HIV/AIDS in Mexico

Prevalence

With less than 1 percent of the adult population estimated to be HIV-positive, Mexico has one of the lowest HIV prevalence rates in Latin America and the Caribbean. Although the overall HIV prevalence is low, UNAIDS estimates that, because of Mexico’s large population, approximately 180,000 people were living with HIV/AIDS in 2005. In 2005, there were 6,200 deaths due to AIDS in Mexico. The epidemic is concentrated in high-risk communities, such as men who have sex with men (MSM) and commercial sex workers, and has not yet become generalized. This situation presents both a challenge and an opportunity to step up prevention measures to contain the spread of HIV/AIDS in Mexico and in the region.

According to the national registry of AIDS cases, 91.4 percent of reported cases were the result of sexual transmission in 2005. The AIDS epidemic is concentrated primarily among MSM, sex workers and their clients, and people who inject drugs. Results of a 2006 study by Bravo-Garcia et al. reported by UNAIDS indicate that sex between men accounts for 57 percent of the HIV infections. Mexico’s National Center for HIV/AIDS Prevention and Control (CENSIDA) estimates that HIV prevalence among MSM was 10 to 13.5 percent in 2006. Results from studies in 2006 by Gayet et al., Magis et al., and the Biological Behavioral Surveillance Survey conducted in Mexico showed that HIV prevalence rates among male sex workers were 25 percent in Monterrey, 20 percent in Guadalajara and Mexico City, and 12 percent in Ciudad Nezahualcóyotl. A gradual shift is occurring toward higher rates of infection among both injecting drug users (IDUs) and women, and rates are also rising among female sex workers (FSWs). A 2004–2006 study by Patterson et al. in 2006 showed that HIV prevalence in Tijuana and Ciudad Juárez, cities on the U.S. border, was 6 percent among FSWs and 16 percent among IDUs. Research by Gayet et al. in 2006 also showed that HIV prevalence among male long-distance truck drivers in Monterrey was 0.7 percent (double the estimated national adult HIV prevalence). More than one-quarter of them had paid for sex in the previous year and one-sixth of them had never used a condom. The role of IDUs in Mexico’s epidemic is difficult to determine, but an association with drug use has been observed in cities along the border with the United States, where the spread of HIV through the sharing of drug-injecting equipment is of growing concern. Population mobility is a factor in HIV/AIDS transmission in Mexico. Cross-border activity, including immigration from Central America and the influx of those returning from migrant work in the United States, has contributed to the spread of the epidemic, particularly in rural parts of the country. Mobile populations are at higher risk of HIV infection because of poverty, violence, lack of access to health services, increased risk-taking behavior, rape, loneliness, and the availability of sex workers.

Although the epidemic in Mexico remains concentrated, it could become generalized due to high-risk behaviors in the general population. There are signs that heterosexual transmission of HIV is increasing as more women are being infected. According to a recent population-based survey by the National Council for HIV/AIDS Prevention and Control, in 2001, 15 percent of married and cohabitating men reported extrarelational sex during the last year, and only 9 percent of them used a condom at last intercourse. Eighty percent of these men perceived no HIV risk from their behavior. Mexican women are at risk for HIV infection because they often are unable to negotiate condom use. According to published research by Olivarrieta and Sotelo (1996) and others, the prevalence of domestic violence in Mexico varies between 30 and 60 percent. In this context, requesting condom use with a stable partner is perceived as a sign of infidelity and asking to use a condom can result in domestic violence.

HIV infection in Mexico is concentrated in urban areas, where more than 77 percent of the population lives. Most HIV prevention programs focus on urban populations, though there are efforts to reach out to rural, mobile, and indigenous populations. The biggest challenge Mexico currently faces is unequal access to quality care and the need to train health workers and clinics in using antiretroviral treatment (ART).

The spread of HIV/AIDS in Mexico is exacerbated by stigma and discrimination (S&D), which act as a barrier to prevention, testing, and treatment. The 2001 UNGASS declaration stated that “stigma, silence, discrimination and denial, together with lack of confidentiality, weaken the prevention efforts, care and treatment.” S&D occur within families, health services, the police, and the workplace. A study conducted by Infante-Xibille in 2004 of 373 health care providers in three states in Mexico described discrimination within health services. HIV testing was conducted only with perceived high-risk groups, often without informed consent. Patients with AIDS were often isolated. A 2005 five-city participatory community assessment by Colectivo Sol, a nongovernmental organization (NGO), found that some HIV hospital patients had a sign over their beds stating they were HIV-positive. There was also discrimination in the workplace. In León, Guanajuato, researchers found that seven out of 10 people in the study had lost their jobs because of their HIV status. The same study also documented evidence of discrimination that MSM experienced within their families.

The potential for HIV-tuberculosis (TB) co-infection is also a concern in Mexico, as it is in other countries. Studies have shown TB to be the second most frequent infection in AIDS patients in Mexico. It is more prevalent in urban centers among IDUs and individuals of lower socioeconomic status. According to the World Health Organization (WHO), the incidence of TB is 10 per 100,000 and 1.1 percent of adults newly diagnosed with TB were found to be HIV-positive in 2006. [http://www.usaid.gov/our_work/global_health/aids/Countries/lac/mexico_profile.pdf "Health Profile: Mexico"] . United States Agency for International Development (June 2008). Accessed September 7, 2008. PD-notice]

National response

Mexico has a national policy on HIV/AIDS treatment and has made notable gains in providing access to ART for the infected population. Since 2003, Mexico has been providing universal access to ART through the national health system. Although the WHO/UNAIDS/UNICEF report Towards Universal Access states that 76 percent of HIV-infected people who needed it were receiving ART in December 2006, the government indicates that everyone identified with advanced disease is receiving treatment. Mexico was also successful in securing the blood supply early on, and no cases of HIV have been detected recently through this mode of transmission. CENSIDA has been active since 1988 and collaborates with other government entities as well as with NGOs, including organizations of persons living with HIV/AIDS. This collaboration is a significant asset in the national response to HIV/AIDS, because a coordinated response between government and civil society has proven to be more effective than government entities acting alone.

Mexico established a national network of HIV/AIDS ambulatory health care facilities known as Centros Ambulatorios Para la Prevencion y Atencion en SIDA e ITS (CAPASITS). The CAPASITS are the result of collaboration among local governments, the national government, and NGOs and provide comprehensive community-based attention and treatment free of charge to people with HIV.

In a landmark decision in February 2007, the Supreme Court ruled that it was unconstitutional for the military to discharge 11 HIV-positive soldiers and deny them access to military health services. The court ruled that being HIV-positive does not in itself imply an inability to serve in the armed forces and that the military must decide on a case-by-case basis whether or not a soldier can remain in active service. The ruling establishes a precedent allowing dismissed soldiers to seek redress in federal appeals court.

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