Inter Press Service - October 19, 2004
Daniela Estrada

"Chile has all of the elements needed to win the fight against AIDS," unlike many other Latin American countries, declared Global Fund representative Aleph Henestrosa at a recent meeting held to report on the results of this initiative.

One of the main achievements so far has been a decrease in the rate of new infections by HIV, the virus that causes AIDS, according to official statistics.

"The growth curve prior to the project led to a forecast of eight new cases a day, compared to the actual rate, which is six. And this downward trend is expected to continue over the next few years, leading to even lower figures," Annabella Arredondo, the executive coordinator of the state-run National AIDS Commission (CONASIDA), told IPS.

According to World Health Organisation (WHO) estimates, there are roughly 26,000 people infected with HIV in Chile, a country of nearly 16 million people, although only 12,000 cases have been diagnosed.

While the HIV/AIDS incidence rate in Chile, 0.3 percent, is relatively low compared to other South American countries like Argentina and Brazil, which both have rates of 0.7 percent, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has warned of an incipient epidemic, and stresses that the country's conservative socio-cultural environment has hindered the effectiveness of many prevention efforts.

Of the total number of people living with HIV/AIDS in Chile, roughly 80 percent are men and 20 percent are women, mainly homemakers infected by their spouses.

There are also around 100 children receiving medical treatment for HIV/AIDS, after contracting the virus from their mothers in the womb or during birth. Another growing cause for concern in Chile is the number of infants and children who are left orphaned when one or both of their parents die of this disease.

Over six million dollars were spent during the first year of this two-year Global Fund-financed project for the Acceleration and Improvement of the National, Intersectorial, Participatory and Decentralised Response to the HIV/AIDS Epidemic.

As its name indicates, the project is aimed at harnessing and strengthening all of the government and civil society forces involved in fighting the epidemic.

The project is administered by a Country Coordinating Mechanism, whose members are CONASIDA, a Ministry of Health agency; Vivo Positivo, an organisation of people living with HIV/AIDS; ASOSIDA, an assembly of non-governmental and social organisations; the Pan American Health Association (PAHO); the WHO regional office; UNAIDS; and a partnership formed by the IDEAS Foundation and the Council of the Americas.

"This project entails a joint response on the part of both the government and civil society. The important thing is that people living with HIV are participating in the design of public policies," underlined Rodrigo Pascal, the executive coordinator of Vivo Positivo (Living Positive).

"The government, civil society and people with HIV/AIDS are working side by side extremely well. In addition, President Ricardo Lagos is fully committed to this issue," noted Henestrosa.

The project was initiated through the signing of an agreement between the Global Fund and Lagos, and has contributed to the development of 49 initiatives that focus primarily on prevention, integral health care and support and reinforcement of civil society organisations.

A particularly significant advance has been 100 percent coverage of antiretroviral therapy for all of the 4,838 AIDS patients registered with the public health system who require this treatment. Chile's centre-left government pays for 80 percent of the cost of these drugs, with the other 20 percent covered by the Global Fund.

Private health care insurance companies in Chile, known as ISAPREs, do not provide coverage for "catastrophic illnesses" like AIDS. However, a new health care reform law on Universal Access with Explicit Guarantees (AUGE), enacted in August, seeks to ensure universal health care coverage for all HIV/AIDS patients.

Since 1984, when the first AIDS case was diagnosed in Chile, more than 3,000 people have died of the disease.

Other health care initiatives undertaken through the project include training for health care personnel who work with HIV/AIDS patients and improvements to the administration and actual physical conditions of 26 hospital pharmacies involved in this field.

Thanks to the project, Vivo Positivo has been provided with the funding needed to establish a legal defence system for people with HIV/AIDS in the Santiago metropolitan area. Its efforts are focused on finding employment for the group's members and fighting discrimination in the workplace and educational institutions.

For its part, ASOSIDA has pursued nine different initiatives, including the creation of a database listing all of the institutions that deal with HIV/AIDS throughout the country, the publication of a manual for community outreach work, and the publication of research papers.

With regards to prevention, the project has made it possible for the first time ever in Chile to develop regional education and awareness campaigns that take into account the distinctive geographical, ethnic and demographic characteristics of each locale.

There are also six research projects currently underway to study newly emerging high-risk groups, including young people, immigrants, indigenous peoples and homemakers. For what are considered top priority groups -- such as sex trade workers of both sexes and the gay and bisexual community -- a special programme has been developed to bolster prevention efforts.

AIDS prevention campaigns have always stirred controversy in Chile, because of the opposition posed by the Catholic Church and conservative sectors to the promotion of condom use

But Arredondo said the prevention campaigns have done what is necessary, even if the efforts could have been improved.

Pascal elaborated, "We've carried out a national HIV/AIDS prevention campaign through the mass media with ads that make explicit reference to homosexual relationships, explicit reference to the use of condoms, and explicit reference to sexual activity among young people. So I think we're heading in the right direction."

There are currently a number of companies undertaking marketing efforts to more effectively promote the use of condoms in Chile as a means of preventing sexually transmitted diseases.

Although condom imports grew by 25 percent last year, to a total of 21 million units, it is estimated that this is actually only one-third of the number that should really be used in the country.

Arredondo noted that there are still obstacles involved in distributing condoms in public places, but this has not been the case in public health care facilities, where some two million condoms have been distributed in the past two years.

According to Marco Becerra, the coordinator of ASOSIDA and chairman of the Country Coordinating Mechanism, "The problem in Chile is a cultural one. It has to do with an approach to sexuality that doesn't allow people to make the right decisions with regard to their sex lives, because sex is viewed as something dirty. So people end up putting themselves in danger, out of a lack of awareness."

Not surprisingly, awareness and prevention efforts in the country's schools have not been easy, although the Ministry of Education has become increasingly more committed to this task. An intersectorial panel of experts is evaluating the work that has been done in this area up until now, in order to formulate a more effective sex education policy for the future.

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+ Global Fund to Fight Aids, Tuberculosis and Malaria (http://www.theglobalfund.org/)

+ Asosida - in Spanish (http://www.asosida.cl)

+ Vivo Positivo - in Spanish (http://www.vivopositivo.org)

+ Conasida in Spanish (http://www.conasida.cl)

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