AIDS in Mexico: Not a Disease?

Posted on May 1, 2014


“In Mexico, AIDS is not a disease.” The smile creasing the young mother’s face seems more of a grimace than a statement motivated by humor as she peers through the window that overlooks a narrow cobblestone street in the city of Oaxaca barrio of Xochimilco. Turning back towards me, she states unequivocally, “It is a sin.”

Her name is Josefina. She would not allow me to use her last name because, she explained, in the smaller town in the state of Oaxaca in southern Mexico where they lived before coming to the city her neighbors had refused to allow their children to associate with her young son and daughter after Josefina had confirmed that she was HIV positive. Unlike many who postponed getting diagnosed and treated, she sought medical help as soon as she learned that she had contracted “SIDA” (the Spanish acronym for AIDS).

“The only man I ever was with was my husband,” she looks away again and shakes her head. “It us from him that I became infected.” Like nearly a million other Oaxacans, she explains, her husband migrated to the United States to work, returning only for a few months each winter. “When I told him what had happened he called me a puta (prostitute) and hit me and left me. I have not seen him since.”

Although Mexico’s National Council for Prevention and Control of AIDS (CONASIDA) has officially identified HIV/AIDS as an “epidemic” Mexico has one of the lowest HIV prevalence rates in Latin America; however, the rate of heterosexual infection has increased substantially. Women are increasingly vulnerable, insists Dr. José Antonio Izazola, the director of Mexico’s HIV/AIDS treatment and prevention program, because traditional gender differences still prevalent in Mexico hamper many women’s ability to control personal risks with sexual partners. He insists that gender equality is a major component in controlling the spread of AIDS and that it is necessary to deal realistically with women’s roles in twenty-first century Mexico and with adolescents becoming involved in their first sexual encounters.

Although many states and Mexico’s Federal District provide free or low cost medical treatment for HIV positives, AIDS is widely considered a disease that affects only homosexuals, drug abusers and prostitutes. Health workers and human rights organizations cite instances where employers fire HIV positive workers, where HIV children or children of mothers being treated antiretrovirally are denied school attendance and where doctors and health care workers refuse to treat HIV patients, even for non-HIV involved emergencies.

Politically, historically and geographically Mexico is a divided country. The sprawling Federal District, which encompasses Mexico City and several of its larger suburbs and includes approximately one-fourth of the nation’s population, is the center of “government, crime, corruption, culture and intellectuality,” according to a local journalist, while the outlying regions are more conservative politically, socially and more traditionally Catholic. For the past fifteen years Mexico City has been governed by a liberal majority while the rest of the nation has remained in the hands of conservative governors and supported the policies of conservative presidents.

“Make condoms available to teenagers?” the governor of Guadalajara, Emilio González, scoffed in 2008, “why not have the state give them a six-pack and chit for a motel room as well?” Like current president Felipe Calderón a member of the conservative National Action Party, González forced the state’s health secretary who had established an AIDS prevention program to resign, although he conceded that Guadalajara would continue to distribute condoms to homosexuals since “they are the ones most in risk of contacting the disease.”

But many gays, like many HIV positives, refuse to disclose their situations to anyone connected with the government, thus inhibiting AIDS prevention programs and making it difficult to obtain accurate statistics. Both CONASIDA and the U.S. Center for Disease Control concede that the number of HIV positives probably is much higher than the 174,000-200,000 figure indicated by official statistics. Mexico registers an average of 5,000 new cases a year and 6,000 deaths a year from AIDS. The majority of infections occur in the 25-44 year old age group; AIDS is the third cause of death of men and sixth cause of death in women among persons between twenty-five and forty-four.

The strong stance taken by President Calderón against abortion and his insistence on “family values” as a deterrent not only of AIDS but of addiction and crime has shifted funding away from public health programs. The federal Department of Health’s legal authority, the former attorney for the Catholic Archdiocese of Mexico, pocket vetoed updating AIDS medications and treatment because he allegedly found “errors” in the paperwork and a federal Congressman from the state of Colima proposed that jail sentences be levied against any person who infects another with a sexually transmitted disease.

By contrast in Mexico’s Federal District liberal administrations have legalized abortion through the first twelve weeks of pregnancy, validated same-sex unions and facilitated the financing of HIV medication and identification of those most at risk. (Nearly half of those identified as HIV positive live there.)

