Programa de comunicación para el cambio de comportamiento relacionado con el VIH para sitios de alta prevalencia en México

The objectives of this study are to present the basic factors driving the Mexican epidemic, analyze the objectives of USAID's HIV/AIDS prevention program and the implementation activities carried out during the period 2005-2009, as well as propose recommendations for future prevention priorities. As of March 31, 2009, a total of 130,969 cases of AIDS had been registered in Mexico, with 82.4% of cases being men, and a male-to-female ratio of 4.7 (CENSIDA, 2009). The 2007-2012 Strategic Plan for HIV/AIDS and STIs of the Mexican government identifies a concentration of the epidemic in key populations: MSM, FSW, TS, and IDUs (Secretariat of Health, 2008). Various studies provide conclusive evidence to support a response directed at the epidemic. The USAID program for Mexico focuses on reducing the risk of HIV transmission in vulnerable populations with high prevalence, through support for behavior change activities and commercial distribution of condoms. Additionally, it promotes positive policy change, multisectoral participation, reduction of stigma, and equitable policies in workplaces. These activities have been designed and implemented in accordance with the priorities and strategies of CENSIDA. During the period 2005-2009, USAID implemented prevention activities through two projects. The first, called Behavior Change in Populations with High Prevalence and Vulnerability to HIV/AIDS in Mexico, is a CCC program implemented by PSI. A second project, called Availability of Condoms in High-Risk Points in Mexico, is a small program directed at social marketing of condoms (MSC) implemented by Abt. Associates (under a sub-agreement with PSI). The CCC program was designed to support the following prevention objectives: * Change behaviors to reduce HIV and other STI transmission, including reducing high-risk sexual behaviors; and increasing perceived risk in high-prevalence populations, using strategies based on the ABC approach; and * Increase coordination of prevention services for high-prevalence HIV populations between public and private institutions that provide counseling and voluntary testing, as well as treatment for other STIs, in order to increase demand for both types of services. Based on best practices in CCC, the USAID CCC program adapted a series of interventions and messages to the Mexican context. Through the program, USAID implemented prevention strategies and messages that supported policies promoted by Mexican authorities. The prevention interventions can be grouped into six categories: individual contact, group contact, multiple-session activities, support groups, event-based activities, and communication campaigns. The individual behavior change interventions, in small groups, and in multiple sessions were designed using the Theory of Stages of Change (Prochaska et al., 1997). The implementation strategy included an approach to achieving the greatest possible coverage of target populations in high-risk areas. Field experience, in parallel with research results, produced several programmatic changes throughout implementation, improving interventions for target populations. In 2005, the CCC program began operating in 11 cities located in eight federal entities; and, by 2006, it expanded to 24 cities in 15 entities. In 2008, a strategic decision was made to reduce the geographic coverage of the program to eight cities in seven federal entities, with a slight decrease in the number of implemented activities and people contacted. The USAID CCC program implemented approximately 57,000 activities between fiscal years 2005 and 2009. Through the project, the individual intervention called Salvando VIHdas was the predominant activity of the program, representing more than 70% of the total CCC activities (Figure 4). Between fiscal years 2005 and 2008, there was a constant increase in the number of individual interventions and a decrease in the number of small group interventions. An analysis of the PSI survey applied to MSM in 2009 was conducted to know if exposure to selected CCC activities had produced behavior changes. In general, exposure to the HIV prevention program was associated with: * A reduction in the number of sexual partners among MSM * A greater use of condoms