STRUCTURAL DETERMINANTS IN THE ACCESS AND ADHERENCE TO ANTIRETROVIRAL TREATMENT OF INDIGENOUS PEOPLE WITH HIV IN SOUTHERN MEXICO.

Apresentação/Introdução
Social vulnerability to HIV infection and lack of medical care access to the indigenous people unlike other populations, in some contexts studied in Latin America, is related with social inequities produced by the cultural, political and economic subordinated positions they have. Little is known about the adherence to antiretroviral therapy in this population in Mexico and Latin America


Objetivos
1- Explore structural determinants in the detection, access and adherence to antiretroviral treatment of indigenous people with HIV. 2- Elucidate differential adherence to antiretroviral treatment compared with non indigenous population.


Metodologia
We carried out a qualitative study case during 2016-2017 in a clinic specialized on HIV medical care in Chiapas (Mexico). We conducted 39 in-deep interviews with patients, their family members and health care providers and carried out participant observation during one month at the medical center. Our participants were indigenous patients, 5 belonging to “chol” ethnic identity and 24 were “tseltal”. They are low-income people in between 20 and 55 years old. 62% are women and 38% men.


Resultados
Late detection and difficult adherence to antiretroviral treatment due to the following factors: Economic: Treatment is centralized in the cities, distances from their place of residences are long and expensive to afford. Social: stigma and discrimination in their place of residence, lack of social support from their families and neighbors. Discrimination on their HIV status in regional hospitals. There are not professionals translators in the medical center, which has consequences in access-taking-monitoring of treatment. Within a 20% of general non adherence rate, 98% of people leaving the treatment were indigenous. We detected 7 case of vertical transmission due to mentioned factors.


Conclusões/Considerações
The results reveals specifics structural determinants to antiretroviral adherence, with a differential adherence rate compared to non-indigenous people. There is a need to improve these situations, in the context studied, and know more about this subject in Mexico and Latin America