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Inter Press Service
HEALTH-CHILE: AIDS Funding Falls Short
Tamara Vidaurr�zaga
February 26, 2001
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 international courts.

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 laboratories.

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 year.

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 more expensive.

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.