San José, Costa Rica, since 1956

Real AIDS Rate Could be Quadruple Official Rate

WHILE the country’s top health officials discuss thedetails of a pending World Bank donation of $8.5 million tofight HIV/AIDS in Central America this week, Costa RicanAIDS statistics do not seem to hold up under scrutiny.Public hospitals reportedly receive 450 new AIDSpatients per year, but the Ministry of Health only has recordof a quarter of those cases and Ministry representatives sayits statistics are the only ones that are considered official.The official number is the only number with which theministry can work to form government AIDS preventionand treatment policies, a ministry official explained.That could indicate under funding of some programs,such as public education, prevention and patient assistance– areas that patients and advocacy groups agree are alreadyoverlooked in the government’s AIDS budget.THOUGH the Health Ministry’s official numbersindicate 110 new cases of the illness in 2003, up from 90in 2002, the AIDS Control Office of the Ministry toldAFP newswire it records nearly 450 cases per year.The director of that office, Solón Chavarría, told AFPthat in each of the major hospitals in San José – México,San Juan de Dios and Calderón Guardia – 12-14 newpatients are entering each month.The Puntarenas hospital, in the port town on the centralPacific coast, is seeing four new cases per month, and theNational Children’s Hospital in San José is admitting 14-16new patients every year.Those five hospitals are the only ones with clinics specializedto treat AIDS patients, and the sum of their statisticsprovides a full view of the national situation, according to Chavarría.“The situation is worrisome,” he said.“Costa Rica is not among the countrieswith the highest percentages (of AIDS) inLatin America, but (the disease) couldbecome unmanageable if we do not allmake an effort.”He explained that the Social SecuritySystem (Caja) has invested some $10 millionannually in AIDS patient treatmentand it foresees that figure rising to $100million or more in 10 years if efforts arenot made to prevent the spread of HIV, avirus that attacks the body’s immune systemand causes AIDS.A total of 2,357 AIDS patients wereregistered in Costa Rica as of July 31, 2002– the most recent statistics provided by theHealth Ministry (TT, Nov. 28, 2003). Since1985, 1,528 Costa Ricans are known tohave died of AIDS-related complications.Health Minister Rocío Sáenz told thepress just before World AIDS Day lastDecember that officials believe “for everyknown case of AIDS, there are tenunknown.”CHAVARRÍA, from the AIDS ControlOffice, said it’s disturbing that the percentageof infected women in Costa Rica hasrisen from 7% of the total in the early1990s to 20% of the total today.That signifies an increase of the epidemicamong the heterosexual population,he said, and an expected increase in casesof infected newborns.Many women contract the disease fromtheir husbands who have unprotected sexwith others, according to members of anAIDS support group in San José thatincludes some of those women.Jessica Salas, director of the GlobalFund Against AIDS, under the Ministry ofHealth, said the official numbers – 110 newcases per year – are based on the reports thathospital doctors must file by law.Asked about the numbers given by theAIDS Control Office, Salas said, “these(the Ministry’s numbers) are the only oneswith which we can work” to form governmentprevention and treatment policies.NON-GOVERNMENTAL organizationsthat work with AIDS patients complainedthat the government invests onlya small amount of its funds in preventionefforts.Most of the government’s budget forHIV/AIDS is spent on treatment.According to Health Minister Sáenz, only“a tiny bit” goes toward prevention (TT,Nov. 28, 2003).Patients who spoke to The Tico Timesthis week were pleased with the medicalattention and thorough information providedto patients in Costa Rican hospitals, butexpressed concern about the lack of public-education campaigns and patient assistanceoutside the nation’s hospitals.“Fine, they treat all the patients, butbeyond that, nothing,” said Carlos Alfaro,director of the Association for theMovement to Fight Against HIV, whichworks with homosexuals in San José. “Thereis no (prevention) campaign directed towardthe gay and transvestite population.”ONE AIDS patient who asked toremain anonymous said the government’seducational advertising policy leaves thehomosexual community isolated.Beyond prevention campaigns, anotherpatient, who also asked his identity be withheld,said, “I’d give more information. I’dtalk about people who are infected as peoplewith HIV, not as people who are alreadydead. It (the government) should explain ontelevision that we (people with HIV/AIDS)can have a good quality of life.”Such campaigns, he said, would helpwith employers’ misconceptions aboutpeople with the disease and could cutdown on the number of firings that nowoccur when they realize an employee hasHIV/AIDS.Employer discrimination leads toanother flaw in government AIDS policy,patients said, that other than treatmentthere is little and sometimes no assistancefor those with HIV/AIDS.“I’M not pensioned,” one patient said.“It has been hard to find a job.” He sellsbracelets and necklaces on the street tomake ends meet.Many patients are kicked out of theirhomes when their families discover theirdisease. Not all AIDS patients receive governmentchecks, and those who do receiveas little as $50 a month, the patients said.“The patients are the ones who arehurt,” by the discrepancy between the realnumber of patients and the official number,Alfaro said.“There is no follow-up” with patientcare outside the hospital, he said.Patients may take eight to 15 pills everyday, depending on the complications of theirillness, and many of them said they knewpeople who died after they stopped takingpills, either because they were tired of beingso drugged or because of severe depression.AMONG those who work with peoplewith HIV/AIDS, fingers are pointed notonly at the government for the holes in itsAIDS policy, they are also leveled at theCatholic Church, accused of keeping realisticoptions out of public-education campaigns.“Sexual relations, condoms and preventionof the disease are taboo subjects inschools,” said Marlone Avila, executivesecretary of the Life Foundation, whichhelps families affected by HIV/AIDS.The fact is, young people are startingtheir sex lives at early ages, “and that has aterrible impact,” she said.Avila said the Catholic Church isresponsible for the lack of informationbecause it has systematically opposed anysex-education program that deviates fromthe concept of abstinence, something shesays “is not realistic.”The Catholic Church simply doesn’twant to get any hopes up, a Churchspokesman responded.“THE Church promotes that whichguarantees 100% of life. It would be a fallacyto lie to people that something (condoms)is protecting their lives. That issomething you cannot do,” said FedericoCruz, director of the Catholic Church’sdepartment of Religious Education.A percentage of people contract HIVeven while using condoms, Cruz said, andby promoting condom use, people are givingthe message that those people whocontract the disease do not count.“To the church, they count,” he said.Condoms are not 100% safe, but ifused properly, will reduce the risk of contractingHIV, according to the U.S. Foodand Drug Administration Web site.ASKED if it isn’t good enough thatcondoms reduce the risk of AIDS and savesome lives, Cruz responded that sex withoutcondoms “is a question of personalresponsibility.”“You can’t blame the Church for people’spersonal actions,” he said.Earlier this year, the Ministry of PublicEducation distributed sex-education policyguides to teachers throughout the country,which attempt to address sexually transmitteddiseases, along with other issuessuch as self-respect and life vision.Unlike the sex-education books thathad been in use since 1992, the new 22-page policy guide was released withoutconsulting the Catholic Church.Still, the “comprehensive” guide mentionsteenage pregnancy only once andAIDS twice in its text (TT, Feb 27).

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