Solidarity through food: Coping with food insecurity among adolescent migrants in transit through Mexico and Central America.

BACKGROUND: The food choices of migrants are frequently limited by lack of access to sufficient and adequate food. Food insecurity (FI) during adolescence has potential negative health consequences, however the experiences of FI of adolescent in-transit migrants have seldom been reported. OBJECTIVE: To explore the experiences of FI of adolescent in-transit migrants and their ways of coping with it. METHODS: Qualitative study, with 19 semi-structured interviews with adolescents (ages 13-19 years), in shelters for migrants in Mexico in 2022-2023. We followed a reflexive thematic analysis strategy. RESULTS: Most participants had experienced FI during the journey, and responded by limiting intake, choosing food according to price, seeking temporary work or asking for food or money in the streets. We defined "solidarity through food" as a central theme that summarized participants' experiences of sharing food with other migrants, as givers or recipients. Solidarity through food was a response to FI, benefitting the more disadvantaged (e.g. young children, those who had been robbed). Despite their young age, interviewees took part in this, giving their food to others and restricting their intake to prioritize younger siblings. DISCUSSION/CONCLUSIONS: Solidarity through food was a form of generalized reciprocity, enacted not only among family members or friends, but extended to other migrants sharing the route. In further studies, it will be important to explore the role and nuances of food sharing as a practice of social exchange of responsibility and care, on adolescent migrants' health, and in their psychological and relational development into adulthood.

Rape, transactional sex and related factors among migrants in transit through Mexico to the USA.

Migrants in transit through Mexico to the USA are at risk of violence, including sexual violence, during the immigration process. This study sought to identify the socio-demographic factors, migration experiences and health conditions associated with the likelihood of sexual violence. A mixed methods study was conducted between 2012 and 2015. The quantitative phase of the work involved a non-random sample (n = 3539) of migrants who were the users of migrant shelters in Mexico. A probit regression model was used to identify the variables associated with the experience of sexual violence by participants. A total of 58 semi-structured interviews took place with migrants who had either experienced sexual violence or who were acquainted with the sexual violence experienced by other migrants. Of those who experienced any kind of violence, 5.7% reported having experienced sexual violence, with statistically significant differences by gender. According to male migrants, women in transit had the advantage of having an 'entry ticket [to the USA] between their legs'. The dynamics of undocumented transit migration provide multiple opportunities for gender-based inequality and sexual violence. We consider the major underreporting of sexual violence due to the stigma and normalisation of violence, in a social context marked by impunity.

["Give me a pill": the meanings of AIDS in bareback practice in Mexico City and its implications for HIV prevention]. / "Dame una pastilla": los significados del VIH/sida en la práctica del bareback en la ciudad de México e implicaciones para la prevención.

OBJECTIVE: To analyze and understand the meanings that gay men in Mexico City associate to unprotected sex such as bareback practices. MATERIALS AND METHODS: Exploratory qualitative study that uses grounded theory analysis of semistructured interviews with gay men that practice bareback sex recruited through the internet. Also a documentary analysis was performed. RESULTS: Gay men engage in bareback sexual practices because they have access to antiretroviral therapy. Access to treatment changes the meanings around AIDS and the perceived risk of infection. The confidence on treatment and the dropback of the Mexican government on preventive strategies explain these perceptions. CONCLUSIONS: Urban and middle class gay men in Mexico City have changed their perception with respect to HIV infection. It is necessary to understand the meanings related to bareback sexual practices and the use of condoms as a preventive strategy. We have to retake the discussion on preventive strategies, damage mitigation, stigma, discrimination, early diagnosis and the impact of antiretroviral therapy.

[Mental health of undocumented migrants in transit at the southern border of Mexico]. / Salud mental de migrantes centroamericanos indocumentados en tránsito por la frontera sur de México.

OBJECTIVE: To identify the perception and needs in mental health of Central American migrants in transit through Tapachula, Chiapas. MATERIALS AND METHODS: Qualitative study in a migrant shelter in Tapachula, Chiapas. In 20 semi-structured interviews with migrant men and women, we explored their perceptions on mental health and expectations on care. We used basic notions of phenomenology to guide the analysis. RESULTS: Migrants had several mental health problems related to the conditions at their country of origin and due to their initial transit through Mexico.Their perception on mental health problems was heavily influenced by the biomedical health paradigm. The expectations they had on the provision of services were related to the satisfaction of basic needs. CONCLUSIONS: It is necessary to strengthen the governmental response to mental health needs through collaborative strategies. Also, actions are needed to further the understanding of mental health in order to transcend the biomedical notions that stigmatize, segregate and create a barrier to accessing services.

