CD4 Counts at Entry to HIV Care in Mexico for Patients under the “Universal Antiretroviral Treatment Program for the Uninsured Population,” 2007–2014

In Mexico, public health services have provided universal access to antiretroviral therapy (ART) since 2004. For individuals receiving HIV care in public healthcare facilities, the data are limited regarding CD4 T-lymphocyte counts (CD4e) at the time of entry into care. Relevant population-based estimates of CD4e are needed to inform strategies to maximize the impact of Mexico’s national ART program, and may be applicable to other countries implementing universal HIV treatment programs. 

For this study, we retrospectively analyzed the CD4e of persons living with HIV and receiving care at state public health facilities from 2007 to 2014, comparing CD4e by demographic characteristics and the marginalization index of the state where treatment was provided, and assessing trends in CD4e over time. 

Our sample included 66,947 individuals who entered into HIV care between 2007 and 2014, of whom 79% were male. During the study period, the male-to-female ratio increased from 3.0 to 4.3, reflecting the country's HIV epidemic; the median age at entry decreased from 34 years to 32 years. 

Overall, 48.6% of individuals entered care with a CD4≤200 cells/μl, ranging from 42.2% in states with a very low marginalization index to 52.8% in states with a high marginalization index, and from 38.9% among individuals aged 18–29 to 56.5% among those older than 50. 

The adjusted geometric mean (95% confidence interval) CD4e increased among males from 135 (131,142) cells/μl in 2007 to 148 (143,155) cells/μl in 2014 (p-value<0.0001); no change was observed among women, with a geometric mean of 178 (171,186) and 171 (165,183) in 2007 and 2014, respectively. 

There have been important gains in access to HIV care and treatment; however, late entry into care remains an important barrier in achieving optimal outcomes of ART in Mexico. The geographic, socioeconomic, and demographic differences observed reflect important inequities in timely access to HIV prevention, care, and treatment services, and highlight the need to develop contextual and culturally appropriate prevention and HIV testing strategies and linkage programs.

Below:  CD4e counts at health care program entry decline after 2011

Full article at:   http://goo.gl/PYlXy0

By:  

Alfonso C. Hernández-Romieu, Carlos del Rio 
Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America

Alfonso C. Hernández-Romieu, Carlos del Rio 

Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America

Carlos del Rio 

Center for AIDS Research, Emory University, Atlanta, GA, United States of America

Juan Eugenio Hernández-Ávila, Hugo Lopez-Gatell, Mauricio Hernández-Ávila 

National Institute of Public Health (INSP), Cuernavaca, Mexico

José Antonio Izazola-Licea 

National Center for Prevention and Control of HIV/AIDS (CENSIDA), Mexico City, Mexico

José Antonio Izazola-Licea, Patricia Uribe Zúñiga 

Joint United Nations Programme on HIV/AIDS (UNAIDS), Evaluation and Economics Division, Geneva, Switzerland

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Constructing a Validated Scale to Measure Community-Level Abortion Stigma in Mexico

OBJECTIVE:

In Mexico, abortion stigma in the general population is largely unexplored. We developed a scale to measure abortion stigma at the community-level, examine its prevalence, and explore factors associated with abortion stigma in a nationally representative sample.

STUDY DESIGN:

Following intensive qualitative work to identify dimensions of the stigma construct, we developed a comprehensive list of statements that were cognitively tested and reduced to 33 to form a scale. We piloted the scale in a nationally and sub-regionally representative household public opinion survey administered to 5,600 Mexican residents.

RESULTS:

Factor analysis tested the internal consistency and reliability of five previously hypothesized dimensions of abortion stigma: secrecy, religion, autonomy, discrimination, and guilt/shame. Under the assumption that these dimensions were independent, confirmatory factor analysis indicated that each of these dimensions functioned as independent sub-scales. However, to test this assumption, we conducted exploratory factor analysis which revealed a strong co-dependence between discrimination, guilt/shame and religion statements, resulting in a 23-item four factor model of abortion stigma and the elimination of the guilt/shame dimension. Both methods revealed a full scale and sub-scales with Cronbach's alphas between 0.80-0.90. Regression analyses suggested that older, less educated individuals living in the north of Mexico report higher levels of stigma, especially related to discrimination and religion.

CONCLUSIONS:

This community-level abortion stigma scale is the first to be developed and tested in Mexico. This tool may be used in Mexico and other similar country settings to document the prevalence of community-level abortion stigma, identify associated factors, and test interventions aimed at reducing abortion stigma.

IMPLICATIONS:

Abortion stigma prevents women from accessing safe abortion services. Measuring community-level abortion stigma is key to documenting its pervasiveness, testing interventions aimed at reducing it, and understanding associated factors. This scale may be useful in countries similar to Mexico to support policymakers, practitioners and advocates in upholding women's reproductive rights.

Purchase full article at:   http://goo.gl/89EOA5

By:  Sorhaindo AM1, Karver TS2, Karver JG2, Garcia SG2.

