Marta Caballero

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

Barreras de acceso al diagnóstico temprano del cáncer de mama en el Distrito Federal y en Oaxaca

Objective. To identify social, cultural and health service barriers that prevent timely access to early detection of breast cancer in two regions: Mexico City Federal District and the state of Oaxaca. Material and Methods. An exploratory cross-sectional qualitative study was carried out in 2008 among women under 25 years of age without pathology, with pathological diagnosis, their male partners and managers of several public and private institutions. Information was collected by focus groups and through interviews that were recorded and transcribed after having received informed consent. Results. Initial exploration allowed the identification of access barriers in three main areas: a) the availability of information for the general population, b) training of firstcontact general practitioners and gynecologists, and c) fears among couples and families. Conclusions. Barriers in the three levels identified are relevant as they reveal important deficiencies in the dissemination of information both to the general population and to health providers.

Las mujeres que se quedan: migración e implicación en los procesos de búsqueda de atención de servicios de salud

OBJETIVO: Analizar los procesos de busqueda de atencion de los servicios de salud en comunidades de alto indice migratorio. MATERIAL Y METODOS: Estudio cualitativo, realizado entre octubre de 2004 y mayo de 2005 en dos comunidades de alto indice de intensidad migratoria internacional en Mexico. Se entrevisto a 60 mujeres companeras de migrantes en dos comunidades (urbana/rural) del centro de Mexico con elevada migracion hacia Estados Unidos. RESULTADOS: En el contexto de la migracion se identifican dos formas de recomposicion familiar: integracion de la mujer a su familia y casos de mujeres solas. La primera mostro mayor apoyo y control para buscar atencion medica, sobre todo en salud sexual y reproductiva. La segunda tiene menor apoyo, pero mayor capacidad para buscar atencion medica, con privacidad e independencia. CONCLUSIONES: La reestructuracion familiar condiciona la busqueda oportuna de servicios de salud en mujeres companeras de migrantes. Las situaciones identificadas funcionan como obstaculos o facilitadores de la movilizacion de recursos para la atencion de la salud.

HIV prevention and men who have sex with women and men in México: Findings from a qualitative study with HIV‐positive men

Unprotected sex between men is the major risk factor for HIV infection in México and many other Latin American countries. There is a substantial body of literature demonstrating that the relationship between sexual identity and sexual practice is not binary or causal — men who have sex with other men do not necessarily perceive themselves as gay — and there is increasing interest in HIV prevention with men who have sex with both men and women. In México, HIV prevention with men who have sex with women and men and who are not socially affiliated or identified with gay men is lacking. This paper explores the sexual histories and HIV‐risk perception of HIV‐positive Mexican men who indicated that they have sex with women in a screening interview and then in the context of an in‐depth interview also reported having had sex with men. We consider the sexual practices and sexual and social identities of these men, examining their explanations for having sex with other men, the strategies used to affirm their masculinity, the management of their sexual identity in their social networks, HIV‐risk perception before diagnosis and sexual practices after diagnosis. Recommendations are made to improve HIV prevention for men who have sex with men as well as women and who do not assume a gay or bisexual identity.

[Relationship between physicians and HIV patients: influence on adherence and quality of life].

