Experiences and perceptions of people who use heroin: public health lessons from Hermosillo, Mexico.

Heroin consumption in Mexico is low compared with its use in the United States; however, this practice is more common in the northern region of Mexico than in the rest of the country, being documented only in cities that are located exactly at the Mexico-U.S. border. The Mexican legal framework is focused on rehabilitation, but its effects on the lives of users are unknown. The objective of this research was to analyze how the regulatory Mexican framework is conceptualized and practiced in the daily life of a group of heroin users from a northern city, where consumption has recently spread and has not been documented. We collected the official registered data from users and conducted a qualitative study in Hermosillo, Sonora. A research on the legal framework was conducted, as well as on the city's context. Data on heroin users can be found at HIV health center, as there is no other source of such records. The Mexican legal framework aims at rehabilitation and at avoiding criminalization; however, the daily life of users drives them towards crime circuits: people commit crimes to stay in prison, where they can control the addiction and get heroin, in case of abstinence. The Mexican State has no empirical information to improve its programs and laws related to the use of heroin. The daily practices of users become not only epidemiological but social risks to the community and to the users themselves. Also, the lack of access due to stigmatization, criminalization and violence, increases the inequities, creating a cycle that reproduces poverty and suffering as part of a social structure. Therefore, changes are needed in the justice system.

Challenges of health services related to the population displaced by violence in Mexico.

OBJECTIVE: To analyze the impacts of the care to the population displaced by violence on the health system and the challenges that this entails. METHODS: This is a narrative review of the national and international literature in PubMed, SciELO, WHO/PAHO, and Bireme. Inclusion criteria were date of publication (from 2000), relation with the subject, and language (Spanish or English). We found 292 documents, of which 91 met the inclusion criteria. RESULTS: The main challenges are the intersectoral, participatory, and integral approach (with emphasis on mental health and sexual and reproductive health), ensured accessibility to health services, the need for a reliable registration and information system of the population displaced by violence and its characteristics, and the addressing of the biopsychosocial problems of the different groups, especially women, persons with disabilities or infectious diseases, adolescents, children, ethnic minorities, older adults and the lesbian, gay, bisexual, transsexual, and intersexual population. CONCLUSIONS: The lack of political will to accept and see the internal displacement by violence and its importance as a humanitarian and public health problem is an obstacle to the adequate and timely care of the population displaced by violence in Mexico.

Experiences and perceptions of people who use heroin: public health lessons from Hermosillo, Mexico / Experiencias y percepciones de personas que usan heroína: lecciones de salud pública desde Hermosillo, México / As experiências e percepções de usuários de heroína: lições de saúde pública de Hermosillo, México

Abstract: Heroin consumption in Mexico is low compared with its use in the United States; however, this practice is more common in the northern region of Mexico than in the rest of the country, being documented only in cities that are located exactly at the Mexico-U.S. border. The Mexican legal framework is focused on rehabilitation, but its effects on the lives of users are unknown. The objective of this research was to analyze how the regulatory Mexican framework is conceptualized and practiced in the daily life of a group of heroin users from a northern city, where consumption has recently spread and has not been documented. We collected the official registered data from users and conducted a qualitative study in Hermosillo, Sonora. A research on the legal framework was conducted, as well as on the city's context. Data on heroin users can be found at HIV health center, as there is no other source of such records. The Mexican legal framework aims at rehabilitation and at avoiding criminalization; however, the daily life of users drives them towards crime circuits: people commit crimes to stay in prison, where they can control the addiction and get heroin, in case of abstinence. The Mexican State has no empirical information to improve its programs and laws related to the use of heroin. The daily practices of users become not only epidemiological but social risks to the community and to the users themselves. Also, the lack of access due to stigmatization, criminalization and violence, increases the inequities, creating a cycle that reproduces poverty and suffering as part of a social structure. Therefore, changes are needed in the justice system.

