By Oscar Lopez
MEXICO CITY, April 17 (Thomson Reuters Foundation) - Thousands of Mexicans living with HIV or at risk of infection could be left without life-saving services after the government changed the way it funds treatment, according to public health experts and LGBT+ rights advocates.
Reforms announced last month to centralise drug procurement risk sparking shortages, they say, while the government counters that it has ample supplies and hopes its changes will save money and cut corruption in the drugs chain.
"There is a crisis," said Ricardo Baruch, a public health expert and LGBT+ rights advocate. "Suddenly everything has happened together."
In February, the government also said that it would no longer fund civil society organisations, leaving more than 200 groups fighting the disease without resources for core activities, such as HIV testing.
Baruch said the knot of changes had created a perfect storm that would hurt marginalised HIV+ communities the most.
"You're going to see a lot of people like sex workers, drug users and gay men left without basic services for prevention and detection," Baruch said. "In Mexico, there aren't many other sources of funding."
Jorge Diaz is a case in point.
On a recent Friday, 33-year-old Diaz arrived before dawn at a public health clinic in the Condesa neighborhood of Mexico City to refill his monthly antiretroviral prescription.
One of just a handful of government clinics - in a city of some 21 million people - that caters specifically to people living with HIV, the Condesa facility gets busy. So Diaz, who is HIV+, knows to arrive before 6 a.m. to see a doctor.
"Accessing medicines for people with chronic diseases in Mexico is... an emotional and physical process," he told the Thomson Reuters Foundation.
On this particular March morning, the experience was made worse by a labour dispute that had shut out many employees. Despite waiting nearly two hours, Diaz was sent away empty handed and told to come back the following month.
"That's always the problem with this chronic illness," he said. "What kills you is the process. What makes you sick is the bureaucracy."
Diaz had enough medication to last until his next appointment, and a few days later, the clinic was again running.
But for him, and many others living with HIV in Mexico City, the struggle is emblematic of a more serious public health issue following the reforms of President Andres Manuel Lopez Obrador.
Lopez Obrador took office in December and announced a clutch of reforms, some of which could have a serious impact on patients living with HIV.
Along with halting funding for some NGOs, the administration changed the way it buys medicines in bulk from drug companies.
In previous years, the National Centre for the Prevention and Control of HIV/AIDS (Censida), had been in charge of purchasing all HIV medicines for patients who depend on the country's "Popular Insurance" health programme.
The agency provides universal access to antiretroviral therapy via the public health system, and currently treats more than 95,000 people living with HIV.
But in March, the administration said the Finance Ministry would now be in charge of overseeing its drug buying.
In a statement sent to government HIV clinics last week and obtained by the Thomson Reuters Foundation, Censida said that due to these changes, "purchase processes have suffered delays".
Censida advised healthcare workers to "only give out treatments for a month", rather than the customary three months, while stocks were replenished.
AIDS experts say government clinics could run out of certain antiretrovirals, leaving thousands who depend on the public health programme untreated for weeks or even months.
"There's a break in the supply chain," said Luis Adrian Quiroz, from the advocacy group Beneficiaries of the Mexican Social Security Institute Living with HIV (DVVIMSS).
"The damage caused...will be immeasurable."
But Carlos Magis, director of comprehensive care at Censida, said that while some medications were scheduled to run out as soon as May, these would be purchased later this month.
And because patients have different medicine regimens, a mass shortage was unlikely.
"It's not something apocalyptic, where suddenly there is nothing for anybody," Magis said.
Lopez Obrador has defended both reforms as part of his wider policy to root out corruption. His logic - that by centralising government spending, there is less chance of money going astray.
"It's not about leaving (patients) without protection. On the contrary, it's about treating them better and ensuring that there's no lack of medicines," Lopez Obrador told the Thomson Reuters Foundation. "What we want is to end corruption, in general, because that's the cancer destroying Mexico."
But in a country where HIV remains a serious public health issue, advocates say the reforms could have drastic fallout.
According to the government, although overall HIV incidence fell by 15 percent between 2005 and 2016, there are still 12,000 new cases diagnosed a year, or 33 new infections every day.
Meanwhile, according to the United Nations, of the 220,000 people in Mexico living with the disease in 2016, only 60 percent were on antiretroviral medication.
U.N. data also shows that gay men and transgender people are among the groups most at risk, with an HIV prevalence above 17 percent, followed by sex workers with a prevalence of 7 percent.
All three risk discrimination at government agencies and are therefore more likely to attend NGOs, according to advocates.
"That's why these organisations work in prevention," said Patricia Mercado, an opposition senator. "They can get close to these vulnerable communities, the LGBT population, sex workers... For the government, that's impossible."
However, Magis at Censida said the break in funding for civil society was only temporary while the government sets up a more transparent system.
"There is no plan in any way for the state to replace the work that civil society can do," he said.
But organisations are meanwhile running out of money.
If the HIV+ lack access to medication, even for a few weeks, rights groups say they face serious health risks themselves and have a greater chance of passing on the virus.
"It's a domino effect," said Leonardo Espinosa, president of Codise, a local organisation that offers HIV testing.
"The strategy for HIV is a combined prevention strategy. The whole plan depends on several joint actions."
The Mexican health ministry said recently on Twitter that its clinics had "enough supply of antiretroviral treatment for people living with HIV".
But health workers, patients and activists remain concerned.
Yasmin, a doctor who works at an HIV clinic outside Mexico City, said she has recently been denied medications that she had requested from Censida, or been offered alternatives.
"They can't tell me some cock-and-bull story that they're fighting corruption and 'sorry for the inconvenience'," she said, asking that her surname be omitted for fear of the fallout at work. "These aren't inconveniences; these are lives that could be lost."
(Reporting by Oscar Lopez @oscarlopezgib; Editing by Lyndsay Griffiths. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters that covers humanitarian news, women's and LGBT+ rights, human trafficking, property rights, and climate change. Visit http://news.trust.org)
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