“They are discriminated against because they’re Hispanic, because they are poor, and now [because] they have HIV,” Bradley-Springer says. “A lot of times immigrants don’t have access to health care services—and when they do, they are scared of being deported.”
If the patient does make it to a clinic, talking about HIV and AIDS can be sensitive, particularly for men from Mexico or Central or South America.
“A lot of health care providers have trouble dealing with the different cultures that come through their door,” Bradley-Springer says. “If you don’t speak Spanish and you don’t understand the concept of machismo, and you have no idea what health care is like in Mexico, then that makes it harder.”
Meanwhile, it can be frustrating to start making progress with a patient, only to have them leave the country and return to Mexico, Panama, or Honduras. But knowing you connected that patient with good care back home brings peace of mind.
“We’re trying to help our clinicians help their patients get the services when they need them,” Bradley-Springer says.
Consequences of Failure
If that connection doesn’t happen, what’s at stake? Despite progress, many HIV-infected immigrants aren’t aware of the significance of the symptoms they are experiencing.
For example, they will feel fatigue but will work right through it, Bradley-Springer explains. If they do not start antiretroviral drugs soon enough, she adds, they will have a greater viral load and will be more likely to spread the infection to others.
Another important aspect of caring for a migrant patient with HIV is the need to emphasize medication compliance.
“They need to know if they stop taking these drugs and then start taking them again sometime in the future, they may not work,” explains Bradley-Springer, who also is a professor of nursing at the University of Colorado, “and eventually, they are going to run out of choices.”
There is also a cost issue. When people ignore the manifestations of HIV and AIDS, they often show up in the emergency department, feeling weak and short of breath, and often in severe pain.
“Unfortunately, this happens more than it should. This is not an emergency, it’s a chronic disease,” she says. “You frequently find out you’re infected when you’re really sick. But when you’re really sick, the drugs don’t work very well.”
So as with any chronic condition, she adds, prevention is best. Health care providers who work with people from Mexico have a responsibility to learn more about HIV and reach out to those who may be at risk of falling through the cracks, especially in those states along the US–Mexico border.
“We should all be able to share our information and education,” Donohoe says. “Hopefully, one day our two countries are going to be more communicative.”