MEXICO CITY – Roberto Navarro has been a dancer since the age of 17. Jazz became his passion and he fell in love with classical dance after taking many classes. And he started teaching four years later.

“I am so happy when I teach my daughters dance because they bring me so much joy, I feel like I help my daughters become better women, not noticing that I am some kind of therapist, ”Navarro told Los Angeles. Blade.

He discovered the discipline of dancing in heels in 2014, which led him to connect and explore his sexuality more. He suffered a lot of intimidation because of it, however.

Navarro, a 33-year-old gay man from Sahuayo de Morelos, Michoacán state, currently owns a dance hall. Navarro said he started to become an entrepreneur, but it hasn’t been easy because of the pandemic.

He was diagnosed with HIV in 2016. Navarro suffered from depression for several months after learning of his status.

“I woke up very overwhelmed in the morning thinking I had to go to the hospital to make a long line of patients; have blood drawn for rapid screening tests, ”he said. “We arrived at 7 am and left until 1 pm.

Navarro has been in treatment for almost five years and still dances.

“Thereafter, I went to my consultations every three or six months depending on my results,” he said. “By the third month, I was undetectable.”

Navarro started with Atripla, an antiretroviral drug he received through Mexico’s Seguro Popular, and was undetectable a month later.

A shortage of Atripla forced a change in Biktarby after President Andrés Manuel López Obrador in 2019 suppressed Seguro Popular and established the Institute of Health for Welfare (INSABI). Pharmaceutical company Gilead said there are many counterfeit versions of the drug on the market.

Seguro Popular had nearly 52 million beneficiaries in 2018. The National Council for the Evaluation of Social Development Policy (CONEVAL) indicated that INSABI had more than 34 million beneficiaries at the end of 2020.

Antiretroviral drugs have been available in Mexico since 2003, although the Mexican health system is divided into various sub-systems depending on where you work.

• Institute of Social Security and Services for State Workers (ISSSTE)
• Mexican Social Security Institute (IMS)
• INSABI (Institute of Health for Welfare) which was previously known as Seguro Popular

They vary in the time it takes to receive the drug and the time for the CD4 viral load tests. The availability of appointments with infectious disease specialists varies in each of the three public health systems.

People with INSABI will take longer to get tested and access doctors. It must also be recognized that everyone, in theory, has the possibility of accessing drugs, but that also depends on the states in which they live.

From Seguro Popular to INSABI

The number of people without access to health care in Mexico increased from 20 million to almost 36 million between 2018-2020. INSABI, more than a year after its creation, still does not fully cover the same amount as its predecessor.

INSABI is an independent agency of the Ministry of Health which aims to “provide and guarantee the free provision of health services, drugs and other associated inputs to people without social security”. The General Health Law says it was to replace Seguro Popular, who was in place from 2004 to 2019.

“The current treatment situation is quite complex, not least because there have been many changes in the health department of Mexico, and this is due to the fact that in 2003, when the Seguro Popular was created; there has been an increase in comprehensive care for people living with HIV and resources for prevention strategies which are mainly managed by civil society organizations which have obtained money from the government. said Ricardo Baruch, who worked at the International Planned Parenthood Federation for almost 15 years.

López, who took office in 2018, sought to eliminate Seguro Popular, which was the mechanism by which access to antiretroviral drugs was given to most people living with HIV in the most vulnerable states. This change was made in theory to expand access for everyone, but the opposite has happened.

There is less access due to changed purchasing mechanisms and a huge shortage across the country. Baruch says this situation has caused a treatment crisis across Mexico.

“The truth is that the Seguro Popular has helped me a lot to get my treatments on time, what I don’t like is that there is not enough staff to attend all the patients that we are waiting for. for our consultations, “said Erick Vasquez, a person who learned in February that she was living with HIV.

Vasquez, 34, is an artist who works in Guadalajara and Playa del Carmen.

Vasquez did not have health insurance like other people through IMS. He got access to Seguro Popular through an organization that supports people living with HIV, but he has to wait until October for his first date.

