Risk for Coccidioidomycosis among Hispanic Farm Workers, California, USA, 2018.

To determine occupational risk factors for coccidioidomycosis among adult Hispanic outdoor agricultural workers in California, USA, we conducted a case-control study of workers seen at the Kern County medical facility and referred to the public health laboratory for coccidioidomycosis serologic testing. Participants completed an interviewer-administered health and work questionnaire. Among 203 participants (110 case-patients with positive and 93 controls with negative serologic results), approximately half were women, and more than three quarters were born in Mexico. Associated with coccidioidomycosis were self-reported dust exposure and work with root and bulb vegetable crops. A protective factor was leaf removal, an activity associated with grape cultivation. We conclude that subjective dust exposure and work with root and bulb vegetable crops are associated with increased risk for coccidioidomycosis among Hispanic farm workers. The agricultural industry should evaluate and promote dust-reduction measures, including wetting soil and freshly harvested products.

Understanding the Impact of Migration on HIV Risk: An Analysis of Mexican Migrants' Sexual Practices, Partners, and Contexts by Migration Phase.

HIV risk among Mexican migrants varies across migration phases (pre-departure, transit, destination, interception, and return), but there is limited knowledge about specific sexual behaviors, characteristics of sexual partners, and sexual contexts at different migration stages. To fill the gap, we used data from a cross-sectional population-based survey conducted in Tijuana, Mexico. Information on migration phase and last sexual encounter was collected from 1219 male migrants. Our findings suggest that compared to pre-departure migrants, repeat migrants returning from communities of origin were more likely to have sex with male partners, use substances before sex, and not use condoms; migrants in the transit phase in the Mexican border were more likely to have sex with casual partners and sex workers; and migrants in the interception phase were more likely to engage in anal sex and use substances before sex. Sexual behaviors, partners, and contexts vary significantly among migrants at different migration phases. Tailored HIV prevention programs targeting Mexican migrants need to be developed and implemented at all migration phases.

Risk behaviours for HIV infection among travelling Mexican migrants: The Mexico-US border as a contextual risk factor.

The Mexico-US border region is a transit point in the trajectory of Mexican migrants travelling to and from the USA and a final destination for domestic migrants from other regions in Mexico. This region also represents a high-risk environment that may increase risk for HIV among migrants and the communities they connect. We conducted a cross-sectional, population-based survey, in Tijuana, Mexico, and compared Mexican migrants with a recent stay on the Mexico-US border region (Border, n = 553) with migrants arriving at the border from Mexican sending communities (Northbound, n = 1077). After controlling for demographics and migration history, border migrants were more likely to perceive their risk for HIV infection as high in this region and regard this area as a liberal place for sexual behaviours compared to Northbound migrants reporting on their perceptions of the sending communities (p < .05). Male border migrants were more likely to engage in sex, and have unprotected sex, with female sex workers during their recent stay on the border compared to other contexts (rate ratio = 3.0 and 6.6, respectively, p < .05). Binational and intensified interventions targeting Mexican migrants should be deployed in the Mexican border region to address migration related HIV transmission in Mexico and the USA.

Migrants in transit: the importance of monitoring HIV risk among migrant flows at the Mexico-US border.

We conducted a probability-based survey of migrant flows traveling across the Mexico-US border, and we estimated HIV infection rates, risk behaviors, and contextual factors for migrants representing 5 distinct migration phases. Our results suggest that the influence of migration is not uniform across genders or risk factors. By considering the predeparture, transit, and interception phases of the migration process, our findings complement previous studies on HIV among Mexican migrants conducted at the destination and return phases. Monitoring HIV risk among this vulnerable transnational population is critical for better understanding patterns of risk at different points of the migration process and for informing the development of protection policies and programs.

Healthcare access among circular and undocumented Mexican migrants: results from a pilot survey on the Mexico-US border.

BACKGROUND: Temporary and unauthorized migrants may face unique obstacles to access health care services in the U.S. OBJECTIVE: This study estimated levels of health care access among Mexican migrants returning to Mexico from the U.S. and factors associated with access to health care, with emphasis on the role of modifiable, enabling factors. METHODS: We conducted a pilot probability health care survey of migrants in the border city of Tijuana, Mexico (N=186). RESULTS: Approximately 42% of migrants reported having used health care services in the U.S. during the past year. Only 38% had a usual source of care and approximately 11% went without needed medical care in the U.S. About 71% of migrants did not have health insurance in the U.S. Lack of health insurance and transportation limitations were significantly related to various access indicators. CONCLUSION: These results have implications for future policies and programs aimed to address modifiable health care access barriers faced by these vulnerable and underserved segments of the Mexican migrant population.

