La Paz, Bolivia: Housing for People Living With HIV/AIDS

The HIV/AIDS Epidemic

Bolivia has the lowest HIV incidence rate in South America. Approximately 4,600 Bolivians are currently living with an HIV/AIDS diagnosis; 18% of this population lives in the state of La Paz. However, UNAIDS estimates that around 8,000 Bolivians are HIV-positive and unaware of their status. The epidemic is concentrated among MSM and sex workers, but it is trending toward a generalized epidemic with 50% of transmissions occurring through heterosexual contact. During the early years of the epidemic in Bolivia, the gender ratio was eight male infections for every one female infection, but this ratio is now closer to 2:1. In a seroprevalence survey carried out in Cochabamba, Bolivia (the city with the second highest HIV prevalence after La Paz), the population with the highest HIV prevalence was homeless youth living on the street.

The Housing Crisis

Bolivia is the poorest country in South America. On the human development index Bolivia ranks 113^th out of 182 countries. About 63% of the Bolivian population lives in urban areas; of this group, 61% lives in slums. The population of the La Paz metropolitan area is approximately 800,000 or 9% of the national population. In La Paz a greater percentage of people live in slum conditions (64%) than the national average. These slums are characterized by a lack of access to water, sanitation, electricity, transportation, and other basic services, as well as insecure tenure. In many cases housing is informally constructed by tenants themselves, and the units are structurally insecure. The housing deficit for the country as a whole is 211,200 units; in La Paz the deficit is approximately 50,000 units.

In a survey of housing conditions of PLWHA in La Paz, results indicate that the majority of participants do not own their own homes because of reported: (1) difficulty in securing and maintaining steady employment; (2) difficulty in saving sufficient funds; and (3) difficulty in accessing credit. In this survey it was noted that the obstacle to securing adequate employment was not a consequence of low educational levels; on the contrary, 61% of respondents had a university degree, while the remaining 39% had all finished high school and attended university (though had not received a degree). The primary barrier to securing employment was the respondents' health status, which led respondents to prefer employment close to home that did not require much physical exertion. In addition to health status, the effects of stigma and discrimination led some respondents to abandon efforts to secure steady employment and maintain a healthy lifestyle. In fact, virtually all of the respondents who had disclosed their HIV status to employers subsequently lost their jobs. Some PLWHA had been kicked out of their homes by their families when they disclosed their status. In terms of savings, respondents explained that because all available funds are prioritized for medical expenses and food, nothing is left to save. Female respondents reported lower salaries than their male counterparts, demonstrating the double burden on HIV-positive women to do more with less.

According to an advocate at National Network of People Living with HIV in Bolivia (REDBOL), homeless shelters do not take HIV into account. Yet one shelter, upon learning that a client was HIV positive, refused to provide services for the client, claiming that he was the "... HIV program's responsibility."

Institutional Response & Solutions

Under Bolivian Law 3729, "Law for the Protection of Human Rights and Comprehensive, Multidisciplinary Assistance for People Living with HIV/AIDS," approved in August 2007, treatment and care for PLWHA in Bolivia is free and guaranteed by the state. The law also protects PLWHA from discrimination and guarantees them the full rights prescribed by the Constitution. Unfortunately this law does not cover all of the medications recommended for PLWHA, which become a substantial out-of-pocket expense.

The unmet need described above from the survey of PLWHA in La Paz led to the following recommendations:

• A mass education and awareness-raising campaign to combat stigma and discrimination;
• Protection against termination of employment for PLWHA;
• Inclusion of PLWHA in public policy discussions and decision-making processes concerning HIV/AIDS and human rights of PLWHA;
• Improved health coverage and access to better treatments and medications;
• Guarantee of all basic services, including transportation, for PLWHA;
• Regulation of market rates for housing, land, rental, and mortgage units and services;
• Creation of service and support organizations specifically focused on housing for PLWHA;
• Creation of a transitional housing program at the regional and national levels;
• Creation of residential programs for PLWHA; and
• Prioritization of support for women, youth, LGBTI, and other vulnerable PLWHA.

"I worked at a transnational business where I was hired for my tax and accounting skills and three university degrees. I assumed many responsibilities in a high-level administrative position until one day last year when I had health problems and was told I needed surgery. The company asked for an annual health exam, which included a clandestine HIV test. I submitted to an HIV test without my knowledge, which is illegal. The company found out that I was positive -- I didn't even know; the doctor who was performing my surgery told me. I was fired the next day. They never admitted it, but I know that it was because the lab technician told them I was positive. Now I know that there are national and international laws that protect us, but what are you going to do? I filed a complaint with the Ministry of Labor, but nothing has happened so far. I am scared to apply for jobs in other major companies because they could reject me if they find out. Despite my education, my hands are tied. I feel like my reputation is stained by this disease."

Advocate testimony provided by Alan Octavio Vera Velasco, independent architect, and Juan Carlos Rejas of the REDBOL National Network of PLWHA -- Bolivia.

Sources

Lambert, Marie-Laurence, et. al., Street Youths are the Only High-Risk Group for HIV in a Low- Prevalence South American Country, Sexually Transmitted Diseases: 32(4), 240-2, 2005.

United Nations Development Programme, Human Development Report 2009: Bolivia, 2009.

UNGASS Country Progress Report: Bolivia, 2010.

UN-Habitat, Bolivia Statistical Overview, 2010.

Vera Velasco, Alan Octavio, La Vivienda y el VIH/SIDA en La Paz, Bolivia, 2010.