Estimating the effectiveness of self-help groups on the adoption of secondary preventive measures by people living with HIV in Central America, 2012.

BACKGROUND: According to UNAIDS, the HIV epidemic has stabilized. This as a result of increased condom use and greater access to coverage for antiretroviral therapy (ART). In Central America, civil society organizations work with self-help groups (SHGs) organized in conjunction with public health services to implement interventions seeking to increase condom use and ART adherence for people living with HIV (PLH). METHOD: To analyze the effectiveness of SHGs in Central America aimed on increasing condom use and ART adherence in PLH, We conducted a cross-sectional study using a questionnaire and a random sample of 3024 intervention group and 1166 control group. Based on propensity scoring and one-to-one matching (with replacement), we formed a comparison group to help estimate the effectiveness of the above-mentioned intervention on two outcome variables (condom use and ART adherence). The internal consistency of the results was tested through weighted least squares (WLS) and instrumental variable (IV) regression. RESULTS: Although bivariate comparisons yielded differences between intervention and control group, we found no evidence that the intervention was effective; nor did we find evidence of a heterogeneous impact among countries after adjusting for propensity scoring and the IV model. The impact observed after performing raw comparisons of the indicators may be attributable to self-selection on the part of PLH rather than to the SHGs strategy. Our results demonstrate that it is imperative to use rigorous intervention evaluation methodology to validate the consistency of results. CONCLUSIONS: The intervention had no impact on the outcome indicators measured. We recommend prioritizing the allocation of economic resources for the implementation of interventions with previously proven effectiveness. We also recommend that future studies explore why the intervention failed to produce the expected impact on condom use and ART adherence.

Rape, transactional sex and related factors among migrants in transit through Mexico to the USA.

Migrants in transit through Mexico to the USA are at risk of violence, including sexual violence, during the immigration process. This study sought to identify the socio-demographic factors, migration experiences and health conditions associated with the likelihood of sexual violence. A mixed methods study was conducted between 2012 and 2015. The quantitative phase of the work involved a non-random sample (n = 3539) of migrants who were the users of migrant shelters in Mexico. A probit regression model was used to identify the variables associated with the experience of sexual violence by participants. A total of 58 semi-structured interviews took place with migrants who had either experienced sexual violence or who were acquainted with the sexual violence experienced by other migrants. Of those who experienced any kind of violence, 5.7% reported having experienced sexual violence, with statistically significant differences by gender. According to male migrants, women in transit had the advantage of having an 'entry ticket [to the USA] between their legs'. The dynamics of undocumented transit migration provide multiple opportunities for gender-based inequality and sexual violence. We consider the major underreporting of sexual violence due to the stigma and normalisation of violence, in a social context marked by impunity.

Social inequality in sexual and reproductive health in Ecuador: an analysis of gaps by levels of provincial poverty 2009-2015.

BACKGROUND: Adequate access to sexual and reproductive health services is associated with better results. Analyzing the differences in access and outcomes of sexual and reproductive health (SRH) by share of poverty at the regional level makes it possible to measure the magnitude of the challenge of inequity. This paper aims to estimate the magnitude of health inequality in SRH in Ecuador for the period 2009-2015. METHODS: This study analyzed health inequalities in sexual and reproductive health indicators (obstetric and abortion complications, caesarean and home deliveries, adolescent fertility, and maternal mortality) for 2009 and 2015 comparing provinces in Ecuador. The absolute and relative gaps were estimated between provinces grouped by the percentage of individuals in multidimensional poverty; the slope index of inequality and the relative index of inequality were estimated as measures of gradient; and finally, the concentration index was also estimated. RESULTS: The analysis identified that obstetric complications, abortion complications, and cesareans have tended to increase from 2009 to 2015, without relevant differences between provinces ordered by poverty. Adolescent fertility decreased in the country as well as the inequality in its distribution among provinces: the CI was - 0.046 in 2015, down from - 0.084 in 2009. Home deliveries as a ratio of total deliveries have a decreasing trend with mixed results in terms of inequality: while there is a decrease in the absolute gap from - 211.06 to 184.4 between 2009 and 2015, the concentration index increased from - 0.331 to - 0.496. Finally, the maternal mortality rate increased in the period, also with greater inequality: from an absolute gap of - 39.30 in 2019, up to - 46.7 in 2015. In the same direction, the CI went from - 0.127 to - 0.174. CONCLUSIONS: Ecuador faces major challenges in terms of both levels and inequalities in SRH outcomes and access to services. These inequalities related to poverty highlight the persistence of social inequities in the country. These health inequalities affect the wellbeing of Ecuadorian women but they are amendable. There is a need for pro-equity interventions, with stronger efforts in areas (provinces) with larger socioeconomic vulnerabilities.

