"To achieve the 90-90-90 goals and 'get to zero' in the Americas, we must tackle equity for indigenous communities," proclaimed Amaranta Gómez of the Secretariado Internacional de Pueblos Indígenas y Afrodescendientes Frente al VIH (International Secretariat of Indigenous and Afro-descendant Peoples Against HIV) at the Community Forum ahead of the 10th International AIDS Society (IAS) Conference on HIV Science in Mexico City. However, indigenous people and other key populations are always accepted late to the table to fight for health, justice, and HIV prevention, she noted.
Indigenous activists first met globally at the 4th International Conference on the Biopsychosocial Aspects of HIV Infection (now known as the AIDSImpact Conference) in Ottawa, Canada, in 1999, and have since tried to raise the visibility of indigenous populations within the larger HIV movement, she explained. The goal of their work has been to describe the socio-cultural determinants of health faced by native peoples, including structural violence, poverty, migration, gender inequality and denial of HIV risk, and to emphasize good practices for culturally sensitive HIV prevention and treatment.
Gómez and others staged a protest at the opening session of the IAS 2019 Conference to demand inclusion of indigenous health issues in all policies, health care access for all, financing of a comprehensive indigenous AIDS response and support for indigenous leadership.
"We have never been silent, but you have not heard us," a spokesperson for the International Indigenous Working Group on HIV and AIDS told attendees. "We call upon national governments, international organizations, private institutions and funding entities to take action and implement our demands."
During a panel the following day entitled "The Plight of Indigenous People," Rubén Muñoz Martínez of Centro de Investigaciones y Estudios Superiores en Antropología Social/Center for Research and Higher Studies in Social Anthropology (CIESAS) explained that one of the hurdles in getting heard was the paucity of data on this population. In Mexico, whether someone is an indigenous person is usually identified by the language they speak. However, such data are only collected to determine if interpreting services are needed. Thus, bilingual people or those from indigenous groups who do not have their own language are not counted. Another problem is that many people do not want to self-identify as indigenous because of the racism with which they have had to contend all their lives, an audience member noted.
The variety of indigenous languages in Mexico also poses a problem for disseminating HIV prevention information, Muñoz Martínez noted in an email interview. Government programs do not even try to cover the main languages, he explained: "The health sector's actions are limited to giving talks about HIV prevention along the lines of programs such as 'Prosper/Opportunities' in Spanish, and most of the health centers in the country don't have translators or linguistic/cultural interpreters available." Government sources also provide no information whatsoever for illiterate people, he wrote. By contrast, cookbooks with step-by-step instructions in photos and similar resources are available, at least in Mexico City.
While public health authorities do not believe that HIV has a special impact on indigenous communities, what little data are available paint a different picture, he noted. In Mexico City, for example, HIV prevalence among indigenous language speakers attending the city's main HIV clinic, Clínica Condesa, is 5 and 8 times higher among men and women, respectively, than the proportion of indigenous inhabitants of the city (1.5%). During the panel, Muñoz Martínez presented results from his study in Oaxaca state, which showed consistently higher HIV and AIDS mortality rates among indigenous language speakers compared to Spanish speakers. Qualitative interviews pointed to structural violence, economic and cultural factors, the lack of interpreters and the city location of the only HIV service center in the state as causes for this discrepancy.
After describing the lack of data and government interest in the HIV crisis among Mexican indigenous people in his email, Muñoz Martínez concluded on a positive note: "Let's hope that this situation will change and that more and more decision makers, academics and indigenous activists will join the fight against HIV among the indigenous people of Mexico."