AIDS Alert International

HIV treatment continues to progress in Mexico

Ministry of Health director discusses advances

[In this interview with AIDS Alert, Jorge A. Saavedra, MD, director general of the National Center for Prevention and Control of HIV/AIDS (CENSIDA), Ministry of Health in Mexico, discusses his nation’s HIV epidemic and response. Saavedra spoke by telephone during a recent trip to Washington, DC, where he met with the U.S. Congress and President George W. Bush’s administration to discuss AIDS-related issues in Mexico.]

AIDS Alert: How widespread is the AIDS epidemic in Mexico, and what is being done with regard to testing?

Saavedra: "We have a low prevalence rate. When you think about the number of people living in Mexico, we are more than 100 million; the numbers of people living with HIV or even those who develop AIDS are large.

"We’re the second country in Latin America with the largest number of people living with HIV. So sometimes just thinking about the prevalence rate doesn’t tell you the whole story about the numbers of people suffering from HIV/AIDS.

"In all cases, we have two numbers that we want to show you: One is the official number of AIDS cases that have been registered, and this is 90,043 AIDS cases since beginning of epidemic in Mexico in 1983. The other number is the people estimated to be living with HIV, while some of them already know they are living with HIV, most of them don’t know they have HIV, and this number is 230,000.

"So those numbers are very large even though the prevalence rate might be seen as low."

"We still have a lot to do in terms of testing; and right now we’re really worried about the migrant population, because recent studies that we are doing with the University of California, Los Angeles are showing us that the prevalence rates for migrants — and when we say migrants in Mexico, we’re talking about Mexican people who come to the United States — prevalence rates for them is five times higher than the rest of the adult population in Mexico. So that means we need to do something in terms of prevention.

Mobile populations present a challenge

"Another big issue for us is we’re starting to work with Central American countries. Just a few months ago, we were helping the Central American countries to submit a proposal before the Global Fund to get some HIV/AIDS prevention in Central America. Most of [the people in Central America] when they are trying to reach the United States, go across Mexico, and they do it through Guatemala.

"With mobile populations, it’s hard to do prevention programs mostly. Of course, our concern is most of Central American migrants will go to the United States, and most of them won’t make it into the United States and will stay in Mexico.

"The prevalence rates in Central America are higher than in Mexico, so that’s a concern for us because our prevalence rate will [grow] higher; not just because of new infections, but also because people are living longer.

"This is due mostly to [the fact that] the government of Mexico has provided free antiretroviral therapy and universal access to all who need it. So that means that people fortunately will have the opportunity to live more years but also the prevalence rate will increase, of course.

AIDS Alert: How does your universal access to HIV treatment work?

Saavedra: "We’ve had universal access for one year. That’s for people who have health insurance, in Mexico — the Social Security.

"The only thing [HIV-infected people] need is go to a public institution and have their lab tests in order to know if they need antiretroviral therapy.

"We at the National AIDS program used national guidelines for the use of antiretroviral therapy. So they need, for example, not only to have an HIV-positive test, but they also have to have less than 350 CD4 cell count.

"If they have anything less than 350 they can access the free access program; or even if their count is above 350 CD4 cell count, but they have a viral load above 50,000, they can enter the antiretroviral program.

"It’s just for Mexican citizens; we don’t have budget for migrants in Mexico. To continue on antiretroviral therapy they need to be legally staying in Mexico. For a poor country, we don’t have enough budget to provide antiretrovirals to migrants."

AIDS Alert: What is the face of your HIV epidemic? Is it primarily men spread through heterosexual sex?

Saavedra: "Right now 84% [of the epidemic] is men.

"There were a lot of women infected at the beginning of the epidemic, but they were mostly infections acquired through blood transfusions. They were the most affected mostly because a lot of women were receiving blood transfusions after birth, after delivery of the baby. Right now transmission from blood transfusions is almost under control in Mexico; and the transmission from mother to child, the trend is lowering every year.

"And we still have a big challenge of sexual transmission of HIV, mostly with men, although 60% of the epidemic in women are women who are normal housewives who are infected through their partners; they were faithful all their lives, and they were infected through their partners, husbands."

AIDS Alert: So you believe the epidemic is mostly caused by men who have sex with men?

