Transcript Diapositiva 1

Cross-Border Infectious
Diseases:
HIV/AIDS
Preliminary data from SYHC’s
Southern CA Border HIV/AIDS
Project – a HRSA SPNS
Demonstration Grant
Rosana Scolari
Director of HIV Services
San Ysidro Health Center
(DHHS, HRSA grant # H97HA00179-05-01)
November 2004
Presentation Goals
 The impact of HIV/AIDS – Latinos and the border
 Provide a brief overview of HIV/AIDS services available
at SYHC and funding sources
 Present preliminary data on SYHC’s HRSA funded
Special Projects of National Significance (SPNS) Grant
in order to:


Inform health care providers and potential funders about trans-border
health care access patterns of people living with HIV and its potential
relevance to the patient’s health and the need for a binational funding
approach for HIV programs
Plan and develop cross-border collaborations with an understanding of
the health care access issues and service utilization choices of HIV+
individuals along the border
Donde comienza la frontera/Where the border begins
Latinos and HIV/AIDS
 Latinos in the US represent 13% of the population and
account for 18% of the AIDS Cases
 Latinos in CA are more likely than other racial/ethnic
groups to be less than 30 years of age at time of AIDS
diagnosis (CA DHS, 2002)
 Latinos tend to seek medical care at later stages of
disease: they also wait longer after finding out HIV+
status prior to coming into care (Mathews, 2002)
HIV/AIDS in Baja California & San Diego
Baja California (2000)
San Diego (2000)
Population: 2.5 million
Population in SD: 2.8 million
Population in Tijuana: 1.2 million
HIV
HIV
 New Cases
(Reported from 1/1/04-6/30/04)
 New Cases
(Reported 7/1/02-10/31/04)
(Reported from 1995-2004)
= 93
= 1,209
AIDS
 New Cases
(Reported 6/30/2004)
 Cumulative Cases
(1983-2004)
= 4,598
= 44
= 3,055
Consejo Nacional para la Prevención y Control del VIH/SIDA
Centro de Salud y Asistencia, Junio 2004
AIDS
 New Cases (2004)
= 286
 Cumulative Cases
(up to 10/31/04)
= 12,382
County of San Diego HIV/AIDS Epidemiology Report 2004 HHS
Accumulated Incidence Rate of AIDS Cases
in the Northern Border States of México
110
106.6
100
90
58.8
80
National
70
Average
49.9
60
48.5
44.8
38.6
50
40
30
20
10
0
Baja
California
Chihuahua Tamaulipas
Nuevo Coahuila
Leòn
Sonora
Source: Registro Nacional de Casos de SIDA. Data as of December 31st 2003.
(69.6)
SYHC HIV/AIDS Services
 1998 - Expansion of RWCA Title I Funding to create CASA

CASA Case Management – from an average of 5 new patients per month (1998)
to an average of 8 new patients per month (2004)
 2000 - Awarded RWCA Title III Funding for HIV Specialty Care Services

SYHC HIV patient load went from 50 patients in October 2000 to 300 patients
November 2004
 2002 – County Funding for HIV Testing


Expanded access for testing services, from one day of testing to three days and
two sites
Testing an average of 83 and identifying an average of 3 HIV+ (last quarter
numbers) a 3.6% positive rate compared to the 2.5% County average.
 1999-2004 - Growth in Prevention Services (local and state funding)

Starting with one prevention program and 100K in funding in 1999 to five
programs (including a binational P3 program) totaling 425K in 2004
 2000 & 2004 - Research & Evaluation Projects


HRSA Special Projects of National Significance (SPNS) in 2000
CDC Behavioral Surveillance Project in 2004
HRSA HIV/AIDS Bureau Special Projects of
National Significance (SPNS)
GENERAL OVERVIEW:
In July 2000, HRSA HIV/AIDS Bureau, Special Projects of National
Significance (SPNS), made awards to a total of five demonstration
service projects along the US/Mexico border (from San Diego to
Brownsville, TX). The objectives are to implement unique models
of HIV/AIDS care for high-risk populations living on the
US/Mexico border.
Project locations/lead agencies include:





