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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

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We studied barriers to HIV care among HIV-positive Latinos in the US-Mexico border region, where HIV prevalence is increasing. HIV-positive participants receiving HIV care were recruited from clinics in Southern California and underwent structured interviews (n = 157). Logistic regression explored covariates associated with ≥1 barrier to HIV care. HIV-positive patients were mostly male (84.7%), of Mexican-origin (82.8%), and had a mean age of 37.3 years. Among males (n = 133), 67% identified as men who have sex with men. In the prior year, patients received the following care in Mexico: HIV care (33.1%), non-HIV care (43.3%), prescription medications (51.6%), and traditional medications/herbs (17.2%). The most common barriers to HIV care included stigma and medication side effects concerns. Factors independently associated with ≥1 barrier to HIV care were HIV diagnosis >1 year ago; being of Mexican-origin; crossing the US-Mexico border <5 times in the past year; obtaining medications in Mexico; and age. Findings illustrate that bi-national health care utilization is common, which has implications for HIV service delivery in both countries. Additional studies are needed to better understand individual, provider and system level barriers to HIV care in the San Diego/Tijuana border region.

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The authors gratefully acknowledge the essential participation and contribution of Vista Community Clinic, Clínicas de Salud del Pueblo, Family Health Centers of San Diego, and San Ysidro Health Center, which made this study possible. This study is part of a broader five-year border HIV/AIDS demonstration project funded in 2000 by the US Department of Health and Human Services, Health Resources and Services Administration (HRSA), HIV/AIDS Bureau, Ryan White Care Act Special Projects of National Significance Program. This project was also partially supported by the National Institutes of Mental Health (Grant Number K01 MH072353) and the San Diego EXPORT Center, National Center of Minority Health and Health Disparities, National Institutes of Health (P60 MD00220). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HRSA or the National Institutes of Health. The authors gratefully acknowledge Estela Blanco and Megan Loughran for their support in preparation and editing of the work, Alisa Olshefsky for her role in overseeing successful implementation and completion of the project, and Terry Whitaker, Director of Program Development (San Ysidro Health Center), for his vision and leadership throughout the development and implementation of this project.

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Correspondence to María Luisa Zúñiga.

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Zúñiga, M.L., Brennan, J., Scolari, R. et al. 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. J Immigrant Minority Health 10, 219–227 (2008).

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