Five hundred and eighty-two HIV/AIDS cases have been officially documented in Puntarenas, the southernmost province of Costa Rica that is predominantly rural and encompasses the majority of the country's Pacific coastline. However, the actual number of undiagnosed HIV/AIDS cases could be as high as 6,000. The majority of HIV transmission in Costa Rica occurs through homosexual transmission with approximately seven male HIV infections for every three female HIV infections.
The majority of the country's HIV/AIDS incidence is located in the urban areas of metropolitan San Jose and other major cities, mirroring the growing urbanization as a result of rural to urban migration. These migrant populations often reside in informal settlements on the outskirts of metropolitan areas, lacking access to basic services as well as sex education and prevention services. Since the majority of infections are concentrated in the large urban areas such as San Jose, HIV/AIDS policies and services often do not reach Puntarenas, even though Puntarenas is the province with the third highest HIV incidence rate.
Little information is known about HIV incidence among mobile populations, particularly immigrant and transit populations, who are often undocumented and do not frequent health centers. Other vulnerable groups include farmers, fishermen, and homeless people. Distrust exists among the Costa Rican population as a whole surrounding guarantees of confidentiality in health centers.
Even though PLWHA are protected from stigma and discrimination under Law 7771 (see below), there have been various reports of discrimination, often associated with homophobic attitudes, that have prevented PLWHA from accessing dental care and HIV-positive women from accessing cervical cancer prevention services. However, the most frequent type of discrimination occurs in the workplace via compulsory HIV testing, mostly in multinational companies. A positive diagnosis often leads to termination or reduction of responsibilities.
Puntarenas is the province with the lowest human development index, highest unemployment rate, and lowest education rate. Poverty in Puntarenas is concentrated in the most populated urban centers (Barranca, Chacarita, El Viente, and Fray Casiano).
In terms of PLWHA in Puntarenas, their lack of adequate housing is a consequence of their social exclusion. Many PLWHA, in order to avoid disclosing their status, have broken their family and community ties, leaving the security of employment and family homes by moving to San Jose. Many of these people eventually become homeless or turn to drugs, both of which represent substantial barriers to regaining employment.
An HIV diagnosis is also a barrier to obtaining a housing voucher in Costa Rica. According to Law 7052, every citizen has the right to request a housing voucher. However, one requirement to accessing a voucher is providing evidence of an insurance policy from the National Institute of Insurance, which has not covered PLWHA since 1999, given the high mortality rate associated with an HIV/AIDS diagnosis.
HIV/AIDS has been identified as a national priority since 1997. Implemented initiatives to mitigate the impact of the disease include obligatory incidence reporting; the General Law on HIV/AIDS (Law 7771); sex education campaigns; the creation of the National Council on Comprehensive HIV/AIDS Care; and the guarantee of comprehensive health services with a special focus on populations at risk.
Law 7771 guarantees the human rights of PLWHA, including the prohibition of discrimination and degrading treatment, and Article 28 states that: "The state may designate the necessary resources for the creation or strengthening of shelters to care for patients that require support, according to the guidelines of the Ministry of Health. The state is authorized to support, on equal terms, non-profit private shelters that are dedicated to serving these patients."
San Jose has two shelters for PLWHA: "Nuestra Señora del Carmen" and "Hogar de la Esperanza," which provide shelter for 15 to 25 people each. Many of the PLWHA who frequent these shelters suffer from drug and alcohol addiction and mental illness. Other religious organizations such as "Casa Santa Clara" and "Casa de Paz Sucot Shalóm" implement strategies aimed at HIV-positive people, families affected by HIV/AIDS, HIV-positive homeless women, IDUs, and others. These strategies include soup kitchens, financial support, and transitional housing. Even though the number of PLWHA who are homeless is unknown, clearly the homeless PLWHA outnumber the spaces in existing shelters.
Casa Hogar Nuestra Señora del Carmen, San Jose, Costa Rica.
"Every day we receive phone calls from people asking if we have space for a family member, friend, or neighbor with HIV who does not have a place to live. Unfortunately, I have to tell them that we don't have any available space, that the Casa Hogar Nuestra Señora del Carmen is full, and we can't house any more people. In fact, we have a surplus of two or three people as it is ..."
Advocate testimony and photos provided by Juan Luis Barrantes Guzmán of the Comunidad Internacional Siloé.
Barrantes Guzmán, Juan Luis, Situación del VIH/SIDA en Costa Rica y las Condiciones de Vivienda en las PVVS, 2010.
UNGASS Country Progress Report: Costa Rica, 2010.
WHO, UNAIDS & UNICEF, Epidemiological Fact Sheet on HIV and AIDS: Core Data on Epidemiology and Response, Costa Rica, 2008.