At any given time, federal experts estimate, approximately 10% of the population of Mexico is living in the United States. And plenty of Americans are going to Mexico, too: An estimated 50 million pedestrians and 200 million cars cross the border each year.
Unfortunately, infectious diseases cross the border between the countries as well. That is why, in 1988, the US government established the US–Mexico Border AIDS Education Steering Team (UMBAST). The organization has AIDS Education Training Centers (AETC) in the border states of Arizona, California, Texas, and New Mexico.
Clinicians who run these UMBAST centers provide CE/CME training modules and resources for physicians, advanced practice nurses, and physician assistants, to help them improve continuity of care for migrant patients who cross between the US and Mexico (as well as those who come to the US from and return to other countries in Central and South America).
Creating Continuity
A health care provider’s most important goal is to make sure there are no gaps in services, even when the patient leaves the US to return to their native country.
“We started this program because [at the time] AIDS was a new disease and nobody knew anything about it,” says Lucy Bradley-Springer, PhD, RN, ACRN, FAAN, principal investigator for the Mountain Plains AETC in Denver.
Now, although much more is known, educational and training programs for PAs and NPs do not always focus much on HIV and AIDS. To enhance their education, clinicians who treat patients with HIV and AIDS may need to seek additional training on their own.
That’s where UMBAST comes in. The organization offers CE/CME training courses and online modules. The agency’s Web site (www.AETCborderhealth.org) also provides detailed information on caring for HIV-infected patients from Mexico and Central or South America.
Fact sheets in both English and Spanish offer information on available services and associated costs of HIV and AIDS treatment in Mexico, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama—as well as what documentation patients will need when they return to their native country, and contact information (Web sites and often phone numbers) for services that can connect patients to clinics and hospitals back home, before they leave the US.
Also available online are a slide presentation addressing continuity of care for patients with HIV who are returning to Mexico, and a chart showing which antiviral medications are available in the US and in Mexico, with the generic and brand names used in each country. There are also reports containing epidemiologic and demographic data on HIV/AIDS.
How It’s Done in Mexico
One of the most valuable lessons is how the Mexican health care system works.
“No two countries share as many people and no two countries have a border that is crossed as frequently as the US and Mexico,” says Tom Donohoe, MBA, a family practice professor at the University of California–Los Angeles’ David Geffen School of Medicine. “It’s good for both countries if we know how health care works.”
Many people don’t realize that Mexico now has a government-run health care program, Seguro Popular. Any Mexican citizen who is not insured by an employer can access care under this system.
“If somebody is working with a client who is returning to Mexico and they happen to have HIV, then they will have access to antiretroviral medications,” says Donohoe, the director and principal investigator for the UCLA training center.
Donohoe often encounters health care providers who don’t believe HIV medication is even available in Mexico. “Those stories were probably true 10 years ago,” he says. “But they’re not very true any more.”
In fact, Mexico now has dedicated outpatient HIV clinics in each state, which are staffed by trained and qualified nurses and doctors.
When Mexican patients are preparing to return to their home country, clinicians should make sure they have the name and contact information for an HIV clinic in Mexico, copies of their lab work, and an adequate supply of medication, plus the proper citizen ID cards to sign up for health care programs, says Bradley-Springer. (Again, see www.AETCborderhealth.org for salient details.)
Display Simpatico
A big part of being an effective caregiver entails understanding the cultural issues involved in migrant care.
“This is a public health issue, but it is also a personal issue,” Bradley-Springer says. “People are not getting the care they need.”
First of all, few clinics in the US are willing to care for immigrants who do not have health insurance. Sometimes, even if a clinic is available, immigrants are afraid to seek care because they are in the country illegally.