1. 1 Assisting PLWHAs Returning to Mexico and other Latin American Countries: A Pilot Project Oscar Gonzalez, PhD Texas/Oklahoma AETC Tracy Tessmann, MA Texas/Oklahoma AETC

2. 2  Project Summary  Establishing Continuity of Care  Referral Process for HIV Providers Serving Migrant Patients  Program Challenges  Navigating HIV Services in Latin America  Other Social Challenges  Conclusions Overview

3. 3 Project Summary  International Continuum of Care  International Continuum of Care Pilot project of Parkland Health & Hospital System & Texas/Oklahoma AETC  HIV infected migrant patients returning to their countries of origin are assisted in linking to HIV clinical care

4. 4 Project Summary - cont’d  Linkage to clinical care:  Ensures continuity of treatment  Reduces the development of resistance  Encourages adherence to treatment  Improves/promotes HIV prevention  Reduces the spread of HIV  Helps people to establish and maintain relationships with HIV providers and the health care systems in Mexico and Latin America

5. 5 Establishing Continuity of Care The target population is providers serving HIV-infected Latino migrant populations in the U.S. The process involves:  Dissemination of project information to HIV clinicians  Providers contact the project via e-mail or telephone  Response is generally 48 hours or less  Situations are assessed individually  Referrals are handled in a culturally appropriate manner

6. 6 Information Needed for Linkage  Who?  Why?  When?  Where?  Regimen?  How long?

7. 7 Destination Referral Includes Providing Information about:  Requirements for accessing care in the destination country  HIV clinic location and contact person  Availability of HIV treatment and services  Physician’s name and credentials  Intake appointment date and time  Tips for navigating the health care system(s)

8. 8 Successful Patient Linkage Information Includes:  Diagnosis letter  CD4 count and viral load test results  Genotype and phenotype test results  List of HIV/AIDS and other medications  Medications for 3 months  Immunization history  Opportunistic infections history Other information needed:  U.S. physician’s contact information  Photo ID  Proof of residence

9. 9 Challenges  Fragmentation/lack of a national health care system for HIV  Patients often rural, clinics mostly urban  Clinical capacity often limited  HIV medications available but access is limited  Cost of international phone calls  Lack of pre-travel planning by patients  Referral follow-up  Non-Mexican citizens do not qualify for HIV care in Mexico

10. 10 Navigating HIV Services in Latin America and Mexico  Scenarios are different Epidemic profiles vary by country and are changing Mexico had 1 HIV clinic in 2005, in 2008: 56 ARV treatment access gaps & limitations Medications: universal access is not reality Lack of support services Funds and resources are still an issue  Processes are different Different treatment guidelines and standards Access to clinical charts from U.S. is a challenge

11. 11 Navigating HIV Services - cont’d  Populations at risk are different Newly vulnerable populations vary by country * Ex-military Migrants Sex workers MSM Transgender Sex tourists Young people and children Pregnant women Feminization of the epidemic Large clinician turnover * Kaiser Family Reporting Manual on HIV*AIDS, July 2008

12. 12 Other Social Challenges  Social taboos  Stigma  Discrimination  Homophobia  Criminalization of sex work  Lack of social justice laws  No integration between sex education, HIV prevention/services and reproductive health services  Human rights issues * Kaiser Family Reporting Manual on HIV/AIDS, July 2008

13. 13 Conclusion  More than 200 referrals  Processes being formalized  Marketing to be expanded  Limited funding  Evidence of demand

14. 14 Questions? Oscar Gonzalez, PhD HIV/AIDS US/MX Border Coordinator Texas/Oklahoma AIDS Education & Training Center 1936 Amelia Court, Second Floor Dallas, TX 75235 (214) 590-2834 PH (214) 590-2184 FAX o1gonz@parknet.pmh.org www.aidseducation.org