A qualitative community health assessment of HIV prevention awareness in a semi-rural Latinx seasonal farm working community in South Florida

Abstract

This article explores HIV awareness and prevention in a Latinx seasonal farmworker community of south Miami-Dade County in the USA. The study took place as part of a larger community assessment that aimed to determine community needs and resources related to substance abuse, violence and HIV in the Latinx seasonal farmworker communities of south Miami-Dade County, with a particular focus on fathers and their male sons’ relationships. The study collected data on HIV knowledge and prevention, healthcare-seeking behaviours, cultural norms, and communication barriers about HIV prevention between fathers and sons. Data were collected through in-depth interviews with community leaders, two focus groups with social and health services providers, and four focus groups involving fathers and their adolescent sons. A deductive approach to data analysis was undertaken. Five major themes were identified: (1) HIV related knowledge and perception; (2) HIV prevention strategies; (3) barriers and needs for tailored preventive health and care services in the community; (4) stress over sex-related communication; and (5) the dominance of traditional masculine gender norms in the household and the community.

International neoliberal policies supported by countries such as the USA create the conditions for economic inequality in countries abroad that lead to emigration. According to Golash-Boza (2015), the “spread of neoliberalism around the globe has pulled countries into the global economy, transformed peasants into international migrants, and lured immigrants to toil in low-wage jobs in countries like the United States” (12).

According to the US National Center for Farmworker Health (NCFH) (2020), there are between 2.5 and 3 million agricultural workers in the USA, with many of them being foreign-born (75%) and 83% identifying as Hispanic (65% identified as Mexican) (Hernandez and Gabbard 2018). In 2017, the state of Florida where this study was conducted had an estimated farm working population of 113,354, sub-divided into migrants¹, seasonal farmworkers² and H-2A³ farmworkers. An estimated 10.12% (n=11,467) of these workers were employed in Miami-Dade County, Florida (Shimberg Center for Housing Studies 2019).

Florida is one of the states in the USA with the largest Latinx farm working populations (Castillo et al. 2021). In 2021, the state’s agricultural industry benefited considerably from the hard-working Latinx population, reporting profits of around US$7.2 billion (Bureau of Strategic Development 2022). According to Serna et al. (2020), around 150,000 to 200,000 agricultural workers travel annually to work in Florida, mainly from Mexico and Central America. Once in Florida, they are structurally vulnerable to occupational injuries and illness, lack of access to health services and exposure to agricultural pesticides (Serna et al. 2020; Chicas et al. 2022; Donley et al. 2022). Consequently, thecommunities where they work host long-standing movements fighting for their people’s justice, health and human rights (Xiuhtecutli and Shattuck 2021).

Due to the physical and emotional distress that seasonal farmworkers experience, they are at a greater risk of facing adverse health outcomes (Shehadeh and McCoy 2014). Previous research with Latinx seasonal and migrant farmworkers in the southern region of Miami-Dade County has found that to develop effective HIV prevention interventions, we must consider workers’ specific circumstances as well as their traditional mistrust of conventional forms of programming and research (Sánchez et al. 2012).

While the US agricultural economy depends heavily on the labour of Latinx farmworkers, it offers limited options for workers to obtain legal immigration to the USA (Golash-Boza 2015). US-bound farm-working Latinx experience barriers to accessing health care, living in rural areas where crowded and poor living conditions increase their exposure to infections and other health issues (Frank et al. 2013). As well as facing disproportionate levels of poverty, farmworkers experience significant work and environmental hazards that may exacerbate their risk of Substance Abuse, Violence and AIDS (SAVA) (Singer et al. 2006).

The data presented in this study derive part of a larger community assessment that aimed to determine community needs and resources and multilevel perspectives on substance abuse, HIV prevention and domestic violence within the Latinx seasonal farmworker communities of south Miami-Dade County, Florida. To be eligible to participate in the current study, fathers needed to have lived or worked in the community for the last 12 months, were seasonal farmworkers who lived in the same community all year-round and did not move or travel to other places with the crops (Chaney and Torres 2017). The present study focuses on findings concerning HIV knowledge and prevention, healthcare-seeking behaviours, cultural norms, and communication barriers about HIV prevention within the Latinx seasonal farmworker community. Data collection was guided by previous research in this same community and the syndemic conceptual framework.

