Factors associated with unmet need for contraception in Mexico: evidence from the National Survey of Demographic Dynamics 2014.

BACKGROUND: Worldwide, the importance of contraception to control fertility has been recognized. A useful indicator of the gap between reproductive preferences and the provision of contraception is "unmet need for contraception". The aims of this paper are to estimate the levels of unmet need for contraception among married and single women, and to explore factors associated with unmet need for contraception for spacing and limiting births in Mexico. METHODS: We used the Mexican National Survey of Demographic Dynamics 2014, using a sub-sample of 56,797 sexually active women aged 15-49 years who were either currently in union or who had never been in union to estimate the prevalence of unmet need for spacing and limiting births. We applied multivariable binary logistic regressions to examine the relationship between unmet need for spacing and limiting considering associated factors. RESULTS: Unmet need for contraception was estimated at 11.5% among women in union (6.4% limiting; 5.1% spacing), and 28.9% for women never in union (8% limiting; 20.9% spacing). In the logistic regression for unmet need for spacing, the likelihood was statistically significant associated with younger women (OR = 6.8; CI = 2.95-15.48); women never in union (OR = 1.6; CI = 1.40-1.79); low levels of education (OR = 1.4; CI = 1.26-1.56); and residing in poor regions (OR = 1.9; CI = 1.52-2.49). Those with full access to public services were significantly less likely to have unmet need for spacing (OR = 0.8; CI = 0.66-0.88). In the logistic regression for unmet need for limiting, being younger (OR = 6.3; CI = 4.73-8.27), never in union and sexually active (OR = 3.0; CI = 2.47-3.54); with less schooling (OR 1.13; CI: 1.02-1.26); rural residence (OR = 1.2; CI = 1.07-1.32); and residing in poor regions (OR = 1.5; CI = 1.23-1.93) were factors positively associated with this unmet need. Women with private health services were the least likely to have unmet need for limiting (OR = 0.5; CI = 0.37-0.77). CONCLUSIONS: Younger women currently in union and never in union had the highest unmet needs of contraception for spacing and limiting. The results from this study suggest that in Mexico family planning services must prioritize the contraception needs of all young women, both in union and not in union, with appropriate and suitable services to cover their needs.

Calendario de inicio sexual en México: Comparación entre encuestas nacionales y tendencias en el tiempo / Sexual debut in Mexico: a comparison of household national surveys

Objetivo. Estimar el calendario de inicio sexual en México y sus tendencias a partir de encuestas poblacionales. Material y métodos. Se analizaron cinco cohortes de nacimiento con cuatro encuestas nacionales (Encuesta Nacional de Salud 2000, Encuesta Nacional de la Dinámica Demográfica 2009, Encuesta Nacional de Juventud 2010 y Encuesta Nacional de Salud y Nutrición 2012) y se identificaron las proporciones de individuos que iniciaron actividad sexual antes de los 16 y antes de los 20 años. Resultados. Las distintas encuestas son, en general, consistentes, pero difieren entre ellas en algunas cohortes. En las cohortes más jóvenes, se identificó una proporción algo mayor de individuos que iniciaron antes de los 20 años; no se advierten cambios en el inicio sexual antes de los 16 años. Conclusiones. La falta de grandes cambios en la edad de inicio de vida sexual con tendencia al adelanto del calendario en México llama a fortalecer la educación sexual integral y la oferta de servicios de salud sexual y reproductiva accesibles a los adolescentes.

Objective. To estimate calendar of sexual debut in Mexico and its trends using national representative household surveys. Materials and methods. Analysis of five birth cohorts extracted from four national population based household surveys in Mexico (National Health Survey 2000, National Survey on Demographic Dynamics 2009, National Youth Survey 2010, and National Health & Nutrition Survey 2012), using as outcome the proportion of individuals that reported sexual debut before the age of 16 and before the age of 20. Results. Overall, the four analyzed surveys produce consistent results, although some differences were found. While a larger proportion among younger cohorts reported sexual debut before the age of 20, that was not the case for sexual debut before 16 years. Conclusions. While data seems to reflect a relative stable age of sexual debut in Mexico, there is a recent trend to prepone sexual initiation that highlights the need to strengthen comprehensive sexual education and the supply of sexual & reproductive health services that are accessible and friendly to adolescents thus responding to the growing demand from this age group.

