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. Author manuscript; available in PMC: 2023 Jan 1.
Published in final edited form as: Ethn Health. 2019 Aug 27;27(1):27–39. doi: 10.1080/13557858.2019.1659234

Associations between Gender Norms and HIV Self-efficacy among Latina Immigrants in a Farmworker Community

Gira J Ravelo 1,2, Mariana Sanchez 1,2, Elena Cyrus 2, Mario De La Rosa 1,2, Nilda Peragallo 3, Patria Rojas 1,2
PMCID: PMC7044041  NIHMSID: NIHMS1538669  PMID: 31450962

Abstract

Latina immigrant farmworkers are a vulnerable and understudied population that face a host of socio-cultural and structural barriers that place them at risk for HIV infection. Cultural factors, including traditional gender roles (egalitarian and marianismo) that frequently inhibit communication between partners and promote rigid roles, may particularly affect self-efficacy for HIV prevention among this population.

Objective:

This study examines the impact of women’s gender norms on HIV knowledge and safe sex negotiation skills, along with the moderating influence of HIV self-efficacy among Latina immigrants in a farmworker community.

Design:

The current cross-sectional analysis study examines data from a sample (N=157) of mostly undocumented Latina immigrant farmworkers in South Miami-Dade County, Florida. Analysis was performed on secondary data obtained from baseline collected on an intervention pilot study. Measures of traditional American (egalitarian) and Latina (marianismo) gender norms, HIV self-efficacy, and HIV knowledge, as well as key demographic variables were collected.

Results:

Findings revealed higher American (egalitarian) gender norms directly and indirectly predict higher HIV prevention factors. Additionally, HIV self-efficacy did not mediate effects of marianismo on HIV risk.

Conclusion:

Findings conclude that HIV prevention can be especially challenging due to socio-cultural and traditional gender norms faced by Latinas in farm working communities and that such norms should be taken into account when developing and adapting culturally appropriate interventions to reduce HIV related risk behaviors for Latinas residing in urban or farm working communities.

Keywords: HIV/AIDS, Hispanic, Latinx/o/a, women, immigrant, farmworker, seasonal worker

Introduction

In 2016, there were nearly 58 million Latinxs (Latinos/Latinas) living in the United States (US); making up 18% of the country’s population. Latinxs are the second largest racial or ethnic group in the nation (second to non-Latinx White [n-LW]) (Flores, 2017); in 2013, they accounted for 21% of people living with HIV in the US (CDC, 2016) and in 2015, made up 24% of all new HIV diagnosis (CDC, 2018). More specifically, Latina women are about four times as likely to be diagnosed with HIV or have AIDS, than that of their n-LW counterparts (US Health and Human Services [HHS], Office of Minority Health [OMH], 2016). Also, among Latinxs living in the US, immigrants account for over 50% of all new HIV cases (Montealegre, Risser, Selwyn, McCurdy, & Sabin, 2012) and of those, 44% are women (CDC, 2011). Despite reporting lower levels of HIV risk behaviors compared to n-LW women and non-Latina Black (n-LB) women (Wohl, Garland, Cheng, Lash, Johnson, & Frye, 2010), Latinas continue to be disproportionately affected by HIV. In fact, one of the most at risk and understudied groups in the US is the Latina immigrant in farmworker communities (LIFW). LIFW are among the most exploited workers in the US; they are given the worst jobs, at the worst pay, they face gender discrimination, yet they are the first to be laid off (Fernandez et al., 2004; Human Rights Watch, 2012).

The US is host to an estimated 2 to 3 million farmworkers, of which 71% are foreign born immigrants (Kandel, 2008) and 48% are undocumented (National Center for Farmworker Health [NCFH]), 2012) Social and structural barriers placing Latinx farmworkers at risk for HIV include language barriers, inadequate or incorrect HIV-related knowledge, and limited access to HIV risk reduction information and techniques. Furthermore, the migrant farmworker lifestyle, characterized by mobility, geographic isolation, separation from family, lack of health knowledge, and different cultural traits and beliefs about safe sex practices, escalates risks (NCFH, 2012).

