Complementary & Alternative Medicine Use in HIV+ Latinos in the US-Mexico Border

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 utilization 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. US Latinos face more
barriers to HIV care than non-Latino Whites including less health insurance, delays in
seeking HIV care, and entering care at advanced stages of HIV disease. Latinos living with
HIV/AIDS may be more likely to use CAM when faced with barriers to accessing conventional
HIV care than non-Latino Whites. CAM use, including herbal therapies, seeking care from
alternative healers, and religious practices may be implicated in HIV-related health
disparities for US Latinos living with HIV, but research is lacking, particularly in the
context of binational healthcare utilization. The United States (US)-Mexico border is a
demographically booming region characterized by a shared population living on either side of
the border and who cross frequently to Tijuana or to San Diego; US HIV care providers
working in the USMexico border region serve many Latinos who access services and care on
both sides of the border.Concern over clinician reaction to CAM may erode Latino
patient-provider communication, yet assessment of CAM use from patient and clinician
perspective and health system characteristics is also lacking. We will describe CAM use in
HIV-positive Latinos in the US-Mexico border region to improve culturally-effective care
delivery and inform future biomedical and behavioral interventions to decrease disparities
in ARV access and utilization, and improve HIV-related health outcomes for US Latinos.

Specific aims of our study 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 access to,
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 using 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 use 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 use ARVs and
report lesser utilization of CAM.

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 physician response to reporting CAM
modalities such as herbal therapies, pharmacy practices in Mexico and folk healing
perception of ARV efficacy, and perception of ARV efficacy.

H3) Among HIV-positive CAM users, disclosure of CAM use will be higher in Latino patients
who report higher satisfaction with communication with clinicians than those who report
lower satisfaction with clinicians.

Aim 4: To explore provider and system barriers to culturally-effective communication about
CAM and ARV adherence with HIV-positive Latino patients, including clinician knowledge about
patient CAM practices.

To address Aims 1-3 we will conduct a quantitative study using interviewer-administered
surveys with 200 HIV positive Latinos (100 from each side of the border). In Aim 4 we will
purposively sample 20 HIV clinicians on both sides of the border and conduct in-depth
interviews. Our aims are consistent with the Office of AIDS Research 2008 Plan to assess
sociocultural and structural determinants and health systems that enhance, sustain and/or
perpetuate health disparities.7 Capitalizing on our HIV research expertise with Latino
communities, this study will lead to development of culturally-effective interventions to
improve timeliness and adherence to HIV care in populations with documented health
disparities and will reduce gaps in care.

Inclusion Criteria:

- Latino

- Speak English or Spanish or both

- Lived in San Diego or Tijuana for at least 1 month in the last year

- 18 years or older

- HIV-positive or living with AIDS

Exclusion Criteria:

- Non-Latino

- Speak neither English nor Spanish

- Have not lived in San Diego or Tijuana for at least 1 month in the last year

- Under 18 years of age

- Not HIV-positive or living with AIDS