California – San Ysidro Health Center
New Mexico – El Rio Health Center
Arizona – Camino De Vida
Texas (El Paso) – Centro Familiar La Fe
Texas (Harlingen) – Valley AIDS Council
Southern California Border HIV/AIDS
Project, SYHC SPNS Project
FUNDING PERIOD:
July 2000 - June 2005
DESCRIPTION:
A five year demonstration project intended to improve HIV/AIDS outreach,
and access to testing and primary care services and cross-border
linkages for people who live or work in San Diego or Imperial counties.
STRUCTURE:
A collaboration of four community health centers in San Diego and Imperial
Counties, including SYHC (lead agency), FHC, VCC, CSP (Imperial Co.)
EVALUATION:
A multi-level evaluation component - local evaluation oversight provided by
UCSD and the University of Oklahoma’s Centro de Evaluación responsible
for multi-site evaluation
TARGET POPULATIONS:
Newly immigrated Latinos, migrant and permanent farm workers, Latinas,
transborder Latinos and Latino men who have sex with men (MSM)
SPNS Project Study Aims
 To describe the socio-demographic, risk and health care access
characteristics of a predominantly Mexican-origin population of HIV+
persons living in the border region between Southern California (US)
and Baja California (México)
 To improve early access to HIV counseling & testing for HIV+
individuals in the San Diego/Tijuana border region and
 To enhance the capacity of CHC’s to provide culturally sensitive care
and promote early entry into primary care and social services for
HIV+ individuals in the San Diego/Tijuana border region
Methods
 HIV+ clients who live or work in the US-Mexico border
region are recruited from four partner sites
 Voluntary and informed consent is obtained and a series
of six survey instruments and a medical chart review are
completed on each person
 Questionnaires are administered primarily on site at the
clinics (on the US side of border only)
Preliminary Data on HIV Positive
Participants (N=269)
A total of 269 HIV+ participants have been enrolled into the study from
July 1, 2001 to June 30, 2004
RACE/ETHNICITY:
 87% (233) are Latinos/as
 13% (36) are non-Latinos (29 White, 6 Black, 2 Asian, 1
Native Hawaiian or P.I., 2 American Indian)
 92% (214) of Latino/a participants reported having ties to
México (e.g. family, social, business)
NOTE:
Subsequent presentation data provided on Latino study participants
HIV+ Latino/a Demographic Profile
(N= 233) 7/01-06/04
GENDER
Male
= 85% (197)
Female = 15% (36)
AGE (average yrs)
Male
= 37 (range 19-73)
Female = 37 (range 19-66)
SEXUAL ORIENTATION
Gay/Lesbian
Heterosexual
Bisexual
refused
= 50% (117)
= 37% (86)
= 12% (28)
= 1% (2)
Exposure and Years Since Diagnosis
(N= 233) 7/01-06/04
EXPOSURE CATEGORY*
MSM (Men-who-have-Sex-with-Men)
Heterosexual Contact
IDU (Intravenous Drug Use) & Hetero Contact
Blood Transfusion
Other/Unknown
= 56%
= 28%
= 7%
= 4%
= 4%
(131)
(66)
(17)
(9)
(10)
AVERAGE # OF YEARS SINCE DIAGNOSIS
Male
= 3.2 years (range 0-19)
~50% were enrolled less than one year after diagnosis
Female= 2.5 years (range 0-12)
~56% were enrolled less than one year after diagnosis
* Percentage does not equal 100% due to rounding
Border Crossing Frequency
Study participants who crossed the US/México
border at least one round-trip per year during the
last year (N=199)
 Low frequency (1 time/year to <2 times/month)
N
78
%
39%
 Medium frequency (2 to 4 times/month)
53
27%
 High frequency crossers (>4 times/month)
68
34%
Note: Months are implied based on the number of round-trip crossings
per year
Number of Months Lived in or Visited México
(≥1 month within the past year, N=149, 36% of total respondents
(84/233) lived/visited less than 1 month)
N (149) %




One to two months
Three to 6 months
Seven to 11 months
12 months
22
19
24
84
15%
13%
16%
56%
Medical Care Seeking Behavior within the
last year (N= 233)
N
%
Non-HIV medical care in México
99 42%
Non-HIV medical care in the U.S.
70 30%
HIV medical care in México
77 33%
Obtain RX medications in México
123 53%
Obtain traditional medications
in México
43 18%
Conclusions…
 About half of study participants enrolled through case management
waited more than one year to enroll in care after having a positive
test result
 121 of 199 Latino participants (61%) made two or more round–trip
border crossings per month in the last year
 About 72% (108/149) of Latino participants are spending seven or
more months visiting or living in México
 Latino participants receiving care in the US also access care and
medications in México
 Preliminary data indicates that many HIV+ Latinos access HIV and
non-HIV medical care on both sides of the border
Impact…
 Health care providers and potential funders need to be
aware about trans-border health care access patterns of
people living with HIV and its potential relevance to the
patient’s health and the need for a binational funding
approach for HIV programs and services
 At the local planning level, understanding the health care
access issues and service utilization choices of HIV+
individuals along the border may provide useful data for
planning of cross-border collaborations
Future Plans…
 Dissemination of SPNS project data and actively seek
publication of outcomes - manuscripts, journal articles,
etc.
 Active efforts will continue to share data collection
instruments, data & databases, and program technical
information with researchers on both sides of the
US/Mexico border.
 Continue to seek funding for transborder research
projects such as SPNS to enhance knowledge of the
impact of the border on behavior and diseases
The Border That Unites Us
Contact Information
Rosana Scolari
Director of HIV Services
San Ysidro Health Center
4004 Beyer Blvd
San Ysidro, CA 92173
(619) 662-4192
[email protected]