A two-way road: rates of HIV infection and behavioral risk factors among deported Mexican labor migrants.

A large number of Mexican migrants are deported to Mexico and released in the North Mexican border region every year. Despite their volume and high vulnerability, little is known about the level of HIV infection and related risk behaviors among this hard-to-reach population. We conducted a cross-sectional, probability survey with deported Mexican migrants in Tijuana, Mexico (N = 693) and estimated levels of HIV infection and behavioral risk factors among this migrant flow. The sample and population estimated rates of HIV for deported males were 1.23 and 0.80 %, respectively. No positive cases were found among the female sample. We found high lifetime rates of reported sexually transmitted infections (22.3 %) and last 12-months rates of unprotected sex (63.0 %), sex with multiple sexual partners (18.1 %), casual partners (25.7 %), and sex workers (8.6 %), compared to U.S. and Mexico adults. HIV prevention, testing, and treatment programs for this large, vulnerable, and transnational population need to be implemented in both the U.S. and Mexico.

Marketing HIV prevention for heterosexually identified Latino men who have sex with men and women: the Hombres Sanos campaign.

This article describes the development process of Hombres Sanos, a social marketing campaign to promote HIV testing and condom use for heterosexually identified Latino men who have sex with men and women. The steps included qualitative formative research and a social marketing analytic framework to understand our target audience better, identify incentives and barriers to risk reduction, guide product development, define an optimal promotional campaign, and inform the selection of campaign platforms. A better grasp of the authors' target beneficiaries' needs and values led to an innovative dual strategy for audience segmentation and targeting. The campaign had consumer-centered, culturally sensitive, and theory-driven communication materials. The authors found communication materials and events to be appealing and effective. The campaign was well received among the wider community, and evaluation showed promising results among Latino men in general and among heterosexually identified Latino men who have sex with men and women in particular. The authors provide a step-by-step overview of the project's formative research, including research methods and findings, and how these were translated into a social marketing campaign. In addition, the authors discuss the challenges encountered in this process and the potential of social marketing to reduce HIV risk among Latinos.

Determinants and prevalence of late HIV testing in Tijuana, Mexico.

Timely diagnosis of HIV is essential to improve survival rates and reduce transmission of the virus. Insufficient progress has been made in effecting earlier HIV diagnoses. The Mexican border city of Tijuana has one of the highest AIDS incidence and mortality rates in all of Mexico. This study examined the prevalence and potential correlates of late HIV testing in Tijuana, Mexico. Late testers were defined as participants who had at least one of: (1) an AIDS-defining illness within 1 year of first positive HIV test; (2) a date of AIDS diagnosis within 1 year of first positive HIV test; or (3) an initial CD4 cell count below 200 cells per microliter within 1 year of first positive HIV test. Medical charts of 670 HIV-positive patients from two HIV/AIDS public clinics in Tijuana were reviewed and abstracted; 362 of these patients were interviewed using a cross-sectional survey. Using multivariate logistic regression, we explored potential correlates of late HIV testing based on the Behavioral Ecological Model. From 342 participants for whom late testing could be determined, the prevalence of late testing was 43.2%. Multivariate logistic regression results (n = 275) revealed five significant correlates of late testing: "I preferred not to know I had HIV" (adjusted odds ratio [AOR] = 2.78, 1.46-5.31); clinic (AOR = 1.90, 1.06-3.41); exposure to peers engaging in high-risk sexual behavior (AOR = 1.14, 1.02-1.27); stigma regarding HIV-infected individuals (AOR = 0.65, 0.47-0.92); and stigma regarding HIV testing (AOR = 0.66, 0.45-0.97). These findings may inform the design of interventions to increase timely HIV testing and help reduce HIV transmission in the community at large.

Feasibility and use of school-based condom availability programs in Tijuana, Mexico.

Condom availability programs (CAPs) may increase access to condoms and contribute to increased condom use among youth. This study describes the characteristics, degree of satisfaction, and gender differences among users of a CAP implemented in two high schools in Tijuana (Baja California, Mexico). A kiosk distributing free male condoms was set up in two high schools in Tijuana. Kiosk users (N=570) were more likely to be male, young, and/or enrolled in a lower SES school. Most kiosk users were either sexually active or planning to have sex. Females were less likely to request condoms and to continue using the kiosk, but more likely to request information on other contraceptive methods. Results demonstrate the feasibility of implementing CAPs in Mexican schools and suggest that these programs can improve adolescents' condom access.