Theoretical Framework

According to Singer (2009), a syndemic may be defined “as the concentration and deleterious interaction of two or more diseases or other health conditions in a population, especially as a consequence of social inequity and the unjust exercise of power”(xv). As such, the syndemic framework guides the understanding of the connection between the behavioural, socio-environmental and structural factors that influence health disparities. Other research on Latinx farmworkers’ health in the USA has used syndemic framework to evidence vulnerabilities. Cartwright (2011) mixed method study, describes how the immigration status of Mexican agricultural workers in the cherry harvest of Montana is situated within “toxic social conditions” that constrain workers’ access to health services and better living and working conditions. Similarly, Saxton’s (2015) ethnographic research in California’s Pajaro Valley documents the synergistic relationship between working in California agricultural production, toxic exposure to pesticides and health disparities that affect the well-being of California farmworkers. Previous formative research based upon the syndemic framework conducted with the Latinx farm working community in south Miami-Dade County has shown that select interpersonal, cultural and socio-environmental indicators serve as common risk and protective factors for substance abuse, family violence and HIV (De La Rosa et al. 2018).

Methods

Recruitment and Sample

During 2018–2019, data were collected via three sets of focus groups (with fathers and sons; with local service providers; and with local community leaders). The community outreach coordinator from the Center for Research on US Latino HIV/AIDS and Drug Abuse coordinated the recruitment process. Participants were primarily recruited through referrals from partnerships with community-based agencies. We also conducted recruitment efforts in local farmworker residential communities, in farming nurseries, at community festivals and health fairs, in recreational parks, shopping malls, barbershops, Hispanic restaurants, private businesses, social service agencies, and health care facilities using word of mouth, study flyers and social/mass media efforts.

Inclusion criteria for participating in the fathers and sons focus groups were (1) being a former or present male farmworker (18 years or older) or a male adolescent child of a farmworker (13–17 years old); (2) living or working in a farm working community; (3) being able to speak and understand English or Spanish; (4) being a father figure (e.g., father, older brother, stepfather, godfather and grandparent) or a son and (5) being able to understand and provide written consent or assent.

For the community service provider’s focus groups, the inclusion criterion was: (1) providing health or social services to the farm working community of Miami-Dade County. For the community leaders’ in-depth interviews, inclusion criteria were: (1) being seen by others as a leader in the local community; (2) exercising a leadership position such as being a community agency’s director or by serving on a community association’s board of directors.

Informed consent and/or assent (for adolescents under 18 years) was obtained from all participants in their preferred language prior to participating in the study. Incentives for participation as compensation for working time lost were set at $40 per participant in a focus group and $50 per participant in an in-depth interview. The study was approved by the University of Miami Ethics Institutional Review Board (IRB# 20170769).

Data Collection

A total of six focus groups were conducted: two with fathers (n=11 and n=9), two with adolescent young men (n=10 and n=8), and two with community health and social service providers (n=11 and n=8). An additional nine in-depth interviews took place with community leaders. Focus groups lasted approximately 2.0 hours in length and individual interviews were approximately 1.5 hours in duration. Both focus groups and in-depth interviews were conducted in private rooms in community settings provided by project partners. Trained bilingual interviewers and note-takers conducted the interviews and focus groups. Interviewers were of the same-sex as the interviewed person-group, audio-recorded, and transcribed verbatim for analysis using NVivo 12 software. A semi-structured interview guide was developed for the focus groups and in-depth interviews. The guide was informed by syndemic theory and included questions related to socio-demographic, ecological and behavioural challenges, socio-cultural risks, and perceived protective factors related to the community.

Qualitative Data Analysis

Trained bilingual coders coded the data from focus groups and in-depth interviews in the language in which they were conducted. A preliminary codebook was created after reviewing the first transcripts. After any discrepancies had been resolved and the codebook refined, a final codebook was created using a structural coding approach (Saldaña 2021). The qualitative coding of the data proceeded as follows. First, transcripts were double-coded, compared, and discussed between coders to ensure coding accuracy and minimize coding bias. After the first coding cycle, the first author returned to the data to proceed with a second coding focusing on patterns and agreement between the participants. A deductive approach to data analysis was adopted, informed by the study’s theoretical framework.