[Central American migrants' sexual experiences and rights in their transit to the USA]. / Sexualidad del migrante: experiencias y derechos sexuales de centroamericanos en tránsito a los Estados Unidos.

OBJECTIVES: To explore the causes and circumstances that determine the way in which migrants experience their sexuality and how this impacts their sexual rights. MATERIALS AND METHODS: Qualitative study conducted between April 2009 and July 2010 in Chiapas, Oaxaca, San Luis Potosí, and Tamaulipas. We conducted 22 in-depth interviews to migrants in transit and to ten different key actors. For the analysis we used elements of grounded theory. RESULTS: Migrants know and identify the risks they may encounter in their transit but have scarce access to services to effectively exercise their sexual and reproductive rights. Their vulnerability makes them internalize and accept the violence enacted on them as part of their destiny and as what they must suffer in order to reach the USA. CONCLUSIONS: Violence, including sexual violence, determines much of the experiences of their transit through Mexico. Differences between groups and between male and female migrants are determined by gender inequalities and power.

[Factors influencing Central America's civil society organization's capacity to provide AIDS related care]. / Contexto de las organizaciones civiles centroamericanas en la atención al sida en poblaciones móviles.

OBJECTIVE: To analyze the capacities of Central American civil society organizations (CSOs) to implement HIV prevention and care strategies in mobile groups within the HIV Mesoamerican Project. MATERIALS AND METHODS: During the year 2008, 14 key actors of nine Central American civil society organizations participating in the Mesoamerican Project were interviewed. The information collected was systematized using Atlas-TI software, and content analysis was performed according to its categories and dimensions. RESULTS: These items were a contribution to capacity: the previous work of CSOs allowed the sensibilization of population and authorities to STD-HIV and to the implemented program; the coordination with government and other involved actors. LIMITATIONS: a good but informal coordination with the government; the worsening economic situation reduced available resources; attended communities are isolated and unsecure. CONCLUSION: To improve the capacities of CSOs in developing this type of project, it is recommended: that an initial community diagnosis be performed in order to better adapt the proposed interventions; to improve administrative efficiency; to formalize collaborative links with the government; and to seek counseling in the development of HIV prevention strategies that consider population mobility.

Food insecurity and coping strategies in international migrants in transit through Mexico.

Background: Although migrants in transit through Mexico have been known to consume insufficient food, data measuring food insecurity (FI) in this vulnerable population is scarce. This study assesses FI in migrants transiting Mexico by examining economic, physical and social food access. Methods: Using a mixed-methods design and a convenience sample of migrants residing in a temporary shelter in Saltillo, Coahuila in northern Mexico, we applied 1) the Food Insecurity Experience Scale (adapted), and 2) a semi-structured interview exploring FI coping strategies. Results: Of the 54 participants, 74.1% reported moderate or severe FI and 24.1% reported severe FI, especially reduced food quantity. Interviewees reported poverty, cargo train travel, and crime as FI contributing factors. All interviewees used FI coping strategies, principally altering food intake and using social resources. Many strategies reported implied negative consequences for both nutrition and general health. Conclusions: This study provides a comprehensive assessment of FI in a mobile population using a standard international measure. Results confirm widespread and severe FI, highlighting a potential humanitarian crisis requiring both national and international attention. Further research is critical to inform strategies for guaranteeing the right to food access for migrants in transit through third (non-destination) countries.

Migrant shelters' response to COVID-19: Comparative case study in four cities close to the Mexico-United States border.

Introduction: In the context of a health contingency such as the current COVID-19 pandemic, some groups may remain invisible, so that their health needs go unnoticed. These groups include migrants, asylum seekers, and refugees (MAR). In Mexico there is a network of migrant shelters (casas del migrante-CM) that provide humanitarian assistance, including access to heath care. Given the major role of the CM in caring for migrants, it was important to identify the main elements of their internal capacities, and of the external resources in the cities in which they are located, that contributed to their role in protecting MRA`s health during the COVID-19 pandemic. Methods: we use a comparative case study approach to understand, explain, and compare how internal capacities and external resources available to four CM in the north of Mexico, influenced the development and implementation of COVID-19 related strategies to protect MRA. The project took place during 2021 in Saltillo and Piedras Negras in Coahuila; Ciudad Juarez, Chihuahua, and in Monterrey, Nuevo Leon. A total of 18 in-depth interviews were performed with key actors from the CM, academia, health care services and international agencies. Results: We found a range from a total closure of one CM, to the continuation of operation of three of them, with differences in the strategies developed to provide services and avoid infections within the facilities. MARs' still face multiple barriers to exercise their right to health, and the response of local governments towards migration and health impacts the response that CM were able to implement. Conclusion: There is a need to strengthening the preparedness and response capacities and coordination mechanisms of local, state and federal authorities to attain their responsibilities in the provision of services directed to MAR, including access to health care.

