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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
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
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

objectives 4
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
slide4
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

[email protected]

which of these us metropolitan areas has the highest percentage of spanish speaking households
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

the richest private citizen on the planet is currently a man named
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

the us mexico border region is how many miles above the border with mexico
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

slide12
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.

slide13
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?
slide14
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

slide15
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

3 how many hiv antiretroviral medications are currently available in mexico
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

hiv and aids in mexico
8HIV and AIDS in Mexico
  • Mexican population: 106,500,000
  • Cumulative cases of HIV/AIDS at the end of 2005: 182,000
slide19
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

slide20
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.

2 in the us hiv prevalence is 6 which of the following represents the hiv prevalence in mexico
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%

slide22
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

slide23
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).

slide26
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

slide27
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
slide28
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

slide29
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

slide30
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?

slide31
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
slide32
25

Regional AETCs

L

us health care 1968 through 2014
27US 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
slide35
28

U.S. HIV Health Care Funding

  • Private insurance
  • Public insurance
  • Ryan White HIV/AIDS Treatment Modernization Act
  • Clinical trials
  • Compassionate release
mexico health as a constitutional right
29Mexico: 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
health care funding sources
30

Secretaría de

Salud

SSA

Secretaría de

Salud

SSA

Secretaría de Salud

SSA

Health Care Funding Sources

Health Services

in Mexico

L

hiv care a priority
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
seguro popular
32Seguro 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
seguro popular 250 medical interventions covered
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

slide41
33

AntiretroviralCoverage

28,600

Source: CENSIDA based in National AIDS Cases Registry.

slide42
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

major hiv care sources
35Major 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
capasits
36CAPASITS

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
slide45
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

capasits border locations
38CAPASITS 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)
slide47
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

referral to capasits
40Referral to CAPASITS
  • Referral from a general medical clinic
  • HIV diagnosis
  • Antiretroviral history
  • Basic labs
  • Clinical summary
capasits services
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
arvs in mexico full chart available at http aidsetc org pdf p02 et et 03 00 mexicodrugs pdf
43ARVs in Mexico:full chart available at http://aidsetc.org/pdf/p02-et/et-03-00/mexicodrugs.pdf
slide54
50

slide57
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

slide58
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

slide59
60

Comments, Questions and Answers

Post Test, Evaluation

and Needs Assessment

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