Results

Demographics

The median age of participants in the study was 40 years for fathers, 14 years for adolescents and young men, and 49 years for community service providers and leaders. With respect to participants’ countries of birth, we found that 50% of fathers were born in México, most adolescents and young men were born in the continental USA (88%), and most community service providers and leaders were born in México (40.7%). Additional demographics are presented in Table 1.

Table 1.

Participant Socio-demographic characteristics

	n	%
Fathers
Age (Median = 40)
27 to 37 years	7	35
38 to 45 years	6	30
46 to 56 years	7	35
Place of Birth
México	10	50
Central Americaa	6	30
Caribbeanb	2	10
USAc	1	5
No response	1	5
Adolescents
Age (Median= 14)
12 to 13 years	5	27.8
14 to 15 years	8	44.4
16 to 17 years	4	22.2
No response	1	5.6
Place of Birth
USA	16	88.9
México	1	5.6
No response	1	5.6
Community service providers & Leaders
Age (Median= 49)
21 to 30 years	4	14.8
31 to 39 years	4	14.8
40 to 49 years	6	22.2
50 to 65 years	13	48.1
Gender
Female	19	70.8
Male	8	29.6
Place of Birth
México	11	40.7
USA	7	25.9
Central America	5	18.5
Caribbean	2	7.4
South Americad	2	7.4

Themes

We identified five prominent themes related to the social factors seen as posing potential risk factors for the Substance Abuse, Violence and AIDS. These themes, along with the selected participant quotations, are presented below.⁴

HIV-related Knowledge and perceptions

Fathers.

Overall, fathers agreed that HIV was a transmissible and infectious disease that required a means of protection to prevent its spread. When we asked participants, ‘What do you understand by HIV?’ most of the father’s responses were related to the perceived danger of HIV and the importance of protecting themselves and young people from it. Many participants agreed that HIV could be transmitted sexually.

It is a sexually transmitted disease that if you do not protect yourself or mess around with a person who is infected with the virus, you run the risk of becoming infected, and it is bad, it is dangerous.

However, among fathers, there were misconceptions about specific means of transmission and detection. Fathers reported relying on a person’s physical appearance to decide whether a risk existed. One of them said, ‘Look at the person’s physique and see what it looks like because if you see [the person] too skinny, one should try not to get too close’. They also saw HIV as potentially transmitted through negligence when preparing food in the kitchen, ‘If you don’t protect yourself, sometimes in the kitchen when you are cooking you can cut your hand and blood can spread out and then you can transfer it [the infection] to the children’. Public restrooms (toilets) were also seen as posing a risk: ‘I advise my children… to be careful when they go to the bathroom because sometimes it is transmitted when one is going to do the necessities’. HIV was also believed to be transmitted through the air: ‘… It’s worrisome because that [HIV] travels through the air…’. Fathers also expressed uncertainty about HIV transmission by means of bodily fluids such as saliva. One of the fathers questioned, ‘I am not sure if it can be transmitted, maybe, through a kiss, or a through saliva too?’

Adolescents.

Similarly, some young men agreed that HIV could be transmitted sexually and through bodily fluids such as blood. As one of them explained, ‘HIV can be transmitted by penetration and can be transmitted by blood. When someone has the virus, they can pass it to another person through blood transfusion.’ Other young men added that HIV could be transmitted from mother to child at birth, ‘if the mom has it and she gives birth, the kid will also have it’; and ‘through cuts… when somebody that, somebody that’s infected, their blood gets in your wound’. Most of the adolescents in the focus groups responded that they did not know very much about HIV.

Community service providers and leaders.

When we asked health/social services providers about HIV in the farm-working communities of south Miami-Dade County, they said that talking about HIV was considered taboo locally, especially among men, who they believed were less informed than women. One service provider argued that members of the farm-working communities were at higher risk of infection than other communities in the region,

Everyone has a very high risk just because of that because, as it has been taboo, they don’t take it very seriously, and they don’t talk about it. And that is why I consider that this community is more at risk than other types of communities. Like, for example, the African-American community talks a lot about it, and they are more informed and take more precautions.

Other providers explained that mobility restrictions contributed to HIV risk in the farming communities especially when there was a lack of access to adequate health information.

