Mobile Populations: Greater Risk
HIV/AIDS takes an especially heavy toll on the most vulnerable and marginalized groups in US society. Poverty, low income, limited education, substandard housing, and inadequate access to health care are some factors that increase overall vulnerability to health concerns. Migration amplifies these vulnerabilities, further destabilizing efforts to maintain health and well-being.
Mobile populations are at greater risk for a missed HIV diagnosis and, if diagnosed, may struggle to remain in care. Mobile patients may encounter additional barriers that prevent diagnoses and keep them out of care, including minimal information about a new community’s resources, language and cultural barriers to accessing that information, immigration status concerns, social isolation, and transportation difficulties. If a mobile individual with undiagnosed HIV does seek care, it is often for an acute co-infection: many of Health Network’s HIV cases were identified when they were brought to treatment for tuberculosis, a serious and common coinfection with HIV in mobile populations.
Misperceptions About Migration
Global South to Global North Migration
There is an ongoing misperception that migration is unidirectional -- from the global south to the global north -- and that the global south is the only source of disease. While some resource-poor countries may struggle with public health initiatives, many have rates of certain diseases equal to or lower than resource-rich countries or excel in public health despite less funding. Prevalence may be unrelated to resources. In regards to HIV specifically, the US has a similar rate of infection among adults as France, Niger, Italy, Honduras, Bhutan, Madagascar, Bolivia, and Laos, although each country has vastly different approaches to and resources for public health.
In the absence of adequate population-based data on migrants who move within the US like farmworkers, useful inferences may be drawn from statistics collected on Latinos in the US, a group known to be disproportionately affected by HIV, and which constitutes a high percentage of the in-country migrant population. In 2015, Latinos made up almost 23 percent of all new HIV infections in the US, despite representing 18 percent of the total population.
Global North to Global South Migration
Considerable attention is paid to migration from the global south to the global north, from low-resourced to high-resourced countries. However, human population movement from the less developed South to the more developed North by adults moving for the first time only constituted 40 percent of world migration between 2009 and 2011.
With regard to HIV, North to South migration may play a critical role. As noted in this article by Rangel, et al:
Mexico and the US may serve as a bridge population from high incidence to low incidence populations. Data from Mexico have suggested a link between migration to the US and the HIV/AIDS epidemic, including increased numbers of AIDS cases in rural communities and a high concentration of AIDS cases in those states that send the highest number of migrants to the US.
Continuity of care services are critical, not only to address the spread of HIV in the US, but to prevent the spread of disease around the world.
Health Network: Health Care Continuity for Mobile Patients with HIV
Health Network assists health care providers with newly-diagnosed persons living with HIV/AIDS who are mobile, to ensure a higher quality of life for the patient and to prevent additional infections, by keeping them in care. Health centers are tasked by the Health Resources and Services Administration (HRSA) to retain newly-diagnosed persons in care, through specific clinical measures aimed at HIV/AIDS patients. Read more about health care continuity for mobile people living with HIV and a Health Network case study in our Summer 2015 issue of Streamline, MCN’s clinical publication. Learn more about Health Network and enrollment on our Health Network page.
View MCN’s archived webinar, Structuring HIV Care for Mobile HIV Patients.
MCN's Ed Zuroweste, MD, presented a webinar in partnership with in+care on our work with HIV providers on retaining patients in ongoing HIV medical care as they move across state and national borders.
View recording | slides | transcript
For more information about HIV/AIDs in the migrant population download the HIV in the Farmworker Population white paper.