Prevalence of risk factors for HIV infection among Mexican migrants and immigrants: probability survey in the North border of Mexico.

OBJECTIVE: To estimate the prevalence of risk factors for HIV infection among Mexican migrants and immigrants (MMIs) in different geographic contexts, including the sending communities in Mexico, the receiving communities in the United States (US), and the Mexican North border region. MATERIAL AND METHODS: We conducted a probability survey among MMIs traveling through key border crossing sites in the Tijuana (Baja California, Mexico)-San Diego (California, US) border region (N= 1,429). RESULTS: The survey revealed substantial rates of reported sexually transmitted infections, needle-sharing and sexual risk practices in all migration contexts. CONCLUSIONS: The estimated levels of HIV risk call for further binational research and preventive interventions in all key geographic contexts of the migration experience to identify and tackle the different personal, environmental, and structural determinants of HIV risk in each of these contexts.

Prevalence of risk factors for HIV infection among Mexican migrants and immigrants: probability survey in the north border of Mexico

OBJETIVO: Estimar la prevalencia de prácticas de riesgo para la infección por VIH en migrantes mexicanos durante su estancia en distintos contextos geográficos, incluyendo sus comunidades de origen en México, las comunidades de destino en Estados Unidos de América (EUA), y la frontera Norte de México. MATERIAL Y MÉTODOS: Encuesta probabilística de migrantes mexicanos que transitan por la región fronteriza Tijuana (Baja California, México)-San Diego (California, EUA) (N=1 429). RESULTADOS: La encuesta reveló una alta prevalencia de infecciones de transmisión sexual, uso compartido de agujas, y prácticas sexuales de riesgo en todos los contextos geográficos estudiados. CONCLUSIONES: Los niveles de riesgo de infección por VIH estimados para migrantes mexicanos en diferentes contextos geográficos exigen estudios e intervenciones preventivas binacionales que identifiquen y aborden los distintos factores de riesgo personales, ambientales, y estructurales que contribuyen al riesgo de infección por VIH en cada contexto.

HIV infection in mobile populations: the case of Mexican migrants to the United States.

OBJECTIVE: Previous studies have indicated varying rates of HIV infection among labor migrants to the United States of America. Most of these studies have been conducted with convenience samples of farmworkers, thus presenting limited external validity. This study sought to estimate the prevalence of HIV infection and risk factors among Mexican migrants traveling through the border region of Tijuana, Baja California, Mexico, and San Diego, California, United States. This region handles 37% of the migrant flow between Mexico and the United States and represents the natural port of entry for Mexican migrants to California. METHODS: From April to December 2002 a probability survey was conducted at key migrant crossing points in Tijuana. Mexican migrants, including ones with a history of illegal migration to the United States, completed an interview on HIV risk factors (n = 1 429) and an oral HIV antibody test (n = 1,041). RESULTS: Despite reporting risk factors for HIV infection, none of the migrants tested positive for HIV. CONCLUSIONS: Our findings contrast with previous estimates of HIV among labor migrants in the United States that were based on nonprobability samples. Our findings also underline the need for early HIV prevention interventions targeting this population of Mexican migrants.

HIV infection in mobile populations: the case of Mexican migrants to the United States / La infección por VIH en poblaciones migratorias: la situación de los obreros itinerantes mexicanos en los Estados Unidos

Objetivo. Estudios anteriores han revelado diferentes tasas de infección por VIH en la población de obreros itinerantes que han ingresado en los Estados Unidos de América. La mayoría de esos estudios se efectuaron con muestras de trabajadores agrícolas tomadas por conveniencia, y por lo tanto su validez externa ha sido limitada. El presente estudio se realizó con el fin de calcular la prevalencia de la infección por VIH y de sus factores de riesgo en los obreros itinerantes mexicanos que se desplazan por el territorio fronterizo de Tijuana, Baja California, México y San Diego, California, Estados Unidos. Esta zona, por donde pasan 37% de los obreros itinerantes que vienen de México a los Estados Unidos, es el natural puerto de entrada de trabajadores mexicanos que van a California. Métodos. De abril a diciembre de 2002 se realizó una encuesta por conveniencia en diferentes puntos clave de Tijuana por donde cruzaban la frontera los obreros itinerantes. Los obreros, entre ellos algunos con antecedentes de inmigración ilegal a los Estados Unidos, completaron una entrevista sobre los factores de riesgo de infección por VIH (n = 1 429) y fueron sometidos a una prueba oral para la detección de anticuerpos contra el VIH (n = 1 041). Resultados. Aunque los obreros indicaron tener factores de riesgo asociados con la infección por VIH, ninguno de ellos tuvo un resultado positivo en la prueba detectora de VIH. Conclusiones. Estos resultados difieren radicalmente de los obtenidos anteriormente al usar muestras no probabilísticas para calcular la tasa de infección por VIH en obreros itinerantes en los Estados Unidos. Resaltan, además, la necesidad de llevar a cabo intervenciones tempranas para prevenir la infección por VIH en obreros itinerantes mexicanos