[Population mobility and HIV/AIDS in Central America and Mexico]. / Movilidad poblacional y VIH/sida en Centroamérica y México.

OBJECTIVE: Estimate the magnitude of the association between population mobility, measured by net migration rate (NMR), and HIV prevalence in Central America and Mexico. METHODS: Using time series models, based on public information from UNAIDS, UNDP, ECLAC, and the World Bank for the period 1990-2009, this association was studied in individuals aged 15-49 years, and adjusted for socioeconomic factors (education, unemployment, life expectancy, and income). RESULTS: NMR was negative in all countries except Costa Rica and Panama. Unadjusted results of the model show a positive association and that NMR can explain 6% of recorded HIV prevalence. When socioeconomic cofactors are included by country (education, health, and income), the magnitude increases to 9% (P<0.05). NMR, even when adjusted for socioeconomic factors, explains some of recorded HIV prevalence. All socioeconomic indicators show improvements in Central America and Mexico, although large gaps persist among countries. CONCLUSIONS: The modest association observed between population mobility and HIV prevalence is conditioned by the socioeconomic status of the countries studied. Information availability limited the study's ability to establish the existence of this association with greater certainty. Accordingly, based on available information, it is not possible to affirm that migration plays a key role in the spread of HIV.

Technical Efficiency of Mexico's Public Health System in the Delivery of Obstetric Care, during 2012-2018.

The objective of this study was to evaluate the technical efficiency of Mexico's public health system in the delivery of obstetric care from 2012 to 2018. A multi-stage quantitative study of the public health institutions responsible for 95% of the system's obstetric services was conducted using data envelopment analysis. The efficiency of state-level productive units (decision-making units, or DMUs) was calculated and juxtaposed with the DMUs' maximum (0.82) and minimum (0.22) scores. Using the outcomes of the initial stage, the average technical efficiency of each institution at the national level was estimated and compared. The results were also utilized to estimate and compare the average efficiency of each state-level health system based on economic characteristics (state GDP per capita). Outputs included prenatal visits and deliveries, while inputs comprised gynecologists, exam rooms, and delivery rooms. Institutional efficiency ranged from 0.16 to 0.82, with an average of 0.417. The Ministry of Health (0.82) and the Mexican Social Security Institute (0.747) exhibited the highest efficiency scores, while the remaining institutions (Institute for Social Security and Services for State Workers [ISSSTE]; Mexican Petroleum [PEMEX]; the Secretary of National Defense [SEDENA]; and the Navy [SEMAR]) scored below the health system average. Of the 153 DMUs, 20% surpassed the maximum (0.82) and 40.6% fell below the minimum (0.22). These findings indicate that 80% of DMUs have unused operational capacity that could be utilized to enhance technical efficiency. No relationship was found between efficiency and the GDP of Mexico's 32 politico-administrative divisions. The efficiency gap between institutions (0.66) shows that while some DMUs are saturated (exhibiting high efficiency scores), the majority have unused operational capacity. Leveraging this untapped capacity could address the needs of vulnerable populations facing restricted access due to health system fragmentation.

[Sexually transmitted infections: profile of care in border areas of Central America (2007-2010)]. / Infecciones de transmisión sexual: Perfil de atención en zonas fronterizas de Centroamérica (2007-2010).

OBJECTIVE: To analyze the profile of care for sexually transmitted infections (STIs) in health centers in border areas of Central America during 2007-2010. MATERIALS AND METHODS: Cross-sectional study in a sample of 3 357 patients. Doctors were trained and medicines, condoms and HIV testing (basic package of care [BPC]) were supplied. Sample was characterized according to sociodemographic variables. Factors associated with the probability of receiving the BPC were identified. RESULTS: Sixty six percent were 25-59 years old, and 93.2% were women. The most frequently diagnosed syndrome was vaginal discharge associated with candidiasis, bacterial vaginosis, trichomoniasis and gonorrhea. Sixty six percent of prescriptions were adhered to the international recommendations. Only 10% received the complete BPC.The likelihood of receiving it was lower in women. CONCLUSIONS: It is not enough to increase service delivery capacity to change care practices. These are deeply rooted in the sociocultural context. Highlights gendered medical practices that adversely affect the profile of care.

