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Mexicans with HIV/AIDS struggle with treatment access

Government in 2019 created new health care entity

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Roberto Navarro (Photo courtesy of Roberto Navarro)

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. 

There are three health care systems in Mexico. (Washington Blade photo by Michael K. Lavers)

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.”

Members of the Gay Men’s Chorus of Mexico City who are living with HIV perform at Clínica Condesa, a public health clinic in Mexico City, on July 21, 2019. The clinic’s 20th anniversary coincided with the International AIDS Society’s Conference on HIV Science that took place in the Mexican capital. (Washington Blade photo by Michael K. Lavers)

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.

Migrants wait for humanitarian visas at the Ciudad Hidalgo port of entry in Ciudad Hidalgo, Mexico, on Jan. 30, 2019. (Washington Blade photo by Michael K. Lavers)

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.

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Two LGBTQ people named to Chilean president-elect’s Cabinet

Gabriel Boric and his government takes office on March 11

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Chilean President-elect Gabriel Boric. (Photo via the Chilean government)

Chilean President-elect Gabriel Boric on Friday named two openly LGBTQ people to his Cabinet.

Marco Antonio Ávila, who is a gay man, will be the country’s education minister. Alexandra Benado, who is a lesbian, will be Chile’s sports minister.

Javiera Zúñiga, a spokesperson for Movilh (Movimiento de Integración y Liberación Homosexual), a Chilean LGBTQ rights group, applauded Boric for naming Ávila and Benado to his Cabinet.

“The visibility of sexual orientation and gender identity is no longer an impediment to access any position in Chile,” said Zúñiga in a press release. “Sexual orientation and gender identity are irrelevant for the positions, whether they are public or private. Capability is the only thing that matters.”

Boric and his government will take office on March 11. Chile’s marriage equality law goes into effect the day before.

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Lesbian couple murdered, dismembered in Mexico border city

Julissa Ramírez and Nohemí Medina Martínez killed in Ciudad Juárez

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From left: Julissa Ramírez and Nohemí Medina Martínez. (Photo via Facebook)

Authorities in the Mexican border city of Ciudad Juárez on Sunday found the dismembered bodies of a lesbian couple along a local highway.

The dismembered body parts of Julissa Ramírez and Nohemí Medina Martínez were found in plastic bags that had been placed along the Juárez-El Porvenir Highway.

El Diario, a Mexican newspaper, reported the married women lived in El Paso, Texas, which is across the Rio Grande from Ciudad Juárez. Authorities said relatives last spoke with Ramírez and Medina on Saturday afternoon.

A source in Ciudad Juárez with whom the Washington Blade spoke on Thursday confirmed Ramírez and Medina “were lesbian women” and their murder was “very violent.”

Members of Comité de la Diversidad Sexual de Chihuahua, an LGBTQ rights group in the state of Chihuahua in which Ciudad Juárez is located, and Chihuahua Gov. María Eugenia Campos Galván are among those who have expressed outrage over the women’s murders. Comité de la Diversidad Sexual de Chihuahua on Wednesday also urged local and state authorities to investigate whether the murder was a hate crime.

“People of sexual diversity are questioned, including their existence through heteronormative discourse,” said the group in a statement. “They have the right to a life free of violence in which they exercise all their rights, in addition to living without fear or fear of rejection and aggressions that can unfortunately escalate to hate crimes.”

El Diario reported Ramírez and Medina are two of the nine women who have been reported killed in Ciudad Juárez since the beginning of the year.

Personas de las Diversidades Afectivo Sexuales, an LGBTQ rights group in Ciudad Juárez, and feminist organizations on Thursday organized a protest during which participants demanded local, state and federal authorities do more to end to violence against women in the city. The press release that announced the demonstration specifically cited Ramírez and Medina.

“We seek justice and clarification in the murder of Nohemí and Yulissa, a lesbian couple who was found in Juárez-Porvenir Highway,” it reads.

LGBTQ activists and feminist groups participate in a protest against femicides in Ciudad Juárez, Mexico, on Jan. 20, 2022. (Courtesy photo)
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Transgender Mexicans receive amended birth certificates at country’s consulates

New policy announced Wednesday in Mexico City

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(Washington Blade photo by Michael K. Lavers)

Mexico’s Foreign Affairs Ministry on Wednesday announced transgender people who were born in Mexico can receive an amended birth certificate at any of the country’s consulates.

Foreign Affairs Secretary Marcelo Ebrard is among those who spoke at a ceremony at the Foreign Affairs Ministry in Mexico City where he and other officials detailed the policy. Trans Congresswomen Salma Luévano and María Clemente García attended alongside Sen. Malú Micher, trans activist Jessica Marjane, Global Equality Caucus Deputy Director Aron Le Fevre and Amicus Director Juan Pablo Delgado are among those who attended.

Amicus, an advocacy group that is based in the state of Guanajuato, represented two trans Mexicans who brought legal action after consulates in the U.S. denied their request for birth certificates that correspond with their gender identity.

Victory Institute International Programs Manager Mateo de la Torre in 2019 sought legal recourse, known as an “amparo” in the Mexican judicial system, after the Mexican Consulate in D.C. said it could not change the sex on his birth certificate.

Delgado earlier this week told the Washington Blade during a telephone interview from Guanajuato that one judge asked De La Torre to file his “amparo” in person in Tijuana because his signature did not correspond with the one on his Mexican ID. Delgado said a trans woman from Guanajuato filed her own “amparo” in 2021 after the Mexican Consulate in Houston said it could not issue her an amended birth certificate.

Trans Mexicans who want to receive an amended birth certificate need to provide their original document, but Delgado told the Blade that consulates can access them through a data base. De La Torre on Wednesday received an amended birth certificate at the Mexican Consulate in D.C.

“This birth certificate comes after a decade of living in my truth as a transgender man and after years of advocating for my right to be recognized as such,” De La Torre told the Blade. “In Mexico and abroad, many trans people face discrimination, violence and endless bureaucratic hurdles in their fight for legal recognition, and after all this time I am most grateful for the ability to vote in my country’s elections.”

“This new process has the possibility of being life saving for many of our most vulnerable community members, and I will continue to advocate for the day that all trans people living in Mexico are also afforded the right to a process that is free of discrimination and based on self-attestation,” added De La Torre.

Delgado described the new policy as “a great advancement towards the recognition of gender identity” in Mexico.

“It’s a super important advancement,” said Delgado.

Delgado noted Mexico City and 18 of Mexico’s 32 states currently allow trans people to receive birth certificates that correspond to their gender identity.

The Mexican Senate has passed a bill that would codify the Foreign Affairs Ministry policy into law. The measure is now before the Mexican Chamber of Deputies, which is the lower house of the country’s Congress.

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