E-drug: Access to AIDS treatment in Honduras
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AIDS TAKING GRIM TOLL IN POVERTY STRICKEN HONDURAS AS PATIENTS TRY TO ORGANIZE
Article by By Richard Stern
e-mail: rastern@sol.racsa.co.cr
A recent visit to Honduras has revealed hospital wards filled with people
dying from AIDS-related opportunistic infections when medical supplies run
out. Hondurans with AIDS have virtually no hope of receiving
anti-retroviral (ARV) medications.
At the state run "Hospital del Thorax" in Tegucigalpa, I visited a 26
bed AIDS unit where patients lack medications that could combat their
opportunistic infections. Maria Elena, who appears to weigh less than 80
pounds, lay in the women's ward and said she gets no medication at all.
She said she has stopped eating and doesn't care any more what happens
to her, adding "this is a mortal illness and I have to accept Gods will."
Her three children will become orphans as her common law husband died three
years ago. When I gave Maria Elena a copy of POZ magazine in Spanish,
she indicated it was the first time she had heard of anti-retroviral
medications.
The so-called "cocktail" of retroviral medications consists of a combination
of three medications that have a significant impact on the damaged immune
systems of most patients with AIDS, enabling them to return to a
relatively productive and normal lifestyle. About 20 percent of patients
do not tolerate the new medications well, and other experimental
combinations are now being tried with this group. The cost of a triple
therapy cocktail would be about $800 per month if purchased individually,
although pharmaceutical companies provide significant discounts when
governments buy large quantities of the
drugs. In Europe and North America, it is estimated that 90 percent of AIDS
patients have access to these medication through a variety of public and
private insurance plans.
Maria Elena�s attending physician, infectologist Milton Gonzales,
indicated that he has run out of the medication to treat opportunistic
illnesses such as severe diarrhea and cryptococcus. "Its only July and we
have used up all of the medication that was to have been for the entire
year, " he said. When a neurological illness is suspected, he and his team
have to guess the diagnosis because there is no neurological testing
available and no neurologist on staff. Gonzales indicated that he has
little hope that the Health Ministry will supply the necessary medications
and would like to receive donations from the international community.
No one is quite sure exactly why Honduras, with just 17 percent Central
America�s population, has over half of the 20,000 reported cases of AIDS in
the region. Honduras, with 5.4 million people has more than 11,000
officially diagnosed cases. Costa Rica, with 3.4 million people has 1,400
cases, and Nicaragua with 4 million has just over 300, according to official
figures. One theory is that the epidemic began with prostitutes serving the
US military community based in Comayagua and spread rapidly as a result of
lack of prevention strategies and extreme promiscuity. The epidemic is
about 85 percent heterosexual in Honduras. One Doctor estimated that 35
percent of
country's 20,000 or more prostitutes are HIV+ and that, ironically, clients
pay extra to have sex without a condom.
Additional factors contributing to the spread of AIDS include extreme
poverty, lack of access to health clinics and lack of knowledge about
methods of prevention. Women, abandoned by their husbands and heading
impoverished households are vulnerable to the sexual whims of their often
promiscuous male partners. Per capita yearly income in Honduras is under
$1,500 per year.
On the hillsides that tower over downtown Tegucigalpa the tenements of clay
and brick appear deceptively scenic from the city below until one gets
close and sees that they are really makeshift hovels built over unpaved
streets without sewer systems or running water. Women descend to the
polluted river that runs through town to wash clothes. These tenements teem
with children and although AIDS is rampant, tuberculosis,dengue fever and
cholera may pose even greater threats.
Two Non-governmental organizations funded by the Dutch government in
Honduras are now beginning to focus more attention on the problem of access
to medications and rampant discrimination against people who live with AIDS.
"Solidaridad and Vida," (Solidarity and Life) directed by a young physician
named Enoch Padilla, provides medical services to several hundred patients
each month in Tegucigalpa. Padilla recognizes the need for the patients
themselves to begin to organize, but pointed out that the death of several
of the more activist patients during the past year dealt a severe setback
to the group.
Some of Padilla�s patients are in a study conducted by the pharmaceutical
company Merck, Sharp and Dohme, and they have access to ARVs as well as
viral load testing. Padilla tries to help patients find sources to obtain
medications for opportunistic infections and has been quite successful in
obtaining donated medications from international sources.
While Tegucigalpa nurses its wounded in a temperate pleasant climate, San
Pedro Sula, 150 miles to the North is a sweltering city of half a million
people carved out of the surrounding jungle. Average daily high
temperatures are in the mid 90's.