[Persisting health and health access inequalities in Mexican indigenous population, 2006-2012]. / Inequidad persistente en salud y acceso a los servicios para los pueblos indígenas de México, 2006-2012.

OBJECTIVE: To analyze socioeconomic, health conditions and access to health services of Mexican indigenous population between 2006 and 2012. MATERIALS AND METHODS: A comparative analysis was done between indigenous and non indigenous population, using the information from th National Health and Nutrition Survey (2006 and 2012). RESULTS: 60% of the indigenous population was allocated at the poorest socioeconomic level in 2012 despite the implementation of social programs. The Seguro Popular increased its coverage from 14 to 61.9% in indigenous population. The increase observed in coverage in no indigenous population was from 10 to 35.7%. Nevertheless, no increase was observed in the utilization of healthcare services between indigenous and non indigenous population. The access to hospital services for childbirth delivery increased from 63.8 to 76.4% in indigenous population. However there is an important difference with non indigenous population (93.9%). CONCLUSIONS: The increase in the coverage of the Seguro Popular in Mexico has had heterogeneous results in the utilization of health care services. Other social programs such a Oportunidades have not had an impact to alleviate poverty in indigenous groups.

[STI and HIV prevention in female sex workers at border communities in Central America]. / Acceso a servicios de prevención de ITS y VIH en trabajadoras sexuales en zonas fronterizas de Centroamérica.

OBJECTIVE: To analyze access to STI and HIV prevention services for female sex workers in border communities of Central America. MATERIALS AND METHODS: A quasi-experimental study was carried out in a non-random sample of 558 sex workers, in border communities with and without prevention interventions related to information on human rights, sexual behavior and access to information on prevention/transmission, condoms, HIV testing, contraception, healthcare and condom use. A descriptive analysis of these variables was done and a logistic regression model was used, in order to identify factors associated with condom use. RESULTS: Female sex workers of communities with intervention had greater access to information on prevention (99 vs 87%), condoms (98 vs 75%), HIV testing (89 vs 61%), contraception (74 vs 65%), gynecological services (83 vs 57%), and condom use with clients, 3.9 (IC:1.2-12.7), compared to workers in communities without intervention. CONCLUSIONS: The observed differences must be considered in a more general framework related to sociocultural characteristics and population mobility in border contexts, as well as to the organization of healthcare services.

[Prevention of HIV among youth from Central American border communities]. / Prevención de ITS/VIH en jóvenes de comunidades fronterizas de Centroamérica.

OBJECTIVE: To examine factors associated to prevention, STI/HIV medical attention and respect for people living with HIV/AIDS (PLWHA) among youth in Central American border communities. MATERIALS AND METHODS: Cross-sectional analysis of a non-probabilistic sample (n=716) in border communities with and without preventive and medical care STI/ HIV interventions. Variables associated with having access to information, respect to PLWHA; HIV/STD tests, condom use and medical care were identified. RESULTS: Youth in communities with interventions have higher levels of information regarding STI/HIV, attitudes of respect toward PLWHA (94.1 vs. 75.3%) and access to HIV tests (50.8 vs. 14.7%). 52% of youngsters had intercourse. Condom use was higher among those who participated in preventive actions (60.5 vs. 50.9%) and those with international mobility (70.6 vs. 51.9%). 8.8% had STI symptoms; only 55% sought medical attention. CONCLUSION: Community interventions are associated with higher levels of information, respect for the rights of PLWHA and access to tests among youth; condom use is related to direct participation in program interventions.

A characterization of cross-border use of health services in a transborder population at the Mexico-Guatemala border, September-November 2021.

BACKGROUND: Cross-border use of health services is an important aspect of life in border regions. Little is known about the cross-border use of health services in neighboring low- and middle-income countries. Understanding use of health services in contexts of high cross-border mobility, such as at the Mexico-Guatemala border, is crucial for national health systems planning. This article aims to describe the characteristics of the cross-border use of health care services by transborder populations at the Mexico-Guatemala border, as well as the sociodemographic and health-related variables associated with use. METHODS: Between September-November 2021, we conducted a cross-sectional survey using a probability (time-venue) sampling design at the Mexico-Guatemala border. We conducted a descriptive analysis of cross-border use of health services and assessed the association of use with sociodemographic and mobility characteristics by means of logistic regressions. RESULTS: A total of 6,991 participants were included in this analysis; 82.9% were Guatemalans living in Guatemala, 9.2% were Guatemalans living in Mexico, 7.8% were Mexicans living in Mexico, and 0.16% were Mexicans living in Guatemala. 2.6% of all participants reported having a health problem in the past two weeks, of whom 58.1% received care. Guatemalans living in Guatemala were the only group reporting cross-border use of health services. In multivariate analyses, Guatemalans living in Guatemala working in Mexico (compared to not working in Mexico) (OR 3.45; 95% CI 1.02,11.65), and working in agriculture/cattle, industry, or construction while in Mexico (compared to working in other sectors) (OR 26.67; 95% CI 1.97,360.85), were associated with cross-border use. CONCLUSIONS: Cross-border use of health services in this region is related to transborder work (i.e., circumstantial use of cross-border health services). This points to the importance of considering the health needs of migrant workers in Mexican health policies and developing strategies to facilitate and increase their access to health services.