Resumen: El consumo de heroína en México es bajo si se compara con su consumo en EE.UU.; no obstante, esta práctica es más común en la zona norte de México que en el resto del país, estando documentada solamente en ciudades que están localizadas exactamente en la frontera entre México y EE.UU. El marco legal mexicano está centrado en la rehabilitación, sin embargo sus efectos en las vidas de los consumidores son desconocidos. El objetivo de esta investigación fue analizar cómo se conceptualiza el marco regulatorio mexicano, y cómo se hace realidad en la vida diaria de un grupo de personas usuarias de heroína, procedentes de una ciudad del norte, donde recientemente el consumo se ha extendido y no se ha documentado. Nosotros recogimos datos oficiales registrados de consumidores y realizamos un estudio cualitativo en Hermosillo, Sonora. Se realizó una investigación sobre el marco legal, así como del contexto de la ciudad. Los datos sobre los consumidores de heroína sólo se pueden encontrar en centros de salud especializados en VIH, pues que no existe otra fuente para tales registros. El marco legal mexicano pretende la rehabilitación y evitar la criminalización; sin embargo, la vida diaria de los consumidores les conduce hacia los circuitos del crimen: la gente comete delitos para estar en prisión, donde pueden controlar la adicción y conseguir heroína, en caso de abstinencia. El estado mexicano no cuenta con información empírica para mejorar los programas y leyes relacionadas con el consumo de heroína. Las prácticas diarias de los consumidores se han convertido no sólo en riesgos epidemiológicas, sino tambiém en riesgos sociales para la comunidad y los propios consumidores. Asimismo, la falta de acceso debido a la estigmatización, la criminalización y la violencia, incrementa las inequidades, creando un círculo vicioso que reproduce la pobreza y el sufrimiento, como parte de la estructura social. Por ello, es necesario que se produzcan cambios en el sistema judicial.

Resumo: O consumo da heroína é baixo no México, comparado ao uso nos Estados Unidos, porém essa prática é mais comum na região Norte do México em comparação com o resto do país, sendo documentada apenas nas cidades localizadas justamente na fronteira com os Estados Unidos. A legislação mexicana visa principalmente a reabilitação, mas seus efeitos sobre a vida dos usuários não são conhecidos. Este estudo teve como objetivo analisar a maneira pela qual o arcabouço regulatório mexicano é conceituado e praticado na vida diária de um grupo de usuários de heroína de um município no Norte do México, onde o consumo tem sido disseminado recentemente, mas sem ter sido documentado até então. Foram coletados os dados oficiais sobre usuários, seguido por um estudo qualitativo em Hermosillo, no Estado de Sonora. Foram estudados a legislação pertinente e o contexto local em Hermosillo. Os dados sobre os usuários de heroína foram encontrados nos centros de atendimento a pessoas com HIV, uma vez que não existe outra fonte desses registros. A legislação mexicana visa a reabilitação dos usuários, evitando sua criminalização, mas sua vida cotidiana os empurra para os circuitos do crime. Assim, os indivíduos cometem crimes para permanecer na prisão, onde conseguem controlar a dependência e obter a droga em casos de síndrome de abstinência. O governo mexicano não dispõe de dados empíricos para melhorar os programas e leis relacionados ao uso da heroína. As práticas diárias dos usuários se transformam em riscos, não apenas epidemiológicos como também sociais, tanto para a comunidade quanto para os próprios usuários. Além disso, a falta de acesso a serviços, em função da combinação de estigmatização, criminalização e violência, aumenta as desigualdades, criando um ciclo que reproduz e o sofrimento enquanto parte de uma estrutura social. Portanto, são necessárias mudanças urgentes no sistema de justiça.

Challenges of health services related to the population displaced by violence in Mexico / Retos de los servicios de salud relacionados con la población desplazada por la violencia en México

ABSTRACT OBJECTIVE To analyze the impacts of the care to the population displaced by violence on the health system and the challenges that this entails. METHODS This is a narrative review of the national and international literature in PubMed, SciELO, WHO/PAHO, and Bireme. Inclusion criteria were date of publication (from 2000), relation with the subject, and language (Spanish or English). We found 292 documents, of which 91 met the inclusion criteria. RESULTS The main challenges are the intersectoral, participatory, and integral approach (with emphasis on mental health and sexual and reproductive health), ensured accessibility to health services, the need for a reliable registration and information system of the population displaced by violence and its characteristics, and the addressing of the biopsychosocial problems of the different groups, especially women, persons with disabilities or infectious diseases, adolescents, children, ethnic minorities, older adults and the lesbian, gay, bisexual, transsexual, and intersexual population. CONCLUSIONS The lack of political will to accept and see the internal displacement by violence and its importance as a humanitarian and public health problem is an obstacle to the adequate and timely care of the population displaced by violence in Mexico.