One trait that has received much recent research attention is Latinx gender norms (Cianelli, et al., 2013; Nunez, et al., 2015; Sastre, De La Rosa, Ibanez, Whitt, Martin, & O’Connell, 2015). Gender norms influence Latinxs behaviors in ways that inhibit prevention and increase risk of HIV infection (Cianelli, et al., 2013; Gonzalez-Guarda, Vasquez, Urrutia, Villarruel, & Peragallo, 2011; Villarruel, 1998). Such traits are most apparent among undocumented Latinx immigrants who have lower acculturation, maintain stronger Latinx cultural gender norms (Kulis, Marsiglia, & Hecht, 2002; Marin, Tschann, Gomez, & Kegeles, 1993), and are in high numbers among South Miami-Dade’s farm working community.

Machismo and Marianismo

Among Latinx cultural gender norms, machismo is one that is most commonly seen and one that is valued by both Latinx males and females. However, machismo also carries disempowering and negative traits (Marín 2003; Sears 2008). As a protective factor, machismo places responsibility on Latinos (males) to be the protectors of the family (Gil & Vasquez, 1996, p. 9). Yet casual, as well as unprotected sex are both encouraged, despite marital status (Laumann, 1994; Marin, Gomez, & Hearst, 1993; Rhodes, et al., 2007; Rhodes, et al., 2009) – a practice that is consistently associated with HIV risk behavior for both the men and their partners (Beaulaurier, Craig, & De La Rosa, 2009; Cianelli, Ferrer, & McElmurry, 2008; Marin, 2003; Pleck, Sonenstein, & Ku, 1993). Consequently, most US Latinas (90%) with HIV, report having been infected via their heterosexual primary partners, making machismo a critical factor to consider in HIV risk among Latinxs (CDC, 2018). Moreover, examining this This is an important factor to consider when studying farm working communities because of the migrant lifestyle that separates men from their families and often result is unprotected sex with sex workers (NCFH, 2012). Although machismo is shown as having both risky and protective characteristics, the current study focuses on machismo as a risky cultural gender norm.

Marianismo has been described as the polar opposite of machismo in that it is a cultural female gender norm. A traditional Latina is expected to play a submissive role and, although she is also expected to be naïve about sex, should be eager to please her partner and overlook his machismo infidelities. By contrast to machismo, marianismo emphasizes chastity and virginity, submission to males, duty and loyalty to partner and family (Baca Zinn, 1982; Pavich, 1986). Latinx cultural gender roles dictate that Latinas remain submissive to their heterosexual partners. These gender roles hinder Latinas in farm working communities from negotiating condom use with their partners - who are likely to have multiple partners or engage in sex with sex workers. (Gonzalez-Guarda, et al., 2011; Rhodes, et al., 2007; Rhodes, et al., 2009). This, places them at higher risk for HIV infection than their more acculturated, or non-Latina White counterparts. Although marianismo is also shown as being risky and protective, the current study will focus on marianismo as a risky characteristic.

Self-efficacy

Self-efficacy is an individual’s belief or confidence in their own ability to control or influence the behaviors that affect their own lives. According to social cognitive psychologist Albert Bandura, this is the foundation of human motivation (Bandura, 1997, 2006). Self-efficacy has been found to enhance a woman’s sense of power to exercise control when dealing with sexually risky situations and can potentially play an important role in HIV prevention behaviors. Research in self-efficacy has long been associated with HIV prevention (Mao, Van de Ven, & McCormick, 2004; Sagrestano, Rogers, Kittleson, & Sarvela, 2005; Schiltz & Sandfort, 2000; Stark et al., 1998), including linking low self-efficacy to low condom use among diverse populations (Moore & Halford, 1999; Reis & Stephens, 1998). Yet, little is known about how HIV self-efficacy impacts HIV behaviors in the Latina farmworker community (Villegas et al. 2013). Cultural factors such as traditional gender roles (machismo and marianismo) frequently inhibit communication between partners and promote rigid roles that may particularly impact self-efficacy for HIV prevention in this population (Gonzalez-Guarda, et al., 2011; NHCF, 2011).