[Economic cost of pregnancy care attributable to the failure of Mexico's teenage pregnancy prevention policy]. / Costo económico de atención de embarazos atribuibles a la falla de la política de prevención del embarazo adolescente en México.

The objective was to estimate the direct medical cost of pregnancy care attributable to the failure of Mexico's teenage pregnancy prevention policy. From the provider's perspective, this economic study estimated the mean cost of prenatal care, childbirth, puerperium, abortion and complications. To quantify the costs attributable to policy failure, three scenarios were constructed: (a) total number of pregnancies; (b) number of pregnancies above the target; (c) number of unwanted pregnancies. The cost of providing contraceptive methods was also estimated and the characteristics of pregnant adolescents were described. Of the adolescents (n = 5,477,027), 30.2% were sexually active; 46.8% used contraception; 44.1% had become pregnant and 9.1% had an abortion. Most pregnant women (65%) attended secondary school or under; 30% dropped out of school; 72.5% lived with a partner; 72.3% had complications. The mean cost of pregnancy care was estimated at USD 2,210.55 and the mean cost of providing contraceptives at USD 64.95. The total cost of policy failure was estimated for each scenario (in millions): (a) USD 1,614.39, (b) USD 876.61 and (c) USD 171.50, respectively; whereas the annual cost of providing contraceptives in each scenario was estimated in: (a) USD 47.43, (b) USD 25.76 and (c) USD 5.04. The failure of the policy is expressed in the high frequency of pregnancy in low-income adolescents and in high costs for the health system. The provision of contraceptives is 34 times cheaper than pregnancy care and could, together with improved living conditions, contribute to reduce the frequency of adolescent pregnancies.

El objetivo fue estimar el costo médico directo de la atención a embarazos atribuibles a la falla en la política de prevención de embarazos adolescentes en México. Estudio económico que estimó, desde la perspectiva del proveedor, el costo medio de atención prenatal, parto, puerperio, aborto y complicaciones. Para cuantificar los costos atribuibles a la falla de la política, se construyeron tres escenarios: (a) embarazos totales; (b) embarazos por arriba de la meta; (c) embarazos no deseados. También se estimó el costo de proveer anticonceptivos y se describieron características de las adolescentes embarazadas. De las adolescentes (n = 5.477.027), 30,2% había iniciado vida sexual; 46,8% usaba anticonceptivo; 44,1% se había embarazado y 9,1% abortó. La mayoría de embarazadas (65%) estudió secundaria o menos; 30% abandonó la escuela; 72,5% vivían en pareja; 72,3% presentó complicaciones. El costo medio de atención del embarazo se estimó en USD 2.210,55 y el de proveer anticonceptivos en USD 64,95. El costo total por la falla de la política se estimó para cada escenario (en millones): (a) USD 1.614,39, (b) USD 876,61 y (c) USD 171,50, respectivamente; mientras que el costo anual de proveer anticonceptivos en cada escenario se estimó en: (a) USD 47,43, (b) USD 25,76 y (c) USD 5,04. La falla de la política se expresa en alta frecuencia de embarazo en adolescentes de bajos ingresos y en altos costos para el sistema de salud. La provisión de anticonceptivos es 34 veces más barata que la atención de embarazos y podría, aunado al mejoramiento de las condiciones de vida, contribuir a disminuir la frecuencia de embarazos en adolescentes.

