Mario Bronfman

Migration and AIDS in Mexico: An overview based on recent evidence

Objectives:Provide an overview of the relation between migration to the United States and AIDS cases in Mexico. Characterize the sexual behaviors of Mexican migrants. Describe HIV/AIDS prevention and clinical attention actions developed. Methods:The following were analyzed: AIDS cases databases, various prevalence studies, the migrants survey, and information of the Ministries of the Interior and of Health. A documental analysis was undertaken of works published between 1992 and 2000 on migration and AIDS. Results:In terms of their sexual practices, migrants in the past year had more sexual partners, tended to use a condom in their most recent relation in greater proportion, and had greater use of injected medicines and drugs. Two bi-national programs undertake epidemiological surveillance activities, while several initiatives have used innovative formats to provide prevention information to migrants. Imminent universal coverage leaves the challenge to assure quality of attention for migrants. Conclusions:Studies to evaluate the impact of international migration on distribution of infected persons will be indispensable to establish priorities in prevention and attention among migrants. More information is needed on bi-national health projects to understand the impact they may have in prevention, while continuity of the prevention initiatives must be guaranteed. Attention to migrants in bi-national contexts requires information exchange agreements on migrants living with the HIV/AIDS.

Mobile populations and HIV/AIDS in Central America and Mexico: research for action

Objective: To present a multi‐centre study that analyses the socioeconomic, cultural and political contexts that give rise to population mobility, and its relationship to vulnerability to sexually transmitted infections (STI)/HIV/AIDS, in order to provide information that can be used to design appropriate and focused interventions. Methods: In each of 11 transit stations (border towns, port cities, areas where mobile populations congregate) in Central America and Mexico, a household survey of the local population was conducted to analyse demographic, socioeconomic characteristics, and information known and opinions held about HIV/AIDS and mobile populations. In‐depth interviews with key informants, community members and mobile populations were held to ascertain knowledge about prevention and transmission of STI/HIV/AIDS. Likewise, an ethnographic study was undertaken to identify interactions between local and mobile populations. Results: The transit stations share low educational levels among the local population, few public services, repeated human rights violations, violence, poverty and corrupt authorities. Within this social context, transactional sex, sex for survival, rape and non‐professional commercial sex happen in conditions that increase the risk of the transmission of STI/HIV, such as infrequent condom use. Migrant women and sex workers are particularly vulnerable in this context. A wide gap exists between information about STI/HIV transmission and reported prevention practices. Conclusion: Given the conditions that exist in these transit stations, interventions should be multisectoral, sustainable, and should defend the human rights of various groups, including women and people living with HIV/AIDS.

El estigma asociado al VIH/SIDA: el caso de los prestadores de servicios de salud en México

Objective. To analyze the social construction of stigma and discrimination processes associated with HIV/AIDS and people living with HIV/AIDS (PLHA), based on the perceptions of health care providers in three states of the Mexican Republic. Material and Methods. Qualitative and quantitative description. Observation at nine institutions; in-depth interviews (14) and surveys (373) directed to providers of health services. Results. Seventy-five percent of providers reported having received training related to HIV/AIDS; however, notions persist as to patients being hopeless; discrimination due to the idea of risk groups; the immediate identification of living with the virus, having the syndrome and death; and specific lack of knowledge of forms of transmission. Twenty-three percent would not buy food from a PLHA and 16% think they should be banned from public services. With respect to confidentiality: 89% believe it should be maintained and 38% think that employers and administrators have the right to know about their employees’ condition. Isolation, notes in clinical histories pointing to HIV, obligatory testing and delays in surgeries for PLHA were constant practices. The perception that men who have sexual relations with men and sexual workers decide their sexual practices marks the division between innocent victims and guilty ones, which determines the stigmatization and dis

Aceptabilidad de los suplementos alimenticios del programa Oportunidades

Objective. To identify cultural beliefs and practices to evaluate the acceptability of dietary supplements of Oportunidades Program. Material and Methods. Ethnographic study with in-depth interviews (n= 43) ‐mothers of children less than five years of age and pregnant and breasfeeding women (PBW)‐, key informants (n= 9); focus groups (n= 8) and direct observation, in four communities from North, Central, South and Southwest of Mexico. Results. The supplement was prepared in several different ways. The liquid preparation was best accepted; generally the supplement was mixed with milk. Initially, the supplement caused nausea, vomiting and diarrhea, but these symptoms disappeared with continued consumption. Acceptance was highest among PBW. Conclusions. The supplement tends to replace milk as a food product in the daily diet. There is a necessity to develop culturally specific evaluations in regions with different food intake practices. The study results should be interpreted in the context of other program components, such as health care and education.

¿Qué se hace para no morir de hambre? Dinámicas domésticas y alimentación en la niñez en un área rural de extrema pobreza de México

Objective. To describe and compare household dynamics in terms of structure, beliefs and nutrition-related behavior in the homes of malnourished and well-nourished children less than five years of age. Material and Methods. The authors carried out a qualitative ethnographic study using participant observation, and in depth interviews. Interviews were conducted with the child’s caretaker or key informants, prior oral informed consent. Child care and childhood feeding practices at home and in the community were the focus of observations. The study included two periods of field work conducted in 2001, in three rural municipalities from the Rio Balsas region, in Guerrero state, Mexico. The study’s ethical and methodological aspects were approved by the National Research Commission of the Mexican Institute of Social Security. Results. Households were differentially characterized by number of members, composition, type of relationship, source of income, and interactions among household members and with the community. Conclusions. Monoparental structures, in an early stage of the household cycle, give rise to conditions that render the child prone to malnutrition. Extended family structure represented more favorable household dynamics.