In San Pedro Sula, the "Fraternidad San Pedrana de Lucha Contra el SIDA"
(San Pedro Brotherhood against AIDS) has five years of work in the
community, and is also funded by the Dutch. There is an established
Association of People Living with AIDS and there are about 50 members in
the group. However, of the 50, only about five are currently receiving
ARVs. Carlos Lopez is the Director of Fraternidad and Alan Dunaway is
President of the Association of AIDS patients. Dunaway, his wife Rosa and
daughter Emilia all have AIDS. The San Pedrana patient Association has
been allowed to participate in the government�s National AIDS commission
and also are lobbing legislators for the approval of a bill to curb
discrimination against people with AIDS.
However, the bill has been "in discussion" for four years and has yet to
be approved. According to Carlos Lopez, "many of the congressman are owners
of or benefit from the large cheap labor factory market known as "maquila."
Says Lopez: "they have no interest in supporting this bill because they
don�t want have to pay sick days or face other problems. Maximizing profits
is their main consideration and fair employment practices are not conducive
to more profits."
Also in San Pedro Sula I spoke to Guillermo a 30 year old ex-transvestite
sex worker who is now the janitor at San Pedro Sula�s gay community
organization known as "Comunidad Gay San Pedrana." Guillermo has had bouts
of AIDS related infections for several years but has survived. He knew
about ARV medications, and expressed frustration at their impossibly high
cost. Guillermo gets one meal a day a the gay community center and sleeps
in a $25 a month rented room that has no electricity. He says his family
in Tegucigalpa is wealthy but will have nothing to do with him. He left
Tegucigalpa in 1996, to try to work in the factories of San Pedro Sula, but
illnesses made this impossible. However, he is pleased that he has received
support and work in the gay center, and has not had to return to
prostitution. He is open about his HIV+ status with the young gays he sees
at the center. "But some of them just don�t pay attention," he says. They
don�t think it will happen to them."
Jonathon Castro, AIDS educator in the gay/lesbian Association in Tegucigalpa
called "Collectiva Violeta" told me about his friend Rafael who died at the
age of 20 on the sidewalk near the downtown area. "They asked him to leave
the hospital because they said they couldn't treat his infections anyway.
So he just went outside and found a place to lie down and died." Full blown
AIDS in
persons as young as 18-22 is quite common in Honduras, as apparently many
very young adolescents are quite sexually active.
Casa Alianza is the Central American branch of New York city�s Covenant
House and operates a center for homeless children in Tegucigalpa. Several
thousand receive medical and residential services each year. Alvaro
Conte, Casa Alianza Director, told me that a study done last year revealed
that 3 percent of these children are HIV+. Subject to constant sexual
abuse, these young AIDS patients also have no access to ARV medications,
although Casa Alianza tries to educate them about prevention strategies. But
many of these children must perform sexual acts just to be able to eat.
It is estimated that only about 60 of an estimated 5,000 People who live
with AIDS in Honduras have access to the triple therapy combination, perhaps
25 who can pay for them with their own means and the rest who are in studies
run by the pharmaceutical companies.
The hopelessness of the situation of most people with AIDS seems tragic
when one considers that AIDS has now become a relatively treatable illness.
In Costa Rica, more than 360 AIDS patients are now receiving ARV
medications as a result of a Supreme Court decision handed down last September.
Guillermo Murillo, President of the Costa Rican Association of People with
AIDS called the Honduran situation "an unnecessary tragedy" and called on
international organizations such as UNAIDS to "seek a solution to enable our
brothers and sisters in Honduras to survive."
ORGANIZATIONS WORKING WITH AIDS IN HONDURAS
Medicos Sin Fronteras
Dr Germaine Hanquet
Apartado Postal 3669
Tegucigalpa, Honduras
Tel: 504-231-1012
e-mail: msfch@sdnhon.org.hn
Prisma
Jose Ramon Ramos
Apartado 459
Tegucigalpa, Honduras
Tel: 504-232-8342
e-mail: prisma@sdnhon.org.hn
Dr. Jorge Alberto Fernandez
Consulting Specialist in AIDS
Ministry of Health
Apartado 3966
Tegucigalpa
Tel: 504-237-4343
Fax: 504-238-3270
Collectivo Violeta
Apartado 4053
Tegucigalpa, Honduras
Tel: 504-237-6398
e-mail: alfredo@optinet.hn
Solidaridad y Vida
Dr. Enoch Padilla
Apartado 2492
Tegucigalpa, Honduras
Tel: 504-223-8972
Fax: 504-239-1204
Fraternidad San Pedrana
de Lucha Contra el SIDA
Dr. Carlos Lopez Ferrera
Apartado 3566
San Pedro Sula
Tel: 504-553-1281
Fax: 504-552-8797
e-mai: fraternidad@mayaneth.hn
Comunidad Gay San Pedrana
Dereck Raickov
Apartado 4317
San Pedro Sula
Honduras
Tel: 504-550-6868
Casa Alianza
Alvaro Conte
504-237-3623
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