Skip to main content

Advertisement

Log in

Social Determinants of Sexual Behavior and Awareness of Sexually Transmitted Infections (STI) Among Low-Income HIV+ or STI At-Risk Hispanic Residents Receiving Care at the U.S.–Mexico Border

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

U.S.–Mexico border communities are uniquely vulnerable to sexually transmitted infection (STI) transmission given the economic and social challenges these communities face. This study examines how marginalized statuses of U.S. border residents are associated with STI awareness and sexual behaviors. We surveyed low-income residents receiving STI testing and/or HIV/AIDS care in the lower Rio Grande Valley of southernmost Texas. Respondents aged 18+ took a self-administered survey available in English or Spanish in a clinic waiting room (N = 282). Approximately 52% of respondents reported being HIV+, and 32% of respondents reported having a prior STI other than HIV. Although most respondents had heard of HPV (72%), awareness of the HPV vaccine was low across all subgroups (28%), including women (< 35%), reflecting previous findings that border residents are less knowledgeable about the HPV vaccine. Almost half of respondents reported always using a condom (45%), which is higher than elsewhere in the U.S. Male and non-Hispanic respondents had higher estimated prevalence ratios (PR) of lifetime partners [PR 1.39 (95% confidence interval 1.43–3.68), PR 1.88 (1.04–3.41), respectively] and sexual partners met online [PR 3.73 (1.00–14.06), PR 19.98 (5.70–70.10), respectively]. Sexual minority, non-Hispanic, and male respondents had higher adjusted odds ratios (AOR) of utilizing the internet to find sexual partners than their peers [AOR 2.45 (1.60–3.87), AOR 1.52 (1.11–2.07), AOR 1.97 (1.20–3.24), respectively], placing them at greater STI-transmission risk. We found diversity in dimensions of STI awareness and sexual behaviors in our sample. Results can help tailor public health interventions to the unique STI risks of marginalized groups in border communities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Adimora, A. A., & Schoenbach, V. J. (2005). Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. The Journal of Infectious Diseases, 191(Supplement_1), S115–S122.

    Article  PubMed  Google Scholar 

  2. Aliabadi, N., Carballo-Dieguez, A., Bakken, S., Rojas, M., Brown III, W., Carry, M. … Schnall, R. (2015). Using the information-motivation-behavioral skills model to guide the development of an HIV prevention smartphone application for high-risk MSM. AIDS Education and Prevention, 27(6), 522–537.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bastida, E., Brown, III, H. S., & Pagán, J. A. (2008). Persistent disparities in the use of health care along the US–Mexico border: An ecological perspective. American Journal of Public Health, 98(11), 1987–1995.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bolding, G., Davis, M., Hart, G., Sherr, L., & Elford, J. (2005). Gay men who look for sex on the Internet: is there more HIV/STI risk with online partners? AIDS, 19(9), 961–968.

    Article  PubMed  Google Scholar 

  5. Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it’s time to consider the causes of the causes. Public Health Reports, 129(1_suppl2), 19–31.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Brooks, R. A., Etzel, M. A., Hinojos, E., Henry, C. L., & Perez, M. (2005). Preventing HIV among Latino and African American gay and bisexual men in a context of HIV-related stigma, discrimination, and homophobia: Perspectives of providers. AIDS Patient Care & STDs, 19(11), 737–744.

    Article  Google Scholar 

  7. Buchmueller, T., & Carpenter, C. S. (2010). Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000–2007. American Journal of Public Health, 100(3), 489–495.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Burger, E. A., Lee, K., Saraiya, M., Thompson, T. D., Chesson, H. W., Markowitz, L. E., & Kim, J. J. (2016). Racial and ethnic disparities in human papillomavirus-associated cancer burden with first-generation and second-generation human papillomavirus vaccines. Cancer, 122(13), 2057–2066.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Carballo-Diéguez, A., Miner, M., Dolezal, C., Rosser, B. S., & Jacoby, S. (2006). Sexual negotiation, HIV-status disclosure, and sexual risk behavior among Latino men who use the internet to seek sex with other men. Archives of Sexual Behavior, 35(4), 473–481.

