Narratives of Disconnection: A Life Course Perspective of Methamphetamine Use Among Sexual Minority Men Living with HIV.

BACKGROUND: Sexual minority men (SMM) are exposed to societal and structural stressors that translate into poor health outcomes. One such outcome is substance use, which research has long documented as a prominent disparity among SMM. Methamphetamine is a particularly deleterious substance for SMM because its use is often framed as a coping response to social and structural stressors. METHOD: Guided by stress and coping theory and a life course perspective, the purpose of this qualitative study is to assess the development of coping strategies in the context of prominent social and structural determinants among SMM living with HIV who use methamphetamine. RESULTS: Data were collected from 2016 to 2018 via in-depth interviews with 24 SMM living with HIV who use methamphetamine in San Francisco, CA. Mean age of participants was 47 and over half self-identified as ethnoracial minorities. Narrative analysis surfaced a sequential pattern of disconnection at foundational, relational, and recovery levels. This analysis revealed that multi-level stressors were present across the life course that amplified engagement in methamphetamine use. CONCLUSION: Findings highlight the benefits of holistic, integrated, and trauma-informed approaches to address the function of methamphetamine use as a response to societal, cultural, and institutional processes of stigmatization and discrimination. Peer-based approaches may also be beneficial to reframe the ways in which SMM living with HIV who use methamphetamine form and sustain relationships.

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.

A Structural-Environmental Model of Alcohol and Substance-Related Sexual HIV Risk in Latino Migrant Day Laborers.

A structural-environmental model of alcohol and substance-related sexual HIV risk in 344 Latino migrant day laborers, participants in a cross-sectional survey, is tested using structural equation modeling. Hypothesized pathways include: (1) direct paths between environmental conditions and both distress related risk factors, and cultural and community protective factors; (2) indirect paths between environmental conditions and distress through cultural and community protective factors; and (3) indirect paths between environmental conditions and sexual risk through both distress risk factors and cultural and community protective factors. As hypothesized, the environmental factors, discrimination and working conditions, were indirectly related to sexual risk through the distress related factor, problem drinking, and through the protective factor, contact with family in country of origin. More specifically, as discrimination and working conditions worsen, contact with family decreases, problem drinking increases, and sexual risk increases. Implications for multi-level interventions are discussed.

RESUMEN: Un modelo estructural-ambiental de riesgo de VIH sexual relacionado con el alcohol y las sustancias en 344 jornaleros migrantes latinos, participantes en una encuesta transversal, se prueba usando modelos de ecuaciones estructurales. Las rutas hipotéticas incluyen: (1) rutas directas entre las condiciones ambientales y los factores de riesgo relacionados con la angustia y los factores de protección culturales y comunitarios; (2) rutas indirectas entre las condiciones ambientales y la angustia a través de factores protectores culturales y comunitarios; y (3) rutas indirectas entre las condiciones ambientales y el riesgo sexual a través de factores de riesgo de angustia y factores de protección culturales y comunitarios. Según la hipótesis, los factores ambientales, la discriminación y las condiciones de trabajo, estaban indirectamente relacionados con el riesgo sexual a través del factor relacionado con la angustia, el problema con el alcohol y, a través del factor de protección, el contacto con la familia en el país de origen. Más específicamente, a medida que empeoran la discriminación y las condiciones de trabajo, disminuye el contacto con la familia, aumenta el problema con la bebida y aumenta el riesgo sexual. Se discuten las implicaciones para intervenciones de múltiples niveles.

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.

La desesperación in Latino migrant day laborers and its role in alcohol and substance-related sexual risk.

The purpose of this study was to better understand the relation between psychological distress and alcohol and substance related sexual risk in Latino migrant day laborers (LMDLs). In addition to examining the roles of depression and anxiety, it was also necessary to examine the role of desesperación, a popular Latino idiom of distress frequently expressed by LMDLs in response to the thwarting of major migration related life goals such as traveling to the U.S. in search of work to support families, projects and purchases in country of origin. Given the structural vulnerability of LMDLs to under-employment and frequent unemployment, LMDLs also refer to desesperación as a prelude to problem drinking, substance use, and sexual risk taking. Hence we developed and validated a scale of desesperación for LMDLs to explore this culturally relevant construct of psychological distress in this unique population of Latinos. Based on a cross sectional survey of 344 LMDLs, this study found that the dissatisfaction subscale of desesperación predicted alcohol-related sexual risk taking, while depression predicted substance-related sexual risk taking. These findings are discussed including implications of preventing alcohol and substance related sexual risk taking in LMDLs.

