World
Mexicans with HIV/AIDS struggle with treatment access
Government in 2019 created new health care entity
Roberto Navarro has been a dancer since he was 17. Jazz became his passion and he fell in love with classical dancing after he took many classes. And he began to teach four years later.
“I’m so happy when I teach dancing to my girls because they bring me so much joy, I feel like I help my girls to become better women, without noticing I’m some kind of a therapist,” Navarro told the Washington Blade.
He discovered the discipline of dancing in heels in 2014, which made him connect and explore more with his sexuality. He did, however, suffer a lot of bullying because of it.
Navarro — a 33-year-old gay man who is originally from Sahuayo de Morelos in Michoacán state — currently owns a dance salon. Navarro said he started to become an entrepreneur, but it hasn’t been easy because of the pandemic.
He was diagnosed with HIV in 2016. Navarro suffered from depression for several months after he learned his status.
“I woke up very overwhelmed in the morning thinking that I had to go to the hospital to make a long line of patients; to have blood drawn for fast screening tests,” he said. “We arrived at 7 in the morning and left until 1 in the afternoon.”
Navarro has been receiving treatment for almost five years, and he is still dancing.
“Subsequently, I went to my consultations every three or six months depending on my results,” he stated. “By the third month I was undetectable.”
Navarro started with Atripla, an antiretroviral drug he received through Mexico’s Seguro Popular, and he was undetectable a month later.
A shortage of Atripla forced a change to Biktarby after President Andrés Manuel López Obrador in 2019 scrapped Seguro Popular and created the Health Institute for Wellbeing (INSABI). The pharmaceutical company Gilead has said there are many counterfeit versions of the drug on the market.
Seguro Popular in 2018 had almost 52 million beneficiaries. The National Council for the Evaluation of Social Development Policy (CONEVAL) said INSABI at the end of 2020 had more than 34 million beneficiaries.
Antiretroviral drugs have been available in Mexico since 2003, although the Mexican health system is divided into various subsystems based on where one works.
- Institute of Social Security and Services for State Workers (ISSSTE)
- Mexican Institute of Social Security (IMS)
- INSABI (Health Institute for Wellbeing) that was previously known as the Seguro Popular
They vary in the time it takes to receive medication and the time for CD4 viral load tests. The availability of appointments with infectious disease specialists varies in each of the three public health systems.
People with INSABI will take longer to get tests and have access to doctors. It must also be recognized that everyone, in theory, has the possibility of accessing medicines, but it also depends on the states in which they live.

From Seguro Popular to INSABI
The number of people without access to healthcare in Mexico rose from 20 million to almost 36 million between 2018-2020. INSABI, more than a year after its creation, still does not completely cover the same amount as its predecessor.
INSABI is an independent agency through the Ministry of Health that aims to “provide and ensure the free provision of health services, medicines and other inputs associated with people without social security.” The General Health Law says it was to replace Seguro Popular, which was in place from 2004-2019.
“The situation for treatment right now, it’s quite complex, particularly because there have been many changes in the health department of Mexico, and this has to do with the fact that in 2003 when the Seguro Popular was established; there was an increase to comprehensive care for people living with HIV and resources for prevention strategies which are mainly handled through civil society organizations that obtained money from the government.” stated Ricardo Baruch, who has worked at the International Family Planning Federation for almost 15 years.
López,, who took office in 2018, sought to eliminate Seguro Popular, which was the mechanism by which access to antiretroviral drugs were given to most people living with HIV in the states with greater vulnerability. This change was done in theory to expand access for everyone, but the opposite happened.
There is less access due to the modification of purchasing mechanisms and a huge shortage throughout the country. Baruch says this situation has caused a treatment crisis across Mexico.
“The truth is that the Seguro Popular helped me a lot to have my treatments on time, what I do not like is that there is not enough staff to attend all the patients that we are waiting for our consultations,” said Erick Vasquez, a person who learned in February he is living with HIV.
Vasquez, 34, is an artist who works in Guadalajara and Playa del Carmen.
Vasquez did not have health insurance like other people through IMS. He obtained access to Seguro Popular through an organization that supports people with HIV, but he has to wait until October for his first appointment.
Vasquez, who has a very low viral load, in March began a job through which he obtained IMS. He had access to his treatments through it.
He received three months worth of Biktarvy at the end of June; one prescription for each month. He said the drug is not difficult to obtain.
“I have not had any problem with the medication, it is not difficult to get it when you are on the insurance, but there is still a long time left until October,” said Vasquez.
The cost of the antiretroviral treatment in Mexico is approximately $650 per month, and one bottle has only 30 pills.
“I have not had side effects, I have not had nausea, I don’t vomit, I take a pill daily, it is one every 24 hours,” Vasquez said. “I feel very well and I hope very soon to be undetectable.”

