How Latino Immigrants Access HIV Care

Jorge Zepeda, San Francisco AIDS Foundation, San Francisco; Hector Carrillo, San Francisco State University, San Francisco
Research on Systems of Prevention and Care
Thematic Priority Area: Immigrants, Migrant Populations, and Issues in HIV Health Care Access and Community
Community Collaborative Research Awards

In this proposal, the San Francisco AIDS Foundation (SFAF) and the Center for Research on Gender and Sexuality (CRGS) at San Francisco State University (SFSU) seek to study how HIV-positive Latino immigrants access HIV services in two California counties: San Francisco and Santa Clara. At the same time, we seek to study how HIV health service providers market their services to Latino/a immigrants in these counties. We envision that this approach and comparison will help policy makers in developing new approaches to HIV care and treatment for California’s immigrant Latino/a community.

The following research questions will serve as the foundation of our study: How are recently diagnosed HIV-positive Latino/a immigrants accessing HIV care, treatment and prevention services in San Francisco and Santa Clara counties? What are the policies and systems – related to the provision of HIV services – that influence the use of HIV-related services in Latino/a immigrant population in these counties? What are the user/customer experiences in accessing these systems? What factors influence early versus late access in the HIV-positive Latino/a immigrant population?

Given the population size, HIV incidence among Latino/as is disproportionately high in these two counties. This can be traced back to issues such as language barriers, fear of deportation and isolation, all of which become compounded and put Latino/a immigrants at greater risk for new health problems, including obesity, diabetes and HIV infection. Language barriers could also make it more difficult for Latino/as to access and understand the medical care services that exist in their communities, and could partially explain why Latino/as characteristically learn about their HIV status at a relatively – and dangerously – late stage of infection.

Because this population is at a heightened risk for HIV infection, it is important to investigate how they learn about and access HIV care and treatment services. It is also important to study what HIV+ Latinos/as think about the scope, effectiveness and cultural appropriateness of these services. At the same time, service providers would offer valuable testimony about how they serve and market to this population. These insights could help us understand why Latinos/as in San Francisco and Santa Clara counties are increasingly at risk for HIV infection, why they test late for HIV, and how existing health services could be tailored or modified to better serve them.

We intend to interview 120 Latinos/as (sixty in each county) with an HIV diagnosis in the past five years. We will interview them initially, stay in touch with them over a nine-month period, and then re-interview them to check how their access to services has changed. We will also interview 20 service providers, to find out how they market services to Latino/as, and how institutional obstacles or challenges impact their service delivery. These interviews will be tape-recorded and transcribed, and will generate a detailed description of Latino/a immigrant participants’ HIV care activities, as well as any differences in how individuals and service providers perceive health services availability and access.

A project of this scope addressing HIV care for Latinos/as has not yet been attempted in San Francisco and Santa Clara counties. Most of the current research focuses on Southern California, but the needs, challenges and characteristics of the emergent HIV-positive Latino/a immigrant community in Northern California have been largely unexplored.

The project will be managed jointly by Jorge Zepeda, SFAF’s Latino Programs Manager, and Dr. Héctor Carrillo, an Assistant Professor in the Department of Sexuality Studies at SFSU. Both men are intimately involved in issues related to Latino health and acculturation. Mr. Zepeda runs SFAF’s El Grupo program, which was inaugurated in 1989 as a weekly peer support group that promotes HIV health and sexual harm reduction practices to Latinos and Latinas living with HIV. Dr. Carrillo’s academic research analyzes how the sexuality of Mexican gay immigrants influences their paths of migration to the U.S., their incorporation into U.S. life, and their sexual health and HIV risk. He is the author of The Night is Young: Sexuality in Mexico at the Time of AIDS and was co-chair of the Social, Behavioral and Economic Sciences track of the 2008 International AIDS Conference in Mexico City.