[Sexual debut in Mexico: a comparison of household national surveys]. / Calendario de inicio sexual en México: Comparación entre encuestas nacionales y tendencias en el tiempo.

OBJECTIVE: To estimate calendar of sexual debut in Mexico and its trends using national representative household surveys. MATERIALS AND METHODS: Analysis of five birth cohorts extracted from four national population based household surveys in Mexico (National Health Survey 2000, National Survey on Demographic Dynamics 2009, National Youth Survey 2010, and National Health & Nutrition Survey 2012), using as outcome the proportion of individuals that reported sexual debut before the age of 16 and before the age of 20. RESULTS: Overall, the four analyzed surveys produce consistent results, although some differences were found. While a larger proportion among younger cohorts reported sexual debut before the age of 20, that was not the case for sexual debut before 16 years. CONCLUSIONS: While data seems to reflect a relative stable age of sexual debut in Mexico, there is a recent trend to prepone sexual initiation that highlights the need to strengthen comprehensive sexual education and the supply of sexual & reproductive health services that are accessible and friendly to adolescents thus responding to the growing demand from this age group.

[The AIDS epidemics in Mexico up to 2008]. / La epidemia de SIDA en México al 2008.

The HIV/AIDS epidemics in Mexico has remained stable in terms of its slow growth during the last decade. Since the beginning of this century, efforts have been made to improve the epidemiological registration system. An important number of probability studies involving multiple geographic locations in Mexico and larger numbers of high-risk vulnerable populations have also been carried out, while continuing surveillance of volunteers for HIV testing. The analysis of recently obtained information and its comparison with that of the past century have unveiled the traces left by the new epidemics in its wake. The joint analysis of available information indicates that there are changes in transmission patterns of HIV/ AIDS that have modified the prevalence figures of previous decades. While transmission of blood-borne HIV infections have ceased, the number of HIV-seropositive drug users has increased, particularly in the northern of Mexico. In the population of men having sex with men (MSM) a decline in HIV prevalence has been noticed, excepting in the male sex working (MSW) group in whom a significant increase has been observed. The population with heterosexual practice clearly shows a steady growth of AIDS in women, particularly in young women from rural areas and in native women.

La epidemia de SIDA en México al 2008 / The AIDS epidemics in Mexico up to 2008

En México, la epidemia de VIH/sida se ha mantenido estable en términos de su lento crecimiento durante la última década. Desde que inició el presente siglo se han realizado enormes esfuerzos para mejorar el sistema de registro epidemiológico, también se ha ejecutado un importante número de estudios probabilísticos que abarcaron gran cantidad de puntos geográficos en el territorio nacional y un relevante número de poblaciones clave en términos de vulnerabilidad frente a la epidemia, sin descuidar la vigilancia centinela que se nutre con las personas que acuden voluntariamente a realizarse la prueba de VIH. El análisis de la información obtenida recientemente y su comparación con la del pasado siglo han permitido el hallazgo de los nuevos rastros que deja la epidemia a su paso. El análisis conjunto y articulado de toda la información obtenida apunta a que hay cambios en los patrones de transmisión del VIH/sida y, por tanto, se han modificado las prevalencias observadas en décadas anteriores. Respecto a la vía de transmisión sanguínea han cesado los contagios relacionados on transfusiones y hemoderivados, sin embargo, ha crecido con fuerza el número de personas seropositivas en la población usuaria de drogas intravenosas, fundamentalmente en la región norte del país. En la población de hombres que tienen sexo con hombres se observa un descenso de la prevalencia, con excepción del grupo de hombres que practican el trabajo sexual, en el cual habría un importante incremento. En la población con prácticas heterosexuales se aprecia con nitidez un crecimiento constante de los casos de sida en mujeres, particularmente en las jóvenes, en las zonas rurales y en las mujeres indígenas.

