Date of Award

2023-12-01

Degree Name

M.P.H.

Department

Public Health

Advisor(s)

Julia Lechuga

Second Advisor

Maria Duarte-Gardea

Abstract

Research indicates that migration is a social determinant of health that increases the risk of acquiring HIV. What is less understood, however, are the pathways through which immigration influences HIV risk. This study employed a cross-national perspective and utilized a social determinants of health framework to understand how structural factors, such as economic conditions and immigration policies and their enforcement, influence HIV risk among migrants. While mobility, migration and displacement are associated with increased HIV risk, they are not inherently the cause but rather a condition under which vulnerability is increased indicating that other distal, upstream, or structural forces are at play. The purpose of this study is to conduct a secondary data analysis of data obtained from a larger study conducted to understand the lived experiences of immigrants who are residing on the US-Mexico Border waiting to cross into the US. The purpose of the secondary analysis was to elucidate potential pathways through which migration influences HIV risk. This study aims to elucidate the factors, operating at different levels of influence, that impact immigrantsâ?? health and HIV risk throughout the different phases of migration, including in the country of origin and at the country of transit. This study aims to better understand the factors that exacerbate or ameliorate ill health and increase HIV risk among migrants and to understand the implications of findings for interventions that aim to promote the health of migrants throughout the different phases of migration, including during transit. This study will utilize data generated from a study which consisted of 28 in-depth interviews with immigrants from Central America or Cuba who had arrived in the US-Mexico border city of Ciudad Juarez in the last 24 months, were at least 18 years of age, and had injected and/or sold drugs in the last month. Participants were recruited through standard outreach and social network referral. The mean age among the participants was 33.4 years (SD = 8.05). Study participants reported many experiences with discrimination and violence during migration, including high levels of violence perpetrated by law enforcement officials; among study participants, 69.2% and 53.8% reported abuse by city police and immigration agents, respectively. Furthermore, 92.3%, 88.5%, and 50% of participants reported being extorted by military agents, immigration officials, and police, respectively. These high levels of discrimination, violence, and extortion experienced by migrants during their perilous journey, coupled with the loss of family and social networks manifested in poor mental health outcomes. Among study participants, 85.2% reported anxiety after migrating, compared with only 44.4% prior to migrating; 77.8% reported sadness after migrating, compared with 48.1% before migrating; 66.6% of study participants also reported feeling down, depressed, or a loss of hope most or almost every day, and 40.7% reported having feelings of suicide or self-harm most or almost every day. The loss of social networks coupled with the inherent structural vulnerability faced during migration including food and housing insecurity, a precarious immigration status, and loss of healthcare access and legal protections expose migrants to discrimination, violence, and extortion. These vulnerabilities in turn increase migrants' HIV risks through their engagement in HIV risk behaviors to cope with or mitigate these realities including substance use and sex in exchange for money, food, shelter, or safety. Results indicated that 92.6% of participants reported using illicit drugs after migrating compared with 44.4% prior to migrating. In light of the passage of recent immigration policies such as the Migrant Protection Protocols whereby migrants and asylum seekers are mandated to remain outside of the US, the country of destination, conducting research with migrants at the transit or interception phases may contribute to a better understanding of the factors that promote HIV risk among migrants. This study elucidates potential pathways through which immigration influences HIV risk including factors that operate at different levels of influence and impact migrant health throughout the different phases of migration, including in the countries of transit and at the US-Mexico Border. The perilous conditions faced at the country of origin and loss of family and social networks after migration coupled with the violence, abuse, and extortion experienced throughout the various phases of migration indicate a perpetuation of HIV risk through distal, upstream, or structural forces including socioeconomic and sociopolitical forces such as immigration policies and their enforcement. Migration is a transnational social process that exerts an influence on a continuum spanning space and time. Immigration policies and public health interventions should consider the interconnectedness of the social determinants of health to contextualize migrant health and to better address the pathways and mechanisms through which sociocultural and socioeconomic forces, such as immigration policies and their enforcement, coalesce to perpetuate ill health and HIV risk.

Language

en

Provenance

Recieved from ProQuest

File Size

139 p.

File Format

application/pdf

Rights Holder

J. M. Aleman

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