mexico city s experience: the sanctuary clinic program - natalie.pdf · hiv, hepatitis b and c,...

Mexico City´s experience: The Sanctuary Clinic Program

The 2018 National Latino HIV and Hepatitis C Conference

Mexico City’s Center for HIV Prevention and Comprehensive CareCondesa Specialized Clinic

Nathalie Gras AllainDeputy Director of Care for Key Populations

and Specific Programs

Andrea González, Florentino Badial, Ubaldo Ramos, Steven Diego Díaz, Luis Manuel Arellano, Israel Macías,

Eduardo Rodríguez, Ricardo Niño, René Leyva, Alejandro Brito, María Paula Castañeda (UNHCR)

Worshop “Continuity of Care for Immigrants and the Repatriated”May 18th, 2018- The Omni Collonade, San Antonio, Texas

Presentation

Mexico City is a sanctuary city and the protection of the migrants and refugees´

health that live with HIV constitutes a human rights imperative, of no discrimination, as well as an essential measure for the control of an epidemic that does not recognize territorial

boundaries or border walls.

Alfonso Rodríguez Ogaz. https://www.flickr.com/photos/69781981@N00

Context

Mexico City

Population: 8,918,653 (2015)

Metropolitan Area

~25 million people

Divided in 16 political delegationsSource: INEGI http://cuentame.inegi.org.mx/monografias/informacion/df/poblacion/

Source: UNHCR

In the regional context, the population from the North of Central America is

highly mobile even following arrival in Mexico, which is a barrier for persons of

concern to have information and access to services. In addition, SGBV (sex and

gender violence) is a main reason that refugees flee their countries of origin and

they continue to face serious risks of SGBV in transit. The creation of a network of

safe spaces is fundamental to address the specific needs of survivors of SGBV in

need of international protection. Safe Spaces provide a minimum package of

basic services to SGBV survivors in a place, or during outreach and awareness-

raising activities, which use a survivor-centered and best interests approach to

foster an atmosphere of non-discrimination and inclusivity. Safe Spaces support

coordination and strengthening of multi-sectoral services to improve a survivor’s

network of care.

Posters at Condesa Specialized Clinics

Sanctuary Clinic Program

The Sanctuary Clinic Program was created on February 2017,although since 2009 we have been providing care to themigrant population through other programs.

The Sanctuary Clinic Program provides services at CondesaSpecialized Clinic and at Condesa-Iztapalapa Specialized Clinic.

The purpose is to speed up the access to treatment formigrants with HIV from Central America and other countries aswell as returning Mexicans to the country.

Service integration is done quickly and personalized for allservices at both clinics.

Target Population

Migrant men, women, and transgender population(adolescents and adults) in conditions of social vulnerability,emphasizing persons from Central America, residents or intransit through Mexico City, independent of their migratorysituation, including asylum seekers, as well as Mexican thatreturn to the country with or without documentation.

Objective

Recognize the right to Health protection of migrant individualsthat is equivalent to the rest of the population.

Intervención Objetivo

Human Rights Module

“Francisco Galván Díaz”

Letra S, Sida, Cultura y Vida Cotidiana

A.C.

Counselling, follow-up services in the presentation and

follow-up of complaints, linkage to legal services for

discrimination or violation of human rights.

As-Par:

Peer navigators

CHECCOS A.C.

Counselling and support for the integration to care of

persons recently diagnosed with HIV. It is

complemented through phone contacts and social

networks, as well as workshops.

Counselling and DiagnosisHIV, Hepatitis B and C, Syphilis diagnosis. Linkage to

appropriate service.

Care for victims of sexual violenceProphylaxis treatment for HIV and STI transmission, as

well as pregnancy.

Sexual and Reproductive Health and STI

Syndromic management of Sexually Transmitted

Infections, prevention of perinatal HIV transmission and

prenatal care for women in high vulnerability situations,

as well as long lasting birth control methods.

Services offered at Condesa and Condesa-Iztapalapa Clinics for Migrants and Repatriated Mexicans

Services offered at Condesa and Condesa-Iztapalapa Clinics for Migrants and Repatriated Mexicans

Intervention Objective

Mental Health AssessmentDiagnosis and treatment of mental health conditions and

interventions to improve adherence to HIV treatment.

HIV Care

Ambulatory medical care for HIV that includes ARV

treatment following the national and international

guidelines.

