P2-S9.10 HIV testing behaviours among undocumented Central American immigrant women in Houston, Texas, 2010
Authors: Montealegre J , Risser J , Selwyn B J 
Published: July 2011

Introduction

Undocumented Central American immigrants in the US are at increased vulnerability to HIV. Almost half of infections are attributed to high-risk heterosexual contact and HIV detection is often delayed. Although HIV testing is a cornerstone of HIV prevention and treatment, we are unaware of any studies that describe HIV testing in this population. The purpose of this paper is to describe HIV testing behaviours among undocumented Central American immigrant women in Houston, Texas.

Methods

We recruited 230 Guatemalan, Honduran, and El Salvadoran women, ages 18–50 years, living in Houston without a US visa or residency papers for an HIV behavioural survey using respondent driven sampling. Present analyses are limited to sexually active participants who provided information on HIV testing (N=182). Ever testing for HIV was defined as receiving an HIV test at least once during one's lifetime. Prevalence estimates are RDS-adjusted.

Results

Sixty seven per cent of women reported ever testing for HIV infection. Among testers, 49% tested at a public health clinic and 30% tested at other healthcare facilities; 50% tested within the past 2 years. The most common reason for getting tested was pregnancy (50%) and to get rid of doubt” regarding their partner's infidelity (29%). Testers were significantly more likely than non-testers to be from Honduras and to have resided in the US for over 5 years. Testers were also older, more educated, and wealthier than non-testers. Testers were more likely than non-testers to have a regular healthcare provider, to have visited a healthcare provider in the past 12 months, and to have healthcare coverage or insurance. Healthcare coverage was predominantly through the indigent healthcare program see Abstract P2-S9.10 Table 1.

Abstract P2-S9.10 Table 1

Difference in socio-demographic and healthcare access and utilisation characteristics, comparing those who self-report ever testing for HIV infection to those not testing* among undoucumented Central American immigrant women in Houston, Texas, 2010

VariablesTesters (%)Non-testers (%)OR (95% CI)Socio-demographicsCountry of origin Guatemala20.940.61.00 Honduras40.822.43.4 (1.42 to 8.38) El Salvador38.337.01.96 (0.88 to 4.41)Number of years in USA Five or less39.968.51.00 Over five60.131.53.21 (1.62 to 6.42)Age (years) 18–3038.260.81.00 31–5061.839.22.59 (1.32 to 5.11)Education Sixth grade or less42.573.11.00 Over sixth grade57.526.93.55 (1.75 to 7.33)Employment status Unemployed46.754.01.00 Homemaker29.122.51.47 (0.65 to 3.41) Employed24.223.51.14 (0.50 to 2.64)Monthly household income $800 or less28.154.61.00 Over $80071.945.43.14 (1.58 to 6.25)Healthcare access and utilisationHas a healthcare provider No38.670.71.00 Yes61.429.32.62 (1.33 to 5.22)Saw healthcare provider, past 12 months No39.067.01.00 Yes61.033.03.29 (1.67 to 6.55)Has health insurance or coverage No51.483.81.00 Yes48.616.24.86 (2.17 to 11.67)*

Prevalence estimates are RDS-adjusted to account for difference in participants’ social network size and recruitment patterns.

Discussion

The prevalence of ever testing for HIV among undocumented Central American immigrant women in Houston was high. This seems to be due to their access to public health services through the county hospital district, which provides healthcare to all indigent residents regardless of immigration status. The association between HIV testing and regular healthcare indicates that access to public health services in this population increases the prevalence of HIV testing. Given that HIV detection among Central American immigrants is often delayed (leading to negative consequences for morbidity, mortality, and transmission), access to HIV screening is integral to HIV prevention in this population.