Vasquez, who has a very low viral load, started a job in March that earned him IMS. He had access to his treatments thanks to her.

He received three months of Biktarvy at the end of June; one prescription per month. He said the drug is not difficult to obtain.

“I haven’t had any problem with the drug, it’s not hard to get it when you’re on insurance, but there’s still plenty of time until October,” Vasquez said.

The cost of antiretroviral therapy in Mexico is around $ 650 per month, and a vial contains only 30 tablets.

“I didn’t have side effects, I didn’t have nausea, I don’t throw up, I take one pill a day, it’s one every 24 hours,” Vasquez said. “I feel great and hope to be undetectable very soon.”

Infrastructure rather than health

Prevention resources have been cut and health resources are now used to finance the Felipe Ángeles International Airport from the Santa Lucía military base in Zumpango in the State of Mexico, a new refinery, the Mayan train and d ‘other major infrastructure projects. And this means that many people who want to access treatment do not receive it. It takes a lot

The cost of the works, including the land connected to the Mexico City International Airport and various military installations, is set at 82,136 100,000 Mexican pesos and arrangements are made to serve 19.5 million passengers in the first year of operation. , according to a report from the Secretariat of National Defense (SEDENA).

On the other hand, HIV tests are much less numerous and this shortage has resulted in a much greater influx of cases of advanced HIV and even AIDS in hospitals. This trend is particularly severe among transgender women and men who have sex with men.

“Here in Mexico we are concentrating the HIV pandemic, and we are at a time when this issue of shortage has not stabilized, that there is already more clarity in purchasing, but it is well known that all of these changes in health systems continue for some time. year over the years they make the situation more and more fragile and with regard to migrants that there was previously a certainty that they could access medicines through the Seguro Popular, there is now a legal vacuum which , in some states, it depends on: the states, clinic or social worker; whether or not they give you medicine, ”Baruch said.

“If you are not a resident or a national here in Mexico, it is a won case for people in transit seeking political asylum or who have stayed in Mexico,” he added.

Migrants do not have access to HIV treatment

Mexico is located between the three regions with the highest HIV rates in the world: the Caribbean, Central America and the United States. According to Siobhan McManus, biologist, philosopher and researcher at the Center for Interdisciplinary Research in Sciences and Humanities at the National Autonomous University of Mexico.

Lack of opportunities, violence and climate change that force people whose livelihoods depend on agriculture to abandon their homes are causing migration from Central America.

Most migrants – LGBTQ and others – experience violence once they arrive in Mexico.

Chiapas and other states have created a large network of clinics known by the Spanish acronym CAPASITS (Centro Ambulatorio para la Prevención y Atención en SIDA e Infecciones de Transmisión Sexual) which are specific HIV and STD units in large cities. They are often near the homes of most people.

The states of Sonora and Chihuahua, which border the United States, often only have such clinics in one or two cities. This lack of access means people will have to travel up to six hours to access these treatments.

People who had been on treatment for a long time previously received up to three months of treatment. They now have to travel monthly to receive their medication due to the shortages.

PrEP available in Mexico

The shortage of drugs for people already living with HIV is a current problem for the Mexican government, but it has made free PrEP available to those who want to protect themselves from the virus.

Ivan Plascencia, 24, who lives in Guadalajara, the state capital of Jalisco, has been using PrEP for several years since becoming sexually active and has never complained about the drug. Plascencia instead recommends that his relatives take advantage of this prevention drug available in one of the CAPASITS where he lives.

Post-pandemic screening tests

An estimated 260,000 people in Mexico are living with HIV. More than 80% of them knew their status before the COVID-19 pandemic.

The number of new cases detected in 2020 was 60% lower than the previous year, but that number does not mean that HIV rates have declined.

In Jalisco, which is one of the most populous states in Mexico with over 8 million people, there was a 40% increase in positive cases in 2020 compared to 2019. This increase has put a strain on service providers.