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Demonstration & Evaluation Models that Advance HIV Service Innovation Along the U.S. - Mexico Border

About this initiative...
Background
Grantees
Journal Articles

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Background

HIV/AIDS is a significant problem along the 2,000-mile border between the United States and Mexico, which stretches from California to Texas. The HIV/AIDS epidemic in this region is made more complex by many factors including Latino cultural norms regarding sexuality, the rural nature of the border resulting in geographic isolation and poverty, and lack of access to culturally sensitive, high-quality health care. The challenge of reaching and providing care to individuals infected and affected by HIV/AIDS is compounded by these social, economic, political, and cultural factors. For example, many individuals cross back and forth over the border for seasonal work, making it difficult to identify people who are at high risk for HIV/ AIDS. Because so many infected individuals along the border do not know their HIV status, bringing people into testing is a critical component of HIV/AIDS outreach.

This initiative sought to develop models of community-based health care networks that effectively reduce barriers to early identification of HIV disease and assure entry to high quality primary health care for individuals who live and/or work in the U.S. region of the U.S./Mexico border area.

The target populations included people at high risk for HIV and people with HIV/AIDS who live and/or work along the U.S. side of the Mexico/U.S. border.

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Grantees

HRSA awarded grants under its Special Projects of National Significance program to the applicants listed below.

    Camino de Vida Center for HIV Services

    Centro de Salud Familiar La Fe

    El Rio Santa Cruz Community Health Center, Inc.

    San Ysidro Health Center

    Valley AIDS Council

    University of Oklahoma (Evaluation Center)


Camino de Vida Center for HIV Services
New Mexico Border Health Initiative
P. O. Drawer 2827
Las Cruces, NM 88004

Description: The New Mexico-Mexico border region is one of the fastest growing and poorest areas in the United States. The rural nature of the area, inadequate transportation, limited resources, low income and low formal education levels of the border population are notable limitations on access to health care. Given the lack of access to medical care, Latino clients infected with HIV are often diagnosed late. Most Latino clients are also late to begin care, and as a result, their treatment regimens are not as effective.

This project had three major goals: 1) determining the patterns of unmet HIV care among Latinos living in the border area, 2) developing culturally appropriate, early HIV detection and referral services for Latinos, 3) improving the system of care to provide better continuity and quality in care for HIV-infected Latinos. To achieve these goals, the New Mexico Border Health initiative is engaging in the following activities: a) conducting a needs assessment to examine the patterns of access and utilization of health care among border Latinos, b) using a promoters program to conduct outreach to specific segments of the Latino population: specifically men who have sex with men, injection drug users, and women at risk of becoming infected with HIV; and c) enhancing and monitoring the current system for continuity and quality of care for HIV infected Latino clients. The project sought to increase the number of underserved Latinos who were tested for HIV, enrolled in early intervention HIV primary care and provided with a seamless referral to a full range of HIV treatment and services.

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Centro de Salud Familiar La Fe, Inc.
Border HIV Disease Management Model
608 S. St. Vrain
El Paso, TX 79901

Description: The HIV service continuum of care in this region was facing serious challenges before the project began. The area’s sole comprehensive AIDS service organization closed in December 1998.  Increased complexity and costs of diagnostic and treatment modalities put additional burdens of service delivery on budgets and staff to provide quality care to growing caseloads of clients with greater level of acuity. Consequently, the traditional system of case management, with its mainly social service functions, proved to be less than adequate to meet the changing healthcare needs of HIV/AIDS clients.

This project created multidisciplinary care teams composed of nurses, positive peer advocates, and a nutritionist to offer combined social and medical case management in the form of a disease management approach. A major component of this model was treatment adherence assessment, education and counseling which was performed by all team members according to detailed job Descriptions and project protocols. This study documented differences in patient outcomes with this enhanced version of disease management compared with the previous case management system.

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El Rio Santa Cruz Community Health Center, Inc. 
The Arizona Border HIV Project
839 West Congress
Tucson, AZ 85749

Description: The Arizona Border HIV/AIDS Care Project was a collaboration of agencies that developed and implemented innovative, seamless service capacities for early intervention and sustained primary medical care for those affected by HIV within the Arizona/Mexico border region. There were many barriers to care, including economic, travel hardships, concerns over lack of confidentiality and the resultant stigmatization, cultural and linguistic differences, and a scarcity of physicians knowledgeable in care for HIV infection. The goals for this project included improving capacity to provide targeted outreach and counseling for testing and identifying those infected with HIV; engaging those who test positive with primary health care services; and enhancing localized capacity of accessible primary care providers skilled in the care of individuals diagnosed with HIV/AIDS along the Arizona/Sonora border.

