Recent trends for the management of hypertension in older adults in Latin America in the context of universal coverage: Evidence from Mexico.

Taking the Mexican case as a tracer of what is happening in Latin America on public health, we estimate the recent changes and challenges for the management of hypertension in older adults in the context of universal health coverage. The population base was 200, and 308 reported cases of older adults with hypertension. The cost-evaluation method used was based on the instrumentation and consensus technique. Regarding epidemiological changes for 2016 versus 2018, there is an increase of 21% (CI: 95%, p < 0.001). Comparing the economic impact in 2016 versus 2018 (CI: 95%, p < 0.001), the increase is 33%. The total amount estimated for hypertension in 2018 (in US dollars) was $ 1,896,520,273. It includes $ 898,064,979 as direct costs and $ 998,455,294 as indirect costs. The recent trends show that the financial requirements for the coming years do not guarantee the effectiveness of the coverage rates required for the elderly. In terms of catastrophic expenditure, the challenge is not minor, the greatest economic burden is for the pocket of patients and their families.

Epidemiological and financial indicators of hypertension in older adults in Mexico: challenges for health planning and management in Latin America.

This study estimated the epidemiological and financial indicators of hypertension in order to identify challenges in strategic planning and management for health systems in Latin America. This is a longitudinal study with a population base of 187 326 reported cases of older adults with hypertension, diagnosed at public health institutions in Mexico. The cost-evaluation method that was used was based on the instrumentation and consensus techniques. To estimate the epidemiological changes and financial consequences for 2015-2017, time series analyses and probabilistic models were constructed according to the Box-Jenkins technique. Regarding epidemiological changes for 2015 versus 2017, an increase of 8-12% is expected (p < 0.001). Comparing the economic impact in 2015 versus 2017 (p < 0.001), there is a 22% increase in financial requirements. The total amount estimated for hypertension in 2015 (in US dollars) was $1 575 671 330. It included $747 527 259 as direct costs and $829 144 071 as indirect costs. If the risk factors and the different healthcare services for older adults remain as they are currently, the financial consequences of epidemiological changes in older adults will have a major impact on the users' pockets, following in order of importance, on social security providers and on public assistance providers. The challenges and implications of our findings in the context of universal coverage reforms in Latin America reinforce the urgent need to develop more and better strategic planning for the prevention of chronic diseases. Copyright © 2016 John Wiley & Sons, Ltd.

Challenges of the epidemiological and economic burdens associated with hypertension in middle income countries: evidence from Mexico.

BACKGROUND: In order to identify the challenges resulting from hypertension in a middle income country, this study has developed probabilistic models to determine the epidemiological and economic burden of hypertension in Mexico. METHODS: Considering a population base of 654,701 reported cases of adults with hypertension, we conducted a longitudinal analyses in order to identify the challenges of epidemiological changes and health care costs for hypertension in the Mexican health system. The cost-evaluation method used was based on the instrumentation technique. To estimate the epidemiological changes for 2015-2017, probabilistic models were constructed according to the Box-Jenkins technique. RESULTS: Regarding changes in expected cases for 2015 vs. 2017, an increase of 12 % is expected (p < 0.001). Comparing the economic impact in 2015 versus 2017 (p < 0.001), there is a 23 % increase in financial requirements. The total amount for hypertension in 2016 (US dollars) will be $6306,685,320 Of these, $ 2990,109,035 will be as direct costs and $ 3316,576,285 as indirect costs. CONCLUSIONS: If the risk factors and care models remain as they are currently in the health system, the financial consequences will have a major impact on the out-of-pocket users, following in order of importance, on social security providers and on public assistance providers.

Sex work in Mexico: vulnerability of male, travesti, transgender and transsexual sex workers.