    Article  PubMed  Google Scholar 

  10. Cardea-Austin. (2014). Charting a new course: HIV Prevention at Hispanic Serving Institutions and Colleges. Austin: Cardea Services.

    Google Scholar 

  11. Castañeda, H. (2015). Mixed status families in the Rio Grande valley of Texas. In A. Schueths & J. Lawston (Eds.), Living together, living apart: Mixed status families and US immigration policy (pp. 106–116). Seattle, WA: University of Washington Press.

    Google Scholar 

  12. Centers for Disease Control and Prevention (CDC). (2015). Texas-State Health Profile. https://www.cdc.gov/nchhstp/stateprofiles/pdf/texas_profile.pdf.

  13. Centers for Disease Control and Prevention (CDC). (2017). Sexually transmitted disease surveillance 2016. Atlanta: U.S. Department of Health and Human Services.

    Google Scholar 

  14. Centers for Disease Control and Prevention-National Health and Nutrition Survey (CDC-NHANES). (2016). National health and nutrition examination survey 1999–2016 survey content brochure. Hyattsville: National Center for Disease Statistics. https://www.cdc.gov/nchs/data/nhanes/survey_content_99_16.pdf.

  15. Chiasson, M. A., Hirshfield, S., Remien, R. H., Humberstone, M., Wong, T., & Wolitski, R. J. (2007). A comparison of on-line and off-line sexual risk in men who have sex with men: An event-based on-line survey. JAIDS Journal of Acquired Immune Deficiency Syndromes, 44(2), 235–243.

    Article  PubMed  Google Scholar 

  16. Crepaz, N., Horn, A. K., Rama, S. M., Griffin, T., Deluca, J. B., & Mullins, M. M. … & HIV/AIDS Prevention Research Synthesis Team. (2007). The efficacy of behavioral interventions in reducing HIV risk sex behaviors and incident sexually transmitted disease in black and Hispanic sexually transmitted disease clinic patients in the United States: A meta-analytic review. Sexually Transmitted Diseases, 34(6), 319–332.

    PubMed  Google Scholar 

  17. Colgrove, J., Abiola, S., & Mello, M. M. (2010). HPV vaccination mandates—lawmaking amid political and scientific controversy. New England Journal of Medicine, 363(8), 785–791.

    Article  CAS  PubMed  Google Scholar 

  18. Cooper, D. L., Hernandez, N. D., Rollins, L., Akintobi, T. H., & McAllister, C. (2017). HPV vaccine awareness and the association of trust in cancer information from physicians among males. Vaccine, 35(20), 2661–2667.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Derose, K. P., Escarce, J. J., & Lurie, N. (2007). Immigrants and health care: Sources of vulnerability. Health Affairs, 26(5), 1258–1268.

    Article  PubMed  Google Scholar 

  20. Du Bois, S. N., Johnson, S. E., & Mustanski, B. (2012). Examining racial and ethnic minority differences among YMSM during recruitment for an online HIV prevention intervention study. AIDS and Behavior, 16(6), 1430–1435.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fernandez, M. E., McCurdy, S. A., Arvey, S. R., Tyson, S. K., Morales-Campos, D., Flores, B., … Sanderson, M. (2009). HPV knowledge, attitudes, and cultural beliefs among Hispanic men and women living on the Texas–Mexico border. Ethnicity & Health, 14(6), 607–624.

    Article  Google Scholar 

  22. Fonner, V. A., Kennedy, C. E., O’Reilly, K. R., & Sweat, M. D. (2014). Systematic assessment of condom use measurement in evaluation of HIV prevention interventions: Need for standardization of measures. AIDS & Behavior, 18(12), 2374–2386.

    Article  Google Scholar 

  23. Fontenot, H. B., Rosenberger, J. G., Mayer, K. H., & Zimet, G. D. (2018). YMSM’S preferences and perspectives for a mobile health tool designed facilitate HPV vaccination. Journal of Adolescent Health, 62(2), S42–S43.

    Article  Google Scholar 

  24. Frisch, M., Biggar, R. J., & Goedert, J. J. (2000). Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Journal of the National Cancer Institute, 92(18), 1500–1510.

