San José, Costa Rica, since 1956

Gov’t Dropping Ball on HIV/AIDS Care

MANAGUA – Rumors that state health clinics are running dangerously low on lifesaving antiretroviral medications for people living with HIV/AIDS sent a wave of anxiety through members of the HIV/AIDS community this week and underscored what some say is the Sandinista government’s inadequate handling of this vitally important human-rights and public-health issue.

Though the government of President Daniel Ortega likes to tout its “revolutionary” advances in healthcare, activists say the level of access and medical attention for people with HIV/AIDS has become increasingly complicated since the Sandinistas returned to power in 2007.

Last year, the government eliminated its HIV/AIDS program in an attempt to fold all epidemiology programs and resources into the same public-health tent (NT, Dec. 8, 2008). AIDS activists say the old program has since been replaced by a jumbled bureaucratic web that has hindered the government’s ability to coordinate, plan or execute a strategy to deal with the problem.

Even simple measures such as purchasing life-saving medications, which need to be ordered from drug manufactures up to six months in advance, have become unduly complicated, activists say.

“There is no early planning or coordination by the government, which is slowing the purchase of these medicines,” said Leticia Romero, president of the Nicaraguan Association of People Living with HIV/AIDS (ASONVIHSIDA).

She added, “People are coming here with their prescriptions because there aren’t any medicines (at the clinics). I have sent letters to the Health Ministry but they haven’t responded.”

While some who work with the HIV/ AIDS community, such as psychologist Patricia Gónzalez of the non-governmental Fundación Xochiquetzal, say they haven’t had any reports of medicine shortages or problems working with government health authorities, ASONVIHSIDA and some doctors are painting a more worrisome picture.

The advocacy group says the lack of coordination and information was illustrated last week when two HIV patients in León called the ASONVIHSIDA office in Managua looking for help after their doctor reportedly told them that the state clinic only has enough antiretroviral medication on the shelf to last through April. Dr. Armando Matute, head of the HIV/AIDS program in León, denies the rumors of a medicine shortage there and said that supplies are adequate “for the moment.”

Antiretroviral treatment (ARV) can lower the viral load in infected people to almost undetectable levels, allowing them to live healthy lives and making them less likely to transmit the virus to others. But without access to ARV, a person’s health condition can complicate quickly and the risk of transmission increases.

In the capital, information about medicine shortages is equally uncertain.

ASONVIHSIDA claims that ARV supplies in Managua are only enough to last through August, and that other basic antibiotics needed to treat opportunistic infections are already in short supply.

Dr. Carlos Quant, an infectologist who heads up the HIV/AIDS department in Managua’s RobertoCalderónHospital, acknowledges that there are shortages of medicines to treat opportunistic infections, and admits that he, too, is concerned about future supplies of ARV treatment.

The problem, Calderón says, is that the government recently fired the person in charge of purchasing HIV/AIDS medications, so now the situation is more confusing and uncoordinated than before.

“Before there was a government official in charge of the program, but now there are several offices dealing with the issue and there is no visible person in charge,” Quant told The Nica Times in a phone interview. “Responsibility has been diluted, and we don’t know who to contact anymore.”

Quant said his Managua clinic administers antiretroviral treatment to 350 people in Managua, nearly 60 percent of all ARV patients in Nicaragua. But now that the government doesn’t have anyone clearly in charge of purchasing medicines, the situation has become precariously uncertain.

“We don’t know who is in charge, and we don’t know how much medication the government has in stock,” Quant said.

The Nica Times tried repeatedly to request an interview this week with the Health Ministry’s Secretary General Dr. Enrique Beteta, the government’s designated representative to the National Commission on AIDS, to discuss the administration’s handling of the HIV/AIDS issue and seek answers regarding medicine supplies. He did not respond by press time.

Bridging the Gap

To date, The Global Fund, an international financing institution to Fight AIDS, Tuberculosis and Malaria, has provided Nicaragua with the funding needed to assure people with HIV/AIDS access to medications.

Though the assistance program ended last month, the funding provided for this year was supposed to be enough to guarantee the purchase of antiretroviral medicine until the end of 2009, when the next Global Fund grant kicks in.

But despite available funding, AIDS activists claim the government hasn’t gotten its act together to purchase the medicines. The money is being handled by the private group NICASALUD, which did not answer requests for comment this week.

The next Global Fund aid program for Nicaragua is scheduled to start at the end of the year, but people in the HIV/AIDS community say they are concerned about how they are going to bridge the gap between now and then.

And some are even concerned that the Global Fund might be hesitant to disperse more funding to Nicaragua if the government is unable to use the money that it has already been given to purchase medicines. Still, the Global Fund remains the best hope for people living with HIV/AIDS in Nicaragua, says Romero of ASONVIHSIDA.

“If the Global Fund didn’t exist, we wouldn’t have any hope for life or healthcare,” she said.

That dependency on charity is exactly what needs to be fixed in the long run if Nicaragua is going to take a serious and sustainable approach to fighting the pandemic, says AIDS activist Ivo Rosales.

“What are we going to do when the funding goes away?” he demanded during last December’s International AIDS Conference in Mexico. “What are we going to do to establish a health system from our government?”


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