1. Migration and AIDS: progress and challenges in Central America, Mexico and the US René Leyva-Flores rleyva@insp.mx Instituto Nacional de Salud Pública México, D.F, 4 de agosto 2008 XVII International AIDS Conference

2. Background  Approximately every year 500,000 people migrate from Mexico and Central America to the US  Places of origin: poor social and economic development  Migrants are one of the most important sources of economic income to developing countries (remittances)  25% are women and children

3. Objetive To identify AIDS prevention progress and challenges related to mobile groups from Central America, Mexico to the US.

4. Methods Research on AIDS prevention to mobile populations in Central America, México and the US 2000-2008, were reviewed.  What do we know?  What are we doing?  What are the results?  Next steps

5. Migration process: what do we know? 1. Heterogeneous social groups (culture, nationalities, goals). 2. Migrants people are one of the most healthier and younger group in the origin countries. 3. Social networks for support migration process. 4. Migrants: their knowledge on HIV and prevention strategies is better than those that stay.

6. Migration: a determinant of vulnerability to HIV infection Transactional and survival Sex: Sex as an exchange tool to transit and to insert in (work, house) in the US Sexual Violence 30% of migrant women are raped during their journey to the US Preexisting stigma Migration-related stigma and discrimination AIDS-related stigma and discrimination Source of social and health problems Increase in the number of sexual partners Riskier sexual practices and low condom use

7. Source: Encuesta sobre comportamiento sexual en grupos móviles, IMPSIDA, Tapachula, Chiapas, 2007 * Encuesta mujeres compañeras de migrantes que se quedan en las comunidades. Morelos, 2006 Mobile groups: trust in their partner and not use condoms % (*)

8. What do we do? Preventive services Information  Information Information  Information  Information  And some condoms

9. What do we do? Access to health services Governmental health services:  restrictions to access  Migrants perceptions (possibility to be deported) NGOs  Complex network with different services  Scarce coordination between NGOs and governmental  There is no relation to migrants social needs  Diminish capacity to solve health problems Migrants:  Self-care

10. HIV prevention projects for mobile population in Central America, Mexico and the US-Mexico border Mesoamerican Project –for Central America- (Supported by: The Global Found, 2005-2010) HIV Regional Project –for Central America- (Supported by: World Bank, 2006-2011) Integral care to HIV: mobile populations at Mexico- Guatemala border (Supported by: CENSIDA, 2008) US-Mexico border: Different governmental and NGOs initiatives (California, Texas, Arizona)

11. HIV prevention project for mobile population in Central America an Mexico

12. RESULTS: Migrants HIV prevalence 1.Migrants in transit at the Mexican- Guatemalan border HIV prevalence: 2% (group: with previous information on HIV/AIDS and exposed to risky sexual practices) Sample: 420 migrants in transit who stayed at “La Casa del Migrante” at Tapachula, Chiapas, 2007. 2. US-Mexican border 3.4% of the total PLWA are latinos; 2006-2007. (Ruiz J. VIH/SIDA en la frontera de Estados Unidos-México, 2006-2007. X Congreso Nacional sobre VIH/SIDA y otras ITS. León, Guanajuanto, México. Nov. 2007)

13. The challenge: What game should we play together? Coordination or collaboration: is it really an option? The NGOs+GO: the best formula to play together? International agencies moving to…? The mobile groups: facing new challenges, vulnerability and risk to HIV/AIDS.