    Article  CAS  PubMed  Google Scholar 

  25. Fu, L. Y., Bonhomme, L. A., Cooper, S. C., Joseph, J. G., & Zimet, G. D. (2014). Educational interventions to increase HPV vaccination acceptance: A systematic review. Vaccine, 32(17), 1901–1920.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Grollman, E. A. (2014). Multiple disadvantaged statuses and health: The role of multiple forms of discrimination. Journal of Health & Social Behavior, 55(1), 3–19.

    Article  Google Scholar 

  27. GLSEN, CiPHR, CCRC. (2013). Out online: The Experiences of Lesbian, Gay, Bisexual and Transgender Youth on the Internet. New York: GLSEN.

    Google Scholar 

  28. Giuliano, A. R., Denman, C., Zapien, J. G. D., Henze, J. L. N., Ortega, L., Djambazov, B., … Hatch, K. (2001). Design and results of the USA-Mexico border human papillomavirus (HPV), cervical dysplasia, and Chlamydia trachomatis study. Revista Panamericana de Salud Pública, 9, 172–181.

    Article  CAS  PubMed  Google Scholar 

  29. Giuliano, A. R., Papenfuss, M., Mendez Brown de Galaz, E., Feng, J., Abrahamsen, M., Denman, C., … Hatch, K. (2004). Risk factors for squamous intraepithelial lesions (SIL) of the cervix among women residing at the US-Mexico border. International Journal of Cancer, 109(1), 112–118.

    Article  CAS  PubMed  Google Scholar 

  30. Haley, D. F., Edmonds, A., Belenky, N., Hickson, D. A., Ramirez, C., Wingood, G. M., … Adimora, A. A. (2018). Neighborhood health care access and sexually transmitted infections among women in the Southern United States: A cross-sectional multilevel analysis. Sexually Transmitted Diseases, 45(1), 19–24.

    Article  Google Scholar 

  31. Hergenrather, K. C., Emmanuel, D., Durant, S., & Rhodes, S. D. (2016). Enhancing HIV prevention among young men who have sex with men: A systematic review of HIV behavioral interventions for young gay and bisexual men. AIDS Education & Prevention, 28(3), 252–271.

    Article  Google Scholar 

  32. Jacquez, F., Vaughn, L., Zhen-Duan, J., & Graham, C. (2016). Health care use and barriers to care among Latino immigrants in a new migration area. Journal of Health Care for the Poor & Underserved, 27(4), 1761–1778.

    Article  Google Scholar 

  33. Jemal, A., Simard, E. P., Dorell, C., Noone, A. M., Markowitz, L. E., Kohler, B., … Cronin, K. A. (2013). Annual report to the nation on the status of cancer, 1975–2009, featuring the burden and trends in human papillomavirus (HPV)–associated cancers and HPV vaccination coverage levels. JNCI: Journal of the National Cancer Institute, 105(3), 175–201.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kamimura, A., Christensen, N., Tabler, J., Ashby, J., & Olson, L. (2013). Patients utilizing a free clinic: Physical and mental health, health literacy, and social support. Journal of Community Health, 38(4), 716–723.

    Article  PubMed  Google Scholar 

  35. Kepka, D., Warner, E. L., Kinney, A. Y., Spigarelli, M. G., & Mooney, K. (2015). Low human papillomavirus (HPV) vaccine knowledge among Latino parents in Utah. Journal of Immigrant & Minority Health, 17(1), 125–131.

    Article  Google Scholar 

  36. Kinsler, J. J., Wong, M. D., Sayles, J. N., Davis, C., & Cunningham, W. E. (2007). The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care & STDs, 21(8), 584–592.

    Article  Google Scholar 

  37. Krehely, J. (2009). How to close the LGBT health disparities gap (pp. 1–9). Washington, DC: Center for American Progress.

    Google Scholar 

  38. Kushel, M. B., Gupta, R., Gee, L., & Haas, J. S. (2006). Housing instability and food insecurity as barriers to health care among low-income Americans. Journal of General Internal Medicine, 21(1), 71–77.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Liau, A., Millett, G., & Marks, G. (2006). Meta-analytic examination of online sex-seeking and sexual risk behavior among men who have sex with men. Sexually Transmitted Diseases, 33(9), 576–584.

