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Voices of Immigrants in Action VIA's mission is to promote dynamic communication addressing the emerging issues of the Hispanic immigrant communities; mobilizing a multi-level response to factors affecting HIV/AIDS transmission in Hispanic Immigrant communities in the rural South.

Snapshot 1, Spring 2011

The Hispanic Community’s Greatest Concerns*

25% Lack of legal documents (residency papers, driver’s license)

24% Lack of stable work

11% Youth dropping out of school

8% Increased alcohol consumption Additional risk factors that were mentioned: 19% unemployment 10% immobilized by fear 9% health-related problems 6% exploitation *Data results taken from 188 in-depth interviews with Hispanic Immigrants in North Central Florida and Eastern Tennessee as part of the 2010 VIA Community Survey.

The Undercurrents Impeding HIV Prevention/Testing Among Rural Hispanic Immigrants Overview: There is a void in HIV/AIDS Incidence data that specifically focuses on Hispanic Immigrants in the South as a unique community. This is critical to quantifying prevalence and addressing prevention, especially since it is estimated that 1 in 52 Hispanics will receive an HIV diagnosis in their lifetime.1 The South is recognized as the the heart of HIV/AIDS in the U.S.,2 with seven of the 10 states having the highest rates of new HIV infection.3 The South is also ranked lowest in “overall health,4” which doesn’t take into account the care access experiences of this population, 1) with limited English proficiency, 2) which is highly mobile, and 3) is forced to maneuver within an ever-increasing xenophobic environment. Social Factors: Social determinants, articulated in the 2010 VIA Community Survey, that place this community at an elevated HIV/AIDS risk include: poverty, under-employment, lack of access to care, migration, discrimination, homophobia, limited rights, defined gender roles, alcohol abuse and depression. HIV Priority: Many immigrants, documented or not, do not have the luxury of prioritizing HIV. The stress related to living without documents, combined with high unemployment rates, has resulted in the observation of increased alcohol use, depression, domestic violence and an increase in the number of youth who have dropped out of school (See VIA Snapshots on women and youth). The community reports that it is further burdened by fear, exploitation, financial challenges and resulting health issues.5. Call to Action: Therefore, as socio-economic status is a powerful predictor of health and illness, the potential elevated risk for HIV infection for Hispanic Immigrants who live in the South cannot be ignored.6 Combating such intense health determinants will require communityunity along with commitments by state, regional and federal partners to create community-focused data and, most importantly, an ambitious, respectful pledge to battling the epidemic with targeted precision.


Diminishing the Challenges Actions to impact the prevalence of HIV among Hispanic Immigrants will require a blending of community-based actions and intuitive attention from health/social institutions.

Community-driven Recommendations Community-driven recommendations construct a bridge for both community engagement and to shift policy and programs for improved service delivery. Broaden the Dissemination of Focused Advocacy/Policy Tools To sustain delivery of relevant information to policy brokers addressing social determinants and emerging issues around Hispanic Immigrants and their correlating HIV risk factors. Establish Leadership Academies To build the Hispanic Immigrant community’s advocacy capacity and policy literacy, strengthening their role in critical policy shifts for testing, access and prevention. Develop Dynamic, Integrated Task Forces To foster an open dialogue between Hispanic Immigrant community members and health/social service providers, creating integrated task forces to shape policy recommendations. Embrace Community-based Prevention To initiate unique, on-going community prevention campaigns that target local objectives and trusted venues (churches, schools, youth, labor organizations, etc.) versus emphasis on annual national days of action.

