From: rastern@sol.racsa.co.cr Date: Thu, 22 Jan 1998 22:27:44 -0600 (CST) Subject: AIDS IN PANAMA 20 January, 1998 IN PANAMA, PEOPLE WITH AIDS ORGANIZE TO SEEK TREATMENT ACCESS By Richard Stern In the Central American country of Panama, People Living with AIDS are beginning to organize around the issue of access to treatment and are entering into a dialogue with health care officials. There are 1,700 diagnosed cases of AIDS in this Central American country of just under three million people. Of diagnosed cases, about 30 percent have occurred in the gay community. About half of the patients have died. The Panamian government provides only AZT to those patients who have government sponsored health care coverage, but only about 50 percent of the population is insured. At this point, many experts consider that providing AZT as "monotherapy" is contraindicated, because the resistance it can cause when given alone could interfere with the effectiveness of other medications if they were to become available. Like Costa Rica, its neighbor to the North, Panama is an example of a country where the government clearly has the resources to provide the new triple therapy medications, but is unwilling to do so because AIDS has never been a priority in the Central American region. As an advocate for people living with AIDS in Costa Rica, I recently had the opportunity to spend time in Panama, meeting with people there who are in process of forming a new non-governmental organization, known as PROBIDSIDA, which will focus on discrimination as well as access to the newer AIDS medications. Throughout Panama City, gleaming skyscrapers and new shopping centers flash in the sun and shadow over the Panama Canal zone. One gets the impression of a prosperous, booming country, although terrible slums also exist. Nobody in Panama has publicly come out as HIV+. There is the fear of the impact on family and in the workplace. In Costa Rica, with patient numbers very similar to Panama, a Supreme Court decision last September, forced the government, through the National Health Care system, to provide the newer medications to people living with AIDS, and virtually all AIDS affected patients with severely compromised immune systems are now receiving these medications. However, in Costa Rica, almost all patients are covered by the Health Care system, whereas in Panama, 50 percent are left with no health coverage whatsoever. PROBIDSIDA has initiated discussions with Doctors and other government officials working in the AIDS field, but so far the results have not been encouraging. I attended a meeting in which also focussed on the possibility of planning a Court challenge in the very near future if changes are not forthcoming. It seems tragic that in many developing countries, groups of patients have to rediscover, painstakingly, lessons already learned in other countries about human rights and access to treatment, as if they were living on a different planet. The Panamian issue also draws attention to an issue of great importance in many developing countries: the existence of a dual system in which only a portion of the population is covered by the national health care system. Even a victory for access to medications in Panama would leave half or more of the AIDS affected population no better off than before because they are not covered by government health care benefits. No one I spoke to in Panama had received any support from UNAIDS or the OPS (Pan American Health Organization) or even knew the functions of these funded Agencies. UNAIDS which has substantial resources, is responsible for the development of programs focussed around access to treatment and human rights issues affecting people living with AIDS, but the impact of its programs on a Central American level appears to be negligible. PROBIDSIDA can be reached by contacting Norma de Quintero at (507)-233-6238, or by e-mail at nquinter@pananet.com. Richard Stern Associacion Triangulo Rosa San José Costa Rica 506-234-2411