Authors: ML Zúñiga, K. Organista, R. Schulhoff, M. Colon, R. Scolari, A. Olshefsky.

Title: Understanding Barriers & Facilitators to Care for HIV+ Persons Living on the US/Mexico Border Region

I. Objective
Two focus groups were held in February 2001 with Latino populations living with HIV/AIDS along the San Diego/Tijuana US-Mexico border. The purpose of the focus groups was to learn from two traditionally disenfranchised Latino groups about barriers and facilitators to accessing HIV/AIDS related care. Information gathered from these groups was intended to enhance our understanding of access to care issues and perceptions of access to care issues that may be unique to persons living in border communities. The focus groups were conducted under the Southern California Border Health HIV/AIDS Project, one of five demonstration projects across the US/Mexico border region that is funded as a Special Project of National Significance (SPNS) grant by the US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau.

II. Methods
The focus groups were held in San Ysidro, California at the primary community clinic that serves individuals and families from both sides of the U.S./Mexico border. Individuals who currently participate in an HIV+ Latina support group and a group of HIV+ Latino men who have sex with men were invited to participate in focus groups at the San Ysidro Health Center. The focus groups were approved by the University of California, San Diego (UCSD) Committee on the Protection of Human Subjects. Participants were read a statement of voluntary consent prior to participation. Eight women participated in the Latina group and eight men participated in the men's group. Participant narratives were coded into four primary themes: Availability of Services, Accessibility of Services, Acceptability of Services, and Accountability of Service to the community.

III. Results
A resounding need for availability of child care and expanded clinic hours was voiced by the women's group. Access to support groups and clinical studies were perceived as facilitators to obtaining needed services by these women. Issues of poor clinic staff sensitivity, language barriers, lack of continuity with clinicians, and concerns with seeking care where others may identify & later stigmatize them were also raised. Some women were dissatisfied with services because they perceived that services were geared toward homosexual populations. For the men's group, issues of transportation to health visits, access to medications for secondary complications of HIV, and need for support with immigration were raised.

IV. Conclusion
In light of client feedback, traditional mechanisms of offering health and social services to Latinos living along the US/Mexico border may need to be reassessed in order to improve client participation in their health and social well being. In terms of HIV/AIDS specific care, the men's groups expressed interest in obtaining support to participate in clinical studies. Further, clients said they would benefit from access to nutritional services and English language instruction. This formative research study allows us to take an initial look at access issues voiced by Latinos living in the US/Mexico border region.