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Assisting HIV-Infected (and other) Patients Who May Return to Mexico (or Central America)

1. Assisting HIV-Infected (and other) Patients Who May Return to Mexico (or Central America). Thursday, February 28, 2013 Los Angeles, CA. Disclosure Information Helping HIV Patients Who May Return to Mexico Tom Donohoe.

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Assisting HIV-Infected (and other) Patients Who May Return to Mexico (or Central America)

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  1. 1 Assisting HIV-Infected (and other) Patients Who May Return to Mexico (or Central America) Thursday, February 28, 2013 Los Angeles, CA

  2. Disclosure InformationHelping HIV Patients Who May Return to MexicoTom Donohoe Continuing Medical Education committee members and those involved in the planning of this CME Event have no financial relationships to disclose. Tom Donohoe I have no financial relationships to disclose -and I will not discuss off label use and/or investigational use in my presentation

  3. Objectives 4 • At the conclusion of this session, participants will be able to: • Review health care delivery systems in Mexico, including those for HIV and other services • Facilitate culturally competent continuity of care for HIV-infected patients returning to Mexico and Central America • Utilize 7 one-page bilingual HIV-referral fact sheets for Mexico and 6 Central American Countries

  4. AETC Warmline: (800) 933 - 3413 PEPline: (888) HIV – 4911 (888) 448 – 4911 Perinatal Hotline: (888) 448 – 8765 http://www.aids-etc.org http://www.AETCBorderHealth.org Tom Donohoe donohoe@ucla.edu

  5. UCLA CHPDP HIV/AIDS Training Programs Delivered in Mexico: 1995- 2005

  6. Which of these US metropolitan areas has the highest PERCENTAGE of Spanish-speaking households? 1) Miami, FL 2) Los Angeles, CA 3) Santa Ana, CA 4) El Paso, TX 5) Las Cruces, NM

  7. The richest private citizen on the planet is currently a man named? 1) Carlos Slim 2) Bill Gates 3) Warren Buffet 4) Ted Turner 5) Charles Delgado

  8. The ‘US/Mexico border region’ is how many miles above the border with Mexico? 1) 5 2) 10 3) 50 4) 62 5) I have no idea

  9. “The Border”

  10. I have had at least 1 patient born in Mexico True False

  11. I can explain how Mexican health care systems work True False

  12. Case 5 Juan is a 23 year-old HIV-infected patient from Mexico who calls the clinic to say he has to return to Mexico in 2-3 days. He does not remember all his medication names, except “Sustiva, 2 colored pills…and Bactrim.” He asks if he can get HIV care in Mexico and shares he has not been there since he was a child. He was born in Zacatecas and tells you he thinks he may have to return there to live with his grandparents.

  13. Questions 6 • Would you be able to connect Juan to HIV care in Mexico? • Why do you think Juan is returning to Mexico? • What other information would you need to assist Juan? Why?

  14. 4) Most Mexicans are covered by the largest health insurance program in Mexico. It is paid for by the employer and is known by the acronym______. IMSS ISSSTE PEMEX RED TOTAL

  15. 7) CAPASITS are _______ HIV/STI care clinics funded through the Secretariat of Health and ______; referral to CAPASITS requires an HIV diagnosis, antiretroviral history, basic labs, clinical summary and a referral from a general medical clinic. Inpatient; CENSIDA Inpatient; PEMEX Outpatient; CENSIDA Outpatient; Seguro Popular None of the above

  16. 3) How many HIV antiretroviral medications are currently available in Mexico? Fewer than 5 Between 5 and 10 Between 11 and 15 Between 16 and 20 More than 20

  17. Overview of the Epidemiology of HIV Infection in Mexico 7

  18. 8 HIV and AIDS in Mexico • Mexican population: 106,500,000 • Cumulative cases of HIV/AIDS at the end of 2005: 182,000

  19. HIV/AIDS Cumulative Cases 9along the U.S.-Mexico Border(as of Dec 31, 2011) Baja Cal Norte: 6,863 Sonora: 2,748 Chihuahua: 6,457 Coahuila: 1,783 Nuevo León: 4,367 Tamaulipas: 3,737 TOTAL: 25,955

  20. 10 Cumulative HIV by Gender From: Update on HIV/AIDS in Mexico, Dec, 2011, General Director, National HIV/AIDS Program (Centro Nacional para Prevención y Control del VIH/SIDA CENSIDA). http://www.salud.gob.mx/conasida Source cited in original slide: CENSIDA based in National AIDS Cases Registry.

