Examining Geographical Differences in the HIV Care Continuum Among Men Who Have Sex with Men in Mexico

Abstract

We analyzed data collected by the Encuesta de Sexo Entre Hombres study from 15,233 Mexican men who have sex with men (MSM) between May-July 2017 to examine differences in the HIV care continuum. Data were stratified into 6 geographical regions. Prevalence ratios assessed associations between region and care outcomes. Among participants never testing HIV positive (n = 13,583), 66.1% had ever been tested and 43.0% in the past year. Among HIV-positive persons (n = 1,650), 83.9% reported counseling post-diagnosis, 61.9% timely linkage to care, 42.4% timely CD4/viral load results, 38.2% timely access to antiretroviral therapy (ART), and 87.7% were currently on ART. The Ciudad de México /Estado de México region had significantly superior care continuum outcomes in ever and recent HIV testing, linkage to care, CD4/viral load results, and current ART use. Understanding geographical variations in HIV care for MSM in Mexico is one important step to inform efforts for ending HIV/AIDS by 2030 in Latin America.

Awareness, willingness to use pre-exposure prophylaxis, and use of post-exposure prophylaxis for HIV prevention among men who have sex with men in Mexico

“…This follows previous evidence for geographical differences in HIV testing and HIV care. 4 Efforts to increase awareness and access to PrEP and PEP for MSM outside of CDMX/EdoMex are warranted. Additional qualitative research on how best to tailor PrEP intervention strategies for MSM and for health care providers that could offer PrEP in these areas could be helpful to ensuring equitable access to effective HIV prevention methods.…”

“…Study methods have been described in detail elsewhere. 4,19 In brief, participants were recruited via banner advertisements and direct message blasts on popular social networking applications (herein referred to as recruitment venues) including Facebook, Grindr, Hornet, Twitter, SoyHomosensual, and Desastre. Recruited persons accessed a link to the online survey via the ad or message and self-administered the screening, consent process, and questionnaire on the SurveyGizmo platform.…”

“…Bivariate models included the covariate as well as recruitment venue given the study design. 4 Multivariate models included the covariate and controlled for age, education, income, region, health insurance, and recruitment venue; these latter variables were included based on a priori evidence of their potential association with PrEP or PEP and after assessing the significance of their associations with the main outcomes in bivariate models. 20 Because our outcomes were generally common (>10%) and obtained from crosssectional data, odds ratios from logistic regression may overestimate associations compared to prevalence ratios, the preferred measure of association.…”

“…3 The prevalence of HIV among MSM in Latin America is estimated at 12.6%, and in Mexico, estimates of HIV prevalence among MSM are between 10.8% to 17.4%. [4][5][6][7] In aiming to meet global HIV prevention and treatment targets including the Joint United Nations Programme on HIV/ AIDS's (UNAIDS) goal of ending AIDS by 2035, measuring key indicators of effective HIV prevention is critical to monitoring progress. Further, assessing factors associated with key indicators can better inform implementation of prevention strategies and messaging.…”