• 1Population Council, Mexico City, Mexico. Electronic address: sorhaindoannik@gmail.com.
• 2Population Council, Mexico City, Mexico. 
• Contraception. 2016 Jan 26. pii: S0010-7824(16)00033-0. doi: 10.1016/j.contraception.2016.01.013. 

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Mexico - PornHub 2015 Use Review

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A Tale of Two Epidemics: Gender Differences In Socio-Demographic Characteristics & Sexual Behaviors among HIV Positive Individuals in Mexico City

BACKGROUND:

To date, the HIV epidemic in Mexico has been concentrated mainly among men who have sex with men, but heterosexual transmission, particularly to women, is increasingly important. This study examine gender differences in socio-demographic characteristics and risk behaviors of HIV positive individuals in Mexico City.

METHODS:

We analyzed data from a cross-sectional survey of 1,490 clinic patients (male:female ratio 8:1) with HIV inMexico City in 2010. We examined socio-demographic characteristics, risk behavior, and history of HIV infection.From multivariate non-linear probability (probit) models we calculated predicted probabilities by sex of several outcomes: marginalization, demographic and sexual risk behaviors.

RESULTS:

Significant differences were found between men and women. Multivariate models suggest that women had lower schooling levels; were less likely to have been employed in the past month and earn more than the minimal wage; more likely to have children, to have been sexually abused, to never have used condoms and to report having been infected by a stable partner. Additionally, women were less likely to report having a partner with a history of migration to the USA and to have engaged in transactional sex.

CONCLUSION:

Significant differences exist between men and women with HIV in Mexico City in terms of their socioeconomicand behavioral profiles, which translate into differences in terms of exposure to HIV infection. Women face social and economic vulnerability while men tend to have riskier sexual behavior. Gender issues must be approached in prevention and treatment efforts, using diverse methods to target those most vulnerable and at risk.

Table 2

History of HIV infection among study participants

	Women	Men	p-value*
	(N = 167)	(N = 1,323)
	Percentage [CI-95 %]
Presumed route of HIV infection
Blood transfusion	6.98 [3.55,12.9]	1.53 [0.95,2.42]	<0.001
Sharing syringes	1.55 [0.07,5.83]	0.51 [0.21,1.14]
Sex without condom	84.5 [77.2,89.8]	82.5 [80.2,84.6]
Condom failure	3.10 [0.95,7.97]	12.1 [10.3,14.1]
I was forced to have sex	3.10 [0.95,7.97]	3.06 [2.21,4.22]
I forced someone to have sex	0.78 [0.00,4.69]	0.34 [0.10,0.90]
Infected by a stable partner	69.6 [61.0,77.0]	44.0 [41.0,46.9]	<0.001
Migrant/military/prison background of the person who infected you
Military or police	18.7 [12.7,26.6]	3.77 [2.64,5.35]	<0.001
Prison experience	16.8 [11.0,24.9]	3.42 [2.29,5.07]	<0.001
Migrant to the USA	17.3 [11.3,25.5]	27.4 [24.1,31.1]	0.01
Migrant, military or prison background	41.5 [33.1,50.3]	24.4 [21.6,27.4]	0.01
Reason for getting HIV test
Unprotected sex	12.6 [8.13,18.9]	19.9 [17.7,22.2]	<0.001
Tested while hospitalized	14.6 [9.76,21.1]	13.9 [12.0,15.9]
Medical advice	12.6 [8.13,18.9]	18.2 [16.1,20.4]
Requested by employer	0.66 [0.00,4.03]	1.62 [1.04,2.51]
When donating blood	3.97 [1.65,8.59]	3.57 [2.66,4.77]
HIV positive partner	25.8 [19.5,33.4]	15.5 [13.6,17.6]
Shared injecting equipment	0.66 [0.00,4.03]	0.16 [0.00,0.63]
Routine test (frequent tester)	1.32 [0.06,5.01]	7.54 [6.19,9.16]
Other	19.9 [14.2,27.0]	19.7 [17.6,22.0]
In pregnancy	7.95 [4.48,13.5]	----

Footnote: *Tests for differences in means or proportions. We used bivariate t-test for continuous variables and Chi-square test for categorical variables to compare men and women

Table 3

Sexual violence and risk behaviour history before HIV diagnosis among study participants

