Women and HIV in Mexico: An exploratory analysis about experiences, expectations and health care needs in Oaxaca, Mexico Open Access

Pineirua, Alicia (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/pn89d705z?locale=en
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Abstract

Background: Women represent 25% of people living with HIV/AIDS (PLWHA) in Mexico. The prevalence of the infection among women is increasing, particularly in sub-urban and rural areas of the country. Most of the HIV transmission among women occurs by heterosexual transmission, through the woman's stable partner. Approximately 62% of HIV positive women in Mexico are diagnosed in advanced stages of the disease, in the presence of symptoms related to AIDS defining conditions. Mexico currently lacks tailored interventions to address women's risk of HIV acquisition.

Objective: Our objective was to explore risk perception, diagnosis circumstances and attitudes towards health care providers among HIV positive women in Oaxaca, Mexico.

Design: This was an exploratory qualitative study of HIV+women living in Oaxaca, Mexico. The study was be conducted at the Ambulatory Center for HIV and STI's care (CAPASITS) located in Oaxaca, Mexico between May and July 2014. Each participant took part in a one time in-depth interview. We stratified our analysis by CD4+ count at the time of diagnosis: participants were divided into two subsets defined as early (CD4>200) and late (CD4<200) stage disease.

Results: Women living in this setting are not considered at risk of acquiring HIV infection. Their circumstances of diagnosis vary, according their age and their stage of diagnosis; but mainly respond to three different scenarios: during pregnancy, symptomatic and AIDS defining conditions or after a family member is diagnosed (usually with advanced disease too). HIV testing during pregnancy although mandatory, is still not universal. Most of the women narrated multiple quests seeking healthcare when symptomatic, in which they were not tested for HIV. HIV diagnosis as a screeening procedure was not described in non-pregnant women in our study.

Conclusions: Increasing the timely diagnosis of women in a is a priority, both from the individual perspective as well as from its implications for HIV mother to child transmission (MTCT). Specific preventive and therapeutic measures, tailored for these populations should be designed and implemented. We suggest starting by optimization of HIV screening during pregnancy and universal testing strategies.

Table of Contents

TABLE OF CONTENTS

I. Chapter 1

1.1 Introduction 1

1.2 Significance 3

1.3 Problem statement 4

1.4 Objectives and specific aims 4

2. Chapter 2: Background

2.1 Epidemiology 5

2.2 Women and HIV: Vulnerability and other social determinants 9

2.3 Social construction of sexuality in Mexico and its impact on HIV risk 14

2.4 Barriers to HIV care among women 17

3. Chapter 3: Methods

3.1 Study design 22

3.2 Setting 24

3.3 Procedures 25

3.4 Data Analysis 27

4. Chapter 4: Results

4.1 General overview 34

4.2 The early stage diagnosis 40

4.3 The delayed diagnosis 44

4.4 Shared outcomes and hopes 53

5. Chapter 5

5.1 Discussion and recommendations 62

5.2 Study limitations 69

5.3 Future research 70

5.4 Conclusion 71

6. References 74

7. Appendix 82


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