Being Alive - December, 1998
Richard Stern

While thousands die of AIDS in the developing world, their brothers and sisters in Europe and North America are taking medication and getting back to the business of focusing on life instead of death. The medications do work. I have seen dramatic evidence of that in Costa Rica, while working as a psychologist in the Triangulo Rosa AIDS service organization here. Last year a dozen of my clients and friends died of AIDS. This year, following the decision of the Costa Rican Supreme Court ordering the government to provide retroviral medications to all people in the advanced stages of AIDS (CD4 of 350 or less) none of the twenty five or so people with AIDS that I am in touch with have died.

Many had multiple hospitalizations in previous years, but this year there have been only a few who have had brief hospitalizations. The medications do work, maybe not for every one, but they are working well here in Costa Rica.

We have a funny way of viewing history. A common criticism of the world's reaction to Hitler's genocide was "how could people just sit back knowing this was happening and not do more to prevent it?" Church authorities in Germany and other European countries could have helped thousands of Holocaust victims to escape, but didn't. I am no expert on the Holocaust, but I know that fifty years later we point the finger of complicity at people who were neither Nazis nor Germans, but just remained passive or neutral.

I think in fifty more years, people will be asking the same questions about the AIDS epidemic. How was it possible that so many people with resources and intelligence, who knew so much about AIDS, sat passively by and watched their brothers and sisters die for lack of the same medications that everyone knows can prevent the deaths of people with AIDS?

When the disease broke out and there were no medications, the Northern country activists, with their tradition of skilled protest, took to the streets and demanded better results from public as well as private interests. They demanded the search for medications that could save their lives. But once they got the medications, they have become considerably more passive, almost complacent, seemingly forgetting their brothers and sisters in developing countries who have no skills in protesting and no resources to protest with.

Thousands are dying and the actual value of the raw material ingredients of these pills probably is a few dollars a month per prescription. It's the international economic system and pharmaceutical pricing structure that brings up the costs of the medications so that the pharmaceutical companies can recover what they say were the costs of the investigations they had to carry out to develop the medications, for people with AIDS in wealthy countries who would be able to afford to buy them.

So this was the ACT UP deal then. Get us our meds at prices that our insurance carriers can afford and once we are OK, we will still be liberal and concerned, but we won't cause too many hassles. If AIDS activism had begun in the developing world, instead of in New York and Paris, you can be sure that the pharmaceutical companies would have "discovered" much cheaper medications.

Arguments are made that poor countries have many medical and social problems that need resolving: malaria, cholera, dysentery, malnutrition; and that the resources don't exist to solve all of these terrible problems. It's true. But none of these other diseases are so intimately connected to a social movement as AIDS is. The medications that exist for AIDS have the blood of so many early Act Up martyrs on their prescription labels-the Michael Callens and the Randy Shilts who never stopped trying to change the lives of people with AIDS. But the movement seems to have slowed down, and people with AIDS in the developing world, who can't get the meds they need, don't even know or understand what Act Up was all about.

In the film "The Life and Times of Harvey Milk," there is a touching and telling moment which occurs on the night of the assassination, when one of Harvey's closest friends screams out at the silently weeping mourners at the San Francisco city hall: "Where is your anger?" I say the same. I know the problem is that the people who could be angry in New York, in London, in Vancouver or in Stockholm, literally don't see their African and Latin American brothers and sisters dying needlessly of AIDS. They are just too far away. If they were here in Central America, where I am, or in Zaire or India, they would be angry and they would go back to the streets.

The only possibility for change in the desperate situation confronting people with AIDS in poor countries would come from a renewed activism in the developing countries to go back to the streets, back to the "zaps," and to develop strategies to force changes in international economic policies and agreements that enable private companies with life saving medications to refuse to give the medications to people who need them unless the people come to the office with money. The pills sit on the shelves in the pharmaceutical company warehouses waiting for someone with money to come along, and outside, the majority of the people die and nobody uses the pills anyway.

Where is UNAIDS in all of this? Where are the activists? What will history say in 50 years about this incredible gap in medical attention that has occurred, and those who stood silently by?

I cross the border into Nicaragua a hundred and twenty miles from San Jose, Costa Rica. I don't see any real difference. The grass is equally green, the road is the same Interamerican Highway that stretches from Texas all the way to Panama. What is a border anyway?

Yet in Costa Rica my friends are getting their medications. But in Nicaragua, Sergio Navas, founder of the AIDS group called "gente positivo" (Positive People) can't get any medications for himself or for the people in the group who die one by one, month after month. Incredibly, there are only 250 People Living With AIDS at this moment in Nicaragua. How much would it cost to save the lives of all of them? About one and a half yards of a "Stealth Bomber." If one or more pharmaceutical companies donated the stockpiled meds that sit in their warehouses, they could save all the people with AIDS in Nicaragua and it wouldn't cost them anything. The medications are just sitting there anyway.

They won't donate these meds without pressure. The pressure has to occur there, up North in the developed world. The pressure shouldn't stop until all people with AIDS have equal access to care and treatment. That would be a movement worth remembering fifty years from now.

Richard Stern, Ph.D., is Health Coordinator of Triangulo Rosa, Costa Rica's gay/lesbian association. He can be reached by telephone and/or fax at 506.234.2411, or by e-mail at rastern@sol.racsa.co.cr.

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