Global AIDS
Global AIDS
Luis Guillermo Murillo Rodriguez, Alajuela, Costa Rica
Age 40 years. Law student, University of Costa Rica. Human rights activist for PWA in Latin America. Diagnosed with HIV in 1991.
When I started treatment 6 years ago, I only had 2 CD4 cells/l. Since then, they're gaining slowly but always progressing upwards [CD4 count now 540 cells/l]. I haven't had any infections or side effects from treatment. My viral load has been undetectable for the last 3 or 4 years.
The health care I've received, for a country like Costa Rica -- still in development, yet with a high investment in the health system -- has been very good. I receive medical care from very professional, competent and humane specialists. Overall, I've received excellent attention in the areas of psychology, medicine, laboratories, dermatology and nutrition, among others. I receive all the medicines I need (antiretrovirals, opportunistic infection prophylaxis, lipid-lowering treatment, etc.).
Before I got treatment, my immune system was very compromised and my energy level was low. I could see my own death coming. In my support group, one or two people died every week. That's when I realized I had to overcome my fears, shame and prejudices if I wanted to survive. In the first years of the struggle, I was very surprised by the capacity I had for defending my rights. It was awesome discovering this capacity, as well as the possibility of helping and supporting other people with HIV/AIDS [PWA] as I found my own acceptance and empowerment.
Six years ago I told my family that I was living with HIV. Everyone in the community knows because I'm very open about my status. I have nothing but support from my parents and friends. I haven't had serious problems with discrimination, however, I've seen some horrible situations with other PWAs who constantly face discrimination at their jobs and sometimes even with their families. One challenge for me is to fight against the stigmatization of PWAs and to make sure that politicians and public figures are aware of AIDS. We don't have public figures or campaigns against HIV/AIDS. It's still seen as a problem for the gay community or sex workers.
Richard Stern, San Jose, Costa Rica
AIDS activist since 1995. Director, Agua Buena Human Rights Association.
Before ARV [antiretroviral] cocktails existed, I was a psychologist for PWAs in a clinic here. At the 1996 World AIDS Conference, I heard about the new medications and came back convinced that PWAs here should form a coalition to pressure the government for access to treatment. At the time, the prices of the medications were close to $8000 per year per person, and everybody considered it impossible that the government would pay. But after a Supreme Court case was filed, PWAs won the right to treatment in 1997.
We're a regional organization. Our target countries are those where there's a continuing need for ARV therapy, including Guatemala, Honduras, El Salvador, Panama Nicaragua, Belize, Peru, Bolivia, Ecuador, Jamaica, Dominican Republic, St. Lucia, Paraguay. In Central America, some countries have responded well, such as Costa Rica, Panama, and El Salvador, where the majority of people now have access to treatment. But in Jamaica, Ecuador, Peru or the Dominican Republic, we're looking at more than 40,000 people who have no treatment access at all -- about 95% of the PWAs in these countries combined.
I'm disappointed that change has come so slow. I never imagined that 6 years after the Costa Rican Supreme Court ordered the government to provide universal ARV access, most people in Latin America still don't have access to medications. When countries do provide ARV therapy, it's often only to those who are enrolled in the so-called "seguro social" programs, which only cover people employed in blue-collar and professional sectors. Some countries provide several second-line cocktails that others don't. There are almost no nongovernmental organizations [NGO] in our target countries that can afford to purchase ARV. A few try to get donated medications, a few also help with medications for opportunistic infections.
In our target countries, people often have to pay for their own CD4 cell count and/or viral load testing, which is even more impossible. Most governments, such as Peru and Dominican Republic, have no reason to provide these tests if they're not providing treatment. Supportive care is also variable. The churches run some hospices, but care in public hospitals is often terrible and the hospices don't have room to take care of all the terminally ill people. I'm afraid that some people die in terrible circumstances.
My biggest frustration is the indifference and/or discrimination of people who are supposed to be running health care systems in these developing countries. In most cases, they're from elite upper classes and have always had health care when they needed it. They seem to think of the poor as somehow less worthy of receiving quality health care.
We've had some success and have helped change the lives of many people. If it weren't for the successes, this would be an unbearable task. Many people we work with die, but some survive when they get the proper medical attention. With the Global Fund resources that are coming into the region, there is more hope at the moment.
Q: How would you define, in one word, this very "moment" in the epidemic from your vantage point?