Access to Health Care for Migrants Along the Mexico-United States Border: Applying a Framework to Assess Barriers to Care in Mexico.

Background: Migrants in Mexico are entitled to care at all levels, independently of their migration status. However, previous studies show that access to care is difficult for this population. As the movement of in-transit migrants and asylum seekers has been interrupted at the Mexico-United States border by migration policies such as the "Remain in Mexico" program, and by border closures due to the COVID-19 pandemic, the Mexican health system has the challenge of providing them with health care. Levesque et al.'s framework, according to which access occurs at the interface of health system characteristics and potential users' abilities to interact with it, is a useful theoretical tool to analyze the barriers faced by migrants. Objective: The objective of this article is to analyze the barriers to access the public Mexican health system, encountered by migrants in cities in Mexican states at the Mexico-United States border during the COVID-19 pandemic. Methods: Data came from a multiple case study of the response of migrant shelters to health care needs during the COVID-19 pandemic. The study consisted of a non-probability survey of migrants with a recent health need, and interviews with persons working in civil society organizations providing services to migrants, governmental actors involved in the response to migration, and academics with expertise in the subject. We analyzed the quantitative and qualitative results according to Levesque et al.'s framework. Results: 36/189 migrants surveyed had sought health care in a public service. The main limitations to access were in the availability and accommodation dimension (administrative barriers decreasing migrants' ability to reach the system), and the affordability dimension (out-of-pocket costs limiting migrants' ability to pay). Civil society organizations were a major source of social support, helping migrants overcome some of the barriers identified. Conclusions: While Mexico's health regulations are inclusive of migrants, in practice there are major barriers to access public health services, which might inhibit migrants from seeking those services. In order to comply with its commitment to guarantee the right to health of all persons, the Mexican health authorities should address the implementation gap between an inclusive policy, and the barriers to access that still remain.

Migrants on the Move and Food (In)security: A Call for Research.

Food insecurity contributes to negative outcomes for health and wellbeing, and its impact may be exacerbated during periods of vulnerability. While food insecurity is both a driver and a consequence of migration, anecdotal evidence indicates that it is also common during migration when people are 'on the move', although its prevalence and severity during these periods are largely undocumented. Food security monitoring is critical to ensuring the universal right to food for migrants, and instruments must be designed which capture the unique challenges faced during these 'extra-ordinary' periods of mobility, including in the context of emergencies such as the COVID-19 pandemic. This paper reviews knowledge on food security in migrants on the move and examines how active mobility intersects with food security and its measurement. Considering the potential consequences on health and wellbeing, we call for interdisciplinary research using standard instruments to document food insecurity in migrants on the move.

In-Transit Migrants And Asylum Seekers: Inclusion Gaps In Mexico's COVID-19 Health Policy Response.

During the COVID-19 pandemic, as immigration and asylum processes were delayed or interrupted, migrants and asylum seekers were stranded at Mexico's northern border. In-transit migrants and asylum seekers are an underserved population, and pandemic preparedness has seldom taken their needs into account. In this article we analyze public health policies developed in Mexico in response to the COVID-19 pandemic and describe how these policies have largely overlooked the needs of vulnerable mobile populations. We reviewed eighty publicly available documents issued by federal, state, and municipal authorities in Mexico between January and September 2020. Only seven policy documents explicitly considered in-transit migrants and asylum seekers and their health care needs. In addition, we identified six major gaps in these policies that, if addressed, would promote greater inclusion of persons in mobility in future pandemic response plans, to protect the health of migrant populations.

Sex work in Mexico: vulnerability of male, travesti, transgender and transsexual sex workers.

In Mexico, male sex workers (MSW) and travesti, transgender and transsexual (TTT) sex workers are among the groups most affected by HIV. They suffer from stigma and discrimination, yet are often absent from the design of programmes and HIV prevention campaigns. The objective of this study was to provide an account of the social context in which MSW and TTT sex workers live, by focusing on their sexual identities, sexual practices and vulnerability to HIV. Data collection took place in Mexico City and involved observational work together with 36 in-depth interviews. Findings reveal a differentiation of vulnerability by sub-group. In general, vulnerability is influenced by the social context, stigma related to homosexuality and sex work, as well as sex workers' access to scarce social capital and the lack of response in terms of social and health programmes. In order to diminish the vulnerability of MSW and TTT sex workers and reduce their risk of HIV infection, preventive measures are needed which take into account their specific health and social needs, promote meaningful participation and the encourage respect for human rights.

