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HIV/AIDS IN LATIN AMERICA - Virus in Paradise When the Guatemalan Social Security Institute told Adam that he had little time to live on being diagnosed HIV+ as they had no antiretroviral drugs to give him, Adam decided he was not ready to sit back and die, choosing instead to seek aid from Médecins Sans Frontières ( MSF) at their Puerto Barrios Hospital project.
Leticia Soriano, a social worker on the MSF Puerto Barrios project, is a frequent visitor to ‘Paradise’: “The person we are going to visit is called Adam and he is 50. We’re not carrying any ID. We’ll leave the car some distance away and walk the rest of the way, in order to protect the confidentiality of the patient. ‘Paradise’ [the name Adam gives his house] is a very well-known place. We’re not trying to keep the visit a secret because he’s got AIDS, but it’s best to be discreet," she warns. The mud on the path to Paradise gets so deep at times that it is completely blocked off, particularly at dusk when the rains are heaviest at this time of year in the Guatemalan Caribbean. We meet at Morales, half an hour from Puerto Barrios in the department of Izabal. “I accepted that I was ill, but not that I had to die so soon” Adam receives us standing. He wobbles a bit on his weak legs but his head is held high and he gives us a welcoming smile. ‘Paradise’ is a humble house with a tiny shop at the entrance selling bread and fizzy drinks. Behind that is an enclosed yard in which hens of various colours and sizes run around. In the distance there is a clearing surrounded by lush green palm trees. “Before I became ill I used to sow crops and do other jobs in the fields,” says Adam as he shows us in, “although I’ve always been a port worker.” Izabal has the biggest commercial port in Guatemala as well as being a thoroughfare for migrants and home to the largest Garifuna community in the country. After the department of Guatemala (the capital), Izabal has the second highest rate of HIV infection. “I found out during Easter last year. I was losing a lot of weight and I could hardly lift a finger. Because I worked at the port, I was entitled to go to the IGSS hospital. I was there for 22 days. After that they sent me away because there were no drugs in Puerto Barrios. They told my wife to take me home to die because there was nothing they could do.” Adam’s gaze settles on the horizon as if acknowledging that there is always a chance hidden somewhere, just where he must have looked the day he was given his sentence. “I’m not going to risk being left with no medication” “I didn’t want to go home. I rejected death,” says Adam. “I found out from another family that Médecins sans Frontières were working at the Puerto Barrios hospital and I asked to be taken there. They didn’t even want to give me an ambulance. I accepted that I was ill, but not that I had to die so soon.”
For this reason, since 2003 MSF has been running a project in the municipalities of Puerto Barrios and Livingston, in an effort to urge the Guatemalan government to decentralise AIDS healthcare and treatment. Talks are now being held to sign an MSF project handover agreement for 2007, but the government has as yet shown little signs of making a true commitment to its patients. The WHO and UNAIDS put current figures for HIV+ patients in Guatemala at 78,000. Antiretroviral treatment (ARV) barely covers 30% of those who urgently need it. MSF provides treatment for around 1,600 patients, in both Guatemala and Izabal departments. On its Puerto Barrios and Livingston projects, MSF sees some 300 people, who come not only from Izabal but from the northern Petén region where some of the most isolated Guatemalan communities reside. They go to Puerto Barrios because it is nearer (around five hours away) than Guatemala City, and many of them arrive in quite an alarming condition. Everyone in the vicinity knows Adam. He has lived his whole life there. “Some people say that I got the illness for this reason or the other. As far as I’m concerned they can say what they like about me, as long as they don’t put my wife and children down.” The head of a woman who keeps a 24-hour watch on Adam’s health pops round the door. “This is my wife,” says Adam, showing us a photo of the couple in their youth at Lake Atitlán. “My two children have been very supportive as well. They’re always making sure I take my tablets and eat properly. They’re amazing. I tell them to take care of themselves – I know now how important precaution is. It’s so hard to get a check-up and treatment afterwards…” On the subject of Adam’s hopes for the future, he talks only about his two children who are now in their twenties. He hopes to see them have families and wells up with tears at the thought. Unless the Guatemalan government comes up with the human and material resources needed to decentralise the national AIDS programme, thousands of Guatemalans will continue to die on being told that there is no hope for them, as could have been the case for Adam. Seeking ways of acquiring good quality lower cost drugs, despite restrictive laws and free trade agreements, and the political will to make health a priority, are vital steps in achieving a goal that still seems very distant at present.
Leticia Soriano, the MSF social worker, tells us that Adam’s case is very special because he is one of the few men she has met whose wife and family support him. “HIV is not just about treatment. The person needs a lot of support from the people closest to them because being HIV+ still has a huge stigma attached to it. We see a lot of men who are turned away by their wives because they have been given the illness by their husband, because they don’t want to use condoms and so on. Adam’s case is different and that has helped him get better.” We saw just what Leticia had been saying about what HIV+ patients have to endure on other visits: in addition to struggling to access treatment, they suffer discrimination, loneliness and are abandoned by their friends and relatives. There is something special about Adam’s case, however. His wife came up to us and offered us her hand. We smiled in astonishment when she told us her name. “I’m called Eve, no joking.” Her husband launched into the story of how they didn’t know each others names when they fell in love. Later, when they met 27 years ago, they knew they were soul mates. “That’s why we call our house Paradise,” says Adam as he bids us farewell and invites us to come back again whenever we want. » Read other feature articles
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