HIV Risk and Access to Health Care Among Mobile Populations

项目总结 通过美墨边境地区旅行的墨西哥移民代表着一个庞大的，高度流动的， 墨西哥国民中社会弱势的一部分。这一群体的人口健康数据很难获得 考虑到他们在地理上的分散性、流动性和很大程度上的无证身份。在过去的9年里，我们有 采用了独特的移徙框架和新的方法来描述疾病负担， 这些流动人口的健康行为以及暴露于保护性因素和危险因素。我们已经实施了 墨西哥蒂华纳墨西哥移民流动的概率调查，产生人口水平的健康估计 对于处于移民前、过境、目的地、拦截/驱逐和返回阶段的移民。迄今为止，我们 审查了两个健康领域：艾滋病毒风险和获得医疗保健的机会。我们上一阶段的发现是 推动在墨西哥边境沿线的五个驱逐站建立免费预防诊所 资金来自墨西哥卫生秘书处。在未来5年，我们建议继续并扩大这一点 工作方法是：(A)将调查向东扩展到另外两个边境城市，以便接触到从 通过和其他区域；和(B)检查更多的卫生领域，以更全面地了解 墨西哥移民健康。我们将对蒂华纳、诺加莱斯和新沃的移民流动进行3次概率调查 Laredo(N=1,200 Ea.)除了关于健康状况和保健服务获得的数据外，每项调查都将有一个 特别关注：1)艾滋病毒和性/生殖健康；2)非传染性疾病；3)精神健康 和物质使用。将获得访谈和生物识别数据，以产生人口水平的估计 保健服务的获取和健康状况，调查不同移徙阶段获取服务的机会和结果的差异， 并探讨医疗保健和移民政策对移民健康的影响。90名受访者 将参加一项试点纵向研究，以测试向我们的 方法：研究方法。该项目将巩固墨西哥-美国边境的一个两国天文台，并将产生 关于移民健康的关键数据。这些数据将成为流动人口健康学者的重要资源，并将 为政策和方案对策提供信息，以增加获得保健的机会，改善妇女的健康状况 移民在发送、过境和接收社区。

PROJECT SUMMARY Mexican migrants traveling through the U.S.-Mexico border region represent a large, highly mobile, and socially vulnerable subset of Mexican nationals. Population-level health data for this group is hard to obtain given their geographic dispersion, mobility, and largely undocumented status. Over the last 9 years, we have adopted a unique migration framework and novel methodological approach to characterize disease burden, health behaviors, and exposure to protective and risk factors among these migrants. We have implemented probability surveys of Mexican migrant flows in Tijuana, Mexico, producing population-level health estimates for migrants in the premigration, transit, destination, interception/deportation, and return phases. To date, we have examined two health areas: HIV risk and access to health care. Findings from our previous phase have propelled the establishment of free prevention clinics in five deportation stations along the Mexican border with funding from the Mexican Secretariat of Health. Over the next 5 years, we propose to continue and expand this work by (a) extending the survey east to two additional border cities in order to reach migrants traveling from, through, and to other regions; and (b) examining additional health areas to obtain a more complete picture of Mexican migrant health. We will conduct 3 probability surveys of migrant flows in Tijuana, Nogales, and Nuevo Laredo (N=1,200 ea.). In addition to data on health status and health care access, each survey will have a special focus: 1) HIV and Sexual/Reproductive Health; 2) Non-communicable Disease; and 3) Mental Health and Substance Use. Interview and biometric data will be obtained to produce population-level estimates of health care access and health status, investigate variations in access and outcomes across migration phases, and explore the impact of health care and immigration policies on migrants' health. Ninety survey respondents will be enrolled in a pilot longitudinal study to test the feasibility of adding a longitudinal dimension to our methods. This project will consolidate a binational observatory at the Mexico – U.S. border and will generate critical data on migrant health. The data will become an important resource for migrant health scholars and will inform policy and programmatic responses to increase access to health care and improve the health status of migrants in sending, transit, and receiving communities.