Abstract
Migration and travel have been significant factors in the human immunodeficiency virus (HIV) epidemic since its emergence in 1981. Understanding the current effects of migration and travel on HIV/AIDS transmission and survival is essential to intervention efforts, especially for immigrants. Previous research highlights differences between immigrants and native ethnic minorities, but few studies compare immigrant groups to their peers in the country of origin. The overall objective of this study was to explore the relationship between migration, travel and risk behavior among Jamaicans infected with HIV. This dissertation study analyzed HIV/AIDS registry data from the New York City Department of Health and the Jamaica Ministry of Health by focusing on HIV positive individuals of Jamaican birth reported to surveillance from January 1, 1988 to December 31, 2007. The research included three specific aims. The first aim explored factors associated with transnational sexual partnerships among persons with HIV in Jamaica, using classification tree methodology and logistic regression modeling. The second aim compared trends in newly reported HIV and AIDS cases as well as deaths among Jamaican cases in New York City and Jamaica. The study design was ecologic and involved the comparison through the use of general linear modeling techniques. The final aim compared factors associated with late stage HIV/AIDS diagnoses between the two locations through a case control study design and logistic regression analysis. Persons with missing gender (n=62) were excluded from all analyses. Tests for interaction by location and gender were performed with each covariate. Significant interactions by both gender and location led to stratified models in the final analysis. A matched sample of 623 cases and 1,869 controls was analyzed to determine factors associated with overseas partnering. Persons who were deportees, in the professional or trade occupation groups, separated or divorced and categorized as MSM or IDU were more likely to have transnational sex partners. Comparisons of HIV, AIDS and death rates between the two jurisdictions revealed significant declines in annual AIDS case rates and deaths with no significant change in newly reported HIV cases. In both settings, rates of late stage diagnoses were alarmingly high (42% and 48% respectively).