Infrastructure over health
Prevention resources were eliminated, and health resources today are used to finance the Felipe Ángeles International Airport at the Santa Lucía military base in Zumpango in Mexico state, a new refinery, the Mayan train and other major infrastructure projects. And this causes many people who want to access treatment not to receive them. It takes much
The cost of the work, including the land connected with the Mexico City International Airport and various military facilities, is set at 82,136,100,000 Mexican pesos and there are provisions to serve 19.5 million passengers the first year of operations, according to a report from the Secretariat of National Defense (SEDENA).
There are, on the other hand, far fewer HIV tests and this shortage has led to a much higher arrival of late-stage HIV cases and even AIDS in hospitals. This trend is particularly serious among transgender women and men who have sex with men.
“Here in Mexico we concentrate the HIV pandemic, and that we are at a time when this issue of shortages has not stabilized, that there is already more clarity in purchases, but it is well known that all these changes in health systems continue for a year over the years they cause the situation to be increasingly fragile and in the matter of migrants that previously there was certainty so that they could access medicines through the Seguro Popular, now there is a legal limbo for which in some states it depends: on the states, the clinic or social worker; whether or not they give you medications,” said Baruch.
“If you are not a resident or a national here in Mexico, this is a matter won for people in transit seeking political asylum or who had stayed in Mexico,” he added.
Migrants lack access to HIV treatment
Mexico is located between the three regions with the world’s highest rates of HIV: the Caribbean, Central America, and the U.S. This has been used as a foundation for a culture of hatred against migrants, according to Siobhan McManus, a biologist, philosopher, and researcher at the Center for Interdisciplinary Research in Sciences and Humanities of the National Autonomous University of Mexico.
The lack of opportunities, violence and climate change that forces people whose livelihoods depend on agriculture to abandon their homes prompts migration from Central America.
Most migrants — LGBTQ or otherwise — experience violence once they arrive in Mexico.

Chiapas and other states have created an extensive network of clinics known by the Spanish acronym CAPASITS (Centro Ambulatorio para la Prevención y Atención en SIDA e Infecciones de Transmisión Sexual) that are specific HIV and STD units in major towns. They are often within close proximity to most people’s homes.
Sonora and Chihuahua states, which border the U.S., often have such clinics in only one or two cities. This lack of access means people will have to travel up to six hours to access these treatments.
People who have already been receiving treatment for a long time were previously given up to three months of treatment. They now must travel every month to receive their medications because of the shortages.
PrEP available in Mexico
The shortage of medical drugs for people who already live with HIV is a current issue for the Mexican government, but they have made free PrEP available for those who want to prevent themselves from the virus.
Ivan Plascencia, a 24-years old, who lives in Guadalajara, the capital of Jalisco state , has been using PrEP for several years since he became sexually active and he never had any complaints about the medication. Plascencia instead recommends his close friends to take advantage of this prevention drug that is available in one of the CAPASITS where he lives.
Post-pandemic screening tests
There are an estimated 260,000 people in Mexico who are living with HIV. Upwards of 80 percent of them knew their status before the COVID-19 pandemic.
The number of new cases that were detected in 2020 were 60 percent less than the previous year, but this figure does not mean HIV rates have decreased.
In Jalisco, which is one of Mexico’s most populous states with upwards of 8 million people, there was a 40 percent increase in positive cases in 2020 compared to 2019. This increase has put a strain on service providers.
Colombia
Colombia anunció la inclusión de las categorías ‘trans’ y ‘no binario’ en los documentos de identidad
Registraduría Nacional anunció el cambio el 28 de noviembre
Ahora los ciudadanos colombianos podrán seleccionar las categorías ‘trans’ y ‘no binario’ en los documentos de identidad del país.
Este viernes la Registraduría Nacional del Estado Civil anunció que añadió las categorías ‘no binario’ y ‘trans’ en los distintos documentos de identidad con el fin de garantizar los derechos de las personas con identidad diversa.
El registrador nacional, Hernán Penagos, informó que hizo la inclusión de estas dos categorías en los documentos de: registro civil, tarjeta de identidad y cédula de ciudadanía.
Según la registraduría: “La inclusión de estas categorías representa un importante avance en materia de garantía de derechos de las personas con identidad de género diversa”.
Estas categorías estarán en el campo de ‘sexo’ en el que están normalmente las clasificaciones de ‘femenino’ y ‘masculino’ en los documentos de identidad.
En 2024 se inició la ejecución de diferentes acciones orientadas implementar componentes “‘NB’ y ‘T’ en el campo ‘sexo’ de los registros civiles y los documentos de identidad”.
Las personas trans existen y su identidad de género es un aspecto fundamental de su humanidad, reconocido por la Corte Constitucional de Colombia en sentencias como T-236/2023 y T-188/2024, que protegen sus derechos a la identidad y no discriminación. La actualización de la Registraduría implementa estos fallos que ya habían ordenado esos cambios en documentos de identidad.
