Productions: Cronicas

By Yuri Lorena Jiménez

While people living with AIDS in Costa Rica fight to obtain anti-retroviral medication, local health authorities insist that they don't have enough money for their AIDS budgets.

The great majority of Costa Ricans who live with AIDS have seen their many struggles worsened by an ironic injustice. Years ago, when there were no medications capable of reducing the effects of their sickness, they lived immersed in a daily uncertainty, awaiting the most minimum progress that would give them at least a glimmer of hope.

Today, when the scientific evidence shows the excellent results of anti-retroviral treatment -known also as the 'cocktail'- the "ticos" [common self-characterization by Costa Ricans] see themselves unable to obtain that which they desired for so long.

According to the Costa Rican Ministry of Health's AIDS Control Department, as of February 15, 1997, 1156 AIDS cases had been diagnosed, half of which represented people still living.

Affected individuals organized themselves and established, together with other Non Governmental Organizations, a common cause struggle with the fundamental purpose of obtaining anti-retroviral medicines for free, or at a reasonable price.

This initiative was strengthened after the two main public institutions of health declared repeatedly that their budgets were insufficient to purchase the medications. But both the Social Security Administration of Costa Rica (CCSS) and the Ministry of Health expressed their intention to find a solution, in view of the grave problem. They have created a group of AIDS experts from both entities.

After ambitious research, which involved world AIDS experts, this coalition recently completed a study of the socioeconomic impact that the epidemic has and will have in the country. The findings are alarming.

According to Dr. Abel Víquez, Coordinator of the Joint Commission Against AIDS for CCSS and the Ministry of Health, the conclusion of the study is as disconcerting as it is overwhelming: "Either we get the funding to provide the anti-retroviral drugs to those people living with HIV/AIDS, or the country will have to prepare for a socio-economic collapse in this country caused by sickness in less than ten years."

In the past few months the Triángulo Rosa Association, the first gay and lesbian group registered in Costa Rica, has knocked at the doors of various pharmaceutical companies with the purpose of obtaining access to the medications.

However, these efforts have not created any significant results, mainly because these companies are only subsidiaries of powerful labs based in Europe and North America, and are, therefore, subject to the home office policies and pricing.

For example, the Roche and Bristol Myers companies in Guatemala declared themselves unable to offer the help required by those affected.

Richard Stern, a psychologist coordinator of Triángulo Rosa and one of the participants in the meetings with representatives of the pharmaceutical companies, recognized that the costs of anti-retroviral medicines are enormous. "But," he noted "those are companies that have lots of money and could show some humanitarian sense, if not giving them away, at least selling them at reduced prices."

At present there are fifty patients in a critical phase of the sickness, who require urgent artiretroviral therapy.

Max Bucher, director of Roche in Costa Rica, said that even though he feels sympathy for people living with AIDS, he has no authority to make decisions and provide those drugs freely. A similar response was given by Randy Robleto, a Bristol Myers' manager.

Due to these circumstances, the group that represents those affected decided to send the requests to the home offices of those companies, but with the realization that they have little hope of the situation being resolved in their favor.

The monthly cost of anti-retroviral therapy in Costa Rica is 800 dollars, but the yearly income per capita, in 1996, was $2,600.

"Here almost nobody can afford those prices, much less people who are sick or incapacitated to work," said Guillermo, a member of the group, who preferred not to reveal his last name.

Stern insisted that it is unfair that the product has to have the same price for people living in San José, than for those in New York or London. "We understand that the labs have to recover the costs incurred by the research that develops those medicines, but they should also consider that we are not talking about television sets. We are talking about a small pill that could help thousands of people," said Stern.

Dr. Víquez agreed with Stern about the urgency of looking for a solution and shared some data which, according to him, make the search for special AIDS funding a true national priority.

According to the socio-economic study mentioned earlier and in light of the pandemic's behavior, it is estimated that by the year 2000, 11,000 people will be living with AIDS in the country. For the health system, the cost of assisting each one of those patients will add up to almost $10,000 dollars, corresponding to in-patient and out-patient care, as well as coverage for disability. According to their estimates, by the year 2005 the country will have spent almost 50 million dollars on AIDS patients. These figures do not include anti-retroviral treatments.

"If the epidemic is not controlled, these projections, which are already alarming, will continue increasing, as the new cases continue showing up. In other words, whatever the government saves now by not buying the antiretroviral medicine, with time will become a boomerang that will end up collapsing the whole health system," argued Vízquez.

The specialist was certain that the only way of controlling the epidemic in the country, will be for the government to design a special fund coming from the state Treasury. According to him, "in Latin America there are five countries that are offering the anti-retroviral drugs to people living with AIDS: Argentina, Uruguay, Brazil, México and Colombia, but those funds come directly from the state . No health system in the world could bear a burden of that nature".

However, people affected are not happy with this diagnosis.

"While the CCSS and the government come to an agreement, here people are going to continue dying. It is not possible that the health care system cannot allocate at least part of its budget to buying the anti-retroviral drugs, even if it is for a limited time, while the government looks for a long term solution," said Stern.

Even though uncertainty continues being their constant companion, the coalition struggling to obtain the combination therapy does not rest: last week their members met with Sandra Pisk, the people's Defendant --a public advocate--, who committed herself to finding an alternative solution.

And they have promissed they will continue their struggle, exploring ways to obtain the so long-awaited treatment, at least for as long as they have the strength to do it.

1 Last moth a group of Venezuelans obtained, through a judiciary order, free access to the drugs. SIDA: Crónica Mensual, April 15th, 1997, The Panos Institute.

Read other Cronicas