HIV Knowledge

Often Latinas’ lack of HIV knowledge is seen as a positive trait within the context of traditional Latinx gender norms. Despite findings, that HIV knowledge decreases HIV risk behaviors (Sanchez, et al., 2016) and is a predictor for HIV self-efficacy in women (Bandura, 1990; 1995; Coleman & Ball, 2009), Latinas who know too much about sex or risky sexual behaviors are considered undignified or improper. Gender norms dictate that such women would be seen as promiscuous, and thus, not candidates for marriage (Burgos, & Díaz Pérez, 1986; Hernandez, Zule, Karg, Browne, & Wechsberg, 2012; Mantell, Schinke, & Akabas, 1988). Consequently, because of such gender norms, Latinas (particularly those in long term heterosexual relationships) do not advocate for themselves and insist their male partners take safe sex measures like using condoms (Cianelli, et al., 2008; Peragallo et al., 2005). The current study examines the impact of woman’s gender norms on HIV related self-efficacy and HIV knowledge, along with the moderating influence of documentation status among Latina immigrants in a farmworker community.

Study Aims

The current study examines the impact of Latina immigrant gender norms on HIV related self-efficacy and HIV knowledge, coupled with the influence of documentation status among Latina immigrants in a farmworker community. The examined data are findings from a pilot study aimed at evaluating the effectiveness of a HIV risk-reduction intervention prevention among Latina immigrants in the farmworker community of South Miami-Dade, Florida. The aims of the current study are as follows:

  1. Examine the impact of traditional gender norms, American (egalitarian) and Latina (marianismo), on HIV knowledge and safe sex negotiation among documented and undocumented Latina women in a farmworker community and

  2. Determine if HIV self-efficacy mediated the effects of woman’s gender norms on HIV knowledge and safe sex negotiation. Demographic covariates included documentation status, acculturation, age, education, income, and marital status were examined.

Methods

Participants

The current study was conducted with a sample (N=157) of Latina immigrants from a farm working community in South Miami-Dade County, Florida. Only adult women up to 50 years of age were included in the study. All participants had to report being sexually active in the past three months and identify as Latina/Hispanic (See Table 1. Inclusion Criteria).

Table 1.

Inclusion and Exclusion Criteria

Criteria Inclusion
Age 18–50 years of age
Ethnicity Self-identified Latina/Hispanic
Gender Female
Country of Birth Central & Latina America or Caribbean
Time in the US 0–10 years in the US
2 Interviews Consent to be interviewed for pre and post interviews
3-day intervention Willing to participate in intervention
Past Interventions Never participated in SEPA or other STI intervention in the past 12 months
Intercourse Engaged in sexual intercourse during past 90 days
Contact Information Willing to provide 2 points of contact
Residence Reside in So. Miami-Dade farmworker community
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Table 1 presents participants’ age ranged from 18 to 50 years of age (M=34, SD=7.47) and most (80%) reported being in a relationship, with 67% reporting undocumented status. Time in the US ranged from 3–10 years (M=7.82, SD=1.80). Over 61% reported having immigrated from Mexico, with the second highest number of participants (15.3%) immigrating from Guatemala. Over half (54.8%) reported not having received a high school diploma and over half (53.4%) of participant reported being unemployed, while the remaining 47% were employed in the farming industry. Overall income reports were relatively low with a mean annual household income of $22,903 (See Table 2. Sample Demographics).

Table 2.

Sample Demographics (n=157)

Variables n %
Marital Status
 No partner 31 19.7
 With a partner 126 80.3
Documentation Status
 Documented 52 33.1
 Undocumented 105 66.9
Country of Origin
 Mexico 96 61.1
 Guatemala 24 15.3
 Honduras 11 7.0
 Caribbean 5 3.2
 Other Central/South American 21 13.4
Employed
 Yes 125 46.6
 No 109 53.4
Education
 Less than high school 86 54.8
 High school diploma 44 28.0
 College degree or some College 27 17.2
Mean (SD) Range
Age 34.32 (7.47) 18–50
Household annual income $22,903 ($10,104) $1,800-$80,000
Years in the US 7.82 (1.80) 3–10
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Data Collection

The current study conducted a cross-sectional secondary analysis using baseline data collected from a community-based participatory research pilot study titled, HIV Risk Reduction in High Risk Latina Migrant Workers in South Florida, which evaluated the efficacy of the Salud/Health, Educación/Education, Prevención/Prevention, y Autocuidado/Selfcare (SEPA) intervention. SEPA is an evidence-based and culturally tailored HIV/AIDS risk reduction intervention (CDC, 2015). Although, SEPA was initially intended for low-income Mexican and Puerto Rican Latinas in Chicago, IL (Peragallo, et al., 2005), it has since been effectively evaluated among Latina immigrants in a farmworking community of South Miami-Dade County, FL (Sanchez, et al., 2016).