Due to lack of information, there are limitations. Someone who is working in the communities here has no reason to go out to other places for reasons of immigration, or for culture, or anything, so there is only a small group in which they are integrated.

Service providers mentioned other risk factors that could contribute to HIV transmission in farming communities, including alcoholism, promiscuity, and machista and homophobic cultures. About this last factor, one community leader said,

I would think it’s more of a machista culture when it comes to the farmworkers in general. It’s like you cannot be openly gay and be a farmworker. When it comes to that, people are more like, they don’t want to talk about sexuality. They must show this persona, like I am a straight macho person, and that is risky when it comes to having sex in general.

HIV Prevention

Fathers.

In the focus group with fathers, discussion regarding HIV prevention strategies centered largely on condom use. Fathers stressed the importance of talking to their sons about the risks of unprotected sex when having sexual intercourse. As one father stated,

I think the same as the other colleagues. You talk to them[adolescents] about it, about AIDS, and as a parent, you worry, concho!... so much that I have spoken to my son about it and that he makes a mistake and gets the disease. Then we, as parents, are going to suffer, a son is lost, but those of us who remain, we are left with the worry and the suffering that it should never have happened. That is why they [the adolescents] are to be warned: if they are going to do it [have sex], put on 2, 3[condoms], it does not matter, with gloves (laughs).

Parents explained that the duties of a father were to ‘protect’ their sons by educating them and providing them with condoms, ‘I buy him condoms, and we talk whenever I can, not just about HIV, about other diseases, Chlamydia, gonorrhoea…’, or by giving them the money to purchase condoms.

Additionally, fathers stressed the need for sons to refrain from sexually engaging with women they were unfamiliar with as a preventive strategy. Importantly, few fathers reported having had an HIV test themselves or being with a partner who had been tested. One participant referred to abstinence from sex; however, the other participants in the group disagreed and saw such an act as akin to starvation.

Adolescents.

Young men also mentioned using condoms as a preventive strategy for sexually transmitted infections and pregnancy. They also reported abstinence from sex and HIV testing their partners; however, they did not mention being tested themselves. Most knew little or nothing about newer HIV prevention strategies such as Pre-Exposure Prophylaxis (PrEP).

Community service providers and leaders.

With them, we explored where parents and adolescents might access information about sexual health education and HIV prevention and sought recommendations for making this information more accessible within the community. Overall, community providers and leaders agreed that most mothers were the ones most likely to talk about sexual health education at home. There were several reasons for this: firstly, fathers’ trust in the mother, and their feeling that they would not handle the situation very well; secondly, lack of time, since fathers worked outside the home almost every day of the week; and third, because of having a lack of information about the topic themselves.

Because they were not taught that information [themselves], so it makes it a little bit weird. For example, some American families have already, like, at age 11, [started] talking to their child about this and that. Hispanic parents are like … the moment they see their son looking at a woman […] they start giving talking about the consequences instead of giving them information… “vas a ver” [you will see]… and this and that.

Both community providers and leaders said that young men would be likely to get their sex education from their friends or from the Internet. That said, there was a view that schools focused only superficially on sexual health education and might omit topics such as HIV.

Regarding recommendations for making sexual education and HIV prevention information more accessible in the community, providers and leaders provided the following advice: (1) provide educational services and condoms inside the agricultural workspace; (2) teach father’s how to communicate with their sons so as to eliminate the sense of vergüenza (embarrassment/shame) when talking about sex-related topics; (3) talk more to parents where they meet, for example, on the corner or in church; (4) use economic, cultural and food incentives to encourage the participation of adolescents and fathers in sexual health and HIV prevention; (5) provide information using simple data visualization techniques (e.g., charts, maps, diagrams) infographics⁵; (6) use technology, text messaging and social media to reach adolescents, (7) maintain a fun environment when talking with adolescents about sex and sexuality; and (8) seek to involve well known community members in the activities undertaken.

Barriers and Needs for Preventive Health & Care Services

Fathers.