Hopeful.
| Total population | 4.1 million (2003) |
| GDP, per capita (US$ per person) | 4136 |
| Life expectancy (general) | 76.1 years (2001) |
| Per capita health expenditures (in US$) | 273 (2000) |
| Adult HIV prevalence rate | 0.6% (2001) |
| People living with HIV/AIDS | 11,320 (2001) |
| AIDS deaths | 890 (2001) |
| a | These figures were drawn from WHO, UNStats, IMF, UNAIDS and the CIA, from the most recent data available at the time of going to press. This section was edited by RonniLyn Pustil, an editor and writer, who works for the Canadian AIDS Treatment Information Exchange and POZ magazine. Translation by Anna Alexandrova and Christian Del Moral. Research assistance from Mark Lipton and David McIver. The figures in this section were drawn from WHO, UNStats, IMF, UNAIDS and the CIA, from the most recent data available at the time of going to press. |
Luis Guillermo Murillo Rodriguez, Alajuela, Costa Rica
Age 40 years. Law student, University of Costa Rica. Human rights activist for PWA in Latin America. Diagnosed with HIV in 1991.
When I started treatment 6 years ago, I only had 2 CD4 cells/l. Since then, they're gaining slowly but always progressing upwards [CD4 count now 540 cells/l]. I haven't had any infections or side effects from treatment. My viral load has been undetectable for the last 3 or 4 years.
The health care I've received, for a country like Costa Rica -- still in development, yet with a high investment in the health system -- has been very good. I receive medical care from very professional, competent and humane specialists. Overall, I've received excellent attention in the areas of psychology, medicine, laboratories, dermatology and nutrition, among others. I receive all the medicines I need (antiretrovirals, opportunistic infection prophylaxis, lipid-lowering treatment, etc.).
Before I got treatment, my immune system was very compromised and my energy level was low. I could see my own death coming. In my support group, one or two people died every week. That's when I realized I had to overcome my fears, shame and prejudices if I wanted to survive. In the first years of the struggle, I was very surprised by the capacity I had for defending my rights. It was awesome discovering this capacity, as well as the possibility of helping and supporting other people with HIV/AIDS [PWA] as I found my own acceptance and empowerment.
Six years ago I told my family that I was living with HIV. Everyone in the community knows because I'm very open about my status. I have nothing but support from my parents and friends. I haven't had serious problems with discrimination, however, I've seen some horrible situations with other PWAs who constantly face discrimination at their jobs and sometimes even with their families. One challenge for me is to fight against the stigmatization of PWAs and to make sure that politicians and public figures are aware of AIDS. We don't have public figures or campaigns against HIV/AIDS. It's still seen as a problem for the gay community or sex workers.
Richard Stern, San Jose, Costa Rica
AIDS activist since 1995. Director, Agua Buena Human Rights Association.
Before ARV [antiretroviral] cocktails existed, I was a psychologist for PWAs in a clinic here. At the 1996 World AIDS Conference, I heard about the new medications and came back convinced that PWAs here should form a coalition to pressure the government for access to treatment. At the time, the prices of the medications were close to $8000 per year per person, and everybody considered it impossible that the government would pay. But after a Supreme Court case was filed, PWAs won the right to treatment in 1997.
We're a regional organization. Our target countries are those where there's a continuing need for ARV therapy, including Guatemala, Honduras, El Salvador, Panama Nicaragua, Belize, Peru, Bolivia, Ecuador, Jamaica, Dominican Republic, St. Lucia, Paraguay. In Central America, some countries have responded well, such as Costa Rica, Panama, and El Salvador, where the majority of people now have access to treatment. But in Jamaica, Ecuador, Peru or the Dominican Republic, we're looking at more than 40,000 people who have no treatment access at all -- about 95% of the PWAs in these countries combined.
I'm disappointed that change has come so slow. I never imagined that 6 years after the Costa Rican Supreme Court ordered the government to provide universal ARV access, most people in Latin America still don't have access to medications. When countries do provide ARV therapy, it's often only to those who are enrolled in the so-called "seguro social" programs, which only cover people employed in blue-collar and professional sectors. Some countries provide several second-line cocktails that others don't. There are almost no nongovernmental organizations [NGO] in our target countries that can afford to purchase ARV. A few try to get donated medications, a few also help with medications for opportunistic infections.
In our target countries, people often have to pay for their own CD4 cell count and/or viral load testing, which is even more impossible. Most governments, such as Peru and Dominican Republic, have no reason to provide these tests if they're not providing treatment. Supportive care is also variable. The churches run some hospices, but care in public hospitals is often terrible and the hospices don't have room to take care of all the terminally ill people. I'm afraid that some people die in terrible circumstances.
My biggest frustration is the indifference and/or discrimination of people who are supposed to be running health care systems in these developing countries. In most cases, they're from elite upper classes and have always had health care when they needed it. They seem to think of the poor as somehow less worthy of receiving quality health care.
We've had some success and have helped change the lives of many people. If it weren't for the successes, this would be an unbearable task. Many people we work with die, but some survive when they get the proper medical attention. With the Global Fund resources that are coming into the region, there is more hope at the moment.
Q: How would you define, in one word, this very "moment" in the epidemic from your vantage point?
Hopeful.
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