In Mexico, male sex workers (MSW) and travesti, transgender and transsexual (TTT) sex workers are among the groups most affected by HIV. They suffer from stigma and discrimination, yet are often absent from the design of programmes and HIV prevention campaigns. The objective of this study was to provide an account of the social context in which MSW and TTT sex workers live, by focusing on their sexual identities, sexual practices and vulnerability to HIV. Data collection took place in Mexico City and involved observational work together with 36 in-depth interviews. Findings reveal a differentiation of vulnerability by sub-group. In general, vulnerability is influenced by the social context, stigma related to homosexuality and sex work, as well as sex workers' access to scarce social capital and the lack of response in terms of social and health programmes. In order to diminish the vulnerability of MSW and TTT sex workers and reduce their risk of HIV infection, preventive measures are needed which take into account their specific health and social needs, promote meaningful participation and the encourage respect for human rights.

[HIV/AIDS-related stigma and discrimination: the case of health care providers in México]. / El estigma asociado al VIH/SIDA: el caso de los prestadores de servicios de salud en México.

OBJECTIVE: To analyze the social construction of stigma and discrimination processes associated with HIV/AIDS and people living with HIV/AIDS (PLHA), based on the perceptions of health care providers in three states of the Mexican Republic. MATERIAL AND METHODS: Qualitative and quantitative description. Observation at nine institutions; in-depth interviews (14) and surveys (373) directed to providers of health services. RESULTS: Seventy-five percent of providers reported having received training related to HIV/AIDS; however, notions persist as to patients being hopeless; discrimination due to the idea of risk groups; the immediate identification of living with the virus, having the syndrome and death; and specific lack of knowledge of forms of transmission. Twenty-three percent would not buy food from a PLHA and 16% think they should be banned from public services. With respect to confidentiality: 89% believe it should be maintained and 38% think that employers and administrators have the right to know about their employees' condition. Isolation, notes in clinical histories pointing to HIV, obligatory testing and delays in surgeries for PLHA were constant practices. The perception that men who have sexual relations with men and sexual workers decide their sexual practices marks the division between innocent victims and guilty ones, which determines the stigmatization and discrimination processes in health services. CONCLUSIONS: The design of strategies to decrease stigma and discrimination associated with HIV/AIDS demands the inclusion of an ethical debate about human rights and a structural focus regarding social conditions that go beyond the notion of risk behaviors.

El estigma asociado al VIH/SIDA: el caso de los prestadores de servicios de salud en México / HIV/AIDS-related stigma and discrimination: the case of health care providers in México

OBJETIVO: Analizar el estigma y la discriminación relacionados con el VIH/SIDA por parte de los prestadores de servicios de salud en tres estados de la República mexicana, con base en las percepciones que tienen sobre la infección y las personas que viven con VIH/SIDA (PVVS). MATERIAL Y MÉTODOS: Descripción cualitativa y cuantitativa. Observación en nueve instituciones; entrevistas en profundidad (14) y encuestas (373) a proveedores de servicios de salud. RESULTADOS: El 75 por ciento de los proveedores recibió capacitación relacionada con el VIH/SIDA, pese a lo cual persiste la discriminación debida a clasificaciones en grupos de riesgo; la identificación de vivir con el virus, padecer el síndrome y morir; y el desconocimiento de las vías de transmisión. El 23 por ciento no compraría comida a una PVVS y 16 por ciento sugiere prohibir su ingreso a servicios públicos. Respecto a la confidencialidad, 89 por ciento opina que debe guardarse y 38 por ciento cree que los patrones tienen derecho a conocer la condición de sus empleados. El aislamiento, registro del VIH en expedientes, pruebas obligatorias y demora en procedimientos quirúrgicos de las PVVS fueron prácticas constantes. La percepción de que los hombres que tienen sexo con otros hombres y las personas que realizan trabajo sexual deciden sus prácticas sexuales establece la división entre víctimas inocentes y culpables e influye en la estigmatización y discriminación en los servicios. CONCLUSIONES: El diseño de medidas para disminuir el estigma y la discriminación relacionados con el VIH/SIDA exige la inclusión del debate ético sobre los derechos humanos y un enfoque estructural de las condiciones sociales que rebase la noción de comportamientos de riesgo.