RESUMEN

OBJECTIVE: To describe condom use among Mexican women living with HIV and analyze factors that facilitate or impede its utilization. MATERIALS AND METHODS: Qualitative analysis of 55 interviews with women of reproductive age living with HIV. RESULTS: Inconsistent condom use and non-use at last sexual intercourse was common, and not clearly related to the male partners' HIV-status. Factors that influenced condom use included perceptions of health benefits, symbolic meaning assigned to the condom within the relationship, and the transformation or persistence of inequitable gender norms. CONCLUSIONS: Gender norms and male partners' attitudes strongly influence condom use among women living with HIV. To increase consistent condom use the health system must implement counseling and service delivery with a gender perspective and innovative actions to involve male partners.

Asunto(s)

Condones/estadística & datos numéricos , Infecciones por VIH/psicología , Sexo Inseguro , Mujeres/psicología , Adulto , Actitud Frente a la Salud , Femenino , Identidad de Género , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Seropositividad para VIH , Humanos , Masculino , México , Cooperación del Paciente , Asunción de Riesgos , Parejas Sexuales/psicología , Factores Socioeconómicos , Sexo Inseguro/psicología , Adulto Joven

RESUMEN

Mexico's policies on antenatal HIV testing are contradictory, and little is known about social and behavioral characteristics that increase pregnant Mexican women's risks of acquiring HIV. We analyzed the association between risk behaviors reported by pregnant women for themselves and their male partners, and women's rapid HIV antibody test results from a large national sample. Three quarters of pregnant women with a reactive test did not report risk behaviors for themselves and one third did not report risk behaviors for themselves or their male partners. In the retrospective case-control analysis, other than reporting multiple sexual partners, reactive pregnant women reported risk behaviors did not differ from nonreactive women's behaviors. However, reactive pregnant women were significantly more likely to have reported risk behaviors for male partners. Our findings support universal offer of antenatal HIV testing and suggest that HIV prevention for women should focus on reducing risk of HIV acquisition within stable relationships.

Asunto(s)

Infecciones por VIH/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Mujeres Embarazadas/etnología , Asunción de Riesgos , Parejas Sexuales , Adulto , Estudios de Casos y Controles , Epidemias , Femenino , Humanos , Masculino , México/epidemiología , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven

RESUMEN

Objetivo. Describir prácticas de uso del condón en mujeres mexicanas con VIH y analizar factores que lo facilitan u obstaculizan. Material y métodos. Análisis cualitativo de 55 entrevistas con mujeres que viven con VIH en edad reproductiva. Resultados. El uso inconsistente y el no uso del condón en la última relación sexual fueron comunes y no mostraron una relación clara con el estatus serológico de la pareja. Factores favorables al uso del condón fueron las percepciones de su beneficio para la salud, significados simbólicos del condón en relaciones de pareja y transformación o persistencia de normas de género. Conclusiones. Las normas de género y las actitudes de la pareja masculina intervienen en el uso del condón entre mujeres con VIH. Para incrementar su uso consistente, el sistema de salud debe ofrecer consejería y servicios con perspectiva de género e implementar acciones innovadoras que involucren a las parejas masculinas.

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Objective. To describe condom use among Mexican women living with HIV and analyze factors that facilitate or impede its utilization. Materials and methods. Qualitative analysis of 55 interviews with women of reproductive age living with HIV. Results. Inconsistent condom use and non-use at last sexual intercourse was common, and not clearly related to the male partners' HIV-status. Factors that influenced condom use included perceptions of health benefits, symbolic meaning assigned to the condom within the relationship, and the transformation or persistence of inequitable gender norms. Conclusions. Gender norms and male partners' attitudes strongly influence condom use among women living with HIV. To increase consistent condom use the health system must implement counseling and service delivery with a gender perspective and innovative actions to involve male partners.