  21. 2) In the US, HIV prevalence is .6%, which of the following represents the HIV prevalence in Mexico? .1% .3% .6% 1.8% 2.4%

  22. Mexico’s Adult HIV Prevalence 11 in Regional Context • Mexico 0.3% • United States 0.6% • El Salvador 0.7% • Guatemala 1.1% • Honduras 1.8% • Belize 2.4% From: Update on HIV/AIDS in Mexico, June, 2007, Dr. Jorge Saavedra, General Director, National HIV/AIDS Program (Centro Nacional para Prevención y Control del VIH/SIDA CENSIDA). http://www.salud.gob.mx/conasida Source cited in original slide: UNAIDS. 2004 Report on the global AIDS epidemic, Geneva, 2004

  23. 15 Stigma and Discrimination • “I will not live in the same house with a person… …of a different race” = 40% …of a different religion” = 44% …with HIV/AIDS” = 57% …who is homosexual” = 66% From: Update on HIV/AIDS in Mexico, June, 2007, Dr. Jorge Saavedra, General Director, National HIV/AIDS Program (Centro Nacional para Prevención y Control del VIH/SIDA CENSIDA). http://www.salud.gob.mx/conasida Source cited in original slide: “Encuesta Nacional de Cultura Política y Prácticas ciudadanas 2001”. Revista Cambio, 17 de Agosto del 2002. (National Survey of Culture, Politics and Citizen Practices, 2001, Change Magazine, August 17, 2002).

  24. 17 HIV in the U.S.-Mexico Border Region

  25. 18 U.S.-Mexico Border

  26. 19 U.S. Border Characteristics • 3 of the 10 poorest counties in the U.S. • 21 counties designated as economically distressed areas • Unemployment rate 250-300% higher than U.S. average • 432,000 people live in 1,200 colonias in TX & NM; unincorporated, semi-rural communities, often with unsafe water supplies and substandard housing United States Mexico Border Health Commission, 2008 http://www.borderhealth.org/border_region.php

  27. 20 U.S. Border Characteristics • Higher incidence of infectious diseases compared with U.S. average • If made a state, border region would rank: • Last in access to health care • 2nd in death rates due to hepatitis • 3rd in deaths related to diabetes • Last in per capita income • 1st in number of school children living in poverty • 1st in number of uninsured children

  28. 21 Immigration • 43 points of entry on U.S. border • Nearly 195M passenger vehicle crossings & 49M pedestrian crossings/year at 25 ports of entry • Numbers do not include undocumented crossings • Not all people who enter from the U.S.-Mexico border are Mexican, numbers include people from further south University of Oklahoma Center for Applied Research, 2005. HIV AIDS Along the US Mexico Border

  29. 22 Mexican Immigration • People of Mexican origin make up 29.5% of all immigrants in the U.S. • In 2005, 11 million Mexican immigrants were living in the U.S. • 66% located in the 4 border states • 70% are 18-44 years of age • 59% have no health coverage • 55% are undocumented Conasida 2008: Manual para la prevención del VIH/SIDA en migrantes Mexicanos a Estados Unidos. www.salud.gob/conasida

  30. U.S.- Mexico Border AETC Steering Team Promote high-quality, culturally sensitive education & capacity building programs Provide focused collaboration through joint planning, resource sharing, & evaluation 23 Who Is UMBAST?

  31. 24 Who Is UMBAST? • UMBASTincludes members from 3 AETCs that serve border region: • Mountain Plains AETC (New Mexico) • Pacific AETC (Arizona & California) • Texas/Oklahoma AETC (Texas) • In collaboration with AETC National Resource & Evaluation Centers, HRSA representatives, & others with an interest in HIV and the border

  32. 25 Regional AETCs L

  33. 26 Mexican Health Care Delivery Systems

  34. 27 US Health Care (1968 through 2014) • Guaranteed only for military, prison, and special programs for poor or elderly • Most obtain coverage through an employer, but employers are not required to provide coverage • Employees often must share plan costs •  30 million without coverage often use ER or pay-for-service clinics

