A range of risk behaviours are more common for men after migration, reported researchers at the International AIDS Conference on August 5th. Sex with a commercial sex worker, sex while under the influence of drugs or alcohol, sex in exchange for money and sex with a man were behaviours identified as being more likely after migration.
These data come from one of a series of studies of Mexican immigration to the United States, and while many of the findings will be specific to that setting, they also highlight a number of issues that may be relevant to prevention work with migrants in other countries, including gay migrants.
Over eleven million Mexican people live in the United States. More men than women migrate, most are of working age, their stay in the US may be temporary, and around half are undocumented migrants. HIV prevalence is lower in Mexico than in the United States, but in the US it is relatively high among the Hispanic/Latino population, and recent migrants report higher levels of risky behaviours. The International AIDS Conference in Mexico City was an appropriate setting for a session on Tuesday afternoon exploring vulnerability to HIV among Mexican migrants.
Melissa Sanchez of the University of California highlighted a range of social factors which are likely to contribute to vulnerability among migrants: poverty, underemployment, poor housing, constant mobility (particularly in order to seek employment), isolation, depression and limited access to healthcare.
Her study was of 364 men who had either been in the US for less than five years, or who went back to Mexico regularly. Participants were recruited at worksites (farms, job pick-up points, makeshift camps), bars and nightclubs (including those used by men who have sex with men) and community venues (family housing, grocery stores, churches etc).
Several previous studies have identified that Mexican migrants to the US have a high level of risk behaviours, but have not been able to measure the change in risky behaviour on an individual level. She therefore asked her respondents about a range of risk behaviour, both before and after migration.
She found that while 18% of respondents had had sex with a sex worker before migration, 29% had done so afterwards (p= <0.0001). Similarly, those having sex while under the influence of drugs or alcohol rose from 25% to 41% (p= <0.0001), and those reporting sex with another man rose from 4% to 7%. Concerning transactional sex (sex in exchange for money, food, shelter, drugs or protection), 1.4% reported this before migration, and 2.7% afterwards.
Sanchez found that risk behaviours were more common in men recruited at work sites and bars/clubs, venues where men were more likely to be isolated from their families.
However Sanchez’s more optimistic finding was that there was greater use of condoms after migration. Those reporting condom use only sometimes, rarely or never, dropped from 81% to 65% (p= <0.0001).
Similar findings on condoms were presented by Rene Leyva-Flores in the same session. The male Mexican migrants he interviewed most commonly perceived California to be a place where AIDS is present, and where condoms need to be used. However when they went back home to their wives in Mexico, AIDS was not seen to be relevant, and condoms were not used.
Pilar Torres’ study was a qualitative investigation into attitudes to migration among young Mexicans, aged 15 to 24. She spoke both to returned migrants and to those who had stayed in Mexico.
Those who moved to the US often sought to resolve financial difficulties, to follow family members, and to escape a variety of problems in Mexico. On the other hand, those who did not migrate often had fewer financial problems and wished to stay in Mexico to care for relatives or pursue their education.
Another difference in attitude emerged, which may be relevant to HIV. Those who migrated were characterised as adventurous and risk-tolerant, whereas those who did not were more fearful and risk-averse. Migration itself is full of dangers, ranging from finding oneself in an unfamiliar and hostile environment, to the risk of death during the border crossing. Torres suggested that these attitudes to risk and uncertainty influence sexual and drug-using behaviours.