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Adulto Joven , Mujeres/psicología , Infecciones por VIH/psicología , Condones/estadística & datos numéricos , Sexo Inseguro/psicología , Factores Socioeconómicos , Parejas Sexuales/psicología , Actitud Frente a la Salud , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Seropositividad para VIH , Cooperación del Paciente , Identidad de Género , México

RESUMEN

INTRODUCTION: HIV testing during pregnancy permits prevention of vertical (mother-to-child) transmission and provides an opportunity for women living with HIV to access treatment for their own health. In 2001, Mexico's National HIV Action Plan committed to universal offer of HIV testing to pregnant women, but in 2011, only 45.6% of women who attended antenatal care (ANC) were tested for HIV. The study objective was to document the consequences of missed opportunities for HIV testing and counseling during pregnancy and late HIV diagnosis for Mexican women living with HIV and their families. METHODS: Semi-structured-interviews with 55 women living with HIV who had had a pregnancy since 2001 were completed between 2009 and 2011. Interviews were analyzed thematically using a priori and inductive codes. RESULTS: Consistent with national statistics, less than half of the women living with HIV (42%) were offered HIV testing and counseling during ANC. When not diagnosed during ANC, women had multiple contacts with the health-care system due to their own and other family members' AIDS-related complications before being diagnosed. Missed opportunities for HIV testing and counseling during antenatal care and health-care providers failure to recognize AIDS-related complications resulted in pediatric HIV infections, AIDS-related deaths of children and male partners, and HIV disease progression among women and other family members. In contrast, HIV diagnosis permitted timely access to interventions to prevent vertical HIV transmission and long-term care and treatment for women living with HIV. CONCLUSIONS: Omissions of the offer of HIV testing and counseling in ANC and health-care providers' failure to recognize AIDS-related complications had negative health, economic and emotional consequences. Scaling-up provider-initiated HIV testing and counseling within and beyond antenatal care and pre-service and in-service trainings on HIV and AIDS for health-care providers can hasten timely HIV diagnosis and contribute to improved individual and public health in Mexico.

Asunto(s)

Diagnóstico Tardío/efectos adversos , Infecciones por VIH/epidemiología , Diagnóstico Prenatal/métodos , Adolescente , Adulto , Niño , Diagnóstico Tardío/economía , Diagnóstico Tardío/psicología , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , Humanos , Masculino , México , Persona de Mediana Edad , Embarazo , Diagnóstico Prenatal/estadística & datos numéricos

RESUMEN

A favourable context for women with HIV to prevent unintended pregnancy is a cornerstone of reproductive rights and will contribute to achieving universal access to reproductive health, a Millennium Development Goal target. This analysis explores the reproductive trajectories of Mexican women with HIV post-diagnosis and their access to reproductive counselling and use of contraceptives. In-depth interviews and short surveys were conducted with women of reproductive age living with HIV. Results indicate that sexual and reproductive health counselling in HIV care focuses on the male condom and does not routinely address reproductive desires or provide information about or access to other contraceptive methods. Unintended pregnancies result from inconsistent condom use and condom breakage. Women experienced discriminatory denial of and pressure to accept particular contraceptive methods because of their HIV status. Mexican women with HIV are not enjoying their constitutionally guaranteed right to freely choose the number and spacing of their children. Mexico's commitment to reproductive rights and the Popular Health Insurance offer policy and financial frameworks for providing family planning services in public HIV clinics. To ensure respectful implementation, rights-based training for HIV healthcare providers and careful monitoring and evaluation will be needed.

Asunto(s)

Condones/estadística & datos numéricos , Seropositividad para VIH , Accesibilidad a los Servicios de Salud , Embarazo no Planeado , Servicios de Salud Reproductiva , Adolescente , Adulto , Consejo , Femenino , Humanos , México , Persona de Mediana Edad , Embarazo , Investigación Cualitativa , Adulto Joven

RESUMEN

Despite recognition that traditional Mexican gender norms can contribute to the twin epidemics of violence against women and HIV, there is an absence of published literature on experiences of violence among Mexican women with HIV. We conducted a cross-sectional survey with 77 HIV-infected women from 21 of Mexico's 32 states to describe experiences of violence before and after HIV-diagnosis. We measured lifetime physical, sexual, and psychological violence; physical violence from a male partner in the previous 12 months; and physical and psychological violence related to disclosing an HIV diagnosis. Respondents reported ever experiencing physical violence (37.3%) and sexual violence (29.2%). Disclosure of HIV status resulted in physical violence for 7.2% and psychological violence for 26.5% of the respondents. This study underlines the need to identify and address past and current gender-based violence during pre- and post-HIV test counseling and as a systematic and integral part of HIV care.