The HIV/AIDS epidemics in Mexico has remained stable in terms of its slow growth during the last decade. Since the beginning of this century, efforts have been made to improve the epidemiological registration system. An important number of probability studies involving multiple geographic locations in Mexico and larger numbers of high-risk vulnerable populations have also been carried out, while continuing surveillance of volunteers for HIV testing. The analysis of recently obtained information and its comparison with that of the past century have unveiled the traces left by the new epidemics in its wake. The joint analysis of available information indicates that there are changes in transmission patterns of HIV/ AIDS that have modified the prevalence figures of previous decades. While transmission of blood-borne HIV infections have ceased, the number of HIV-seropositive drug users has increased, particularly in the northern of Mexico. In the population of men having sex with men (MSM) a decline in HIV prevalence has been noticed, excepting in the male sex working (MSW) group in whom a significant increase has been observed. The population with heterosexual practice clearly shows a steady growth of AIDS in women, particularly in young women from rural areas and in native women.

A life course approach to patterns and trends in modern Latin American sexual behavior.

This article explores trends in sexual behavior in Latin America, envisaged from a life-course perspective, taking into account social differences. It is focused on three main issues: the timing of early sexual and reproductive events, sexual activity during adulthood, and measurement of homosexuality-bisexuality. It draws on general population data from nonspecific surveys, as surveys dealing specifically with sexual behavior are scarce in Latin American countries. A traditional feature in these societies is the huge amount of social inequality, which translates directly into social differences in sexual experience, especially among women. Despite the decline in fertility, an early start of unions and of reproductive experience remains typical of groups with lower education. Another aspect is the diversity of national patterns and gender systems, very far from the image of cultural homogeneity generally associated with this region. Data show a low prevalence of homosexuality/bisexuality, which can be a result of underreporting. The paper eventually stresses the necessity of carrying out more sexual behavior surveys of the general population in the region.

Estimated numbers of men and women infected with HIV/AIDS in Tijuana, Mexico.

Tijuana, Mexico, just south of San Diego, California, is located by the busiest land border crossing in the world. Although UNAIDS considers Mexico to be a country of "low prevalence, high risk," recent surveillance data among sentinel populations in Tijuana suggests HIV prevalence is increasing. The aim of this study was to estimate the number of men and women aged 15 to 49 years infected with HIV in Tijuana. Gender and age-specific estimates of the Tijuana population were obtained from the 2000 Mexican census. Population and HIV prevalence estimates for at-risk groups were obtained from published reports, community based studies, and data from the Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA). Age-specific fertility rates for Mexico were used to derive the number of low and high-risk pregnant women. Numbers of HIV-positive men and women were estimated for each at-risk group and then aggregated. A high growth scenario based on current HIV prevalence and a conservative, low growth estimate were determined. A total of 686,600 men and women in Tijuana were aged 15 to 49 years at the time of the 2000 census. Considering both scenarios, the number of infected persons ranged from 1,803 to 5,472 (HIV prevalence: 0.26 to 0.80%). The majority of these persons were men (>70%). The largest number of infected persons were MSM (N = 1,146 to 3,300) and IDUs (N = 147 to 650). Our data suggest that up to one in every 125 persons aged 15-49 years in Tijuana is HIV-infected. Interventions to reduce ongoing spread of HIV are urgently needed.

HIV prevalence and correlates of receptive needle sharing among injection drug users in the Mexican-U.s. border city of Tijuana.

