Monday, December 12, 2016

HIV medicines disappear from CAPASITS, IMSS and ISSSTE clinics in México, and patients are discriminated.

HIV is not a death sentence anymore. Well, at least that's the case here in the U.S., where the latest drugs are avalailable for free if you lack access to healthcare. Unfortunately south of the border, in places like Monterrey, Veracruz and México City, the stories of many HIV patients feature disbelief, anxiety, impotence and horror. Following are just a few of them.

In the CAPASITS clinic at the Regional Hospital of Veracruz, 215 bottles of antriretrovirals went missing during the months of August, September and October of this year. The CAPASITS clinics are run by Mexico's federal government, and their acronym stands for "Ambulatory Centers for the Prevention and Care of AIDS and Sexually Transmitted Diseases).

"We inspect the CAPASITS clinics," Patty Ponce Jiménez, president of the Multisectorial Group for Sexually Transmitted Diseases and HIV/AIDS in Veracruz, told me. "We make sure that they have potable water, toilet paper, and the supplies needed for appropriate care. And during our inspections we found out that those 215 bottles were missing."

"And what we immediately did was to ask the Ministry of Health to corroborate our findings, which they did,"  Jiménez continued. "And we demanded legal action against anyone responsible for this crime."

On November 10th, the legal department of Veracruz's Ministry of Health filed a police report, but there is no public update on the investigation. No word on how 215 people were deprived of the drugs that they need to stay alive.

"Now it's in the hands of justice", Ponce informed. "It is in the hands of the Public Ministry of Veracruz, and what we are going to do now is to make sure that these people have their medication".

But the disappearance of antiretrovirals is not the only concern in the State of Veracruz. Some pregnant women living with the virus are denied cesarean sections with the argument that "their children will be born infected anyway." Sometimes files are "lost," and mother-to-child infection, which is 100 percent preventable here in the U.S., becomes a very possible risk in México.

"In the Regional Hospital of Veracruz, pregnant women suffer from obstetrical violence. They are humiliated, insulted and reprimanded for having gotten pregnant, Ponce Jiménez reported. "In general, this hospital provides a service with stigma and discrimination against HIV positive people. Not everyone there, obviously, but we have to be very vigilant and report them."

There are similar irregularities with the delivery of HIV medicine at IMMS and ISSSTE hospitals, the two major providers of state health care in Mexico. IMSS stands for the "Mexican Institute for Social Security," and ISSTE is the "Institute of Security and Social Service for State Workers."

"The lack of medicine at IMSS and ISSSTE is like a culture that cannot be documented," said Abel Quiroga, president of Acodemis A.C., a psycho-educational group that provides support to HIV positive individuals in the northern city of Monterrey.

"There are groups of people living with HIV, where they help each other by sharing their drugs, but they do not file a complaint." Stigma is cited as the main reason for not making a report.

Mexicans living with HIV are also discriminated when they seek employment. A person hired to work as a police officer for the Ministry of Public Safety went to the ISSSTE clinic in Nuevo León (ISSSTELEON) in 2014 for a physical check. There, the employee told him that he was HIV positive, and that for that reason it was not possible for him to get the job. The health worker also told him that he was a person of high risk, and that "people with that virus, the only thing that they do is spread the disease."

The rejected officer filed a complaint with the State Commission on Human Rights, and last month, the institution issued a recommendation. The document says that ISSSTELEON denied it access to the patient's file, but that "it recognized that he had tested positive, and that he was not healthy or employable," without stating on which basis it made such decision.

"The resolution issued by the Institute (ISSSTELEON) in relation with the health of the person lacks grounds, and therefore it constitutes an arbitrary act that is discriminatory. Practices that undermine the human rights of people are pervasive within ISSSTELEON, and in this case it was the right to social benefits."

"The obligation of the State," the recommendation adds, "is to combat and supress discriminatory acts, and to issue norms and measures that recognize, and above all, assure the effective equality of all people before the law. Because an act that lacks objective and reasonable justification is discriminatory."

Patients Without Drugs Take to the Streets 

On January 21st of this year, 50 patients wearing masks staged a demonstration outside of the Gabriel Mancera Hospital in México City. Desperate because of their situation, some patients have taken to the streets, demanding that their prescriptions be filled.

Photo: Mexican Movement of Positive Citizenry
"There are some of us that are left sometimes without medication for months," Flor Nájera, one of the protesters, told Proceso magazine. "Our drug cocktail consists of three medicines. If we only take one, it has no effect."

 "The authorities from IMSS and ISSSTE are violating our right to life daily, and systematically," Georgina Gutierrez, the organizer of the protest, also told Proceso. Gutierrez, who is president of the Positive Citizenry Mexican Movement, denounced that  "with cynicism, they tell us at the pharmacies that they do not have the drugs, but in their database they check them as delivered."

With corruption out of control in this country, who knows what is going on with the care of HIV positive people, but the Mexican government  always says that there is enough supply of drugs. In real life, however, there is proof that something is happening once the medicine is delivered to IMSS, ISSSTE and CAPASITS.
We hope to get prompt answers to the problems in Veracruz, Monterrey and Mexico City. Who took the medicine? What did they do with it, and what are the reasons why this is happening? Why are patients with HIV treated inadequately by being denied the basic tests that are required for their condition?

Inspections mechanisms, such as those in place in Veracruz, need to be present throughout the country to make sure that the drugs are being given to the people who need them. Effective action must be taken to decrease stigma, and to encourage patients to report any abuse.

"And I would like to say that the proper care of an HIV positive person is not just the delivery of the antiretrovirals." Quiroga tells me that patients from the CAPASITS, IMSS and ISSSTE clinics in Monterrey do not get the proper maintenance care. (Remember, these clinics are all run by the Mexican state). "They have to get CD4 and biometric tests done regularly. They have to get all the recommended vaccines, and IMMS, CAPASITS and ISSTE are not offering these services in a proper manner."

Patients who are being denied their medicine or are victims of discrimination are asked to contact Ricardo Hernandez Forcada, director of the HIV program at the National Commission on Human Rights. His email is, and the phone number is 5377-3575, in México City. "People need to make a report. The problem is that they do not complaint," Ponce Jimenez emphasized.

Link to Spanish story.

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