The Undiagnosed HIV Epidemic in Mexico: Factors Associated With HIV-Testing Behaviors in Mexican Men Who Have Sex With Men Open Access
Valenzuela Lara, Marisol (Spring 2023)
Abstract
Background: Mexico has the third-largest number of people living with HIV (PLWH) in the Americas. HIV testing and early diagnoses are crucial to engage PLWH in the HIV continuum of care and prevent new HIV infections. Like many other regions, Mexican men who have sex with men (MSM) are disproportionally affected by HIV. However, one-third of MSM in Mexico have never been tested for HIV, and more than half of MSM living with HIV are unaware of their infection. Despite significant progress to scale up HIV treatment in Mexico, undiagnosed PLWH remains the most crucial challenge of the national HIV response and is exacerbated as new HIV infections continue to accrue. Mexico's new HIV infection estimates have not been consistent over time, and results have not been desegregated by key populations. Robust HIV incidence estimates and differentiated HIV testing strategies are crucial for guiding Mexico’s HIV strategy and reducing new HIV infections within all subpopulations and geographic settings.
Goal: The overarching goal of this dissertation was to generate improved knowledge about awareness of HIV status among Mexican MSM by elucidating the geographical distribution of undiagnosed PLWH in Mexico, comparing factors associated with HIV testing frequency among Mexican MSM in Mexico and the United States, and estimating the impact of improving HIV testing frequency among MSM in Mexico's HIV epidemic.
In Aim 1, using data from Mexico's National HIV Surveillance Systems and CDC's most recent methodology, an effective alternative to estimate new HIV infections and monitor subnational HIV response without the need for historical data is proposed. Important disparities in the geographical distribution of undiagnosed PLWH in Mexico were found, particularly in the South region, where HIV testing advances at a slower pace, disproportionally affecting MSM.
In Aim 2, the cross-sectional association between HIV testing frequency and predisposing, enabling, and perceived needs factors for health services utilization in Mexican MSM living in Mexico and the U.S. was examined. Results showed that recent STI diagnosis and PrEP awareness, independently of PrEP use, were strongly associated with more frequent HIV testing. However, these associations were stronger among Mexican-born MSM living in the U.S., suggesting that further public health policies should be implemented in Mexico to promote PrEP and ensure HIV testing during STI diagnosis.
In Aim 3, the impact of increasing HIV testing frequency among MSM on HIV incidence was estimated by adapting a compartmental HIV transmission model to simulate the HIV epidemic among MSM in Mexico. Reductions in new HIV infections were observed in the low uptake scenario. However, nationwide targets were only reached when substantial increases in HIV testing frequency among the youngest group and those never tested were implemented.
The results of this dissertation have improved our understanding of the HIV epidemic in Mexico, providing essential information for effectively allocating HIV testing and prevention resources and guiding the development of targeted interventions to increase HIV testing rates among Mexican MSM. The long-term goal is to increase awareness of HIV status and reduce HIV transmission among MSM.
Table of Contents
1 Introduction 1
1.1 Background 1
1.2 Overarching Goal and Specific Aims 18
1.3 Data Sources 20
2 Geographical variation of new HIV cases and undiagnosed PLWH in Mexico 22
2.1 Introduction 22
2.2 Methods 23
2.3 Results 27
2.4 Discussion 40
2.5 Supplemental material 42
3 Factors associated with HIV testing frequency among Mexican MSM 49
3.1 Introduction 49
3.2 Methods 50
3.3 Results 53
3.4 Discussion 69
3.6 Supplemental materials 71
4 Effect of increasing HIV testing frequency among MSM in Mexico’s HIV epidemic 76
4.1 Introduction 76
4.2 Methods 77
4.3 Results 90
4.4 Discussion 93
5 Conclusions 95
6 References 97
About this Dissertation
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Supplemental Files
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