“I believe that knowing the HIV situation in Mexico is complicated, first, because there are no free tests, sexual health is not encouraged and there are no statistics for those who already have a positive serological status. For example, I never took a test until I found out that I had a risky relationship. I never knew about prevention methods like PreP or PiP and then it was too late. I know that with ART (antiretroviral treatment) my life is normal, many people think otherwise, but I like to think that one day we will leave the stigma behind,” Carlos T said in an interview with El Economista.
Carlos – who asked this publishing house to hide his last name for privacy reasons – received his positive diagnosis at the end of 2016 and receives his treatment at the IMSS (Mexican Institute of Social Security). Since then and until now he has experienced a couple of times “or maybe a little more” delays or irregularities in receiving medication. Carlos lives in Mexico City together with Fernando Z, who also lives with HIV and receives care at Clínica Condesa and describes his experience with this institution as very good.
Both are undetectable, which also means that their viral load is untransmittable. “We know it, but a lot of people don’t. You see, we do see that there are many activists and we would very much like to be part of that, tell our experiences and that this would serve to prevent in our spaces, but the truth is that we think about it a lot when it comes to sharing our serological status, because the people like that don’t see you the same anymore, they change with you and it’s part of the idea that still exists around the virus”, said Carlos and Fernando.
The WHO and UNAIDS (the UN body for HIV/AIDS) have detected that cases in Latin America increased 21% from 2010 to 2019, which would imply that nearly 20,000 more people were diagnosed with HIV in this period. Although virus-related deaths have decreased significantly, the question that remains is: Why have prevention strategies not had an impact in the region?
The Covid-19 pandemic definitely meant a significant centralization of public health efforts and resources, which in some Latin American countries left behind many other services related to sexual and reproductive health. HIV prevention, detection, care and follow-up services.
And, although there is not enough public information, the available data shows that since the beginning of the pandemic the level of diagnoses has dropped significantly. In Mexico City, the Condesa Clinic continued to operate as a necessary activity, the truth is that the reality of the capital is far away in many entities of the country.
What are the factors that are influencing the increase in cases?
In Mexico, a cut in resources has been observed for both public health institutions and specialized groups. Mass dissemination and prevention campaigns have almost disappeared. Preventive treatments such as PreP and PiP have arrived late and access to them is still scarce.
And above all, the stigmatization around HIV continues to be the main obstacle to prevention, detection, care and even effective access to human rights.
“On the one hand, many prevention strategies that were promoted at the community level – from civil organization associations on prevention and timely detection – disappeared or stopped receiving resources at the beginning of this six-year term with the promise that these activities would be resumed. later, but in the end resources were cut and there was no longer anyone who did it, or who paid for it,” said Ricardo Baruch, a specialist in public health, sexual rights and the LGBT+ community, in an interview with El Economista.
Another factor that explains the rise in cases in countries such as Mexico and others in the Latin American region is “timing” between sexual practices accompanied by prevention methods. “It was observed that the ‘non-use of condoms’ increased, which responded to dynamics that occurred in countries such as the United States and Canada or Europe, but the difference is that there they already had PreP (Pre-Exposure Prophylaxis), but here PreP it was quite late. This, added to the pandemic, obviously the irruption of basic health services also caused less detection and greater transmission, “added the specialist.
The concentration of services in the pandemic could also mean that many people who were already undetectable did not receive treatment and became detectable again and therefore could transmit the virus to others.
PreP and PiP, limited and insufficient
PreP and PiP, pre-exposure prophylaxis and post-exposure prophylaxis of the virus, which can reduce the risk of contracting the virus by 80 to 99%.
PreP consists of the daily intake of medication for people who have not acquired the virus, while PiP is the intake of medication for 72 hours after sexual intercourse that may be considered risky.
And although both are available in Mexico, access to them is still very limited and insufficient. “Since we know our serological status, we have not shared it on networks, but we have shared it with our friends and we are always encouraging them to take PreP, get tested constantly and everything, but the difficult thing is that they give you PreP and even more the PiP, because they are only for “vulnerable populations” and I think it should be for everyone,” said Carlos and Fernando.
Just during 2021, PreP was introduced in five cities in the country for users of the Capasits in the states (Ambulatory Center for the Prevention and Care of AIDS and Sexually Transmitted Infections) and the Condesa Clinic in Mexico City. These centers serve only the population NOT affiliated with any type of public or private institution (IMSS, ISSSTE or insurance for major medical expenses).
And while more cities and states are being included in the PreP program, clinics are stuck in red tape; “It is assumed that the medicine is available, but there is no personnel assigned to the PreP project,” said Ricardo Baruch.
“The IMSS, for its part, also opened its PreP program, however, it took a long time to make it clear what it consisted of, many people went to the clinics and had no idea about anything, they were given drugs that were not, etc. And just a few months ago it began to be regularized; in theory, PreP is available in all states through IMSS, but the reality is that to get to the point where they give you PreP, the process is very difficult,” he added.
In the ISSSTE, flatly, there is no PreP.
So it is a situation of: yes you want, but there is lack of coordination between the federal and the state and some institutions and others has caused the start to be much slower than expected.
Eradicate the esteem already
Although there is a combination of factors that have influenced the HIV situation in Mexico and Latin America,
“The issue that is always pending is just stigma-discrimination, in recent years there have been much fewer actions related to this, due to the weakening of institutions such as Conapred and the CNDH, which are the ones that carried out specialized and massive campaigns on matters of protection of the human rights of people living with HIV. And that is something that is no longer happening. It is not only a health issue, but also a human rights issue. There are many pending issues because discrimination is something we see every day” Baruch concluded.