Choosing Sides: HIV Health Care Practices among Shared Populations of HIV-Positive Latinos Living near the US-Mexico Border

Abstract

Background We compared HIV-positive patients receiving care in the border cities of San Diego, United States, with Tijuana, Mexico. Methods Participants were HIV-positive Latinos (n = 233) receiving antiretroviral therapy (ART) from San Diego– Tijuana clinics (2009-2010). Logistic regression identified correlates of receiving HIV care in San Diego versus Tijuana. Results Those with their most recent HIV visit in San Diego (59%) were more likely to be older, have at least a high school education, and were less likely to have been deported than those with last visits in Tijuana. Despite reporting better patient–provider relationships and less HIV-related stigma than those with visits in Tijuana, San Diego patients were twice as likely to make unsupervised changes in their ART regimen. Conclusions We observed poorer relative adherence among HIV-positive Latinos receiving care in San Diego, despite reports of good clinical relationships. Further study is needed to ascertain underlying reasons to avoid ART-related resistance.

A binational comparison of HIV provider attitudes towards the use of complementary and alternative medicine among HIV-positive Latino patients receiving care in the US–Mexico border region

“…Concern about CAM's effect on adherence and its potential negative interaction with ART (Piscitelli, et al, 2000; Mills, Montori, Perri, Phillips & Koren, 2005) was more common among some Tijuana providers who did not think that their patients used CAM. In contrast with this finding, our earlier work indicates that CAM use is fairly common (67%) among HIV-positive Tijuana patients (Servin, Muñoz, Strathdee, Kozo & Zúñiga, 2012). Integrative medicine is less common in Mexico and provider lack of awareness of patient CAM use may be because it is not currently part of formal physician training which focuses more on evidence-based medicine.…”

Healthcare provider perspectives on barriers to HIV-care access and utilisation among Latinos living with HIV in the US-Mexico border

“…Individuals living in the US-Mexico border region, including HIV-positive patients, frequently utilize health services on both sides of the border (Landeck and Garza 2003; Servin et al 2012; Su et al 2011; Zúñiga 2012). The US-Mexico border region is approximately 1969 miles long and is one of the fastest growing regions in the USA.…”

Understanding social determinants of healthcare access from the perspective of Hispanic Latino immigrants in Louisville, Ky.

“…Furthermore, immigrants are less likely to access or utilize preventive services, especially in areas of cancer screening, STD testing, vaccinations, and pediatric and prenatal preventive care (Echeverria & Carrasquillo, 2006;Goel et al, 2003;Lees et al, 2005;Cohen & Christakis, 2006). Delayed presentation of HIV was also of particular concern among HLI, due to lack of screening and preventive measures (Levy et al, 2007;Servin et al, 2012). As seen among participants in this study, advances in the stages of the disease process that are left undetected can pose serious threats to the health and wellbeing of the community as a whole, while consequently increasing healthcare expenditures.…”

“…Several participants indicated that they received better medical attention, resources and social support for being HIV positive in the U.S. than they did in their home countries. As indicated in the literature, access to better quality health and social services for HIV in the U.S. was a major reason that compelled HLI to remain in the country, despite undocumented and lower socioeconomic status (Servin, Munoz, Strathdee, Kozo & Zuniga, 2012).…”

“…Although study findings indicated that HIV was a growing problem among HLI Louisville, statistics on HIV rates among HLI in Louisville and Kentucky were limited. Furthermore, cultural factors were shown to influence the ability of these communities to obtain access to culturally competent preventive care and education (Levy et al, 2007;Servin et al, 2012). Individuals with HIV were ashamed to be open about their condition for fear of being judged by family and community members.…”