Asunto(s)

Infecciones por VIH/fisiopatología , Violencia , Adulto , Femenino , Humanos , México/etnología , Persona de Mediana Edad , Adulto Joven

RESUMEN

Introduction The Mexican HIV epidemic is characterized by affecting a greater number of men than women, with the bulk of infections occurring among men who have sex with men, and women being exposed primarily through their stable male partner. Since the beginning of the epidemic, the proportion of women with HIV has increased and the most recent estimates indicate that one out of every four Mexicans with HIV is a woman. Analyzing the emotional and psychological impact of HIV from a gender perspective highlights that while there are similarities in how Mexican men and women experience the HIV diagnosis and adjust to life with HIV, there are also important differences. This study sought to understand how gender influences the type of material and emotional support received by Mexican men and women with HIV. In this article, we discuss the ramifications of gender in two specific situations: first, the reaction to the HIVdiagnosis and related perceptions about how infection occurred; and second, the process of learning to live with the virus. We argue that social constructions of gender are determinant for shaping personal experiences, expectations and roles, as well as for creating differential access to the material, social and symbolic resources necessary for personal development among people with HIV. Dominant Mexican gender norms make men and women more vulnerable to HIV infection and also limit access to resources for improving quality of life post-diagnosis. Methods This article draws on in-depth semi-structured interviews with 20 adult men and 20 adult women with HIV from Morelos, Guerrero, Mexico City and Mexico State carried out during 2003-2004. Inclusion criteria for participation in the study were having known the HIV-diagnosis for more than a year, self-defining as heterosexual, and being ambulatory. The authors completed an inductive analysis, drawing on the basic elements of Grounded Theory proposed by Glaser and Straus in which data collection and analysis mutually inform the emergence of central themes. The research protocol was approved by the Research, Biosecurity, and Ethics review boards of the Mexican National Institute of Public Health. All research participants completed written informed consent. Results and discussion While all of the people with HIV interviewed lived an emotional process fraught with sadness and uncertainty as they assimilated the HIV diagnosis, most men «suspected¼ that they could be HIV-positive before the diagnosis while for most women the HIV diagnosis was «unimaginable¼. This finding relates directly to gendered constructions of sexuality in Mexico. Congruent with epidemiological findings, most of our women research participants were infected in the context of a stable relationship where they had been sexually monogamous. Consequently, they experienced the diagnosis as a betrayal which shook the foundations of their identity, their relationship and sometimes provoked critical reflection on the dominant social narratives about the rewards of being a «good woman¼. For other women, the threat recognition of their male partner's sexual infidelity posed to the relationship and to their sense of self made continued avoidance of the evidence preferable. The dominant narratives of romantic love and fidelity which have been inculcated in Mexican women contribute to their vulnerability to HIV infection by encouraging them to deny, or at least remain silent about men's extramarital sexual relationships. Social constructions of sexuality also put men at risk of HIV infection. Men had internalized cultural messages about «how to be men¼which included having multiplesexual partners and using alcohol and drugs. Among our research participants, the combination of alcohol or drugs with sex was frequently the context for the highest risk behaviour for acquiring HIV, such as unprotected sex between men. Many men described the HIVdiagnosis as confirming their fears about being infected or perceived the diagnosis as a logical outcome of their «voracious¼ and socially legitimated sexual risk-taking behaviour and substance use. In reflecting on how gender norms had contributed to their HIV infection, men expressed regret and confusion, and when they had exposed their female partner, guilt about harming an «innocent¼ and «defenseless¼ woman. Transformation of dominant constructions of heterosexuality and an ethics of mutual honesty and responsibility in the context of greater equality between men and women is clearly needed to prevent new HIV infections and to support resolution of negative feelings about the diagnosis and route of infection. Similarly, a gender divide was identified in the realm of social and emotional support. Women continued to «care for others¼ after the diagnosis, providing emotional support to their male partner and family, and if they were widowed or separated, assuming the breadwinner role. Admitting feelings of sadness or pain and asking for help are culturally constructed as feminine attributes, and doing so challenges men's socially constructed gender role. However, the fact that men are not socialized to solicit emotional and practical support does not imply that it is not available. The gendered social structure is enacted in such a way that women provide support without men asking. Men with HIV continued to be cared for by women post-diagnosis; if men were widowed or separated, female friends or family members provided practical and emotional support. Gendered expectations about the respective roles of men and women also limited some men's access to social support because of the belief that they could'not begin a new affective relationship because they had «nothing to offer¼ without economic earning power. For both men and women, learning to live with HIV was a process. In general, the more time had passed since the diagnosis the more likely it was for people with HIV to receive specialized medical care, have access to accurate information about HIV disease, and to report social support from family, friends and other people with HIV. Peer relationships in support groups and civil society networks were a catalyst for personal transformation and improving quality of life post-diagnosis. Men and women who expressed more traditional gender roles experienced higher barriers to support group participation. The men who most fervently defended their heterosexual identity were uncomfortable with the predominantly homosexual composition of support groups. Women who confined themselves to the homemaker role and did not participate in support groups continued to perceive themselves as victims, were treated as dependents within their social networks, and were less able to overcome negative feelings associated with the diagnosis. Other women with HIV used support groups as a resource for reconstructing their lives and social networks, and some became advocates for the rights of women and people with HIV.

