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CHILE: Achievements in AIDS Fight Marred by Irregularities

Daniela Estrada

SANTIAGO, Oct 23 2008 (IPS) - Irregularities like delays in notifying 25 people that they were HIV-positive, which led to the deaths of at least two of them, have cast a shadow on Chile’s exemplary image in the field of AIDS prevention and treatment.

A local TV station reported earlier this month that 25 people who tested positive for HIV in 2004 were not immediately notified by the city hospital in Iquique, in the northern Tarapacá region.

Shortly after the broadcast, the La Tercera newspaper put the number of people who tested positive for HIV but were not notified at once as high as 100.

The facts came to light with the Jul. 10 death of 34-year-old Dearnny Aguilar from pneumonia. Since she had not been promptly informed that she was HIV-positive, she never received the antiretroviral treatment that might have saved her life. On Oct. 9 her 35-year-old husband, Juan Sarabia, also died of AIDS-related complications.

Out of the 25 people, four have yet to be advised of their HIV status: a mentally ill man, a person living on the streets, and two foreigners who have left the country.

The Health Ministry has only confirmed the deaths of the married couple among those who were not notified of their test results, but press reports say that three or even four persons from that list have died. Other complaints about similar cases have also arisen in Iquique and several other regions around the country.

The government of socialist President Michelle Bachelet said this was “a mistake that must not be repeated,” and promised to identify and take measures against those responsible and improve notification methods.

The Attorney General’s Office has opened a formal investigation, and rightwing opposition lawmakers are considering impeachment proceedings against Health Minister María Soledad Barría.

Barría announced on Oct. 18 that the head of medical services, the head nurse and the head of the blood bank at Iquique Hospital had been temporarily suspended.

She sent a special team to Iquique, headed by Undersecretary of Public Health Jeanette Vega, to oversee the internal investigation on the spot, and to report back on Friday. She also promised to give the Health Committee in the lower house of Congress a report on the status of notifications nationwide.

The Committee is discussing the need to improve the 2001 AIDS Law, according to which HIV tests must be “voluntary” and “confidential.”

In Chile, after counselling, the ELISA (enzyme-linked immunosorbent assay) technique is used. If the result is positive, a second test is performed and the identity of the patient is double-checked. If the diagnosis is confirmed, the patient is personally informed.

The scandal at Iquique revealed that many people who have been tested fail to return to the hospital to find out the result, and they tend to give incorrect personal information, probably for fear of being stigmatised, which makes notification difficult.

But Aguilar went to the hospital a number of times, suffering from the opportunistic infections that characterise AIDS patients, without medical staff realising that she had been diagnosed HIV-positive.

Non-governmental organisations (NGOs) like Vivo Positivo and the Movement for Homosexual Integration and Liberation (MOVILH) are concerned about the direction taken by public debate on the issue.

Activists fear that in order to “guarantee public health,” there may be a retreat from voluntary, confidential testing and notification, stipulated in the AIDS Law in order to avoid stigma and encourage the public to come forward for testing.

The controversy at Iquique “has shown us the less-than-friendly side of certain groups or associations that are seeking scapegoats. They do not hesitate to cancel individual rights in the name of ‘public health matters,’ and are even in favour of using uniformed police officers to notify HIV-positive people,” activist Leonardo Arenas, of the AKI organisation, which works on HIV/AIDS issues in prisons, told IPS.

This attitude is steering the country away from the fundamental issue of prevention, which involves those living with the virus as much as those who are not, activists say.

Instead of reinforcing the message that no one is “immune” to HIV/AIDS, so that taking preventive measures is always necessary, public attention has focused on the possibility that HIV-positive people who have not been notified of their status may be “infecting” – considered to be a discriminatory term – other people with whom they have sex.

“There is no real concern about prevention in Chile,” the national coordinator of the Assembly of Social Organisations and NGOs working on HIV/AIDS (ASOSIDA) and the head of Acción Gay, Marco Becerra, told IPS.

Becerra and Arenas said an ongoing prevention campaign is needed, not just a once a year effort. They also called for “sex education based on evidence, not beliefs,” and faster HIV testing to reduce notification errors.

Between 1984 and 2006, 18,552 people were notified that they were living with HIV, and 5,710 people died of AIDS-related illnesses. In Chile, the epidemic mostly affects men who have sex with men, and the AIDS virus is mainly sexually transmitted.

Up to a year ago, Chile prided itself on providing universal antiretroviral treatment, counselling programmes and an integrated approach, with prevention strategies and close collaboration between the government and civil society.

“It has not been a good year for those of us who participate in work on HIV,” Arenas said.

In 2007, irregularities were detected in the handling of funds granted to Chile by the Global Fund to Fight AIDS, Tuberculosis and Malaria for the period 2003-2008.

The reports of misappropriation of funds were investigated by the justice system, which prosecuted two executives at Consejo de las Américas (CDLA), one of the organisations awarded the contract to administer 39 million dollars donated by the Global Fund. Although the government and civil society were cleared of any wrongdoing, the ongoing investigation delayed the final disbursement from the Global Fund.

As the funds have not been released, the National AIDS Commission (CONASIDA) had to dismiss 14 professional workers and postpone its annual prevention campaign until November. Social organisations that receive government funding will also be affected.

Provision of antiretroviral treatment, which does not depend on the Global Fund, has not suffered cutbacks. Universal access to these drugs has been guaranteed since 2005, in the private health system as well as in the public system, which treats 80 percent of patients.

But the dismantling of CONASIDA led ASOSIDA and Vivo Positivo to file an appeal against Minister Barría, which has been declared admissible. All this happened before the Iquique scandal came to light.

“We have gone from being a Latin American example of how to deal with a complex epidemic, with civil society having an influence on and cooperating with the state, to a country that is an example of how opportunities can be wasted, when those opportunities are unlikely to be repeated,” Arenas concluded.