Hear the VIA Voices: View the VIA Multi-media Video

Anti-immigrant Fervor Hampers HIV Prevention/Testing An undercurrent of fear has created serious barriers to seeking assistance and making informed decisions. Whether documented or not, racial profiling and the potential separation by deportation of undocumented familes or friends, keeps many on edge. Fear of being targeted by law enforcement, combined with the emerging state laws and federal agreements, impedes the accessing of HIV prevention and testing services, regardless of legal status.7 This fear has been heightened by reported cases of immigration actions at health/social service facilities.8 Anti-Immigrant state laws, such as Arizona’s SB1070, are an example of a stringent state immigration laws intended to identify, prosecute, and deport undocumented immigrants. Presently, in the Southern United States, there are six proposed copycat laws in the works. Such laws depend on racial profiling, under the cloak of “reasonable suspicion9”. Immigration and Customs Enforcement’s (ICE) 287(g) agreements deputize county sheriffs as Immigration officials to investigate, apprehend and/or detain deportable immigrants.10 For immigrants, this is seen as free reign for deputies to stop, interrogate and charge people as they go about their daily activities (work, school, daycare, doctor, etc.). The focus on racial profiling from these proposed bills, with potential harassment of legal residents and citizens,11 as well as the undocumented, creates a level of insecurity for people of color and also reduces their trust in the police.12 The present political atmosphere has the potential to jeopardize not only the health of Hispanic Immigrants, but in the long run, U.S. communities as well.

http://www.youtube.com/user/TheRWHPorg?feature=mhum Citations

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1) CDC, 2010; 2) Human Rights Watch, 2010; 3) CDC, 2007; 4) United Health Foundation, 2009; 5) RWHP, 2010; 6) A Positive Life; 7) Kretsedemas, 2008; 8) Walton, 2009; 9) Archibold, 2010; 10) Immigration and Customs Enforcement, 2011; 11)Lopez & Minushkin, 2008; 12) Lopez, & Livingston, 2008. Full citations at http://www.via.rwhp.org/citations.html

©2011, Rural Women’s Health Project. www.rwhp.org G rwhp@cafl.com G 352-372-1095 This project is funded by AIDS United-Southern REACH/Gulf Coast HIV/AIDS Relief Fund, with funds from the Ford Foundation.


Voices of Immigrants in Action Rural Hispanic’s

Perspectives on HIV/AIDS 2010 Findings

If HIV continues to increase in the Hispanic community it could become a catastrophe for all of us.

With an epidemic of HIV in the community, we would have a bad reputation as Hispanics and we’d have more probability of getting infected too.

32-year old, Mexican woman, FL

14-year old Mexican youth, FL

Hispanics and HIV: There are three issues fueling the discussion of HIV/AIDS incidence as it affects Hispanic Immigrants. First, there are no statistics to quantify prevalence among the Immigrant sub-group. Secondly, Hispanic/Latinos represent 17% of new HIV infections,1 yet only comprise 15% of the U.S. population. And, lastly, Hispanics/Latinos face notable HIV detection and access disparities. For example Hispanics/Latinos who are HIV-positive are more likely to: 1) suffer from late detection, 2) have late initiation of treatment and 3) discontinue treatment prematurely compared to others living with HIV.2 Prioritizing HIV: Findings from the 2010 VIA Community Survey indicated that 22% of respondents knew of someone who was HIV-positive.3 Yet, with this alarming prevalence, HIV was not identified as the health issue of greatest concern for the community. Co-occurring issues such as poverty, discrimination, lack of steady employment, school drop-out and laws targeting immigrant communities diminish the significance of HIV in the community. Greatest Impact: According to the 2010 VIA Community Survey, more than half of the community believes that youth are at greatest risk for HIV. Citations

An increase of HIV in the community would mean that we will lose interest in loving others for fear of the disease. 30-year old Mexican man, TN

However, among the community there is an emerging focus on the risk of infection for women (married and single), newborns and Hispanics in general. This reflects a broader understanding of basic HIV transmission. Alternative Approaches to Testing: Until Immigrants have access to affordable medical care and the issues of stigma are resolved, it is problematic to depend on the community accessing services in locations they do not identify as supportive to their status and needs. One in four community members recommends testing/prevention services at health fairs, farmworker associations and churches.4 Call to Action: There are important lessons to be learned about the need to provide data to communities. The community’s perception of the importance of prioritizing the issue of HIV in the community increased from 68% to 91% with the presentation of clear, culturally relevant HIV/AIDS statistics. Twenty percent of respondents are actively engaged in educating the broader community about HIV. Seventynine percent recommend local HIV prevention campaigns and trainings.5

1) CDC, 2010; 2) Levin, 2007; 3) RWHP 2010; 4) ibid; 5) ibid; 6) The White House, 2010; 7) Ritter & Hoffman, 2010; 8) Rhodes, McCoy, Vissman, Hergenrather, Foley, Alonzo, Bloom & Eng, 2011; 9) RWHP, 2010; 10) RWHP, 2010; 11) Ritter & Hoffman, 2010. Full citations at http://www.via.rwhp.org/citations.html

