INTRODUCTION

The Ryan White HIV/AIDS Treatment Modernization Act of 2006 addresses the unmet health needs of people living with HIV/AIDS (PLWHA) by funding primary health care and support services that enhance access to and retention in care. It is the Government’s largest program designed specifically for PLWHA, and it reaches more than 500,000 people each year. It is administered by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB).

Activities funded by the Ryan White HIV/AIDS Program fill the gaps in care that would otherwise leave many PLWHA without access to life-enhancing health care services. Because the programs are the “payer of last resort,” they increase access to care among underserved populations and improve the quality of life for people living with HIV disease.

The Special Projects of National Significance (SPNS) program is the research and development arm of the Ryan White HIV/AIDS Program; it assesses the effectiveness of particular models of care, supports innovative program design, and promotes replication of effective models. SPNS grants fund innovative models of HIV care and support the development of effective care delivery systems.

“The Demonstration and Evaluation of Models that Advance HIV Service Innovation Along the U.S.–Mexico Border,” better known as the SPNS U.S.–Mexico Border Health Initiative, was designed to develop models of community-based health care networks that effectively reduce barriers to early identification of HIV disease and ensure entry to high-quality primary health care programs on the U.S. side of the U.S.–Mexico border area. The target populations included people at high risk for HIV and PLWHA who live or work on the U.S. side of the border. Five SPNS Border Health Initiative demonstration projects and an evaluation center were awarded grants under the initiative.

The sample in this study consists of 1,200 PLWHA who received primary HIV/AIDS medical services between January 1, 2001, and July 30, 2004, from any one of the five SPNS Border Health Initiative demonstration projects.

Sample

Participants were between 18 and 64 years old; 1,003 (84.0 percent) were men, and 197 (16.0 percent) were women. For the purpose of this analysis, gender was treated as missing for people who self-identified as transgender (5 male-to-female participants, 0 female-to-male participants).

Of the 859 participants (71.9 percent) who reported current ties to Mexico, most were men (84.9 percent) and of Hispanic descent (85.0 percent). For the 336 (28.0 percent) participants without current ties to Mexico, 272 (81.0 percent) were men, and more than half (73.0 percent) were of Hispanic descent. Five participants failed to provide information regarding their ties to Mexico and were excluded from further analysis.

Data

A core set of standardized data collection instruments was created collaboratively for use across all five sites. Information was obtained by SPNS staff in face-to-face interviews with participants at initial entry into the program. Interviews were conducted in Spanish or English, depending on the language preference of the participant. Each SPNS Border Health Initiative grantee provided services in a unique care environment, and their approaches reflected that diversity. Each grantee wanted to broaden the system of HIV/AIDS care throughout its region. A primary component of the strategy was to secure the active participation of the HRSA-funded Community and Migrant Health Centers in a collaborative approach to provide medical care and essential support services. Outreach was also a critical component of the grantees’ activities; the objective was to reduce the time between seroconversion and entry into care. Using peers to conduct outreach was a key factor in the success of a program.

The lessons learned from the initiative, which are described in this volume, can be adopted by other programs to improve the health and quality of life of border residents and other vulnerable populations at risk for HIV/AIDS.