HIV Risk and Access to Health Care Among Mexican Migrants

墨西哥移民的艾滋病毒风险和获得医疗保健的机会

• 批准号: 7212581
• 负责人: Ana P Martinez-Donate
• 金额: $ 45.67万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-13 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7212581
• 关键词: AIDS prevention; AIDS/HIV problem; Acculturation; Anal Sex; Area; Behavior; Behavioral; Biological; California; Cities; Collaborations; Communities; Country; Data; Development; Disease Outbreaks; Disruption; Economics; Effectiveness; Environment; Environmental Risk Factor; Epidemic; Epidemiology; Exposure to; Face; Family; Future; Gender; HIV; HIV Infections; Health; Health Services; Health Services Accessibility; Healthcare; Immigrant; Improve Access; Individual; Infection; International; Joints; Lead; Learning; Legal; Light; Maintenance; Measures; Medical Surveillance; Methodology; Methods; Mexican; Mexico; Modeling; Monitor; Needle Sharing; Nomads; Operative Surgical Procedures; Pattern; Policies; Population; Poverty; Prevalence; Probability; Probability Samples; Process; Psychosocial Factor; Public Health; Rate; Reporting; Research; Research Personnel; Resources; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Role; Rural; Sampling; Seroprevalences; Services; Sexual Partners; Sexually Transmitted Diseases; Site; Social isolation; Societies; Source; Staging; Surveillance Modeling; Survey Methodology; Surveys; System; Testing; Time; Travel; Vagina; alcohol and other drug; base; disorder risk; experience; health disparity; improved; migration; prevent; programs; role model; sex; social; socioeconomics; study characteristics; transmission process; vector transmission

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.

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，并且在获得医疗保健服务方面面临重要障碍。研究估计，与墨西哥和美国总人口相比，MMI 中的艾滋病毒感染率高出 10 倍以上，并表明 MMI 是墨西哥农村地区艾滋病毒/艾滋病发病率增加的传播媒介。大多数关于这一主题的研究都受到方法学上的困难的限制，无法接触到这个流动性大、地理分布广泛且往往没有记录的人群。关于 MMI 中 HIV 感染的真实流行率、相关风险做法和 HIV 风险的决定因素（包括接触美国社会的作用和有限的医疗保健机会），目前几乎没有确凿的数据。这项两国研究将调查穿越圣地亚哥 - 蒂华纳边境地区的 MMI 人群的代表性样本中 HIV 感染的患病率、模式和决定因素以及相关风险做法。该地区集中了约37%的通过美墨边境的移民流，是墨西哥和加利福尼亚州之间的天然过境港口。 El Colegio de la Frontera Norte (COLEF) 的墨西哥调查人员在超过 13 年来已成功运用调查方法来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。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关于艾滋病毒和移民的横断面、多阶段概率调查。代表不同移民阶段的四个不同亚群的 MMI（N=3,800）将接受 HIV 感染检测，并调查 HIV 相关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返回墨西哥； (c) 从其他墨西哥边境地区抵达蒂华纳； (d) 从墨西哥其他地区向北行驶。根据行为生态模型，将研究人口、地理、经济、社会和社会心理因素对这四个亚人群的艾滋病毒风险实践的作用，以及这些因素与移民过程的不同背景和阶段相关的变化。此外，还将开展一项关于医疗保健获取和利用的试点调查（N=300），以测试将所提出的调查方法应用于本地区和其他流动人口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，并可能促使墨西哥和美国采取行动减少艾滋病毒感染并改善 MMI 的医疗保健可及性。这项研究还可以为监测移民健康方面的两国合作奠定基础，并提供基线数据来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。