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San Ysidro Health Center
4004 Beyer Boulevard
San Ysidro CA 92173

Description: This program improved HIV/AIDS outreach, primary care services and cross-border linkages for people living or working in San Diego and Imperial counties. The number of new AIDS cases for Latinos was disproportionately high relative to their total population nationwide and in the border region. Latinos face barriers to care such as lack of knowledge about service, language barriers, and lack of culturally competent services. The underserved sub-populations targeted by this program include 1) newly immigrated Latinos/as; 2) migrant and permanent farm workers; 3) Latinas; and 4) Latino/a youth survival sex workers.  The three main goals of the project were 1) to increase early detection of the underserved HIV-positive Latino/a population; 2) to increase access to comprehensive HIV/AIDS primary care services; and 3) to enhance the capacity of community health centers to provide culturally sensitive care. The intervention model utilized five community health centers (CHCs) as service delivery hubs to conduct outreach and coordinate systems of care. Border competent outreach workers and case managers worked to ensure that underserved high-risk Latino populations were reached and linked into primary care services. A binational program connected Latinos/as diagnosed as HIV-positive in San Diego or Imperial counties with a provider in Tijuana or Mexicali if necessary, and vice versa. The lead agency supported the CHCs with activities such as social marketing campaign, a cross-border HIV/AIDS resource guide, and a quality cultural competency training curriculum.

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Valley AIDS Council
Proyecto Juntos/Project Together
418 East Tyle
Harlingen TX 78550

Description: The goals of the Juntos Project goals were to increase access to HIV primary health care and to increase the capacity of the primary health care system to effectively meet the HIV health care needs of poor, underserved populations living with HIV and residing along the Texas-Mexico Border.  Juntos also sought to better organize health care networks by linking the lead AIDS service organization in the target area with community health centers (CHCs) providing primary care in its service area. These CHCs are major providers of primary health care to indigent populations in the target area, and included the Valley AIDS Council, Brownsville Community Health Center, La Fe del Valle, and United Medical Centers of Eagle Pass.  The Juntos Project model included a rotating HIV primary health care component designed to move HIV primary care closer to locations where persons with HIV live and into the three CHCs where capacity to provide this care had been limited. Nurses were located at each center to coordinate care and referrals across the partner agencies. The project also strengthened  the capacity of the area network of health and human service agencies to provide a comprehensive and coordinated array of care and services to the Target Population.

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University of Oklahoma
Centro De Evaluacion: HIV/AIDS Evaluation & Technical Assistance Center
Department of Anthropology
3200 Marshall Avenue
Norman, OK 73069

Description: Border populations face many challenges that include poverty, discrimination, unemployment, lack of health insurance, fluidity of US/Mexico population movements, language barriers, and cultural dynamics about sexual behavior and dramatic population growth. The University of Oklahoma served as the Evaluation and Technical Assistance Center for this initiative.  The Center provided the five sites with technical assistance that included assessment of health care networks, model development, variable selection, instrument creation, and data analysis.  The Center also conducted a multi-site evaluation of cross-cutting issues that included outcome measures, lessons learned, and best practices with a focus on removing barriers to HIV primary care access.

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Journal Articles

Keesee MS, Natale AP, & Curiel HF. HIV Positive Hispanic/Latinos Who Delay HIV Care: Analysis of Multilevel Care Engagement Barriers. Social Work in Health Care, 2012; 51(5): 457-478. PubMed Abstract

Zúñiga ML, Blanco E, Brennan JJ, Scolari R, Artamonova IV, Strathdee SA. Binational care-seeking behavior and health-related quality of life among HIV-infected Latinos in the U.S.-Mexico border region. Journal of the Association of Nurses in AIDS Care, May-June 2011; 22(3): 162-172. PubMed Abstract

Carabin H, Keesee MS, Machado LJ, Brittingham T, Williams L, Sonleitner NK, Anderson KG, Cajina A, & Foster MW. Estimation of the prevalence of AIDS, opportunistic infections, and standard of care among patients with HIV/AIDS receiving care along the U.S.-Mexico border through the Special Projects of National Significance: a cross-sectional study. AIDS Patient Care and STDs, 2008; 22 (11): 887-895. PubMed Abstract