RESUMEN OBJETIVO Analizar las implicaciones de la atención de la población desplazada por violencia para el sistema de salud y los retos que le implica. MÉTODOS Revisión narrativa de literatura nacional e internacional en PubMed, SciELO, WHO/OPS, y Bireme. Los criterios de inclusión fueron, la fecha de publicación (a partir de 2000), la relación con el tema, y el idioma (español o inglés). Se encontraron 292 documentos, de los cuales 91 cumplían con los criterios de inclusión. RESULTADOS Los principales retos se referirán: al enfoque integral (con énfasis en la salud mental y la salud sexual y reproductiva), intersectorial, y participativo; a la garantía de la accesibilidad a los servicios de salud; a la necesidad de un sistema de información y registro confiable de la población desplazada por violencia y sus características; y al abordaje de las problemáticas biopsicosociales de los diferentes grupos, especialmente mujeres, personas con discapacidad o con enfermedades infecciosas, de adolescentes, niños y niñas, minorías étnicas, población adulta mayor y la población lésbica, gay, transexual, bisexual y intersexual. CONCLUSIONES La ausencia de voluntad política para la aceptación y visibilización del desplazamiento interno por violencia y de su importancia como problema humanitario y de salud pública, constituye un obstáculo para atender a la población desplazada por violencia de forma adecuada y oportuna en México.

Condiciones de trabajo en consultorios adyacentes a farmacias privadas en Ciudad de México: perspectiva del personal médico / Working conditions in outpatient clinics adjacent to private pharmacies in Mexico City: perspective of physicians

Objetivo: Analizar, desde la perspectiva del personal médico, las condiciones laborales de los consultorios adyacentes a farmacias privadas (CAF), así como sus elementos organizativos. Método: Estudio cualitativo exploratorio consistente en entrevistas semiestructuradas a 32 médicos/as de los CAF en Ciudad de México. Se utilizó la técnica de análisis de contenido dirigido basado en códigos previamente construidos y emergentes, relacionados con la experiencia vivida de los sujetos en su campo laboral. Resultados: El personal médico percibió que trabajar en los CAF no cumple con sus expectativas profesionales por la baja remuneración, la informalidad en la contratación y la ausencia de garantías laborales establecidas en la ley. Esto les impide disfrutar de los beneficios asociados con el empleo formal y sustenta el deseo de laborar en los CAF solo de manera temporal. Consideraron que los incentivos económicos por número de consultas, procedimientos y ventas alcanzadas por la farmacia les permiten aumentar su ingreso sin influir en su conducta prescriptiva. Señalaron que los sistemas de supervisión y presión en los CAF buscan afectar su autonomía para activar la venta de medicamentos en la farmacia. Conclusiones: El personal médico que labora en CAF enfrenta una difícil situación laboral. Los elementos gerenciales usados para inducir la prescripción y activar las ventas de las farmacias conforman un entorno laboral que genera retos en materia de regulación, y subraya la necesidad de monitorear la calidad de los servicios brindados en estos consultorios y los posibles riesgos a los usuarios (AU)

Objective: To analyse the working conditions of physicians in outpatient clinics adjacent to pharmacies (CAFs) and their organizational elements from their own perspective. Methods: We carried out an exploratory qualitative study. Semi-structured interviews were conducted with 32 CAF physicians in Mexico City. A directed content analysis technique was used based on previously built and emerging codes which were related to the experience of the subjects in their work. Results: Respondents perceive that work in CAFs does not meet professional expectations due to low pay, informality in the recruitment process and the absence of minimum labour guarantees. This prevents them from enjoying the benefits associated with formal employment, and sustains their desire to work in CAF only temporarily. They believe that economic incentives related to number of consultations, procedures and sales attained by the pharmacy allow them to increase their income without influencing their prescriptive behaviour. They express that the monitoring systems and pressure exerted on CAFs seek to affect their autonomy, pushing them to enhance the sales of medicines in the pharmacy. Conclusions: Physicians working in CAFs face a difficult employment situation. The managerial elements used to induce prescription and enhance pharmacy sales create a work environment that generates challenges for regulation and underlines the need to monitor the services provided at these clinics and the possible risk for users (AU)

[Working conditions in outpatient clinics adjacent to private pharmacies in Mexico City: perspective of physicians]. / Condiciones de trabajo en consultorios adyacentes a farmacias privadas en Ciudad de México: perspectiva del personal médico.

