Documentation Status as a Contextual Determinant of HIV Risk Among Young Transgender Latinas

Abstract

Purpose: The purpose of this study was to explore the contextual factors that determine or mitigate vulnerability to HIV among Latina transgender women. Documentation status (legal authorization to live in the United States) has been cited by other studies as a barrier to recruitment or engagement in HIV-related care among immigrant Latinos, but not explored as a determinant of HIV risk for transgender immigrant Latinas. Methods: We collaborated with a community-based organization to explore these contextual, including social and structural, factors. In-depth interviews in Spanish captured life histories of eight 18-to 29-year-old transgender Latinas, who collectively self-identify as chicas trans. Codes were assigned deductively from the interview guide, and emerging themes were identified throughout data collection. Results: Most participants migrated to the United States from Central America after experiencing discrimination and violence in their countries of origin. Participants emphasized documentation status as a critical factor in three areas related to social and structural determinants of HIV risk: gender identity expression, access to services, and relationship power dynamics. Chicas trans who gained legal asylum reported greater control over sexual relationships, improved access to services, and less risky employment. Conclusions: Documentation status emerged as a key HIV risk factor for this population. For undocumented transgender Latinas, legal asylum appears to be a promising HIV-related protective factor. Further research could assess whether legal assistance combined with wraparound support services affects HIV prevention for this population.

Promoting Pre-exposure Prophylaxis to Prevent HIV Infections Among Sexual and Gender Minority Hispanics/Latinxs

“…In addition, many sexual and gender minority Latinxs face stressors that must be addressed as part of comprehensive HIV care and preventive services (Martinez et al, 2011; Palazzolo et al, 2016). Latinx gender and sexual minorities commonly report feelings of discrimination, social rejection, and isolation, which lead to depression, alcohol and substance abuse.…”

“…Latinx gender and sexual minorities commonly report feelings of discrimination, social rejection, and isolation, which lead to depression, alcohol and substance abuse. In addition, the migration experience itself can be associated with anxiety, depression, acculturation challenges, economic hardship, and discrimination (due to their immigration status as well as sexual or gender identity) (Palazzolo et al, 2016; Rhodes, Martinez et al, 2013; Rhodes et al, 2015). For example, immigrants from Mexico and Central America typically have lived through traumatic events in their country of origin, including gang violence and sexual assault, and many continue to be targets of violence in the U.S.…”

“…In addition, many gender and sexual minority immigrants may qualify for asylum because of persecution in their country of origin. Obtaining legal status can be life-changing and may mitigate the risk of HIV (Palazzolo et al, 2016), but it underscores the overall importance of having service providers who are knowledgeable about immigration policies and can refer individuals for affordable legal advice. This usually requires strong partnerships with community and advocacy organizations, and, when possible, medico-legal collaborations.…”

“…Recent purposive community studies have documented high incidence and prevalence, as well as unique challenges for HIV prevention among this population, including access to comprehensive health care (Palazzolo, Yamanis, De Jesus, Maguire-Marshall, & Barker, 2016). It should be further noted that current population-based HIV data collapses all Latino men who have sex with men into a single MSM category, making it hard to understand subgroup differences between those who have sex exclusively with men and those who have sex with both men and women.…”

High Stakes for the Health of Sexual and Gender Minority Patients of Color

“…Undocumented transgender Latinas are at higher risk for HIV infection due to worse healthcare access, housing, and employment. 26 SGM patients of color are targets of an increasingly dangerous and hostile environment. At least eight transgender women of color have been murdered since the beginning of 2017.…”