Undocumented - illegal immigration in NYC

Hidden Community and HIV

Researchers worry about an HIV epidemic among certain undocumented
populations in New York City.

Erik Sass

A new HIV epidemic may be spreading through one of New York City’s largest minority groups, affecting a recent wave of Latino immigrants who live in rapidly growing “hidden communities.” But the scariest part of this already troubling scenario, according to a group of leading experts on HIV, is that health officials don’t even know the true scope of the problem.

Experts on the epidemiological, socioeconomic and cultural aspects of HIV transmission say that three specific groups of recent Latino immigrants – Mexicans, Dominicans, and people from the Central American countries of Honduras, Nicaragua, Guatemala, Costa Rica, and El Salvador – may be increasingly afflicted by the virus. However, cultural barriers and an instinctive distrust of government officials by these populations are preventing voluntary HIV testing and reporting of new infections.

“There’s certainly a problem of HIV infection in all those groups, but it’s hard to say whether it’s going up or not,” said Don Des Jarlais, a professor in the Albert Einstein College of Medicine’s Department of Epidemiology and Population Health and leading expert on HIV epidemiology. As the director of the Chemical Dependency Institute there, Des Jarlais recently completed a groundbreaking study proving that needle exchange is both safe and effective in preventing HIV, relying exclusively on voluntary testing and reporting of test results.

“There are both sociocultural and socioeconomic obstacles to the kind of empirical, quantitative testing the needs to be done,” Des Jarlais explained. “When people don’t have economic resources it’s difficult to get them to pay attention to long-term health concerns, and there’s also the cultural aspect of the double stigmatization of HIV and minority status. So they’re just not getting tested.”

Robert Remien, an assistant professor of clinical psychology at Columbia University and research scientist at the HIV Center for Clinical and Behavioral Studies, agreed, “It’s certainly fair to say that doing studies targeting immigrant communities is more challenging because of these barriers.”

Other experts in the field agree. “I do think we’re starting to see signs of [an increase in these communities],” said Jeffrey Parsons, an associate professor of psychology at Hunter College and director of the Center for HIV/AIDS Educational Studies and Training there. “But the question is: is that a blip, a one-time thing in the data, or is it going to bear itself out and become more serious? One of the frustrating things about this is that we rely on testing data for these studies, and we know that immigrants are much less likely to get tested because of welfare and immigration issues.”

“I don’t think we have any kind of a handle in these populations. We don’t know how at risk they are, but we know that they are at risk here,” said Michelle Shedlin, a cultural anthropologist who studies attitudes among Latino immigrants towards HIV/AIDS and the medical community. “We don’t know about the sero-prevalence in these populations because they’re not coming in for testing.”

Indeed, the main stumbling block to increased testing among these specific sub-groups within the Latino immigrant community is concern that it may jeopardize their immigration status or cause them to lose their healthcare, housing, or welfare benefits.

Fear of deportation is especially prevalent among illegal immigrants and immigrants who came to the United States legally but whose visas have lapsed. Their fears are even more real given the government’s post-9/11 reorganization and extension of duties formerly in the purview of the Immigration and Naturalization Service (INS) under the newly created Department of Homeland Security (DHS). In this unfriendly climate, Latino immigrants cannot afford to jeopardize their position by calling attention to themselves. This is especially true because “[many of] these people are either here to earn money and put down roots, or earn money and send it back home,” according to Shedlin, whose studies integrate a broad range of related factors, including date of arrival, age, gender, income, employment, and nationality.

But according to “HIV/AIDS and Immigrants: A Manual for HIV/AIDS Service Providers,” put out by the National Immigration Project of the National Lawyers Guild, illegal immigrants discovered by the DHS are indeed in danger of being deported – regardless of their HIV status – but healthcare workers have neither the right nor the obligation to report illegal immigrants to the DHS or to any other agency. Further, HIV status is not supposed to be considered in deportation or citizenship hearings. New York City law also expressly prohibits employees of city agencies from reporting information about clients to immigration authorities – including their HIV status.

The researchers and activists interviewed agreed there was a crucial need to communicate reassuring information about HIV confidentiality and immigration law to Latino immigrants, and all viewed a fear of deportation or change in immigration status as the single largest deterrent to HIV testing in these communities. They also want to spread information about the ways that HIV can be transmitted, because some immigrants lack even basic education on these topics.