OBJECTIVE: To analyse the working conditions of physicians in outpatient clinics adjacent to pharmacies (CAFs) and their organizational elements from their own perspective. METHODS: We carried out an exploratory qualitative study. Semi-structured interviews were conducted with 32 CAF physicians in Mexico City. A directed content analysis technique was used based on previously built and emerging codes which were related to the experience of the subjects in their work. RESULTS: Respondents perceive that work in CAFs does not meet professional expectations due to low pay, informality in the recruitment process and the absence of minimum labour guarantees. This prevents them from enjoying the benefits associated with formal employment, and sustains their desire to work in CAF only temporarily. They believe that economic incentives related to number of consultations, procedures and sales attained by the pharmacy allow them to increase their income without influencing their prescriptive behaviour. They express that the monitoring systems and pressure exerted on CAFs seek to affect their autonomy, pushing them to enhance the sales of medicines in the pharmacy. CONCLUSIONS: Physicians working in CAFs face a difficult employment situation. The managerial elements used to induce prescription and enhance pharmacy sales create a work environment that generates challenges for regulation and underlines the need to monitor the services provided at these clinics and the possible risk for users.

["Give me a pill": the meanings of AIDS in bareback practice in Mexico City and its implications for HIV prevention]. / "Dame una pastilla": los significados del VIH/sida en la práctica del bareback en la ciudad de México e implicaciones para la prevención.

OBJECTIVE: To analyze and understand the meanings that gay men in Mexico City associate to unprotected sex such as bareback practices. MATERIALS AND METHODS: Exploratory qualitative study that uses grounded theory analysis of semistructured interviews with gay men that practice bareback sex recruited through the internet. Also a documentary analysis was performed. RESULTS: Gay men engage in bareback sexual practices because they have access to antiretroviral therapy. Access to treatment changes the meanings around AIDS and the perceived risk of infection. The confidence on treatment and the dropback of the Mexican government on preventive strategies explain these perceptions. CONCLUSIONS: Urban and middle class gay men in Mexico City have changed their perception with respect to HIV infection. It is necessary to understand the meanings related to bareback sexual practices and the use of condoms as a preventive strategy. We have to retake the discussion on preventive strategies, damage mitigation, stigma, discrimination, early diagnosis and the impact of antiretroviral therapy.

Public health services and their relationship with rapid HIV test utilization and access for key populations in Morelos, Mexico.

OBJECTIVE: In 2009, 4 749 rapid HIV tests were run in Morelos, Mexico, despite lacking evidence on their results. This article seeks to analyze how public health organization relates to utility of rapid HIV test among healthcare users. MATERIALS AND METHODS: Joint study: comparison of differences in applied test and positive results for each group with the Bonferroni statistical tool, observational study in 34 health subsystems, and 11 interviews with public healthcare users. RESULTS: Each subsystem processes influenced the use and usefulness of screening; for instance, primary care centers test only pregnant women and exclude men who have sex with men (MSM). That group shows significant differences (p<0.007) in the HIV-positive test with respect to other groups. CONCLUSIONS: Despite the availability of rapid detection tests and epidemiological evidence, the way public health services are organized impedes an efficient diagnosis in the group with higher risk, namely MSM. The distribution of rapid HIV tests was guided by stigmatization.

Public health services and their relationship with rapid HIV test utilization and access for key populations in Morelos, Mexico / La organización de los servicios de salud y su relación con la utilización y acceso a las pruebas rápidas para la detección del VIH en las poblaciones clave en Morelos, México

Objective. In 2009, 4 749 rapid HIV tests were run in Morelos, Mexico, despite lacking evidence on their results. This article seeks to analyze how public health organization relates to utility of rapid HIV test among healthcare users. Materials and methods. Joint study: comparison of differences in applied test and positive results for each group with the Bonferroni statistical tool, observational study in 34 health subsystems, and 11 interviews with public healthcare users. Results. Each subsystem processes influenced the use and usefulness of screening; for instance, primary care centers test only pregnant women and exclude men who have sex with men (MSM). That group shows significant differences (p<0.007) in the HIV-positive test with respect to other groups. Conclusions. Despite the availability of rapid detection tests and epidemiological evidence, the way public health services are organized impedes an efficient diagnosis in the group with higher risk, namely MSM. The distribution of rapid HIV tests was guided by stigmatization.

