PANOS Institute, Friday, September 18, 1998
Richard Stern

Western pharmaceutical companies have in recent years developed a series of 'anti-retroviral' drugs which directly attack HIV, the virus which causes AIDS. The so-called Combination Therapy -- a cocktail of drugs -- significantly extends the life of many people who would otherwise almost certainly die within two years of developing AIDS.

But the high cost of these drugs, averaging 800 dollars a month, initially restricted their distribution to the industrialised world. Recently, protests by people with HIV/AIDS have persuaded some developing countries to supply them free.

The situation in Central America represents a microcosm of the developing world, with some people with AIDS having full access to treatment and others none at all.

The first -- and so far only -- government in the region to provide combination therapy is that of Costa Rica. Initial studies supported by SIDALAC, a World Bank-funded AIDS initiative, and AIDSCAP, a US government-funded regional AIDS body, led government officials to claim that the cost of the therapy would have a devastating economic impact on the country's health care system.

But the conclusion was rejected by a small group of people living with AIDS. Beginning late 1996 the group -- the Patient Coalition -- negotiated for a year with the government, but officials insisted anti-retrovirals were too costly. Frustrated, the group wrote an appeal to the Supreme Court in 1997 and won its support, forcing the government to begin offering anti-retroviral drugs to people with HIV/AIDS.

"We won the right to receive medication and we let the government and society know that we will not become silent victims of hate and discrimination," said Guillermo Murillo, President of the Asociacion Costarricense de Personas Viviendo con el SIDA, an organisation of people living with HIV/AIDS.

Currently 360 Costa Ricans with AIDS out of an estimated total of 700 with HIV receive Combination Therapy.

But insisting that the government provides the medication appears to be only part of the solution -- a greater problem is getting people with AIDS to ask for the medication.

"A person with AIDS in Central America must be taught the skill of asking for what he or she needs. They have to realise that being deprived of medication is a denial of human rights. Once they understand that there are other options then they must be encouraged to speak up and ask for what they need," said Ruben Mayorga, a physician and Director of Oasis, a Guatemalan gay and lesbian organisation.

Elsewhere in Central America, however, conditions differ vastly. In Nicaragua, people with AIDS have little hope of receiving treatment for their opportunistic infections and none at all of receiving anti-retrovirals.

Treatment is only available through nongovernmental organisations which buy medicines with fees from patients who have the ability to pay.

Despite the existence of a law guaranteeing the rights of people living with AIDS, the disease is on a list of conditions specifically excluded from government medical attention. This means people with AIDS who seek medical attention for an infection must hide their HIV status from the health authorities, says Roberto Pao, the government health department coordinator.

That's not difficult -- the government does not stock the HIV-antibody test.

So far, Nicaragua has been relatively untouched by the disease, with UNAIDS estimates of 4,000 people living with HIV, but thousands of Nicaraguans migrate to work in other parts of Central America, where the rates of infections are much higher.

Neighbouring Honduras, for example, has a slightly larger population, but 43,000 people with the virus. Here, the greater poverty and lack of mobilisation appear to have prevented the formation of a group of people with HIV/AIDS to seek better medical attention or new medications.

Things are slightly better in Panama, where 9,000 people are believed to have contracted HIV. The government provides AZT, an anti-retroviral drug, for several years to everyone with AIDS enrolled in the government health care system -- an estimated 500 people -- but not combination therapy.

That is a state of affairs Norma de Quintero of PROBIDSIDA -- the Foundation for the Wellbeing and Dignity of People with AIDS -- wants changed.

Earlier this year, PROBIDSIDA entered into negotiations with the government healthcare agency. Should the agency refuse, they have lined up 30 people with AIDS who are willing to sign an appeal to the Supreme Court.

But even if they succeed, many Panamanians with AIDS would be no better off because they are not covered by government health care benefits. This is because Central American government health care systems only reach a portion of the population -- those who can afford to pay for them.

In Guatemala, which has the largest population in the region, including 27,000 people living with the virus and almost 3,000 with symptoms of AIDS, under 15 percent of the population is covered by the state health system.

Guatemalans with AIDS enrolled in the government health system receive some anti-retroviral drugs. An additional 30 people are believed to buy the medication and 50 patients receive free drugs under a study sponsored by a pharmaceutical multinational. This means that an estimated 80 percent of Guatemalans with AIDS receive no anti-retroviral medication.

"Things are getting started here but progress is slow," Ruben Mayorga of Oasis said, pointing to the emergence of an organisation called "Gente Positivo" (Positive People). But this group has yet to forcefully demand treatment.

Experts say it will be some time before people with HIV/AIDS in Central America have equal access to new treatments because it is likely to happen only after legal and social pressure is brought on by organisations of people with the disease and their supporters.

However, Guillermo Murillio said: "It is difficult for Central Americans to come together in such organisations, partly because once symptoms of AIDS appear, the focus of people's attention is usually in trying to survive and keeping the fact secret. People are also inhibited by a tradition of not questioning authority and very few attend support group or organisational meetings."

* Editor: Dipankar De Sarkar. Publishers are asked to send clippings of published features to Panos Features, 9 White Lion Street, London NI 9PD. Panos Features are also available on the Panos website http://www.oneworld.org/panos and by e-mail from Mark Covey, markc(at)panoslondon.org.uk. (END/PANOS/RS/DDS/98)
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