Resistance, health, and latent tuberculosis infection: Mexican immigrants at the U.S.-Mexico border.

Mexican immigrants living in the U.S.-Mexico border region are confronted with different national explanations about latent tuberculosis infection (LTBI) and preventive treatment. The purpose of this study was to explore how a group of Mexican immigrant women (N = 8) at risk of LTBI treatment failure interpreted and ultimately resisted LTBI preventive treatment. A critical ethnographic methodology, grounded in asymmetrical power relations that are historically embedded within the U.S.-Mexico border culture, was used to examine the encounters between the participants and the health care provider. The study findings are discussed from the perspective of women who experienced oppression and resistance in the U.S.-Mexico border region, providing an account of how Mexican immigrant women become entangled in U.S.-Mexico TB health policies and through resistance manage to assert control over health care choices. In the context of the U.S.-Mexico border region, health care professionals must be skilled at minimizing asymmetrical power relations and use methods that elicit immigrant voices in reconciling differences in health beliefs and practices. Keywords: Mexican immigrant health; latent tuberculosis infection; U.S.-Mexico border; resistance; critical ethnography Tuberculosis (TB) remains an enormous health challenge throughout the world. Approximately two billion persons or one-third of the world's population are infected with Mycobacterium tuberculosis (MTb). Ten to fifteen million persons infected with MTb live in the United States (CDC, 2000a). A 77% increase in active TB disease among U.S. Hispanics has been documented within the last decade. Seventy-five percent of active TB cases among Mexican-born persons (the largest Hispanic subpopulation) in the United States in 1999 were reported from the four U.S. states (Arizona, California, New Mexico, and Texas) bordering Mexico (Lobato & Cegielski, 2001). Without preventive drug therapy, which is optional under current policies specified by the Centers for Disease Control (CDC), 10% of persons diagnosed with latent tuberculosis infection (LTBI) will develop active TB disease at some point in their lifetime (CDC, 2000b). Because the risk of developing active TB disease is highest during the first two years after becoming infected with MTb, it is important to identify the infection early and begin preventive treatment as soon as possible (CDC, 2002). Preventive treatment is often confusing and difficult for patients and families to understand. The infection caused by MTb may remain dormant for the remainder of an infected person's life; this is known as LTBI. Conversely, the disease may become active at any time and progress into active TB. Treatment of LTBI substantially reduces the risk that the infection will progress to active TB disease. The activity of highest priority for TB control programs in the United States is the detection and cure of all active cases of TB, thereby stopping transmission of the disease (American Thoracic Association, 1992). A second priority is the identification and treatment of those persons who have LTBI and are, therefore, at an increased risk of developing active TB disease. There are several treatment options available for persons diagnosed with LTBI. The most common treatment protocol for LTBI is a single drug, isoniazid, taken daily for 9 months (CDC, 2005b). In clinical trials, daily isoniazid treatment for 12 months reduced the risk of TB disease by more than 90% in patients who completed a full course of therapy. The CDC acknowledges that treatment for 6 months with isoniazid may also be quite effective; certainly it would cost less than a 9- or 12-month regimen and possibly result in greater client adherence (Geiter, 2000). Nevertheless, for now the recommendation is that isoniazid be taken daily for nine months. Despite the effectiveness of treatment, the acceptance of the diagnosis and treatment as well as completion of a preventive program for LTBI can be problematic. …