Fathers reported that the main barriers preventing farm workers from accessing health services were the lack of the correct documentation to do so, and economic means: A third barrier mentioned was lack of information about where to go. Connected to the first two barriers was access to health insurance. As one father said,

without [immigration] documentation, they [the service providers] cannot [provide health services] or [the community] does not have the opportunity to obtain [health] insurance because most [health insurance plans] require documentation… That is why so many of us do not have insurance.

Adolescents.

When we asked adolescents about the “main barriers that people in this community encounter to have access to health care?” they referedr to being a migrant and lack of documentation, cost and lack of insurance,

Because we are immigrants! A lot of people don’t have medical care. They don’t go because they do not have the money or transportation. To further comment, I think medical insurance is a big factor and money. It’s very costly to go to the doctor for a check-up.

Community service providers and leaders.

In general, providers agreed with the fathers, reporting that the barriers encountered by farmworkers when seeking health care services were having no health insurance, lack of finance, fear of deportation by immigration services, time constraints, and the inconvenient operating hours of health care clinics that conflict with the work schedules of farmworkers. They explained that the farmworkers only seek care from a [medical] doctor if their condition is an emergency and, when this happens, they use the Emergency Department services.

Regarding HIV/STI prevention services available for fathers, service providers recommended establishing trust with the farmworkers locally, lowering the cost of health care services, and using technology (e.g., mobile apps) to allow users to ask health questions and receive replies in their phones. Providers stressed the need to steer away from health aids that required reading since farmworkers would be disinclined to use them. Furthermore, they recommended that providers should be persistent and make themselves accessible and available at times that suited the workers to overcome the general distrust farm workers have with the health care system,

They may not be ready today, may not be ready tomorrow- but if they are still here and they visit [the health services], they might be ready the day after. Knowing the information and [having the] resources, they are going to use them when they are ready.

Providers and leaders also stressed the need for confidentiality and to provide services in Spanish in locations near to the places farmworkers visited frequently. Providers also suggested using unidentifiable vehicles that do not explicitly state they are providing HIV prevention services within the neighbourhood, offering free and anonymous testing services.

Stress in sex-related communication between fathers and sons

Fathers.

Some fathers felt that sex-related conversations have been traditionally taboo in Hispanic family settings. Fathers reported learning little about sex from their parents and relied on friends instead. One father mentioned that religious beliefs and conservatism in the past had limited this type of conversation,

My dad almost didn’t speak about sex when I was a teenager. It was a topic that I learned from my friends. My dad didn’t speak freely about sex because he was very religious… the little that I learned was on the streets.

We asked fathers ‘What are the things that cause you the most stress when you talk about sex or drugs to your children?’, most responses focused on feeling ignored or not being heard by their sons: ‘No, so many times they do not want to hear. You talk to them, and their attention is somewhere else “la tienen por allá”. Hey, I’m talking to you!’. Or, as another father explained, ‘It is stressful when you explain [something] because they can listen, it’s true, but they don’t do what you tell them, and that causes sadness, stress, and even despair…’. More specifically in relation to sex and HIV, one father said,

As I said, my son trusts me. He has already had sexual relations, and he already told me, and we have discussed it, and we have talked about AIDS. I have never taught him how to use a condom, though. I imagine that he already knows about that from friends and the Internet because they [young people] are more informed than us…

Other fathers were concerned about early pregnancy and the economic consequences and responsibilities of this for their son’s future,

… sexual relations… they end their lives because if they want to continue studying when they get a girl pregnant, it’s over. Because in this country, there is child support, and you must work and maintain it [the child] until they are 18 years old.

When we asked fathers ‘What would happen if your teenager told you that he was having sex?’ only one said, ‘esas palabras lo sacan a uno de onda. No sabes cómo reaccionar’ (Those words throw you. You don’t know how to respond). Other parents were more receptive and, as one father said, ‘I would thank him for trusting me and talk to him about the risks…’

Adolescents.

When exploring with adolescents their overall stress when communicating with parents, some of their responses focused on the dislike of being lectured,

When they start a conversation, it turns into a lecture like they get on your case. For one little thing, you bring up and want to focus on that specific topic and ignore everything else, that bothers me. They do not respect me when I do not want to talk about that…

and the feeling of not being heard or understood by their parents,

I believe that when the discussion turns into an argument, and they just see their perspective, they do not want to see your point of view, and that is what causes stress between adolescents and parents. To have a conversation, you must have both sides of the story and not only one and be open on certain topics.

