HIVAIDS ISSUES ON THE U.S.MEXICO BORDER

1
HIV/AIDS ISSUES ON THE U.S./MEXICO BORDER

• The University of Oklahoma
• May 2001
• David D. Barney, MSW, MPH, PhD

2
Border HIV/AIDS Issues

• Many diagnosed, but do not enter care
• may wait many years for treatment
• Citizenship /eligibility rules vary
• patients may need to travel for care
• Limited treatment in Mexico for those with funds,
  very limited public-funded treatment for indigent

3
HIV issues (cont)

• Limited public-funded HIV testing in Mexico
• Forced testing in maquiladorasbut no results
• HIV/AIDS medications available mostly for higher
  income in Mexico
• Substantial mobility of population

4
U.S. P.H.S. HRSA SPNS US/Mexico Border Health
Initiative

• Funded by US Public Health Service
• Health Resources and Services Administration
• HIV/AIDS Bureau
• Special Projects of National Significance
• SPNS Research and demonstration branch for all
  titles of the Ryan White CARE Act

5
Goals of the Initiative

• 100 Access -- 0 Disparity
• Improve early detection of HIV
• Outreach
• Increase capacity of primary care providers
• Increase access to primary care for HIV infected
  on the US/Mexico Border

6
Five Demonstration Sites

• Location of Service Projects

7
Southern California

• SAN YSIDRO HEALTH CENTER

8
Arizona

• EL RIO COMMUNITY HEALTH CENTER
• Tucson, AZ

9
New Mexico

• CAMINO DE VIDA
• Las Cruces, NM

10
El Paso, TX

• LA FE CLINIC

11
Lower Rio Grande Valley, TX

• VALLEY AIDS COUNCIL
• Harlingen, TX

12
Centro de Evaluación

• School of Public Health
• School of Social Welfare
• University of California,
• Berkeley

• School of Social Work
• University of Oklahoma, Norman

13
Centro de Evaluación STAFFING

• Primary Principal Investigator
• David D. Barney, MSW, MPH, PhD
• Assistant Professor, School of Social Work,
  University of Oklahoma Norman
• Teaches advanced group work program evaluation
  (MSW program)
• M.S.W., San Diego State University
• M.P.H., University of California, Berkeley
• Ph.D., University of Kansas

14
Centro de Evaluación STAFFING

• Project Director
• Betty E.S. Duran, MSW, MPH
• From Pojoaque Pueblo, New Mexico
• Second HRSA multi-site evaluation center (former
  Director of Client Services, NNAAPC)
• M.S.W., University of Kansas
• M.P.H., University of Oklahoma

15
Centro de Evaluación STAFFING

• Graduate Research Assistants
• A. Saleem G Ahmad
• Ph.D. candidate in Communications
• Sudhir Vallamkondu
• M.S. student in Computer Sciences

16
Centro de Evaluación STAFFING

• Co-Investigator
• Herman Curiel, MSW, PhD
• Associate Professor, School of Social Work, OU
  Norman
• Teaches clinical supervision direct practice
  practicum (MSW program)
• M.S.W., Our Lady of the Lake Univ.
• Ph.D., Texas A M University

17
Partner Evaluators

• University of California, San Diego
• School of Medicine
• University of Arizona, Tucson
• Mexican American Studies
• University of Texas, Houston at El Paso
• HSC, School of Public Health
• University of Texas, El Paso
• Psychology Department
• University of Texas, San Antonio
• HSC, College of Medicine

18
Spanish version DEMOGRAPHICS
19
Local module 1 SOCIAL SUPPORT Future
Karnofsky scale Outreach contacts
20
Sample Size (May 24, 2001)
21
Demographics

• Gender of client

22
Demographics

• Sexual orientation

23
Demographics

• Education in Mexico

24
Demographics

• Exposure category

25
Presenting Treatment Issues
26
Lifestyle Culture

• Ties to national identities

27
Lifestyle Culture

• Number of round trip border crossings

28
Lifestyle Culture

• Number of months per year lived in Mexico

29
Lifestyle Culture

• Patient is migrant farm worker

30
Lifestyle Culture

• Patient uses traditional healer

31
Lifestyle Culture

• Medical care/medication access

32
Lifestyle Culture

• Patient has health insurance in Mexico

33
Lessons learned (so far . . . )

• EVALUATION RESEARCH
• Spanish translation of data instruments is
  difficult
• Finding common elements is difficult across the
  Border as needs vary so greatly
• Clients are very satisfied with services
• no variance
• social support concepts may work better

34

• Cultural complexity of Border mandates
  qualitative exploration of issues
• prior to hypothesis development

35

• Cultural concepts, such as promotores, vary
  according to location along the borderand are
  not necessarily consistent with Mexican
  definitions

36
Lessons learned (so far . . . )

• LIFE ON THE US/MEXICO BORDER
• Different everywhere along the border
• socioeconomic
• language
• ethnic demographics

37

• HIV medical care usage runs contrary to popular
  usage of medical care by Hispanics on the
  US/Mexico Border
• Individuals usually prefer medical care in Mexico
  but not for HIV/AIDS care

38

• Any solutions to social and health problems
  requires a BI-NATIONAL approach

39
Future Directions

• Qualitative research
• What is your daily life like?
• What are your concerns for the future?
• How are individuals living in a war zone
  influenced when seeking health care?

40
Evaluation Research Activities

• GIS mapping
• epi picture
• mapping of at-risk metropolitan areas for outreach

41
(No Transcript)
42
CHAID analysis

• Segmentation modeling
• identifies uniqueness of sub-populations
• important for determination of client needs
  program services

43
International development

• Data collection activities in Mexico
• Possible expansion into Central America

44
For more information

• Websites
• www.ou.edu/border
• faculty-staff.ou.edu/B/David.D.Barney-1