Objective. Previous studies have indicated varying rates of HIV infection among labor migrants to the United States of America. Most of these studies have been conducted with convenience samples of farmworkers, thus presenting limited external validity. This study sought to estimate the prevalence of HIV infection and risk factors among Mexican migrants traveling through the border region of Tijuana, Baja California, Mexico, and San Diego, California, United States. This region handles 37% of the migrant flow between Mexico and the United States and represents the natural port of entry for Mexican migrants to California. Methods. From April to December 2002 a probability survey was conducted at key migrant crossing points in Tijuana. Mexican migrants, including ones with a history of illegal migration to the United States, completed an interview on HIV risk factors (n = 1 429) and an oral HIV antibody test (n = 1 041). Results. Despite reporting risk factors for HIV infection, none of the migrants tested positive for HIV. Conclusions. Our findings contrast with previous estimates of HIV among labor migrants in the United States that were based on nonprobability samples. Our findings also underline the need for early HIV prevention interventions targeting this population of Mexican migrants

Evaluation of two school-based HIV prevention interventions in the border city of Tijuana, Mexico.

This research project examined the individual and combined effectiveness of an HIV prevention workshop and a free condom distribution program in four high schools in Tijuana, Mexico. Adolescents (N = 320) completed baseline measures on sexual practices and theoretical correlates and participated in a two-part study. In Study 1, students were randomly assigned to an HIV prevention workshop or a control condition, with a 3-month follow-up assessment. Results indicate three significant workshop benefits regarding HIV transmission by altering sexual initiation, access to condoms, and traditional beliefs regarding condoms. In Study 2, we set up a condom distribution program at two of the participating schools, and students completed a 6-month follow-up assessment. Results indicate that exposure to the workshop followed by access to the condom distribution program yielded two beneficial results for reducing HIV transmission: moderating sexual initiation and increasing condom acquisition. Access to the condom distribution program alone had no effects on behavioral and psychosocial correlates of HIV transmission. We discuss implications of these results.

Gender differences in condom-related behaviors and attitudes among Mexican adolescents living on the U.S.-Mexico border.

Adolescents are at increasing risk for HIV infection in Mexico. Research on gender differences in risk behaviors and determinants is needed to develop effective HIV prevention interventions targeting Mexican adolescents. This study examined gender differences in the likelihood of unprotected sex and theoretical correlates among high school students in the border city of Tijuana. Three hundred seventy high-school students completed a face-to-face interview and a self-administered survey. Differences in sexual initiation, condom use, intentions to use condoms in the future, and attitudes towards condoms in this population were assessed. Although male students initiated sexual practices earlier than females, females were more likely to have unprotected sex. Females perceived themselves as more likely to avoid unprotected sex in the future and held more favorable attitudes about condoms. The results suggest that stereotypical gender roles and communication barriers place Tijuana female high school students at higher risk for HIV infection than their male peers.

Increasing Latino adolescents' adherence to treatment for latent tuberculosis infection: a controlled trial.

OBJECTIVES: We sought to determine the efficacy of coaching Latino adolescents with latent tuberculosis infection to adhere to isoniazid treatment. METHODS: Participants (n = 286) were randomly assigned to adherence coaching, attention control, or usual care groups. Adherence was measured via interviews and validated with urine assays. RESULTS: Coaching resulted in significant increases in adherence compared with attention and usual care groups. Bicultural adolescents were more likely to be adherent than those most or least acculturated. Age and risk behavior were negatively related to adherence. CONCLUSIONS: Coaching can increase Latino adolescents' adherence to treatment for latent tuberculosis infection and should contribute to tuberculosis control for adolescents at high risk of contracting the disease.