Forms and determinants of migration and HIV/AIDS-related stigma on the Mexican-Guatemalan border.

In this study we examined the origins and consequences of HIV/AIDS-related stigma on the Mexican-Guatemalan border. To explore these issues, an inductive/deductive approach was taken. Data were collected using qualitative methods including nonparticipant observation, in-depth interviews, and informal conversation. Informants included Central American immigrants, locals, and contextual key informants. Findings reveal that gender, social class, and race/ ethnicity function as key determinants of HIV/AIDS-related stigma, but serve also as the basis around which migration-related stigma is constructed within this particular context. These issues need to be taken into account in addressing the vulnerability of mobile populations, as well as the stigma attached to migration and HIV/AIDS. To be effective, responses should be based in the social and contextual realities faced by migrants and mobile populations, and be part of a more general process of empowerment that improves their legal, social, economic, and health status.

Migrants in transit through Mexico to the US: Experiences with violence and related factors, 2009-2015.

OBJECTIVES: The objectives of the study are to 1) estimate the burden of physical, sexual, and psychological violence among migrants in transit through Mexico to the US; and 2) examine the associations between experiencing violence and sociodemographic characteristics, migratory background, and health status in this vulnerable population. METHOD: A cross-sectional study combining qualitative and quantitative methods was carried out from 2009 to 2015 with a sample of 12,023 migrants in transit through Mexico to the US. Information on gender (male, female, and transsexual, transgender and transvestite -TTTs-); nationality; health status; migratory background; and experiences with violence was obtained. Fifty-eight migrants participated in in-depth interviews to explore any experiences of violence during their journey. A descriptive analysis was performed and a probit regression model was applied to analyze the factors associated with violence. Qualitative information was analyzed to understand experiences, meanings and responses to violence. RESULTS: The overall prevalence of suffering from any form of violence was 29.4%. Nearly 24% reported physical violence, 19.5% experienced psychological violence, and approximately 2% reported sexual violence. TTTs experienced a significantly greater burden of violence compared to men and women. Violence occurred more frequently among migrants from Central American (30.6%) and other countries (40.0%) than it did among Mexican migrants (20.5%). Experiences involving sexual, physical and psychological violence as well as theft and even kidnapping were described by interviewees. Migrants mistrust the police, migration authorities, and armed forces, and therefore commonly refrain from revealing their experiences. CONCLUSION: Migrants are subjected to a high level of violence while in transit to the US. Those traveling under irregular migratory conditions are targets of even greater violence, a condition exacerbated by gender inequality. Migrants transiting through Mexico from Central American and other countries undergo violence more frequently than do Mexican migrants. Protective measures are urgently needed to ensure the human rights of these populations.

Household wellbeing and health risks in Mexican households with and without migrants: a cross-sectional analysis.

BACKGROUND: Migration between Mexico and the USA constitutes the world's largest migration corridor with more than 13 million movements of people in 2016. Furthermore, Mexico has a complex migration profile, being a country of origin, transit, destination, and return. While there has been discussion on the relationship between migration and development of origin communities, evidence on social and health issues faced by origin households is limited. This case study is a first attempt at documenting, through analyzing a national representative health survey of Mexican households (n = 9474), the relationship between international migration from Mexico and origin household health characteristics. CASE PRESENTATION: Mexican international migration moves largely (90% of migrants) toward the USA. Migration has passed from being mostly circular (from the early to late 1990s) to a permanent pattern of residence in the destination country due to changes in migration policies that have progressively restricted the irregular entrance of immigrants making re-entry more difficult.The present case study compares the socioeconomic, demographic, and health characteristics of households in Mexico with and without emigrants using data from a national representative health survey. Accordingly, in 2016, 5.8% (n = 1,802,980) of all Mexican households reported having a member living abroad.Households with members living abroad were found to more likely be headed by a female (45.8%), have Seguro Popular health insurance, and not to be among the poorest household population. In terms of health profile, a higher frequency of adults with a reported diagnosis of diabetes and/or hypertension (33.9 vs 21.7% for households with vs without emigrants, respectively; p = 0.067), and a higher severity of diabetes reflected a higher probability of hospitalization. CONCLUSIONS: Results showed that socioeconomic, demographic, and health conditions differed between households with and without emigrants. These differences were determined as not being attributable to migration and cannot be considered as predisposing factors of migration.

