We propose to investigate structural environmental factors associated with alcohol-related sexual HIV risk in Latino migrant day laborers (LMDLs). A major objective is to develop and test a theoretical model of risk and resiliency in LMDLs coping with alcohol-related situations in which safer sex is difficult to practice. Results will also be used to recommend structural environmental interventions (e.g., community and culture-based resources), capable of decreasing alcohol-related sexual HIV risk. Literature reviews on HIV risk and alcohol use in Latino labor migrants document numerous risk factors: multiple sex partners in the U.S., sex with female sex workers, sex between men, low condom use, high rates of alcohol use that co-occur with sexual activities. However, existing studies focus almost exclusively on behavioral risk without incorporating the contexts within which risk occurs. Our conceptual model draws upon Sweat and Dennison's multi-level model of AIDS causation, and Diaz et al.'s empirically derived model of substance-related sexual HIV risk in predominantly immigrant Latino MSM as on outcome of socially oppression factors. We will similarly explore how harsh migration-related environmental conditions result in psychological distress, which in turn may increase participation in alcohol-related situations in which sexual HIV risk is likely for LMDLs.
Study aims are to: 1) Explore qualitatively relations between environmental and individual factors, related to sexual HIV risk, and mediated by alcohol-related situations encountered by LMDLs;2) Develop a model of alcohol- related sexual HIV risk and resiliency based on qualitative data, and empirically test this model with quantitative survey data;and 3) recommend structural environmental interventions capable of decreasing alcohol-related sexual HIV risk based on model results and continuing qualitative research.
Aim 1, will be achieved with participant observation ethnography and in-depth interviews with 50 LMDLs, to identify environmental and individual factors, related to sexual HIV risk, and mediated by alcohol-related situations.
Aim 2 will be achieved by using qualitative data from Aim 1 to refine our model and develop a quantitative survey instrument that will be used to test our model by conducting an epidemiological survey of 300 LMDLs, preceded by cognitive interviews with 12 LMDLs to refine, and field testing with 24 LMDLs to finalize, survey. To achieve Aim 3, model results and continuing ethnography (i.e., 6 focus groups with LMDLs using and not using community resources, key informant interviews with 12 LMDL-serving agency partner staff), will be synthesized to recommend structural environmental interventions capable of decreasing alcohol-related sexual HIV risk. Prevention science will benefit from greater understanding of the complex context of HIV risk and resiliency in an especially marginalized group of Latinos, and from a set of recommended structural environmental prevention interventions derived through theory-driven systematic research.
The proposed study will generate new understanding of how migration-related structural environmental factors contextualize alcohol-related sexual HIV risk and resiliency, in an especially marginal at-risk group of Latinos. The study will also yield strong recommendations for developing new, including scaling-up existing community and culture-based resources to be, structural environmental prevention interventions capable of decreasing risk by mitigating harsh migrant- related environments, consequent individual level distress, and by reducing participation in or improve coping with alcohol-related situations in which safer sex practices are less likely.
|Bourgois, Philippe; Holmes, Seth M; Sue, Kim et al. (2016) Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care. Acad Med :|
|Quesada, James; Arreola, Sonya; Kral, Alex et al. (2014) "As Good As It Gets": Undocumented Latino Day Laborers Negotiating Discrimination in San Francisco and Berkeley, California, USA. City Soc (Wash) 26:29-50|
|Worby, Paula A; Organista, Kurt C; Kral, Alex H et al. (2014) Structural vulnerability and problem drinking among Latino migrant day laborers in the San Francisco Bay Area. J Health Care Poor Underserved 25:1291-307|
|Organista, Kurt C; Worby, Paula A; Quesada, James et al. (2013) Sexual health of Latino migrant day labourers under conditions of structural vulnerability. Cult Health Sex 15:58-72|