Inter Press Service - December 5, 2001
Diego Cevallos*

Hugo Estrada, 43, has been HIV-positive for the last five years and says he is content with his life. He has access to medications, timely medical treatment and psychological support. Furthermore, he receives a disability pension and has a very supportive family.

Estrada's case might be considered normal in an industrialised country, but in Latin America, where there are 1.4 million people with HIV/AIDS - 130,000 who became infected this year - he is the exception.

"I am among the privileged," acknowledges Estrada. His good fortune, he says, is linked to having state social security benefits and a university education, but is largely due to his leadership in the Mexican organisation known as the National Front of People with HIV/AIDS.

"I can't think about a future in the long term, but with the time I have left and the prospects for new medications, I will always put up a fight," he says. Activists defending the rights of people who are HIV-positive recognise that notable progress has been made in Latin America as far as access to medical attention. This is closely related to the discovery of new drugs, particularly the antiretrovirals that have transformed AIDS from a killer into a chronic disease because they destroy HIV or prevent the virus from multiplying.

Nevertheless, there are still many infected individuals who are excluded from health services and marginalized by society.

The majority of HIV-positive Latin Americans are from poor communities where education levels are relatively low, which generally means they lack the awareness to demand the treatments that are available. Often, if they do obtain the services, they are unable to maintain the rigorous schedule required for taking the AIDS drugs.

When it comes to AIDS, the problem is "not only individual, but also social," says Marclei Guimaraes, a Brazilian sociologist who is HIV positive. "Among those with low incomes, adherence to treatment programmes is low. Not for lack of motivation, but because of objective social conditions," he adds.

In countries like the United States, where medical attention for HIV/AIDS patients is generally of very high quality, the national health expenditure is 4,180 dollars per capita. In contrast, the average in Latin America is 349 dollars per capita, according to the United Nations Development Programme.

"We can't compare ourselves to a rich country. In Latin America, there are few countries that offer medical attention like that available in the United States," said Mexican activist Estrada.

But there has been some progress. In Venezuela, where the Supreme Court of Justice declared last April that all Venezuelans with HIV/AIDS shall receive medical attention, including antiretroviral drugs, the number of people receiving treatment for AIDS skyrocketed from 2,000 late last year to 10,000 in 2001. However, some 62,000 Venezuelans, in a national population of 23 million, are believed to be HIV positive.

In Brazil, meanwhile, there are 105,000 HIV/AIDS patients receiving free health services from the state, and the number rises by 15,000 to 20,000 each year. But an estimated half-million more are HIV positive, and few of them are aware of it.

The Portuguese-speaking nation of 162 million people stands out in Latin America for its capacity to produce generic AIDS-fighting drugs. But this advantage has meant clashes with the big transnational pharmaceutical companies, which defend their drug patents tooth and nail.

"The success of the Brazilian programme is due to the government's early response to AIDS, the participation of civil society, and the defence - in the national and international spheres - of ensuring access to all the necessary medications," says Rosemeire Munhoz, assistant coordinator of the sexually transmitted disease programme at Brazil's Ministry of Health.

Of the AIDS drugs distributed in Brazil in 2000 - at a cost of 303 million dollars - 41 percent were produced by laboratories inside the country.

In Mexico, the state provides antiretroviral drugs for approximately 20,000 people, or 85 percent of Mexicans with the disease, according to Carlos Magis, head of research at the National Centre for the Prevention and Control of HIV/AIDS.

But activists say the true percentage of HIV/AIDS patients receiving the medications is much lower because of the under- reporting of cases. They calculate that some 120,000 people are infected with the virus in Mexico, a nation of approximately 100 million people.

Furthermore, there are 4,400 Mexicans with AIDS who do not have social security benefits. Their only possibility for obtaining antiretroviral drugs is through a special government-run programme, but it can only cover 2,000 patients.

If an HIV-positive Mexican requires medical attention and has no insurance, he or she has to wait until someone abandons the programme or dies, says activist Estrada. "The only alternative may be to shut yourself away at home and wait for death," he adds.

In Mexico, Brazil and Venezuela - and all Latin American countries - state support is vital for the HIV-positive population because treatment in the private sector would cost each patient 700 to 1,000 dollars a month, a sum that is out of reach for most people.

Though the governments of Latin America still need to do much more, the situation for HIV/AIDS patients in the past was even more complicated.

Improving the quality and quantity of medical services has cost a great deal of effort and many lives, agree activists and governments alike.

The changes in the fight against AIDS in Latin America are the result of the activism of the people with the disease, the mobilisation of local and international organisations, and the negotiations between governments and pharmaceutical companies - which have brought down drug costs by as much as 80 percent, as was the case of the Merck corporation in Mexico

It does not represent a comprehensive victory for the region, however. There are still relatively few people with HIV/AIDS who receive free medical treatment from the government like Estrada does in Mexico.

"Unfortunately, in this country (Mexico) and others, if you don't put on the pressure, if you don't yell and demand treatment, nothing happens. If you don't take action, you die," Estrada said.

Psychological support, regular laboratory tests, treatment and control of the opportunistic illnesses associated with AIDS are still scarce in most countries, say activists.

The governments of Latin America recognise the potential long- term savings of providing the antiretroviral drugs, but many argue that current economic problems limit their ability to take immediate action. Still, several are promising that they will take all possible steps to improve the quality and expand the quantity of medical coverage for AIDS patients.

"Collective experience with HIV/AIDS has evolved to the point where it is now possible to state with confidence that it is technically, politically and financially feasible to contain HIV/AIDS and dramatically reduce its spread and impact," UN Secretary-General Kofi Annan has said.

But until all Latin Americans with HIV/AIDS receive comprehensive and high quality treatment like Mexico's Estrada, the "dramatic reduction" will remain a pending goal for most countries in the region.

* IPS correspondents Mario Osava (Brazil) and Andr s Ca±iz lez (Venezuela) contributed to this article, which was produced with the support of the Pan-American Health Organisation (PAHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS).
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