In Mexico, the stigma associated with HIV/AIDS exists mainly because it is a fatal disease, most frequently transmitted sexually. The concentration of HIV/AIDS in sub-sectors of society has contributed to the lack of an effective response. The widely-held belief that AIDS is only associated with gay men, sex workers and drug users has led to the subsequent pinpointing of what people consider "high-risk groups" – as opposed to high-risk practices. By considering themselves exempt from these groups, most people do not adopt safer sexual practices to limit the risk of HIV infection.

The tragedy of misinformation, stigma and denial is reflected in the changing pattern of the epidemic: increasingly, women are being infected. Of the HIV cases reported, 86% are men and 14% are women. The male/female ratio has been changing however. Initially 30:1, today women make up as much as 25% of the total cases. The change in ratio reflects a trend of increasing heterosexual transmission, from 2.5% in 1987 up to 20% by 2000. In Mexico, the strong influence of machismo and Catholicism have contributed to pressurising MSM into leading a double life, hiding their sexual contacts with men from their wives. This has exacerbated the spread of HIV among women.

If the Mexican government is going to respond effectively to the spread of the epidemic, it must promote and defend the rights of people with HIV/AIDS. Although it signed the Paris Summit Declaration on AIDS in 1994 and is party to UNAIDS, the government's commitment to human rights is weak in terms of legislation and public policy.

The Official Norms for HIV Prevention and Control provide clear guidelines for minimising adverse social consequences from HIV blood tests. The norms stipulate that HIV tests can only be carried out with people's full consent, that information on a person's HIV status will be confidential, used exclusively for statistical purposes. It also establishes measures for hygiene and protection of medical personnel and states that HIV status cannot be a basis for any kind of discrimination.

Unfortunately, as these rights have not yet been integrated into existing legal bodies, the government's commendable commitments in relation to human rights and HIV/AIDS remain meaningless. For example, Article 134 of the Federal Work Act establishes that an employer can ask to see medical records if deemed necessary, effectively annulling the legal prohibition against demanding such information established in the Official Norms. In practice, HIV tests are carried out for the benefit of employers who wish to identify HIV-positive personnel. While the government's National Human Rights Commission (CNDH) recognises cases of discrimination, it does not intervene, as it is not legally competent to do so. The few people who dare to demand justice tend to become disillusioned as CNDH recommendations achieve little.

NGOs such as the Centre for Human Rights, Miguel Agustín Pro Juárez (PRODH) in Mexico City, daily experience the horror of the situation. Most of the 125 cases PRODH has advised or defended involve medical negligence as a result of HIV-related discrimination, HIV testing without consent and HIV-related dismissals from work. PRODH regularly conducts awareness campaigns and training programmes on human rights and HIV/AIDS for medical professionals, universities, other NGOs and for PLWHAs.

Ultimately, however, the government has the responsibility to make its commitments on human rights and HIV/AIDS actionable in terms of rapid legal reforms. It must also train and hold to account lower level public officials who are at the forefront of the epidemic such as doctors, nurses and teachers. Public awareness campaigns are also needed to combat stigmatisation and ignorance. Lack of political will has meant that none of these obligations are being carried out effectively.

Recommendations and guidelines are simply not enough to protect PLWHAs. A legal framework must be in place and a culture of human rights must be nurtured, where people can confront the epidemic without fear of social stigmatisation, lack of medical care, withdrawal of emotional support or redundancy from work, as this fear encourages stigmatisation and prevents people from changing their own behaviour. The changing pattern of the epidemic is worrying: if the reality of these changes do not affect people's consciousness, and if government continues to fail to implement effective national programmes and legal reforms, Mexico's privileged global position as a low-prevalence country will undoubtedly disappear.