	Women	Men	p-value*
	(N = 167)	(N = 1,323)
	Mean or percentage [CI-95 %]
Any time in life
Frequently, almost always or always	3.85 [1.19,9.79]	19.4 [16.5,22.6]	<0.001
Sex with men only	91.7 [85.3,95.6]	80.6 [78.1,82.9]	0.01
Sex with women only	4.13 [1.53,9.56]	9.46 [7.82,11.4]
Sex with men and women	4.13 [1.53,9.56]	9.93 [8.26,11.9]
Risk behavior at sexual encounters before diagnosis
Frequency of condom use
Never	73.8 [65.3,80.8]	49.8 [46.7,52.8]	<0.001
Sometimes	11.5 [6.84,18.5]	23.1 [20.6,25.8]
Frequently, almost always or always	14.8 [9.45,22.2]	27.1 [24.5,29.9]
Frequency of alcohol use
Never	70.7 [62.1,78.1]	55.2 [52.1,58.2]	<0.001
Sometimes	18.7 [12.7,26.6]	27.9 [25.3,30.8]
Frequently, almost always or always	10.6 [6.16,17.4]	16.9 [14.7,19.3]
Frequency of drug use
Never	86.7 [79.3,91.7]	79.8 [77.2,82.1]	0.20
Sometimes	7.50 [3.82,13.8]	10.8 [9.07,12.9]
Frequently, almost always or always	5.83 [2.65,11.8]	9.38 [7.73,11.3]
Frequency of both drug and alcohol use
Never	88.5 [81.5,93.2]	80.2 [77.7,82.6]	0.06
Sometimes	4.92 [2.05,10.5]	11.4 [9.54,13.4]
Frequently, almost always or always	6.56 [3.18,12.6]	8.41 [6.86,10.3]
Sexual abuse
Sexually abused at least once	17.9 [12.7,24.6]	12.6 [10.9,14.6]	0.09
Average (sd) number of times sexually abused	11.8 [4.66,18.9]	3.69 [2.72,4.67]	0.02
Age when first sexually abused	17.9 [13.6,22.2]	13.5 [11.9,15.2]	0.05
Number of sexual encounters in the last month a	9.30 [6.57,12.0]	9.18 [8.30,10.1]	0.94
Age of first sexual intercourse	16.9 [16.3,17.6]	15.5 [15.2,15.7]	<0.001

Footnote: *Tests for differences in means or proportions. We used bivariate t-test for continuous variables and Chi-square test for categorical variables to compare men and women

a78 % of women reported having frequent sex with regular partners (42.9 % among males), the rest reported frequent sex with an occasional or one-time partner (data not shown)

Full article at:  http://goo.gl/t4YzOU

By:   Bautista-Arredondo S1, Servan-Mori E2, Beynon F3, González A4, Volkow P5.

• 1National Institute of Public Health, Cuernavaca, Mexico. sbautista@insp.mx.
• 2National Institute of Public Health, Cuernavaca, Mexico. eservan@insp.mx.
• 3National Institute of Public Health, Cuernavaca, Mexico. fenellajb@gmail.com.
• 4Mexico City's AIDS Program, Mexico City, Mexico. andrea.gonzalez.condesa@gmail.com.
• 5National Institute of Oncology, Mexico City, Mexico. pvolkowf@incan.edu.mx. 

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HIV Prevalence, Sociodemographic Characteristics & Sexual Behaviors among Transwomen in Mexico City

To present results from HIV testing, knowledge of HIV status and socioeconomic factors associated with the probability of having a HIV positive result among transwomen (TW) in Mexico.

In 2012, we conducted an HIV seroprevalence survey to 585 TW in Mexico City in three strata: gathering places, the Condesa HIV Clinic and in four detention centers. We estimated the prevalence of HIV in each strata and applied a probit model to the overall sample to analyze factors associated with the probability of a HIV positive result.

The prevalence of HIV was 19.8% in meeting places; 31.9% in detention centers and 64% among the participants of the clinic. Age, low education and number of sexual partners was positively associated with HIV.

Results from the study provide relevant information to design HIV prevention interventions tailored to the needs of the TW population.

Full article at:  http://goo.gl/Ir15D8

By: Colchero MA1, Cortés-Ortiz MA1, Romero-Martínez M1, Vega H2, González A2, Román R3, Franco-Núñez A1, Bautista-Arredondo S1.

• 1Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
• 2Clínica Especializada Condesa, México, Distrito Federal, México.
• 3Inspira Cambio, AC., México. 

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Preventing HIV Transmission among Partners of HIV-Positive Male Sex Workers in Mexico City

Mexico has a concentrated HIV epidemic, with male sex workers constituting a key affected population. 

...We estimated annual HIV incidence among male sex workers' partners to be 8.0%. Simulation models demonstrated that increasing condom use by 10%, and scaling up HIV treatment initiation by 50% (from baseline values) would decrease the male sex workers-attributable annual incidence to 5.2, 4.4 % (CVS) and 3.2 % (FVS), respectively. 

Scaling up the number of male sex workers on ART and implementing interventions to ensure adherence is urgently required to decrease HIV incidence among male sex workers' partners in Mexico City.

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By:  Monteiro JF1, Marshall BD, Escudero D, Sosa-Rubí SG, González A, Flanigan T, Operario D, Mayer KH, Lurie MN, Galárraga O.
1School of Public Health, Brown University, 121 South Main Street, Box G-121S-7, Providence, RI, 02912, USA