HIV/AIDS mortality rates show no improvement in Mexico:
'lack of patient adherence'
"Because of the shame of HIV infection, people are afraid to be tested.....patients are not diagnosed until the disease is very far advanced.....These patients may continue to unknowingly infect other people and will not receive the necessary treatment to control their disease until it is too late for it to be effective......even patients who are diagnosed HIV-positive early on are not always notified in a timely manner, which means that their treatment is often delayed........the backlog for notifying infected patients can be as long as three or four years...... opportunistic infections such as tuberculosis and hepatitis are not being given the importance they deserve"|
Mar 02, 2009 (The News - McClatchy-Tribune Information Services via COMTEX) --
Despite an increased availability of antiretroviral drugs, the rate of mortality among HIV/AIDS patients in Mexico has remained relatively steady over the course of the last 12 years, according to experts at the National Institute of Public Health, or INSP.
"In 2008, there were 6,747 new cases of HIV infection detected in Mexico, and 5,093 people died as a result of the virus," said JosAc Antonio Izazola Licea, director of the National Center for the Prevention and Control of HIV/AIDS.
But while the overall number of new cases dropped by nearly 1,000 between 2007 and 2008, the percentage of HIV deaths has remained nearly constant, Izazola Licea said.
In 2005, for example, there were about 6,500 new reported cases and nearly 4,500 deaths.
"Since there is now almost universal availability of antiretroviral medications," he said, "we would expect the percentage of patients dying from the virus to be much lower, and for there to be a steady decline in the ratio."
Unfortunately, he said, "that is just not the case."
In fact, according to a report published by the INSP late last year, AIDS and AIDS-related diseases represent the 16th leading cause of deaths in Mexico, and the fourth highest cause among men between the ages of 25 and 34.
That report says that Mexico now ranks third in the Americas in the total number of registered HIV cases, with more than 124,500 cumulative cases since the first recorded incidence in 1983.
DRUGS OFTEN INEFFECTIVE
Preliminary studies in the early 1990s by both the Health Secretariat and the INSP suggested that a greater availability of antiretroviral pharmaceuticals in the country would help to stem fatalities from the virus, Izazola Licea said.
The government implemented a program guaranteeing universal access to the antiretrovirals in 2004.
However, Izazola Licea said, while there has been a noticeable decrease in the annual number of confirmed cases since that legislation, the death rate among HIV/AIDS patients has remained disquietingly stable.
Izazola Licea said that main reason that the mortality rate has not dropped significantly is due to the lack of patient adherence.
"The drugs are available and economically accessible for almost every person who has been confirmed to be infected with HIV," said Stefano M. Bertozzi, acting executive director for the INSP's Center for Evaluation, Research and Surveys.
"However, if a patient does not adhere 95 percent or more to the rigorous drug therapy regimen, the medication just isn't going to be effective," he said
Without strong clinical and family support, Bertozzi said that it is "extremely difficult" for patients to meet that degree of adherence.
Another problem with reducing HIV/AIDS mortality is that the condition still carries a severe social stigma, Izazola Licea said.
"There has to be a continued program of public education and social awareness to discourage discrimination and homophobia," he said.
Because of the shame of HIV infection, people are afraid to be tested.
As a result, Izazola Licea said many patients are not diagnosed until the disease is very far advanced.
These patients may continue to unknowingly infect other people and will not receive the necessary treatment to control their disease until it is too late for it to be effective.
PUBLIC HEALTH MEASURES NEEDED
Izazola Licea also said that because of bureaucratic snags and communication breakdowns, even patients who are diagnosed HIV-positive early on are not always notified in a timely manner, which means that their treatment is often delayed.
ecording to Izazola Licea, in some areas of the country, the backlog for notifying infected patients can be as long as three or four years.
Another concern among HIV/AIDS specialists in Mexico is the fact that opportunistic infections such as tuberculosis and hepatitis are not being given the importance they deserve, Izazola Licea said.
"These conditions are intrinsically linked, and about 5 percent of all HIV-positive patients will test positive for tuberculosis," said Carlos del Rio, clinical director of the HIV program and division of infectious diseases at Emory University in Atlanta, who is currently in Mexico working with the INSP on AIDS research.
"We have to treat and prevent opportunistic diseases if we are going to be successful in slowing the tide of HIV," he said.
Izazola Licea also said that it is especially important to ensure that pregnant women are checked and treated for HIV in order to prevent mother-child infections.
Currently, about 18 percent of confirmed HIV cases in Mexico are of female patients, most of whom contract the virus through heterosexual relationships.
"With the right medications and prenatal care, we can avoid infant contagion," Izazola Licea said.
But Luis Xochihua Diaz, head of the HIV/AIDS clinic of the National Institute of Pediatrics, said that only about 25 percent of the infants who die of HIV infections or complications are properly diagnosed.
"There are a lot more infant deaths from HIV than are reported," he said, "and there are a lot more people infected with the virus than are registered."
LEARNING FROM PAST SUCCESSES
Both Izazola Licea and Bertozzi were quick to point out that Mexico has been successful in some areas of HIV prevention, including through the implementation of a "Sangre SegurO ("Safe Blood") program as early as 1986. This forbid the commercialization of blood and drastically reduced infection via transfusions.
Also, they noted that the Health Secretariat implemented a program openly encouraging condom use as early as 1987, no easy task in a predominantly Catholic country.
Last August, Mexico hosted the 17th International AIDS Conference.
"We have made great strides in combating the spread of HIV/AIDS," said Bertozzi, "but now we need to be even more aggressive and take a new approach concentrating on the long-term treatment of the problem."
Now that HIV infection is a treatable condition rather than an unavoidable death sentence, del Rio said, the primary goals must be prevention and research.
"We need to look beyond just providing medication to treat HIV," Bertozzi said.
"We need to concentrate again on prevention."
But while provisions in a 2000 Health Secretariat outline for AIDS control stipulate that Mexico should be spending more than 2.5 billion pesos this year in prevention, there are only about 100 million pesos available for that area.
By the year 2012, Izazola Licea said, the government will need to invest 5.6 billion pesos in prevention.
"It's time to rethink how we deal with the virus in Mexico," Bertozzi said.
"We need new programs that focus on prevention, improved training for medical personnel and more public awareness."