HIV Prevalence Among Central American Migrants in Transit Through Mexico to the USA, 2009-2013.

HIV prevalence was estimated among migrants in transit through Mexico. Data were collected on 9108 Central American migrants during a cross-sectional study performed in seven migrant shelters from 2009 to 2013. Considerations focused on their sociodemographic characteristics, sexual and reproductive health, and experience with violence. Based on a sample of 46.6 % of respondents who agreed to be HIV tested, prevalence of the virus among migrants came to 0.71 %, reflecting the concentrated epidemic in their countries of origin. A descriptive analysis was performed according to gender: the distribution of the epidemic peaked at 3.45 % in the transvestite, transgender and transsexual (TTT) population, but fell to less than 1 % in men and women. This gender differential is characteristic of the epidemic in Central America. Furthermore, 23.5 % of TTTs and 5.8 % of women experienced sexual violence. The predominant impact of sexual violence on TTTs and women will influence the course of the AIDS epidemic.

[Knowledge, attitudes, and practices concerning Chagas disease in schoolchildren from an endemic area in Peru]. / Conocimientos, actitudes y prácticas sobre la enfermedad de Chagas en población escolar de una zona endémica del Perú.

This study analyzes knowledge, attitudes, and practices concerning Chagas disease among 241 primary schoolchildren in "La Tinguiña", Ica, Peru (December 2000 - January 2001). Less than 1% of those interviewed knew that triatomines transmit Chagas disease, while nearly a quarter recognized the illness based on the appearance of "lumps" on the skin; 35.27% knew that vector infestation is controlled using insecticides; 26.56% recognized the adult stage of the vector, and 21.16% the nymphal instar; 14.11% knew triatomines or "kissing bugs" by the name "chirimacha"; 82.57% would accept an entomological survey, 66.80% would submit to a serological study, and 63.90% would participate in a triatomine search. The study shows that the population, despite having very limited knowledge on the disease and its vectors, shows interest in collaborating. Therefore, it is recommended that Chagas disease surveillance and control include educational programs and community participation.

Willingness-to-accept reductions in HIV risks: conditional economic incentives in Mexico.

The objective of this study was to measure willingness-to-accept (WTA) reductions in risks for HIV and other sexually transmitted infections (STI) using conditional economic incentives (CEI) among men who have sex with men (MSM), including male sex workers (MSW) in Mexico City. A survey experiment was conducted with 1,745 MSM and MSW (18-25 years of age) who received incentive offers to decide first whether to accept monthly prevention talks and STI testing; and then a second set of offers to accept to stay free of STIs (verified by quarterly biological testing). The survey used random-starting-point and iterative offers. WTA was estimated with a maximum likelihood double-bounded dichotomous choice model. The average acceptance probabilities were: 73.9 % for the monthly model, and 80.4 % for the quarterly model. The incentive-elasticity of participation in the monthly model was 0.222, and 0.515 in the quarterly model. For a combination program with monthly prevention talks, and staying free of curable STI, the implied WTA was USD$ 288 per person per year, but it was lower for MSW: USD$ 156 per person per year. Thus, some of the populations at highest risk of HIV infection (MSM and MSW) seem well disposed to participate in a CEI program for HIV and STI prevention in Mexico. The average WTA estimate is within the range of feasible allocations for prevention in the local context. Given the potential impact, Mexico, a leader in conditional cash transfers for human development and poverty reduction, could extend that successful model to targeted HIV/STI prevention.

Violence committed against migrants in transit: experiences on the Northern Mexican border.

Thousands of Mexican and Central American migrants converge at the Mexico-United States border. Undocumented migrants in transit to the United States are vulnerable due to their lack of access to health care and legal assistance. This study attempts to provide evidence on the violent-related consequences that migration has on migrants. A mixed-method study was conducted between April 2006-May 2007 in shelters in Baja California, Mexicali and Tijuana, Mexico. 22 in depth interviews were performed and fifteen hundred and twelve migrants responded a questionnaire. Results from both in-depth interviews and the analysis of the quantitative data shows the different types of violence experiences by migrants which include threats, verbal abuse, and arbitrary detention based on ethnicity, as well as assaults, beatings and sexual violence. It is crucial to stress the importance and the need to evidence the condition in which migrants' transit to the US and to effectively respond to the violence they experience.