HIV Risk and Access to Health Care Among Mobile Populations

项目摘要 穿越美国的墨西哥移民-墨西哥边境地区是一个大的，高度移动的， 墨西哥国民中社会弱势群体。很难获得这一群体的人口健康数据 鉴于他们的地理分散性、流动性和大部分无证身份。在过去的9年里，我们 采用了独特的迁移框架和新的方法来描述疾病负担， 健康行为，以及暴露于这些移民的保护和危险因素。我们已实施 在墨西哥蒂罗尔州对墨西哥移民流进行概率调查，得出人口水平的健康估计 在移徙前、过境、目的地、拦截/驱逐出境和返回等阶段为移徙者提供服务。迄今为止，我们 研究了两个健康领域：艾滋病毒风险和获得医疗保健。我们上一阶段的发现 推动在沿着墨西哥边境的五个驱逐站建立免费预防诊所， 由墨西哥卫生部资助。在未来5年，我们将继续并扩大这一点。 （a）将调查范围向东扩大到另外两个边境城市，以接触来自， （B）审查其他卫生领域，以更全面地了解 墨西哥移民健康我们将在蒂华纳、诺加莱斯和努埃沃进行3次移民流概率调查 拉雷多（N= 1，200个）。除了关于健康状况和获得保健服务的数据外，每项调查还将有一个 特别重点：1）艾滋病毒和性健康/生殖健康; 2）非传染性疾病; 3）心理健康 和物质使用。将获得访谈和生物统计数据，以产生人口水平的估计， 卫生保健的获得和健康状况，调查各移徙阶段获得和结果的差异， 并探讨卫生保健和移民政策对移民健康的影响。90名调查对象 将参加一项试点纵向研究，以测试在我们的 方法.该项目将巩固墨西哥-美国边境的两国观测站，并将产生 关于移徙者健康的重要数据。这些数据将成为移民卫生学者的重要资源， 为政策和方案对策提供信息，以增加获得医疗保健的机会， 移民在输出、过境和接收社区的分布情况。

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.