HIV Haunts Venezuela Again

Time was when public health officials in Africa travelled to Venezuela to learn best practices in handling the HIV/AIDS epidemic. But times change.

Stephanie Nolen’s chilling piece for Toronto’s Globe and Mail two days ago shows HIV patients in Venezuela are living a situation that much of Africa left behind a decade ago.

Her story about a recently diagnosed man in Caracas’ Central University Hospital, fragile and on the brink of death after failing to receive his antiretrovirals for months, paints a grim picture:

“Juan Coronel was so thin that his kneecaps jutted out like tent poles in his sweatpants. He was 39 when I met him a few weeks ago, with reddish-brown hair that clung to his scalp like a baby’s and deep hollows below his cheekbones.”

It was not the first time Nolen saw scenes like these: a veteran Africa correspondent, she says she’d witnessed similar cases in Zimbabwe, fifteen years ago. But she wasn’t expecting such a dire situation in Venezuela, a country whose state-sponsored free anti-HIV program was for years a model for developing countries.

“Back when I was covering the African epidemic, Venezuela was invoked with admiration: This country has had free, public treatment for HIV since 1999. Its AIDS program was a model for countries throughout the developing world. Venezuela’s socialist government imported affordable generic drugs from India, challenged the patent monopolies of Western pharmaceutical companies and targeted marginalized communities, including sex workers, gay men and transgender people for free condom distribution – while most other countries were still grappling with the shame of HIV.”

But that once famous system started facing increasingly tougher times as the economic model developed by Hugo Chávez and eventually Nicolás Maduro, literally destroyed the public health system.

Today some patients can remain untreated for months, making scenes like the one she describes in this terrifying report more and more common.

Nolen says such scenes are becoming rare in Africa, but pervasive in Venezuela. I have a feeling she’s confusing Venezuela with Caracas, though. The country’s a lot bigger than the capital.

You need a functioning infrastructure, and as Nolen points out, that’s exactly what we don’t have.

As a medical student interning in a public hospital in Merida, I can say that untreated patients dying of AIDS are the exception, not the rule. I’m close to a few HIV+ patients, and they generally tell stories of antiretrovirals still delivered on time. To be sure, some have told me their treatment schemes have had to be changed as the government limited the variety of drugs it imports. But their reality is far from the Boschian hellscape Nolen reports.

This doesn’t mean I don’t believe her. I’m sure what she reports is true. Each part of the country has its own independent HIV program and even though they all face problems, the collapse has hit some much worse than others. We don’t see it here, but it doesn’t mean it’s not happening.

I’ve talked to friends working in regional NGOs and they confirm that the number of patients reaching full-blown AIDS has in fact been rising recently, even though most of them receive their drugs on a regular basis. In order to work, the HIV program requires much more than just drugs.

Nolen says such scenes are becoming rare in Africa, but pervasive in Venezuela.

You might find antiretrovirals more easily in Mérida than in Caracas, but then you don’t have access to the tests required to check if they’re working as they should. Maybe these tests are available in Táchira, but all the infectologists needed there to design the best treatment strategy have already left the country.

A good public health response to an HIV epidemic has a lot of moving parts. You need affordable condoms for people to stop spreading the virus, infant formula to prevent transmission through breast milk from infected mothers to their children, tests to diagnose the patients and check how effective the treatment is resulting. You need a functioning infrastructure, and as Nolen points out, that’s exactly what we don’t have.

Even food shortages may be influencing on the recent rise of patients reaching a full AIDS stage: how’s your immune system supposed to cope with a virus programmed to destroy it if it doesn’t even have the nutrients it needs to keep running?

When you have HIV and the whole of the economy and the society is breaking down around you, not even steady access to antiretrovirals will save you.

Juan Carlos Gabaldón

Medical doctor from Merida, currently studying Medical Parasitology at the London School of Hygiene and Tropical Medicine