The pilot study was conducted with the approval of the institutional review board of a large university in Miami, Florida. Overall aims of the pilot was to (1) develop a plan of action for HIV prevention among a community of Latinx immigrant farmworkers through improvement of access to HIV/AIDS prevention programs and to (2) increase the Latinx immigrant farmworkers’ capacity to respond to HIV infection at the local level through the provision of tools to educate and empower other women in the community. The pilot was conducted with the collaboration of South Miami-Dade County farmworker communities and a local community-based organization (CBO). The CBO provides services to the Latinx farmworker community on topics such as intimate partner violence, sexual violence and assault, and HIV/AIDS, focusing particularly on the more vulnerable population of immigrant women and their families. Recruitment was conducted via flyers handed out at local community health fairs, neighborhood activities street outreach activities, and by word of mouth from community leaders and advisory board members. Recruitment was concentrated near partnering CBOs and adjacent areas comprised of farmworker communities in South Miami-Dade County. Potential participants were screened for eligibility and consented by trained bilingual interviewers. The structured interview was conducted using a computer assisted personal interview software (CAPI) in a private space provided by the CBO and lasted approximately 90 minutes. Participants received an incentive of $50 for each for pre-interview, intervention completion, and post-interview. Retention was maintained on a formal monthly and ad hoc basis via telephone calls, text messaging, and home visits.

Measures

Baseline data was collected through validated scales previously utilized with Latinas. Measures of self-efficacy, HIV knowledge, traditional American (egalitarian) and Latina (marianismo) gender norms as well as key demographic variables were collected.

Sociodemographics.

All measures used in the current study were previously translated to Spanish and applied in other investigations examining the effectiveness of the SEPA intervention prevention with other Latina samples. Some of the language was adapted to the target population based on feedback from the community assessments and by our community advisory board. A demographics form assessed, in part, participants’ marital status (0=single; 1=in a relationship; 2=married), employment status (1=employed; 0=not employed), and annual household income in the past 12 months. U.S. documentation status was measured by 11 possible categories (e.g., temporary or permanent resident, temporary work visa, expired visa, documented, undocumented, etc.). Documentation categories were recoded into a dichotomous variable (0=undocumented; 1=documented). Education level was measured by six possible categories (1=less than high school to 6=graduate/professional studies). The education categories were recoded into three categories (1=less than high school; 2=high school diploma; 3=greater than high school diploma).

HIV knowledge.

The Heckman HIV knowledge scale was used to measure HIV related knowledge (Heckman et al., 1995; Sikkema, et al., 1996). The scale is made up of 12 dichotomous items (true/false) measuring knowledge of HIV transmission, prevention, and consequences. Total scores indicate number of items answered correctly (1 point per each correct answer; total scores represent number of correct answers; Range = 0–12). Higher scores indicate a higher level of HIV-related knowledge. This scale has been used with previous studies examining the efficacy of SEPA (Peragallo et al., 2005), with a reported α=0.75. Our study revealed an internal consistency of α=0.72.

Self-efficacy for HIV prevention.

As in Bandura’s self-efficacy theory (1990,1995), the Self-efficacy for HIV prevention scale measures the participant’s level of confidence in their ability to practice HIV preventative behaviors Seven items were rated on a 4-point Likert scale (1=strongly disagree to 4=strongly agree); total scores were calculated by adding the number of correct responses (Range=7–28) to a higher score representing a higher level of self-efficacy for HIV prevention. The scale has been used previously with Latinas both in the United States (Peragallo et al., 2005) and internationally (Cianelli et al., 2012) in studies examining the efficacy of SEPA. The scale has been found to have a fairly low reliability of α=0.68 (Peragallo et al., 2005). In the current study, the scale yields an internal consistency of α=0.61.

American (egalitarian) gender norms.

