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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:

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.

Source: 
U.S./Mexico Border AETC Steering Team (UMBAST)
Publication Date: 
August 17, 2011

Readers' CommentsBlog Policy

Felix Castillo on Thu, 10/20/2011 - 00:18.

Hi Tom,

I noticed that you define the border region as "U.S. communities 60 miles above Mexico and stretches 2,000 miles long from the Pacific Ocean to the Gulf of Mexico." Not a word about the adjacent area south of the border. Is there a reason for this omission?  The United states-Mexico Border Health Commission says the border region is defined as "the area land being 100 kilometers (62.5 miles) north and south of the international boundary (La Paz Agreement)...Four states in the United States and six states in México."

Tom Donohoe on Thu, 10/27/2011 - 02:24.

Hi Felix-

You are right! I should have said I was defining the US border region as we are funded by HRSA to work on the US side of the border to train US clinicians and other HIV service providers and organizations. However, these providers consistently tell us in all of our needs assessments that we need to maintain a binational perspective. We have tried to do this by inviting Mexican clinicians to our trainings. The US/Mexico Border Health Commission has assisted with simultaneous interpretation at these trainings. We have also included Mexican HIV officials in our planning meetings on the border and worked with them (through a private donor) to offer 9 border clinician scholarships (5 for the US and 4 for Mexico) to the 2008 International AIDS Conference in Mexico City. You can read about these efforts and our "2008 Border Heroes" on our website at the link below:

http://aids-etc.com/aidsetc?page=rep-event

Can you think of other ways we can maintain a binational perspective while training US border HIV clinicians and US border community health centers?

Thank you for your comment!

Lucy Bradley-Spr... on Tue, 08/23/2011 - 18:58.

Thank you Tom. I think there are so many important issues related to HIV in the border area that it can seem overwhelming - poverty, lack of access to care, lack of education, high rates of other infectious diseases, as well as things that were not mentioned such as violence, crime, and incarceration - all contribute to high risk behaviors. In addition, it is difficult to come up with a coordinated effort to deal with these problems because the area crosses 4 U.S. states and an international border. UMBAST has worked to create some coordination with AETCs in those states as well as with national and international agencies that are dealing with the same issues. While there have been a number of successes, a lot of work remains to be done.

Tom Donohoe on Tue, 08/23/2011 - 22:41.

I agree 100%. I suppose I am hoping we can discuss these issues (and others) on this Blog and propose possible solutions, or share resources. I know people are doing great work out there. The AETCs certainly can train and provide technical assistance, but we need to go where there is the most unmet need. We need providers (clinicians, case managers, promotores, etc) ON the border to help guide us. I remember once hearing in a focus group "promotoras are the headlights on the border." Well, we need to hear from these and other providers and other folks who work in border community clinics, especially as everyone we all prepare for health care reform implementation in 2014. I think my next post will be address healthcare reform, HIV and the border. Keep looking for updates.

Thank you for your comment Lucy!

Greg Allen Curran on Mon, 09/12/2011 - 03:32.

Hi Tom, Great work! This is such a great tool. You are the best!

Greg