Subject: AIDS IN HONDURAS
From: [email-masked]
Date: Mon, 27 Jul 1998 17:47:08 -0600 (CST)

AIDS TAKING GRIM  TOLL  IN POVERTY STRICKEN HONDURAS AS PATIENTS TRY TO ORGANIZE

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 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 to obtain
medications for opportunistic infections and has been quite successful in
obtaining  
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: [email-masked]

Prisma
Jose Ramon Ramos
Apartado 459
Tegucigalpa, Honduras
Tel: 504-232-8342
e-mail: [email-masked]

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: [email-masked]

Solidaridad y Vida
Dr. Enoch Padilla
Apartado 2492
Tegucigalpa, Honduras
Tel: 504-223-8972
Fax: 504-239-1204

Fraternidad San Pedrana
de Lucha Contra el SIDA
Dr. Carlos Lopez Ferrera
Apartado 3566
San Pedro Sula
Tel: 504-553-1281
Fax: 504-552-8797
e-mai: [email-masked]

Comunidad Gay San Pedrana
Dereck Raickov
Apartado 4317
San Pedro Sula
Honduras
Tel: 504-550-6868

Casa Alianza
Alvaro Conte
504-237-3623