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Introducción Aun cuando las cifras de infección en México son mayores entre hombres que en mujeres (71.5 y 28.5% respectivamente), el análisis de la epidemia desde un enfoque de género arroja luz sobre posibles similitudes y diferencias en la experiencia de vivir con VIH/SIDA para ambos. El interés del presente estudio se centró en identificar diferencias de género en el soporte emocional y social proveniente de las redes de apoyo de estas personas. En este artículo nos referiremos a dos situaciones particulares: primero, la percepción de la manera en que se adquirió el virus, lo cual sirve como ejemplo de la construcción social del género que impacto en las emociones y vivencias de la enfermedad según se sea mujer u hombre, ysegundo, el proceso de transformación por el que las personas con VIH reorganizan sus necesidades y circunstancias después del diagnóstico. Material y métodos Se realizaron entrevistas en profundidad a personas que viven con VIH/SIDA (20 hombres y 20 mujeres), en estado ambulatorio y con más de un año de diagnóstico, en cuatro Estados de la República Mexicana (Morelos, Guerrero, Estado de México y el Distrito Federal), todas ellas autodefinidas como heterosexuales. La información se analizó de manera inductiva usando elementos de la teoría fundamentada. Con base en una tipología de códigos y definiciones creada a partir de la guía de entrevista y reconformada a lo largo del proceso de codificación, se organizó la información por temas emergentes. Resultados La mayor parte de los hombres tendió a recibir el diagnóstico de VIH como algo «sospechado¼, mientras que la mayoría de las mujeres como «inimaginable¼, lo cual se relaciona con normas de género que limitan la capacidad de las personas para actuar frente al VIH. Mientras que la mayoría de las mujeres informó tener menos parejas sexuales y más estables a lo largo de su vida, los hombres reportaron mayor número de encuentros sexuales ocasionales, con hombres o mujeres, incluso cuando vivían con una pareja estable. Aunque en algunos casos no había certeza sobre quién transmitió el virus a quién, en su mayoría los hombres asumían la responsabilidad de haber infectado a sus parejas. Lo anterior desencadenaba procesos diferenciados de manejo de la información acerca del diagnóstico, de sentimientos de culpa o resentimiento, así como del estado emocional con que unos y otras manejaban su nueva condición de seropositivos(as). El contacto con redes sociales alternativas, que permiten re-significar las normas sociales y estructuras rígidas de género, puede tener efectos positivos para hombres y mujeres con VIH. La participación en grupos de autoapoyo y la oportunidad de relacionarse con otras personas que viven con VIH/SI DA constituyó para hombres y mujeres la posibilidad de enfrentar la enfermedad deforma menos solitaria, de acceder a información veraz, a mejores condiciones de vida y de atención en salud. Es decir, su participación en grupos posibilitó tomar la enfermedad en sus manos dándoles la oportunidad de modificar sus relaciones personales y estructuras de género. Discusión Los efectos positivos así como las limitaciones de los grupos y redes sociales de apoyo a hombres y mujeres con VIH, muestran la necesidad de establecer programas y políticas de prevención y atención bajo una perspectiva de género y de derechos humanos, que entre otros beneficios ayude a incrementar la calidad de vida de estas personas.