Referrals to 2nd/3rd levels of careMedical referrals to services not available at the

Condesa clinics based on medical assessment.

Follow-up

Counselling and linkage to social programs offered by

non-governmental organizations, private , and public

agencies.

Punto SeguroPersonalized care for male sex workers with or without

HIV.

Harm reduction in non-injectable drugsFocused on mitigating risks and harm associated to

drug use by persons with HIV.

Ponte a PruebaDetection, Treatment and HIV Care in prisons in Mexico

City.

Transgender Clinic Hormone therapy for sex change transformation.

National HIV Foreigners Registry by countryMarch 2018

34% come from Central

America, gathering 909

people

Country Men Women Total Country Men Women TotalHonduras 238 149 387 Israel 3 0 3United States 315 56 371 Japan 2 1 3Venezuela 299 17 316 Nigeria 0 3 3Colombia 222 27 249 Netherlands 2 1 3Guatemala 126 88 214 Paraguay 3 0 3El Salvador 145 63 208 Austria 2 0 2Argentina 125 16 141 China 2 0 2Cuba 103 4 107 Congo 1 1 2Spain 64 15 79 Dominica 2 0 2Brazil 53 2 55 Egypt 2 0 2Peru 38 9 47 Greece 2 0 2France 41 3 44 Guinea 0 2 2Chile 36 2 38 Kenya 1 1 2Nicaragua 29 8 37 Lebanon 2 0 2Italy 30 3 33 Norway 1 1 2

Belize 17 15 32 Czech Republic 2 0 2

Canada 25 3 28 Senegal 2 0 2Germany 24 0 24 Ukraine 2 0 2Costa Rica 21 2 23 Uganda 1 1 2Haiti 11 9 20 Afghanistan 1 0 1

Dominican Republic 14 4 18 Antigua and Barbuda 1 0 1

Mexico 11 3 14 Ivory Coast 0 1 1Cameroon 5 8 13 Fiji 1 0 1Uruguay 10 2 12 Gabon 1 0 1Australia 8 1 9 Ghana 1 0 1Ecuador 9 0 9 Hong Kong 1 0 1United Kingdom 8 1 9 Hungría 1 0 1Panama 6 2 8 India 1 0 1Portugal 7 0 7 Ireland 1 0 1Puerto Rico 5 2 7 Islas Aland 1 0 1Russia 6 1 7 Lithuania 1 0 1Bolivia 6 0 6 Micronesia 1 0 1Denmark 4 2 6 Mozambique 1 0 1Switzerland 4 1 5 Romania 1 0 1Jamaica 4 0 4 Sierra Leone 1 0 1Poland 3 1 4 Thailand 1 0 1South Africa 3 1 4 Taiwan 1 0 1Sweden 4 0 4 Turkey 1 0 1Belgium 3 0 3 Vietnam 1 0 1South Korea 3 0 3 Zambia 0 1 1Philippines 2 1 3 Total 2,138 534 2,672

