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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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Africa

For queer Nigerians, being on gay dating apps is still a risk

Homophobes target users for violence

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(Bigstock photo)

Gay hookup apps like Grindr, and dating apps like Tinder and Bumble have managed to proliferate queer communities in countries like Nigeria. 

Those who seek one night stands find what they want while those looking for love equally find what they seek. These platforms have managed to position themselves as safe spaces for queer people in anti-gay Nigeria. In  recent times, however, it is proving to be unsafe, as homophobic people are quickly learning about the apps, and opening accounts that either seek to outrightly threaten queer people, or pretend to be queer, have long chats with gay people, invite them over, and inflict violence on them.

Take the case of Biodun, a queer Nigerian man who joined Grindr to meet up with guys like him. 

After Biodun had built a connection and agreed to meet with someone whose display name was “Mamba,” they decided to meet up only for him to be met with violence. Apparently, Mamba ran a catfish account. 

“I’ll never forget that day,” Biodun, who asked the Washington Blade not to use his last name because of safety concerns, said. “I still think about it, and sometimes blame myself for being very careless, even though Grindr was supposed to be our safe space.” 

Biodun’s experience isn’t peculiar to him. 

In Nigeria, draconian laws that criminalize same-sex relationships exist, making queer people turn to the digital realm to explore their identities and seek connections beyond the confines of societal oppression that comes with the physical environment. Gay dating apps such as Grindr, therefore, have emerged as virtual sanctuaries, offering spaces for queer Nigerians to forge friendships, find solidarity, and pursue romantic or sexual relationships. Spaces like this, however, have morphed into a landscape fraught with danger, as homophobic people have weaponized these platforms to perpetuate hate and violence. 

“Sometimes, I often wonder how they learned about these platforms,” Daniel, which is not his real name, told the Blade. “You would think that it is just us in the platforms, until you find out that the accounts are rooted in homophobia.” 

One time, someone’s bio read, “I’m only here to deal with the gay people. I know all of you, and I will find and kill you. We no want una for here (translates to we do not want you here, in English.)” It was a stark reminder that these spaces are no longer LGBTQ-friendly for Nigerians. In 2014, there was the passage of the Same-Sex Marriage Prohibition Act by former President Goodluck Jonathan, which not only criminalized same-sex unions, but also imposed severe penalties on anyone involved in LGBTQ advocacy or support. 

This law catalyzed a surge in discrimination and violence against queer Nigerians; emboldening regular civilians, religious extremists, and even law enforcement agencies to target individuals perceived as deviating from traditional gender and sexual norms. Again, amid this hostile environment, gay dating apps emerged as lifelines for many queer Nigerians, offering avenues for discreet communication, community building, and the pursuit of intimate relationships.

The very anonymity and freedom these apps provided, however, became double-edged swords. 

The advent of screenshot and screen-recording capabilities on these apps, for example, reduced the risks of exposure, strengthening the safety and privacy of users. However, this also comes with its own lapses, as queer people using Grindr have often relied on screenshots and screen recordings to confirm the identities of potentials with their friends, before accepting to meet. 

“Before the removal of the screenshot option, I usually shared photos of others with my trusted friends,” Biodun shared. “But since that was taken off, there was no way for me to do that.” 

Although, according to Grindr’s terms and conditions, the removal came with privacy concerns, as it was to facilitate a safe dating experience.

This erosion of digital safe spaces is depriving queer Nigerians of vital avenues for self-expression and affirmation,and is exacerbating the psychological toll of living in a society that continues to systematically demonize their identities. Moreover, the normalization of homophobic rhetoric and violence in both physical and digital realms has perpetuated a cycle of fear and oppression, and is reinforcing this notion that LGBTQ individuals are inherently unworthy of dignity and respect. Despite these challenges, though, the resilience of queer Nigerians continue to persist, as they defy societal norms and assert their right to love and be loved.

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Caribbean

Dominica High Court of Justice strikes down sodomy law

Gay man challenged statute in 2019

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Dominica flag (Public domain photo)

Dominica’s High Court of Justice on Monday struck down provisions of a law that criminalized consensual same-sex sexual relations.

A gay man who remains anonymous in 2019 challenged sections of the country’s Sexual Offenses Act that criminalized anal sex and “gross indecency” with up to 10 years and 12 years in prison respectively. The plaintiff argued the provisions violated his constitutional rights. 

The Dominica Equality and Sexual Expression Association and the Eastern Caribbean Alliance for Diversity and Equality, a group that advocates for LGBTQ and intersex rights in the region, in a press release noted the court in its ruling affirmed “the criminalization of consensual same-sex activity between adults is unconstitutional.” The groups added Justice Kimberly Cenac-Phulgence “declared that the laws commonly known as buggery and gross indecency laws, contravenes the constitution of the Commonwealth of Dominica, namely the right to liberty, freedom of expression, and protection of personal privacy.”

“It is long past time that the dignity and dreams of all Dominicans were recognized,” said DESEA Executive Director Sylvester Jno Baptiste in the press release. “We are all God’s children, and he loves us all equally. Laws that treat some Dominicans as less than others, have no place in a just society.” 

