Nicaraguans: "We Need Medications"
In a July 11 meeting in Managua, Nicaraguan people living with AIDS confronted their government's Health Ministry with its failure to implement the country's new AIDS law prohibiting discrimination and guaranteeing adequate health care.
Flor de Maria Alvarado, President of ASONVIH/SIDA (Nicaraguan Association of People Living with AIDS), the newly formed PWA advocacy organization, addressed the group, which included approximately thirty AIDS professionals. "We need medications," she said repeatedly. "At any moment the four of us who are leaders of this group won't be here to continue the struggle, and then things have to begin all over again." Several previous activists in Nicaragua have died, and non-governmental organizations have run out of donated medications, while the government says it cannot afford drugs even for opportunistic infections.
Doctor Guillermo Porras, who treats destitute AIDS patients for free, urged the Health Ministry to overcome the bureaucratic obstacles to implementation of the AIDS law. Congresswoman Ritha Fletes, President of the Congressional Health Commission, made a commitment to speak directly with the Health Minister and challenged pharmaceutical companies to make their products affordable in Nicaragua.
There are relatively few people living with AIDS in this country of 3 million -- perhaps as few as 150 according to government estimates. About 200 are listed as having died, and another 220 have tested positive and remain asymptomatic. The actual numbers remain unknown, however, with critics pointing to a lack of epidemiological reporting.
No one can adequately explain why there are so few reported AIDS cases in Nicaragua. Honduras to the north has 13,000 cases, and Costa Rica to the south around 2,000. Even if underreporting is 100 percent, that still leaves Nicaragua with fewer than a thousand cases. Many Nicaraguans with AIDS may be living in neighboring countries, where jobs as well as medical care are more available than at home.
Being few in number has been of no advantage to Nicaraguan PWAs. At times the government has argued that there is "no AIDS crisis" in Nicaragua and that other health problems are more significant. "When there are too many people, Central American governments say that they do not have the resources to confront the problem," says Guillermo Murillo, Central American AIDS activist based in Costa Rica, "and when there are too few they say the problem is unimportant."
ASONVIH/SIDA members pointed out that the Calderon Hospital in Managua, run by the Health Ministry, has an inconsistent policy about accepting and treating patients. Patients, even those with severe opportunistic infections, may be turned away. Those who are admitted often find that medications for their infections are unavailable. Discrimination by poorly trained nurses and doctors continues in the hospital. There is no hospice in Nicaragua for dying PWAs.
Viral load and CD4 tests, basic to treatment with antiretrovirals, are not available. Pharmaceutical companies have offered to donate testing equipment and supplies for testing when the government begins to buy medications.
Author's CommentsManagua is a sprawling city of approximately a million people. There is no city center as such; it was destroyed by the 1972 earthquake that killed thousands. Because of unemployment, grown men and teenage boys are everywhere, sitting idly on street corners, trying to find shade from the merciless afternoon heat. During our week-long visit, ragged twenty-year-old taxis drove us around the city as we visited the various non-governmental agencies that try to provide some support for people living with AIDS.
Nicaragua indeed faces severe economic hardship, as it has for decades. But the constant cry of "We can't afford it" is no excuse for not providing PWAs with consistent access to hospital care and basic treatment, at least for opportunistic infections. The government has made no effort to negotiate prices with pharmaceutical companies, nor has it looked at the possibility of importing cheaper generic drugs.
There is no visible evidence of any effort by local UNAIDS representatives to confront the situation. Regional efforts to lower drug prices, sponsored by international agencies such as PAHO (Pan-American Health Organization) and UNAIDS, making use of a still hypothetical monetary fund, continue to exist mainly as rumors. Two other Central American countries, Costa Rica and Panama, are proceeding on their own and have signed an agreement to buy AIDS medications cooperatively. Both already provide antiretrovirals to the majority of their AIDS-affected populations.
David Balsam is coordinating an effort to obtain donated medications for Dr. Guillermo Porras's clinic. If you can help, get in touch with him by telephone or fax at (506) 283-0469 or by e-mail at firstname.lastname@example.org.
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