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GUATEMALA
Losing the HIV battle
Rommel Gonzales
4/24/2008
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Remote areas most affected by centralization of medical attention.

Using a pseudonym, Delia told of the day she went to the hospital with her husband and her voice broke, filling with pain and indignation. The doctor said her husband had only 20 days to live and that she and her children would also soon die of Acquired Immune Deficiency Syndrome (AIDS). Six years after her husband’s passing, she continues to live, enjoying every minute with her children.

According to official statistics, there are around 100,000 people living with the Human Immunodeficiency Virus (HIV), or AIDS in Guatemala, which causes more than 4,000 deaths each year — roughly the same number of deaths caused by violence in the country.

As in other Central American countries, there are no statistics on the epidemic’s spread beyond the capital. However, available data indicates the rise in persons living with HIV or AIDS (PLHA) among the indigenous population.

The “2006 AIDS Epidemic Update,” from the United Nations Joint Program on HIV/AIDS (UNAIDS), reports that in 2004, 74 percent of AIDS cases were found in the mestizo population and 22 percent in indigenous. But in 2007 — just one year later — the mestizos account for 69 percent and indigenous for 28 percent.

Great difficulties
Delia lives in the southwestern Retalhuleu department, more than four hours from the capital. She belongs to a mutual support group and explains that the greatest difficulty is buying bus tickets so that PLHA can go to a hospital for consultations or to receive antiretroviral medication found in the capital Guatemala City, in Coatepeque or north of Retalhuleu in Quetzaltenango — all very far from where they live.

“In the group, what we do is have quick raffles for those who need it, since there are a lot of people in extreme poverty. There are patients who get there to sleep the night before and go to their appointment in the early morning, standing in line starting at three in the morning,” said Delia.

But this is not only a problem for the group in Retalhuleu. Inhabitants of Petén, in the far northeast, who come from families with an income of less than US$100 per month, have to spend around $130 in order to go to a doctor appointment.

Lídice López Tocón, from the Asociación Agua Buena, a Central America association for the right to antiretroviral treatment, explains there are various barriers that hinder access to antiretroviral treatment in Guatemala, including late diagnoses.

Furthermore, there are only 16 establishments that offer AIDS testing. Medical treatment after testing is more centralized and very difficult for people to access. In addition to high transportation, housing and food costs, AIDS patients suffer discrimination by others in society, especially by health personnel. The wide range of indigenous languages also presents a barrier for the populations who don’t speak Spanish.

Lack of information and prevention
Juan Alberto Cutz, of the Research, Development and Integral Education Association, claims that what most affects the rural population is the lack of information.

“There is no prevention program directed at these communities. It is difficult to find any information on health, whatever it may be, which is why these towns know very little about what HIV is,” he said. “Furthermore, when someone gets an opportunistic disease, they don’t pay attention to it and don’t go to a health center because they are generally treated with traditional medicine, and only when this is unsuccessful, they go to a health center. In some cases, when they manage to reach a hospital, they are already in the AIDS stage. Currently there are more than 300 people receiving medicine in the Quetzaltenango clinic — 50 percent come from urban areas and 50 from rural areas.”

Dee Smith, coordinator for the Life Project in Coatepeque, explained that in these areas, “the government has not had a systematic plan to strengthen health centers’ assistance to people with HIV in order to reduce the distance between services and people; nor is there a real projection of demand for medicine in remote areas. Furthermore, the government doesn’t want to finance the required medicine and keeps depending on the Global Fund [to fight AIDS, Tuberculosis and Malaria], to avoid assuming more responsibility.”

Though the state has implemented some responses and actions, these meager efforts are comparable to putting out a forest fire with a glass of water. For example, of the $12 million needed to start up the National AIDS Program, which would implement the necessary activities to see to the HIV problem in Guatemala, only $5.6 million have been approved.

For Alma de León, president of the National Alliance Group of PLHA, “it’s important to keep in mind that though there are funds for [medical] attention, those invested in health directed at the issue of HIV/AIDS — given by the Health Ministry, Global Fund and the Guatemalan Institute for Social Security — only reach 41 percent national coverage. Meanwhile, people keep dying because there’s no way to get attention. And in order to achieve something, we need a government committed to this issue.”


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