SANTIAGO, Feb 26 (IPS) - The Chilean state provides combination
anti-retroviral drug therapy to less than half of the official
number of AIDS patients, and the government's programme against
HIV/AIDS has had to opt for treating patients instead of
carrying out prevention campaigns, due to limited funding.
"Low-income AIDS patients have to wait for another to die
before receiving treatment that will enable them to continue on
with their lives," C�sar Herrera, president of Vida Optima
(Optimal Life), one of the groups comprising the national
coordinating group Vivo Positivo (I Live Positive), told IPS.
"Our constitution says that we have the right to health but not
to medicine. But without medicine there is no health; that is
an enormous contradiction," said the activist.
Last November, the Supreme Court dismissed a lawsuit accusing
the state of denying the right to health care and life by
failing to extend anti-retroviral drug treatment to all AIDS
patients. Vivo Positivo is planning to take the case to the
Vida Optima complains that the funds earmarked by the state for
treating people with AIDS are insufficient in a country with
3,741 people with full-blown AIDS (Acquired Immune Deficiency
Syndrome) and 4,392 people living with HIV (Human
Immuno-deficiency Virus), according to the figures provided by
the Health Ministry's National AIDS Commission (Conasida).
But that is just the official number of people living with HIV
or AIDS, and the real figure is actually higher, said Herrera,
who pointed out that there is no strict enforcement of the
requirement that physicians report every case of HIV to the
Health Ministry, especially in the interior of this Southern
Cone country of 15 million.
In addition, private clinics are not required to report to the
government, which means many cases do not figure in the
official statistics, which also overlook those who receive
treatment abroad, said Herrera.
The state administers combination anti-retroviral drugs to
1,500 patients, which means at least 2,241 patients must dig
into their own pockets for treatment that runs to 714 dollars a
month, in a country where the minimum wage is 178 dollars.
Given the high cost of the cocktail treatment, Chile is
participating in a pilot project led by the joint United
Nations Programme on HIV/AIDS (UNAIDS) which is working on
obtaining special prices through direct negotiations with
Furthermore, the drug therapy is only extended to patients
whose lymphocyte counts have fallen below 300, a level at which
a risk of death is already present, even though international
standards set the level for treatment at 500. A healthy person
has a count of between 800 and 900.
That requirement is outlined in the National Protocol on Anti-
retroviral Therapy, which Conasida plans to review and update
next month in conjunction with physicians and representatives
of universities and scientific associations. And before the new
protocol goes into effect, it will be submitted to Vivo
Positivo for evaluation, said Conasida's Gloria Berr�os.
Herrera said Conasida gave poor use to the resources it was
assigned by the state by initiating treatment without previosly
carrying out exams to identify the specific anti-retroviral
drugs most suited to each patient.
"You could spend eight million pesos over two years instead of
spending 150 at the start (for the exams), and saving the
person's life," said Herrera. Making those exams a routine part
of treatment would cost the state less than 500,000 dollars a
Berr�os responded, however, that "we must remember that
combination anti-retroviral therapy arrived relatively recently
in Chile, and that it is administered to a limited number of
people, which means that this year we cannot divert funds to
additional exams from a budget which only allows us to continue
the treatment that has already been prescribed."
But well-designed and supervised treatment would actually save
the state money, said Herrera, since patients who do not take
their medicine and must be hospitalised regularly end up being
Activists warn that a mutant kind of multiple drug resistant
HIV that researchers say has arisen due to haphazard treatment
regimes could crop up in Chile, because patients here are often
forced to interrupt their treatment because they cannot afford
it, or end up using two instead of three anti-retroviral drugs.
No medicine has yet been found to treat the multiple anti-
retroviral resistant HIV.
The Chilean state continues to assign Conasida the same funds
it allotted three years ago, although the number of patients
has been growing by 25 percent a year, according to Conasida.
That means the agency has had to choose between carrying out
prevention campaigns and treating people with AIDS, and no TV
campaigns have been conducted since 1997.
Herrera said the spread of AIDS could be curbed with adequate
prevention and education, as it has been in many countries of
the industrialised North. He cited the example of a group of
sex workers in the northern part of Santiago who remain free of
HIV and AIDS, despite attending an average of 40 clients a
week, because they organised and use condoms.