San José, Costa Rica, since 1956

Anonymous HIV Testing Prohibited Here for Better AIDS Control

CHANGING people’s attitudestoward HIV testing and protecting themselvesagainst the virus that causes AIDS isthe tireless aim of Solón Chavarría, directorof HIV/AIDS programs for CostaRica’s Social Security System (Caja).His office is in the AIDS ControlClinic in southeastern San José, one ofseveral Caja clinics around the countryoffering free testing for HIV and other sexuallytransmitted infections (STIs).Unlike free AIDS clinics in some othercountries, however, Costa Rica’s clinics donot – and cannot – offer anonymous HIVtesting.ANONYMOUS testing is prohibitedin Costa Rica because the Caja, which runsthe nation’s public health-care system,needs to know who has the disease to keepit under control, explained Dr. GloriaTerwes, head of the Caja’s AIDS ControlOffice.Also, she told The Tico Times, thepartner(s) of the infected person have aright to know they may have been exposedto the AIDS virus.“The identity of the person with HIVremains totally confidential. Our policy isto contact the partners of the infected person.It is very important the partners alsoget tested,” Terwes said.Under Costa Rican law, private laboratoriesand clinics must report all positiveHIV tests and the names of the test-takersto the Caja, she said.Still, authorities admit it would be possiblefor someone to provide a false nameto a private laboratory to protect their identitywhen getting an HIV test. To get AIDStreatment from the Caja, however, a valididentification document is required.WHILE both the government andnon-profit organizations in Costa Ricastrive to increase AIDS awareness andencourage people to get tested, CostaRican AIDS statistics do not seem to holdup under scrutiny.Last year, for example, it was revealedthat public hospitals receive quadruple thenumber of cases on record with theMinistry of Public Health, whose statisticsare the only ones considered official (TT,Aug. 27, 2004).Chavarría says approximately 4,455people have tested positive for HIV sincethe disease arrived in the country in 1982.The AIDS foundation believes another10,000 people may be infected with HIVand not know it – while government healthauthorities say this number is more likelybetween 15,000 to 20,000 people – or more.“FOR every known case of AIDS,there are 10 unknown,” Health MinisterRocío Sáenz told the press just beforeWorld AIDS Day in 2003 (TT, Nov. 28,2003).According to the Public HealthMinistry, a total of 2,546 people developedfull-blown AIDS between 1983 and theend of 2003 (TT, Dec. 3, 2004). Ministrystatistics show that of those, 1,664 havedied. Approximately 11% of those whodied of AIDS-related complications werewomen.HIV has spread dramatically amongyoung people. According to the ministry,28% of sufferers are under 30, suggestingmany young women of reproductive agehave the virus.Ministry of Health statistics show 43babies have been born with the disease,although the real figure is probably muchhigher.IN Costa Rica, 1,850 patients havefull-blown AIDS and are currently receivingtreatment, according to Chavarría.He added that these patients are in aprivileged position compared to many inother countries, because the Caja, whichcovers the health care of about 95% of thepopulation, provides the expensive medications.Chavarría says the government currentlyspends $14 million a year on antiretroviraltreatments – and should the figureof AIDS sufferers dramaticallyincrease, the strain on government fundswill be enormous.“I will admit we have had a few casesof foreigners who are already HIV positiveabusing the system by coming to live in thecountry, to receive the medication theycan’t afford in their own country,”Chavarría said. “It is a problem we are currentlytrying to resolve.”CHAVARRÍA admits the people whoconcern him most are those who are notcovered by Caja insurance, such as sexworkers and illegal immigrants.“What are we to do? These people haveno resources and nowhere to go and getchecked. We have to test them,” he said.Because AIDS is considered a matterof public health, the Caja has allowed theAids Control Clinic in San José, as well asclinics in Guápiles, Golfito, Ciudad Neilyand the Pacific port town of Puntarenas, totest anyone who comes through theirdoors, whether or not they are insured andwhether or not they are in the countrylegally.In fact, Chavarría says, 92% of thepeople they attend in San José do not haveinsurance and 62% are Ticos, 20%Nicaraguans, 15% Dominicans and 6%Colombians. Many are sex workers, due tothe huge tourist influx Costa Rica receivesyear round.HOWEVER, his concern for the illegalimmigrants goes further.