Immigration statistics confirm that the majority of recent Mexican immigrants to New York come from four mostly rural states around Mexico City, including Puebla, Guerrero, Jalisco, and Michoacan. All four states devote very little money to their public schools, even by the standards of Mexico’s troubled educational system. Most of the Mexican immigrants are young – 24.3 years old on average, as opposed to 34.4 for New York overall – and many have not even completed what little primary education was offered to them in Mexico. In 2000, 60 percent of Mexican immigrants in New York had not completed high school, as opposed to 30 percent of New Yorkers overall, and among Mexican-Americans ages 18-19 in New York only 25 percent of the men and 31.1 percent of the women were enrolled in high school, as opposed to 67.6 percent and 71.2 percent for New Yorkers in that age range generally.

Most disturbingly, in their countries of origin even health professionals still display widespread ignorance. A study described in a 2004 edition of the online journal Sexual Health Exchange found that “[o]ne quarter of the health professionals surveyed… thought HIV and AIDS were the same thing; almost a fifth did not know that a mother could transmit HIV to her child through breast milk…”

As far as ordinary folks, another study found that “[a]mong Mexican youth, 41 percent cannot gauge their risk level, no matter whether they are sexually experienced or not.” The same study states they “[l]ess than half the students in Mexico… were confident that they knew how to use a condom correctly.” It also found that “sexually experienced students in Mexico… do not rate themselves at higher risk of HIV infection.”

Dr. Susan Tross, an HIV prevention and intervention researcher on the faculty at Beth Israel Medical Center and the New York State Psychiatric Institute who has studied HIV transmission in New York since 1983, summed up the situation: “If you’re a Latino immigrant, and you’re poorly educated, it’s true – you could be in real trouble.”

“Of course there are new risks for them,” Shedlin confirmed. “For example, most of these people come from traditional communities where there’s not very much drug use, and here they may very well end up working with people who are using drugs. Also, being away from home and hiring a sex worker because they’re lonesome definitely puts them at risk. It’s a common practice, because many of them come from cultures where sex workers are not so looked down on, so disapproved.”

Meanwhile studies in the home countries of several Latino immigrant sub-groups point to emerging HIV epidemics and raise the possibility that immigrants may be infected before they even arrive here. “The HIV epidemic is increasing in Central America,” Shedlin warned. “We’re doing in-country studies, for example in Nicaragua – and we’re finding that there’s a combined drug epidemic and HIV epidemic that seems to be getting under way. The two are inter-related. Honduras has also had a significant epidemic for some time now.” And another article in the Sexual Health Exchange says: “HIV infection is pandemic and adolescents are at high risk because many are exploring sexual interactions without adequate sex education and protection.”

As far as a program to reach these immigrants, “I think it needs to be tailored, it needs to be really specific,” said Jeff Parsons. “The organization and the agenda can’t come from the health department, it has to come from the communities themselves. There need to be partnerships between these community organizations, of whatever kind, and the city’s health organizations. I think that more ways of working collaboratively need to be developed.”

For a model, Robert Remien and Jeff Parsons pointed to the success of recent studies where researchers from Columbia University and the New York Psychiatric Institute cooperated with community activists from an organization called the Asian-Pacific Islander Coalition on HIV/AIDS (APICHA) to reach out to illegal immigrants in that community. The community contacts helped allay the immigrants’ concerns that their immigration status might be revealed by health officials and educated them about their legal rights, allowing researchers to conduct studies that combined quantitative, empirical investigation of HIV rates through testing and educational interventions teaching about the virus.

Of these studies Remien said, “We did a pretty good job of accessing those specific immigrant communities because we formed the appropriate partnerships with community organizations.”

But the problems of “illegal” status, lack of education, poverty, and urban anonymity make undocumented aliens from Central America especially hard to reach. According to Shedlin the Mexican, Dominican, and Central American immigrant communities in New York are saddled with a coupling of insufficient education and an almost total lack of social “infrastructure” to disseminate messages about personal health.

“They’re coming into what I call ‘disrupted communities,’” Shedlin said. “This new wave of immigrants comes in large part from rural communities in Mexico, Central America, and the Dominican Republic – and they bring little pieces of their community, little pieces of their culture, but not the infrastructure of schools, places for socializing, labor associations, things like that. Most of them are poorly educated, and in a sense they get here and they’re completely isolated.”

This is not to say that potential areas of cooperation have not been identified. For example, churches (often Protestant evangelical) create some of the most powerful social and cultural bonds among Latino immigrants.

“In the North Fork of Long Island, the church is the main institution that is trusted and can reach people, really reach these hidden communities,” said Michelle Shedlin. “Also, the Apostolado Hispano in Riverhead, New York, is one of the only organizations that can reach undocumented immigrants with information about HIV.” Shedlin included these suggestions in an official advisory report titled “Qualitative Needs Assessment of HIV Services among Dominican, Mexican, and Central American Immigrant Populations Living in the New York Eligible Metropolitan Area,” which was submitted in April, 2004 to the New York State Ryan White AIDS Council.