Advocates in Mexico call for greater effort against HIV/AIDS

AIDS-related mortality rates in Mexico have remained somewhat steady over the past 12 years, despite increased access to antiretroviral drugs in the country, officials at the National Institute of Public Health, or INSP, said recently, The News/Individual.com reports.

A 2008 INSP report said that AIDS-related diseases represent the 16th leading cause of death in Mexico and that they are the fourth highest cause of death among men ages 25 to 34. Josac Antonio Izazola Licea, director of the National Center for the Prevention and Control of HIV/AIDS, said that the country's "almost universal availability" of antiretrovirals would lead experts to "expect the percentage of patients dying from the virus to be much lower, and for there to be a steady decline in the ratio." However, he added that "this is just not the case."

According to Izazola Licea, 6,747 new HIV cases and 5,093 AIDS-related deaths were reported in 2008. The percentage of deaths related to HIV/AIDS in Mexico remained nearly constant, despite a decline in the number of new cases between 2007 and 2008, he said, adding that in 2005 there were about 6,500 newly reported HIV cases and almost 4,500 deaths. The main reason for the steady numbers is lack of adherence to antiretroviral treatment regimens, Izazola Licea said. Stefano Bertozzi -- acting executive director for INSP's Center for Evaluation, Research and Surveys -- said that antiretrovirals are "available and economically accessible for almost every person who has been confirmed to be" living with HIV. He added, "However, if a patient does not adhere 95% or more to the rigorous drug therapy regimen, the medication just isn't going to be effective." According to Bertozzi, it is "extremely difficult" for HIV-positive people to adhere to their drug regimens without strong clinical and family support.

Additionally, HIV/AIDS experts and advocates have expressed concern that opportunistic infections, such as hepatitis and tuberculosis, are not being given adequate attention, Izazola Licea said. Carlos del Rio, clinical director of the HIV program and division of infectious diseases at Atlanta's Emory University, said, "These conditions are intrinsically linked, and about 5% of all HIV-positive patients will test positive for tuberculosis." Del Rio, who is working on HIV/AIDS research in Mexico with INSP, also said that the treatment and prevention of opportunistic diseases is necessary "if we are going to be successful in slowing the tide of HIV."

The social stigma associated with HIV/AIDS also presents issues, as it often leaves people afraid to be tested for the virus and at risk for unknowingly spreading it, Izazola Licea said. "There has to be a continued program of public education and social awareness to discourage discrimination and homophobia," he said. He added that many people are not diagnosed with HIV/AIDS until the disease is in the advanced stages. Additional delays in treatment often occur because of "bureaucratic snags and communication breakdowns" that prevent test results from reaching people in a timely manner, The News/Individual.com reports. Izazola Licea said the backlog for notifying HIV-positive people in some areas of Mexico can be as long as three to four years.

According to The News/Individual.com, Mexico has been successful in some areas of HIV/AIDS prevention, including the 1986 implementation of the "Sangre SegurO," or Safe Blood, program that prohibits the commercialization of blood and helped to reduce HIV transmission through transfusions. A program encouraging condom use also was implemented by the Health Secretariat as early as 1987. Bertozzi said the country has "made great strides in combating the spread of HIV/AIDS, but now we need to be even more aggressive and take a new approach concentrating on the long-term treatment of the problem." According to del Rio the primary goals in addressing HIV/AIDS must be prevention and research. Bertozzi said, "We need to look beyond just providing medication to treat HIV. We need to concentrate again on prevention."

According to The News/Individual.com, a provision in a 2000 Health Secretariat outline for HIV/AIDS control specified that Mexico should be spending more than 2.5 billion pesos -- about $163 billion -- for prevention in 2009. Only about 100 million pesos -- about $6.5 million -- has been allocated for such efforts, The News/Individual.com reports. Izazola Licea said the government will need to invest 5.6 billion pesos -- about $365 billion -- by 2012 for prevention. Bertozzi said that it is time officials in Mexico "rethink how we deal with" HIV, adding that the country needs "new programs that focus on prevention, improved training for medical personnel and more public awareness" (Margolis, The News/Individual.com, 3/2).