“We can get state insurance for a legalresident who does not have insurancewhen they come for the test, but an illegalimmigrant who is found to be HIV positiveis not eligible for insurance and thereforecannot get the medication they need. It isvery difficult,” Chavarría said.However, when asked what happens tothese people, Chavarría hinted the Cajadoes what it can to help the patient receivethe necessary treatment.“In a way, why should we help themwhen they aren’t nationals and their countrywouldn’t do the same for us? Yet whatwould you have us do? Leave the person todie? It’s complicated and we’re talkingabout human lives,” Chavarría said.TEST results at the AIDS ControlClinic take 8-15 days and patients aregiven emotional and psychological support before and after the test, particularly tofind out their attitude toward protectingthemselves from sexually transmittedinfections.“We have found the female sex workersto be better at protecting themselvesthan male sex workers,” Chavarría commented.If a patient tests positive for HIVafter the first blood test, known as theELISA, a confirmation test known as theWestern Blot is taken, and if positive thepatient is referred to one of five specialHIV clinics in San José, at the CalderónGuardia, San Juan de Dios, Mexico,Monseñor Sanabria or Children’s hospitals.The Caja will soon be opening a specialclinic in Alajuela and in the futureone in Cartago and one in Limón,Chavarría explained.TERWES told The Tico Times thereare 113 Caja-run medical clinics across thecountry where insurance-covered residentscan get tested for free for HIV, as well asfor other STIs such as syphilis, gonorrheaand chlamydia.“Foreign residents without Caja insuranceand tourists can also get tested forHIV or checked for other STIs in any privateclinic such as the Clínica Bíblica,Hospital CIMA, Clínica Católica or thepublic San Juan de Dios by paying for thetest or even in private laboratories,”Terwes added, although she warned privatelaboratories provide no emotionalsupport or psychological counseling –recommended for those who learn theyhave tested positive for the virus thatcauses AIDS.ASOVHI-SIDA (255-1869), a nonprofitorganization that has been fightingHIV and AIDS in Costa Rica for sevenyears, offers free counseling to anyonewho has found out they have HIV, regardlessof their nationality or legal status.“We run projects involving counselingand emotional support for HIV sufferers,and we give educational talks in schools.We also have a library with up-to-dateinformation for anyone who wants to dosome research,” said Marco Montero,administrator at ASOVHI-SIDA.He added that organizing support andeducational programs has been made easiersince the non-profit organizationreceived financial aid from the GlobalFund, which received an $8.5 milliondonation from the World Bank to help thefight against HIV/AIDS in Costa Rica.PSYCHOLOGICAL help is also offeredto the families of the infected person.“We have the facilities,” Chavarríasaid. “The problem is getting people tocome and get tested.” He added that as acampaign for World Aids Day celebratedlast Dec. 1, the Caja took 300 blood testsin a park in Alajuela, northwest of SanJosé. Two tests came back HIV positive,and 13 people turned out to have syphilis.“The campaigns must be stronger andpeople must change their attitude towardprotection,” Chavarría said.He bemoaned the fact that sex educationin Costa Rica is heavily influenced byreligion, especially in a country where20% of the pregnancies are of girls ages15-19.“Of just under 80,000 births a year,more than 15,000 teenage girls are havingbabies. We all know they have to have sexto do that and they’re obviously not usingcondoms. For goodness sake, if you’regoing to have sex, protect yourself fromsexually transmitted diseases and put on acondom” he said.LATIN machismo exacerbates theproblem of the spread of the AIDS virus,Chavarría said.“Costa Rican men don’t like to usecondoms,” he said, “and women help tofoment that by allowing men to have sexwithout a condom.”Chavarría says women are the oneswho must help change take place, insteadof helping perpetuate the machismo.“If the woman doesn’t want to havesex without a condom, the man can’t doanything,” he said.Though many Ticos appear to believeAIDS is a homosexual disease, statisticsprove it is not. The rate of infection inCosta Rica used to be one woman out ofevery seven men, but that has now risen toone in four.Half of the 40 million HIV and AIDSsufferers worldwide are women and 20%of HIV carriers in Costa Rica are women –up from 7% in the early 1990s.

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