San José, Costa Rica, since 1956

Policies to Stop Spread of HIV Moving Slowly

The nation is years away from adopting a comprehensive strategy to tackle HIV,Vice Minister of Health Lidieth Carballo said this week.

The state commission charged with coordinating HIV and AIDS policy has published three plans with goals for HIV prevention and treatment in the past year.

Carballo, who heads the commission, acknowledged that the implementation has been slow.

“We have not advanced much on this issue,” she said. Some 4,000 people here are known to have HIV, although the true number could be as high as 24,000, according to the United Nations Programme on HIV/AIDS. The figure is low compared to other countries in Latin America. Based on U.N. data from 2005, Costa Rica ties with Chile,Mexico and Ecuador as having the third-lowest incidence of HIV in Latin America among people 15 to 49 years old.

That’s no reason for complacence, said Solón Chavarría Aguilar, who directs the AIDS prevention and treatment program for the state’s Social Security System (Caja).

“The idea is…to control (HIV) well, so it does not get out of hand,” he said. Chavarría estimates there are about 500 new cases of HIV every year in Costa Rica.

The three plans by the National Commission for Holistic Attention to HIVSIDA (CONASIDA) are detailed and ambitious.

Last week, the commission presented a “National HIV-AIDS policy” that calls on various state ministries and institutions, as well as non-governmental organizations, to help treat and control the virus.

The policy, which echoes a plan released last November, demands high-quality services for people with HIV, as well as changes in the curriculum to better educate students about the virus.

The commission also proposed a plan this summer to create a single system to track HIV-AIDS statistics, which are now gathered by disparate state institutions.

Carballo said it could take years for the state to fully implement these plans. Edgar Briceño, a commission member who was diagnosed with HIV 12 years ago, seemed frustrated with the slow pace. He talked to The Tico Times this week during a snack break at a two-day training for commission members by the New York-based consulting group Cicatelli Associates.

“We write a lot of documents, and in the end…,” he said, throwing up his hands. He compared the process to passing laws that are never enforced.

Still, he said, the commission has achieved some key successes. First, it has expanded in recent years, incorporating members from more state ministries. The Ministries of Labor, Justice, Public Security, Education and Health are all now represented on the commission, as are non-governmental organizations, HIV-infected Ticos, the U.N. Programme on HIV/AIDS, and the University of Costa Rica (UCR).

The commission also works as an intermediary between people with HIV and state institutions, said Briceño, who also helps run the Costa Rican Association of People who Live with HIV and AIDS. Briceño reports concerns about state behavior or policies toward people with HIV, and commission members help resolve them.

Members will soon propose a bill to the Legislative Assembly that would strengthen the commission further, allowing it to have a budget and hire outside services. The bill would also beef up HIV prevention programs and strengthen workplace protection for people with the virus, said Guiselle Lucas, an adviser at the Ministry of Health.

An event last week at the Supreme Elections Tribunal (TSE), where the commission presented its AIDS policy to President Oscar Arias, was perhaps a measure of the group’s increased clout. Arias threw his weight behind the policy.

“Each of us must decide if we will join the fight here and now, or if we will simply walk among the victims, hoping never to become one of them,” Arias said.

In the coming year, the commission will monitor whether state institutions are working to comply with its HIV/AIDS policy. So far, its proposals on education have met with the most resistance, Carballo said.

The commission wants to change the curriculum at all levels – from preschool to college – to include more material on sexuality.

But conservative parents and the Catholic Church – which opposes condoms, an effective measure in preventing HIV transmission – have made change slow, commission members said.

Wary of parents and church leaders, teachers already limit their discussion of HIV, said Melissa Ávila, who works in the Ministry of Education’s department of health and environment.


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