OBJETIVO: Analizar factores de la relacion con los medicos que afectan la adherencia terapeutica y la calidad de vida de las personas con VIH/Sida. METODOS: Estudio cualitativo realizado en Mexico en 2003 con informantes reclutados en grupos de autoayuda y organizaciones no gubernamentales de VIH/Sida y servicios de infectologia de hospitales publicos. Fueron entrevistadas 40 personas viviendo con VIH/Sida y cinco lideres de grupos de autoapoyo. Para la recoleccion de datos los informantes respondieron un cuestionario sociodemografico y entrevistas en profundidad sobre la experiencia de vivir con VIH/sida, incluyendo los tratamientos, la percepcion de la enfermedad, la calidad de vida, la salud fisica y emocional y la relacion con los medicos. Las respuestas fueron grabadas, transcritas y organizadas por temas en base a codigos, usando un analisis inductivo. RESULTADOS: La edad de la mayoria de los entrevistados vario entre 26 y 45 anos. Los principales problemas durante la busqueda de atencion se relacionaron con la falta de conciencia de riesgo y de informacion entre las personas viviendo con VIH/Sida y los medicos. Los medicos mostraron falta de capacitacion en VIH/Sida. En la etapa de continuidad de la atencion, los problemas se relacionaron con una adherencia terapeutica deficiente, producto principalmente de la falta de comunicacion con los medicos y de la discriminacion en los servicios publicos. CONCLUSIONES: De manera general se observaron problemas de informacion; falta de capacitacion y paternalismo por parte de los medicos, y estigma social de las personas viviendo con VIH/Sida asociado a la epidemia.

Factors that influence communication about sexuality between parents and adolescents in the cultural context of Mexican families

Sexually transmitted infections and unplanned pregnancy among adolescents are important public health issues that can be tackled through the implementation of effective education strategies. Previous studies have documented the importance and effectiveness of parents as primary educators for their adolescents. A qualitative study based on grounded theory was undertaken in five different public high schools in Mexico and 33 interviews were carried out (18 parents and 15 first-year students). The primary prevention message that parents transmit to their adolescent children is abstinence. Prevention messages that include condom use and emergency contraception are scarce or absent. Promoting safer sexual behaviors among adolescents in Mexico is of critical importance. Nevertheless, the cultural scenario in the country is dictated mainly by a Catholic morality, which makes it difficult for parents to accept the possibility of their children being sexually active. Hence, the transmission of concrete information on the use of contraceptives is limited. Therefore, the challenge is to develop strategies that promote early and constant dialogue about sexuality between parents and children, respecting moral values within the family, but at the same time favoring clear and precise information about modern prevention practices.

El ejercicio de los derechos sexuales y reproductivos: un estudio cualitativo de personas heterosexuales con VIH en México

Objective. To analyze experiences of heterosexual Mexican people living with HIV (PLWHA) related to the exercise of their sexual and reproductive rights. Material and Methods. Qualitative study based on 40 in-depth interviews with PLWHA in four Mexican States. Results. Lack of support and counseling limits the exercise of sexual and reproductive rights by PLWHA, especially women. Principal limitations include feelings of frustration and confusion, fear of re-infection, scanty information, lack of power to negotiate condom use, social stigma and discrimination, and limited access to services and adequate technologies. Conclusion. To increase awareness and exercise of rights by PLWHA it is necessary to: improve sexual education; promote processes of cultural change to combat gender inequality and stigma and discrimination; and provide timely and scientific information about HIV prevention.

Formación de médicos y enfermeras para la detección temprana del cáncer de mama en México

Objetivo Analizar la formacion academica que reciben los estudiantes de medicina y enfermeria sobre el cancer de mama (CaMa) durante el trascurso de su carrera universitaria. Materiales y Metodos Estudio exploratorio realizado en 2009. Basado en entrevistas semi-estructuradas a actores clave y revision documental. Poblacion de estudio: 199 Facultades/Escuelas de medicina y 108 Escuelas/Institutos de enfermeria. Unidad de analisis: plan de estudios. Resultados En 16,8 % de los planes de estudio de medicina y 6,3 % de enfermeria se encontro informacion especifica de contenidos sobre CaMa. La capacitacion que reciben los medicos es predominantemente desarrollada por las areas biomedica y clinica y en menor proporcion en el area socio-medica. En enfermeria los temas que mas se desarrollan son en areas comunitarias, abordando contenidos de promocion de la salud y prevencion de la enfermedad (estilos de vida saludable e identificacion de mujeres con alto riesgo de padecer CaMa). Discusion Se encontro escasa evidencia sobre entrenamiento especifico para la deteccion y atencion del cancer de mama en los planes de estudio. Por los resultados encontrados es necesario fortalecer los curriculos para formar a los futuros profesionales con capacidades para trabajar en la solucion de los problemas y necesidades especificos de salud de la poblacion particularmente en acciones de prevencion primaria y secundariaOBJECTIVE Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. MATERIALS AND METHODS This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. RESULTS 16.8% of the medical courses and 6.3% of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). DISCUSSION Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected populations problems and health needs, particularly regarding primary and secondary prevention.Objective Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. Materials and Methods This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. Results 16.8 % of the medical courses and 6.3 % of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). Discussion Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected populations problems and health needs, particularly regarding primary and secondary prevention.