Source: National System (SALVAR)31st March, 2018

National HIV Foreigners Registry by stateMarch 2018

State Total registry Total foreigners Proportion Foreigner menForeigner

womenCiudad de México 21,417 881 4.1 776 105

Chiapas 6,022 347 5.8 196 151

Jalisco 9,083 253 2.8 226 27

Quintana Roo 3,937 190 4.8 145 45

Baja california 4,986 112 2.2 84 28

Nuevo León 5,247 104 2 95 9

Tamaulipas 4,269 67 1.6 52 15

Yucatán 3,322 60 1.8 54 6

Veracruz 12,135 57 0.5 35 22

Oaxaca 3,506 49 1.4 35 14

Guanajuato 2,978 48 1.6 34 14

Puebla 4,380 43 1 30 13

Chihuahua 3,290 39 1.2 29 10

Tabasco 5,185 36 0.7 22 14

México 9,982 32 0.3 24 8

Coahuila 1,653 30 1.8 24 6

Querétaro 1,502 29 1.9 23 6

Morelos 2,346 23 1 21 2

Michoacán 2,319 22 0.9 19 3

San Luis Potosí 1,505 20 1.3 18 2

Sonora 2,034 17 0.8 14 3

Baja California Sur 972 15 1.5 15 0

Nayarit 1763 14 0.8 14 0

Hidalgo 1,232 13 1.1 10 3

Sinaloa 1,784 12 0.7 11 1

Campeche 1,604 11 0.7 5 6

Durango 923 11 1.2 10 1

Aguascalientes 877 8 0.9 8 0

Colima 1,068 8 0.7 6 2

Guerrero 3,938 3 0.1 3 0

Tlaxcala 966 3 0.3 2 1

Zacatecas 670 3 0.4 3 0

Nayarit 1,311 0 0 0 0

Institutos y Hospitales 670 112 0.4 95 17

Total 128,876 2,672 2.1 2,138 534


National HIV Foreigners RegistryMarch 2018

Historically at the national level, 2% of the total of the patients areforeigners

The largest proportions take place in these cities:

▪ Chiapas with 5.8%

▪ Quintana Roo with 4.8%

▪ Mexico City with 4.1%

34% come from Central America, gathering 909 people


Foreigners women and men receiving HIV care at the Condesa Specialised Clinic VSChiapas HIV Program

March 2018

Chiapas347 foreigners

5.8%

State Total registry Foreigners registry Proportion

Mexico City 21,417 881 4.1%

Chiapas 6,022 347 5.8%

Mexico City881 foreigners 4.1%

Country Men Women Total Country Men Women Total

Venezuela 165 11 176 Portugal 3 0 3

Colombia 131 14 145 Austria 2 0 2

United States 60 7 67 Congo 1 1 2

Argentina 61 5 66 Dominica 2 0 2

Honduras 35 12 47 Guinea 0 2 2

Spain 30 14 44 Jamaica 2 0 2

Cuba 41 2 43 Japan 1 1 2

Brazil 32 0 32 Paraguay 2 0 2

El Salvador 27 3 30 Puerto Rico 2 0 2

Peru 19 7 26 Russia 1 1 2

Chile 23 1 24 South Africa 1 1 2

France 20 1 21 Sweden 2 0 2

Guatemala 13 3 16 Switzerland 2 0 2

Costa Rica 13 1 14 South Korea 1 0 1

Germany 9 0 9 Philippines 0 1 1

Italy 8 0 8 Fiji 1 0 1

Cameroon 2 5 7 Greece 1 0 1

Uruguay 6 1 7 Hong Kong 1 0 1

Ecuador 6 0 6 Ireland 1 0 1

Nicaragua 5 1 6 Israel 1 0 1

Great Britain 6 0 6 Kenya 1 0 1

Belize 3 2 5 Netherlands 0 1 1

Bolivia 5 0 5 Czech Republic 1 0 1

Denmark 3 2 5 Romania 1 0 1

Dominican Republic 5 0 5 Senegal 1 0 1

Australia 4 0 4 Taiwan 1 0 1

Canada 4 0 4 Turkey 1 0 1

Haiti 2 2 4 Vietnam 1 0 1

Panama 2 2 4Total 776 105 881Poland 2 1 3

Country Men Women Total

Honduras 62 57 119

Guatemala 51 54 105

El Salvador 57 35 92

Nicaragua 9 4 13

Cuba 6 0 6

Argentina 2 0 2

Chile 2 0 2

Colombia 1 1 2

Mexico 2 0 2

Costa Rica 1 0 1

Spain 1 0 1

Jamaica 1 0 1

Panama 1 0 1

Total 196 151 347


Foreigners Voluntary HIV Counselling and Testing (VCT) Datum from January 2017 to February 2018

The Counselling and Testing Service gathers

the largest number of foreigners (641 people)

attended at the Condesa Specialised Clinic (from January 2017 to February 2018)

