A binational comparison of HIV provider attitudes towards the use of complementary and alternative medicine among HIV-positive Latino patients receiving care in the US–Mexico border region

Abstract

Use of complementary and alternative medicine (CAM) is common among Latinos living with HIV in the United States (US)–Mexico border region. Health providers may vary in their approach to communicating acceptance or non acceptance of CAM use, which can undermine patient confidence in disclosing CAM use. Patient–provider communication about CAM is important because certain types of CAM can affect antiretroviral therapy (ART) adherence. We undertook the present binational study to understand US and Mexican provider beliefs, and perceptions surrounding CAM use among Latino patients, and to learn if and how CAM communication occurs. Between July and December 2010, we conducted in-depth, qualitative interviews in Tijuana and San Diego. Analysis procedures drew upon principles of Grounded Theory. The sample was comprised of 19 HIV-health care providers, including 7 women and 12 men. Emerging CAM-related themes were: Provider's perceptions, attitudes and knowledge about CAM; CAM types and modalities; and patient–provider CAM communication. Many clinicians were uncomfortable supporting CAM use with their patients. San Diego providers reported more frequent instances of CAM use among Latino patients than Tijuana providers. Providers from both cities reported that patients infrequently disclose CAM use and almost half do not routinely ask patients about CAM practices. Most of the providers acknowledged that they lack information about CAM, and are concerned about the drug interaction as well as the effects of CAM on adherence. Our findings have important implications for understanding provider communication surrounding CAM use in a highly transnational population and context. Because CAM use may undermine ART adherence and is highly prevalent among Latinos, provider communication about CAM is critical to improved health outcomes among HIV-positive Latinos. Considering the significant growth of US Latinos, especially in the US–Mexico border region, assessment of Mexican and US provider training and communication needs surrounding Latino patient CAM use is warranted.

Keywords:

• patient-physician communication
• HIV/AIDS
• ART adherence
• alternative and complementary medicine
• perceptions and attitudes

Acknowledgements

The study that yielded the data for this paper was supported by NIH/National Center for Complementary and Alternative Medicine (NCCAM) [R21 AT004676-01A1] (Zúñiga); NIH/NCCAM Diversity Supplement [3R21AT004676-01A1S1] (Muñoz); NIH/National Institutes of Mental Health [1R21MH084266-01, 5K01 MH072353] (Zúñiga). Dr. Muñoz was also supported by the NIH/NIAID [5T32AI007384-21 A1]. The authors gratefully acknowledge the following individuals and community partners: Sergio Rivera, Héctor Miguel Corral Estrada, Jorge Luis Martínez, Dr. María Remedios Lozada, Staff at the San Ysidro Health Center, Agencia Binacional Familiar (AFABI), and special acknowledgment to Carolyn Ponting. We also wish to express gratitude to the Secretaría de Servicios y Asistencia and the Centro Ambulatorio de Prevención y Atención en SIDA e ITS (CAPASITS), Tijuana, Instituto Mexicano del Seguro Social, ISSSTECALI and the Hospital General de Tijuana.