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
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.
KeywordsSTI HIV/AIDS HPV Sexual behavior STI knowledge Border community Hispanic health
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.
- 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.CrossRefGoogle 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.CrossRefGoogle 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.CrossRefGoogle 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.CrossRefGoogle 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.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.CrossRefGoogle 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.CrossRefGoogle 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.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.CrossRefGoogle Scholar
- 37.Krehely, J. (2009). How to close the LGBT health disparities gap (pp. 1–9). Washington, DC: Center for American Progress.Google Scholar
- 40.Long, J. S., & Freese, J. (2006). Regression models for categorical dependent variables using Stata. College Station: Stata press.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.CrossRefGoogle 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.CrossRefGoogle 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
- 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/.
- 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.CrossRefGoogle 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.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.CrossRefGoogle Scholar