Public health program for penitentiaries in Mexico City: detection and care for HIV and other diseases
N. Gras1, A. González1, J. Sierra2, S. Bautista3, F. Badial3, P. Volkow4, S. Bertozzi5
1Mexico City HIV/AIDS Program, Mexico, Mexico, 2National Medical Sciences and Nutrition Institute, Mexico, Mexico, 3National Institute of Public Health (INSP), Mexico, Mexico, 4National Cancerology Institute (INCAN), Mexico, Mexico, 5Gates Foundation, Seattle, United States
Issues: Incarcerated population in Mexico City penitentiaries is facing inadequate conditions as the number of inmates has tripled in only five years (2003-2008) while the buildings and resources have remained constant. Poor living conditions in penitentiaries (crowding, lack of light and fresh air, bad nutrition) combine with risky practices; often not under the control of inmates (tattoos, lack of access to clean syringes and condoms, nonconsensual sex) are placing inmates at high risk for diseases.
Description: A healthcare program is being implemented for the ten penitentiaries in Mexico City, with a total population of 40,400 inmates (38,000 men and 2,400 women). Initially, an informational and awareness campaign is being carried out among inmates and personnel to communicate which diseases would be detected and treated. Detection of HIV, syphilis, herpes, hepatitis B and C, tuberculosis, diabetes, hyperlipidemia and high blood-pressure is being carried out with voluntary and confidential participation. HIV testing is integrated with detection of other diseases to reduce HIV-related stigma, follow-up outside of jail was also offered. Treatment and counseling is being provided for diseases detected, an HIV care model was implemented which includes, specialized HIV care, free access to HAART accordingly to National Guidelines, an intensive adherence program and viral load and CD4 count monitoring.
Lessons learned: The program has retrieved early detection and access to HIV treatment. The quality of healthcare for inmates with HIV was also enhanced; this has led to better adherence to HAART. The Mexico City HIV/AIDS program collaborated with research institutes as the Mexican National Institute of Public Health, Nutrition and Cancer and with the Penitentiary System.
Next steps: The analysis of the situation in penitentiaries provides scientific evidence for the need of HIV prevention through implementation of comprehensive early detection and care programs, as health problems in incarcerated would ultimately impact on whole population health.
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