Stigma as a barrier to HIV care in the context of binational care access among HIV-positive Latinos living in the California/Baja California US-Mexico border region

Background: From 2002-2006 Latinos represented 71% of AIDS cases in San Diego County's southern region, a region with the highest Latino HIV infection rate since 2003. Little is known about binational Latino populations living with HIV/AIDS in the US-Mexico border region. Improved understanding is needed of demographic, behavioral profile, barriers to care and healthcare utilization practices of HIV-positive persons living in the US-Mexico border region.

Methods: This is a cross-sectional study looking at barriers to care among HIV-positive Latinos accessing care along the California/Mexico border region. Participants were recruited from clinics in Southern California and underwent structured interviews (N=157). Logistic regression explored covariates associated with >=1 barrier to HIV care. HIV-positive patients were mostly male (84.7%), of Mexican-origin (82.8%), and had a mean age of 37.3 years. Among potential barriers to HIV care (e.g. lack of transportation); this study explored several manifestations of HIV-stigma as potential barriers.

Results: The most common barriers to HIV care were stigma-related, including concern others might think badly of the person (26%) or learn of their HIV status (11.5%); or that friends/family may be against their receiving services (9.6%). Crossing the US-Mexico border (roundtrip) >= 5 times in the last year was inversely associated with reporting >= 1 barrier to care.

Conclusions: Perceived HIV-stigma is an important barrier to HIV care for border-dwelling Latino populations. Cross-border mobility and care utilization will require more detailed study, particularly if stigma influences care-seeking behavior. Our findings have implications for HIV service delivery in the San Diego/Tijuana border region.