USMexico HRSA SPNS Border Health Initiative

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US/Mexico HRSA SPNS Border Health Initiative

• APHA 129th Annual Meeting
• October 24, 2001
• Atlanta, Georgia

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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

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HEALTH RESOURCES AND SERVICES ADMINISTRATION

• 100 ACCESS / 0 Disparity
• Eliminating race, gender, and
• Geographic disparities in health
• outcomes

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Special Projects of National Significance (SPNS)

• Direct grants to public and non-profit private
  entities
• Demonstration and assessment of innovative and
  potentially replicable service delivery models
• Advance knowledge and skills in the delivery of
  health and support services to underserved
  populations

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US/Mexico Border Issues

• Rapid population growth
• 35 Border
• 10 other U.S.
• High poverty rates
• 1/3 below poverty
• Unemployment
• 300 higher

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Border Health Issues

• Inadequate health care, high rates of
• TB
• Hep
• STD
• Diabetes
• Inadequate housing and infrastructure
• Environmental degradation

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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 HIV testing in Mexico due to
  inadequate resources

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HIV issues (cont)

• Repressive attitudes about homosexuality
• Bisexuality is a category in Mexico statistics
• Machismo facilitates extra-marital relationships
• For relationships with females
• Individuals are surviving in a war zone of
  racism, poverty, and isolation

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Goals of the HRSA Border Initiative

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

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Goals accomplished by . . .

• Service-based demonstration projects
• with key primary care components
• Program Evaluation
• both multi-site and local
• innovative model development
• wide dissemination of findings

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Five Demonstration Sites

• ASO or CHC
• all have Ryan White Title III(b) clinics or
  contracts
• approximately 27 service sites in total
• covering approximately 2,000 miles
• funding for CHCs from HRSA Primary Health Care
  Bureau
• Demonstration projects evaluation center
  competitively funded

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Five Demonstration Sites

• Location of Service Projects

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Centro de Evaluación

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

• School of Social Work
• University of Oklahoma, Norman

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Centro de Evaluación Staff

• David D. Barney, PhD Univ. of Oklahoma
• Herman Curiel, PhD Univ. of Oklahoma
• Elizabeth Duran, MSW, MPH -Univ. of Oklahoma
• Timothy Brittingham, MSW - Univ. of Oklahoma
• Michael Tarter, PhD UC Berkeley
• Kurt Organista, PhD UC Berkeley

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Data Management

• Multi-site data is collected by local project
• Data consists of a matrix system or modules
  pertaining to particular issues
• Serves as core data for both local and multi-site
  evaluation

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Spanish version DEMOGRAPHICS
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English version DEMOGRAPHICS
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English version LIFE STYLE CULTURE
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English version RISK FACTORS
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English version QUALITY OF LIFE
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English version CLIENT SATISFACTION
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Data under development

• Barriers to Care
• Created a new Barriers to HIV/AIDS Primary
  Medical Care module
• Outcomes data based on chart review
• Year 3 5

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Sample Size October 19, 2001
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Gender of Client
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Sexual Orientation
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Hispanic Group
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Exposure Category
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Presenting Treatment Issues
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Primary Health Care Source
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Lifestyle Culture
Ties to National Identities
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Lessons learned (so far . . . )

• LIFE ON THE US/MEXICO BORDER
• Different everywhere along the border
• socioeconomic
• language
• ethnic demographics
• How individuals respond to oppression is
  different by region
• Lower Rio Grande Valley is different from El Paso
  area service system responds accordingly

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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

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

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

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• 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

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

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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?

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CHAID analysis

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

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For more information

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