A: This study was designed to inform policies and programs that address risks for HIV/AIDS experienced by new Hispanic immigrants in the New York metropolitan area.

A: The study included 301 new immigrants—men and women—from the Dominican Republic, Guatemala, El Salvador, Honduras and Mexico. Participants were recruited from urban, suburban, and semi-rural areas in the New York metropolitan area. All of the participants had lived in the United States for less than three years.

We interviewed 100 of these participants individually and collected group data from the others through focus group sessions. We also interviewed and conducted focus groups with advocates and health care and social services providers. Ethnographic observations within the study communities throughout the course of the research informed recruitment strategies and also provided valuable data for the study.

A: Recruitment of immigrant populations into a research study poses significant challenges, including:

• Immigrant fear of institutional contact, especially of any institutions related to, or perceived to be related to, the government or immigration authorities
• Immigrants' general sense of caution and vulnerability, particularly among Central Americans, due to documentation issues and lack of supportive social networks

To address these challenges, our team made efforts to establish a positive rapport with community leaders, clergy, and service providers who had gained the trust of members of the target population. We also maintained a consistent presence in the target communities prior to and during the study as part of our ethnographic field work.

A: Because this population tends to be difficult to engage, and because of the sensitive nature of the research topic (HIV/AIDS), we decided to use "snowball" sampling to recruit participants. That is, we reached out to community leaders and providers to help us recruit participants from within their networks, as well as encouraging participants to refer other eligible community members for participation in the study.

We provided each participant $25 in appreciation for their time, an amount deemed not to be coercive by community leaders. In addition, we provided food and beverages at focus group sessions and during some interviews. Information and referrals for health and social services were made by the study team when problems were identified during interviews.

A: We initiated the recruitment process by developing relationships with key community members with connections to the target population, including:

• Religious and political leaders
• Immigrant advocates
• Legal agency staff
• Health/HIV and social service providers
• Restaurant and store owners

Religious institutions in particular proved to be a significant resource for this study. Interestingly, though, they also presented a challenge for the study in that researchers needed to ensure that religious influences would not bias the interviews.

A: To establish a positive rapport with our target population, we spent a great deal of time in the community and interacted extensively with people in the community before starting the research activities. For example, we conducted field visits in Hispanic-owned stores and restaurants.

On average, fieldworkers visited recruitment sites at least three times, with each visit lasting 4-8 hours. After getting to know the proprietor, the researchers started to talk with potential participants visiting the store or restaurant. Sometimes the store or restaurant owner facilitated these interactions by securing the potential participants' permission to be approached by fieldworkers in advance.

In some cases, restaurant owners gave our research team permission to conduct interviews at the restaurant, which was ideal because it provided a space where potential participants felt safe. In addition, the familiarity of the flavors, smells, and dialect spoken in the restaurant helped to create a favorable environment for sharing experiences and ideas. Other "safe" interview places included neutral, confidential, and familiar locations such as frequently-visited agency offices and secluded corners of coffee shops.

The research team also made sure to offer as many additional details about the study as necessary for the participants to feel comfortable with proceeding. For example, we took special care to clarify and explain the informed consent document, which was initially overwhelming to many prospective participants due to their low literacy levels and concern about official documents. We also shared with them how their contribution of experience and ideas to the study might benefit their community and other immigrant communities in the future. These careful and detailed explanations often eased their concerns and helped to engage participants in a collaborative dynamic.

We also found that certain study-related words such as "investigation" and "research" evoked a negative reaction among many participants, so we made an effort to use less threatening-sounding words such as "conversation" and "study."

And lastly, when meeting with participants, the trained bilingual interviewers made sure to validate participants' knowledge, opinions, and experiences by explaining to the participants that they were the "teachers" of their lives and experience and that the interviewers were the "students."

A: Again, collaborating with community leaders is critical not only in the recruitment process, but in helping to facilitate communication and trust with participants. Developing these relationships takes time, which researchers should anticipate when developing a timeline for recruitment and for the study in general.

As with any study, researchers also need to clearly communicate key aspects of the study—its objectives, how confidentiality will be maintained, how the data will be collected and used—to participants and potential participants.

Particularly when the topic under investigation is sensitive, as was the case in this study, researchers need to understand the effects of stigma and discrimination in relation to immigrant status and the topic of the study in different cultures. Researchers also need to be sensitive to the anxiety undocumented immigrants tend to feel toward authorities, especially those associated or perceived to be associated with immigration.

And lastly, when a study includes multiple Hispanic cultures, it's important for researchers not to homogenize these groups with regard to recruiting and retaining participants as well as drawing conclusions from the data collected. Ethnic and cultural differences among Hispanics can be significant even within a given nationality, and these variances often warrant different considerations and approaches for researchers.