HIV infected women in Mexico: vulnerability, missed opportunities and late diagnosis

1. HIV infected women in Mexico: vulnerability, missed opportunities and late diagnosis MARTIN-ONRAET A.3, ALVAREZ-WYSSMAN V.1, VOLKOW-FERNANDEZ P.3, GONZALEZ-RODRIGUEZ ANDREA2, VELAZQUEZ-ROSAS G.4,RIVERA-ABARCA L.4, TORRES-ESCOBAR INDIANA5, SIERRA-MADERO J.1 1Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 2Clínica Especializada Condesa, 3Instituto Nacional de Cancerología, Mexico City, Mexico, 4 Centros Ambulatorios de Prevención y Atención en SIDA e ITS (CAPASITS) Oaxaca,5Centros Ambulatorios de Prevención y Atención en SIDA e ITS (CAPASITS) Puebla.

2. INTRODUCTION • HIV in Mexico is a concentrated epidemic driven by infection in MSM • Late presentation remains the most important challenge • Women represent 20% of affected population • Detection campaigns focus on high risk groups that do not include women • The only screening strategy for HIV detection in women is pregnancy • HIV infected women are particularly vulnerable and represent a double challenge

3. GOALS • What are the sociodemographic and clinical characteristics of Mexican women recently diagnosed with HIV infection? • How are women diagnosed with HIV? • Are there specific factors reflecting increased vulnerability in women infected with HIV?

4. STUDY DESIGN AND SAMPLE SUBJECTS: Mexican born HIV-infected women, diagnosed between 2009 and 2013, attending one of 4 HIV care centers of 3 different states: • Oaxaca • Puebla • Mexico City: Instituto de Nutriciónand ClínicaCondesa DATA: Structured face to face interviews and medical records: • Socio demographics, risk behavior, history of physical/sexual violence, circumstances of HIV diagnosis and access to medical and prenatal care • Clinical information from files • Standard statistical analysis was done with Stata 12.0 • Ethics approval was obtained, informed consent from women • Women were offered legal and psychological counseling

5. results

6. SAMPLE 331 women invited 30 did not accept 270 women interviewed 31 accepted file review 301 women included

7. SOCIODEMOGRAPHIC CHARACTERISTICS 31% 31%

8. CLINICAL CHARACTERISTICS *Diabetes Mellitus (5.3%), arterial hypertension (4.4%), dyslipidemia (14.3), others (7.7%)

9. VULNERABILITY FACTORS a There might be more than one agressor per woman

10. Clinical and socio demographic characteristics in different centers * Kwallis test, ** χ2 test a There were statistical differences between INCMNSZ and Oaxaca, for diagnosis through pregnancy (p=0.02)

11. SOURCE OF HIV INFECTION *tatoo(1), rape (5), sharingneedles (1), transfusion(5), workingaccident(3) aTesting campaigns, donation, prenuptial studies, getting to a lab

13. CLINICAL STAGE AT PRESENTATION Number of AIDS defining events: 111 (there were more than one per patient) Waisting syndrome (48), Cytomegalovirus disease (9), extrapulmonary tuberculosis (9), Candida esophagitis (8), P.jiroveci pneumonia(8), atypical mycobacterial disease (3), pulmonary tuberculosis (5), cryptococosis (3), others (18)

14. MEDICAL CARE PRIOR TO DIAGNOSIS * Symptoms such as weight loss, fever, chronic diarrhea, oral candidiasis, herpes 68% of women diagnosed through symptoms had sought medical care before

17. Characteristics associated to late stage disease at diagnosis (CD4 count <200) NS: Physicalviolence, sexual abuse, speakingindigenouslanguage, illegalsubstanceabuse,studydegree

18. PRENATAL CARE

19. CONCLUSIONS • Women recently diagnosed with HIV in Mexico have vulnerability factors such as a high prevalence of physical and sexual violence, low level of education, pregnancies atyoung age, low incomes and acquiring HIV mainly through their stable partner • Women are detected late, except for women diagnosed through pregnancy • Most women (73%) are diagnosed because of an infected partner/offspring or being symptomatic • Missed opportunities of earlier diagnosis and low rates of HIV testing were detected, during medical and prenatal care

20. Consequences and perspectives • Late diagnosis in women seems to be the result of a deficient health care system and lack of risk perception both from health care workers and women, in a context of high vulnerability and the absence of screening policies for non-pregnant women • Strategies for early detection need to be reevaluated for women in countries with concentrated epidemics such as the one in Mexico

21. ACKNOWLEDGMENTS • Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán: • Juan Sierra Madero • María de Lourdes Guerrero Almeida • Juan Calva Mercado • Brenda Crabtree Ramírez • Rigoberto Aramburo García • Clínica Especializada Condesa: • Andrea González Rodríguez • Jesús Casillas Rodríguez • Carlos Magis Rodríguez • Florentino Badial Hernández • Ubaldo Ramos Alamillo • Victoria Alvarez Wyssmann • Ricardo Niño Vargas • Instituto Nacional de Cancerología: • Patricia Volkow Fernández • Diana Vilar Compte • Hospital general Manuel Gea González • Rafael Valdez Vázquez • Patricia Rodriguez Zulueta • Daniel Aguilar Zapata • CAPASITS Oaxaca • Gabriela Velázquez Rosas • Lesvia Rivera Abarca • YukoNakamura López • CAPASITS Puebla • Indiana Torres Escobar • Tayde Pérez reyes