Hispanic immigrants bear a disproportionate burden of HIV infection in the US. Along with disproportionate rates of HIV infection, Hispanic immigrants are affected by three important drivers of the US HIV epidemic: disordered alcohol and drug use, intimate partner violence, and reduced rates of HIV testing. Importantly, each of these drivers of HIV infection is or has been legally regulated. Findings from a preliminary study suggest that immigration-related laws, Hispanic immigrants' beliefs about the immigration ramifications of engaging in HIV health-seeking behaviors, and immigrants' concerns about the bounds of immigration authority may deter or prevent them from utilizing important health care services and resources. To our knowledge there has never been a direct empirical study of the influence of immigration-related laws and legal concerns on Hispanic immigrants' sensitive HIV-related health-seeking behaviors. The proposed study will address this knowledge gap. Law and policy scans, key informant interviews, and structured focus groups with Hispanic immigrants living in 4 US metropolitan areas with diverse immigration law and enforcement environments will be conducted to explore immigrants' experiences with legal barriers and to identify the immigration-related concerns, beliefs, and misconceptions that influence their service utilization. Using the information gained from these activities, we will develop, refine, and psychometrically evaluate a novel measure of immigration-related concerns about health-seeking behaviors. The resulting Immigration Law Concerns measure will be administered to a large cross-section of Hispanic immigrants. Quantitative analyses of the survey data will identify the immigration law-related beliefs and concerns of our Hispanic immigrant sample, and to determine whether these concerns significantly influence their utilization of, or willingness to utilize alcohol or drug dependence, IPV, and HIV testing services. Associations between immigration environments, legal barriers to healthcare utilization, and resident immigrants' immigration concerns about utilizing services will also be explored. Identifying the nature of Hispanic immigrants' concerns about seeking help for key drivers of HIV infection and the barriers erected by immigration laws and policies will provide important evidence for intervention??at individual-, community-, and structural-levels??to reduce disproportionate rates of HIV infection among Hispanic immigrants and to shape laws and policies that are consistent with our National HIV Prevention Strategy.
Significance The proposed project will examine the influence of US immigration-related laws and policies, and US Hispanic immigrants' beliefs and concerns about immigration laws and authorities on their willingness to utilize and actual utilization of healthcare and resources related to three legally regulated drivers of HIV infection: alcohol and drug use disorders, intimate partner violence, and reduced HIV testing. Identifying the nature of Hispanic immigrants' concerns about seeking help for key drivers of HIV infection and the barriers erected by immigration laws and policies will provide important evidence for intervention??at individual-, community-, and structural-levels??to reduce disproportionate rates of HIV infection among Hispanic immigrants and to shape laws and policies that are consistent with our National HIV Prevention Strategy.
