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CHILE: 512 HIV-Positive People Not Notified

Daniela Estrada

SANTIAGO, Nov 13 2008 (IPS) - Chilean Health Minister Álvaro Erazo reported Thursday that 512 people who tested positive for HIV were not notified by the public health system.

He acknowledged there were problems and announced several measures to confront the health emergency.

“The measures will work as long as the necessary resources are available,” Patricio Novoa, of Vivo Positivo (Living Positive), an umbrella group linking 30 non-governmental organisations, told IPS. “What is needed here is training for many people, and the hiring of services.”

On Thursday, Minister Erazo presented the “national report on the state of the situation of confirmed HIV/AIDS cases 2004-2008” to the health committee of the lower house of Congress, which the committee had requested when the scandal first broke out in October over patients who were not immediately notified in the hospital in Iquique, in the northern region of Tarapacá.

On Oct. 14, a local TV station reported that 25 people who tested positive for HIV in 2004 were not notified by the Iquique hospital, and that at least two had died because they failed to receive antiretroviral treatment.

The scandal prompted then health minister Dr. María Soledad Barría to resign on Oct. 28, as right-wing lawmakers were preparing to seek her removal. She was replaced by Dr. Erazo, mayor of the Santiago metropolitan region at the time.

The investigation carried out by the Health Ministry established that 9,901 patients had been confirmed as HIV-positive by the Public Health Institute (ISP) between 2004 and 2008. Of that total, 6,636 were treated by the public health system and 3,265 by private clinics and hospitals.

Of the total number of HIV-positive patients identified by the ISP, 81.5 percent, or 5,407 people, have been notified of their status and are being monitored or are receiving antiretroviral drugs.

But 512 people have not yet been informed of their status. In 244 cases, there are records showing that the health services had actively attempted to track them down by means of “telephone calls, home visits, and/or certified letters,” says the report.

However, in another 268 cases – four percent of all patients confirmed as HIV-positive by the ISP – “there are no records” showing that efforts were made to locate the patients, said Erazo.

The members of the legislative health committee called for the authorities and health system personnel responsible for the negligence to be held accountable.

The report clarifies that with the information currently available, it is not possible to affirm that the HIV-positive individuals in question were never actually notified, but only that there are no records showing that they were.

Seventy percent of the individuals who were not told they were HIV-positive are concentrated in two health services in the metropolitan region of Santiago and one health service in the southern region of Los Lagos.

Finally, it was established that 717 patients have died – or 10.8 percent of all cases confirmed by the ISP in that period.

Of that group, “according to the minister, 90 percent were notified when they were already in the terminal stage of the illness, but we don’t know how many were notified that late as a result of the delay. It is not clear how many died because they did not receive timely treatment,” said parliamentary Deputy Karla Rubilar of the right-wing opposition National Renovation Party, who is a member of the health committee.

Under-secretary of Public Health Jeanette Vega said “there may be a small number of cases” of people who died in circumstances like those found in the hospital in Iquique.

Furthermore, the Health Ministry does not yet have precise figures on notifications in the private health sector, which could mean that more than 512 people were not notified.

“A 28-year-old man who lives in Puerto Montt, in the (southern) region of Los Lagos, complained that he had been informed at his workplace that he had contracted HIV. Health personnel showed up in an ambulance to notify him, which led to his dismissal,” the La Tercera newspaper reported Thursday. The health service in question maintained that the proper steps were followed.

National Renovation Party Deputy Roberto Sepúlveda, meanwhile, said 182 people were hastily notified over the last two weeks.

Erazo denied that since the investigation was launched, people were notified in a manner that violated patient confidentiality, as protected by the country’s 2001 law on HIV/AIDS.

“There are no ‘express’ (hasty) notifications. What there has been is an effort to improve the systems that up to now had not been functioning properly,” said the minister.

One of the measures adopted by the Health Ministry to improve the system involving HIV diagnosis, notification and treatment was the restructuring of the National AIDS Commission (CONASIDA).

Besides naming Dr. Aníbal Hurtado to replace Edith Ortiz, a nurse, as chair of CONASIDA, the minister reported that professionals with a range of skills and specialties would be incorporated, in order to restructure the programme of prevention and control of HIV/AIDS and other sexually transmitted diseases (STDs).

This process will be carried out jointly with teams from the under-secretariat of health, the health services, academia and the private sector, said the minister.

In addition, a unified reporting system will be created, to standardise the information at a national level, which will make continuous monitoring of patients possible, using encoded data to safeguard their privacy.

But “a large group of people who were not previously taken into consideration are going to have access to the HIV programmes, which are already overwhelmed and in a state of near collapse. There are not many specialists in the public health system. There will be excess demand, and the teams will need support,” said Novoa, of Vivo Positivo.

“The relevant legal framework will be reviewed, in order to balance public health objectives and protection of people based on the principles of confidentiality and individual responsibility,” according to the government report.

In addition, “there will be a review of the protocols on patient information, and of the mechanisms for a broad active search and follow-up of care for suspected HIV-positive patients, in the public as well as the private sector,” it says.

Furthermore, a panel of experts will be established to advise the Ministry in order to optimise the National HIV/AIDS/STD Prevention and Control Programme, review the law on HIV/AIDS, and design a programme for ongoing training in the control of the disease in the public and private health systems.

“The data show us that there are many health services that have no problems, which means the problem does not lie in the legislation but in the way things are run. If there was a problem with the law itself, there would be an even more serious situation, at a nationwide level,” said Novoa.

Vivo Positivo is not opposed to a review of the law, but insists that the rights of confidentiality and voluntary testing be respected.

Between the notification of the first cases of HIV/AIDS in Chile in 1984 and December 2007, 18,552 cases were reported, and 5,710 patients died.

In this South American country of 16 million people the epidemic mainly affects adults between the ages of 20 and 39, principally men who have sex with men. But HIV transmission among heterosexuals is steadily growing.