,QIRUPH¿QDOGH*XDWHPDOD !"#$#%&#'%()*+#,"%-(.,/)*(.%-01(1*(23'*"*.(#"14+*"%. 5%-01(.*60%-(7()*8),10$&#'%(7(9!:( *"(%1,-*.$*"&*.(7(23'*"*.(#"14+*"%. ,QIRUPHÀQDOGH*XDWHPDOD Esta publicación fue producida por el Proyecto de Curso de Vida Saludable de la Organización Panamericana de la Salud/Organización Mundial de la Salud, bajo la dirección de la Dra. Ma-­ tilde Maddaleno. Se realizó con el apoyo de la Agencia Española de Cooperación Internacio-­ nal (AECI). La versión electrónica del Informe Regional está disponible en la página web de la Unidad y se puede acceder a través de www.paho.org. Para información adicional del informe ¿QDOGHSDtVHQ*XDWHPDODe-­mail@gut.ops-­oms.org Coordinadoras Marta Elena Casaús Arzú Alejandra Hurtado de Mendoza Cristina Torres Investigadora principal Guatemala Regina Fuentes Oliva Investigadores de campo Olivia Santiago Ceto Alba Judith Cap Jaime de León de León Ministerio de Salud Pública y Asistencia Social de Guatemala, Departamento de Regulación de los Programas de Atención a las Personas Representación OPS/OMS Guatemala *XDWHPDODIHEUHUR Créditos fotografías de portada: 3UHVLGHQFLDGHOD5HS~EOLFDGH*XDWHPDOD Equipo COMUNICARES /HRQHO0LMDQJRVE\KWWSQHORZV Diseño y diagramación: Alejandro Alvarez Ordóñez, IGRAFIX STUDIO, DOHMDQGUR#LJUD¿[VWXGLRFRP Tabla de contenidos Resumen ejecutivo ....................................................................................................... 1 I Algunos datos socio-­económicos de Guatemala........................................................ 5 II Situación de salud ..................................................................................................... 7 III Cultura, sexualidad, género y VIH .......................................................................... 13 IV Salud sexual y reproductiva, VIH y sida en pueblos indígenas ............................. 19 V Metodología de trabajo ........................................................................................... 23 VI Principales hallazgos ............................................................................................. 27 VII Conclusiones ......................................................................................................... 57 Siglas utilizadas .......................................................................................................... 63 5HIHUHQFLDVELEOLRJUi¿FDV .......................................................................................... 65 Anexos ........................................................................................................................ 71 'DWRVVRFLRHFRQyPLFRV .............................................................................. 71 5HWUDWRVGHODVHQWUHYLVWDVHKLVWRULDVGHYLGDPiVUHOHYDQWHV .................. 