Subject: IN COSTA RICA, AIDS PATIENTS CONTINUE RECEIVING MEDICATIONS
From: [email-masked]
Date: Sun, 16 Nov 1997 13:19:45 -0600 (CST)

San Jose, 15 November,  1997

IN COSTA RICA  AIDS PATIENTS CONTINUE RECEIVING MEDICATIONS
                                              By Richard Stern

More than 30 Costa Ricans are now receiving the new retroviral AIDS
medications, as a result of  a Supreme Court decision that was handed down
last September.  But the government´s health care provider,  the Caja
Costarricense de Seguro Social (CCSS) still has not begun to voluntarily
 provide the medications. 

Each individual patient must still file an appeal to the Supreme Court  so
that the Court can order the CCSS to give the medications  to the patient.

Apparently the CCSS is now in process of developing a plan to provide the
medications but details of the plan  are not clear and Guillermo Murillo,
President of the Association of People of Living with AIDS, fears that the
plan  could take months  to implement.  "We have to continue to present each
case to the Supreme Court, because  the government´s plan continues to be
vague. and a person with AIDS cannot affort to wait to receive necessary
medications," he stated.   Generally the Supreme Court has been resolving
cases in about  two weeks.

This writer has also provided donated medications to  patients whose appeals
are pending but have not  yet been decided.  The medications were sent by
people in the United States who no longer needed them for one reason or
another.  The patients can get started on their regime sooner, and when they
have won their court appeal,  the donated medications can then be given to
another person who is just starting the appeal process.  Additional donated
medications  are welcome.

Appeals of the Court´s decision  filed by CCSS Director Alvaro Salas have
been turned down by the Supreme Court and the  Court   continues to decide
in favor of all patients who present their case to the Court. The Court´s
committment  to People Living with AIDS was emphasized by   Judge  Rudolfo
Piza Escalante in  a meeting with this writer and Guillermo Murillo on
November 7th.   Piza was also critical of delays by the CCSS in implementing
an efficient treatment delivery system for People Living with AIDS.

In Costa Rica, 1,256 cases of AIDS had been diagnosed as of last August, and
518 people were still alive.  Of the total cases 10 percent were women and
66 percent were gay or bisexual.

In a related issue, Costa Rica´s second largest daily newspaper LA
REPUBLICA, published  a front page story last Wednesday highlighting
discrimination against people with AIDS in the workplace.  The story
focussed on the situation of school teacher Minor Navarro who was
transferred from the school where  he
had worked  for 3 years when   his Principal found out that he was HIV+, and
encouraged parents of children in the school to sign a petition requesting
his transfer.  The Costa Rican Education Ministry, which transferred Navarro
to another school, has yet to develop a policy protecting teachers from this
type of discrimination.  However, the article in LA REPUBLICA was highly
favorable towards People Living with AIDS, and highly critical of the school
Principal.  Navarro has an appeal pending with the  Costa Rican government´s
ombudsmen organization, and is considering a  Supreme Court challenge as well.

This writer and Guillermo Murillo are anxious to expand this program to a
more regional basis and we are seeking funding to begin an extensive central
American effort focussed on Access to Treatment  early in 1998.  Anyone
interested in providing support for   this effort could contact us 
at [email-masked].

Key points of the approach necessary to confront   Human Rights violations
against People Living with AIDS are emphasized in the following document.

 METHODOLOGY UTILIZED TO CONFRONT HUMAN RIGHTS      VIOLATIONS AGAINST
PEOPLE LIVING WITH AIDS  IN A LATINO CULTURAL CONTEXT

For the past several years we have specialized in the area of Human Rights
advocacy here in Costa Rica  where  we have created and coordinated a
multi-faceted program dealing with the problem of severe human rights
violations against people living with AIDS:   Key elements in this program are:

1) the recognition people who live with AIDS, because of the terrible
discrimination they have suffered are extremely reluctant to get involved,
to sign complaints etc. It is very delicate process requiring incredible
patience to work with victims of  discrimination in a machista, vertical,
authoritarian culture.

2) the need to draw attention in the media, on a national as well as
international level, to the discrimination and abuse occurring here.  For
this it has been necessary for us  to write more than 50 news bulletins and
articles over a two year period  continually  describing the unfolding story
of the abuses and their impact, as well as administrative and judical
actions that have been  taken and the results of these actions.  

3) to look for empowered leaders from the target group of  AIDS affected people
 who can begin to assume a role of leadership and importance in drawing
attention to the problems of their own group and to serve as models for
others members of
the abused population.

4) to understand completely and utilize whenever possible the existing
administrative and judicial resources on a national, and where appropriate,
on an international level.  To never allow the burearcratic obstacles
placed by these bodies to interfere with the continuing process of placing
complaints whenever and wherever they are appropriate.  In Costa Rica we
have continually met with and  continued to pressure a whole series of
public and private Agencies that deal with person living with AIDS, and we
have utilized the Judicial system, which has resulted in several important
victories.

5) to understand as completely as possible the nuances of the local culture
and its impact on human rights, on the resolution of conflicts, and on the
victims themselves.  In Costa Rica, this has involved a thorough
understanding of several elements including:

a) the nature of the machista, heterosexist culture and its impact on sexual
minorities and women who live with the AIDS virus.

b) the understanding of  how  burearacy is used to discourage and confuse
people who live  with AIDS and their advocates.

c) the various differences in standards of ethics which give tacit
permission to government officials to provide false or misleading
information to minority group members and their advocates.

d) the impact in Costa Rica on a person living with AIDS if family, or
employers discover their HIV status.

e) the basically non-confrontational nature of Costa Rican culture where it
is viewed as inappropriate to publicly engage in a dispute.  This ultimately
works against minorities  because they have a great deal of trouble
expressing feelings of anger and frustration.

f) to understand the importance of patience, and persistence in denouncing
human rights violations in a culture where these issues are not seen as
important.  To  continually reinforce and support People with AIDS  in
recognizing that changes  happen very slowly but that it is important to
persist, and to continue to denounce and call attention to these situations
even when it
appears that nobody is listening. 

Access to Treatment and Human Rights violations against people with AIDS are
expected to be two of the critical issues discussed at the upcoming Latin
American Conference on AIDS in Lima, Peru which will take place early in
December.