RESUMEN

International migration is associated with increased HIV vulnerability, but little is known about the vulnerability of internal migrants. This qualitative study explored perceptions of HIV and condom use among Mexican migrant female factory workers. Migration and male sexual infidelity contributed to increased HIV vulnerability and unprotected sex was ubiquitous. The dominant cultural discourse that dichotomizes "good" (monogamous) and "bad" (sexually stigmatized) women, and male partner's resistance, were barriers to condom use. Women's positive attitudes toward the dual protection (pregnancy and sexually transmitted infections) offered by condoms and sexual agency expressed by refusing unwanted sexual contact are resources for HIV prevention.

Asunto(s)

Actitud Frente a la Salud/etnología , Condones , Infecciones por VIH/prevención & control , Sexo Seguro/etnología , Migrantes/psicología , Mujeres Trabajadoras/psicología , Adulto , Condones/estadística & datos numéricos , Conducta Cooperativa , Relaciones Extramatrimoniales/etnología , Femenino , Infecciones por VIH/etnología , Infecciones por VIH/transmisión , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , México/epidemiología , Investigación Cualitativa , Factores de Riesgo , Asunción de Riesgos , Sexo Seguro/estadística & datos numéricos , Parejas Sexuales/psicología , Apoyo Social , Estereotipo , Encuestas y Cuestionarios , Migrantes/educación , Migrantes/estadística & datos numéricos , Poblaciones Vulnerables/etnología , Poblaciones Vulnerables/estadística & datos numéricos , Mujeres Trabajadoras/educación , Mujeres Trabajadoras/estadística & datos numéricos

RESUMEN

OBJECTIVE: To analyze experiences of heterosexual Mexican people living with HIV (PLWHA) related to the exercise of their sexual and reproductive rights. MATERIAL AND METHODS: Qualitative study based on 40 in-depth interviews with PLWHA in four Mexican States. RESULTS: Lack of support and counseling limits the exercise of sexual and reproductive rights by PLWHA, especially women. Principal limitations include feelings of frustration and confusion, fear of re-infection, scanty information, lack of power to negotiate condom use, social stigma and discrimination, and limited access to services and adequate technologies. CONCLUSION: To increase awareness and exercise of rights by PLWHA it is necessary to: improve sexual education; promote processes of cultural change to combat gender inequality and stigma and discrimination; and provide timely and scientific information about HIV prevention.

Asunto(s)

Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Heterosexualidad/psicología , Derechos Humanos , Conducta Sexual , Adulto , Confusión , Escolaridad , Miedo , Femenino , Frustación , Infecciones por VIH/prevención & control , Humanos , Masculino , México , Persona de Mediana Edad , Prejuicio , Reproducción , Sexo Seguro , Parejas Sexuales/psicología

RESUMEN

OBJETIVO: Analizar experiencias relacionadas con el ejercicio de los derechos sexuales y reproductivos de personas heterosexuales que viven con VIH (PVVIH) en México. MATERIAL Y MÉTODOS: Estudio cualitativo donde se realizaron 40 entrevistas en profundidad a PVVIH en cuatro estados del país. Resultados. Vivir con VIH sin apoyo ni consejería limita el ejercicio de los derechos sexuales y reproductivos, especialmente en las mujeres. Las principales limitantes son sentimientos de frustración, falta de claridad en la información, temor a la reinfección, falta de poder para negociar el uso del condón, estigma, discriminación y falta de acceso a servicios y tecnología adecuados. CONCLUSIÓN: Para una mayor conciencia y ejercicio de los derechos de las PVVIH se necesita promover la educación sexual, cambios culturales que combatan la desigualdad de género, el estigma y la discriminación, e información oportuna y científica sobre prevención del VIH.

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OBJECTIVE: To analyze experiences of heterosexual Mexican people living with HIV (PLWHA) related to the exercise of their sexual and reproductive rights. MATERIAL AND METHODS: Qualitative study based on 40 in-depth interviews with PLWHA in four Mexican States. RESULTS: Lack of support and counseling limits the exercise of sexual and reproductive rights by PLWHA, especially women. Principal limitations include feelings of frustration and confusion, fear of re-infection, scanty information, lack of power to negotiate condom use, social stigma and discrimination, and limited access to services and adequate technologies. CONCLUSION: To increase awareness and exercise of rights by PLWHA it is necessary to: improve sexual education; promote processes of cultural change to combat gender inequality and stigma and discrimination; and provide timely and scientific information about HIV prevention.