Objetivo. En 2009, 4 749 pruebas rápidas de detección de VIH fueron aplicadas en Morelos, México, sin evidencias de resultados. Se hace necesario analizar la distribución de estas pruebas y las consecuencias que la organización de los servicios de salud tuvo para el diagnóstico del VIH en las poblaciones clave. Material y métodos. Estudio mixto: comparación de diferencias en pruebas aplicadas y casos diagnosticados en grupos mediante la técnica de Bonferroni, observaciones en 34 subsistemas de salud y 11 entrevistas a usuarios. Resultados. Los procesos de cada subsistema incidieron en la utilización y utilidad del tamizaje: se focalizó en mujeres embarazadas y se excluyó a grupos en mayor riesgo (p<0.007) en hombres que tienen sexo con otros hombres (HSH). Conclusiones. A pesar de la disponibilidad de las pruebas y de información epidemiológica, la organización de los servicios impidió una mayor captación de HSH. La estigmatización influyó en las formas de distribuirlas.

"Dame una pastilla": los significados del VIH/sida en la práctica del bareback en la ciudad de México e implicaciones para la prevención / "Give me a pill": the meanings of AIDS in bareback practice in Mexico City and its implications for HIV prevention

Objetivo. Analizar los significados que, sobre el sexo bareback, tienen hombres gay en la ciudad de México. Material y métodos. Investigación cualitativa basada en la teoría fundamentada que utilizó entrevistas semiestructuradas a barebackeros reclutados a través de páginas web. También se realizó un análisis documental sobre el tema. Resultados. Los entrevistados reportaron tener sexo desprotegido. La argumentación al respecto indicó que el acceso al tratamiento antirretroviral modifica la percepción del riesgo de infección. La confianza en torno a los beneficios de este tratamiento y la disminución de las campañas de prevención se identificaron como nociones que guían esta práctica. Conclusiones. Los hombres gay de la ciudad de México con ingresos económicos medios y altos y acceso a antirretrovirales han variado su percepción respecto al VIH. Esto hace necesaria una revisión de los programas de prevención, reducción de riesgos, diagnósticos tempranos y un análisis de nuevas formas de estigmatización y discriminación que podrían causar las campañas que desconozcan estos nuevos significados.

Objective. To analyze and understand the meanings that gay men in Mexico City associate to unprotected sex such as bareback practices. Materials and methods. Exploratory qualitative study that uses grounded theory analysis of semistructured interviews with gay men that practice bareback sex recruited through the internet. Also a documentary analysis was performed. Results. Gay men engage in bareback sexual practices because they have access to antiretroviral therapy. Access to treatment changes the meanings around AIDS and the perceived risk of infection. The confidence on treatment and the dropback of the Mexican government on preventive strategies explain these perceptions. Conclusions. Urban and middle class gay men in Mexico City have changed their perception with respect to HIV infection. It is necessary to understand the meanings related to bareback sexual practices and the use of condoms as a preventive strategy. We have to retake the discussion on preventive strategies, damage mitigation, stigma, discrimination, early diagnosis and the impact of antiretroviral therapy.

[Diagnosis of capacity to perform essential public health functions in the Central American countries, the Dominican Republic, and the Mexican states of Chiapas and Quintana Roo]. / Diagnóstico de la capacidad para el ejercicio de las funciones esenciales de salud pública en países de Mesoamérica, los estados mexicanos de Chiapas y Quintana Roo y la República Dominicana.

OBJECTIVE: Characterize the capacity of public and private institutions in the Central American countries, the Dominican Republic, and the Mexican states of Chiapas and Quintana Roo to perform essential public health functions (EPHFs). METHODS: An online survey of 83 organizations in Belize, Costa Rica, the Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Mexican states of Chiapas and Quintana Roo was conducted to learn about their capacity to perform each of the 11 EPHFs. The results were validated in a workshop with representatives of the ministries of health from the seven countries and the two participating Mexican states. RESULTS: High levels of performance capacity were found most often for EPHF 1 (monitoring, evaluation, and analysis of health status of the population), EPHF 2.1.1 (surveillance, research, and control of risks and threats to public health from infectious diseases), and EPHF 5 (policy development and health planning). The greatest weakness was found in EPHF 2.1.2 (surveillance, research, and monitoring of noninfectious diseases). Asymmetries in EPHF performance within each country mainly revealed weaknesses in the laboratory and public health research functions. CONCLUSIONS: In the countries and territories analyzed, there is a need to improve strategic performance in most of the EPHFs, as well as to strengthen infrastructure, upgrade equipment, and further develop human resources at both the strategic and the tactical levels. A regional approach should be used to take advantage of the different levels of capacity, with a view to greater strengthening and enhanced technical support and cooperation.