Zúñiga ML, Brennan J, Scolari R, & Strathdee SA. Barriers to HIV care in the context of cross-border health care utilization among HIV-positive persons living in the California/Baja California US-Mexico border region. Journal of Immigrant and Minority Health, June 2008; 10 (3): 219-227. PubMed Abstract

Olshefsky AM, Zive MM, Scolari R, & Zúñiga ML. Promoting HIV-Risk Awareness and Testing in Latinos Living on the US-Mexico Border: The Tú No Me Conoces Social Marketing Campaign. AIDS Education and Prevention, October 2007; 19 (5): 422-435. PubMed Abstract

Zúñiga ML, Baldwin H, Uhler D, Brennan J, Olshefsky AM, Oliver E, & Mathews WC. Supporting Positive Living and Sexual Health (SPLASH): a clinician and behavioral counselor risk-reduction intervention in a university-based HIV clinic. AIDS and Behavior, September 2007; 11 (5th Supplement): S58-S71. PubMed Abstract

Felderman-Taylor J & Valverde M. A Structured Interview Approach to Evaluate HIV Training for Medical Care Providers. Journal of the Association of Nurses in AIDS Care, July-August 2007; 18 (4): 12-21. PubMed Abstract

Torres K, Zive MM, Scolari R, Olshefsky AM, & Zúñiga ML. Acceptance of a Nutrition Curriculum for HIV positive Latinos Living on the U.S.-Mexico Border. Journal of Transcultural Nursing, April 2007; 19 (2):107-113. PubMed Abstract

Eldred L, Cheever L and Parham-Hopson D. Accessing Care for U.S./Mexico Border Populations Living with HIV/AIDS. Journal of HIV/AIDS & Social Services, 2006; 5(2): 7-13. Publisher Abstract Exit Disclaimer

Keesee M, Shinault KA, Carabin H, Ahmad ASG, Anderson KG, Brittingham T, Williams L, Sonleitner NK, Cajina A, Schulhof R, Curiel H, & Foster M. Socio-Demographic Characteristics of HIV/AIDS Individuals Living and Receiving Care Along the U.S.-Mexico Border Through Five SPNS Demonstration Projects. Journal of HIV/AIDS & Social Services, 2006; 5(2): 15-35. Publisher Abstract Exit Disclaimer

Zúñiga ML, Organista KC, Scolari R, Olshefsky AM, Schulhof R, & Colón M. Exploring Care Access Issues for HIV Seropositive Mexican-Origin Latinos Living in the San Diego/Tijuana Border Region. Journal of HIV/AIDS and Social Services, 2006; 5(2): 37-54. Publisher Abstract Exit Disclaimer

Valverde M & Felderman-Taylor J. HIV/AIDS Outreach in Southern New Mexico: From Design to Implementation. Journal of HIV/AIDS and Social Services, 2006; 5(2): 55-71. Publisher Abstract Exit Disclaimer

Sinclair GL & Cantu Y. A Training Program Designed to Increase the Capacity of Community Health Centers along the United States-Texas-Mexico Border to Treat HIV Infection. Journal of HIV/AIDS and Social Services, 2006; 5(2): 73-88. Publisher Abstract Exit Disclaimer

Organista KC, Alvarado NJ, Balbutin-Burnham A, Worby P, & Martinez SR. An Exploratory Study of HIV Prevention with Mexican/Latino Migrant Day Laborers Camino de Vida Center for HIV Services. Journal of HIV/AIDS and Social Services, 2006; 5(2): 89-114. Publisher Abstract Exit Disclaimer

Keesee M, Ahmad ASG, Nelson W, Barney DD, & Duran ES. An Application of Borrayo's Cultural Health Belief Model to HIV/AIDS Seropositive Hispanics Living Along the US/Mexico Border. Journal of HIV/AIDS & Social Services, 2004; 3 (3): 9-34. Publisher Abstract Exit Disclaimer

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Part F - SPNS Resources

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The SPNS program began with some of the first Federal grants to target adolescents and women living with HIV, and over the years, initiatives have been developed to reflect the evolution of the epidemic and the health care arena.



Part F - SPNS Products and Publications

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