This was measured with the Americanism subscale of the Bidimensional Acculturation Scale (Marin & Gamba, 1996), a 12-item scale with each item ranging from 1 to 4. Total scores are calculated by adding each item and averaging by 12. For the current study, the scale indicated high reliability with this sample (α=0.95).

Latina (marianismo) Gender Norms.

To measure marianismo, the current study utilized the Marianismo Beliefs Scale (Castillo, Perez, Castillo, & Ghosheh, 2010). The scale is a 24-item instrument made up of five subscales (Family Pillar, Virtuous and Chaste, Subordinate to Other, Self-silencing to Maintain Harmony, and Spiritual Pillar). The instrument measures the degree to which a Latina believes she should enculturate and exercise the cultural tradition of marianismo. In the present study, the scale yield good internal consistency (α=0.89) and total scores were calculated by summing all items.

Analytic Plan

A series of four moderation models with 10,000 bootstrap iterations were tested with PROCESS v2.13 (Hayes, 2013). Figure 1 illustrates mediation models 1 thru 3 tested in the analyses. Model 1 tests the direct and indirect effects of American gender norms and HIV self-efficacy on HIV knowledge; Model 2 tests direct and indirect effects of American gender norms and HIV self-efficacy on safe sex negotiation; and Model 3 tests direct and indirect effects of marianismo and HIV self-efficacy on HIV knowledge.

Figure 1.

Figure 1.

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Primary Analysis

* = p < 0.05; ** = p < 0.01

The models estimated the direct effect of predictors American and Latina (marianismo) gender norms on HIV self-efficacy (a-path) and HIV knowledge/safe sex negotiation (c-path); direct effects of mediator HIV self-efficacy on outcomes HIV knowledge and safe sex negotiation (b-path); and the indirect effect of American and Latin (marianismo) gender norms on HIV knowledge/safe sex negotiation through mediation of HIV self-efficacy (c’-path). It should be mentioned that PROCESS v2.13 only produces confidence intervals for unstandardized regression coefficients; therefore, results for mediation models presented in unstandardized values (B).

Results

Bivariate correlations for all key variables are presented in Table 3. Analyses of potential covariates indicated the following significant correlations. Women who reported being documented reported higher levels of HIV knowledge (r = .210, p < 0.01), HIV self-efficacy (r = .20, p < 0.05) and acculturation (r = .34, p < 0.01); American (egalitarian) gender norms were associated with higher acculturation (r = .19, p < 0.05), education (r = .28, p < 0.01), and HIV self-efficacy (r = 37, p < 0.01). Conversely, Latina gender norms (marianismo) was associated with lower levels of education (r = −.18, p < 0.05), HIV knowledge (r = −.33, p < 0.01) and acculturation (r = −.19, p < 0.05). Consistent with the literature, higher levels- of education were linked to greater HIV knowledge (r = .33, p < 0.01) and HIV self-efficacy to safe sex negotiation (r = .38, p < 0.01).

Table 3.

Bivariate correlations of key observed variables

Variable 1 2 3 4 5 6 7 8
1. Education 1.00
2. HIV Knowledge .329** 1.00
3. HIV Self Efficacy .146 .303** 1.00
4. Safe Sex Negotiation .104 .188* .382** 1.00
5. American (egalitarian) Gender Norms .280** .342** .366** .282** 1.00
6. Latina Gender Norms (marianismo) −.182* −.334** −.043 −.144 −.282** 1.00
7. Documentation Status .221** .210** .190* .139 −.108 −.108 1.00
8. American Acculturation .519** .415** .148 .148 −.185* −.185* .338** 1.00
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*

= p < 0.05

**

= p < 0.01

Primary Analyses

Model 1 tested the mediating effects of HIV self-efficacy being tested on American (egalitarian) gender norms and HIV knowledge. Results indicate that predictor variables accounted for 16% of the variability in HIV knowledge. Higher levels of American (egalitarian) gender norms were directly associated with higher self-efficacy (B = 0.25, p < .0001). Similarly, greater HIV self-efficacy was directly associated with higher levels of HIV knowledge (B = 0.12, p < .05). Additionally, test showed direct effects of American (egalitarian) gender norms on HIV knowledge (B = 0.11, p < .01), the model also shows American (egalitarian) gender norms had a significant indirect effect on HIV knowledge (index = .03, 95% CI [ .004, .070]) (See Figure 1).