Asunto(s)

Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Heterosexualidad/psicología , Derechos Humanos , Conducta Sexual , Confusión , Escolaridad , Miedo , Frustación , Infecciones por VIH/prevención & control , México , Prejuicio , Reproducción , Sexo Seguro , Parejas Sexuales/psicología

RESUMEN

Con el objetivo de conocer la magnitud de la no adherencia al tratamiento antirretroviral e identificar los factores que intervienen en personas adscritas al programa de VIH de la Secretaría de Salud de Tamaulipas en México entre junio de 2006 hasta octubre del 2008, se desarrolló un estudio de corte transversal, incluyendo a las 117 personas del programa de tratamiento, identificando no adherencia en los cuatro días y cuatro semanas últimas previas de aplicada la encuesta.Se utilizó regresión logística para identificar factores asociados en la no adherencia. Se observó que la tasa de noadherencia fue del 50 por ciento y el 48 por ciento en los últimos cuatro días y cuatro semanas, respectivamente. Los factores identificados en la no adherencia son no guardar el medicamento en un lugar específico, percepción insatisfecha de su salud actual y considerar difícil el manejo de su tratamiento. Las condiciones reconocidas son factibles de ser modificados por el sistema de salud, sobre todo, antes del inicio del tratamiento.

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With the objective to describe the extent of treatment adherence and identify factors that impact antiretroviral treatment among individuals participating in the HIV treatment program of the Ministry of Health in Tamaulipas, Mexico between June 2008 and October 2008. A cross-sectional study including all individuals in the treatment program (117) was carried.To identify non-adherence in the last four days and the previous four weeks were applied a survey. Logistic regression was performed in order to identify factors influential to no adherence. 50 per cent and 48 per cent were non-adherent during the past four days and four weeks, respectively. The factors influencing non-adherence were: not keeping medications in a specific place, current insatisfation with their health status, and the difficulty in the administration of their treatments. Thefactors influencing antiretroviral adherence identified can be modified within the health system, ideally before initiating treatment.

Asunto(s)

Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Antirretrovirales , Infecciones por VIH/terapia , Síndrome de Inmunodeficiencia Adquirida/terapia , Terapia Antirretroviral Altamente Activa , Estudios Transversales

RESUMEN

Demand for reproductive health services by people with HIV is increasing, as is the urgency of protecting and promoting their reproductive rights. The reproductive rights of Mexicans with HIV are formally protected by the constitution and by health and anti-discrimination legislation, as well as by international conventions. However, the reproductive rights of women with HIV continue to be violated in public clinics and hospitals. This paper discusses three violations identified as priority problems by Mexican women with HIV, illustrating these problems with cases identified during a participatory skills building workshop. The violations cover the following rights: the right to non-discrimination, the right to adequate information and informed consent to medical procedures, and the right to choose the number and spacing of children. Physicians can either violate or promote reproductive rights. Unfortunately, in many instances Mexican physicians continue to perpetrate reproductive rights abuses against women with HIV. Collaborations between women with HIV, civil society, government, and international organizations are needed to educate and sanction health care providers and to support women with HIV in their pursuit of reproductive rights. Demanding accountability from health care practitioners and the State to guarantee reproductive rights in countries where these rights are formally protected will improve the quality of life of people with HIV and can demonstrate that rights-based approaches are compatible with and indeed, crucial for public health.

Asunto(s)

Infecciones por VIH/psicología , Servicios de Salud Reproductiva/organización & administración , Derechos Sexuales y Reproductivos/legislación & jurisprudencia , Adulto , Femenino , Disparidades en Atención de Salud/organización & administración , Humanos , México , Educación del Paciente como Asunto , Prejuicio , Servicios de Salud Reproductiva/legislación & jurisprudencia , Salud de la Mujer , Derechos de la Mujer

RESUMEN

OBJECTIVE: To assess the influence of the relationship between people living with HIV/AIDS and health care providers on treatment adherence and quality of life. METHODS: Qualitative study conducted in Mexico, in 2003, with informants recruited from HIV/AIDS support groups, non-governmental organizations, and infectious disease clinics in public hospitals. A total of 40 people living with HIV/AIDS and five support group leaders were interviewed. Data were collected using sociodemographic questionnaires and in-depth interviews exploring the experience of living with HIV/AIDS, including treatment, disease perception, quality of life, physical and emotional health, and relationship with physicians. Responses were recorded, transcribed and organized thematically based on codes using an inductive analysis. RESULTS: Most respondents aged between 26 and 45 years. The main obstacles to care were related to lack of risk awareness and information among people living with HIV/AIDS and physicians. Physicians proved not to be well trained on HIV/AIDS care. During the follow-up care, most problems were related to inadequate treatment adherence mainly caused by poor communication with physicians and discrimination in public services. CONCLUSIONS: Overall the problems identified were related to information deficiencies, physicians' lack of training and paternalism, and social stigmatization of people living with HIV/AIDS associated with the epidemic.