The number of people from

Central America (81) and

Colombia (81) are equal

HIV Prevalence

15.3%98 HIV positives

from 641 foreigners

Country Frequency Total% of all the

patients

VENEZUELA 109 109 17

Central America

HONDURAS 33

GUATEMALA 17

EL SALVADOR 15

COSTA RICA 5

NICARAGUA 4

PANAMA 7 81 12.6

North America

UNITED STATES 66

CANADA 5 71 11.1

South America

COLOMBIA 81

ARGENTINA 36

BRAZIL 19

CHILE 16

PERU 10

BOLIVIA 4

ECUADOR 4

URUGUAY 4

PARAGUAY 3 177 27.6

Caribbean

CUBA 15

DOMINICAN REPUBLIC 5

PUERTO RICO 3 23 3.6

TOTAL 461 71.9

Country Frequency

Other countriesSPAIN 43

FRANCE 40

ITALY 16

GERMANY 12

ENGLAND 11

JAPAN 5

AUSTRALIA 3

CHINA 3

KOREA 3

CROATIA 3

DENMARK 3

HOLLAND 3

INDIA 3

SWITZERLAND 3

BULGARY 2

GREECE 2

NIGERIA 2

PORTUGAL 2

SWEDEN 2

CONGO 1

AUSTRIA 1

BANGLADESH 1

BELGIUM 1

CAMEROON 1

SOUTH KOREA 1

SCOTLAND 1

SLOVENIA 1

GRENADA 1

HONG KONG 1

INDONESIA 1

ISRAEL 1

MALAYSIA 1

NEW ZEALAND 1

PAKISTAN 1

MOLDAVIAN REPUBLIC 1

ROMANIA 1

TUNISIA 1

UKRAINE 1

Total from all the countries 641

Source: Condesa SpecializedClinic´s- Laboratory report

Voluntary HIV Counselling and Testing (VCT) Datum from January 2017 to February 2018

n= 641

HIV Positives

Age group Men Women Transgender Total %

18 to 25 16 0 2 18 18.4

26 to 40 55 2 5 62 63.3

More than 40 15 3 0 18 18.4

Total 86 5 7 98 100.0

HIV Negatives

Age group Men Women Transgender Total %

< 18 7 2 1 10 1.8

18 to 25 116 43 9 168 30.9

26 to 40 234 61 6 301 55.4

More than 40 51 13 0 64 11.8

Total 408 119 16 543 100.0

HIV Prevalence15.3%

98 HIV positive from 641 foreigners

Source: Condesa SpecializedClinic´s- Laboratory report

HIV prevalences by countryUNAIDS 2016

Central AmericaCountry Population group Prevalence

BelizeAdult prevalence

From 15 to 49 years1.8%

[1,5% - 2,3%]

Costa RicaAdult prevalence


[0.4% - 0.5%]

El SalvadorAdult prevalence


[0.5% - 0.7%]

GuatemalaAdult prevalence

15 a 49 años de edad0.5%

[0.3% - 0.7%]

HondurasAdult prevalence


[0.3% - 0.5%]

NicaraguaAdults prevalence


[0.2% - 0.3%]

Country Population group Prevalence

CameroonAdult prevalence


[3.1% - 4.5%]

VenezuelaAdult prevalence


[0,5% - 0,7%]

MexicoAdult prevalence


[0.2% - 0.3%]

Migration and HIV in Central America and Mexico

• Central American Migrants in Transit through Mexico have a 0.71% HIV general prevalence and a 3.45% HIV prevalenceamong transgender people.

– 23. 5% of transgender people and 5.8% of women reportedsexual violence.

– Only 46.6% of the survey respondents accepted the HIV test.

Source: Leyva-Flores et al 2016

Profile by RegionI. Central Americans:

▪ Men, women, Trans women, children and adolescents with low educational levels

▪ Fleeing gang violence (Discrimination towards the LGBT population)

▪ Travel by foot, by bus and raft: risks (sexual violence, muggings, kidnapping…)

▪ Referred by NMI, COMAR and NGO´s

▪ Mainly diagnosed in Mexico City

▪ Few support networks

II. South Americans:

▪ Middle class men: students and professionals

▪ Flight

▪ Referred by COMAR and NGO´s besides contacts thorugh the social networks

▪ Diagnosed and previously treated: come to continue with care

▪ Have support networks

II.1. Venezuela:

▪ Fleeing the political and economic crisis

▪ They face hostilities when they arrive

▪ Flight

▪ Referred by COMAR and NGO´s besides contacts through the social networks

▪ Diagnosed and previously treated: come to continue with care (shortage of medications)


Profile by Region

III. Africans:

▪ Men, women and children: professionals

▪ Fleeing political conflict: repression and prison to sympathizers

▪ Flights (long travel times)

▪ Diagnosed and previously treated: come to continue their treatment

▪ Few support networks

IV. Europeans and North Americans:

▪ Middle class men and women: students and professionals

▪ The majority have regular residency

▪ Flights



V. Mexican Repatriated from the USA

▪ Working class men

▪ Detention center (ICE)/prison

▪ Buses and flights


▪ Have support networks but CULTURAL SHOCK

Guidelines of “Seguro Popular” for foreigner people

Proof of residency.

