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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 3, Spring 2011

Risk Factors & Recommendations HIV/AIDS and Rural Hispanic Immigrant Women HIV infection among Hispanic women in the South is increasing. Of the Hispanic women diagnosed with AIDS in 2006, 75% became infected from heterosexual contact.1 Domestic violence, machismo and the traditional role of women in the Hispanic community make condom use negotiation difficult, at best. HIV risk increases when women lack control over their body and in the use of birth control.2 These issues overlap with the 2010 VIA Community Survey findings.

The Community’s Greatest Concerns about Women* Domestic Violence Lack of prioritzing their own health Depression Lack of self-esteem Barriers to accessing health care Stable, safe employment

*Data results are from 188 in-depth interviews with Hispanic Immigrants in North Central Florida and Eastern Tennessee as part of the 2010 VIA Community Survey.

Emotional Health Factors: Key risk factors for HIV infection include low self-esteem and depression.3 In the 2010 VIA Community Survey, the community expressed heightened concern about women’s self-esteem and mental health. In a 2009 study from the same region, more than half of the community women receiving lay-health worker services requested information about mental health, referrals for depression or assistance for improving communication with their partner.4 Health Care Access: Lack of access to health care is one issue driving the increase in HIV/AIDS infection among Hispanic women in the South. In 2009, 64% of Hispanic Immigrant women in North Florida did not have a regular health care provider, 63% did not have health insurance and 33% did not know where to go for care.5 Cultural Attitudes: Three cultural factors are important to address in serving Hispanic Immigrant women. One, women’s dual role as mother and laborer, two, the lack of identification of HIV risk as married women, and three, their religious beliefs. These factors are key to shifting prevention behaviors and for the implementation of programs that make an impact.6 Domestic Violence: For Immigrant women, adjunct to the universal barriers women face in reporting abuse or leaving their abuser, is the issue of their immigration status, or that of the abuser. The implementation of the current policies does not always respect immigrant women’s rights to legal support or safety. Call to Action: To maximize Hispanic Immigrant women’s ability to reduce their risk for HIV will require a multi-level approach: increase health literacy, address cultural attitudes and streamline access to health services/ programs–all of which are crucial.


Community-driven Recommendations Community-driven recommendations construct a bridge for both community engagement and to shift policy and programs for improved service delivery. Unification of Services “Unified Resource Hubs” are critical bridges to offering clinical care, mental health services, legal assistance, empowerment programs and access to resources and referrals. Lay-Health W orker Outreach Women need allies in achieving prevention and reducing such risk factors as machismo, abuse and traditional roles. Lay-health worker programs provide women with trusting, relevant and intimate support within their neighborhoods. Community Education Immigrant communities benefit from understanding their responsibilities and rights to health care, social and safety services. Workshops addressing patient and legal rights serve to diminish barriers that are created by misinformation or lack of information. Church-led Initiatives Central to shifting the cultural attitudes and stigma that impede HIV prevention is the inclusion of pastoral services/ programs which offer a faith perspective to strengthen communication between men and women and to increase community support.

Increasing Women’s Health Literacy as Prevention Reproductive and emotional health are main tenants of comprehensive women’s health. These are vital elements for the successful utilization of risk reduction strategies by Hispanic Immigrant women.7 Person-centered education increases a woman’s ability to synthesize her emotional needs with her physical health. The connection helps a woman to understand the consequences of her health behaviors. This holistic approach enhances her ability to make better health choices,8 improving her self-esteem and overall mental health9. Health literacy campaigns for Hispanic women can be implemented at churches, community and migrant health centers and through community-based lay-health worker programs.

