Marks Charles, Zúñiga María Luisa
School of Social Work, San Diego State University, San Diego, CA, United States.
SDSU-UCSD Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, United States.
Front Public Health. 2019 Jun 28;7:179. doi: 10.3389/fpubh.2019.00179. eCollection 2019.
Latinos living in the United States-Mexico border region bear a disproportionate HIV/AIDS burden compared to individuals living in the interior of both nations and face a constellation of barriers that determine their ability to access and adhere to HIV care. Use of complementary and alternative medicine (CAM) may be associated with suboptimal treatment adherence. Sociodemographic factors, health practices, and social determinants of health unique to the border region may further contribute to health disparities that undermine care engagement and continuity. Improved understanding of HIV-positive Latino subgroups and their risk profiles can lead to more effective, targeted clinical and public health interventions. We undertook this study to identify and characterize distinct classes of HIV-positive Latinos in the San Diego-Tijuana border region, differentiated by HIV and border-related factors, utilizing latent class analysis. We investigated relationships between class membership and CAM utilization and self-reported antiretroviral therapy (ART) adherence. Five distinct classes were identified with unique demographic, HIV risk, and border mobility profiles. CAM was recently used by nearly half of each class, though there were significant differences in the proportion of CAM use by class ranging from 44.4 to 90.9%. As well, all classes were currently receiving ART at similarly high rates and ART adherence outcomes were not significantly different based on class. Findings highlight the significant use of CAM by all HIV-positive Latinos in the border region and imply the need for a research framework which appropriately acknowledges the heterogeneous nature of this population, such as intersectionality. Further research is recommended into understanding how patients integrate CAM into HIV treatment and the risks and benefits of incorporating CAM into HIV treatment.
与生活在美国和墨西哥内陆地区的人相比，生活在美国 - 墨西哥边境地区的拉丁裔承受着不成比例的艾滋病毒/艾滋病负担，并且面临着一系列阻碍他们获得和坚持艾滋病毒治疗的障碍。使用补充和替代医学（CAM）可能与次优的治疗依从性相关。边境地区特有的社会人口因素、健康行为和健康的社会决定因素可能进一步加剧健康差距，从而破坏医疗参与和连续性。更好地了解艾滋病毒呈阳性的拉丁裔亚群体及其风险概况可以带来更有效、更有针对性的临床和公共卫生干预措施。我们开展这项研究，利用潜在类别分析来识别和描述圣地亚哥 - 蒂华纳边境地区不同类别的艾滋病毒呈阳性的拉丁裔，这些类别由艾滋病毒和与边境相关的因素区分开来。我们调查了类别归属与CAM使用以及自我报告的抗逆转录病毒疗法（ART）依从性之间的关系。识别出了五个不同的类别，它们具有独特的人口统计学、艾滋病毒风险和边境流动性概况。每个类别中近一半的人最近使用过CAM，尽管不同类别中CAM使用比例存在显著差异，范围从44.4%到90.9%。同样，所有类别目前接受ART的比例都同样高，并且基于类别，ART依从性结果没有显著差异。研究结果突出了边境地区所有艾滋病毒呈阳性的拉丁裔对CAM的大量使用，并意味着需要一个适当承认该人群异质性的研究框架，例如交叉性。建议进一步开展研究，以了解患者如何将CAM纳入艾滋病毒治疗以及将CAM纳入艾滋病毒治疗的风险和益处。