Foreigners must prove their

residency on mexican

territory.

If foreigners are not able to

show the evidentiary

documentation nor their

legal residency in the

country, a temporary

incorporation will

proceed: only for 90 days.

Migration status of population served(transit, temporary and permanent)

Migration statusTreatment Access according to the

guidelines of “Seguro Popular”

Temporal or Permanent Residency

Turist

Humanitarian visa

Refugee Applicants

Refugees

Indocumented

Repatriated

Without country

?

✓

✓

Interagency contributions (good practices)

Currently, Clínica Condesa is co-chairing with UNHCR the safe spaces network in

Mexico City. UNHCR, the Mexican Refugee Agency (COMAR), Clínica Condesa and

partner NGOs including migrant shelters, regularly coordinate for cases with special

needs, such as pregnant woman, LGBTI persons, persons with STIs/HIV. A special

referral system was established for these cases. Awareness raising activities on sexual

and reproductive health to persons of concern are also implemented, for example,

Condesa Clinic along with partner NGOs and UNHCR organized a sexual and

reproductive health fair in the migrant shelter Cafemín offering free HIV/ITS detection

tests. In addition, UNHCR and COMAR gave a joint training to Condesa staff on

identification of persons with international protection needs and the asylum process.

In turn, Clínica Condesa offered a training to COMAR, UNHCR, and NGO partners on

sexual health and HIV/STIs.

Conclusions

Access to health services for the migrant population,specifically in HIV prevention and care, should be a HealthSystem objective and should be audited by internationalorganisms.

The diagnosis and treatment of immigrants with HIV is aneeded component of the strategy for epidemic control, forthe prevention of Aids cases as well as death and for virustransmission prevention which is achieved when treatment isoffered to persons with HIV (Treatment as Prevention).

The Condesa and Condesa-Iztapalapa Clinics are safe spaces forthe migrant population, repatriated, and refugees.

Health services Access is necessary to guarantee the right tolive, physical wellness, free transit, and evidently to health.

The Young population is the age group with the highest needfor HIV services, pregnancy care, and sexual violence, and atthe same time, a population group with great mobility insideand outside country borders.

– The refusal of such services due to migratory status is a discriminatory act of grave consequences for world youth.

Conclusions

UNHCR Information at the Condesa Clinic

Source: UNHCR

ReferenciesAdministrative Manual for the Sanctuary Clinic Program (February 2017)

Affiliation and Operation Manual for the Seguro Popular (2013): https://transparencia.info.jalisco.gob.mx/sites/default/files/Manual%20de%20Organizacion%202013.pdf

Annual Activity Report 2017:http://www.condesadf.mx/pdf/DiaMundialCDMX2017_vFINAL_.pdf

Antiretrovirals Administration, Logistics and Surveillance System (SALVAR): https://www.salvar.salud.gob.mx/ (March 2018)

Condesa Specialized Clinics Laboratory report (February 2018)

Leyva, René et al. Chapter VI. “Migrants in transit through Mexico: Health status and access to health services” in: Migration and Health. Perspectives on the immigrant population. Secretariat of Government/National Population Council, Health Initiative of the Americas, School of Public Health, University of California, Berkeley. Mexico, 2016.

National Institute of Statistics and Geography (INEGI) Report 2016: http://cuentame.inegi.org.mx/monografias/informacion/df/poblacion/

The Joint United Nations Programme on HIV/AIDS (UNAIDS): http://www.unaids.org/en(October 2017)

United Nations High Commissioner for Refugees (UNHCR): http://www.unhcr.org/(October 2017)

http://www.condesadf.mx/pdf/DiaMundialCDMX2017_vFINAL_.pdf

https://www.salvar.salud.gob.mx/

http://cuentame.inegi.org.mx/monografias/informacion/df/poblacion/

http://www.unaids.org/en

http://www.unhcr.org/

[email protected]

[email protected]+52 55 26 14 29 58 and +52 55 50 38 17 00 ext. 6446

Clínica Especializada Condesa Clínica Especializada Condesa Iztapalapa

“Dr. Jaime Sepúlveda Amor”

THANK YOU

http://www.condesadf.mx/

mailto:[email protected]

mailto:[email protected]

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