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AIDS TAKING GRIM TOLL IN POVERTY STRICKEN HONDURAS By - Richard Stern 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 streets and alleys 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 for free or low cost medications for opportunistic infections and has been quite successful in obtaining some 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 ========================================================
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