    Article  PubMed  Google Scholar 

  40. Long, J. S., & Freese, J. (2006). Regression models for categorical dependent variables using Stata. College Station: Stata press.

    Google Scholar 

  41. Lopez-Quintero, C., Shtarkshall, R., & Neumark, Y. D. (2005). Barriers to HIV-testing among Hispanics in the United States: Analysis of the National Health Interview Survey, 2000. AIDS Patient Care & STDs, 19(10), 672–683.

    Article  Google Scholar 

  42. Lowy, D. R., & Schiller, J. T. (2012). Reducing HPV-associated cancer globally. Cancer Prevention Research, 5(1), 18–23.

    Article  PubMed  Google Scholar 

  43. Marks, G., Crepaz, N., Senterfitt, J. W., & Janssen, R. S. (2005). Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. Journal of Acquired Immune Deficiency Syndromes, 39(4), 446–453.

    Article  PubMed  Google Scholar 

  44. Meites, E., Kempe, A., & Markowitz, L. E. (2016). Use of a 2-dose schedule for human papillomavirus vaccination—updated recommendations of the Advisory Committee on Immunization Practices. Morbidity & Mortality Weekly Report, 65(49), 1405–1409.

    Article  Google Scholar 

  45. Meyer, I. H., Schwartz, S., & Frost, D. M. (2008). Social patterning of stress and coping: Does disadvantaged social statuses confer more stress and fewer coping resources? Social Science & Medicine, 67(3), 368–379.

    Article  Google Scholar 

  46. Molokwu, J., Fernandez, N. P., & Martin, C. (2014). HPV awareness and vaccine acceptability in Hispanic women living along the US-Mexico border. Journal of Immigrant & Minority Health, 16(3), 540–545.

    Article  Google Scholar 

  47. Morris, J. L., Lippman, S. A., Philip, S., Bernstein, K., Neilands, T. B., & Lightfoot, M. (2014). Sexually transmitted infection related stigma and shame among African American male youth: implications for testing practices, partner notification, and treatment. AIDS Patient Care & STDs, 28(9), 499–506.

    Article  Google Scholar 

  48. Moyer, L. B., Moyer, L. B., Brouwer, K. C., Moyer, L. B., Brouwer, K. C., Brodine, S. K., … & Moyer, L. B. (2008). Barriers and missed opportunities to HIV testing among injection drug users in two Mexico–US border cities. Drug and Alcohol Review, 27(1), 39–45.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Mustanski, B., Greene, G. J., Ryan, D., & Whitton, S. W. (2015). Feasibility, acceptability, and initial efficacy of an online sexual health promotion program for LGBT youth: The Queer Sex Ed intervention. The Journal of Sex Research, 52(2), 220–230.

    Article  PubMed  Google Scholar 

  50. Olshefsky, A. M., Zive, M. M., Scolari, R., & Zuñiga, M. L. (2007). Promoting HIV risk awareness and testing in Latinos living on the US–Mexico border: The Tú No Me Conoces social marketing campaign. AIDS Education & Prevention, 19(5), 422–435.

    Article  Google Scholar 

  51. Patterson, T. L., Semple, S. J., Staines, H., Lozada, R., Orozovich, P., Bucardo, J., … De la Torre, A. (2008). Prevalence and correlates of HIV infection among female sex workers in 2 Mexico—US border cities. The Journal of Infectious Diseases, 197(5), 728–732.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Peterman, T. A., Tian, L. H., Warner, L., Satterwhite, C. L., Metcalf, C. A., & Malotte, K. C. … RESPECT-2 Study Group. (2009). Condom use in the year following a sexually transmitted disease clinic visit. International Journal of STD & AIDS, 20(1), 9–13.

    Article  CAS  Google Scholar 

  53. Pfeiffer, E. J., McGregor, K. A., Van Der Pol, B., Hansen, C. H., & Ott, M. A. (2016). Willingness to disclose STI status to sex partners among college-age men in the United States. Sexually Transmitted Diseases, 43(3), 204–206.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Schmitz, R. M., Sanchez, J., & Lopez, B. (2018). LGBTQ+ Latinx young adults’ health autonomy in resisting cultural stigma. Culture, Health & Sexuality. https://doi.org/10.1080/13691058.2018.1441443.