Diagnóstico de la capacidad para el ejercicio de las funciones esenciales de salud pública en países de Mesoamérica, los estados mexicanos de Chiapas y Quintana Roo y la República Dominicana / Diagnosis of capacity to perform essential public health functions in the Central American countries, the Dominican Republic, and the Mexican states of Chiapas and Quintana Roo

OBJETIVO: Caracterizar la capacidad para el desempeño de las funciones esenciales de la salud pública (FESP) de las instituciones públicas y privadas en países de Mesoamérica, los estados mexicanos de Chiapas y Quintana Roo y la República Dominicana. MÉTODOS: Se aplicó una encuesta en línea a 83 organizaciones de Belice, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panamá, la República Dominicana y los estados mexicanos de Chiapas y Quintana Roo sobre la capacidad de cumplir cada una de las 11 FESP. Los resultados se validaron en un taller con representantes de los ministerios de salud de los siete países y los dos estados mexicanos participantes. RESULTADOS: La mayor capacidad para el desempeño se identificó en la FESP 1 (monitoreo, evaluación y análisis del estado de salud de la población), la FESP 2.1.1 (vigilancia, investigación y control de riesgos y amenazas a la salud pública para enfermedades infecciosas) y la FESP 5 (desarrollo de políticas y planificación en salud). La mayor debilidad se encontró en la FESP 2.1.2 (vigilancia, investigación y monitoreo de las enfermedades no infecciosas). Las asimetrías en el desempeño de las FESP al interior de cada país indican debilidades en las funciones de los laboratorios y de la investigación en salud pública. CONCLUSIONES: Se requiere mejorar el desempeño estratégico en la mayor parte de las FESP en los países y territorios analizados y reforzar la infraestructura, el equipamiento y los recursos humanos, tanto a nivel estratégico como táctico. Se debe aplicar un enfoque regional para aprovechar la capacidad diferencial con vistas al fortalecimiento y el apoyo técnico cooperativo.

OBJECTIVE: Characterize the capacity of public and private institutions in the Central American countries, the Dominican Republic, and the Mexican states of Chiapas and Quintana Roo to perform essential public health functions (EPHFs). METHODS: An online survey of 83 organizations in Belize, Costa Rica, the Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Mexican states of Chiapas and Quintana Roo was conducted to learn about their capacity to perform each of the 11 EPHFs. The results were validated in a workshop with representatives of the ministries of health from the seven countries and the two participating Mexican states. RESULTS: High levels of performance capacity were found most often for EPHF 1 (monitoring, evaluation, and analysis of health status of the population), EPHF 2.1.1 (surveillance, research, and control of risks and threats to public health from infectious diseases), and EPHF 5 (policy development and health planning). The greatest weakness was found in EPHF 2.1.2 (surveillance, research, and monitoring of noninfectious diseases). Asymmetries in EPHF performance within each country mainly revealed weaknesses in the laboratory and public health research functions. CONCLUSIONS: In the countries and territories analyzed, there is a need to improve strategic performance in most of the EPHFs, as well as to strengthen infrastructure, upgrade equipment, and further develop human resources at both the strategic and the tactical levels. A regional approach should be used to take advantage of the different levels of capacity, with a view to greater strengthening and enhanced technical support and cooperation.

La organización de las poblaciones clave ligadas a la transmisión del VIH: una intervención para abatir el estigma; México, 2005-2009 / The organization of key populations connected to HIV transmission: an intervention to abate stigma; Mexico, 2005-2009

Una aproximación cuali-cuantitativa es la base para el análisis de los resultados del proyecto "Vida Digna", cuyo objetivo fue abatir el estigma y la discriminación en el campo de la transmisión del VIH a partir de las acciones realizadas por organizaciones de la sociedad civil durante el período 2005 al 2009, en la región mexicana llamada El Bajío. Los resultados se analizaron en los años 2009 y 2010. Las organizaciones participantes estuvieron compuestas por y para las denominadas poblaciones clave, definidas como grupos vulnerables a infectarse pero también capaces de resistir y controlar la transmisión del VIH, el estigma y la discriminación, que se constituyen en barreras importantes para la búsqueda de atención y en el control efectivo del VIH. Se describen y analizan las acciones y el fortalecimiento de las organizaciones participantes. Resaltan la visibilización de nuevos actores sociales, como las mujeres transgénero y los usuarios de drogas inyectables, y las acciones informativas dirigidas a periodistas, policías y militares para evitar la criminalización y persecución de estos grupos.