80 (QWUHYLVWDD$MNLM .......................................................................................... 96 <*.0=*"(*2*$0&#', (VWHHVWXGLRSUHVHQWDXQVRQGHRFXDOLWDWLYRVREUHODVH[XDOLGDGODSUHYHQFLyQ\YLYHQFLDGHO9,+\VLGDHQMyYHQHV +&4G3"&5#'3$5*"%52*")-#. /DPHWRGRORJtDHPSOHDGDSDUDUHDOL]DUHOHVWXGLRFRQVLVWLyHQODUHYLVLyQELEOLRJUi¿FDGHGRFXPHQWRVVREUHHO *"%5>'25'="52+M5)+7&'4"'3=$E-#'Q-)52"#')-&'54-2"#)"&*"#'A'54$2*-#'4"'E-F25)+-&"#'+&4G3"&5#>'5#G')-%-'"&*=",+#*5#' +&4+,+4$52"#')-&'E"=#-&5#'R$"',+,"&')-&'B0C'SKBB:T.'U5'+&Q-=%5)+7&'=")-2")*545'E"=%+*+7')-&#*=$+='L+#*-=+5#'4"' ,+45'R$"'E25#%5&>')-&'$&'2"&3$5("'4+=")*->'25#'"%-)+-&"#>')=""&)+5#'A',+,"&)+5#'4"'"#*5#'E"=#-&5#.' 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Casos notificados VIH y Sida segun departamento de residencia y sexo Guatemala enero 1984 - octubre 2009 Femenino Masculino Sin dato Total Departamento de Gran Sin Sin Sin Sin Tasa residencia Sida VIH Total Sida VIH Total Sida VIH Total Sida VIH total dato dato dato dato 193 255 507 277 1302 145 371 335 52 78 105 59 71 52 58 132 56 22 36 27 58 45 4 108 4348 Retalhuleu Izabal Escuintla Suchitepequez Guatemala Peten San Marcos Quetzaltenango El Progreso Zacapa Sacatepequez Santa Rosa Jutiapa Chiquimula Baja Verápaz Alta Verápaz Chimaltenango Jalapa sololá Totonicapan El Quiché Huehuetenango Extranjero Sin dato Total 244 353 365 124 859 203 339 232 48 28 29 39 71 36 24 77 42 19 20 14 35 17 16 44 3278 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 6 0 1 0 0 0 0 9 437 608 872 401 2161 348 710 567 100 106 134 100 142 88 82 209 98 47 56 42 93 62 20 152 7635 463 478 982 680 3219 251 862 681 99 161 180 165 212 152 78 212 125 69 74 74 116 75 13 302 9723 249 332 246 101 923 182 341 187 35 40 34 57 52 33 22 70 29 13 15 16 33 22 5 53 3090 0 0 0 0 0 0 0 0 0 0 0 5 2 0 0 1 0 8 1 0 0 0 0 1 18 712 810 1228 781 4142 433 1203 868 134 201 214 227 266 185 100 283 154 90 90 90 149 97 18 356 12831 0 0 1 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 10 1 0 0 0 4 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 8 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 22 656 733 1490 957 4525 396 1233 1016 151 239 285 224 283 204 136 344 181 91 110 101 174 120 17 415 14081 494 0 685 0 611 0 225 0 1786 0 385 0 681 0 419 0 83 0 68 0 63 0 96 7 123 2 69 0 46 0 147 1 71 0 32 14 35 1 30 1 68 0 39 0 21 0 103 1 6380 27 1150 1418 2101 1182 6311 781 1914 1435 234 307 348 327 408 273 182 492 252 137 146 132 242 159 38 519 20488 427.52 382.69 344.24 292.85 280.97 251.93 242.24 230.13 198.40 175.98 172.07 112.14 105.38 99.60 88.57 73.34 65.31 64.67 53.22 39.56 37.12 19.48 204.66 Fuente: Base sida, CNE )XHQWH*DUFtD-XGLWK(VWDGtVWLFDVGHFDVRVDFXPXODGRVQRWL¿FDGRV9,+\VLGD(QHURRFWXEUH 12="4"4-='4"2';P'e'4"'2-#'5Q")*54-#'#-&'L-%F="#>'#+*$5)+7&'R$"'"#*V')5%F+5&4-'A5'R$"'"&'2-#'d2*+%-#'5[-#'#"' E"=)+F"'$&5'*"&4"&)+5'L5)+5'25'Q"%+&+M5)+7&'4"'25'"E+4"%+5.'U5'E=+&)+E52',G5'4"'*=5&#%+#+7&'"#'#"?