HIV Treatment Education in 2002
As a gay man who fled Mexico in 1994, I understand the injustice, discrimination and abuse endured by homosexuals there. Mexican society as a whole disapproves of homosexuality. Public opinion is dominated by the official view of the Christian and Catholic Churches -- homosexuality is a sin. This disapproval is combined with a "machista," or chauvinistic philosophy, that requires men to be manly and women to be feminine.
There is tremendous societal pressure on gay men to remain closeted in Mexico, so many marry and have children. Openly gay and transgendered individuals are persecuted daily and sometimes murdered in all parts of Mexico, their bodies often unclaimed by family members. These so-called "crimes of passion" are seldom solved; legal authorities may not bother to investigate. The city, state and judicial police are frequently involved in the abuse, torture and extortion of gay, lesbian and transsexual individuals. I have witnessed and experienced these scenarios myself.
Mexican men who test positive for HIV come to the United States if they possibly can. There are two main reasons. Once identified as having HIV, they are assumed to be gay by family members, co-workers and, sometimes, spouses. Second, medical treatment and the costly antivirals are limited and often unavailable in Mexico. Only individuals with a significant employment history and membership in the Social Security medical system in Mexico are eligible to receive medications.
People with HIV in Mexican hospitals are isolated from other patients. Doctors and other healthcare providers often wear double gloves and masks when entering an HIV-positive patient's room. A young Mexican mother who now receives medical treatment in San Diego was initially diagnosed in Tijuana. She spent three weeks in a hospital there. During that time, she was never touched by a nurse or a nurse's assistant. Her meals were left outside the door of her room on the floor with the door closed.
Many gay men from Mexico who come to the U.S. seeking medical care and the freedom to be themselves petition for political asylum. I did it in 1997, and the INS granted my case in 1998. Since 1999, I have worked as a case manager and treatment advocate at Comprehensive Health Center (CHC), a community clinic in San Diego. Most of my clients are monolingual Latino men who can identify with me and whose situations often reflect those of my past. Although I may not disclose personal details, I do refer my clients to the support groups and immigration team that assisted me.
The Treatment Education and Advocacy Program (TEA) at CHC has as its primary goal the empowerment of individuals beginning or changing antiviral therapy. Adherence is always stressed in the context of a client's immediate circumstances and needs. For those who are homeless or living in untenable situations, I facilitate housing and other relevant referrals since stability is a prerequisite for a person who is serious about taking HIV medications. Stability includes economic security, mental health, recovery from substance abuse and other factors such as access to transportation and medical care.
A second important requirement is information about HIV and how the medications work. As a treatment educator, I give workshops in Spanish about the etiology of the virus, the effect of antivirals on CD4 count and viral load, short and long-term side effects of the medications, and the necessity of adherence. In an abbreviated form, I attempt to do the same thing with individual clients considering treatment or changing therapies. Unless they are stuck in denial, most HIV-positive individuals are receptive to and grateful for this information. Increased knowledge helps people empower themselves to take charge of their health.
Finally, a system of support is essential for the person who is ready to be adherent to medications. If family or friends are not available or supportive, the individual must look elsewhere. Currently in San Diego there are four active Latino agencies that offer counseling and support groups in Spanish. When I first arrived here, there was only one organization providing assistance to monolingual Hispanics. Additionally, there is now an HIV ministry affiliated with a local church. It provides vital information and spiritual support to infected individuals.
When stability, information and support are in place, there is a greater likelihood that a person will be adherent to medications. When the viral load goes down and the CD4 count begins to rise, the client understands what is happening and how the medications are working. Equally important, the individual may speak about "getting his or her life back" and the renewed pursuit of short and long-term goals once abandoned because of HIV.
How fortunate we are in San Diego and other cities in the United States. The infrastructure here provides treatment for persons with HIV regardless of ethnicity, social or economic class, and sexual orientation. In my opinion, it will be a long time before the Mexican government faces this epidemic with the same commitment evidenced here. As the small, independent agencies in Mexico struggle to help HIV-infected individuals, we can only hope that our example serves as a beacon of hope and promise for them.
Tito Ramirez is a Case Manager and Treatment Advocate, Treatment Education and Advocacy, Comprehensive Health Center, San Diego, California.
This article was provided by AIDS Community Research Initiative of America. It is a part of the publication ACRIA Update. Visit ACRIA's website to find out more about their activities, publications and services.