Asunto(s)

Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/psicología , Cooperación del Paciente/psicología , Relaciones Médico-Paciente , Calidad de Vida/psicología , Adulto , Actitud del Personal de Salud , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , México , Persona de Mediana Edad , Investigación Cualitativa , Factores Socioeconómicos

RESUMEN

OBJETIVO: Analizar factores de la relación con los médicos que afectan la adherencia terapéutica y la calidad de vida de las personas con VIH/Sida. MÉTODOS: Estudio cualitativo realizado en México en 2003 con informantes reclutados en grupos de autoayuda y organizaciones no gubernamentales de VIH/Sida y servicios de infectología de hospitales públicos. Fueron entrevistadas 40 personas viviendo con VIH/Sida y cinco líderes de grupos de autoapoyo. Para la recolección de datos los informantes respondieron un cuestionario sociodemográfico y entrevistas en profundidad sobre la experiencia de vivir con VIH/sida, incluyendo los tratamientos, la percepción de la enfermedad, la calidad de vida, la salud física y emocional y la relación con los médicos. Las respuestas fueron grabadas, transcritas y organizadas por temas en base a códigos, usando un análisis inductivo. RESULTADOS: La edad de la mayoría de los entrevistados varió entre 26 y 45 años. Los principales problemas durante la búsqueda de atención se relacionaron con la falta de conciencia de riesgo y de información entre las personas viviendo con VIH/Sida y los médicos. Los médicos mostraron falta de capacitación en VIH/Sida. En la etapa de continuidad de la atención, los problemas se relacionaron con una adherencia terapéutica deficiente, producto principalmente de la falta de comunicación con los médicos y de la discriminación en los servicios públicos. CONCLUSIONES: De manera general se observaron problemas de información; falta de capacitación y paternalismo por parte de los médicos, y estigma social de las personas viviendo con VIH/Sida asociado a la epidemia.

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OBJECTIVE: To assess the influence of the relationship between people living with HIV/AIDS and health care providers on treatment adherence and quality of life. METHODS: Qualitative study conducted in Mexico, in 2003, with informants recruited from HIV/AIDS support groups, non-governmental organizations, and infectious disease clinics in public hospitals. A total of 40 people living with HIV/AIDS and five support group leaders were interviewed. Data were collected using sociodemographic questionnaires and in-depth interviews exploring the experience of living with HIV/AIDS, including treatment, disease perception, quality of life, physical and emotional health, and relationship with physicians. Responses were recorded, transcribed and organized thematically based on codes using an inductive analysis. RESULTS: Most respondents aged between 26 and 45 years. The main obstacles to care were related to lack of risk awareness and information among people living with HIV/AIDS and physicians. Physicians proved not to be well trained on HIV/AIDS care. During the follow-up care, most problems were related to inadequate treatment adherence mainly caused by poor communication with physicians and discrimination in public services. CONCLUSIONS: Overall the problems identified were related to information deficiencies, physicians' lack of training and paternalism, and social stigmatization of people living with HIV/AIDS associated with the epidemic.

Asunto(s)

Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/psicología , Cooperación del Paciente/psicología , Relaciones Médico-Paciente , Calidad de Vida/psicología , Actitud del Personal de Salud , Infecciones por VIH/tratamiento farmacológico , México , Investigación Cualitativa , Factores Socioeconómicos

RESUMEN

Unprotected sex between men is the major risk factor for HIV infection in México and many other Latin American countries. There is a substantial body of literature demonstrating that the relationship between sexual identity and sexual practice is not binary or causal -- men who have sex with other men do not necessarily perceive themselves as gay -- and there is increasing interest in HIV prevention with men who have sex with both men and women. In México, HIV prevention with men who have sex with women and men and who are not socially affiliated or identified with gay men is lacking. This paper explores the sexual histories and HIV-risk perception of HIV-positive Mexican men who indicated that they have sex with women in a screening interview and then in the context of an in-depth interview also reported having had sex with men. We consider the sexual practices and sexual and social identities of these men, examining their explanations for having sex with other men, the strategies used to affirm their masculinity, the management of their sexual identity in their social networks, HIV-risk perception before diagnosis and sexual practices after diagnosis. Recommendations are made to improve HIV prevention for men who have sex with men as well as women and who do not assume a gay or bisexual identity.