Fumar entre adolescentes: análisis cuantitativo y cualitativo de factores psicosociales asociados con la decisión de fumar en escolares mexicanos

Resumen: Objetivo: Analizar factores psicosociales asociados con la decision de fumar en estudiantes de entre 13 y 15 anos de edad en la Ciudad de Mexico. Material y metodos: Se utilizaron modelos de regresion logistica de la Encuesta de Tabaquismo en Jovenes (n=945) y cuatro grupos focales (GF) en dos escuelas secundarias, realizada en 2011 y 2012. Resultados: Factores asociados a fumar: a) creer que es seguro (RM=2.4, IC95% 1.28-4.7), GF: capacidad de control sobre consumo y danos a largo plazo; b) tener al menos un padre fumador (RM=1.6, IC95% 1.1-2.3), GF: influyen para iniciar/mantener consumo; c) tener amigos fumadores (RM=5.0, IC95% 1.9-13.6), GF: influyen para experimentacion/repeticion, escuelas sin normas sobre prohibicion y tener acceso a cigarros (RM=2.1, IC95% 0.9-4.1). Factores protectores: a) creer que es danino (RM=0.3, IC95% 0.14-0.65), GF: rechazo a convivencia con fumadores; b) comunicacion con familia (RM=0.5, IC95% 0.36-0.91), GF: apelar al auto-cuidado; c) Considerarse joven para fumar (RM=0.2, IC95% 0.12-0.43), GF: conocimientos sobre danos y percepcion de riesgo. Conclusion: Se deben fortalecer destrezas psicosociales positivas y el cumplimiento de legislacion de proteccion a jovenes.

Doctors and nurses' training for the early detection of the breast cancer in Mexico

Objetivo Analizar la formacion academica que reciben los estudiantes de medicina y enfermeria sobre el cancer de mama (CaMa) durante el trascurso de su carrera universitaria. Materiales y Metodos Estudio exploratorio realizado en 2009. Basado en entrevistas semi-estructuradas a actores clave y revision documental. Poblacion de estudio: 199 Facultades/Escuelas de medicina y 108 Escuelas/Institutos de enfermeria. Unidad de analisis: plan de estudios. Resultados En 16,8 % de los planes de estudio de medicina y 6,3 % de enfermeria se encontro informacion especifica de contenidos sobre CaMa. La capacitacion que reciben los medicos es predominantemente desarrollada por las areas biomedica y clinica y en menor proporcion en el area socio-medica. En enfermeria los temas que mas se desarrollan son en areas comunitarias, abordando contenidos de promocion de la salud y prevencion de la enfermedad (estilos de vida saludable e identificacion de mujeres con alto riesgo de padecer CaMa). Discusion Se encontro escasa evidencia sobre entrenamiento especifico para la deteccion y atencion del cancer de mama en los planes de estudio. Por los resultados encontrados es necesario fortalecer los curriculos para formar a los futuros profesionales con capacidades para trabajar en la solucion de los problemas y necesidades especificos de salud de la poblacion particularmente en acciones de prevencion primaria y secundariaOBJECTIVE Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. MATERIALS AND METHODS This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. RESULTS 16.8% of the medical courses and 6.3% of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). DISCUSSION Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected populations problems and health needs, particularly regarding primary and secondary prevention.Objective Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. Materials and Methods This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. Results 16.8 % of the medical courses and 6.3 % of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). Discussion Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected populations problems and health needs, particularly regarding primary and secondary prevention.