A qualitative and quantitative approach forms the base of this analysis of the results of "Vida Digna," a project aimed at abating stigma and discrimination in the HIV transmission field with actions taken by civil society organizations from 2005 to 2009 in the Mexican region of El Bajío. The results were analyzed in 2009 and 2010. The organizations involved were made up of key populations, defined as groups vulnerable to infection but also capable of resisting and controlling the transmission of HIV and the stigma and discrimination that are important barriers in the seeking of care and the achievement of effective HIV control. We describe and analyze the actions taken and the strengthening of the participating organizations. The visibility of new social actors such as transgender women and injecting drug users, as well as informative activities directed at journalists, the police and the military to prevent the criminalization and persecution of these groups, are highlighted.

La organización de las poblaciones clave ligadas a la transmisión del VIH: una intervención para abatir el estigma; México, 2005-2009 / The organization of key populations connected to HIV transmission: an intervention to abate stigma; Mexico, 2005-2009

Una aproximación cuali-cuantitativa es la base para el análisis de los resultados del proyecto "Vida Digna", cuyo objetivo fue abatir el estigma y la discriminación en el campo de la transmisión del VIH a partir de las acciones realizadas por organizaciones de la sociedad civil durante el período 2005 al 2009, en la región mexicana llamada El Bajío. Los resultados se analizaron en los años 2009 y 2010. Las organizaciones participantes estuvieron compuestas por y para las denominadas poblaciones clave, definidas como grupos vulnerables a infectarse pero también capaces de resistir y controlar la transmisión del VIH, el estigma y la discriminación, que se constituyen en barreras importantes para la búsqueda de atención y en el control efectivo del VIH. Se describen y analizan las acciones y el fortalecimiento de las organizaciones participantes. Resaltan la visibilización de nuevos actores sociales, como las mujeres transgénero y los usuarios de drogas inyectables, y las acciones informativas dirigidas a periodistas, policías y militares para evitar la criminalización y persecución de estos grupos.(AU)

A qualitative and quantitative approach forms the base of this analysis of the results of "Vida Digna," a project aimed at abating stigma and discrimination in the HIV transmission field with actions taken by civil society organizations from 2005 to 2009 in the Mexican region of El Bajío. The results were analyzed in 2009 and 2010. The organizations involved were made up of key populations, defined as groups vulnerable to infection but also capable of resisting and controlling the transmission of HIV and the stigma and discrimination that are important barriers in the seeking of care and the achievement of effective HIV control. We describe and analyze the actions taken and the strengthening of the participating organizations. The visibility of new social actors such as transgender women and injecting drug users, as well as informative activities directed at journalists, the police and the military to prevent the criminalization and persecution of these groups, are highlighted.(AU)

[The organization of key populations connected to HIV transmission: an intervention to abate stigma; Mexico, 2005-2009]. / La organización de las poblaciones clave ligadas a la transmisión del VIH: una intervención para abatir el estigma; México, 2005-2009.

A qualitative and quantitative approach forms the base of this analysis of the results of "Vida Digna," a project aimed at abating stigma and discrimination in the HIV transmission field with actions taken by civil society organizations from 2005 to 2009 in the Mexican region of El Bajío. The results were analyzed in 2009 and 2010. The organizations involved were made up of key populations, defined as groups vulnerable to infection but also capable of resisting and controlling the transmission of HIV and the stigma and discrimination that are important barriers in the seeking of care and the achievement of effective HIV control. We describe and analyze the actions taken and the strengthening of the participating organizations. The visibility of new social actors such as transgender women and injecting drug users, as well as informative activities directed at journalists, the police and the military to prevent the criminalization and persecution of these groups, are highlighted.

