Convention.189 In this regard, the Court has asserted that protection of the right to personal integrity supposes the regulation of health services within the domestic sphere, as well as implementation of a series of mechanisms to ensure that this regulation is effective. 190 162. In the instant case, the Court notes that patients living with HIV may experience severe suffering as a result of the physical and mental effects of the opportunistic diseases, and from social factors resulting from their condition. As mentioned previously, adequate medical treatment and social support can mitigate both the physical and psychological aspects of this suffering. In this regard, expert witness Olga Alicia Paz Bailey explained that the illnesses caused by HIV/AIDS cause physical pain and prevent the realization of daily activities, and this results in the person being stigmatized and an object of social prejudices.191 In this way: The physical ailments suffered by the individual: numbness in arms and legs, cramping, the affected parts of the body do not respond when the person wishes to move them, nausea, headaches, fever, diarrhea, tiredness, lack of physical strength, and the series of opportunistic diseaes that take advantage of the clinical conditions, are the signs of an ailing body, which the patient will try and hide, because the stigma associated with HIV/AIDS condemns him to marginalization, exclusion and discrimination. At this stage, the physical suffering becomes psychological suffering: anguish, depression, guilt, shame.192 163. Accordingly, the Court finds it proved that 46 presumed victims suffered physical and mental effects as a result of their condition as people living with HIV. Therefore, for the reasons mentioned in the preceding section (supra paras. 119 and 126), the Court notes the existence of a causal nexus between the lack of adequate medical treatment for the presumed victims, and the physical and mental effects they suffered as people living with HIV. Indeed, the State, by failing to ensure antiretroviral therapy, perform the corresponding diagnostic tests, and provide social support, which could have allowed the presumed victims to mitigate or eliminate the endogenous and exogenous factors that were the cause of their physical and mental suffering arising from their condition as people living with HIV, is responsible for violating their right to personal integrity. Consequently, the State is responsible for the violation of the obligation to ensure the right to personal integrity recognized in Article 5(1) of the American Convention to the detriment of 46 presumed victims in this case.193 Regarding the other presumed victims, the Court lacks Cf. Case of Tibi v. Ecuador. Preliminary objections, merits, reparations and costs. Judgment of September 7, 2004. Series C No. 114, para. 156 and 157, and Case of Poblete Vilches et al. v. Chile. Merits, reparations and costs. Judgment of March 8, 2018. Series C No. 349, para. 152. 189 Cf. Case of Ximenes Lopes v. Brazil. Judgment of July 4, 2006. Series C No. 149, paras. 89 and 90, and Case of Poblete Vilches et al. v. Chile. Merits, reparations and costs. Judgment of March 8, 2018. Series C No. 349, para. 152. 190 Cf. Expert opinion of Dr. Olga Alicia Paz Bailey provided on December 17, 2017 (merits file, folios 1412 and 1419). 191 192 Expert opinion of Dr. Olga Alicia Paz Bailey provided on December 17, 2017 (merits file, folio 1436). The following fall within this category: i) Ismar Ramírez Chajón, ii) José Cupertino Ramírez, iii) Sebastián Emilio Dueñas, iv) Julia Aguilar, v) Luis Rubén Isabel Alvarez Flores, vi) Saira Elisa Barrios, vii) Felix de Jesús Cabrera Morales, viii) César Noé Cancinos Gómez, ix) Aracely Cinto, x) Luis Rolando Cuscul Pivaral, xi) María Felipe Pérez, xii) Mardo Luis Hernández and Hernández, xiii) Luis Armando Linares Ruano, xiv) Pascuala de Jesús Mérida Rodríguez, xv) Darinel López Montes de Oca, xvi) Audencio Rodas Rodríguez, xvii) Zoila Marina Pérez Ruíz, xviii) Santiago Francisco Valdéz Aguilar, xix) Karen Judith Samayoa Vásquez, xx) Francisco Sop Quiej, xxi) Miguel Lucas Vaíl, xxii) Sandra Lisbeth Zepeda Herrera, xxiii) Petrona López Robledo, xxiv) Rita Mariana Dubón Orozco, xxv) Maria Blanca Vail López, xxvi) José Rubén Delgado López, xxvii) Elsa Miriam Estrada Ruíz, xxviii) Guadalupe Herminia Cayaxon García, xxix) Juana Aguilar, xxx) Melvin Yovani Ajtun Escobar, xxxi) Felipe Tebalan Ordoñez, xxxii) Martina Candelaria Álvarez Estrada, xxxiii) Ismerai Olibia García Castañon, xxxiv) Santos Isacar Vásquez Barrios, xxxv) Marta Alicia Maldonado Paz, xxxvi) Dora Marina Martínez Sofoifa, xxxvii) Israel Pérez Charal, xxxviii) 193 56