When AIDS first appeared in Mexico in 1981 the only reported cases occurred in Mexico City and in cities along the Mexico-U.S. border. Health authorities identified “men who have sex with men” as the group most affected. The outbreak remained confined until 1988 when, according to U.S. Centers for Disease Control and Prevention statistics, the increase became “exponential,” not only in the Federal District but throughout the country. This exponential increase continued through 1996, then stabilized to average between 4,000 and 5,000 new cases each year.

Infection through blood transfusions dropped dramatically after the first years of the epidemic and injection drug use was uncommon in Mexico and not a major source of transmission. But the rate of heterosexual infection increased substantially every year after 1996, primarily among women and in greater proportions every year in non-urban areas. A large percentage of those affected were, like Josefina, the wives of men who returned from long periods of time working in the United States or in the border cities.

To counter the spread of cases being reported rurally, the federal government in conjunction with state governments created ambulatory centers of attention for patients with AIDS and sexual transmitted diseases. These centers, called CAPASITS for the initials in Spanish, focus on patient care and monitoring the use of the antiretroviral drugs, particularly for patients who otherwise might interrupt or stop treatment. Despite these efforts, which are focused on treatment rather than prevention, an unknown number of HIV positives postpone seeking help until their situations become desperate, a factor in the higher percentages of deaths among HIV positives in Mexico that statistics from many other countries show. CONASIDA reported in 2008 that during the previous year only 57 percent of those needing antiretroviral drugs were receiving them and less than 1 percent of women living with HIV were receiving antiretroviral therapy for prevention of mother-to-child transmissions.

Both the federal government and the government of the Federal District have sponsored educational and informational campaigns concerning HIV and AIDS but Dr. Izazola doubts that a person’s reaction to “a spectacular announcement” in a microbus or newspaper is going to increase his or her condom use. Information about safe sex and HIV prevention often is confusing and controversial, particularly since the hierarchy of the Catholic Church has taken a strong stand against condom use and against homosexuality and same sex unions. In 2003 two bishops condemned President Vicente Fox’s wife Marta Sahagún for urging people to express the “moral courage” to fight AIDS through safe sex education. The bishop of the central state of Tlaxcala, Jacinto Guerrero, averred that “millions of people are infected with AIDS because of the propaganda surrounding condom use.”

Bishop Guerrero’s appraisal echoes that of Mexico’s Catholic hierarchy which has countered discussions about HIV and AIDS prevention with homilies about family values, heterosexuality and sexual abstention. Cardinal Norberto Rivera repeated Pope Benedict XVI’s dictum “the AIDS problem cannot be resolved with the distribution of condoms. They only exacerbate the problem…the only efficient way to fight the epidemic is by spiritual renovation.” The Council of Mexican Bishops recently endorsed this stance, insisting that the fight against AIDS had to concentrate on education in “the use of sexuality and the reaffirmation of the role of marriage and the family” without mentioning poverty, migration or lack of employment as factors in the breakup of so many traditional Mexican families. President Calderón echoed the Council’s assertion when he announced publicly that youth criminality resulted from a “failure to believe in God.”

These attitudes contrast with Church support at the parish level of CAPACITS and other AIDS education and treatment programs. Catholic private schools throughout Mexico provide sex education classes in junior high school in conformance with federal regulations although (as in public schools) the quality of presentation varies greatly.

Although both international and Mexico HIV/AIDS reports indicate that the “epidemic” is controlled with the number of deaths more or less equaling the number of new cases reported, there are danger signs on the horizon. Calderón insists that the country’s financial collapse that began in 2008 has bottomed out; nevertheless, the federal government has made extensive budget cuts in funds destined for health and education. Although part of HIV/AIDS funding comes from private sources (foundations, etc.) cutbacks could severely affect current research projects and CAPASITS’ ability to identify and treat HIV positives . In addition, the dramatic increase in drug use within Mexico and the government’s failure to fund prevention and rehabilitation programs threatens to increase the propagation of HIV/AIDS and stimulate the popular belief that the disease is retribution for addiction an for “immoral” sexual practices.

Fist published in Conscience, 2009