Por su parte, el registrador nacional, Penagos, comentó que: “se trata del cumplimiento de unas órdenes por parte de la Corte Constitucional y, en segundo lugar, de una iniciativa en la que la Registraduría ha estado absolutamente comprometida”. Y explicó que en cada “una de las estaciones integradas de servicio de las más de 1.200 oficinas que tiene la Registraduría Nacional se va a incluir todo este proceso”.
Japan
Tokyo court upholds Japan’s same-sex marriage ban
Country is only G7 nation without legal recognition of same-sex couples
The Tokyo High Court on Nov. 28 ruled the lack of marriage rights for same-sex couples in Japan is constitutional.
The Associated Press notes Judge Ayumi Higashi upheld the legal definition of a family in Japan as a man and a woman and their children. The court also dismissed the eight plaintiffs’ demand for 1 million yen ($6,406.85) in damages.
Hiromi Hatogai, one of the plaintiffs, told reporters after the court ruled that she is “so disappointed.”
“Rather than sorrow, I’m outraged and appalled by the decision,” said Hatogai, according to the AP. “Were the judges listening to us?”
Japan remains the only G7 country without legal recognition of same-sex couples, even though several courts in recent years have ruled in favor of it.
The Sapporo District Court in 2021 ruled the denial of marriage benefits to same-sex couples violates the constitution’s equality clause. The Nagoya District Court in 2023 issued a similar ruling. The Fukuoka District Court in a separate decision said Japan’s current legal framework is unconstitutional. The Tokyo High Court in 2024 came to the same conclusion.
The Washington Blade last month noted Prime Minister Sanae Takaichi, who is Japan’s first female head of government, opposes marriage equality and has reiterated the constitution’s assertion the family is an institution based around “the equal rights of husband and wife.”
India
India’s Jharkhand state works to improve trans people’s access to health care
People for Change working with local officials to address disparities
The transgender community has been part of India’s social fabric for centuries, but decades of policy neglect pushed many into poverty and inadequate health care.
The Supreme Court formally recognized trans people as a third gender in 2014, yet state-level services developed slowly. Telangana opened India’s first dedicated trans clinic, the Mitr Clinic, in 2021 with support from the U.S. Agency for International Development and Johns Hopkins University. Jharkhand State has now ordered all government hospitals and medical colleges to establish dedicated outpatient units for transgender patients.
People for Change, an LGBTQ organization, spent the past year mapping gaps in trans health care across Jharkhand. Its surveys of 100 trans residents in five districts found limited access to gender-affirming care, hormone therapy, dermatology, and mental-health services. The group followed this survey with a May 2025 consultation in Jamshedpur, an industrial town in Jharkhand, that brought together clinicians and community leaders to outline a feasible outpatient model.
Those findings were presented to Health Minister Irfan Ansari in June, backed by input from allied organizations and more than 50 trans leaders. The process helped inform the state’s decision to introduce dedicated trans outpatient departments in all government hospitals and medical colleges.
People for Change, which played a central role in shaping the policy, noted that government hospitals in Jharkhand still face infrastructure and resource gaps. Even so, the group said the order reflects a clear policy commitment to creating dedicated trans health services.
If Jharkhand’s trans outpatient departments system functions as planned, it could become a regional model for states with comparable gaps in public health access.
Government data from the 2011 Census — the latest official count to identify an “other” gender category — lists 13,463 trans residents in Jharkhand, alongside sizable populations in neighboring states: 40,827 in Bihar, 30,349 in West Bengal, 22,364 in Odisha, 18,489 in Chhattisgarh, and 137,465 in Uttar Pradesh. Though likely underreported, these figures underscore the scale of need across eastern and central India.
“The decision to start dedicated transgender OPDs (outpatient departments) is not just an administrative step — it is a statement of inclusion, a recognition that the transgender community deserves discrimination-free, dignified, and responsive healthcare. When the government takes such a deliberate step, it sets a tone for systemic change,” said Souvik Saha, founder of People for Change. “It creates an official entry point for transgender healthcare.”
“For the first time, transgender persons will have a recognized and respectful space within the public health system,” added Saha. “That itself is a major shift. It signals to doctors, nurses, and administrators that transgender health is a priority. This leads to sensitization, accountability, and the gradual improvement of attitudes within hospitals.”
Saha told the Washington Blade the policy is likely to trigger broader improvements, noting that once a service is formally notified, budget allocations, training, infrastructure, and staffing typically follow. He said the move could strengthen the system gradually, “step by step.”
“We are realistic: we know improvements won’t happen overnight. But we are also optimistic because the state has already shown genuine leadership and empathy by issuing this order,” said Saha. “And since Jharkhand is celebrating its 25th year of formation, this decision reflects the state’s intention to move towards greater equality and social justice.”
