Samplinghealth services in Phoenix, AZ
Dulce Maria Ruelas, DrPH(c), MPH, CHES, CBC Wesley Health and Community Centers, Grand Canyon University
Carol Galletly, JD, Ph.D. Medical College of Wisconsin,
Department of Psychiatry and Behavioral Science, Center for AIDS Intervention Research
Arizona Health Equity Conference October 15, 2020
Objectives
1. Describe Latinx immigrants’ concerns about the immigration ramifications of
seeking important publicly funded health and social services.
2. Describe how misunderstandings about immigration laws can deter Latinx
immigrants from seeking services.
3. Describe how perceptions of the current, hostile immigration climate can lead
immigrants to avoid seeking services for themselves and their children.
Thank You
Institute of Minority Health and Health
Disparities under grant 5R01MD011573 and
the National Institute of Mental Health under
Grant P30MH052776.
Elizabeth Ortiz de Valdez and Wesley
Community and Health Centers for their
contributions to this project.
Immigrants in Arizona:
• In 2018, 960,275 immigrants (foreign-born individuals) lived in Arizona comprising 13% of the total population. 55% of Arizona's immigrants are from Mexico.
• 275,000 immigrants in Arizona or 28% of the total immigrant population are undocumented. Undocumented immigrants made up 4% of the total state population in 2016.
• 466,047 people in Arizona, including 255,489 U.S. citizens, lived with at least one undocumented family member between 2010 and 2014.
• 192,896 children or approximately 1 in 9 children in Arizona were U.S. citizens living with at least one undocumented family member.
Source: American Immigration Council Immigrants in Arizona. Retrieved from
Unauthorized*
Immigrant
Population
Unauthorized*
unauthorized*
immigrants
Arizona 275,000 3.9% 10.70% 78% United States 10,700,000 3.3% 7.6% 51%
Unauthorized Immigrant Population in Arizona, 2016
*non-lawful status
influence of actual and perceived immigration laws
on Latinx immigrants’ willingness to utilize services
for HIV testing and for two drivers of HIV infection–
disordered alcohol and drug use and intimate
partner violence. As part of the study’s formative
research activities, focus groups were conducted in
Phoenix, AZ
Study Methods
• Recruitment and
mouth and flyers throughout Phoenix, AZ.
Eligibility criteria included:
• being a foreign-born, Spanish speaking
immigrant
• Focus groups included documented and
undocumented immigrants
• Anonymous screening
• Undisclosed locations
• 35 participants
Sample Focus Group Questions
1. Are there any immigration reasons that might make a Latinx immigrant
not want to seek medical care?
2. How do immigration laws, policies, or enforcement make it difficult to
seek help?
3. Do immigrants in your community have concerns about attracting
government attention or attracting the attention of immigration
authorities [when they seek healthcare or other services]?
4. Can immigrants have immigration problems because they received
healthcare services that were funded by the government?
Focus Group Flyer
• Rumors from friends, family, neighbors
• News reports with misinformation
consulate identification
Results-Concerns
•Asking for help in seeking services
•Lack of information about their rights as a person living in the U.S.
•Rights for children - eligibility for services
•Rights when experiencing domestic violence
•Birth certificates for US Citizen children
Quotes on Concerns
“If I ask for AHCCCS, is it going to hurt me? If I ask for food stamps for my children, not for me, would it hurt me if I want to fix it [her immigration status]? …It is a lie. They've always put us into that fear, but it's a lie.”
“It's just that they scare you. They say, ‘Oh, do not ask for AHCCCS for an emergency!’ or ‘Do not ask for [food]stamps for your children.’"
Misunderstanding=Misinformation
• Immigrants are ineligible for health services – can access healthcare only through hospitals
• Healthcare providers routinely share information with immigration authorities
• Using any publicly-funded services at any time can result in negative immigration consequences
Mistrust
Quotes on Misunderstandings
“I am an undocumented immigrant, but I have three [citizen] children. I prefer not to go to the doctor because I know that if they are going to deport me, my children, with whom are they going to stay? Then my children will be alone… That's where you come from, what you put first. Because sometimes you do that, you think you're protecting your children, so you just say, "I'm not going to expose myself." Maybe I can get attention, I may have the opportunity to, but I am exposing myself to lose something very important.”
“People are totally believing, as we said at the beginning, "I do not ask for help from the government" because they think Immigration will go to the stamps [SNAP administrators] and deport the person.”
Results-Immigration Environment
Avoidance of Services • Thinking organizations belong to or represent the government • Immigrants are perceived as draining public resources when
instead they are contributing to the US economy • Escalating concerns
“I have seen that many people no longer want to go near where Immigration is because they know where the agents are and they fear the agents. Even if you have an appointment or something, many people will no longer accompany a family member or something like that.”
“The only thing I’ve heard is that if you receive help from the government, that it will affect your immigration status.”
Quotes on Immigration Environment
R1: “It is that we are here to have a better life. We want to do everything correctly. And that's what immigration authorities think, that we're a burden while we do not have papers.” R2: “Or that we are criminals.”
“For example, I have seen cases of people who I believe prefer to endure a disease that they entrust to God to help rather than not to go to a hospital. Because from there directly, they are deported.”
Quotes on Immigration Climate
• Trainings for health care personnel
• Professional development opportunities for non-profit, private, & not-for-profit organizations and institutions about discussing polices and laws with Spanish media
Questions?