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.

Depression Treatment Uptake in Integrated Primary Care: How a "Warm Handoff" and Other Factors Affect Decision Making by Latinos.

OBJECTIVE: Integrated behavioral health care has the potential to reduce barriers to mental health treatment among low-income and minority populations. This study aimed to identify predictors of Latino patients' decision to follow through with referrals to depression treatment in an integrated primary care setting, including type of referral (a "warm handoff" from a primary care provider [PCP] to a behavioral health care provider or a prescribed referral). METHODS: The authors conducted a sequential medical record review of 431 patients referred for depression treatment in integrated behavioral health services followed by qualitative semistructured interviews with a subsample of 16 patients. RESULTS: English-speaking Latinos were four times less likely to attend an initial visit within two months of a referral if they received a warm handoff rather than a prescribed referral. The strength of the patient-provider relationship and the quality of the referral experience, including whether the PCP addressed patients' health literacy and expectations for depression care, affected patients' decision to engage in depression treatment. CONCLUSIONS: Engaging Latinos in needed mental health treatment is a challenge, even when treatment is provided in primary care settings. Warm handoffs are considered effective components of engagement, but this study suggests that the effectiveness of warm handoffs may vary depending on the patient's primary language. The following factors seem important to engaging Latinos into care: patient-provider relationship, quality of the referral process, addressing expectations about depression care, and reducing communication barriers, including health literacy and linguistic barriers. Future studies of engagement strategies should explore these factors.

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].

Entertainment-education? A fotonovela? A new strategy to improve depression literacy and help-seeking behaviors in at-risk immigrant Latinas.

Research shows high risk for depression among immigrant Latinas known to increase during the acculturation process. Several barriers such as stigma and low health literacy result in an under-utilization of needed treatment among these women. In response, this study replicated the effectiveness of a Spanish language fotonovela, a form of Entertainment-Education (E-E), designed to increase depression literacy, decrease stigma, and increase help-seeking knowledge and behavior in Latinos. Specifically, this study evaluated a fotonovela delivered in a multifaceted approach to health education used by promotoras. A pretest-posttest randomized control group experimental design with 142 immigrant Latinas at risk for depression was employed. Results indicate significant posttest improvements in depression knowledge, self-efficacy to identify the need for treatment, and decreased stigma in experimental as compared to control group participants. Findings support the application of E-E health literacy tools such as fotonovelas, delivered in multifaceted approaches to health education used by promotoras, to Latinas at risk for mental health concerns.

Contextual influences on the drinking of male Latino immigrant day laborers.

This study explored self-reported alcohol use of Mexican and Central American men who had recently migrated to the United States to work. Ethnographic observation took place at a day laborer hiring site in 2006-2007 and qualitative interviewing involved 120 men with divergent drinking patterns. Short interviews were conducted informally on the street, and interviews lasting 1-2 hours addressed day laborers' perspective about how life conditions shape where drinking takes place and how much alcohol gets consumed. Resulting situations, such as roommates bringing alcohol home for extended nights of drinking, and specific strategies used to avoid excess alcohol use are addressed.

Sexual health of Latino migrant day labourers under conditions of structural vulnerability.

The purpose of this paper is to explore the context of the sexual health of Latino migrant day labourers in the USA, challenges to sexual health and ways of coping, with attention to conditions of structural vulnerability permeating the lives of this unique Latino population. Given the limited information about this topic and population, ethnographic research employing in-depth semi-structured interviews with 51 labourers, recruited through purposive sampling in the San Francisco Bay Area, was utilised. The sexual health aspirations of the men are deeply embedded in the core value and practice of Latino familismo or, in this case, the central goal of securing a family headed by men as providers and present husbands/fathers. However, such goals are frequently thwarted by the poverty engendering work and prolonged separations from home that characterise predominantly undocumented day labour in the USA. Resulting goal frustration, combined with pent up sexual urges, often lead to sexual risk in spite of efforts to cope with challenges to sexual health. Unless community-, state- and national-level interventions are developed to mitigate the pronounced structural vulnerability of migrant day labourers, individual level interventions to promote sexual health, and decrease risk and distress, are likely to have diminishing returns.