O objetivo deste estudo foi estimar os custos médicos diretos da assistência à gravidez relacionados ao fracasso da política de prevenção à gravidez na adolescência no México. Este estudo econômico avaliou, a partir da perspectiva da prestação de serviços, os custos médios do pré-natal, parto, puerpério, aborto e complicações da gravidez na adolescência. Para quantificar os custos relacionados ao fracasso dessa política de assistência, foram analisados três cenários: (a) total das gestações; (b) gravidez acima da média; (c) gravidez indesejada. Também foi estimado o custo do fornecimento de anticoncepcionais e descritas as características da gravidez na adolescência. Do total de adolescentes grávidas (n = 5.477.027), 30,2% tinham iniciado a vida sexual; 46,8% usavam métodos anticoncepcionais; 44,1% engravidaram e 9,1% abortaram. A maioria das grávidas (65%) tinha o ensino médio completo ou nível de escolaridade inferior; 30% abandonaram a escola; 72,5% moravam com o companheiro; e 72,3% apresentaram complicações. O custo médio da assistência à gravidez foi estimado em USD 2.210,55, e o do fornecimento de anticoncepcionais em USD 64,95. O custo total do fracasso dessa política foi estimado para cada cenário (em milhões): (a) USD 1.614,39, (b) USD 876,61 e (c) USD 171,50, respectivamente; enquanto o custo anual do fornecimento de contraceptivos em cada cenário foi: (a) USD 47,43, (b) USD 25,76 e (c) USD 5,04. O fracasso dessa política esteve relacionado à alta frequência de gravidez em adolescentes de baixa renda e aos altos custos para o sistema de saúde. A oferta de anticoncepcionais é 34 vezes mais barata do que a assistência à gravidez e pode contribuir para a redução da gravidez na adolescência, junto com uma melhoria nas condições de vida dessa população.

Use of self-help groups by people living with HIV in Central America.

Self-help groups (SHGs) for people living with HIV (PLHIV) are organizations created by the community to provide individuals with security, affection, improved self-esteem, and a sense of belonging. However, SHGs have also been used by the government to help implement HIV control policies. This study aimed to identify the characteristics associated with the use of SHGs by PLHIV and the routes and displacement patterns adopted by users. An analytical cross-sectional study was conducted based on data collected in six Central American countries during 2012. Using a list of SHGs, a random sampling was conducted in two stages. Firstly, the SHGs were selected. Then, the selected SHGs were visited and every third user who attended the SHG was surveyed. Logistic regression models were used to identify the characteristics associated with the use of SHGs and with attending the nearest SHGs. A spatial analysis was performed to identify the routes followed by users to reach the SHGs from their home communities. We found that the characteristics significantly associated with higher odds of SHG usage were country of residence and schooling level. The average and median distances traveled by users to attend SHGs were 20 and 5 kilometers, respectively. PLHIV do not use the SHGs closest to their locality, perhaps for fear of stigma and discrimination. We recommend that research on this topic use a mixed qualitative-quantitative methodology to better understand utilization decisions, user expectations, and the degree to which these are being met.

Increased Rate of Protease Inhibitor-resistance Associated Mutations in Human Immunodeficiency Viruses Infecting Mexicans who Had Been Living Abroad.

BACKGROUND: Migrants face multiple barriers to accessing health services and antiretroviral therapy (ART). We tested the hypothesis that HIV-infected ART-experienced Mexicans with a history of residence in the U.S. have a higher rate of viral drug-resistance associated mutations (RAMs) versus those without such a history. METHODS: Viral genotypic resistance tests obtained from 336 HIV-infected Mexican patients throughout the country were analysed for the presence of viral-RAMs and its rate was compared between migrants and non-migrants. Adjustment for potential confounders was done though a multivariate analysis. RESULTS: Eighty-four Mexicans who had lived for at least 3 months in the U.S. were more likely to have three or more protease inhibitor (PI)-major RAMs (aOR = 2.47; 95% CI = 1.06-5.76; p < 0.05) than in 252 individuals without this background, independently of the time spent on ART. CONCLUSIONS: A migration background is associated with a higher likelihood of the emergence of HIV variants with decreased susceptibility to several PI.

Ten-year hospitalization trends in Mexico: Examining the profile of national and transient and migrants.

