In the present study of male Latino day laborers, the only factor found to be associated with self-reported HIV testing in the previous 12 months, after controlling for the presence of other variables, was annual income. The association between self-reported HIV testing and annual income found in this study is consistent with another study that examined HIV testing among Latino farmworkers, a different sub-group of Latino immigrants.28
Although HIV testing may be available free of charge in large urban areas through public health clinic sites and community based organizations, such sites may not be easily accessible for low-income Spanish-speaking populations.
A previous study has developed consumer-based indicators to evaluate the accessibility of private and public nonhospital HIV testing organizations in Los Angeles County; this study used a telephone survey protocol to contact 148 sites and assess consumer-relevant accessibility measures. Only 50% of the sites could be contacted after three telephone calls; hence a consumer who tried to reach one site had only a 50–50 chance of success.29
Such findings indicate that HIV testing sites may not be readily available.
Although it may be argued that most day laborers in this study had low annual incomes, it appears that those with the lowest annual incomes may face more barriers in finding HIV testing in their communities than those with higher incomes, especially if they believe that they have to pay for testing. A need exists to make low income populations, such as day laborers, aware of the availability of free or affordable HIV testing sites in their communities.
Two ways of raising awareness of the need for HIV testing in the day labor population may include outreach programs by a county’s Department of Public Health, especially if done through trusted community-based organizations, as well as social marketing campaigns conducted in Spanish. Social marketing campaigns, especially if done through radio, a media that is commonly used by low-income Spanish speaking Latinos,30
would be able to reach a large segment of the Spanish speaking population; a recent study indicates that such campaigns may be effective in promoting HIV testing in Latinos.31
The utility of social marketing campaigns is likely to be enhanced considerably by close integration, at the local level, of social marketing and HIV testing services. 29
The finding of higher annual income being associated with self-reported HIV testing in the present study contradicts a previous study that examined intention to test for HIV among a sample of Latino day laborers. In this previous study, lower income was associated with greater likelihood of having intentions to test for HIV in the subsequent 6 months. The present study findings indicate that when self-reported HIV testing history is measured rather than “intention to test”, there may be less likelihood of a socially desirable response among the lower income day laborers. 21
The self-reported HIV testing rate in the previous 12 months among this sample of Latino day laborers was 46%; a rate that is higher than the 30% reported on a previous study on Latino day laborers.9
However, day laborers who engaged in high risk behaviors, such as having sex with both men and women, were not found to be more likely to self-report HIV testing in the past 12 months. This finding contrasts with studies on other populations that have found that men who have sex with men (MSM) are more likely than heterosexual men to receive HIV testing.32–33
In addition, while a previous study reports relatively high rates of HIV testing among MSM, that study included only men who self-identified as gay or bisexual.34
However, men who have sex with men and women may not always identify as homosexual or bisexual, and this lack of association between sexual behavior and self-identified sexual orientation may be even more common among Latino subgroups such as day laborers. Therefore, future studies need to assess sexual behaviors and not just sexual orientation.
In addition, future research needs to evaluate the specific social and cultural issues that serve as barriers or facilitators for HIV testing among Latino men who have sex with men and women. A previous study describes that HIV-related stigma is an important barrier keeping persons at risk for HIV from seeking HIV testing.35
Although the present study did not measure HIV-related stigma, we suspect that this may be an important barrier for HIV testing among Latino men who have sex with men and women; qualitative research in this area focused on Latino men who have sex with men and women is needed.
In the present study, all of the day laborers who reported having had sex with men also reported having had sex with women (8%). The proportion of day laborers reporting having had sex with men is similar to a previous study of day laborers.9
However in this previous study, the participants who had sex with men were not asked if they also had sex with women. Despite 8% of the sample reporting bisexual behavior in the present study, only 1% self-identified as bisexual and no one self-identified as gay/homosexual. The discrepancy between sexual identification and reported sexual behavior found in this sample is a cause for concern because a recent study indicates that men who have sex with men who identify as heterosexual are more likely to have had STDs, to have unprotected intercourse with female partners, and to report having sex under the influence of alcohol or other drugs. 36
A need exists for the development of interventions that promote sexual risk behavior reductions as well as HIV testing among Latino men who have sex with men and women and who identify as heterosexual.
The strength of this study is that it is the first to focus on self-reported HIV testing by Latino day laborers using a large sample from an urban area. Regarding the limitations of the study, one limitation is that this study did not actually conduct laboratory HIV testing on the day laborers who participated in this study and that the history of HIV testing is based on self-report. Another limitation is that the data did not include measures on day laborers’ perceived risk for HIV or HIV/AIDS-related knowledge. It is likely that more recent immigrants may have less HIV-related knowledge; many immigrants come from rural areas where access to information on HIV is limited. A previous study documents low levels of HIV knowledge among Latino immigrants.15
In addition, recent immigrants may be emigrating from areas where the HIV prevalence is low and therefore they may not be as aware of the need to practice safe sex to prevent HIV. Another limitation of this study is that it is based on a convenience sample of day laborers; however, in comparing the socio-demographic profile of our study participants to that of a recent national study on day laborers, we found many similarities, including a similar proportion of day laborers born in Mexico and similar education levels, marital status, and years spent in the United States.4
Finally, it is possible that our study, based on pre-existing data from another original study, did not have sufficient statistical power in order to be able to detect significant differences in HIV testing among certain subgroups of day laborers. Ex post facto we considered the ability of our multiple logistic regression model to predict whether a day laborer would have been tested for HIV. For example, among other potential predictor variables, we specifically considered the case of an individual who was low risk for HIV (men who had sex with only women) versus one who was high risk for HIV (me who had sex with both men and women). Using the numbers obtained from our actual study, we assumed an approximate 50% rate of HIV testing in the population under consideration (the rate for the dependent variable), an approximate rate of about 10% of the population being high risk (the independent variable of interest), an approximate R-squared of 0.1 between all of the independent variables in the model, and a 0.05 significance level. With a sample size of 356, the study had 80% power to detect an odds ratio of 3.02 for the high risk group (versus the low risk group). Thus only a fairly large odds ratio of about 3 could have been detected with the given sample size and rarity of the high risk group in the population under study. Thus it is not surprising that we found no significant difference in HIV testing between men who had sex with women only and those who had sex with both men and women.
Nevertheless, this study presents findings not previously addressed in the few articles that exist on HIV testing among day laborers, and the findings are based on a sample size larger than those utilized in previous HIV studies with day laborers. Our findings indicate that interventions that target lower income day laborers are needed to promote HIV testing among this population. Such interventions will need to be linguistically and culturally appropriate. As noted by the Center for Disease Control and others, 16–20
early HIV detection is an important strategy in preventing the spread of HIV in the community.