Evaluating a Culturally Tailored HIV Risk Reduction Intervention Among Latina Immigrants in the Farmworker Community

• Author: Mariano Kanamori,Mario R. De La Rosa,Elena Cyrus,Gira Ravelo,Tan Li,Nilda P. Peragallo,Patria Rojas,Mariana Sanchez,Weize Wang
• DOI: http://doi.org/10.1002/wmh3.193
• Published date: 01 September 2016
• Date: 01 September 2016

Evaluating a Culturally Tailored HIV Risk Reduction

Intervention Among Latina Immigrants in the

Farmworker Community

Mariana Sanchez, Patria Rojas, Tan Li, Gira Ravelo, Elena Cyrus, Weize Wang,

Mariano Kanamori, Nilda P. Peragallo, and Mario R. De La Rosa

Latina immigrants in the farmworker community are a vulnerable and understudied population at

risk of acquiring HIV. Employing a CBPR framework, this pilot study was the f‌irst to evaluate the

eff‌icacy of SEPA, a CDC evidenced-based and culturally tailored HIV risk reduction intervention

on a cohort of N¼110 predominantly undocumented Latina immigrants in a farmworker

community. Findings revealed SEPA was effective in increasing HIV knowledge and decreasing

HIV risk behaviors. However, no changes in self-eff‌icacy were found in the present sample. We posit

specif‌ic socio-cultural and structural barriers specif‌ic to the farmworker community not targeted in

the original intervention may have hindered the program’s capacity to inf‌luence changes in self-

eff‌icacy among this less acculturated population. Possible socio-cultural adaptations of the

intervention to the target population and policy implications are discussed.

KEY WORDS: HIV/AIDS, Hispanic, Latino/a, immigrant, farmworker, migrant worker, seasonal

workers, women

Introduction

Nationally, rates of new HIV infections among Latinas are more than four

times (4.2) that of non-Latino White women (Centers for Disease Control and

Prevention [CDC], 2012, 2013a). Immigrant Latinas are a rapidly growing segment

of the U.S. population, with an increasing risk of acquiring HIV (Sastre, Sanchez,

& De La Rosa, 2015). In 2011, of the estimated 11,032 U.S. Latinos diagnosed with

HIV, 50 percent reported being foreign-born, with 44 percent of those being

women (CDC, 2011).

Less acculturated Latinas who recently immigrated to the United States may

be particularly vulnerable to contracting HIV as these women have (i) less

perceived risk of HIV/AIDS, (ii) less knowledge of how HIV/AIDS is contracted,

(iii) less likelihood of knowing where HIV testing can be obtained, and (iv) higher

stigma associated with HIV/AIDS (Shedlin, Ulises, & Oliver-Velez, 2005). In

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addition, previous research indicates most Latina immigrants living with HIV

become infected in the United States, underscoring the opportunity and need for

prevention services early in the immigration process (CDC, 2014; Dennis et al.,

2013).

Existing investigations examining the effectiveness of culturally tailored HIV

risk interventions among Latina immigrants have primarily focused on metropoli-

tan areas such as Miami and Chicago (Peragallo et al., 2005). These studies reveal

that cities with high concentrations of Latino immigrants have been particularly

affected by HIV/AIDS. In Miami-Dade County, 65 percent of residents are

Latinos, two-thirds (66 percent) of which are foreign born (mainly from the

Caribbean and South and Central America). Miami-Dade is not only home to the

most diverse Latino population of any U.S. city (U.S. Census Bureau, 2010), but

also leads the nation in highest rate of new cases of HIV infection and number of

people living with HIV/AIDS (CDC, 2013a). Between 2003 and 2012, the County

has seen a 40 percent increase in the proportion of reported HIV infections among

Latinos. Latinos in Miami-Dade are f‌ive times more likely to have HIV than non-

Latino White individuals (Florida Department of Health, 2013).

While existing studies reveal that Latino immigrants residing in urban areas

are particularly affected by HIV, far less is known about Latinas in farmworker

communities. Latinas in farmworker communities are among the most vulnerable

and understudied groups in the United States. Most of the produce we eat in the

United States is planted, nurtured, and harvested by migrant and seasonal

farmworkers. Migrant farmworkers move from one state to another or sometimes

within the same state to do agricultural work. Seasonal farmworkers live in one

place year-round, doing f‌ield work part of the year (planting, harvesting) and

other agricultural work (e.g., packing industry, nurseries) during the off-season

(National Center for Farmworker Health, 2016). Women make up 21 percent of

the estimated 2.5 million migrant and seasonal farmworkers in the United States

(Farmworker Justice, 2014). While they play a vital role in harvesting the food on

our plates, farmworker women are arguably the most exploited workers in this

country, even more vulnerable than male farmworkers as females in the f‌ields are

often given the least desired, lowest paying jobs, are the f‌irst to be laid off, receive

fewer opportunities to advance, and face a culture of discrimination and

machismo in the workplace (Fernandez et al., 2004; Human Rights Watch, 2012).

Farmworkers experience a conf‌luence of socio-demographic, ecological, and

behavioral circumstances that place them at risk for HIV infection (Fernandez

et al., 2004; Worby & Organista, 2007). Data regarding the incidence of HIV/AIDS

among farmworkers are scarce and most studies have been conducted on small,

farmworker community populations. Some research has identif‌ied HIV infection

rates among farmworkers to be as high as 13 percent (NCFH, 2011; Organista,

Organista, & Soloff, 1998). However, these statistics have been questioned as they

do not fairly encompass the farmworker population (Rao, Hancy, Velez, Freeman,

& Davis, 2008).

Social and structural barriers placing farmworkers at risk for HIV include

(i) language barriers; (ii) inadequate or incorrect HIV-related knowledge;

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