AIDS and Behavior

, Volume 23, Issue 2, pp 336–346 | Cite as

HIV Testing, Risk Behaviors, and Fear: A Comparison of Documented and Undocumented Latino Immigrants

  • Jane J. LeeEmail author
  • Gary Yu
Original Paper


Latino immigrants in the United States are at elevated risk for HIV infection and delayed HIV diagnosis. Immigration documentation status and its contribution to fears are important barriers to accessing health services including HIV testing. A currently changing political climate within the United States may have increased the complexity of the intersection of documentation status and health care access. This study used an anonymous survey conducted in March and April 2017 in New York City to compare: sociodemographic characteristics, HIV testing behaviors, HIV risk behaviors, and perceptions of fear around HIV testing among documented and undocumented Latino immigrants (N = 301). We found that undocumented immigrants reported lower levels of education, income, and health insurance than did documented immigrants. However, groups did not differ in having tested for HIV in the last 12 months, in future intentions to test for HIV, or in emotional/cognitive perceptions of fear around HIV testing. Undocumented immigrants reported lower rates of having ever tested for HIV in their lifetime (68.6%) than documented immigrants (80.5%) (p = 0.027). In conclusion, we found that despite sociodemographic challenges, undocumented immigrants had similar HIV testing behaviors as their documented counterparts in our study community. Further understanding of the mitigating factors that resulted in seemingly equal access to HIV testing in this community for undocumented immigrants is warranted.


HIV testing HIV risk behaviors Fear Latino Immigrants 


Los inmigrantes Latinos tienen un mayor riesgo de contraer el VIH y de tener retraso con el diagnóstico en los Estados Unidos. El estatus de documentación de inmigración y su contribución al miedo son obstáculos importantes al acceso a los servicios de salud como la prueba de VIH. El clima político está cambiando actualmente in los estados unidos, lo cual se haya aumentado la complejidad de la intersección del estatus de documentación y el acceso a la asistencia sanitaria. Este estudio utilizó una encuesta anónima realizado en marzo y abril de 2017 en la Ciudad de Nueva York para comparar las características sociodemográficas, los comportamientos de pruebas del VIH, los comportamientos de riesgo, y el miedo de la prueba de VIH entre los inmigrantes Latinos documentados y los indocumentados (N = 301). Encontramos que los inmigrantes indocumentados reportaron niveles más bajos de educación, ingresos, y seguro médico que los inmigrantes documentados. Sin embargo, no hubo diferencias significativas entre los grupos en haberse hecho la prueba del VIH en los últimos 12 meses, en intenciones futuras de hacerse la prueba de VIH, o en la evaluación del miedo cognitivo/emocional acerca de la prueba de VIH. Los inmigrantes indocumentados reportaron tasas más bajas de alguna vez haberse hecho la prueba del VIH (68.6%) que los inmigrantes documentados (80.5%) (p = 0.027). En conclusión, encontramos que, a pesar de las dificultades sociodemográficas, los inmigrantes indocumentados tenían comportamientos similares de hacerse la prueba de VIH que sus contrapartes documentadas en nuestra comunidad en estudio. Es, por tanto, necesario que tengamos una mejor comprensión de los factores atenuantes que contribuyen al acceso a la prueba de VIH que parece igual para inmigrantes indocumentados en esta comunidad.