Furthermore, when exploring how they felt talking about sex and substance abuse with their parents, adolescents had different responses. These ranged from, ‘I don’t talk about that with my parents’ to ‘I am not going to have sex.’

Community Service Providers and Leaders.

We explored with community service providers and stakeholders what things might stress parents when talking with their sons about sex. Their responses centred on lack of knowledge, ‘I believe that is the lack of knowledge, right, and that they can’t express themselves, it is possible that the person thinks that they don’t have adequate information to provide that type of information’, and ignorance and fear when talking about the topic,

Ignorance and fear, not having the correct words to express oneself with a child or thinking about what others are going to say or thinking that a child is not prepared for that [talking about sex] until they are 18 years old.

Additionally, service providers and leaders mentioned parents’ lack of engagement in children’s upbringing because of work, ‘the father thinks that he only came here to work and to work hard’, vergüenza (shame) or feeling uncomfortable, ‘I think shame. It’s difficult for them to open up...’ and the language disconnect between parents and sons, “We speak Spanish, us fathers and our sons, but it’s like a different Spanish.’

Effects of traditional masculine gender norms at home and the community

Fathers.

Exploring how cultural beliefs, values, and gender roles in the home affect communication within the father-son relationship, we asked fathers and their sons the following question, ‘What does it mean for you to be a man?’. The consensus among the fathers was that to be a man was to be ‘la cabeza principal de la casa’ (head of the household) and ‘responsable con la familia’ (responsible for the family). As one father put it,

To be a man is to be responsible for everything in the house. Do not leave it to the woman because the man is the principal of the house, and if you see something wrong in the house, tell the woman because she is your second. That’s being a man in the house.

We also asked fathers about machismo and how they defined it. Many fathers argued against it, characterizing a ‘macho’ as a man who wants to control, dominate and impose their will on their household, a selfish person, ‘el mandón de la casa’ (the controlling authority of the house) and someone who diminishes women. Several fathers argued that ‘el machismo se acabó’ (machismo is over) and that reference to machismo is a way to stigmatize men and Latinx cultures in US society.

Machismo today is like a stigma. The culture where we come from. Because of our culture in previous generations, well, yes, the man was the one in charge of everything, and the woman was kept as a servant, but I believe that today it is more balanced.

Adolescents.

Young men’s responses too were strongly oriented towards being a provider, a hard worker, the head of the household, and a person responsible for his actions and his family. As one young man put it, ‘Be responsible for yourself and your family. You work, make sure your kids have a roof over their heads, and bring the food.’ Another added,

I wanted to say that to be a man, you must strive to be the best you can be in your family and outside your family to the best of your ability. Some say that being a man is having multiple women to show dominance or power. I disagree. I think one must take care of his wife and daughter. But talking about machismo, it’s something that has been going on since the past, and not so much now as women are getting more informed and educated about [it], but it’s still going on in some cultures…

Community service providers and leaders.

When we asked service providers and community stakeholders ‘What cultural beliefs influence upbringing in adolescent farmworker’s families?’ many identified machismo as the main factor influencing parenting process in local communities, ‘Well, the biggest [factor] here is machismo. […] no one has been able to cut the umbilical cord’, said the stakeholder, referring to the connection between machista culture and its ancestral roots in the country of origin. Adding to the discussion, another community leader argued,

We have this mentality that we need to please people or make people believe we are stronger than we feel, I guess. That mentality is horrible! And it happened to me; I cannot cry. I think machismo plays a significant role in the Latinx community, in the farmworker’s community. You are a man. You must be the sole provider; women don’t work. You will be judged if she works. You cannot make less than her. So, you are not a man. That mentality is enormous.

Another stakeholder said,

… we are very machista, even the women too. We emphasise that the man is the one who decides and has the last word. We are very attached to the decisions of the man, the macho, the head of the household. This imposition, I will honestly say that this happens because the man forces his authority on others, and because of this, there is much domestic violence.