$52'SHD.H'eT>' OHVLJXHODWUDQVPLVLyQPDGUHKLMRFRQXQ(VGHGHVWDFDUTXHHQORVJUXSRVGHHGDGGHDHQGRQGH "&)-&*=5%-#'5'2-#'54-2"#)"&*"#'A'(7,"&"#>'25'*5#5'4"'%5#)$2+&+454'"#'25'%V#'F5(5'4"'*-4-#'2-#'3=$E-#'"*5=+-#'R$"' )-&*=5"&'"2',+=$#'E-='*=5&#%+#+7&'#"?$52>'=","25&4-'$&5'Q"%+&+M5)+7&'4"'25'"E+4"%+5'E5=5'54-2"#)"&*"#'A'(7,"&"#. &DVRV9,+\VLGDVHJ~QTXLQTXHQLRGHQRWLÀFDFLyQ\VH[RGHDRFW Guatemala, 1984 a octubre 2009 Femeninos Quinquenio 1984-1988 1989-1993 1994-1998 1999-2003 2004-2009 Sin dato Total Masculinos Sin clasificar sexo Sin Sida VIH Sin dato Total Sida VIH Total Sida VIH Total dato 6 1 72 1 443 37 1349 312 2477 2925 1 2 4348 3278 0 0 0 0 7 2 9 7 73 480 1661 5409 5 7635 43 0 341 12 1412 64 2957 353 4969 2658 1 3 9723 3090 0 0 0 0 17 1 18 43 353 1476 3310 7644 5 12831 0 0 0 10 0 0 10 0 0 4 3 0 4 12 0 0 4 13 0 4 22 Totales Sida VIH Sin dato Total 49 1 413 13 1855 105 4316 668 7446 5583 2 9 14081 6380 0 0 0 0 24 3 27 50 426 1960 4984 13053 14 20488 % 0.24 2.08 9.57 24.33 63.71 0.07 100 Fuente: base Sida, CNE )XHQWH"85=)G5>'h$4+*L.(VWDGtVWLFDVGHFDVRVDFXPXODGRVQRWL¿FDGRV9,+\VLGD(QHURRFWXEUH (QODGLVWULEXFLyQJHRJUi¿FDKD\XQFUHFLPLHQWRSDXODWLQR$SUR[LPDGDPHQWHHOGHOWHUULWRULRQDFLRQDOFRQ6 )"&*=5')"=)5'4"2';9'e'4"')5#-#.'U5#'*5#5#'%V#'52*5#'4"')5#-#'="E-=*54-#'#"')-&)"&*=5&'"&'2-#'4"E5=*5%"&*-#' /D' 85=)G5.'(VWDGtVWLFDVGHFDVRVDFXPXODGRVQRWL¿FDGRV9,+\VLGD(QHURRFWXEUH 10 ,QIRUPH¿QDOGH*XDWHPDOD GH5HWDOKXOHX,]DEDO(VFXLQWOD4XHW]DOWHQDQJR6XFKLWHSpTXH]\*XDWHPDOD/X'K-='#$'E5=*"'2-#'4"E5=*5%"&*-#' FRQODVWDVDVPiVEDMDVVRQ+XHKXHWHQDQJR(O4XLFKp$OWD9HUDSD]\7RWRQLFDSiQ(VWRSRGUtDGHEHUVHDXQD ,+45')-%$&+*5=+5'%V#'*=54+)+-&52'A'2-#')5#-#'="E-=*54-#'#"'5#-)+5&'5'%+3=5)+7&'*"%E-=52'+&*"=&5'5'M-&5#'4"'52*5' SURGXFWLYLGDGSHURWDPELpQSRGUtDHVWDUDVRFLDGRDXQDFFHVRGH¿FLHQWHDORVVHUYLFLRVGHVDOXG $MXLFLRGHOLQIRUPHGHO3URJUDPDGH9,+\VLGDGHO%DQFR0XQGLDOUHDOL]DGRHQ³H[LVWHXQDPD\RUFRQFHQ6 WUDFLyQHQORVGHSDUWDPHQWRV\FLXGDGHVGHPD\RUDFWLYLGDGSURGXFWLYDHVSHFt¿FDPHQWHHQODFRVWDVXUHQODUXWD R$"')-&4$)"'5'25')+$454'8$5*"%525.'U5'="3+7&'=")+F"'*5%F+@&>'"&')+"=*5#'@E-)5#'4"2'5[->'3=5&4"#')-&*+&3"&*"#' L$%5&-#'R$"'22"35&'E5=5'*=5F5(5='"&'25')-#")L5'4"')5[5'A')5Q@.'14"%V#'SiT'%+3=5&*"#'E=-,"&+"&*"#'4"'-*=-#' SDtVHV«UXPERD0p[LFR\(VWDGRV8QLGRV´/9$ Mapa de tasa de VIH por 100.000 habitantes por distribución geográfica Guatemala, 1984-octubre 2009 Tasas por 100.000 hab. 0 – 67,32 67,33 – 142,10 142,11 – 249.51 249,52 – 427,51 Fuente: CNE, 2009 )XHQWH&1( 6HJ~QHOLQIRUPHUHDOL]DGRSRUHO%DQFR0XQGLDO\FLWDGRDUULEDVHFRQVLGHUDTXHORVVHFWRUHVPiVYXOQHUDEOHVD 25'"&Q"=%"454'#-&'L-%F="#'R$"'*+"&"&'#"?-')-&'L-%F="#'jC:C6'A'%$("="#'*=5F5(54-=5#'4"2'#"?-'jIW:6'E-=R$"' "&'4+)L-#'3=$E-#'25'#"=-E=",52"&)+5'"#'#$E"=+-='52'9'e.'W5%F+@&'"2'3=$E-'4"'E"=#-&5#'R$"'#"'"&)$"&*=5&'E=+,545#' 4"'2+F"=*54'"#')-&#+4"=54-'4"'52*-'=+"#3-. 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