Abstract

Gender and operational barriers to post-exposure prophylaxis for HIV in Mexico

H. Fortune-Greeley¹, G. Egremy², C. Infante³, R. Silvan Perez⁴, G. Vargas², K. Morrison¹, M. Negroni<sup>5

1</sup>Futures Group, Health Policy Initiative, Washington, United States, ²Independent Consultant, Mexico City, Mexico, ³Instituto Nacional de Salud Pública, Cuernavaca, Mexico, ⁴Independent Consultant, Cuernavaca, Mexico, ⁵Health Policy Initiative, Mexico City, Mexico

Issues: Despite international standards calling for post-exposure prophylaxis (PEP) to prevent HIV transmission following exposure through sexual violence (SV), policies to implement this recommendation are limited, and operational barriers abound. In Mexico, HIV is concentrated among most at-risk populations (MARPs), such as men who have sex with men (MSM) and transgenders?who also experience high levels of SV as a result of their expressions of their gender and sexual identities.
Description: In this project, the USAID | Health Policy Initiative sought to 1) examine the policy context for PEP in Mexico; 2) conduct qualitative research with HIV stakeholders and providers to identify barriers to PEP, especially those based on gender norms; and 3) identify interventions to overcome these barriers.
Lessons learned: There are many operational barriers to implementing PEP for HIV in Mexico, particularly for SV survivors. Many providers do not identify and refer SV survivors for treatment?particularly men or transgenders?and many women, men, and transgendered survivors do not seek out care and treatment because of stigma, discrimination, and fear of further violence. The populations most at-risk for SV and resulting transmission of HIV are unaware that possible treatment is available, and increased advocacy is necessary for decisionmakers to prioritize gender-sensitive PEP provision.
Next steps: To promote effective access to PEP, it is imperative that providers, decisionmakers, and civil society in Mexico continue to collaborate, through evidence-based policy dialogue and the use of existing international gold-standard policies and protocols. Specifically, the project recommends: 1) Increasing awareness of PEP among MARPs and HIV groups to increase civil society demand for gender-sensitive PEP; 2) Using evidence and advocacy to secure financing for antiretrovirals for PEP; 3) Creating and implementing gender-sensitive operational protocols for PEP, including dissemination and training; and 4) Strengthening referral networks and access points for PEP for all SV survivors.