title: Public health services and their relationship with rapid HIV test utilization and access for key populations in Morelos, Mexico.
abstract: OBJECTIVE
  In 2009, 4 749 rapid HIV tests were run in Morelos, Mexico, despite lacking evidence on their results. This article seeks to analyze how public health organization relates to utility of rapid HIV test among healthcare users.
  
  
  METHODS
  Joint study: comparison of differences in applied test and positive results for each group with the Bonferroni statistical tool, observational study in 34 health subsystems, and 11 interviews with public healthcare users.
  
  
  RESULTS
  Each subsystem processes influenced the use and usefulness of screening; for instance, primary care centers test only pregnant women and exclude men who have sex with men (MSM). That group shows significant differences (p<0.007) in the HIV-positive test with respect to other groups.
  
  
  CONCLUSIONS
  Despite the availability of rapid detection tests and epidemiological evidence, the way public health services are organized impedes an efficient diagnosis in the group with higher risk, namely MSM. The distribution of rapid HIV tests was guided by stigmatization.
authors.affiliation: Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Silvia Magali
authors.initials: SM
authors.lastname: Cuadra-Hernández
authors.affiliation: Dirección de los Servicios de Salud del Estado de Morelos, Cuernavaca, Morelos, México.
authors.forename: Jesús Israel
authors.initials: JI
authors.lastname: Bernabé-Aranda
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Carlos Jesús
authors.initials: CJ
authors.lastname: Conde-Glez
authors.affiliation: Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Mario Salvador
authors.initials: MS
authors.lastname: Sánchez-Domínguez
authors.affiliation: Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Doris Verónica
authors.initials: DV
authors.lastname: Ortega-Altamirano
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods* / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006679:HIV Seropositivity; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008800:Mexico / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology; D011287:Prejudice; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011329:Prisoners; D015980:Public Health Practice / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D057545:Social Stigma; D013997:Time Factors; D035862:Vulnerable Populations