Injection drug use is a growing but understudied problem in Tijuana, a city situated on the northwestern Mexico-U.S border. The authors studied factors associated with receptive needle sharing in an effort to inform prevention activities. In 2003, street-recruited injection drug users (IDUs) in Tijuana underwent interviews on injection risk behaviors and rapid HIV antibody tests. Logistic regression was used to identify correlates of receptive needle sharing at the last injection episode. Of 402 IDUs, 87.6% were male; the median age was 34. HIV prevalence was 4.01% (95% CI: 2.29-6.51). One third reported receptive needle sharing at last injection. Factors independently associated with receptive needle sharing were years living in Tijuana (Adjusted Odds Ratio [AdjOR]= 0.97 per year, 95% CI: 0.96-0.99), being bisexual/homosexual (AdjOR=2.12; 95% CI: 1.30 - 3.44), unemployed (AdjOR=2.5; 95% CI: 1.52-4.10), never having an HIV test (AOR: 4.02; 95% CI: 2.44-6.60), having friends who placed importance on avoiding HIV (AdjOR: 0.36; 95% CI: 0.19-0.68) and last injecting in a shooting gallery (AdjOR=1.98; 95% CI: 1.21-3.24). These results underscore the need to increase access to voluntary HIV testing and counseling to IDUs and migrants in Tijuana, as well as expand access to sterile syringes in an effort to avert widespread HIV transmission.

Sexual behavior and herpes simplex virus 2 infection in college students.

BACKGROUND: Given the relevance of HSV-2 infection in youth, the aim of this study was to determine the seroprevalence of HSV-2 in college students in Cuernavaca, Mexico, as well as the sociodemographic and sexual behavioral characteristics associated with this infection. METHODS: A cross-sectional study was carried out using convenience sampling with consenting students of both genders. Students answered a questionnaire and provided a blood sample to detect antibodies to HSV-2 by Western blot. To establish the magnitude of the association between the prevalence of HSV-2 infection and the selected risk factors, we estimated prevalence odds ratios by performing logistic analyses of these results RESULTS: Overall seroprevalence of HSV-2 was 5.9% (20/340; CI(95%) 3.7-8.9), 7.0% (14/200; CI(95%) 3.9-11.5) for women and 4.3% (6/140; CI(95%) 1.6-9.1) for men. HSV-2 infection was independently associated with female sex (POR=5.3, CI(95%) 1.4-19.7), age (26 years and over, POR=4.7, CI(95%) 1.0-22.2), number of sexual partners over the last year (two or more partners POR=4.1, CI(95%) 1.2-14.2), a history of genital ulcers (POR=6.1, CI(95%) 1.9-19.8), and having been paid for sex (POR=21.4, CI(95%) 1.0-447.5). CONCLUSIONS: The frequency of HSV-2 infection among these students was lower than in other Mexican populations who have high-risk sexual behavior. However, there was a subgroup of participants identified as having high-risk sexual behavior. These individuals could, therefore, be prone to acquiring and transmitting HSV-2 infection and represent the target group for whom preventive interventions against HSV-2 and other STIs might be developed.

Mujeres que viven con VIH/SIDA y servicios de salud. Recomendaciones para mejorar la calidad de la atención / Women that live with HIV/AIDS and health services. Recomendations for improve the quality of care

"Entre los aspectos que resultan cruciales para las mujeres con VIH (Virus de la Inmunodeficiencia Humana) se encuentran los servicios de salud, los recursos disponibles para hacer frente a la infección y el acceso real que tienen a los mismos. Conocer este ámbito de la realidad e identificar líneas orientadoras para su mejoramiento es el propósito de este estudio realizado con mujeres VIH positivas, del cual derivan múltiples recomendaciones para mejorar la calidad de la atención que se les ofrece." (AU). Contenido: 1) Introducción: objetivos de la investigación, metodología, población estudiada. 2) Marco de referencia para la respuesta al VIH/SIDA: consideraciones sobre el sector de mujeres. 3) Los servicios a través de la experiencia y las voces de las mujeres: : importancia de los servicios y barreras para el acceso; caracterización (servicios de prevención; prueba, conserjería y diagnóstico; consentimiento informado y conserjería pre y post prueba; pruebas de laboratorio); atención médica (calidad y calidez; barreras socio-culturales y socio-económicas para el acceso; servicios especializados; ginecología; apoyo psicológico); estigma y discriminación en servicios médicos; medicamentos y adherencia; embarazo y derechos sexuales y reproductivos; relación con los médicos y otros prestadores de servicios de salud. 4) Conclusiones y recomemdaciones: prevención; prestación de servicios de salud; personal de salud; investigación; usuarios de los servicios de salud y sus parejas; derechos humanos; consentimiento informado. Anexo: guía de entrevista sobre acceso a servicios

