700 PLWA in Panama Face 'Death by Bureaucracy'
By Richard Stern and Guillermo Murillo
Agua Buena Human Rights Association*
Unbelievable as it seems, 700 People Living with HIV/AIDS (PLWA) in Panama have been without their anti-retroviral treatment for over two months due to bureaucratic "errors."
Most of these 700 people receive ARVs through the Panamanian Ministry of Health at one major inner city hospital and come from the country's working classes, and informal labor force, and are therefore among the nation's most impoverished people.
1100 employed middle and upper class PLWA who receive treatment through the government run but semi-autonomous "Social Health Institute," continue to receive their treatment. Like many Latin American countries Panama has a divided health care system, with the poorest people generally receiving little or no health care through the Health Ministries.
This past April, two Panamanian NGO's, Genesis and PROBIDSIDA sent letters to Health Minister Fernando Garcia demanding the end to interruptions of ARV therapy, which succeeded in immediately ending a brief treatment interruption for those who receive medications from the Social Health Institute, but has had no impact on the care and treatment of those who must rely on the Health Ministry.
In total, 1,823 PLWA receive ARV therapy in Panama, through both segments of the divided Health care system.
Dr. Gladis Guerrero, National AIDS program director acknowledged that because of "human error," the Health Ministry program failed to carry out purchases to insure continued treatment access for those who receive their ARV's through its programs. The result has been a complete halt to treatment for these 700 people. Agua Buena spoke with Dr. Guerrero on May 21st.
Dr Guerrero would not say when the problem was expected to be resolved, only that she hoped that it would be "as soon as possible."
Just six months ago, during the third Central American AIDS Conference held among Panama City's five star hotels and skyscrapers, the country was praised by officials from UNAIDS, PAHO, and WHO for its efforts to combat the epidemic. But now that the limelight has shifted elsewhere, the Panamanian government seems to have found a way to save some money at the expense of the country's poorest people who have little impact on government policies and face overwhelming social and economic obstacles. Meanwhile not a word of protest or concern has come from these same International Agencies of Cooperation who are busy espousing new programs at innumerable press conferences.
Although both government and international officials are aware of the danger of resistant strains of AIDS, not to mention the inevitable deterioration and eventual death of those affected, there has been virtually no public outcry other than the fruitless gestures by the Panamanian NGO's.
50 other Panamanians with advanced AIDS who also receive their health care from the Health Ministry have completed the onerous bureaucratic procedures in order to qualify to begin anti-retroviral therapy but many of them have already died while waiting for medications that have never arrived.
Dr. Peter Piot, Director General of UNAIDS, and Dra. Mirta Roses Periago, Director of PAHO,** should step forward and condemn this blatant human rights abuse that violates all of the best practices developed by the various UN Agencies with respect to the epidemic, and also singles out as its victims the most defenseless members of Panamanian society.
Although failure to place individuals on anti-retroviral therapy should be condemned, in our opinion it is even more horrible to start PLWA on treatment and then interrupt this treatment for a period of months, which will inevitably lead to death for some, and constitutes a serious public health problem for all concerned. If UNAIDS and PAHO continue to maintain "neutrality," around such blatant abuses they lose their moral credibility and become accomplices in this very worst example of abuse by indifferent authorities against a class of totally marginalized individuals.
**PAHO is the Pan American Health Organization, responsible for implementation of the WHO "3 x 5" program in Latin America.
*Agua Buena Human Rights Association
San José, Costa Rica
Richard Stern, Director
(Agua Buena wishes to recognize Javier Rozette of
Fundacion Genesis for his support in compiling this information)