Aim: In Mexico, as in other societies, migrants are seen as over-users of health services. However, the extent, distribution, and trends of use over time are unknown. Evidence is needed to inform health policies and improve health services for foreign patients. The objective of this study was to examine factors associated with the distribution and trends of Mexican and foreign resident hospitalizations in Mexican public hospitals from 2010 to 2020. Methods: A graphical and statistical analysis (descriptive and correlational) of discharge trends in public hospitals was carried out. Hospitalization trends were analyzed by country of habitual residence (Mexico, US, Central and South America, and Other Continents), age, sex, primary discharge category, and region of service delivery. Adjusted Poisson modeling was used to examine the factors associated with annual hospitalizations of Mexican and foreign residents. Results: Between 2010 and 2020, there were 26,780,808 hospitalizations in Mexican public hospitals. Of these, 0.05% were of foreign residents. Hospitalizations for Mexican residents remained stable from 2010 to 2019, while those for foreign residents trended upward over the same period. In 2020, hospitalizations of Mexican residents fell by 36.6%, while foreign resident hospitalizations fell by 348.8%. The distribution of hospitalizations by sex was higher among females for all categories of habitual residence, except among US residents. Obstetric discharges were the most common reason for hospitalization among Mexican residents (42.45%), Central and South American residents (42.24%), and residents from Other Continents (13.73%). The average hospital stay was 2 days. Poisson regression confirmed these results, showing that hospitalizations was higher among women (except among foreign residents) and in the ≤ 17 age group. Poisson modeling also showed that trauma injury was the leading cause of discharge for foreign residents after obstetric causes. Discussion: It is unlikely the upward trend in hospitalizations among foreign residents in Mexico from 2010 to 2019 affected the Mexican public health system, given the small proportion (0.05%) of hospitalizations and the brief length of hospital stay. The increased number of hospitalizations during the study period may be explained by local and national measures to facilitate foreign residents' access to hospital services, while the decrease in hospital utilization in 2020 is likely associated with COVID-19. Geographic location and the most frequent primary discharge categories of hospitalizations within each population could provide evidence for modifications to public health policy in Mexico.

Determinants of COVID-19 Vaccine Acceptance and Uptake in a Transborder Population at the Mexico-Guatemala Border, September-November 2021.

Assessing COVID-19 vaccination uptake of transborder populations is critical for informing public health policies. We conducted a probability (time-venue) survey of adults crossing from Mexico into Guatemala from September to November 2021, with the objective of describing COVID-19 vaccination status, willingness to get vaccinated, and associated factors. The main outcomes were receipt of ≥1 dose of a COVID-19 vaccine, being fully vaccinated, and willingness to get vaccinated. We assessed the association of outcomes with sociodemographic characteristics using logistic regressions. Of 6518 participants, 50.6% (95%CI 48.3,53.0) were vaccinated (at least one dose); 23.3% (95%CI 21.4,25.2) were unvaccinated but willing to get vaccinated, and 26.1% (95%CI 24.1,28.3) were unvaccinated and unwilling to get vaccinated. Those living in Mexico, independent of country of birth, had the highest proportion vaccinated. The main reason for unwillingness was fear of side effects of COVID-19 vaccines (47.7%, 95%CI 43.6,51.9). Education level was positively associated with the odds of partial and full vaccination as well as willingness to get vaccinated. People identified as Catholic had higher odds of getting vaccinated and being fully vaccinated than members of other religious groups or the non-religious. Further studies should explore barriers to vaccination among those willing to get vaccinated and the motives of the unwilling.

Migrants in transit through Mexico to the US: Experiences with violence and related factors, 2009-2015.

OBJECTIVES: The objectives of the study are to 1) estimate the burden of physical, sexual, and psychological violence among migrants in transit through Mexico to the US; and 2) examine the associations between experiencing violence and sociodemographic characteristics, migratory background, and health status in this vulnerable population. METHOD: A cross-sectional study combining qualitative and quantitative methods was carried out from 2009 to 2015 with a sample of 12,023 migrants in transit through Mexico to the US. Information on gender (male, female, and transsexual, transgender and transvestite -TTTs-); nationality; health status; migratory background; and experiences with violence was obtained. Fifty-eight migrants participated in in-depth interviews to explore any experiences of violence during their journey. A descriptive analysis was performed and a probit regression model was applied to analyze the factors associated with violence. Qualitative information was analyzed to understand experiences, meanings and responses to violence. RESULTS: The overall prevalence of suffering from any form of violence was 29.4%. Nearly 24% reported physical violence, 19.5% experienced psychological violence, and approximately 2% reported sexual violence. TTTs experienced a significantly greater burden of violence compared to men and women. Violence occurred more frequently among migrants from Central American (30.6%) and other countries (40.0%) than it did among Mexican migrants (20.5%). Experiences involving sexual, physical and psychological violence as well as theft and even kidnapping were described by interviewees. Migrants mistrust the police, migration authorities, and armed forces, and therefore commonly refrain from revealing their experiences. CONCLUSION: Migrants are subjected to a high level of violence while in transit to the US. Those traveling under irregular migratory conditions are targets of even greater violence, a condition exacerbated by gender inequality. Migrants transiting through Mexico from Central American and other countries undergo violence more frequently than do Mexican migrants. Protective measures are urgently needed to ensure the human rights of these populations.

