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 (U.S.)-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 U.S. 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 U.S. Latinos, especially in the U.S.-Mexico border region, assessment of Mexican and U.S. provider training and communication needs surrounding Latino patient CAM use is warranted.

Prevalence and Characteristics of CAM Use among People Living with HIV and AIDS in Lebanon: Implications for Patient Care

“…Hence, disclosure and open communication about CAM use with the treating physician is an important part of HIV/AIDs care as it may protect PLWHA from dangerous and unproven therapies as well as maximize the potential health benefits of CAM. To overcome and reduce these risks, it is recommended that physicians be aware of frequently used CAM therapies [9, 12, 15, 23, 24] and where appropriate discuss its use with their patients, in order to improve physician-patient relationship and adherence to HAART and to identify potential safety issues [25, 26]. …”

“…For instance, CAM use may interfere with the success of conventional HIV treatment as a result of interactions between ingested forms of CAM with HAART and the possibility that CAM use may impede uptake or adherence to HAART [7, 10–12, 21, 22]. To overcome and reduce these risks, it is recommended that physicians be aware of frequently used CAM therapies, their efficacy, and side effects [9, 12, 15, 23, 24] and where appropriate discuss such use with their patients, in order to improve physician-patient relationship and adherence to HAART and to identify potential safety issues [25, 26]. However the role of the health care provider has been less clear in the context of CAM use, especially with the significant rates of nondisclosure of use reported in the literature [12, 27, 28] and the reliance mainly on family, friends, and the media as main sources of information for the choice of CAM [29, 30].…”

Beliefs and practices of complementary and alternative medicine (CAM) among HIV/AIDS patients: A qualitative exploration

“…[39,40] Since a variety of traditional medications, approaches and processes are regarded as CAM, there is no explicit list of such modalities [26]; moreover CAM practices greatly depends upon peoples' beliefs, cultures and other psychosocial factors. [23] Even though the recent data on CAM use among PLWHA is promising [12], there are still issues where oral CAM can cause potential safety issues through interactions with conventional ARTs. [11] Therefore an important lesson to be learnt is the fact that healthcare providers should actively discuss CAM with their patients as it may encourage valuable self-management and ensure patient safety.…”

“…Open ended question were preferred so as to provide interviewees with a maximum opportunity to express their views and help in gaining deeper understanding of issues. [23,24] The initial version of the draft questionnaire was discussed among the authors; and was modified after a few rounds of discussions. In addition to checking whether a particular given set of questions were useful in the retrieval of objective information, pilot interviews were conducted with HIV/AIDS patients.…”

Latino Immigrants, Acculturation, and Health: Promising New Directions in Research

“…Yet public health research using a transnational perspective is still in its infancy (3, 83, 109, 116), and large quantitative sources for this type of study are rare (3, 47, 83, 109, 111, 116). Furthermore, research using this approach would benefit from focusing on Latino groups (other than Mexicans) with important circular patterns of migration (e.g., the “air bridge” between New York City and the Dominican Republic).…”