The study was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R36MH108395. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional support was provided by the Center for Latino Adolescent and Family Health at New York University Silver School of Social Work.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board at New York University and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Centers for Disease Control and Prevention. Atlanta, GA: HIV Among Latinos; 2017.Google Scholar
  2. 2.
    Centers for Disease Control and Prevention. HIV/AIDS Atlanta, GA: Centers for Disease Control and Prevention; 2017 [Available from:
  3. 3.
    Office of National AIDS Policy. National HIV/AIDS Strategy for the United States: Updated to 2020. Washington, DC; 2015.Google Scholar
  4. 4.
    Girardi EM, Sabin CA, Monforte AD. Late diagnosis of HIV infection: epidemiological features, consequences and strategies to encourage earlier testing. J Acquir Immune Defic Syndr. 2007;46:S3–8.CrossRefGoogle Scholar
  5. 5.
    Wohl AR, Tejero J, Frye DM. Factors associated with late HIV testing for Latinos diagnosed with AIDS in Los Angeles. AIDS Care. 2009;21(9):1203–10.CrossRefGoogle Scholar
  6. 6.
    Lopez-Quintero C, Shtarkshall R, Neumark YD. Barriers to HIV-testing among Hispanics in the United States: analysis of the National Health Interview Survey, 2000. AIDS Patient Care STDs. 2005;19(10):672–83.CrossRefGoogle Scholar
  7. 7.
    Espinoza L, Hall HI, Selik RM, Hu X. Characteristics of HIV infection among Hispanics, United States 2003–2006. J Acquir Immune Defic Syndr. 2008;49(1):94–101.CrossRefGoogle Scholar
  8. 8.
    Chen NE, Gallant JE, Page KR. A systematic review of HIV/AIDS survival and delayed diagnosis among Hispanics in the United States. J Immigr Minor Health. 2012;14(1):65–81.CrossRefGoogle Scholar
  9. 9.
    Derose KP, Escarce JJ, Lurie N. Immigrants and health care: sources of vulnerability. Health Aff. 2007;26(5):1258–68.CrossRefGoogle Scholar
  10. 10.
    Yang PQ, Hwang SH. Explaining immigrant health service utilization:a theoretical framework. SAGE Open. 2016;6(2):1–5.CrossRefGoogle Scholar
  11. 11.
    Documet PI, Troyer MM, Macia L. Social support, health, and health care access among latino immigrant men in an emerging community. Health Educ Behav. 2018.Google Scholar
  12. 12.
    Pérez-Escamilla R, Garcia J, Song D. Health care access among Hispanic immigrants: ¿alguien está escuchando? [is anybody listening?]. NAPA Bull. 2010;34(1):47–67.CrossRefGoogle Scholar
  13. 13.
    Levy V, Prentiss D, Balmas G, Chen S, Israelski D, Katzenstein D, et al. Factors in the delayed HIV presentation of immigrants in Northern California: implications for voluntary counseling and testing programs. J Immigr Minor Health. 2007;9(1):49–54.CrossRefGoogle Scholar
  14. 14.
    Passel JS, Cohn DV. Overall number of U.S. unauthorized immigrants holds steady since 2009. Washington, DC: Pew Research Center; 2009. p. 2016.Google Scholar
  15. 15.
    Centers for Disease Control and Prevention. Improving HIV surveillance and prevention intervention efforts among Hispanic or Latino migrant communities in United States-Mexico Border States: Arizona, California, New Mexico and Texas. Atlanta, GA; 2014.Google Scholar
  16. 16.
    Ross J, Hanna DB, Felsen UR, Cunningham CO, Patel VV. Emerging from the database shadows: characterizing undocumented immigrants in a large cohort of HIV-infected persons. AIDS Care. 2017;29:1–8.CrossRefGoogle Scholar
  17. 17.
    National Center for Health Statistics. Survey Description, National Health Interview Survey, 2016. Hyattsville, Maryland: National Center for Health Statistics (NCHS); 2017.Google Scholar
  18. 18.
    Berk ML, Schur CL, Chavez LR, Frankel M. Health care use among undocumented Latino immigrants. Health Aff. 2000;19(4):51–64.CrossRefGoogle Scholar
  19. 19.
    Marshall KJ, Urrutia-Rojas X, Mas FS, Coggin C. Health status and access to health care of documented and undocumented immigrant Latino women. Health Care Women Int. 2005;26(10):916–36.CrossRefGoogle Scholar
  20. 20.
    Ortega AN, Fang H, Perez VH, et al. Health care access, use of services, and experiences among undocumented mexicans and other Latinos. Arch Intern Med. 2007;167(21):2354–60.CrossRefGoogle Scholar
  21. 21.