El trabajo de las parteras sobre VIH/SIDA y otras infecciones de transmisión sexual / The work of the midwives on HIV/AIDS and others infections of sexual transmission

"La investigación que aquí se presenta tuvo lugar en una comunidad rural de Morelia, Michoacán, México, y tuvo como propósito analizar el papel que pueden jugar las parteras en la prevención, detección y tratamiento del VIH/SIDA y otras ITS (Infecciones de Transmisión Sexual) dentro de las comunidades rurales. Los resultados muestran que las parteras pueden contribuir de forma importante en las acciones de prevención de las ITS, aunque para lograrlo requieren de información, capacitación y el apoyo de las instituciones de salud." (AU). Contenido: Introducción. 1) Planteamiento del problema y marco teórico de la investigación: el VIH/SIDA y las ITS; El Estado y las parteras; aproximación metodológica. 2) El duscurso de IMSS-Oportunidades en el proceso de interrrelación con las parteras: la relación IMSS-Oportunidades-parteras desde el punto de vista de un protagonista institucional; el marco conceptual de las capacitaciones, una revisión de los documentos de capacitación; el modelo educativo de capacitación; las parteras según el punto de vista de los agentes institucionales; interrelación en la práctica. 3) Las parteras: los procesos de interrelación; el VIH/SIDA, el conocimientos de otras ITS y prevención; seguimiento de pacientes; necesidades de las parteras. 4) Los médicos: el discurso médico desde el nivel central y estatal; la inserción de los médicos en las UMR (Unidades Médicas Rurarles); los médicos, las parteras y el VIH/SIDA y las ITS. 5) Las usuarias de los servicios de parteras: el SIDA y otras ITS. 6) Conclusiones y recomendaciones

Migration and AIDS in Mexico: an overview based on recent evidence.

OBJECTIVES: Provide an overview of the relation between migration to the United States and AIDS cases in Mexico. Characterize the sexual behaviors of Mexican migrants. Describe HIV/AIDS prevention and clinical attention actions developed. METHODS: The following were analyzed: AIDS cases databases, various prevalence studies, the migrants survey, and information of the Ministries of the Interior and of Health. A documental analysis was undertaken of works published between 1992 and 2000 on migration and AIDS. RESULTS: In terms of their sexual practices, migrants in the past year had more sexual partners, tended to use a condom in their most recent relation in greater proportion, and had greater use of injected medicines and drugs. Two bi-national programs undertake epidemiological surveillance activities, while several initiatives have used innovative formats to provide prevention information to migrants. Imminent universal coverage leaves the challenge to assure quality of attention for migrants. CONCLUSIONS: Studies to evaluate the impact of international migration on distribution of infected persons will be indispensable to establish priorities in prevention and attention among migrants. More information is needed on bi-national health projects to understand the impact they may have in prevention, while continuity of the prevention initiatives must be guaranteed. Attention to migrants in bi-national contexts requires information exchange agreements on migrants living with the HIV/AIDS.

[Use of condoms among Mexican adolescents for the prevention of sexually transmitted diseases]. / Uso del condón entre adolescentes mexicanos para la prevención de las infecciones de transmisión sexual.

OBJECTIVE: To investigate the current sexual behavior and condom use during the first sexual intercourse among adolescents, as well as variations and factors influencing condom use at first sexual intercourse. MATERIAL AND METHODS: The data source for this study was Mexico's National Health Survey 2000. Study subjects were male and female adolescents aged 12 to 19 years (n = 16,258). Statistical analysis consisted of descriptive statistics and multivariate logistic regression, to assess the association of four types of factors (demographic, socioeconomic, cultural, and cognitive) with condom use during the first sexual intercourse. RESULTS: Males and residents of urban areas reported greater sexual activity and condom use. Typically, adolescents who used condoms during the first sexual intercourse were male, older, resided in urban areas, non-speakers of an indigenous language, and with higher schooling. CONCLUSIONS: New policies should be framed to prevent sexually transmitted infections to span the gap between knowledge and practice, targeting adolescents starting sexual activity earlier, those who speak an indigenous language, living in rural areas, with less schooling, and females. The English version of this paper is available too at:http://www.insp.mx/salud/index.html.

