The goal of our community-based participatory research study is to identify the nature and extent of complementary and alternative medicine (CAM) use among HIV-positive Latinos in the United States (US) - Mexico border region. HIV-positive Latinos in the US face substantial health disparities when compared to non- Latino Whites, including delayed care entry/entering care with advanced HIV disease and they are disproportionately impacted by HIV-stigma and poor patient-provider communication. CAM use (e.g. herbal therapies, alternative healers, and spirituality/religious practices) may be implicated in disparities (e.g. low antiretroviral therapy (ARVs) adherence).
Study aims and hypotheses are:
Aim 1 : To assess CAM-specific health care behavior, including bi-national CAM utilization from allied/alternative health personnel (e.g. pharmacists, non-Western medicine healers) among HIV-positive Latinos residing in Tijuana and San Diego. Hypothesis 1 (H1) Greater use of CAM will be observed among HIV-positive Latinos who report a) crossing the U.S. border more frequently, and b) having migrated to Tijuana or San Diego (e.g. from southern Mexico).
Aim 2 : To assess use of CAM in the context of HIV treatment utilization and practices, including factors related to delayed entry into HIV care (e.g. HIV stigma);and utilization of and adherence to ARVs among HIV-positive Latinos residing in Tijuana or San Diego. H2.a) Compared to HIV-positive Latinos who report using herbal CAM, those who do not use herbal CAM are more likely to be receiving ARVs and report higher levels of adherence to ARVs;H2.b) Compared to HIV-positive Latinos who do not attend religious services regularly, those who attend religious services regularly are more likely to be receiving ARV;H2.c) Compared to HIV- positive Latinos who report experiencing HIV-related stigma, those who do not report experiencing HIV-related stigma are significantly more likely to be receiving ARV.
Aim 3 : To determine perceived barriers to communicating use of CAM and ARV adherence to clinicians among HIV-positive Latinos residing in Tijuana or San Diego, including satisfaction with clinician communication, concern about clinician response to reporting CAM use and perception of ARV efficacy;H3) Among CAM users, disclosure of CAM use will be higher among Latino patients who report higher satisfaction with clinician communication than among those who report lower satisfaction.
Aim 4 : To explore provider and system barriers to culturally-effective communication about CAM and ARV adherence in HIV+ Latinos.
In Aims 1 -3 we will conduct quantitative, interviewer-administered surveys with 200 HIV+ Latinos (100 from each side of the border).
Aim 4 will assess clinician perspectives on CAM through interviews with 20 HIV clinicians on both sides of the border. This study will reduce health disparities in US Latinos by improving culturally-effective clinician communication and will lead to interventions to increase adherence to ARVs and improved health outcomes.
The goal of our community-based participatory research study is to identify the nature and extent of complementary and alternative medicine (CAM) use among HIV-positive Latinos on the San Diego/Tijuana border. CAM use among US Latinos living with HIV is associated with delayed utilization of and poor adherence to antiretroviral therapies (ARVs) that may exacerbate health disparities in HIV care access and health outcomes. This study will lead to development of culturally-effective interventions to improve access and adherence to HIV care in Latinos who face health disparities. ??
