HIV Risk and Access to Health Care Among Mexican Migrants

描述（由申请人提供）：研究表明，在美国的墨西哥移民和移民（mmi）感染艾滋病毒的风险增加，并且在获得卫生保健服务方面面临重要障碍。研究估计，与墨西哥和美国的总体人口相比，mmi人群中的艾滋病毒感染率高出10倍以上，并表明mmi是墨西哥农村艾滋病毒/艾滋病发病率上升的传播媒介。大多数关于这一主题的研究都受到方法上的困难的限制，无法接触到这个流动的、地理上广泛的、通常没有证件的人口。关于mmi中HIV感染的真实流行率、相关风险做法和HIV风险决定因素的结结性数据很少，包括暴露于美国社会和有限的医疗保健机会的作用。这项两国研究将调查在圣地亚哥-蒂华纳边境地区旅行的MMI人口的代表性样本中艾滋病毒感染的流行程度、模式和决定因素以及相关风险实践。该地区集中了约37%的穿越美墨边境的移民，是墨西哥和加利福尼亚之间的天然过境港。将使用墨西哥北部边境大学（COLEF）的墨西哥调查人员13年来成功应用于描述墨西哥北部边境MMI人口的社会人口、劳动力和地理模式的调查方法。将在边境城市蒂华纳（墨西哥下加利福尼亚州）的主要移民过境点进行艾滋病毒和移民的横断面多阶段概率调查。代表移民经历不同阶段的四个不同亚群的mmi （N=3,800）将进行艾滋病毒感染测试，并调查与艾滋病毒相关的实践和理论决定因素。样本将包括mmi (a)自愿从美国返回墨西哥；(b)由美国边境巡逻队从美国送回墨西哥的；(c)从墨西哥其他边境地区抵达蒂华纳；(d)从墨西哥其他地区向北旅行。根据行为生态学模型，人口、地理、经济、社会和心理社会因素在这四个亚人群中对艾滋病毒风险实践的作用，以及这些因素在不同背景和移民过程阶段的变化将被检查。此外，还将进行一项关于卫生保健获取和利用的试点调查（N=300），以检验将拟议的调查方法应用于该地区和其他移民卫生领域研究的可行性。这项研究的结果将推动行为流行病学的发展，并可能导致墨西哥和美国采取行动，减少艾滋病毒感染，改善mmi人群的卫生保健可及性。这项研究还可能为监测移徙者健康方面的两国合作奠定基础，并提供基线数据，以评估旨在减少两国艾滋病毒风险和健康差距的未来政策的有效性。

DESCRIPTION (provided by applicant): Studies suggest that Mexican migrants and immigrants (MMIs) in the US are at increased risk for HIV infection and face important barriers to access health care services. Studies have estimated that HIV infection is over 10 times more prevalent among MMIs compared to the overall Mexican and US population and suggested that MMIs serve as transmission vectors for increasing rates of HIV/AIDS in rural Mexico. Most research on this topic has been limited by methodological difficulties to reach this mobile, geographically widespread, and often undocumented population. Few conclusive data exist regarding the true prevalence of HIV infection, related risk practices, and determinants of HIV risk among MMIs, including the role of exposure to US society and limited health care access. This binational study will investigate the prevalence, patterning, and determinants of HIV infection and related risk practices among a representative sample of the MMI population who travels through the San Diego - Tijuana border region. This region concentrates about 37% of the migrant flow traveling through the US-Mexico border and represents the natural crossing port between Mexico and California. Survey methods that have been successfully applied to characterize the socio-demographic, labor, and geographic patterns of the MMI population in the North border of Mexico for over 13 years by Mexican investigators at El Colegio de la Frontera Norte (COLEF) will be used. A cross-sectional, multi-stage probability survey on HIV and migration will be conducted at key migrant crossing sites in the border city of Tijuana (Baja California, Mexico). MMIs (N=3,800) representing four distinct subpopulations at different stages of the migration experience will be tested for HIV infection and surveyed on HIV-related practices and theoretical determinants. The sample will include MMIs (a) returning voluntarily from the US to Mexico; (b) returned from the US to Mexico by the US Border Patrol; (c) arriving at Tijuana from other Mexican border regions; and (d) traveling North from other Mexican regions. Following the Behavioral Ecological Model, the role of demographic, geographic, economic, social, and psychosocial factors on HIV risk practices in these four subpopulations and the changes in these factors associated with different contexts and stages of the migration process will be examined. In addition, a pilot survey (N=300) on health care access and utilization will be conducted to test the feasibility of applying the proposed survey methods to the study of this and other migrant health areas. Results from this study will advance behavioral epidemiology and may lead to actions in Mexico and the US to reduce HIV infection and improve health care access among MMIs. This study may also set the basis for binational collaboration in the monitoring of migrants' health and provide baseline data to evaluate the effectiveness of future policies aimed at reducing HIV risk and health disparities in both countries.