[Women who are left behind: the impact of international migration on the process of seeking health care]. / Las mujeres que se quedan: migración e implicación en los procesos de búsqueda de atención de servicios de salud.

OBJECTIVE: To analyze how women who are left behind seek care in communities with a high migration index. MATERIAL AND METHODS: This is a cross-sectional study which used a qualitative approach. Sixty in-depth interviews were conducted between October 2004 and May 2005 with female partners of migrants in two communities (urban / rural) from a region in central Mexico with high migration to the United States. RESULTS: Migration determines two forms of familial reorganization: one in which female partners of migrants reintegrate with their families; and one in which they remain on their own. Women who reintegrate with their families receive more support, but are also subjected to more control, rendering them with less capability to seek care, particularly related to sexual and reproductive health. Women who remain on their own have less support but have more control and capacity to seek care, with privacy and independence. CONCLUSIONS: The familial reorganization influences timely health care-seeking behaviour of female partners of migrants. The situations identified can function as obstacles or facilitators to mobilize healthcare resources.

Medicines in Mexico, 1990-2004: systematic review of research on access and use.

OBJECTIVE: To review original research studies published between 1990 and 2004 on the access and use of medicines in Mexico to assess the knowledge base for reforming Mexico's pharmaceutical policy. MATERIAL AND METHODS: A literature review using electronic databases was conducted of original studies published in the last 15 years about access and use of medicines in Mexico. In addition, a manual search of six relevant journals was performed. Excluded were publications on herbal, complementary and alternative medicines. RESULTS: Were identified 108 original articles as being relevant, out of 2289 titles reviewed, highlighting four policy-related problems: irrational prescribing, harmful self-medication, inequitable access, and frequent drug stock shortage in public health centers. CONCLUSIONS: This review identified two priorities for Mexico's pharmaceutical policy and strategies: tackling the irrational use of medicines and the inadequate access of medicines. These are critical priorities for a new national pharmaceutical policy.

Household wellbeing and health risks in Mexican households with and without migrants: a cross-sectional analysis.

BACKGROUND: Migration between Mexico and the USA constitutes the world's largest migration corridor with more than 13 million movements of people in 2016. Furthermore, Mexico has a complex migration profile, being a country of origin, transit, destination, and return. While there has been discussion on the relationship between migration and development of origin communities, evidence on social and health issues faced by origin households is limited. This case study is a first attempt at documenting, through analyzing a national representative health survey of Mexican households (n = 9474), the relationship between international migration from Mexico and origin household health characteristics. CASE PRESENTATION: Mexican international migration moves largely (90% of migrants) toward the USA. Migration has passed from being mostly circular (from the early to late 1990s) to a permanent pattern of residence in the destination country due to changes in migration policies that have progressively restricted the irregular entrance of immigrants making re-entry more difficult.The present case study compares the socioeconomic, demographic, and health characteristics of households in Mexico with and without emigrants using data from a national representative health survey. Accordingly, in 2016, 5.8% (n = 1,802,980) of all Mexican households reported having a member living abroad.Households with members living abroad were found to more likely be headed by a female (45.8%), have Seguro Popular health insurance, and not to be among the poorest household population. In terms of health profile, a higher frequency of adults with a reported diagnosis of diabetes and/or hypertension (33.9 vs 21.7% for households with vs without emigrants, respectively; p = 0.067), and a higher severity of diabetes reflected a higher probability of hospitalization. CONCLUSIONS: Results showed that socioeconomic, demographic, and health conditions differed between households with and without emigrants. These differences were determined as not being attributable to migration and cannot be considered as predisposing factors of migration.

Costo económico de atención de embarazos atribuibles a la falla de la política de prevención del embarazo adolescente en México / Economic cost of pregnancy care attributable to the failure of Mexico's teenage pregnancy prevention policy / Custo econômico da assistência à gravidez atribuível ao fracasso da política de prevenção à gravidez na adolescência no México

