First in a two-part series
MEXICO CITY – Experts and activists from around the world are urging Latin American governments to take swift action to stay ahead of the world epidemic before it reaches the alarming levels afflicting sub-Saharan Africa.
In Central America, where the prevalence of HIV/AIDS is still less than 1 percent of the population and access to life-saving antiretroviral drugs is better than in other parts of the developing world, the issue is not yet viewed as a problem.
In Costa Rica, more than 95 percent of people with HIV live healthy lives on antiretroviral medication, while in neighboring Nicaragua, the government has decided the country’s 0.2 percent HIV prevalence no longer merits a national AIDS program, which was eliminated earlier this year.
Activists, however, warn the region remains vulnerable to a larger outbreak and should take more proactive measures now to avoid a crisis later.
“This is not the time for complacency,” said Grammy and Academy Award-winning singer and activist Annie Lennox, one of 5,000 participants in this week’s International AIDS Conference in Mexico City, the first of its kind to be held in Latin America.
Lennox called on Latin America to take advantage of this “golden window of opportunity” to prevent and treat HIV/AIDS before it spirals out of control.
“The time bomb is ticking,” she said. AIDS experts agree. Dr. Peter Piot, executive director of the United Nation’s interagency project to address the disease, UNAIDS, and a keynote speaker at the opening ceremony of the conference, stressed it is “better to act now than pay later.”
Piot told The Nica Times that Central America is particularly vulnerable to an AIDS pandemic because of migration patterns, unequal access to health care and a machista culture that pushes homosexual activity underground.
“Just because HIV is not a problem today doesn’t mean it won’t be a problem tomorrow. Southern African countries are paying the price now for a lack of action in the past,” Piot said.
Even the victories of today could become problems in the future, activists warn.
In Costa Rica, for example, the country’s economic classification as “upper-middle income” threatens to reverse advances in achieving affordable antiretroviral treatment once the newer generation of medications are developed, said Richard Stern, director of Agua Buena Human Rights Association, an HIV/AIDS activist group based in San José.
“There is a threat looming on the horizon in that newer and more potent antiretroviral drugs are also going to be more expensive, especially in Costa Rica,” he said.
Stern notes that drug company Merck recently announced that it will price one of its new HIV medications at $829 per month, or nearly $10,000 per year. That’s compared to the $2,100 a year it currently costs the Costa Rican Social Security System (Caja) to supply medication to HIV patients, creating a ballooning financial obligation on the state.
In Nicaragua, the situation is equally precarious. According to a recent budget analysis by a non-governmental coalition of AIDS activist groups in Nicaragua, the Sandinista government has eliminated all line-item budgetary spending for HIV/ AIDS as part of its effort to incorporate all epidemiology programs under the same umbrella in the Public Health Ministry.
“We’ve studied the budget and the Nicaraguan government has not dedicated a single penny to HIV or AIDS,” said Ivo Rosales, a Nicaraguan activist who spoke at the conference. “The government says the money for AIDS is ‘dispersed’ in other budget health expenditures, but there are no specific programs for AIDS.”
Though Nicaragua is eligible for foreign HIV/AIDS assistance through the Global Fund and the U.S. President George W. Bush administration’s President’s Emergency Plan for AIDS Relief (PEPFAR) – a $48 billion U.S. initiative to combat HIV/AIDS on a global level – Rosales said he’s leery about relying entirely on foreign money.
“What are we going to do when the funding goes away?” Rosales demanded. “What are we going to do to establish a health system from our government?”
Regional AIDS Profile
Though the prevalence of HIV infections in Central America is still less than 1 percent of the population – compared to more than 30 percent in parts of southern Africa – there are certain populations in the region that are at higher risk of exposure, including sex workers, men who have sex with men, intravenous drug users and, in some cases, indigenous populations.
Yet even among those populations, there is evidence to suggest that public health campaigns, namely the promotion of condom use, have reduced the incidence of new infections in certain cases. For example, a 2006 study by the Honduran government showed that AIDS prevalence among homosexual men in Tegucigalpa had dropped from 10 percent in 1998 to 5.7 percent in 2006. And in San Pedro Sula, the Honduran city with the highest HIV/AIDS prevalence in all of Central America, the infection rate among homosexual men had dropped from 16 percent to 9.7 percent in five years.
HIV prevalence among sex workers in Honduras has shown a similar decline, largely credited to condom use.
In Nicaragua, however, the face of HIV is increasingly feminine and young. According to a 2008 government report by the Nicaraguan government, the population most at risk of exposure is housewives between the ages of 20 and 35. Some of these women, impregnated by philandering husbands, then transmit the virus to their children at childbirth, accounting for a more than 10-fold increase in mother-child transmission in Nicaragua during the past seven years.
Mother-to-child transmission can be prevented by antiretroviral medications, indicating that most of the women who transmit HIV to their children are probably unaware they are infected by the virus, which can take years to progress to AIDS in healthy people.
The phenomenon of housewives infected with HIV by their husbands is becoming increasingly common in machista cultures, especially in Latin America, AIDS activists say.
“We know beforehand that men always have other women on the side, so we have to be conscious of this,” said “Adriana,” a 34-year-old Mexican woman who said she was infected with HIV by her husband, her only sexual partner in life, after seven years of marriage. “We want to think that our man is only for us, but that’s a lie. We have to be realistic.”
Behind the Numbers
The official HIV statistics in Central America still appear manageable. According to Web page globalhealthfacts.org, in Nicaragua the government reports only 3,275 people are infected; Costa Rica reports 9,700 people; El Salvador, 35,000; Honduras, 28,000; and Guatemala, 59,000.
The official statistics, however, are believed to be low. In Nicaragua, for example, non-governmental groups that work with the HIV/AIDS population claim the infection rate is two to five times higher than what the government reports.
Globally, it is estimated that 80 percent of those infected with HIV don’t know it.
What is known is that despite the achievement of getting 1 million more people on antiretroviral treatment last year, some 2.7 million additional people were infected with HIV, bringing the worldwide total to 33 million.
“For every one new person who gets put on treatment, there are three new infections,” noted the Piot. “So the gap is growing. It’s not over. It’s far to early to declare victory.”
Next week: AIDS and the culture of complacency.
Tim Rogers covered the International AIDS Conference on a Journalist to Journalist fellowship from the U.S. National Press Foundation.