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During the month of March an international convention on HIV took place in Brazil, hosted by the UN. The task: to review the situation from location to location around the world and try and improve the way HIV is prevented and treated.
Why, despite meetings like these and a situation so much better than some other Latin American nations, are two-thirdsof the 130,000 Argentines infected with HIV unable to get treatment?
Argentina is deemed to have a relatively low level of HIV/Aids in comparison to other Latin American nations. Although nations such as Bolivia have a rate as low as 0.1%, Argentina’s rate of 0.6%, compares favourably to nations such as Belize where the rate of infection is 2.5%.
However, the HIV epidemic “has become a poor and marginal people disease”, according to Kurt Frieder, the executive director of Huesped, an Argentine non-profit organisation involved in the fight against HIV/Aids. Most carriers, he said, are unable to secure or afford the medication.
On top of this, there are a host of other factors that result in a very low number of sufferers getting treatment. While health access is guaranteed by law in Argentina, a simple logistical problem emerges due to the fact that the majority of impoverished areas are isolated or rural. Mr Frieder states that getting treatment is easier in big cities due to a higher prevalence of clinics, but also because cities are where better clinics and doctors usually are.
One Buenos Aires resident highlighted the problem when she explained that a recent anti-HIV drive, that was spear-headed by free testing clinics, had been implemented in Recoleta. “It’s a mess,” she stated. “The help is only in well-developed areas rather than the places that most need it.”
Mr Frieder also suggests that within the communities most affected there is a stigma attached to HIV and Aids, due to the social structure of those communities, that results in people preferring not to be treated locally and thus never getting into a treatment programme.
The UN agrees with Mr Frieder’s assertion in their Country Situation Analysis, stating that, “even though HIV prevalence remains less than 1%, the epidemic is concentrated among populations at particular risk”. The analysis states that within poor communities in Argentina, certain groups, like women and drug users, are at an even greater risk from HIV.
Mr Frieder believes that there is an increasing drug use problem, although UN statistics claim that a high level of injecting drug users are able to receive treatment, with the number in Argentina currently standing at 93%. However, according to the UN organisation UNAIDS, young women are “particularly at risk to HIV infection due to their low level of education, unequal access to formal employment, unequal income, social status and limits on their ability to negotiate the use of condoms or safer sex”.
A united front?
Argentina was the first Latin American nation to provide full health assistance to sufferers, keeping the level of HIV/Aids infection thus relatively low at 0.6% of the population.
There are a number of organisations, both Argentine and international, which have projects in Argentina and are having some success in the fight against HIV/Aids. Organisations such as Huesped are beginning to implement projects that specifically target women or youngsters in low income areas in the hope of improving the situation in “vulnerable populations” and thus increasing the number of infected receiving treatment. Other charities such as Casa M.A.N.U. or La Cinta Roja adopt or house children with HIV, feeding and caring for them.
The Ministry of Health has pledged to take action. Argentina is committed to a continent-wide agreement on safe sex and pledges an annual budget of around US$115m for implementing such projects. On top of this they have been able to buy antiretroviral drugs at what Mr Frieder describes as good prices.
However, according to Huesped, the Argentine government is still failing in their responsibilities in the fight against HIV. Mr Frieder sees a number of factors in the manner by which the Ministry of Health deals with HIV and Aids that have not helped the situation. Huesped and other organisations work in conjunction with the government whenever they can but Mr Frieder notes that “the government is not usually able or interested”.
On top of this, Mr Frieder goes as far as to state that the government has not done much but invest “some resources in buying scarce condoms and producing lousy and old model campaigns”. The majority of what has been implemented by the government in recent years has depended heavily on the Global Fund activity, a fund that is ending this year after five years and a US$28m subsidy. Although Argentina is entitled to present a new project, it is unlikely to be so heavily funded again, leading to a fear that without stronger government involvement, the situation will worsen.
There is widespread agreement that the government is not only under-funding the fight against HIV but is not targeting the areas that most need it. UNAIDS highlighted, in their situation analysis of Argentina, that there is “limited political commitment to develop strategies”. The idea that the government has ignored the poor areas is, Frieder argues, down to the fact that “identifying more infected people also means giving health assistance to them and allocating more resources.”
Frieder argues that sexual education is one of the greatest resources being neglected by the government. He says: “It has become a very serious problem, how to reach youngsters and change their sexual attitudes.” This is an argument supported by the UN, which calls sexual education a priority issue and highlighted a limited implementation of HIV prevention programs especially focused on sexual education.
Difficulties in improving sexual education do not all fall on government shoulders though. Latin America is predominantly Catholic, which means changing school programmes to promote safe sex runs into barriers created by parents, the schools themselves, and local officials.
Success across the border
In the 1990s Brazil was seen as a potential disaster zone for HIV/Aids with the World Bank predicting that by 2000 1.2m people would be living with the virus.
But an aggressive policy including free condoms, and over 200 NGOs with anti-Aids policies cut the number to 600,000. As the charity Avert puts it: “Brazil is a success story…the government acted swiftly… and stigma and discrimination were reduced.”
It did so by breaking medical patents, rejecting prices set by pharmaceutical companies by either producing medication themselves or contracting cheaper companies, which insured that the number of infected Brazilians receiving treatment is far higher than the 33% in Argentina.
Prices of HIV medication vary greatly depending on the drug and the place, but typically range from US$200 to US$1,400 a month. Brazil’s decision to pressure pharmaceutical companies to lower prices, and specifically to buy common antiretroviral drugs such as Atazanavir from the Bristol-Myers Squibb Company, allowed them to lower the costs buy 76%.
Brazilian president Luiz Inacio Lula da Silva stated that: “It is not possible for anyone to get rich with the misery of others. In a choice between our trade and our health, we will take care of our health.”
Brazil now offers free HIV/Aids medication to everyone and has seen the numbers of deaths fall by half since the late 1990s.
The way forward
Mr Frieder believes that in order to insure that a higher proportion of people receive treatment, Argentina must set up a national aids commission. He argues that the existence of a similar commission in Brazil is a major reason behind their success and elaborates that it is essential that the heads are in the upper levels of national government.
Although not enough is being done, many organisations are striving to improve the situation through initiatives like the Global Youth Coalition. But the government must match the commitment of health organisations.