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MEXICO: Int’l AIDS Funds Necessary but Not Sufficient

Emilio Godoy

MEXICO CITY, Jul 14 2009 (IPS) - For the first time, Mexico is eligible for a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria. But even if its application is successful, resources for HIV/AIDS prevention among high-risk sectors of the population will fall short.

The Country Coordinating Mechanism (CCM), the Mexican body which interacts with the Global Fund, presented a proposal in June for 76.5 million dollars for HIV/AIDS prevention programmes among men who have sex with men (MSM) and injection drug users (IDU) – the groups with the highest HIV prevalence, with rates of 10 percent for MSM and six percent among IDU.

“The grant money could help curtail the spread of the illness, because there is an imbalance between prevention and treatment. But it won’t be enough,” Anuar Luna, president of the Mexican Network of People Living with HIV and a member of the CCM, told IPS.

The proposal, which was seen by IPS, is for a five-year period, and its stated goal is “strengthening the national response to HIV for MSM and male and female IDU in Mexico.”

“If the Global Fund approves the grant, the Mexican health ministry will have more resources to target populations that were left out of the proposal, such as sex workers,” Alejandra Gil, head of the Mexican sex workers rights organisation APROASE and a member of the CCM, told IPS.

The first HIV/AIDS cases in Mexico were reported in 1983 and were mainly caused by blood transfusions. In 1987 the government banned the sale of blood and its subproducts in an attempt to curb the spread of the disease.

In 2007 the number of people in Mexico living with HIV was 200,000, the second largest affected population in Latin America after Brazil, which had 730,000 HIV-positive people, although the overall prevalence rate in Mexico (0.3 percent) is among the lowest in the region, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

The number of new HIV/AIDS cases reported in 2007 was 7,681, and after government efforts to overcome under-registration, 12,437 new cases were notified in 2008. This year 871 new cases have been reported so far, according to the National Centre for the Prevention and Control of HIV/AIDS (CENSIDA).

The estimated total number of deaths from the virus up to and including 2007 is 5,151, according to CENSIDA, although the UNAIDS estimate puts it at 11,000.

The CCM, formed in July 2006 to coordinate the application to the Global Fund, is made up of 10 government agency representatives and nine from civil society organisations. It drew up the proposal between October 2008 and April 2009.

The Global Fund, based in Geneva, Switzerland, “is governed by an international Board that consists of representatives from donor and recipient governments, non-governmental organisations (NGOs), the private sector (including businesses and philanthropic foundations) and affected communities,” its web site says.

In its eighth round of funding proposals in 2008 it awarded nearly three billion dollars to support initiatives in 140 countries to fight AIDS, tuberculosis and malaria. Of these funds, 158 million dollars were allocated to Latin America and the Caribbean.

If the Global Fund approves the ninth round Mexican proposal at its next meeting in November, the first instalment, 13 million dollars, would be disbursed in 2010.

The goal of the Mexican proposal is to increase the coverage of prevention programmes for MSM and of harm reduction and health services for IDU men and women, as well as improving the quality and quantity of services provided without stigma or discrimination for these key populations and people living with HIV by community groups and public services.

It also aims at improving the technical, managerial and administrative capabilities of state health services and NGOs, especially in the area of prevention.

“Detection of HIV is still too low, and prevention strategies aimed at the most affected groups are rather limited. Mexico’s epidemic is classified as concentrated, with high HIV prevalence in key groups,” the document says.

The planned programme will be carried out in the 44 cities with the highest rates of HIV prevalence in MSM and IDU populations, which are estimated nationally at 645,000 people and 53,000 people, respectively. Within the 44 locations chosen there are an estimated 476,000 men who have sex with men.

The 44 selected cities include 72 percent of the AIDS cases among MSM reported between 2003 and 2008.

“This wide coverage of cities represents a unique opportunity for key populations of both sexes to receive services, support and access. Services will be offered at places where they socialise and at health centres, as a combined effort by the government and NGOs,” says the proposal.

After five years, the expected outcome of the programme is a reduction of HIV prevalence in MSM from 10 percent to eight percent in the 44 selected cities, and among IDU from six percent to five percent.

The Global Fund applies stricter criteria for the eligibility of proposals from upper-middle income countries, like Mexico, than for lower-middle or low income countries, including the stipulation that the activities proposed must target identified vulnerable groups with an HIV prevalence of at least five percent.

In Luna’s view, Mexico’s application is being made at a time when the Global Fund’s disposable resources are diminished because of the global economic crisis, and will have to wait in line behind poorer countries which have higher priority.

“Mexico should have applied in the eighth round. Now it’s at a disadvantage compared with other countries competing for a grant,” the activist said.

The CCM did not have the budget for its proposal ready in time for the eighth round deadline, in July 2008, and therefore was unable to apply last year.

In a consensus decision, the CCM nominated the non-governmental Consorcio de Investigación sobre VIH/Sida y Tuberculosis (CISIDAT, Consortium for Research on HIV/AIDS and Tuberculosis) to be the “Principal Receptor” responsible for administering the funds.

CISIDAT is composed of clinical, biomedical, epidemiological, psychological, economics and public health researchers and experts from 11 health institutions.

Other applicants interested in assuming the duties of the Principal Receptor were the state National Institute of Public Health and the private Mexican Family Planning Foundation (MEXFAM), Mexican Health Foundation (FUNSALUD), Rostros y Voces (Faces and Voices, a member of Oxfam International) and the Carso Health Institute, financed by Carlos Slim, the richest man in Latin America.

Forestalling the epidemic and treating HIV-positive people is an expensive undertaking. The proposal sent to the Global Fund estimates total financial needs at some 100 million dollars in 2010, and 180 million dollars in 2013.

In 2008 the government spent 360 million dollars on preventing and fighting HIV/AIDS, but this year the budget is half that, 180 million dollars.

“Unless the focus is on prevention, treatment will be more costly,” said Gil.

NGOs working on HIV/AIDS have been invited by CENSIDA to a Jul. 17-20 convention in Mexico City, where government and civil society representatives will design the National HIV/AIDS Prevention Strategy.

And the 11th National Congress on HIV/AIDS and other Sexually Transmitted Infections will be held in the southern state of Chiapas in late November.