    Vargas Bustamante A, Fang H, Garza J, Carter-Pokras O, Wallace SP, Rizzo JA, et al. Variations in healthcare access and utilization among Mexican immigrants: the role of documentation status. J Immigr Minor Health. 2012;14(1):146–55.CrossRefGoogle Scholar
  22. 22.
    Martinez O, Wu E, Sandfort T, Dodge B, Carballo-Dieguez A, Pinto R, et al. Evaluating the impact of immigration policies on health status among undocumented immigrants: a systematic review. J Immigr Minor Health. 2015;17(3):947–70.CrossRefGoogle Scholar
  23. 23.
    Hacker K, Anies M, Folb BL, Zallman L. Barriers to health care for undocumented immigrants: a literature review. Risk Manag Healthc Policy. 2015;8:175–83.CrossRefGoogle Scholar
  24. 24.
    Poon KK, Dang BN, Davila JA, Hartman C, Giordano TP. Treatment outcomes in undocumented Hispanic immigrants with HIV infection. PLoS ONE. 2013;8(3):e60022.CrossRefGoogle Scholar
  25. 25.
    Fernández MI, Collazo JB, Bowen GS, Varga LM, Hernandez N, Perrino T. Predictors of HIV testing and intention to test among Hispanic farmworkers in South Florida. J Rural Health. 2005;21(1):56–64.CrossRefGoogle Scholar
  26. 26.
    Kinsler JJ, Lee S-J, Sayles JN, Newman PA, Diamant A, Cunningham W. The impact of acculturation on utilization of HIV prevention services and access to care among an at-risk Hispanic population. J Health Care Poor Underserved. 2009;20(4):996–1011.CrossRefGoogle Scholar
  27. 27.
    Schulden JD, Painter TM, Song B, Valverde E, Borman MA, Monroe-Spencer K, et al. HIV testing histories and risk factors among migrants and recent immigrants who received rapid HIV testing from three community-based organizations. J Immigr Minor Health. 2014;16(5):798–810.CrossRefGoogle Scholar
  28. 28.
    Berk ML, Schur CL. The effect of fear on access to care among undocumented Latino immigrants. J Immigr Health. 2001;3(3):151–6.CrossRefGoogle Scholar
  29. 29.
    Kellerman SE, Lehman JS, Lansky A, Stevens MR, Hecht FM, Bindman AB, et al. HIV testing within at-risk populations in the United States and the reasons for seeking or avoiding HIV testing. J Acquir Immune Defic Syndr. 2002;31(2):202–10.CrossRefGoogle Scholar
  30. 30.
    Schwarz N. Emotion, cognition, and decision making. Cogn Emot. 2000;14(4):433–40.CrossRefGoogle Scholar
  31. 31.
    Castelfranchi C. Affective appraisal versus cognitive evaluation in social emotions and interactions. In: Paiva A, editor. Affective interactions. 1814. Berlin: Springer; 2000.Google Scholar
  32. 32.
    Solorio R, Forehand M, Simoni J. Attitudes towards and beliefs about HIV Testing among Latino immigrant MSM: a comparison of testers and nontesters. AIDS Res Treat. 2013;2013:10.Google Scholar
  33. 33.
    Gilbert PA, Rhodes SD. HIV testing among immigrant sexual and gender minority Latinos in a US region with little historical Latino presence. AIDS Patient Care STDs. 2013;27(11):628–36.CrossRefGoogle Scholar
  34. 34.
    Vissman AT, Hergenrather KC, Rojas G, Langdon SE, Wilkin AM, Rhodes SD. Applying the theory of planned behavior to explore HAART adherence among HIV-positive immigrant Latinos: elicitation interview results. Patient Educ Couns. 2011;85(3):454–60.CrossRefGoogle Scholar
  35. 35.
    Dolan RJ. Emotion, cognition, and behavior. Science. 2002;298(5596):1191–4.CrossRefGoogle Scholar
  36. 36.
    Hacker K, Chu J, Leung C, Marra R, Pirie A, Brahimi M, et al. The impact of immigration and customs enforcement on immigrant health: perceptions of immigrants in Everett, Massachusetts, USA. Soc Sci Med. 2011;73(4):586–94.CrossRefGoogle Scholar
  37. 37.
    Park LS-H. Entitled to nothing: the struggle for immigrant health care in the age of welfare reform. New York: New York University Press; 2011.CrossRefGoogle Scholar
  38. 38.
    Williams D, Mohammed SA. The color of poverty. In: Lin AC, Harris DR, editors. Poverty, migration, and health. New York: Russell Sage Foundation; 2008. p. 135–69.Google Scholar
  39. 39.
    Rhodes SD, Mann L, Simán FM, Song E, Alonzo J, Downs M, et al. The impact of local immigration enforcement policies on the health of immigrant Hispanics/Latinos in the United States. Am J Public Health. 2015;105(2):329–37.CrossRefGoogle Scholar
  40. 40.
