Barriers to Care & Treatment Practices in HIV+ Latinos in US-Mexico Border Region

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DESCRIPTION (provided by applicant): The goal of our community-based participatory research study is to identify barriers to HIV care among HIV- positive Latinos in the U.S.-Mexico border region. California ranks among the top five states with highest numbers of Latino AIDS cases and Latinos comprise 66% of reported HIV cases in San Diego County's southern region. Latinos face substantial barriers to HIV care and enter care at advanced stages of HIV disease, but reasons for this are poorly understood, and could involve issues related to stigma, HIV treatment optimism and use of traditional, complementary and/or alternative medicines (CAM). We will assess barriers to HIV care and care practices among Latinos in the U.S.-Mexico border region applying Andersen & Aday's Behavioral Model of Health Services Use as our conceptual framework to study environmental, structural, behavioral and societal factors. We propose a community-based binational collaborative study that builds on existing academic-community partnerships and employs quantitative and qualitative methods to address aims. Aim 1: To assess binational health care seeking behavior and HIV treatment utilization, including access to ARVs and use of CAM (e.g. folk medicine, herbal medicine) among HIV-positive Latinos who currently reside in Tijuana, Baja California, Mexico or San Diego, CA. Aim 2: To determine specific barriers to HIV care, including manifestations of HIV-related stigma, mobility and spirituality/religiosity among HIV-positive Latinos who reside in Tijuana and San Diego. Aim 3: To explore provider and system-level barriers to continuity of HIV care and receipt of ARVs in HIV-positive Latinos within the health care delivery context of both sides of the US- Mexico border. To address Aims 1 and 2 we will conduct a quantitative study, based on interviewer- administered surveys with 200 HIV-positive persons (100 participants recruited from both sides of border). We will use descriptive and multivariate logistic regression statistical analyses to test specific hypotheses. To meet Aim 3, we will purposively sample 20 providers/administrators, conducting in-depth interviews on experiences with patient barriers to HIV care. Following Grounded Theory methods, data collection and analysis will include development and revision of interview guides using constant comparison method. The investigator team will independently code and reach consensus on interview coding to reflect themes/issues, accounts of behaviors, and opinions on organizational/system characteristics that influence health services. This study will decrease health disparities in HIV-positive Latinos through improved understanding of HIV care-seeking behavior; HIV care practices}including CAM use; development of community-based and culturally-relevant research methods and measures; and advancing efforts to positively impact care delivery in Latinos living in the US- Mexico border region and in other US Latino populations living with HIV/AIDS. PUBLIC HEALTH RELEVANCE The goal of our community-based participatory research study is to identify barriers to HIV care among HIV- positive Latinos in the U.S.-Mexico border region. Latinos face substantial barriers to HIV care and enter care at advanced stages of HIV disease, but reasons for this are poorly understood, and could involve issues related to stigma, HIV treatment optimism and use of traditional, complementary and/or alternative medicines (CAM). The proposed study will assess barriers to HIV care and care practices among HIV-positive Latinos in the U.S.-Mexico border region applying Andersen & Aday's Behavioral Model of Health Services Use as our conceptual framework to study environmental, structural, behavioral and societal factors.