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NICARAGUA
Housewives at risk of contracting HIV
Carmen Herrera
3/24/2017
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International agencies recognize policies for prevention and care of people infected with HIV, but late diagnosis could elevate the mortality rate.

Despite the persistent presence of the cultural and religious influence that stigmatizes and discriminates against people infected with HIV; that uncertain official data is published of programs that do not include women as part of the populations at risk; and the fact that there is a need for a permanent visibility of the campaigns on the pandemic, Nicaragua is well recognized by international agencies as an example of a country that is complying with the 90/90/90 strategy. 

This strategy consists in compliance by 2020 of goal 1: increase to 90 percent the proportion of people with HIV that are aware of their HIV status; goal 2: increase to 90 percent the proportion of HIV infected people who are on antiretroviral treatment; and goal 3: that 90 percent of people on antiretroviral treatment are virally suppressed.

The strategy is promoted by the Pan American Health Organization (PAHO) since 2014 and applies to the certification of the World Health Organization (WHO) to be registered as a State with a zero index of mother-to-child transmission of the virus, validation only reached by Cuba and so recognized by this organization.

“The problem in Nicaragua is that all HIV projects have been aimed at key populations: sexual diversity, sex workers, men who have sex with men, mobile populations as the members of the military, and bisexuals. But, where does that leave housewives, the women who cannot demand a condom from their husbands, those who have a stable marriage or relationship, but do not know who the husband is having sexual relations with? We do not know if he uses protection in the street, if this man is having relations with two or three transgender girls or gay men, and then he gets home, and this turns into an infection chain of re-infections. The fact of maintaining these populations concentrated with follow-ups does not allow us to learn with exactitude the status of these housewives,” Mistica Guerrero, leader of the Organization for Transgender People (ODETRANS) of Nicaragua, who provides support to people with HIV, told Latinamerica Press.

José Tomás Morales, promoter of the Global Fund to Fight AIDS, Tuberculosis and Malaria in Nicaragua, said to Latinamerica Press that some 11,000 people have been diagnosed with the virus in the country since the first case was detected in 1987.

The project of the Global Fund for the fight against HIV called “Nicaragua Strengthened in the Prevention and Health Care of the Key Populations with HIV in the Framework of the Sustainability of the Response” — administered by the Center for Health Research and Studies (CIES), that is part of the Nicaraguan AIDS Commission (CONISIDA) —works with the strategy called Comprehensive Set of Preventive Actions (CIAP), which consists in providing information, access to condoms, access to water based lubricants and HIV testing, in the identified populations: men who have sex with men, transgender population and sex workers.

Restricted information
However, the former Director of Epidemiology of the Health Ministry and current President of the Nicaraguan Society of General Medical Practitioners, Leonel Argüello, told Latinamerica Press that there is an under-reporting of cases of people with HIV, mainly in women in rural areas, that cannot be corroborated, as state authorities do not make that information public and the number of organizations of civil society which provide assistance to this population has decreased from 17 to seven in the last five years.

This situation, according to Argüello, affects the prevention programs since the government is the only one controlling the activities that take place in favor of prevention and care of the at-risk populations as are women living in rural areas and those who work from their homes, and the government does not cover what happens with those people who receive care in the many small and large private clinics that exist throughout the country or with women in rural areas who do not go to health centers.

“It is the man, in the case of rural areas, the one who goes from home to the city to do the shopping and at the same time goes to bars, brothels. And that man returns home and does not know that he could have become infected with HIV or any other venereal disease,” Argüello says.

“The country has classified HIV as occurring in a concentrated population and for this reason it has directed the prevention programs to those key populations because it has to do with cost-benefit; each reactive and each test has a cost. As a country, the intention is to include the largest number of people with HIV at an early stage so that they go and receive treatment, get them linked with the health unit. We know that the faster a person is detected, this person has a higher possibility of having a better quality of life,” Morales states.

For Argüello, although there are serious problems to confront an HIV pandemic, Nicaragua is in a better position than other countries in the region due to its history of blood market control. After the victory of the Sandinista Popular Revolution in 1979, the sale of blood was banned, sex education was implemented in schools, and prevention programs started early since the first HIV case emerged in 1987.

However, he considers that there was a setback in the 1990s and 2000s with the start of the governments sympathetic to the Catholic Church, which promotes reproduction, prohibits sex education and the use of contraceptives.

“Added to these problems, now there is no sex education provided by the state, and there is no permanent HIV campaign, which means that the population feels that they are not at risk and as a result they do not use protection,” he says.

No mortality figures
Despite the current Sandinista government having a clear religious leaning and political and economical alliances with the more conservative sector of the Catholic Church and private enterprise, it makes considerable efforts to promote and facilitate contraceptive methods in health centers, according to people interviewed.

Regarding to the prevention process, the government is successfully applying the 90/90/90 strategy of the PAHO. Also, Morales says that Nicaragua is applying to the WHO to be registered as a country that has eliminated the mother-to-child transmission of the HIV, this after achieving that only 2 percent of women with HIV transmit the virus to their infants.

About the government’s assertion that 70 percent of the HIV-infected population receives treatment, Guerrero considers that “this datum is real because I have seen in hospitals the distribution of medications where people go for their controls; there are people with five years of having contracted HIV and they take their medication and there is no problem. The problem lies in late diagnosis. If you get to a medical center or hospital in bad condition and you do not have access to any medication, it is not the responsibility of the state; it is a personal matter, of social context. Those persons of diverse sexuality feel embarrassed to go and take an HIV test, even to ask for condoms,” he says.

Although HIV is not one of the main causes of death in Nicaragua, the truth is that there is not a specific record of those people who have died because of the virus.

“Nowadays there should not be any deaths associated to HIV because we have treatment that is first class; the person who follows the treatment is going to have the same life expectancy as a person without the virus. HIV is considered as a chronic disease in the country,” Morales states.

For Guerrero however, HIV cases have increased.

“What we see now is the mortality associated to HIV, and we observe this due to an advanced state of AIDS”, he says.

For example, he stated that in the Manolo Morales Hospital, in Managua, two to three people die in one day due to advanced HIV, “when antiretroviral drugs are available in Nicaragua that can improve the lives of people; where there are two or three organizations that have self-support groups that can provide the support needed to people to improve their quality of life; this is a chronic disease and not a terminal condition.”

“People do not realize this because they do not turn to the health system, they are not aware of what is going on; we do not have real statistics. I feel that there is a rise in HIV and this is shown by the mortality in hospitals as a result of [the most advanced phase] of this virus,” he said. —Latinamerica Press.


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Mística Guerrero, leader of the Organization for Transgender People (ODETRANS) of Nicaragua who provides support and accompanies transgender people with HIV in their treatment. / Carmen Herrera
Latinamerica Press / Noticias Aliadas
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