Mexico has a concentrated HIV epidemic affecting predominantly key populations at higher risk of HIV infection (Fig. 6.1). At the end of 2010, an estimated total of 225 000 people were living with HIV, with 143 281 people with AIDS and about 102 000 total deaths. Sex among men has been estimated as the main mode of transmission in the country, accounting for about 59% of all the cumulative people infected with HIV.
Since 2007, the National Center for AIDS Prevention and Control in Mexico (CENSIDA) has invested more than US$ 15 million through nongovernmental organizations to fi nance prevention activities and strategies focusing on men who have sex with men. The federal government currently distributes around 25–30 million male condoms per year, mostly for men who have sex with men and other key populations at higher risk for HIV infection, along with an additional 60–80 million condoms through state-level programs for specifi c population groups. In 2011, Mexico started to implement a fi ve-year, US$ 64 million project supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria in 44 cities with the highest cumulative HIV incidence among men who have sex with men. It will promote HIV testing and counselling, distribute condoms and lubricants and implement peer workshops for behaviour change.
Before 2003, immediate access to antiretroviral therapy depended on insurance provided by health social welfare institutions linked to formal employment, and waiting lines were frequent for uninsured people. In addition, antiretroviral therapy was restricted to women, children and “family men”, thus excluding men who have sex with men, transgender people, sex workers and people who inject drugs. However, universal access to antiretroviral therapy was introduced in 2003, and implementation was completed in 2008–2009. Now all people with a medical indication for antiretroviral therapy in accordance with national treatment guidelines (CD4 cell count at or below 350 cells/mm3) are immediately enrolled in care and antiretroviral therapy, although late diagnosis remains an important issue among men who have sex with men.
Stigma and homophobia are still prevalent in many sectors of Mexican society and have been identifi ed as major obstacles to accessing health care, prevention and early diagnosis of HIV. The National AIDS Programme has introduced a full-fl edged training process to raise awareness and sensitize health personnel working at centres that provide direct HIV services to prevent discrimination, stigma, homophobia and transphobia. CENSIDA has also launched mass media and face-to-face seasonal campaigns, called “Homophobia is OUT”, as well as
Fig. 6.1 Estimated HIV prevalence by key population, Mexico, 2008–2009
2 4 6 8 10 12 14 16
Women who have sex with men 0.2%
Prevalence (%)
Direct comparisons between HIV prevalence may not be appropriate because of differences in sampling methods and populations surveyed.
Men who do not have sex with men 0.5%
Clients of sex workers 0.6%
Prison inmates 1.0%
Female sex workers 2.0%
People who inject drugs 5.0%
Men who have sex with men 11.0%
Male sex workers 15.0%
0
Promoting
countries reporting 113 110 110 111 109 113 113 109 109 107
Number of countries reporting this intervention
79 70 55 48 33 84 80 60 23 15
East, South and South-East Asia
Yes 20 20 12 14 8 24 22 21 7 2
No 6 6 14 12 18 2 4 5 19 24
Europe and Central Asia
Yes 16 14 13 9 12 17 17 11 7 5
No 3 4 4 9 5 2 2 6 10 11
Latin America and the Caribbean
Yes 20 15 18 14 7 19 19 13 4 3
No 1 4 3 7 14 2 2 8 17 17
North Africa and the Middle East
Yes 7 7 4 3 3 8 8 4 2 2
No 4 4 6 7 7 3 3 6 8 8
Sub-Saharan Africa
Yes 16 14 8 8 3 16 16 11 3 3
No 20 22 28 28 32 20 20 24 32 32
a This indicator may underestimate the availability of condom programmes, since it may not include non-targeted programming from non-public providers.
b Includes screening for asymptomatic Neisseria gonorrhoeae infection, Chlamydia trachomatis infection and syphilis.
Table 6.4 Number of low- and middle-income countries (of 149 countries surveyed) reporting the availability of interventions for HIV
prevention, treatment and care among men who have sex with men
6.2.3 Sex workers
A total of 113 low- and middle-income countries reported information on the existence of programmes and policies engaging sex workers1 (Table 6.5). Similar to men who have sex with men, the most commonly available targeted intervention was HIV testing and counselling, reported by 101 of the 113 countries. HIV treatment and care were available in 100 countries and symptomatic treatment of sexually transmitted infections in 94 countries. The least commonly reported intervention was access to a package of interventions for sex workers who also inject drugs.
Regional variation was considerable. In East, South and South-East Asia, all reporting countries indicated making available targeted services for HIV testing and counselling, HIV treatment and care and treatment of symptomatic sexually transmitted infections. In contrast, availability was substantially more limited in
1 Most data refer to female sex workers.
North Africa and the Middle East, where at least one quarter of the reporting countries indicating having no targeted interventions for sex workers.
Despite the availability of interventions for STI management among sex workers, syphilis prevalence remains high in several regions of the world (Box 6.4).
The reported prevalence of active syphilis was over 15%
in countries such as Argentina, Guinea-Bissau, Mongolia, Nicaragua, and Papua New Guinea (Annex 1).
Sex workers are also often subject to the effects of harmful legislation and human rights violations, which include coercion, stigma, poor access to information and prevention services and frequent exposure to violence.
Structural interventions, including decriminalizing sex work and involving sex workers in planning and implementing interventions, are necessary to reduce social vulnerability and improve the access to and uptake of essential HIV interventions.
Targeted condom programminga
HIV testing and counselling
HIV treatment and care
Treating symptomatic
sexually transmitted
infections
Treating asymptomatic
sexually transmitted
infections
Periodic presumptive
treatment of sexually transmitted infectionsb
Access to a package for people who inject
drugs
Empowerment of sex workersc Total number of
countries reporting 113 113 112 109 109 109 109 109
Number of countries reporting this intervention
95 101 100 94 64 34 16 74
East, South and South-East Asia
Yes 24 26 25 26 19 10 4 20
No 2 0 0 0 7 16 22 5
Europe and Central Asia
Yes 15 17 18 13 9 4 4 8
No 4 2 1 4 7 10 12 7
Latin America and the Caribbean
Yes 19 20 19 18 12 6 2 16
No 2 1 2 3 9 15 17 5
North Africa and the Middle East
Yes 7 8 8 6 4 1 2 3
No 4 3 3 4 6 9 8 7
Sub-Saharan Africa
Yes 30 30 30 31 20 13 4 27
No 6 6 6 4 16 22 31 8
a This indicator may underestimate the availability of condom programmes, since it may not include non-targeted programming from non-public providers.
b Or syndromic management of sexually transmitted infections in accordance with recent guidelines (13).
c Participation in planning and implementation of HIV and sexually transmitted infection prevention and care activities.
Table 6.5 Number of low- and middle-income countries (of 149 countries surveyed) reporting the availability of interventions for the
prevention, treatment and care of HIV among sex workers
Box 6.4