Saavedra: "Yes, definitely. We have a low number of cases related to injection drug users (IDUs). In Mexico we have a lot of problem with drug users, but probably because of people using [cocaine] in Mexico, they don’t use needles. So that’s why we have a low number of people who got infection through needles.

"[IDU transmission] is important in the border cities. At least all the cases we have from people who got the infection through needles are mostly coming from Tijuana, Mexicali, and some other border cities."

AIDS Alert: Starting universal access must have been very costly. Has your country also increased its funding of prevention?

Saavedra: "We’re mostly accepting all prevention initiatives that come from abroad and come from different organizations and institutions and also aid from other governments because most of the government funds are directed to antiretrovirals, which is very costly.

"We pay around $5,000 per patient per year just on medication, and that’s from the federal government funds. The state governments are in charge of providing the lab tests and also to do prevention programs. However, the governments of the 32 states really have a lack of resources. Sometimes, they have a terrible time trying to invest in prevention.

"We know the most important thing is prevention, but the emergency right now is to save lives, and that’s why we’re directing most of our resources into providing antiretrovirals."

$5,000 per patient?

AIDS Alert: Last year, there were international organizations that were very concerned that Mexico and other Latin American countries were not able to get the best rates they could for purchasing antiretrovirals; $5,000 per patient seems high when in India it’s much less.

Saavedra: "If you go to Honduras, they got antiretrovirals for $300 to $400 per patient per year, and we’re paying $5,000 per patient per year. But it’s mostly because the pharmaceutical industry says that Mexico is better off so we can pay more. But we have a larger number of AIDS cases, so that’s big challenge for our budget. We have had negotiations with the pharmaceutical industry to get better prices, and that’s why do a centralized cost system for antiretrovirals. We had antiretroviral therapy three years ago that was almost $10,000 per patient per year, and we are paying now half that price.

"Even so, we are hearing we’re still paying more than most developing countries are doing. Also, we have laws that protect patents, so we cannot just say I’m going to copy that medication and produce it in a cheaper way. Some countries in the developing world will do that, but we cannot do that because the laws protect patents of all these new drugs."

AIDS Alert: Is that part of your mission here to talk to American officials about helping Mexico get cheaper drugs?

Saavedra: "That could be one part, but mostly this time I came here to work on what has to do with the training of physicians and training of people with HIV to get better response with antiretroviral therapy. And we are going to do a forum, a North American forum for treatment at the end of this year. The National Minority AIDS Council [based in Washington, DC] is having this forum each year in the United States, and Mexican participants are asked to come here. So we say, let’s have it this time in Mexico, and so we’re hosting it at the end of this year in the city Juahaco, southeast of Mexico City.

"This is a way of training people and physicians; and of course, we want to see that we can share and obtain some funds to do more work in Mexico, since most of our budget is going toward antiretrovirals."

AIDS Alert: You’ve said your prevention mainly is coming from grants from other countries. How extensive is your prevention program, and are you confident your prevention program is as good as prevention in other countries that have held the epidemic stable?

Saavedra: "We’re kind of stable in the number of new infections each year. There are 4,000 new infections each year — around 4,000 people are diagnosed with AIDS. However, we’re not satisfied with that.

"We know there is need for more testing in Mexico. It’s voluntary testing, and there are some groups that are higher on risk, and we should be having more testing services free of charge. One of these groups is the migrant population, and we’re concerned about it. Other groups we’re concerned about are men who have sex with men, and discordant sex partners of people infected with HIV."

AIDS Alert: In talking with Mexican health officials before, they’ve brought up that the Catholic Church is an obstacle to condom distribution?

Saavedra: "We have condom distribution. Our policy is we’re addressing a public health problem and are focusing condom use on people who have sex. We’re not telling people to have sex; we’re telling people who have sex to use protection. We’re promoting use of condoms among people who are having sex, so that’s a different kind of focus.

"There are some groups who, of course, will oppose, but we’re not discussing moral values. That’s not our goal or duty. We’re not going to side about those issues. We’ll respect people who promote abstinence and be-faithful strategies, and we think it’s good for those points of view, but if you are having sex, protect yourself and use a condom."