HIV in Mexico City

INTRODUCTION
Between 2015 to 2019, Mexico had an estimated population of over 120 million [1]. According to the UNAIDS
statistics, Mexico had around 12,000 new HIV infections, 4,200 AIDS-related deaths and approximately
220,000 people living with HIV in 2016[2]. Its capital, Mexico City, has a population of 8.8 million and is
consistently ranked in the top contributing states for new HIV infections in Mexico [3].

Although the overall prevalence of HIV in Mexico (0.3%) is lower than her neighbours (Guatemala, Brazil,
Argentina etc), there is room for improvement [4]. In 2016, it is estimated that only 60% (48% to 69%) of HIV
patients in Mexico are accessing antiretroviral therapy (ART) and only 50% (45% to 55%) have suppressed
viral loads [2]. Additionally, the Global Burden of Disease 2017 HIV study reported that Mexico’s annualised
rate of change in new HIV infections was 2.8% (0.7% to 4.8%) from 2007 to 2017, compared to -3.8% (-5.2%
to -2.4%) from 1990 to 2007 [5]. This suggests a gradual but worrying uptrend in Mexico’s HIV incidence.

Mexico City has a concentrated epidemic amongst key populations, namely homosexual men, men who have
sex with other men (MSM), transgender women, sex workers, and people who inject drugs (PWID) [6-8]. The
highest prevalence of HIV is observed in two groups: MSM and transgender women, at 17.3% and 17.4%
respectively [2]. It is noteworthy that a further subgroup of these two populations, the MSM and transgender
women sex workers, is especially vulnerable.

UNDERLYING DRIVERS
Boerma and Weird proposed that HIV infection is driven by biological determinants and proximate
determinants such as condom and ART use [9]. These are further influenced by underlying determinants such as
demographics, sociocultural factors and the greater national or political backdrop.

MSM and transgender women in Mexico City suffer from continued HIV transmission due to reasons which
span all three classes of determinants and also Whitehead’s rainbow model of health determinants [10]:
1. Employment discrimination due to widespread homophobia in Latin America drive these populations
into unemployment and lower socioeconomic status. To make a living, many have no bargaining power
and engage in transactional sex work with unsafe sexual practices
2. Community and social isolation result in MSM and transgender women suffering from higher rates of
anxiety and depression which are risk factors for substance dependence and intravenous drug use.
These behaviours preclude meaningful employment and education attainment, trapping them in a
vicious cycle.
3. Inaccessibility to HIV testing and treatment due to fear of stigma even at medical facilities.
Unfortunately, MSM and transgender women suffer “a double whammy” as their sexual practices are
often deemed immoral and being HIV positive deals an additional blow. In 2017, the REDLACTRANS
regional report “Waiting To Die” poignantly highlighted the stigma and violence experienced by
transgender women even at clinics and hospitals, resulting in them walking away without ever
receiving help [11].

Current state of response

Mexico has been providing universal access to ART since 2003, financed by the government’s Catastrophic
Expenditure Protection Fund [12]. At the community level, mobile clinics operating in vans (condonetas)
circulate the redlight districts. They perform free HIV testing and distribute free condoms and injection kits
[13].