Additionally, health literacy can be increased by incorporating dynamic, culturally-relevant health education into outreach work, one-on-one trainings and even as discussion tools at women’s workshops. Making sure women don't have to suffer VAWA and Immigrant Women beatings in silence, The Violence Against Women Act (VAWA) is designed to offer protection to all whatever their victims of abuse. Concern has been raised about improper implementation of immigration status, VAWA by the Department of Homeland Security and local law enforcement who has to be a priority. Rep. Raul Grijalva, work under the Secure Communities agreement.10 There are cases of immigrant, Arizona's 7th district abuse victims facing deportation proceedings, rather than focusing on the perpetrator’s crime. As Arizona’s Rep. Grijalva stated, “Abusive relationships are not a political issue–they're a public health and human rights issue.” This will continue to occur if law enforcement agencies are not trained about the rights for all immigrants under VAWA.

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Citations 1) Avert, 2008; 2) Lichtenstein, 2005; 3) ibid; 4) RWHP, 2008; 5) ibid; 6) Weidel, 2008; 7) Coffman & Norton, 2010; 8) Kutner, Greenberg, Jin, & Paulsen, 2006; 9) RWHP, 2010; 10) Grijalva, 2010. Full citations at http://www.via.rwhp.org/citations.html

Stay informed: www.ViaBlog.net ©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

InBrief In

No. 2

Women’s Health Literacy

Reproductive and emotional health are main tenants of comprehensive women’s health. These are vital elements for the successful utilization of risk reduction strategies by Hispanic Immigrant women.1 Person-centered education increases a woman’s ability to synthesize how her emotional status intersects with her physical health. A holistic approach enhances a woman’s ability to make better health choices2, improving her selfesteem and overall mental health.3 This connection allows a woman to understand the consequences of her health behaviors. In Health Literacy: A Prescription to End Confusion, health literacy is defined as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.4” Critical to health literacy is the selfidentification of risk. Therefore, to strengthen its impact, health literacy information needs to be presented in such a way that individuals are able to evaluate their own risk. Central to this, in any community, is context; cultural, economic and social.5 This is key when working with the immigrant community, where cultural differences and current environments add layers which interfere with the fluid absorption of information. The alternative to turning away from an emphasis on context and the correlation to mental health results in a lack of implementation of recommendations and a discouragement to access related services.6 This can be problematic when there are numerous emotional health concerns and a high incidence of chronic health issues identified in this community. 7/8

So what to do? The inclusion of concise attention to the ramifications of illness, medications and lack of cardiovascular exercise to one’s emotional health is an essential first step to increasing health literacy. The use of testimonial stories, presenting women and outcomes, help to increase the reality of the connection between health and emotions and allow for the potential of reflection and self-identification. Most importantly, making the connection between emotional health and physical health helps women to simply understand the old “neckbone is connected to the backbone” idea that our body is an interconnected system. When and where? Health literacy can be increased by incorporating dynamic, culturally-relevant health education outside of the clinic. The issue of health literacy should be the building blocks for both clinical interaction and health outreach. Broadening health literacy for Hispanic women beyond the medical setting means that it can be implemented at various locations: churches (from the pulpit and social groups), adult education programs, parent meetings and through community-based lay-health worker programs, to name a few. Most notably, the greatest benefit of the health literacy approach outlined above is the time taken to talk, reflect and self-evaluate one’s own health behaviors. For women, those reflections can be the segue to positive health choices. For more on health literacy, review: Kickbusch, I. (2001). Health literacy: addressing the health and education divide. Health Promotion International, 16 (3): 289-297. Access online: http://heapro.oxfordjournals.org/content/16/3/289.full#sec-6

