From: rastern@sol.racsa.co.cr Date: Sun, 16 Nov 1997 13:19:45 -0600 (CST) Subject: IN COSTA RICA, AIDS PATIENTS CONTINUE RECEIVING MEDICATIONS San Jose, 15 November, 1997 IN COSTA RICA AIDS PATIENTS CONTINUE RECEIVING MEDICATIONS By Richard Stern More than 30 Costa Ricans are now receiving the new retroviral AIDS medications, as a result of a Supreme Court decision that was handed down last September. But the governmentīs health care provider, the Caja Costarricense de Seguro Social (CCSS) still has not begun to voluntarily provide the medications. Each individual patient must still file an appeal to the Supreme Court so that the Court can order the CCSS to give the medications to the patient. Apparently the CCSS is now in process of developing a plan to provide the medications but details of the plan are not clear and Guillermo Murillo, President of the Association of People of Living with AIDS, fears that the plan could take months to implement. "We have to continue to present each case to the Supreme Court, because the governmentīs plan continues to be vague. and a person with AIDS cannot affort to wait to receive necessary medications," he stated. Generally the Supreme Court has been resolving cases in about two weeks. This writer has also provided donated medications to patients whose appeals are pending but have not yet been decided. The medications were sent by people in the United States who no longer needed them for one reason or another. The patients can get started on their regime sooner, and when they have won their court appeal, the donated medications can then be given to another person who is just starting the appeal process. Additional donated medications are welcome. Appeals of the Courtīs decision filed by CCSS Director Alvaro Salas have been turned down by the Supreme Court and the Court continues to decide in favor of all patients who present their case to the Court. The Courtīs committment to People Living with AIDS was emphasized by Judge Rudolfo Piza Escalante in a meeting with this writer and Guillermo Murillo on November 7th. Piza was also critical of delays by the CCSS in implementing an efficient treatment delivery system for People Living with AIDS. In Costa Rica, 1,256 cases of AIDS had been diagnosed as of last August, and 518 people were still alive. Of the total cases 10 percent were women and 66 percent were gay or bisexual. In a related issue, Costa Ricaīs second largest daily newspaper LA REPUBLICA, published a front page story last Wednesday highlighting discrimination against people with AIDS in the workplace. The story focussed on the situation of school teacher Minor Navarro who was transferred from the school where he had worked for 3 years when his Principal found out that he was HIV+, and encouraged parents of children in the school to sign a petition requesting his transfer. The Costa Rican Education Ministry, which transferred Navarro to another school, has yet to develop a policy protecting teachers from this type of discrimination. However, the article in LA REPUBLICA was highly favorable towards People Living with AIDS, and highly critical of the school Principal. Navarro has an appeal pending with the Costa Rican governmentīs ombudsmen organization, and is considering a Supreme Court challenge as well. This writer and Guillermo Murillo are anxious to expand this program to a more regional basis and we are seeking funding to begin an extensive central American effort focussed on Access to Treatment early in 1998. Anyone interested in providing support for this effort could contact us at rastern@sol.racsa.co.cr. Key points of the approach necessary to confront Human Rights violations against People Living with AIDS are emphasized in the following document. METHODOLOGY UTILIZED TO CONFRONT HUMAN RIGHTS VIOLATIONS AGAINST PEOPLE LIVING WITH AIDS IN A LATINO CULTURAL CONTEXT For the past several years we have specialized in the area of Human Rights advocacy here in Costa Rica where we have created and coordinated a multi-faceted program dealing with the problem of severe human rights violations against people living with AIDS: Key elements in this program are: 1) the recognition people who live with AIDS, because of the terrible discrimination they have suffered are extremely reluctant to get involved, to sign complaints etc. It is very delicate process requiring incredible patience to work with victims of discrimination in a machista, vertical, authoritarian culture. 2) the need to draw attention in the media, on a national as well as international level, to the discrimination and abuse occurring here. For this it has been necessary for us to write more than 50 news bulletins and articles over a two year period continually describing the unfolding story of the abuses and their impact, as well as administrative and judical actions that have been taken and the results of these actions. 3) to look for empowered leaders from the target group of AIDS affected people who can begin to assume a role of leadership and importance in drawing attention to the problems of their own group and to serve as models for others members of the abused population. 4) to understand completely and utilize whenever possible the existing administrative and judicial resources on a national, and where appropriate, on an international level. To never allow the burearcratic obstacles placed by these bodies to interfere with the continuing process of placing complaints whenever and wherever they are appropriate. In Costa Rica we have continually met with and continued to pressure a whole series of public and private Agencies that deal with person living with AIDS, and we have utilized the Judicial system, which has resulted in several important victories. 5) to understand as completely as possible the nuances of the local culture and its impact on human rights, on the resolution of conflicts, and on the victims themselves. In Costa Rica, this has involved a thorough understanding of several elements including: a) the nature of the machista, heterosexist culture and its impact on sexual minorities and women who live with the AIDS virus. b) the understanding of how burearacy is used to discourage and confuse people who live with AIDS and their advocates. c) the various differences in standards of ethics which give tacit permission to government officials to provide false or misleading information to minority group members and their advocates. d) the impact in Costa Rica on a person living with AIDS if family, or employers discover their HIV status. e) the basically non-confrontational nature of Costa Rican culture where it is viewed as inappropriate to publicly engage in a dispute. This ultimately works against minorities because they have a great deal of trouble expressing feelings of anger and frustration. f) to understand the importance of patience, and persistence in denouncing human rights violations in a culture where these issues are not seen as important. To continually reinforce and support People with AIDS in recognizing that changes happen very slowly but that it is important to persist, and to continue to denounce and call attention to these situations even when it appears that nobody is listening. Access to Treatment and Human Rights violations against people with AIDS are expected to be two of the critical issues discussed at the upcoming Latin American Conference on AIDS in Lima, Peru which will take place early in December.