Discussion

In comparison to other communities in the USA, Latinx communities have a low access to, and use of, HIV prevention and treatment services (Guilamo-Ramos et al. 2020). The situation is especially acute for Latinx farmworkers who often lack migratory documentation, especially in the State of Florida, where new immigration policies like the State of Florida Senate Bill 1718⁶ create a serious burden for this population (The Florida Senate Bill 1718: Immigration 2023). The South Florida Latinx farmworking community not only encounters health inequity in services to prevent HIV but also with respect to the prevention of cancer (Casanova, Knaul, and Rodriguez 2021), HPV (Vamos et al. 2021) and oral health (Castañeda et al. 2010).

This paper has reported on findings from a community assessment that aimed to determine community needs and resources related to HIV within the Latinx seasonal farmworker communities of south Miami-Dade County, with a particular focus on father-son relationships. The use of a syndemic conceptual framework provided us with the opportunity to explore how structural (e.g. immigration), behavioural (e.g. lack of information about HIV prevention), and cultural (e.g. traditional masculine gender norms) factors affect health in the community. Findings reveal how the absence of sexual health education and the family household culture limit father-son communication, especially in relation to HIV prevention. Our findings also show how structural barriers related to the lack of money, immigration documentation, and the need for tailored preventive and clinical health services affect access to community healthcare.

Lack of knowledge and misconceptions about HIV transmission was evident among both fathers and sons. Overall, fathers reported that HIV was a transmissible disease; however, they had limited knowledge of how HIV is transmitted and shared some misconceptions, similar to those documented in other studies with Latinx men in the USA (Fenkl, Jones and Orta 2016; Guilamo-Ramos et al. 2020) and with Latinx Men who have Sex with Men (Murray et al. 2018; Zapata et al. 2023). These results confirm about the need to increase knowledge about HIV ( Rojas et al. 2020). Most adolescents in this study indicated not knowing much about HIV, although they did not seem to subscribe to the same misconceptions. Health and social service providers identified communication taboos, mobility restrictions and lack of access to information as barriers putting the community at risk for HIV.

In their study, Guilamo-Ramos et al. (2019) identified lack of knowledge as a common communication barrier between fathers and their sons when talking about condom use. Fathers in this study provided their sons with condoms without educating them about how to use condoms correctly. Additionally, most fathers and sons lacked knowledge of other HIV prevention strategies, such as regular testing and PrEP. In other research by Rao et al. (2021), it has been shown that PrEP awareness is lower among Hispanics compared to Whites, with language and cultural barriers being identified as factors causing this lack of familiarity (Chan et al. 2022). In contrast, fathers expressed concern about early pregnancy and its economic consequences for their sons.

Our study revealed contradictory evidence concerning the role of gender norms in contributing to HIV-related risk. While traditional gender norms have been evidenced in studies of Latinx women farmworkers in South Florida ( Fava et al. 2020; Ravelo et al. 2022), and while fathers in this study subscribed to the view that the role of the man is to be the head of the household, they were critical of dominant discourse about machismo, seeing this as a way of stigmatizing men in Latinx cultures. Their perspective was shared by sons who saw machismo as something of the past. In contrast, community leaders and service providers identified machismo as a key cultural factor influencing communities’ household and parenting practices. These contradictions in discourse could be due to a legitimate desire to escape the stigmatized gaze of majoritarian (Anglo-American) society.

Limitations

This study has many of the limitations characteristic of a small-scale qualitative research. Data were collected from a small group of seasonal workers from Mexico and Central America and excluded farmworkers from different backgrounds. Additionally, compared to fathers in the sample, sons’ responses to the topics explored were more modest and future studies should consider the use of other data collection methods (i.e. in-depth interviews) with young men to explore key issues in more depth.

Conclusion

Findings shed light on the intersecting social conditions that place this south Miami-Dade County Latinx farm workers at risk of HIV. As in previous studies, our research suggests that the interplay between individual, interpersonal, cultural, and socio-environmental factors affects vulnerability to HIV (Kanamori et al., 2016). While fathers in this study saw value in father-son communication regarding HIV prevention, many did not have the knowledge and skills necessary to educate their sons about HIV-preventive practices. Accordingly, service providers emphasised the need to build greater trust with fathers and sons by using tailored healthcare services to reach the community. To reduce the future risks of HIV, programmes are needed to increase knowledge and strengthen relational skills between fathers and sons in the community alongside the provision of culturally appropriate educational models and service provision to reach out into the community.