Asunto(s)

Bisexualidad/psicología , Coito/psicología , Infecciones por VIH/prevención & control , Seropositividad para VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Adulto , Bisexualidad/etnología , Características Culturales , Infecciones por VIH/etnología , Seropositividad para VIH/etnología , Homosexualidad Masculina/psicología , Humanos , Masculino , México , Asunción de Riesgos , Identificación Social , Apoyo Social , Encuestas y Cuestionarios

RESUMEN

The goal in this article is to examine social problems associated with highly active antiretroviral therapy (HAART) adherence in Mexico and the related challenges for Mexican persons living with HIV/AIDS (PLWHAs). The study was conducted from the perspective of infected and affected individuals. The authors completed 64 in-depth interviews with heterosexual male and female PLWHAs, as well as with some key individuals from their social network. Following the principles of grounded theory, they carried out inductive analysis to create codes and organize central themes. The authors identified problems related to accessing HAART and found that conditions for implementing recommendations made in the international literature to improve adherence are poor. The findings highlight the importance of social factors, such as health care system irregularities, ineffective physician-patient communication, and availability of family and other sources of social support such as self-help groups for PLWHAs' access and adherence to antiretroviral therapy in Mexico.

Asunto(s)

Terapia Antirretroviral Altamente Activa/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Accesibilidad a los Servicios de Salud , Cooperación del Paciente , Adulto , Comunicación , Femenino , Humanos , Entrevistas como Asunto , Masculino , México , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Relaciones Médico-Paciente , Investigación Cualitativa , Medio Social , Apoyo Social

RESUMEN

BACKGROUND: There is a need to enhance the quality and sustainability of environmental health programs in Mexico. What socio-cultural factors influenced the adoption or rejection of Clean Water in Homes programs in this population? We applied rapid appraisal procedures (RAP) to evaluate these community-based programs. METHOD: Qualitative study conducted in communities along Mexico's northern border. We conducted informal dialogues, semi-structured interviews, field notes and observations. Home visits used a checklist to observe: sources of water, handwashing, as well as human waste and garbage disposal patterns. Data analysis was conducted using ATLAS.ti, which facilitated comparison and illustration of discrepancies, the elaboration of emerging issues and relationships between them. RESULTS: Community members perceived that the Clean Water program was a top-down intervention. Water is perceived as a political issue and a matter of corruption. Inequity also limits solidarity activities involved in environmental sanitation. Migration to the United States of America (US) contributes to community fragmentation, which in turn dilutes communal efforts to improve water and sanitation infrastructure. While targeting women as program "recipients", the Clean Water program did not take gendered spheres of decision-making into account. Community members and authorities discussed the main results in "assemblies", particularly addressing the needs of excluded groups. CONCLUSION: The oversight of not exploring community members' needs and priorities prior to program implementation resulted in interventions that did not address the structural (economic, infrastructure) and socio-cultural barriers faced by community members to undertake the health-promoting behaviour change, and provoked resentment.

Asunto(s)

Planificación en Salud Comunitaria/organización & administración , Características Culturales , Desarrollo de Programa , Saneamiento/métodos , Abastecimiento de Agua/normas , Adolescente , Adulto , Anciano , Participación de la Comunidad , Toma de Decisiones , Países en Desarrollo , Femenino , Grupos Focales , Humanos , Higiene , Entrevistas como Asunto , Masculino , México , Persona de Mediana Edad , Investigación Cualitativa , Saneamiento/normas , Apoyo Social , Factores Socioeconómicos , Factores de Tiempo , Contaminación del Agua/prevención & control

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida/epidemiología , VIH-1 , Congresos como Asunto , Países en Desarrollo , Salud Global , Humanos

RESUMEN

"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

Asunto(s)

VIH , Salud de la Mujer , Servicios de Salud para Mujeres