    Article  Google Scholar 

  55. Semega, J. L., Fontenot, K. R., & Kollar, M. A. (2017). Income and poverty in the U.S: 2016. Pg 60–259 in American Community Survey 2012–2016 5 Year Data. Washington D.C.: Census Bureau.

    Google Scholar 

  56. South Texas Equality Program [STEP]. (2018). South Texas Equality Program. http://www.our-step.org/.

  57. Texas Health & Human Services. (2016). Human papillomavirus (HPV) strategic plan: 2016. Austin: Texas Department of State Health Services.

    Google Scholar 

  58. Toska, E., Cluver, L. D., Hodes, R., & Kidia, K. K. (2015). Sex and secrecy: How HIV-status disclosure affects safe sex among HIV-positive adolescents. AIDS Care, 27(sup1), 47–58.

    Article  PubMed  PubMed Central  Google Scholar 

  59. U.S. Census Bureau (2017). Small area income and poverty estimates. Austin: Texas Association of Counties.

    Google Scholar 

  60. Valley AIDS Council [VAC] (2018). Mission and history. http://www.valleyaids.org/.

  61. Vaughan, A. S., Rosenberg, E., Shouse, R. L., & Sullivan, P. S. (2014). Connecting race and place: A county-level analysis of White, Black, and Hispanic HIV prevalence, poverty, and level of urbanization. American Journal of Public Health, 104(7), e77–e84.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Viens, L. J., Henley, S. J., Watson, M., Markowitz, L. E., Thomas, C. C., Thompson, T. D., Razzaghi, H., & Saraiya, M., Centers for Disease Control and Prevention (CDC) (2016). Human papillomavirus-associated cancers—United States, 2008–2012. Morbidity and Mortality Weekly Report, 65(26), 661–666.

    Article  PubMed  Google Scholar 

  63. Walby, S., Armstrong, J., & Strid, S. (2012). Intersectionality: Multiple inequalities in social theory. Sociology, 46(2), 223–240.

    Article  Google Scholar 

  64. Warner, D. C., & Jahnke, L. R. (2003). US/Mexico border health issues: The Texas Rio Grande valley. Regional Center for Health Workforce Studies, Center for Health Economics and Policy, The University of Texas Health Science Center at San Antonio.

  65. Ybarra, M. L., & Mitchell, K. J. (2016). A national study of lesbian, gay, bisexual (LGB), and non-LGB youth sexual behavior online and in-person. Archives of Sexual Behavior, 45(6), 1357–1372.

    Article  PubMed  Google Scholar 

  66. Young, R. M., Friedman, S. R., & Case, P. (2005). Exploring an HIV paradox: An ethnography of sexual minority women injectors. Journal of Lesbian Studies, 9(3), 103–116.

    Article  PubMed  Google Scholar 

  67. Zúñiga, M. L., Brennan, J., Scolari, R., & Strathdee, S. A. (2008). Barriers to HIV care in the context of crossborder health care utilization among HIV-positive persons living in the California/Baja California US-Mexico border region. Journal of Immigrant and Minority Health, 10(3), 219–227.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank the Valley AIDS Council for their partnership and support of this project, including Dr. Dora Alicia Martinez, M.D., Dr. Ruben Davila Martinez, M.D., F.A.C.O.G., Oscar Lopez, Wally Cantú, Diego Huerta, and Ruben Patlan. Drs Jennifer Tabler and Laryssa Mykyta were supported by funding from National Science Foundation (NSF) ADVANCE Grant #1209210.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennifer Tabler.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tabler, J., Mykyta, L., Schmitz, R.M. et al. Social Determinants of Sexual Behavior and Awareness of Sexually Transmitted Infections (STI) Among Low-Income HIV+ or STI At-Risk Hispanic Residents Receiving Care at the U.S.–Mexico Border. J Community Health 44, 127–136 (2019). https://doi.org/10.1007/s10900-018-0562-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-018-0562-5

Keywords

Navigation