“For the transgender community, this is not just a service — it is dignity. It is visibility. It is inclusion,” he added. “And with the government, civil society, and community working together, we believe this will lead to meaningful and lasting change in the years ahead.”
Saha told the Blade that the dedicated transgender outpatient will operate within existing government medical colleges and hospitals in Jharkhand and will be staffed by current medical and paramedical teams, with no separate funding required at this stage. He said the policy does not call for separate wards or beds, but for clearly designated outpatient spaces for trans patients. The service, he added, will be run by existing staff who will receive training and orientation as needed.
“At this moment, the specific operational details are still being discussed with the government of Jharkhand. However, what is clear is: the OPD will function as a dedicated space within the hospital, not limited to a specific day,” said Saha. “Transgender individuals will have access to focused, discrimination-free services through this dedicated space. The clinic will run through existing hospital systems, with linkages to psychiatry, dermatology, endocrinology, and other departments when required.”
“This structure allows the government to start services immediately without needing new construction, new staff positions, or separate budget lines,” he added. “It is a practical and efficient first step, making the service accessible while keeping the doors open for: future budget allocations, specialized staffing, expansions into gender-affirming services, and strengthened infrastructure. The government’s intent is very clear: to ensure dignified, equitable, and discrimination-free healthcare for the transgender community. This order is a strong beginning, and operational details will continue to evolve through collaborative discussions between the government, hospitals, and People for Change.”
Saha acknowledged that taboos, misinformation, and stereotypes about the trans community persist in Jharkhand and in many other states. However, Saha said there are encouraging models at which to look.
He pointed to Kerala and Chhattisgarh, which have introduced sensitization programs and begun integrating trans-inclusive practices into their public health systems. These examples, he noted, show that when health departments invest in training and awareness, attitudes shift and services become more respectful and accessible.
“In Jharkhand, People for Change has proposed a similar approach. We have formally recommended to the government that civil surgeons, chief medical officer, doctors, nurses, and other hospital staff be trained on gender sensitization and transgender health challenges. This includes understanding gender identity, psychological needs, respectful communication, medical protocols, and ways to ensure discrimination-free services,” said Saha. “The encouraging part is that these proposals are already being discussed in detail with the government of Jharkhand. The government has shown strong intent through the issuance of the transgender OPD order, and training health professionals is naturally the next crucial step.”
Saha noted that it remains unclear whether trans people will be recruited into government health roles, saying it is too early to make any definitive statement. He explained that recruitment requires separate processes, policies, and approvals, and the current order does not address new staffing or the creation of government positions.
A recent performance audit by the Comptroller and Auditor General of India, the constitutional authority responsible for auditing government spending and administration, outlined severe human-resource and medicine shortages across Jharkhand’s public health system.
Tabled in the state assembly in February, the report found that about 61 percent of sanctioned posts for medical officers and specialists were vacant, along with more than half of all staff-nurse positions and roughly four-fifths of paramedic posts. The audit also documented acute shortages of essential drugs in the hospitals it reviewed, with stock gaps ranging from 65 to 95 percent during the 2020-2022 period. The findings highlight the systemic constraints that the new trans outpatients will have to navigate.
Saha acknowledged that drug shortages remain a serious issue in government hospitals and said the concern is valid. Even so, he added that he is approaching the new outpatient policy with hope and confidence.
“The government of Jharkhand has made a historic and intentional decision by opening dedicated transgender OPDs,” said Saha. “When a government takes such a strong step of recognition and inclusion, it also shows the readiness to understand the specific health challenges and medication needs of the transgender community.”
“As more transgender persons start coming to the OPDs and their health requirements become clearer through proper documentation and reporting, we are confident that the state will make every effort to ensure that essential medicines are available for them,” he added.
Saha said People for Change is also seeking support outside the public system. The organization has begun briefing civic service groups — including Lions Club, Rotary Club and Inner Wheel, international volunteer organizations that run local welfare and health projects — on the outpatient order and the community’s needs. According to Saha, several of these groups have indicated they may help trans patients with medicines and other essentials when prescribed by a doctor.
“So the effort is two-fold: the government is creating an inclusive health system and will be informed of the community’s specific medicinal needs through the OPDs. People for Change and partners are strengthening the safety net to ensure that transgender persons are never left unsupported,” said Saha. “We truly believe that this collaborative approach will ensure that transgender individuals receive the medication and care they deserve — with dignity, consistency, and compassion.”
“Every hospital may take a slightly different amount of time depending on internal readiness, but overall: The foundational work is already underway, Hospitals have started preparing their designated OPD spaces, And coordination is happening at the level of civil surgeons, medical superintendents, and hospital management teams,” he added.
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