Sharing U.S. Border-Related HIV Needs, Stories, Questions, Answers, and Resources
Tom Donohoe, MBA
Director, UCLA Local Performance Site, Pacific AETC
U.S.-Mexico Border Project Coordinator, Pacific AETC
If you are reading this entry it is likely that you work on the U.S. border, are interested in HIV along the U.S. border, or are looking for border-related HIV resources. For clarity you should know that ‘the border’ covers U.S. communities 60 miles above Mexico and stretches 2,000 miles long from the Pacific Ocean to the Gulf of Mexico. Border-related HIV issues like migrant populations, urban and rural health, substance abuse, and stigma, for example, are topics that are not unique to this area, but are highlighted there.
UMBAST has developed resources to address some of these issues; check them out on our website at: AETCBorderHealth.org
Imagine the border as a U.S. state. San Diego, which comprises 44% of the total population of the border, is its largest urban area by far. I would say the health capital of the border is El Paso, as that is where the U.S./Mexico Border Health Commission (USMBHC) and other federal and international agencies have their offices. However, large cities are rare along the border and many of the challenges are economic and rural health issues. Indeed, if it were a state, the border would have three of the ten poorest counties in the U.S., two to three times the U.S.national unemployment rate and would be:
- Last in access to health care
- 2nd in death rates due to hepatitis
- Last in per capita income
- 1st in number of school children living in poverty
I had the opportunity to speak with some border providers in Sierra Vista, Arizona at a half-day training in May that covered updates in HIV, hepatitis, and substance abuse. Those present shared their concerns about whether health care reform would be able to help the working poor in the region. A case manager from a Federally Qualified Health Center Ryan White program in the area emphasized to the group that they are still able to meet the HIV-related health needs of their patients, but it was clear that many in the community (including providers) are not aware that there are programs for HIV-infected patients at a range of income levels. No one could identify a case where a patient who needed HIV medical services, such as HIV medications, and could not obtain them, but the lack of awareness suggests that important information sharing and referrals are not being made.
It was encouraging to see a room full of U.S. HIV providers from the border motivated to spend half their day learning about local resources. But what do all these challenges mean for them and how do they continue to test, link, and keep patients in care even as state HIV testing, prevention, and care budgets are cut in Arizona, California, Texas and New Mexico? How do HIV providers cope with dwindling services for comorbid conditions such as mental illness and substance abuse? What bi-national efforts might impact our work and how will healthcare reform affect HIV work on the border as we move toward 2014? Post your questions, comments and ideas and let’s keep the discussion flowing.