MULTISITE HIVAIDS ISSUES ON THE U.S.MEXICO BORDER ACROSS FIVE PROJECTS

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MULTI-SITE HIV/AIDS ISSUES ON THE U.S./MEXICO
BORDER ACROSS FIVE PROJECTS

• Research Evaluation Center in the School of
  Social Work
• The University of Oklahoma
• May 30, 2003
• David D. Barney, MSW, MPH, PhD Betty E.S. Duran,
  MSW, MPH Herman Curiel, MSW, PhD Tim
  Brittingham, MSW Gregg Fryday, BSW Saleem G.
  Ahmad, MA Marguerite Keesee, MS

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Donde comienza la frontera/Where the border begins
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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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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

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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

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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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Partner Evaluators

• University of California, San Diego
• School of Medicine
• University of Arizona, Tucson
• Mexican American Studies
• New Mexico State University, Las Cruces
• Department of Sociology
• University of Texas, El Paso
• Psychology Department
• University of Texas, San Antonio
• HSC, College of Medicine

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TYPES OF DATA COLLECTED

• Local site specific data
• Multi-site quantitative data
• Qualitative data for all sites
• Medical outcomes data (4 years)

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SAMPLE SIZE
Total Multi-Site Sample as of May 1, 2003
 
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QUANTITATIVE FINDINGS
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Demographics

• Gender of client

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Demographics

• Sexual orientation

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Demographics
Hispanic ethnicity
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American Indian or Alaska Native
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Demographics

• Exposure category

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Demographics

• Education in Mexico

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Demographics

• Primary health care source

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Presenting Treatment Issues
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Lifestyle Culture

• Ties to national identities

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Lifestyle Culture

• Number of round trip border crossings

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Lifestyle Culture

• Number of months per year lived in Mexico

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Lifestyle Culture

• Patient is migrant farm worker

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Lifestyle Culture

• Patient uses traditional healer

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Lifestyle Culture

• Medical care/medication access

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Lifestyle Culture

• Patient has health insurance in Mexico

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MEDICAL OUTCOMES
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HIV infection level
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CD4 Statistics
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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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CHAID analysis

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

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Predictors of Client Satisfaction based upon
client subpopulations

• Client subpopulations
• Patients who need mental health treatment
• Patients with different levels of personal
  identification between Mexico and the U.S.
• Patients with a history of forced sex with
  intimate partner
• Patients with lower quality of life

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Additional Border Data

• 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?
• What does it feel like to be a client in an
  HIV/AIDS care project

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Paradise Ahead? (Tijuana side of border fence)
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For more information

• www.ou.edu/border
• www.ou.edu/socialwork/data
• www.ou.edu/hiv