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.

Sexually transmitted diseases and risk behaviors among California farmworkers: results from a population-based survey.

CONTEXT: The prevalence of sexually transmitted diseases and associated risk behaviors among California farmworkers is not well described. PURPOSE: To estimate the prevalence of sexually transmitted diseases (STDs) and associated risk behaviors among California farmworkers. METHODS: Cross-sectional analysis of population-based survey data from 6 California agricultural regions was performed for participants tested for Chlamydia trachomatis (CT), Neisseria gonorrhea (GC), and syphilis, and who completed an interviewer-administered behavioral risk factor survey. FINDINGS: Among the 403 males and 234 females examined and interviewed, males (29.3%) were more likely than females (9.6%) to have had 2 or more sex partners in the past 5 years. Forty-two percent of males ever had sex with a commercial sex worker; unmarried males were more likely than married males to report sex with a commercial sex worker in the past 2 years. Twelve percent of males and 5% of females reported ever having had an STD. Most participants did not report any methods to protect against STDs. Of 192 males and 178 females tested for CT, 3 males and no females were positive. No cases of GC were found. Of 387 males and 194 females tested for syphilis, 4 males and 1 female had positive rapid plasma reagin (RPR) and Treponema pallidum particle agglutination (TPPA) results. CONCLUSIONS: In this population-based survey among agricultural workers, there was low STD prevalence but high prevalence of sexual risk behaviors, particularly among males.

Migrant Latino day laborers and intentions to test for HIV.

This cross sectional study utilized convenience sampling to investigate the HIV testing intentions of 290 sexually active, male, migrant Latino day laborers, 18 years old or older. The findings indicate that day laborers are indeed at risk for HIV. Nearly two-thirds of the men intended to test for HIV in the next year. Men who were at higher risk of infection from their sexual encounters with female partners were more likely to intend to test, as were men making less money and men who did not perceive themselves to be at risk. Men who attended high school or beyond, and reported using a condom with casual female partners, were much more likely to intend to test than men who did not attend school and reported no such condom use. The prevalence of high risk sex and the low rates of condom use have implications for the increased transmission of HIV.

Predictors of HIV transmission among migrant and marginally housed Latinos.

This study examined predictors of HIV-related sexual risk taking in a high risk and understudied convenience sample of 366 predominantly Mexican, migrant adults without stable housing. The sample included 27% men who have sex with men, 28% injectors of illegal drugs, and 21% sex workers. Hierarchical regression analysis showed that sexual risk taking was predicted by low condom self-efficacy, high-risk behavior, and being female. Interestingly, those who engaged in the highest-risk behaviors were more likely to use condoms consistently during sex, although they carried condoms less.

Pilot survey of HIV risk and contextual problems and issues in Mexican/Latino migrant day laborers.

A preliminary survey was conducted with 102 migrant day laborers (MDLs) to assess HIV risk and related contextual problems and issues. These men were primarily Mexican, of low SES background, low in acculturation to the United States, and their income ranged from $100 and $400 a week, 40% of which is sent back home. The psychosocial context of HIV risk included concerns expressed about lack of money and employment, followed by racism, social isolation, sadness and loneliness. High rates of alcohol use and binge drinking that co-occur with sexual activities were reported. While only 7% of MDLs reported illegal injection drug use, needles were frequently shared without bleach cleaning. Men generally did not carry condoms and knowledge of proper condom use was poor. For the most common form of sex reported, vaginal sex, condom use was infrequent. However, men did report confidence in being able to insist on condom use in challenging sexual situations, and they also reported fairly frequent pro-condom attitudes and behaviors within their social circles. Slightly over half of the men reported sexual activity with female partners, during the past 2 months. These female partners were almost evenly divided into regular sex partners, including spouses, and riskier partners such as one time only sex partners, prostitutes, and multiple sex partners. Results also indicated encouraging efforts by MDLs to reduce risk with risky partners (e.g., more condom use).