1) Coffman, K.J., & Norton, C.K. (2010). Demands of immigration, health literacy, and depression in recent latino immigrants. Home Health Care Management & Practice , 22, 116-122. 2) Kutner, M., Greenberg, E., Jin,Y., & Paulsen, C. (2006). The health literacy of Americaʼs adults: results from the 2003 national assessment of adult literacy (NCES 2006–483). U.S. Department of Education. Washington, DC: National Center for Education Statistics. 3) Rural Womenʼs Health Project. (2010). Entre Nosotras White Paper, 8-9. http://www.rwhp.org/research.html 4) Clear Language Group. Health literacy. Retrieved from http://www.clearlanguagegroup.com/clear-communication/health-literacy/ 5) Ibid. 6) Baker, D.W. (1996). The health care experience of patients with low literacy. Archives of Family Medicine, 1996; 5(6). 7) Rural Womenʼs Health Project. (2010). Entre Nosotras White Paper, 3. http://www.rwhp.org/research.html 8) Coffman, K.J., & Norton, C.K. (2010). Demands of immigration, health literacy, and depression in recent latino immigrants. Home Health Care Management & Practice, 22, 116-122.

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.


Voices of Immigrants in Action

No. 3

InBrief Reaching Hispanic Immigrant

Women Through Resource “Hubs”

To maximize Hispanic immigrant women’s utilization of health and social services, we need to truly understand the well-documented barriers encountered by the community. Immigrant women, with a broad range of concerns, continuously rely on those who they trust to offer them guidance.

Consulate mobile unit, referrals to local health providers, health fairs in the fields, adult education, youth programming, support and referral for domestic violence, notary services and a justice of the peace.

In Putnam County’s program, health is not the focus, yet this service center assists the community by reducing the The “Unified Resource Hub” concept strives to ensure that barriers that often stand in the way of healthy families. a person and populations are connected to meaningful Through their “Hub,” the community becomes better health and social services that produce positive outcomes.1 informed, educated and linked to skills, programs and services that respond to their holistic needs. These critical services include clinical care, mental health services, “Hubs”... legal assistance, domestic violence often do best when The value of a “Hub” is further substantiated in the findings of the VIA Community Survey.2 Barriers to accessing advocacy, empowerment programs located within key healthcare continue to exist. Seventy-one percent of those and access to resources and referrals and trusted pro surveyed paid out-of-pocket for medical services. Another for women in this community. grams embraced 14%, in Florida, stated that they had a family member who by the community. was unable to access medical care in the last six months. For the Hispanic community, it is While 55% stated that the availability of translation is most imperative that the “Hub” concept go beyond the management of an individual’s or family’s important in selecting a clinic, 21% needed transportation health issues, but rather links individuals with a myriad of or other assistance to access care. services. “Hubs” take a comprehensive approach, the best ones being those that the community often returns to. Low-cost medical services are not the single answer to “Hubs” don’t need to be located in medical establish- improved health outcomes for immigrant communities. A ments—in fact, they often do best when located within key broader vision, a greater understanding and a more and trusted programs embraced by the community. Clearly, comprehensive response to their life challenges by trusted the mere ability to access care will not result in improved facilities are the best approach. Community partners outside of the health field need to be included in order to meet health outcomes. the community where they’re at and link them to valued services, assuring that together we are building healthy Located throughout each state, Migrant Education programs are excellent examples of productive “Unified communities. Resource Hubs”. In Florida, the Putnam County Migrant 1) Agency for Healthcare Research and Quality, Connecting Those at Risk to Care A Guide to Building a Community “HUB” To Promote a System of Collaboration, Education Office is a treasured case in point. This one-stop Accountability, and Improved Outcomes. AHRQ Publication No. 09(10)-0088, location offers assistance for a variety of programs includSeptember 2010. ing: migrant student services, assistance with applying for Data results are from 188 in-depth interviews with Hispanic Immigrants in North public services, legal services through the Mexican 2) Central Florida and Eastern Tennessee as part of the 2010 VIA Community Survey. For a description of existing “Community Hubs”-http://www.innovations.ahrq.gov/guide/HUBManual/existinghubs.aspx

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.

Risk Factors & Recommendations: HIV/AIDS and Rural Hispanic Immigrant Women  

Hispanic immigrant women speak out on the risk factors for HIV and what they want done about it. In this issue - get the facts and recommend...