    New York City Department of Health and Mental Hygiene. Geographic co-occurence of HIV/AIDS, viral hepatitis, sexually transmitted diseases and tuberculosis in New York City. Epi Data Brief; 2012.Google Scholar
  41. 41.
    Ku L, Matani S. Left out: immigrants’ access to health care and insurance. Health Aff. 2001;20(1):247–56.CrossRefGoogle Scholar
  42. 42.
    Lobo AP, Salvo JJ. The newest New Yorkers: characteristics of the city’s foreign-born population. New York: The City of New York, Department of City Planning, Office of Immigrant Affairs; 2013.Google Scholar
  43. 43.
    Seña AC, Hammer JP, Wilson K, Zeveloff A, Gamble J. Feasibility and acceptability of door-to-door rapid HIV testing among Latino immigrants and their HIV risk factors in North Carolina. AIDS Patient Care STDs. 2010;24(3):165–73.CrossRefGoogle Scholar
  44. 44.
    Keating S, Carlson B, Jimenez S, Estrada J, Gastelum B, Romero T, et al. Psychometric testing of the immigrant barriers to health care scale: Hispanic version. Nurs Health Sci. 2009;11(3):235–43.CrossRefGoogle Scholar
  45. 45.
    Ajzen I, Fishbein M. Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice Hall; 1980.Google Scholar
  46. 46.
    Dodge T, Jaccard JJ. Negative beliefs as a moderator of the intention–behavior relationship: decisions to use performance-enhancing substances. J Appl Soc Psychol. 2007;37(1):43–59.CrossRefGoogle Scholar
  47. 47.
    Jaccard J. The prevention of problem behaviors in adolescents and young adults: perspectives on theory and practice. J Soc Social Work Res. 2016;7(4):585–613.CrossRefGoogle Scholar
  48. 48.
    Jaccard J, Levitz N. Parent-based interventions to reduce adolescent problem behaviors: new directions for self-regulation approaches. In: Oettingen G, Gollwitzer P, editors. Self-regulation in adolescence. New York: Cambridge University Press; 2013.Google Scholar
  49. 49.
    Marin BV, Gomez C, Tschann JM, Gregorich SE. Condom use in unmarried Latino men: a test of cultural constructs. Health Psychol. 1997;16(5):458–67.CrossRefGoogle Scholar
  50. 50.
    Catania JA, Coates TJ, Stall R, Turner H, Peterson J, Hearst N, et al. Prevalence of AIDS-related risk factors and condom use in the United States. Science. 1992;258(5085):1101–6.CrossRefGoogle Scholar
  51. 51.
    Jaccard J, Litardo HA, Social Wan CK. Social psychology and cultural context. 1999 2017/07/20. Thousand Oaks, CA: SAGE Publications, Inc; 1999.Google Scholar
  52. 52.
    Rowan N, Wulff D. Using qualitative methods to inform scale development. Qual Rep. 2007;12(3):450–66.Google Scholar
  53. 53.
    Dang BN, Giordano TP, Kim JH. Sociocultural and structural barriers to care among undocumented Latino immigrants with HIV Infection. J Immigr Minor Health. 2012;14(1):124–31.CrossRefGoogle Scholar
  54. 54.
    Zong J, Batalova J. Frequently requested statistics on immigrants and immigration in the United States. Washington, DC: Migration Policy Institute; 2017.Google Scholar
  55. 55.
    Sheehan DM, Trepka MJ, Dillon FR. Latinos in the United States on the HIV/AIDS care continuum by birth country/region: a systematic review of the literature. Int J STD AIDS. 2015;26(1):1–12.CrossRefGoogle Scholar
  56. 56.
    Deren S, Shedlin M, Decena CU, Mino M. Research challenges to the study of HIV/AIDS among migrant and immigrant Hispanic populations in the United States. J Urban Health. 2005;82(3):313–25.Google Scholar
  57. 57.
    Jaccard J. A theoretical analysis of selected factors important to health education strategies. Health Educ Monogr. 1975;3(2):152–67.CrossRefGoogle Scholar
  58. 58.
    Ajzen I, Timko C. Correspondence between health attitudes and behavior. Basic Appl Soc Psychol. 1986;7(4):259–76.CrossRefGoogle Scholar
  59. 59.
    Paulhus DL. Measurement and control of response bias. In: Robinson JP, Shaver PR, Wrightsman LS, editors. Measurement and control of response bias, vol. 1., Measures of social psychological attitudesSan Diego, CA: Academic Press; 1991. p. 17–59.Google Scholar
  60. 60.
    Paulhus DL. Two-component models of socially desirable responding. J Pers Soc Psychol. 1984;46(3):598–609.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Social WorkUniversity of WashingtonSeattleUSA
  2. 2.Center for Drug Use and HIV/HCV Research (CDUHR)New YorkUSA
  3. 3.NYU Rory Meyers College of NursingNew YorkUSA

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