Investigating access to HIV Prevention Services in the San Diego County bi-national (United States - Mexico) border region
Embargo Date
2027-01-16
OA Version
Citation
Abstract
BACKGROUND: HIV is a public health concern across San Diego County. San Diego County has made significant progress reducing new HIV infections and improving outcomes of people living with HIV over the last 10 years. However, HIV infection targets outlined in the local Ending the HIV Epidemic Initiative plan are not on track to be met by their 2030 deadline. Several population groups continue to be disproportionately impacted by HIV in the San Diego County region. These vulnerable groups include but are not limited to transgender people. METHODS: This dissertation research was guided by the Situated Vulnerabilities and Resiliencies Framework (SVRF). Systematic scoping review methods were used to identify the primary barriers and facilitators to accessing HIV prevention services in the San Diego County binational region. SVRF vulnerability domains, scoping review results and Geographic Information System methods were used to develop a localized HIV Prevention Vulnerability Index (HVI) to identify geographic areas that lack HIV services. An HVI guide was then developed to demonstrate how and why to use the HVI. RESULTS: Seven core characteristics of HIV prevention services for transgender people in San Diego County were identified in the scoping review. Although improvements have been made, transgender inclusion in local research and decision-making remains limited. Increased representation is needed to better understand transgender-specific needs and improve research and program planning. The HVI demonstrated how social, economic, and environmental factors significantly impact geographical HIV vulnerability across the county. HVI analysis revealed local service barriers including geographic service availability, urban-rural differences, and racially driven healthcare disparities. An HVI user guide identified how public health and service delivery providers can apply the Index in local decision-making processes. CONCLUSION: This dissertation emphasized the importance of understanding geographic context and the specific characteristics and needs of vulnerable populations when planning and delivering HIV prevention initiatives. The approaches presented in this dissertation can be adapted in other local health jurisdictions to improve services for vulnerable communities. Research findings can also help local health officials identify gaps in surveillance systems and community strengths, and develop an enhanced understanding of localized health-related needs.
Description
2026