  35. 28 U.S. HIV Health Care Funding • Private insurance • Public insurance • Ryan White HIV/AIDS Treatment Modernization Act • Clinical trials • Compassionate release

  36. 29 Mexico: Health as a Constitutional Right • Mexican Constitution establishes the right of health care for all Mexican citizens • Secretary of Health, appointed by the President, oversees Secretaria de Salud • Secretaria de Salud charged with health surveillance, reporting, prevention, and management • Constitution protects migrant populations, indigenous populations, children, youth, women, and agricultural laborers

  37. 30 Secretaría de Salud SSA Secretaría de Salud SSA Secretaría de Salud SSA Health Care Funding Sources Health Services in Mexico L

  38. CONASIDA:Policy-setting body Consejo Nacional para la Prevención y Control del SIDA(National Council for the Prevention and Control of HIV/AIDS) CENSIDA: Funding, care, prevention, & education Centro Nacional para la Prevención y el Control del VIH/SIDA (National Center for the Prevention and Control of HIV/AIDS) 31 HIV Care: A Priority

  39. 32 Seguro Popular • 2001: Secretaria de Salud instituted Seguro Popular insurance program to provide health care coverage to uninsured/underserved populations • 2005: 5.1 million families covered by Seguro Popular • 2007: Seguro Popular becomes law

  40. Seguro Popular> 250 medical interventions covered • Diabetes……….YES (# 78. “Diagnosis and pharmacological treatment of diabetes mellitus 2 (blood sugar)” • TB Treatment…YES • Family Planning Services…YES • STI Treatment (CAPASITS) • HIV Treatment (CAPASITS) • Hepatitis C Treatment…NO http://www.seguropopular.org

  41. 33 AntiretroviralCoverage 28,600 Source: CENSIDA based in National AIDS Cases Registry.

  42. SSA CENSIDA Seguro Popular ISSSTE DIF CRM SM SME IMSS SMM SMP SDN PEMEX Health Services ONG Hospitals & Universities HIV Health Care Funding Sources 34

  43. 35 Major HIV Care Sources • Most public employees: ISSSTE(Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado) • Insured private sector employees: IMSS(Instituto Mexicano del Seguro Social) • Uninsured/Migrant: SSA/CENSIDA(Secretaria de Salud/Centro Nacional para la Prevención y el Control del VIH/SIDA) • Referred to CAPASITS Clinics • Insured under Seguro Popular

  44. 36 CAPASITS Outpatient Center for Prevention and Care for AIDS and Sexually Transmitted Infections • Centro • Ambulatorio de • Prevención y • Atención en • SIDA y • Infecciones de • Transmisión • Sexual

  45. CAPASITS Locations 37 From: National Center for Prevention and Control of HIV/AIDS, Operative Investigation Administration, Mexico Secretariat of Health, (Centro Nacional para la Prevención y el Control del VIH/SIDA Dirección de Investigación Operativa, Secretaría de Salud). http://www.salud.gob.mx

  46. 38 CAPASITS Border Locations • Tijuana (San Diego, CA) • Mexicali (El Centro, CA) • Nogales (Nogales, AZ) • Cd. Juarez (El Paso, TX) • Piedras Negros (Eagle Pass, TX) • Nvo Laredo (Laredo, TX) • Reynosa (McAllen, TX) • Matamoros (Brownsville, TX)

  47. 39 CAPASITS Ciudad Victoria Nayarit La Paz Mexicali Veracruz Zacatecas From: National Center for Prevention and Control of HIV/AIDS, Operative Investigation Administration, Mexico Secretariat of Health, (Centro Nacional para la Prevención y el Control del VIH/SIDA Dirección de Investigación Operativa, Secretaría de Salud). http://www.salud.gob.mx

  48. 40 Referral to CAPASITS • Referral from a general medical clinic • HIV diagnosis • Antiretroviral history • Basic labs • Clinical summary

  49. 42 General medical care HIV care ART treatment Laboratory testing Specialist referrals Dental care Behavioral health services Social work services Adherence counseling STD screening Outreach CAPASITS Services

  50. 43 ARVs in Mexico:full chart available at http://aidsetc.org/pdf/p02-et/et-03-00/mexicodrugs.pdf

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