Na política centrada no programa de vacinação contra o HPV no México: suas dilema ético / La política focalizada en el programa de vacunación contra el Virus del Papiloma Humano en México: aspectos éticos / The policy focused on the HPV vaccination program against Human Papilloma Virus in Mexico: ethics aspects

Se plantea un análisis ético de aspectos relacionados con la introducción de nuevas vacunas contra el Virus del Papiloma Humano en México, cuya política de distribución atiende a la equidad más que a la igualdad y tiene como ejes fundamentales abarcar a las personas más vulnerables y al costo más bajo posible, es decir, atiende a los principios de justicia distributiva. El esquema inicial de vacunación contra este virus en México se ha focalizado a la población femenina más marginada, la cual se concentra en las mujeres indígenas. Las estrategias de distribución de nuevas vacunas deberán tomar en consideración las características específicas en que se desenvuelven estos grupos y analizar las implicaciones éticas que tales medidas conllevan. Sin ello, una política de salud pública podría aumentar las desigualdades en materia de salud...

This article raises an ethical analysis of issues related to the introduction of new vaccines against Human Papillomavirus in Mexico, whose distribution policy attend to equity more than equality, and has as fundamental axes to cover the most vulnerable people and the lowest cost possible, i.e. serving the principles of distributive justice. The initial scheme of vaccination against this virus in Mexico has been focused on the most marginalized female population, which focuses on indigenous women. Distribution strategies for new vaccines must take into account the specific characteristics that develop these groups and analyze the ethical implications that such measures will involve; without this public health policy could increase health inequalities...

O propósito foi fazer uma análise ética das questões relacionadas com a introdução de novas vacinas contra o Papilomavírus Humano, no México, cuja política de distribuição serve apenas para a equidade mais do que para a igualdade e tem como eixos fundamentais abrangir os mais vulneráveis e os menores custos possíveis, isto é, servindo aos princípios de justiça distributiva. O regime inicial da vacinação contra esse vírus no México tem sido focado na população feminina mais marginalizada, que incide sobre as mulheres indígenas. As estratégias de distribuição de novas vacinas devem tomar em consideração as características específicas que desses grupos e analisar as implicações éticas que tais medidas implicam, sem isso a política de saúde pública poderia aumentar as desigualdades na saúde...

Los derechos humanos en las normas sobre el VIH/SIDA en México y Centroamérica. 1993-2000 / The inclusion of human rights in AIDS/HIV norms in Mexico and Central America. 1993-2000

Objetivo. Analizar la situación de los derechos humanos en las normas sobre el VIH/SIDA de México y Centroamérica en el periodo de 1993 a 2000. Material y métodos. Se analizó el contenido de las leyes y normas de la Región relacionadas con la prevención y control del VIH/SIDA. Se tomó como referencia una visión constructivista de los subsistemas jurídicos y de los derechos humanos. Se elaboraron categorías de análisis basadas en la Declaración Universal de los Derechos Humanos y a cada una se le asignaron códigos de significado. Resultados. Durante el periodo se observó una intensa actividad legislativa sobre el control de la transmisión del VIH/SIDA en la Región donde el tema de los derechos humanos fue incorporado. Sin embargo, en algunos casos (la Ley de Panamá y la Propuesta de Honduras) contienen apartados que lesionan el derecho a la no discriminación y a la privacidad. Ello marca dos vertientes: una, que garantiza totalmente los derechos humanos, y otra, que se convierte en un contexto que puede volver aún más vulnerables a ciertos grupos. Discusión. Se centra en proponer una resignificación del sujeto social y de la vigilancia epidemiológica con base en una normatividad que incluya el tema de los derechos humanos

[The inclusion of human rights in AIDS/HIV norms in Mexico and Central America: 1993-2000]. / Los derechos humanos en las normas sobre el VIH/SIDA en México y Centroamérica: 1993-2000.

OBJECTIVE: To analyze the inclusion of human rights in HIV/AIDS norms in Mexico and Central America for the 1993-2000 period. MATERIAL AND METHODS: Norms and regulations for HIV/AIDS prevention and control in this region were analyzed. A constructivist perspective of judiciary subsystems and human rights was used as a reference framework, to establish categories of analysis with significance codes based on the Universal Declaration of Human Rights. RESULTS: During the study period, human rights were included within a vigorous legislative activity for HIV/AIDS transmission prevention. In some cases (as in the Panama Law and the Honduras Proposal) there were passages of law violating the right to non-discrimination and privacy. These laws lead to either of two conflicting paths: one ensuring human rights, and another increasing the vulnerability of some groups. CONCLUSIONS: The authors emphasize the importance of gaining a new understanding of social subjects and epidemiological surveillance, based on norms that incorporate human rights issues.