Model 2 also tested the mediating effects of HIV self-efficacy on American (egalitarian) gender norms and safe sex negotiations. Analysis indicated that predictor variables accounted for 15% of the variability in safe sex negotiation. Higher levels of American (egalitarian) gender norms were directly associated with higher HIV self-efficacy (B = 0.25, p < .001). Higher HIV self-efficacy was directly associated with safe sex negotiation (B = 0.15, p < .01). Analysis also showed a direct association of American (egalitarian) gender norms to safe sex negotiation (B = 0.08, p < .05). Test of conditional indirect effects suggest that American (egalitarian) gender norms also had a statistically significant indirect effect on safe sex negotiation (index = 0.04, 95% CI [ .011, .071]).

Lastly, Model 3 tested mediating effects of HIV self-efficacy on marianismo and HIV knowledge. Tests indicated that predictor variables accounted for 6% of the variability in HIV knowledge. Contrary to the literature, no direct effects of marianismo on levels of HIV self-efficacy were found. Non-significant effects are likely due to study small sample size (N=157) However, higher HIV self-efficacy was directly associated with higher levels of HIV knowledge (B = 0.16, p < .01), conversely, higher levels of marianismo was directly associated with lower levels of HIV knowledge (B = − 0.08, p < .001). However, no indirect effects were found between marianismo and HIV knowledge.

Discussion

The current study is the first to examine the mediating effects of HIV self-efficacy on gender norms as an examination of HIV prevention behaviors among immigrant Latinas from a farm working community. HIV prevention can be especially challenging among Latinas in farm working communities that face socio-cultural barriers for HIV prevention (Fernandez, et al., 2004). Interventions may need to address multi-level strategies such as gender norms, women’s sexual rights, and cultural beliefs when tailoring HIV interventions in this particularly marginalized and underrepresented population.

Some of the current study finding were consistent with the literature, such as egalitarian gender norms being more likely to predict HIV self-efficacy as well as HIV knowledge and safe sex negotiation skills. Yet, unlike the literature, in this population, Latina gender norms had no significant effects on HIV self-efficacy, a result that may accounted for by a relatively small sample size. Also, Latina gender norms showed only a negative effect on HIV knowledge, that is, higher scores of traditional Latina gender norms (marianismo) predicted lower HIV knowledge. Additionally, HIV self-efficacy had no moderating effects between marianismo and HIV knowledge. Overall HIV Knowledge and American (egalitarian) gender norms had the most positive correlations on all constructs except on Latina (marianismo) gender norms, where it was shown to have negative correlations for both. Despite protective factors of marianismo, such as chastity (Baca Zinn, 1982; Pavich, 1986), and the current study’s small sample size, marianismo remains a risk factor in areas like HIV knowledge, even when mediated by self-efficacy.

Future Research

By testing the mediating role of HIV self-efficacy, this study explored possible content for interventions for this high-risk population. To date, most studies that have been done in these communities have been with Latino men, including men who have sex with men and sex workers. Yet, further research in the area of HIV prevention and cultural risk factors among Latinas from farm worker communities are still needed. Furthermore, the current study has shown that HIV prevention can be particularly challenging due to the socio-cultural and traditional gender norms that Latinas in farm working communities face. Such factors should be taken into account when developing and adapting culturally appropriate HIV interventions for Latinas residing in urban or farm working communities. In addition, dyadic intervention programs that target machismo and marianismo within the traditional Latinx couple could prove to be quite innovative in this target population.

Limitations

The current study has predictive limitations in its cross-sectional design; since exposure and outcome are simultaneously assessed, generally, there is no evidence of temporal relationship between the two. Additionally, the dataset is relatively small and taken from self-reported and face to face interviews, which may be susceptible to social desirability and recall errors. Moreover, although the current study underscores the role machismo plays in HIV risk behaviors among traditional Latinas, because the scope of the parent study did not include data collection from the participant partners, the current study was unable to evaluate the partners’ gender norms.

Footnotes

Declaration of Interest Statement:

The authors declare that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere. Research was reviewed and approved by the appropriate institutional and/or national ethical review committee.

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