Dominica is a former British colony that is located between Guadeloupe and Martinique in the Lesser Antilles.  

Antigua and Barbuda, St. Kitts and Nevis, Barbados, and Trinidad and Tobago in recent years have decriminalized consensual same-sex sexual relations. 

The Inter-American Commission on Human Rights in 2021 issued a decision that said Jamaica must repeal its colonial-era sodomy law. The country’s Supreme Court last year ruled against a gay man who challenged it. 

A judge on St. Vincent and the Grenadines’s top court in February dismissed two cases that challenged the country’s sodomy laws.

“Decriminalization helps create an environment where LGBTQ individuals can live openly without fear of persecution, enabling them to access health care, education, and employment without facing discrimination,” said Outright Executive Director Maria Sjödin on Monday in response to the Dominica ruling. “The repeal of these discriminatory laws is a testament to the tireless efforts of activists, advocates, and allies who have long fought for justice and equality. It is a victory for human rights and a significant milestone in the ongoing struggle for LGBTQ rights in the Caribbean.”

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Africa

Upcoming Ugandan Census will not count intersex people

Advocacy group report documents rampant discrimination, marginalization

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(Image by rarrarorro/Bigstock)

Uganda’s national Census next month will not count intersex people.

The revelation about the exclusion of intersex Ugandans in the 9-day Census exercise that will begin on May 10 has been confirmed to the Washington Blade by the head of Uganda’s Bureau of Statistics.

UBOS Executive Director Chris Mukiza in response to the Blade’s questions on the issue said the agency has “no business with intersex.”

Their counting could have made Uganda the second African country and the third globally after Australia and Kenya to collect an intersex person’s data in a Census. 

Kenya’s 2019 Census determined there were more than 1,500 intersex people in the country.

Uganda had a population of 34.8 million, according to the country’s last Census that took place in 2014.

Intersex people in Uganda are among marginalized groups, subject to stigma and discrimination. The government has yet to recognize them as the third sex and consider them among other minority groups, such as people with disabilities, who enjoy special treatment.

Intersex people cannot be exclusively categorized as male or female for having a biological congenital condition with unique sex characteristics due to inherent and mixed anatomical, hormonal, gonadal, or chromosomal patterns that could be apparent before, at birth, in childhood, puberty, or adulthood.

Mukiza’s position of excluding intersex people in the Census, however, comes amid the prime minister’s office’s demands for inclusivity and equality for all the population. (The Constitutional Court on April 3 refused to “nullify the Anti-Homosexuality Act in its totality.”)

“We recognize that much work remains to be done particularly in addressing the needs of the marginalized and vulnerable communities, promoting inclusive economic growth, and combating climate change,” said Dunstan Balaba, the permanent secretary in the prime minister’s office.

Balaba spoke on April 18 during the National Population and Housing Census prayer breakfast meeting the UBOS convened. Religious leaders and other stakeholders attended it.

President Yoweri Museveni has noted that data from the country’s sixth national Census will be crucial towards achieving the nation’s Vision 2040 and help the government, non-governmental organizations, and donors in providing services to the diverse population.

“It will also provide the basis for planning the provision of social services such as education, health, and transport, among others at the national and local level,” Museveni said as he urged citizens to fully support the Census and provide accurate information.

Uganda has an intersex rights organization, “Support Initiative for People with Atypical Sex Development (SIPD),” which activist Julius Kaggwa founded in 2008 with the support of groups that advocate for children, women, and other marginalized populations.

Some of SIPD’s work as a non-profit, grassroots organization includes community outreach and engagement, sharing reliable information with the society for the protection of intersex people’s rights, and championing the need for organized medical and psychological support.

The organization, through its numerous reports, has decried human rights violations against intersex people that include surgery without consent, discrimination in homes, schools and medical centers, parents abandoning intersex children, and stigma due to lack of legal protection by the government.

Uganda’s Registration of Births and Deaths Act allows a parent or guardian of a child under the age of 21 to change the name or sex at the local registration office. The SIPD, however, maintains this law is discriminatory to intersex people over 21 who want to change their sex characteristics, and want parliament to repeal it. 

The intersex rights organization wants the Health Ministry to establish a central registry to register intersex children after they’re born in order to receive support in terms of healthcare, social and legal by the government and other stakeholders as they grow up. 

SIPD particularly wants the government to enact a policy that would allow a gender-neutral marker on birth certificates for intersex children to ease any change of sex in the future. The organization also wants the government, through the Education Ministry, to adopt a curriculum that also considers intersex issues in schools and creates a friendly environment for intersex children to learn and graduate like their non-intersex peers.

These demands follow SIPD’s findings that disclosed many intersex children were dropping out of school because of the stigma and discrimination they suffered. The organization has further called on the public-funded Uganda Human Rights Commission to live up to its constitutional mandates of defending human rights by leading the promotion and protection of the rights of intersex people across the country.

SIPD has also challenged religious leaders, who play a key role in Ugandan society and are influential at the local and national level, to promote acceptance of intersex people and to end discrimination against them.

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