Abstract
HIV testing and counseling is a critical component of HIV prevention efforts and core element of current “treatment as prevention” strategies. Mobility, low education and income, and limited access to health care put Latino migrants at higher risk for HIV and represent barriers for adequate levels of HIV testing in this population. We examined correlates of, and missed opportunities to increase, HIV testing for circular Mexican migrants in the U.S. We used data from a probability-based survey of returning Mexican migrants (N=1161) conducted in the border city of Tijuana, Mexico. We estimated last 12-months rates of HIV testing and the percentage of migrants who received other health care services or were detained in an immigration center, jail, or prison for 30 or more days in the U.S., but were not tested for HIV. Twenty-two percent of migrants received HIV testing in the last 12 months. In general, utilization of other health care services or detention for 30 or more days in the U.S. was a significant predictor of last 12-months HIV testing. Despite this association, we found evidence of missed opportunities to promote testing in healthcare and/or correctional or immigration detention centers. About 27.6% of migrants received other health care and/or were detained at least 30 days but not tested for HIV. Health care systems, jails and detention centers play an important role in increasing access to HIV testing among circular migrants, but there is room for improvement. Policies to offer opt-out, confidential HIV testing and counseling to Mexican migrants in these settings on a routine and ethical manner need to be designed and pilot tested. These policies could increase knowledge of HIV status, facilitate engagement in HIV treatment among a highly mobile population, and contribute to decrease incidence of HIV in the host and receiving communities.
Highlights
Mobile populations are more vulnerable to HIV and other infectious diseases and can play an important role in the relocation and spread of disease between home and host countries
We found that 23.9% of migrants received other health care services in the prior 12 months (24.9% of southbound and 18% of deported migrants), but were not tested for HIV infection
Our models indicate that interactions with health services, immigration, or correctional systems were the strongest predictors of HIV testing
Summary
Mobile populations are more vulnerable to HIV and other infectious diseases and can play an important role in the relocation and spread of disease between home and host countries. In the U.S, approximately 20% of people infected with HIV are unaware of their infection and this group is estimated to be responsible for nearly half of new transmissions.[7] Undiagnosed HIV infected individuals are more likely to engage in riskier behavior and transmit the infection to others compared to those who are aware of their positive status The former may not achieve the same quality-of-life adjusted years benefit as those who know they are infected and start treatment earlier.[8] Previous studies have documented barriers to HIV testing for Latino immigrants in the U.S, including undocumented immigrant status, lack of knowledge regarding HIV risk, limited access to health care,[9] and social stigma.[10] Late HIV testing is a prevalent problem for foreign-born Latinos in the U.S, with about 43% of HIV-infected cases progressing to AIDS within a year of diagnosis.[11] In Mexico, it is estimated that 52% of HIV cases are undiagnosed[12] and previous research has documented high levels of late HIV testing (approximately 61% of new HIV cases), which contribute to a lack of reduction in AIDS deaths.[13]
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