The Hispanic Community’s Perspectives on HIV/AIDS

1 in 5

4 in 5

Knew someone infected with HIV

Recommend local HIV prevention campaigns


Voices of Immigrants in Action

InBrief

No. 1

Lay-Health Worker Outreach

are not necessarily paid staff. Most importantly, effective Lay-health worker programs provide women with trusting, lay-health workers are not always associated with health relevant and intimate support within their neighborhoods. providers or health institutions, but rather churches, As peers, lay-health workers can address cultural factors, community groups and grassroots associations. A peer who knows how to respectfully speak to the which correlate with women’s health issues. Lay-health workers can be the bridge between community community, enthusiastically shares trusted resources, yet is and service providers in areas most affected by disparities still part of their reality is what is deemed effective by the 5 6 in health and education. They are concerned about the community. Ideal characteristics: • Come from the community in which they work health status of their commu• Are defined by their active stance within the nity and are passionate for "People who are community and healthcare setting new information and skills to Promotores(as) have a • Are not "doctors and nurses without a license," share through face-to-face gift for service and a they are well trained and expected to perform noble and kind heart. We exchanges with their target health promotion, education and service delivery communities.1 Using effecthink about things and within a limited scope tive health communication take care of people. We • Use "popular education" in their work. identify with the people tools, lay-health workers can be part of an integral The inclusion of lay-health workers into strategies which and the needs of the approach to eliminating build access, health literacy and support is essential in community." disparities and reaching Hispanic immigrant communities who are greatly -Mirian Perez, health Promotora improving health outcomes.2 affected by health disparities. Lay-health workers are a Known by many names (promotores, peer educators and sustainable option to shifting community health realities community health workers), lay-health workers are because the worker is tied to the community. As trusted community members who feel moved to serve their community members, they have the unique opportunity to community. Once trained, they strengthen the well-being continually affect positive health change within their comof their community through workshops, community munities, long after programs end. Women need allies in achieving prevention.

service and leadership development.3 There is much discussion about the role of lay-health workers. According to the National Community Health Advisor Study, "The cornerstone of Promotor(a) programs is the recruitment of community members who possess an intimate understanding of the community's social networks as well as its strengths and its special health needs."4 Layhealth workers, while often given incentives or a stipend,

For more information about lay-health worker programs: Florida Promotor Initiative: http://www.rwhp.org/FPI.html

Migrant Health Promotion: http://www.migranthealth.org/index.php?option=com_content &view=article&id=41&Itemid=38

1) Lewy R., Ricardo F., Forges B., Nelson A. (2008). Tuberculosis and the Foreign-born Spanish Speaker on the Border and Beyond. EpiLink Online Bulletin, vol. 65, 1. Retrieved February 28. 2008 from: http://www.dshs.state.tx.us/idcu/epilink/volume_65/issue_1/Docs/65_01_01.pdf. 2) Rural Women's Health Project, http://www.rwhp.org/FPI.html 3) Rural Women's Health Project, http://www.rwhp.org/lay-health.html 4) Rosenthal, E.L., Wiggins, N., Brownstein, J. N., Rael, R., Johnson, S., & Koch, E. et.al. (1998). The final report of the National Community Health Advisor Study: Weaving the future. Tucson, Arizona: University of Arizona, Health Sciences Center. 5) The Rural Women’s Health Project (2010) VIA Community Survey. 6) The Next Door, Inc., http://www.nextdoorinc.org/programs_ncs_health_promoters.html, accessed June, 28, 2011.

The VIA InBriefs are an elaboration on 2010 community-driven recommendations. Our goal is to construct a bridge to community engagement and strategy shifts for improved service delivery. ©2011, Rural Women’s Health Project. ● www.via.rwhp.org ● rwhp@cafl.com ● 352-372-1095 This project is funded by AIDS United-Southern REACH/Gulf Coast HIV/AIDS Relief Fund, with funds from the Ford Foundation.


The Undercurrents Impeding HIV Prevention/Testing Among Rural Hispanic Immigrants