Uso del condón entre adolescentes mexicanos para la prevención de las infecciones de transmisión sexual / Condom use among Mexican adolescents to prevent sexually transmitted infections

OBJETIVO: Investigar el comportamiento sexual actual y el uso de condón en la primera relación sexual de adolescentes de 12 a 19 años de edad, la variación en distintos contextos y la influencia de factores sobre el uso del condón en esa primera relación. MATERIAL Y MÉTODOS: Se utiliza la Encuesta Nacional de Salud 2000, y se consideran adolescentes a jovenes de 12 a 19 años de edad, de ambos sexos (n=16 285). Se presenta en primer lugar un análisis descriptivo básico y luego una regresión logística multivariada para determinar la influencia de cuatro tipos de factores (demográficos, socioeconómicos, culturales y cognitivos) sobre el uso de condón en el debut sexual. RESULTADOS: Se reporta mayor actividad sexual y un mayor uso de condón entre los hombres y en áreas urbanas. El perfil del adolescente que usó condón en la primera relación es ser adolescente que inicia la vida sexual a una mayor edad, de residencia urbana, que no habla lengua indígena, altamente escolarizado, o de sexo masculino. CONCLUSIONES: Deben diseñarse nuevas políticas de prevención de infecciones de transmisión sexual para cerrar la brecha entre conocimiento y práctica, y dirigidas a los adolescentes que inician su vida sexual más temprano, a los que hablan lengua indígena, a los que viven en áreas rurales, a los menos escolarizados y a las mujeres.

[Whom do Mexican adolescents talk to about AIDS?]. / Con quién hablan los adolescentes mexicanos sobre el SIDA.

OBJECTIVE: To establish whether certain characteristics of the young influence their choice of people with whom to discuss AIDS. MATERIAL AND METHODS: A national survey was conducted in 1997 by the Consejo Nacional para la Prevención y Control del SIDA (CONASIDA, Mexican Council for AIDS Prevention and Control). Study subjects were 4886 male and female 15-19 year-old teenagers. Multinomial logistic regression was used to analyze data. RESULTS: A model including the variables sex, sexual activity, work conditions, and father's schooling level, turned out to be significant and highly predictive of people with whom teenagers discuss AIDS, as compared to teenagers speaking with no one. Male teenagers discuss AIDS with their fathers more than female teenagers, and female teenagers discuss AIDS more with their mothers. Sexually active teenagers discuss AIDS more with their friends and less with their teachers than sexually inactive teenagers. The greater schooling level the father has, the more people teenagers have with whom to discuss AIDS and the more they discuss AIDS at home, compared to teenagers with fathers without schooling. CONCLUSIONS: Differentiated sexual education training strategies should be designed in accordance with subpopulations' characteristics. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Con quién hablan los adolescentes mexicanos sobre el SIDA / Whom do Mexican adolescents talk to about AIDS?

OBJECTIVE: To establish whether certain characteristics of the young influence their choice of people with whom to discuss AIDS. MATERIAL AND METHODS: A national survey was conducted in 1997 by the Consejo Nacional para la Prevención y Control del SIDA (CONASIDA, Mexican Council for AIDS Prevention and Control). Study subjects were 4886 male and female 15-19 year-old teenagers. Multinomial logistic regression was used to analyze data. RESULTS: A model including the variables sex, sexual activity, work conditions, and father's schooling level, turned out to be significant and highly predictive of people with whom teenagers discuss AIDS, as compared to teenagers speaking with no one. Male teenagers discuss AIDS with their fathers more than female teenagers, and female teenagers discuss AIDS more with their mothers. Sexually active teenagers discuss AIDS more with their friends and less with their teachers than sexually inactive teenagers. The greater schooling level the father has, the more people teenagers have with whom to discuss AIDS and the more they discuss AIDS at home, compared to teenagers with fathers without schooling. CONCLUSIONS: Differentiated sexual education training strategies should be designed in accordance with subpopulations' characteristics.