Perceived risks and barriers to care for international migrants in transit through Mexico

Background

Mexico has implemented policies seeking to reduce barriers to care for migrants in transit; however, it is estimated that only 3% of migrants use public health services when needed. The main purpose of this study was to identify the barriers to access public health services faced by migrants in transit through Mexico.

Methods

Under the human security perspective, in 2018, a qualitative study was carried out in Mexican communities with high migrant mobility. 34 semi-structured interviews were conducted with migrants in transit, and personnel from public health services and migrant shelters (NGOs). Values and meanings related to risks, health problems, barriers to care, experiences of health services utilization, and opinions on facilitating elements to diminish these barriers were identified.

Results

Migrants in transit through Mexico face risks that affect all dimensions of human security. Perceived anti-migratory and discriminative attitudes during the journey were constantly mentioned in the interviews. Barriers to care were found in the four stages of health care access, classified according to the Tanahashi framework, with the majority related to accessibility and acceptability. The following facilitating elements were also identified: political willingness of local government, knowledge and talent management of health personnel, and strategies implemented for adapting local health care services to migrants.

Conclusions

Social and political conditions in Mexico disrupt any effort to reduce social risks and barriers to care for migrants in transit. Non-governmental actors are key players for facilitating interactions between migrants and local governmental health care institutions. However, the general anti-migratory context negatively affects access to health care and influence the perspectives of migrants, NGOs, and health personnel.

Key messages

The predominant perceived barriers to care are in counterpoint to local governmental pro-migrant rights perspectives. NGOs are key actors to promote access to public health care services.

Abriendo Futuros: An empowerment program for indigenous adolescent girls in Yucatán, Mexico

Background

Abriendo Futuros is a a girl-centered empowerment program that engages community leaders and trains older indigenous girls as mentors to run community girls’ clubs, known as safe spaces. Mentors work directly with indigenous girls to deliver program curricula tailored to the girls’ specific and unique needs to builds girls’ assets in areas such as sexual and reproductive education, gender equality, violence prevention, leadership, financial education and healthy lifestyles.

Objectives

The program aims to improve critical health, social, and cognitive skills that help girls have a voice and choice in their lives and allows them to draw the path to a healthy adult life, overcoming the risks present in their context. The program was implemented in 8 rural communities in the south of Yucatan. A total of 657 girls were enrolled over the 18-month-implementation period (2015 - 2017).

Results

A quasi-experimental evaluation was implemented in 11 communities (8 intervention and three control). Preliminary findings, using the Propensity Score Matching technique, suggest significant positive effects on intermediate outcomes such as financial literacy, attitudes towards gender norms, sexual reproductive health knowledge, social capital, and perceived exposure to physical violence. No statistically significant results were achieved in main outcomes (reduce adolescent pregnancy and school dropout). We associate this, mainly to the fact that the intervention was only at an individual level, but also to the limited sample size and the brief observation period (18 months).

Conclusions

Girl-centered programming increases access to spaces where girls meet to expand their knowledge and social networks and build assets that reduce their risks and broadens their opportunities. However, further evidence is needed on multi-level and multisector girl-centered interventions to address teenage pregnancy and other complex issues.

Key messages

The program generates a social safety net among girls and mentors that is key to the well-being of girls. Girl-centered programs have positive effects on girĺs empowerment for girls who live in vulnerable situations and unequal social contexts.

Challenges in Priority Setting from a Legal Perspective in Brazil, Costa Rica, Chile, and Mexico

Priority setting is the process through which a country's health system establishes the drugs, interventions, and treatments it will provide to its population. Our study evaluated the priority-setting legal instruments of Brazil, Costa Rica, Chile, and Mexico to determine the extent to which each reflected the following elements: transparency, relevance, review and revision, and oversight and supervision, according to Norman Daniels's accountability for reasonableness framework and Sarah Clark and Albert Wale's social values framework. The elements were analyzed to determine whether priority setting, as established in each country's legal instruments, is fair and justifiable. While all four countries fulfilled these elements to some degree, there was important variability in how they did so. This paper aims to help these countries analyze their priority-setting legal frameworks to determine which elements need to be improved to make priority setting fair and justifiable.

The Decline in HIV-1 Drug Resistance in Heavily Antiretroviral-Experienced Patients Is Associated with Optimized Prescriptions in a Treatment Roll-Out Program in Mexico

A decrease in the rate of acquired antiretroviral (ARV) drug resistance (ADR) over time has been documented in high-income settings, but data on the determinants of this phenomenon are lacking. We tested the hypothesis that in heavily ARV-experienced patients in the Mexican ARV therapy (ART) roll-out program, the drop in ADR would be associated with changes in ARV drug usage. Genotypic resistance tests obtained from 974 HIV-infected patients with virological failure and at least 2 previously failed ARV regimens from throughout the country were analyzed for the presence of nucleos(t)ide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and protease inhibitor (PI) resistance-associated mutations (RAMs). Patients were divided into two groups according to their first ART start date: 488 patients initiated ART before mid-2003 (group 1) and 486 after mid-2003 (group 2). The rate of RAMs, median resistance score of several sentinel ARVs, and composition of ART drugs in patient's entire treatment history were compared between both groups. Patients in group 2 were less likely to have >3 thymidine analogue-associated mutations (TAMs) and >3 PI-mRAMs [adjusted odds ratio (aOR) = 0.37; 95% confidence interval (95% CI) = 0.25-0.54; p < .001 and aOR = 0.53; 95% CI = 0.36-0.77; p = .001, respectively] and had a significantly lower resistance score for zidovudine, tenofovir, ritonavir-boosted (r)-lopinavir, r-atazanavir, and r-darunavir than group 1 patients. A significantly lower proportion of patients in group 2 used monotherapy, bitherapy, thymidine analogue-containing regimens, nonboosted PI-containing regimens, and low resistance barrier PI-containing regimens. In Mexican ARV-experienced patients, the occurrence of TAM and PI-mRAM has significantly declined over time. This can be explained by treatment optimization in the national ART roll-out program in recent years.

Effects of an integrated control programme with ivermectin on growth, carcase composition and nematode infection of beef cattle in Argentina's western pampas

The effect of previous pasture management and ivermectin treatment on gastrointestinal parasitism, weight gain and carcase composition of steers was studied in the semiarid Pampeana region of Argentina from April 1986 to April 1987. Three groups, each of 15 weaned calves, were grazed on separate lucerne pastures. Group 1 control calves, which grazed paddocks previously grazed by nematode-infected weaners and yearlings with a high nematode egg output, were only medicated when heavy parasitism was recorded. Group 2 calves, which grazed paddocks previously infected by steers at least two and a half years old with low nematode egg output, were treated strategically with ivermectin. Group 3 calves, which grazed on 'clean' paddocks, were treated monthly with ivermectin. Group 1 calves showed heavy parasitism and parasitological parameters were higher than in groups 2 and 3. The liveweight gain responses of groups 2 and 3 were significantly greater than those of group 1 (P less than 0.001) during autumn, winter and early spring. At the end of the study when cattle reached market condition, the liveweight gains of groups 2 and 3 were 74.1 and 81.9 kg, respectively, greater than group 1. Carcase analyses showed significantly greater weight and killing-out percentages in groups 2 and 3 than in group 1. Reduced total bone, muscle and fat weights were observed in group 1.