Social and Cultural Determinants and Health Strategies in Specialized Medical Care to Mayan Population with HIV in Chiapas

The article analyzes social and cultural determinants that impact on access, adherence and timely follow-up of antiretroviral treatment of the Tseltal and Chol population with HIV in Chiapas and strategies of care and accessibility to treatment of support networks and health personnel. It contributes to the scarce existing research on non-adherence to antiretroviral treatment among indigenous peoples in Mexico and Latin America. The methodology is qualitative, based on a case study in an HIV care clinic (SAIH), during the period 2017-2018, with health personnel, users and family members, and is complemented with descriptive quantitative data on mortality and differential vertical transmission. The results demonstrate the impact on this population of the centralization of treatment in the SAIH, of the economic difficulties for travel, of the stigma and discrimination existing in their communities, and of the organizational culture of the SAIH. Strategies regarding care and/or pluralism of care are also identified. It is urgent to generate knowledge and specific measures from public policies and their implementation.