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Plan to combat HIV/AIDS puts aside the focus on prevention
Gabriela Read
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New strategy concentrates on the diagnosis to at-risk groups and the handout of antiretroviral medications.

By 2015, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that there was a population in the Dominican Republic of at least 68,000 people living with HIV. The incidence, according to statistical data, had been diminishing during the previous years until settling at 0.8 percent — a figure higher than the average in the region that stands at 0.4 percent — after years of a mainly preventive approach.

The strategy switched that same year to an approach more oriented towards a diagnosis of the disease, as explained by Leonardo Sánchez, director and activist of the Amigos Siempre Amigos gay group, something that in the next few years could skyrocket the number of cases that as of now is calculated to be 2,000 new infection cases per year.

In fact, in April 2015, the government launched the National Strategic Plan to Answer STDs (Sexually Transmitted Diseases) and HIV/AIDS, a tool that aims to concentrate its efforts in the next three years in the groups that contribute more to the prevalence of the epidemic: male and female sex workers and the LGBTI (lesbian, gay, bisexual, transsexual and intersex) population, through early detection and by providing antiretroviral treatments.

It is the strategy called 90/90/90, promoted since 2014 by UNAIDS and the Pan American Health Organization (PAHO), that pretends that by 2020, 90 percent of the HIV infected population are aware of their diagnosis; 90 percent of the people who live with the virus receive antiretroviral treatment; and that 90 percent of them are virally suppressed.

This at least on paper; in practice, the application of the strategy has found itself with a country that is not yet prepared for this strategy to work.

“First, the country has not yet accepted that HIV is a disease of national priority. Secondly, is that the budgetary allocation to combat the disease is still less than 1 percent [of the national budget],” Sánchez tells to Latinamerica Press.

According to this strategy, “each person who is diagnosed with HIV has to be introduced into the health system, implying that the person will immediately start receiving the antiretroviral treatment,” adds the activist. “But we are coming across many people of all ages living with HIV and we are sending them to the care units. There they come face to face with the national reality: many of these units are saturated and are not taking on new patients.”

Insufficient funds
In October of last year, the Dominican Network of People who Live with HIV and AIDS (REDOVIH) denounced that 30 percent of HIV positive people were at risk of being left without the antiretroviral treatment if the budget that the State allocates to the National Program of Comprehensive Care of People who Live with HIV/AIDS was not increased for 2017.

From the very first year when the National Strategic Plan for the Answer to STDs and HIV/AIDS, the medication program was already operating with a deficit of US$3.7 million, according to figures provided by Dulce Almonte, the president of REDOVIH.

“It is not that the strategy is bad or inadequate; it is that the country is not prepared for this strategy to work to perfection,” points out Sánchez. “We are talking about the economic inability, in terms of structure and in terms of the number of professionals in the health system with the capacity to medicate and do follow-up of an HIV infection.”

But not all is negative, considers Nairovi Castillo, coordinator of the Community of Transgender and Transvestite Sex Workers (COTRAVETD), which seeks to respond to the needs of health, safety, and psycho-social aspects of the group. For her it was a gain that during the creation of the concept note of the National Strategic Plan they succeed in being excluded from the “men who have sex with men” category, something that now allows them to have specific statistics regarding HIV cases in their group and, based on this, work to promote public policies that allows them to deal better with the prevention of the disease among their group.

According to the Second Survey of Behavior Surveillance with Serological Linking in Key Populations of 2012, there is a population of 8,891 transgender persons in the country. Of this number, COTRAVETD estimates that 28 percent are HIV infected, Castillo told Latinamerica Press.

The activist considers that in the last few years the group has reaped other benefits, rather small, but positive. For instance, to be treated with respect inside the health system, when HIV infected transgender sex workers go looking for health care.

“The cases of discrimination have come down somewhat in health centers. Many hospitals already know that there is an organization in the country that defends transgender people. They look at me like as a ‘fighter’; they know that I am going to go in front of a TV camera to demand respect,” she says proudly.

She also points out that the close relationship of the organizations with funding agencies with influence in the Ministry of Public Health, has contributed with these improvements, by demanding respect for them from the system and by providing training to the health staff.

“They have the power to meet with the Minister of Health, to send letters and to say: look, these people are asking for this,” she said.

Subjects of law
Bignatisis Vásquez, a promoter and educator of the United Women’s Movement (MODEMU), which brings together more than 2,000 sex workers in the country, agrees with Castillo.

Although admitting that there are still cases of discrimination and stigma taking place in the health system, she considers that cases are more infrequent thanks to the work done by organizations that provide support to these groups in situation of vulnerability and also thanks to the empowerment of its members who now see themselves as subjects of law.

From her work, what worries her most is access to medicines and the discrimination in other areas such as in the labor realm. And in that sense, she speaks from her own experience and of her colleagues.

When she retired from sex work, she tried to find a job in a free trade zone. But, according to her, they tested her to detect HIV and she was not hired. Although this type of practice is illegal, most companies conduct these unreported lab tests before hiring.

This keeps many people from integrating into the labor force, including former sex worker infected with HIV, while this make difficult for them, due to economic hardships, to have access to medication when the health system itself cannot provide them. In the Dominican Republic, the coverage of people receiving antiretrovirals barely reaches 58 percent, according to data from the National Council for HIV and AIDS.

But if these groups now celebrate the improvement in the manner they are treated in the health system, this comes as a result of years working with a preventive approach in community spaces that also served to make them aware of their rights.

“With this new approach [the 90/90/90 strategy], the population has lost a space of prevention and community empowerment that the civil society organizations provided them through our preventive programs that no longer exist,” Sánchez regrets.

For now, all that is left is to wait for the country to make the readjustments in the national health system to accommodate the new demands that crop up as a result of this new approach. —Latinamerica Press.


With a focus on prevention, transgender and sex workers rights organizations attain equal treatment in the health system. / COTRAVETD
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Latinamerica Press / Noticias Aliadas
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