem patterns in their historical, social, and cultural contexts. The article builds to a description of the practice model by selectively reviewing and synthesizing state-of-the-art models and methods of culturally competence practice. The resulting 2 x 4 matrix describes four major dimensions of culturally competent practice, across generalist and domain-specific levels of practice, considered essential to practice with U.S. Latinos: (1) increasing service availability and access, often through outreach; (2) assessment in social and cultural context, emphasizing basic grounding in the nature of oppression and social justice-oriented services; (3) selecting interventions acceptable to Latinos on the basis of their social and cultural experience and diverse subgroup memberships; and (4) institutionalizing multiple forms of social work service accountability to Latino clients and communities.