El objetivo fue estimar el costo médico directo de la atención a embarazos atribuibles a la falla en la política de prevención de embarazos adolescentes en México. Estudio económico que estimó, desde la perspectiva del proveedor, el costo medio de atención prenatal, parto, puerperio, aborto y complicaciones. Para cuantificar los costos atribuibles a la falla de la política, se construyeron tres escenarios: (a) embarazos totales; (b) embarazos por arriba de la meta; (c) embarazos no deseados. También se estimó el costo de proveer anticonceptivos y se describieron características de las adolescentes embarazadas. De las adolescentes (n = 5.477.027), 30,2% había iniciado vida sexual; 46,8% usaba anticonceptivo; 44,1% se había embarazado y 9,1% abortó. La mayoría de embarazadas (65%) estudió secundaria o menos; 30% abandonó la escuela; 72,5% vivían en pareja; 72,3% presentó complicaciones. El costo medio de atención del embarazo se estimó en USD 2.210,55 y el de proveer anticonceptivos en USD 64,95. El costo total por la falla de la política se estimó para cada escenario (en millones): (a) USD 1.614,39, (b) USD 876,61 y (c) USD 171,50, respectivamente; mientras que el costo anual de proveer anticonceptivos en cada escenario se estimó en: (a) USD 47,43, (b) USD 25,76 y (c) USD 5,04. La falla de la política se expresa en alta frecuencia de embarazo en adolescentes de bajos ingresos y en altos costos para el sistema de salud. La provisión de anticonceptivos es 34 veces más barata que la atención de embarazos y podría, aunado al mejoramiento de las condiciones de vida, contribuir a disminuir la frecuencia de embarazos en adolescentes.

The objective was to estimate the direct medical cost of pregnancy care attributable to the failure of Mexico's teenage pregnancy prevention policy. From the provider's perspective, this economic study estimated the mean cost of prenatal care, childbirth, puerperium, abortion and complications. To quantify the costs attributable to policy failure, three scenarios were constructed: (a) total number of pregnancies; (b) number of pregnancies above the target; (c) number of unwanted pregnancies. The cost of providing contraceptive methods was also estimated and the characteristics of pregnant adolescents were described. Of the adolescents (n = 5,477,027), 30.2% were sexually active; 46.8% used contraception; 44.1% had become pregnant and 9.1% had an abortion. Most pregnant women (65%) attended secondary school or under; 30% dropped out of school; 72.5% lived with a partner; 72.3% had complications. The mean cost of pregnancy care was estimated at USD 2,210.55 and the mean cost of providing contraceptives at USD 64.95. The total cost of policy failure was estimated for each scenario (in millions): (a) USD 1,614.39, (b) USD 876.61 and (c) USD 171.50, respectively; whereas the annual cost of providing contraceptives in each scenario was estimated in: (a) USD 47.43, (b) USD 25.76 and (c) USD 5.04. The failure of the policy is expressed in the high frequency of pregnancy in low-income adolescents and in high costs for the health system. The provision of contraceptives is 34 times cheaper than pregnancy care and could, together with improved living conditions, contribute to reduce the frequency of adolescent pregnancies.

O objetivo deste estudo foi estimar os custos médicos diretos da assistência à gravidez relacionados ao fracasso da política de prevenção à gravidez na adolescência no México. Este estudo econômico avaliou, a partir da perspectiva da prestação de serviços, os custos médios do pré-natal, parto, puerpério, aborto e complicações da gravidez na adolescência. Para quantificar os custos relacionados ao fracasso dessa política de assistência, foram analisados três cenários: (a) total das gestações; (b) gravidez acima da média; (c) gravidez indesejada. Também foi estimado o custo do fornecimento de anticoncepcionais e descritas as características da gravidez na adolescência. Do total de adolescentes grávidas (n = 5.477.027), 30,2% tinham iniciado a vida sexual; 46,8% usavam métodos anticoncepcionais; 44,1% engravidaram e 9,1% abortaram. A maioria das grávidas (65%) tinha o ensino médio completo ou nível de escolaridade inferior; 30% abandonaram a escola; 72,5% moravam com o companheiro; e 72,3% apresentaram complicações. O custo médio da assistência à gravidez foi estimado em USD 2.210,55, e o do fornecimento de anticoncepcionais em USD 64,95. O custo total do fracasso dessa política foi estimado para cada cenário (em milhões): (a) USD 1.614,39, (b) USD 876,61 e (c) USD 171,50, respectivamente; enquanto o custo anual do fornecimento de contraceptivos em cada cenário foi: (a) USD 47,43, (b) USD 25,76 e (c) USD 5,04. O fracasso dessa política esteve relacionado à alta frequência de gravidez em adolescentes de baixa renda e aos altos custos para o sistema de saúde. A oferta de anticoncepcionais é 34 vezes mais barata do que a assistência à gravidez e pode contribuir para a redução da gravidez na adolescência, junto com uma melhoria nas condições de vida dessa população.