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Chile in the Vanguard of Monitoring AIDS Therapy

SANTIAGO, Nov 22 2012 (IPS) - In Chile, not only do all people diagnosed with HIV/AIDS receive treatment, but the country also has advanced mechanisms for monitoring outcomes of the antiretroviral therapy.

“Treatment is available in many other parts of the world, but no one knows whether or not it is working,” Marcelo Wolff, an infectologist who studies HIV/AIDS at the University of Chile, told IPS.

In this South American country, “coverage extends to nearly everyone living with HIV,” added Wolff, who won a Richard and Hinda Rosenthal Award this year, which recognises innovative research that has made a notable contribution to improved clinical care in the field of internal medicine.

A red ribbon, the global symbol of the fight against AIDS. Credit: Gary van der Merwe CC BY-SA 3.0

Officially, some 22,000 people are living with HIV/AIDS in Chile, although the real number could be between 40,000 and 70,000, Wolff said.

“It is estimated that there are two to three undiagnosed people for every diagnosed person,” he said, “which means the total would be between 0.3 and 0.4 percent of the population over the age of 15” in this country of 16.5 million people.

The approach involves a monitoring system in 32 public healthcare centres around the country, which makes it possible to take timely measures addressing the specific needs of each case.

The monitoring is carried out by the Chilean AIDS Cohort (ChiAC), established by a team of professionals like Wolff, who joined a multidisciplinary and non-governmental network, SIDA Chile (AIDS Chile), founded in 2003.

“Knowing about what is happening to the people being treated is the main novelty,” Wolff said. “And the Chilean AIDS Cohort has been able to study that: the survival, morbidity and hospitalisation rates, and labour and social reinsertion.”

The same monitoring system is used for all patients taking the life-extending antiretroviral drugs, to evaluate the results of the therapy.

The data generated is used to inform policy-making. And specific measures can be taken to adapt the therapy to local conditions, based on the results. The information gathered also contributes to global assessments of the spread of HIV/AIDS.

“Results from developed countries and poor nations have traditionally been published, but there were few evaluations from the large group of middle-income nations, and the Chilean AIDS Cohort has provided that,” Wolff said.

Law 19,779, approved in December 2001, guarantees the rights of all Chileans to prevention, diagnosis, control and treatment, and safeguards the free and equal exercise of other rights and freedoms of those living with HIV/AIDS, expressly prohibiting discrimination in access to education, work and healthcare.

In addition, the “universal access of explicit guarantees plan”, which guarantees the right to treatment, with specific guidelines, was expanded to those living with HIV/AIDS.

And the “national programme of expanded access to antretroviral therapy”, in effect since 2001, ensures access to the latest treatment options for all patients.

As a result of the alliance between the government’s national programme and the Chilean AIDS Cohort, “mortality has been reduced by more than 80 percent, and the rate of hospitalisation has gone down, which has made it possible for people to take up their day-to-day lives again.

“Among our patients, we have achieved results comparable to those of developed countries,” he said.

Based on this joint effort, the social and economic conditions of those living with HIV/AIDS have improved, said Manuel Jorquera, the coordinator of the AIDS advocacy group Vivo Positivo. “There is more timely treatment, and it is guaranteed, along with the free monitoring,” he told IPS.

These benefits are tangible for Martín (not his real name), a 36-year-old journalist who was diagnosed with HIV four years ago.

“It was difficult to digest at first, but I had the support of several of my friends who are also living with HIV and who have managed to deal with the disease really well,” he told IPS.

Although HIV/AIDS remains underreported, a higher proportion of cases are now documented. Since the first cases were detected in this country in 1984, the highest AIDS (six out of 100,000 people) and HIV (9.6 out of 100,000) notification rates were recorded in 2011, according to the Health Ministry’s Epidemiology Department.

The evolution of HIV/AIDS in Chile is in line with global trends that reflect a 20 percent reduction in the number of new infections worldwide and a 17 percent increase in the number of people living with HIV in 2011, compared to 2001, when the AIDS epidemic was at its height.

There are 34 million people living with HIV/AIDS worldwide, according to the latest global report, published by UNAIDS Tuesday Nov. 22.

But not every aspect involving HIV/AIDS has been solved in Chile.

Martín said that in his company people do not “officially” know he is gay, although “many suspect it.” What they definitely do not know, he said, is that he is HIV-positive and receives antiretroviral treatment at a public hospital.

“I have a totally normal lifestyle,” he said. “I go to work, I go out with my friends. But not even my mother knows I am infected. It would just destroy her.”

His fears are not unfounded. Despite the advances made at the level of public policies in Chile, deep-rooted discrimination persists, which exacerbates the fear of having an AIDS test.

“People feel the real fear of suffering from discrimination once it is known that they are infected,” Wolff said.

In his view, the most important challenge “is to keep people from being infected,” and to do that, “prevention campaigns must be much more direct than they have been.”

In addition, he said, “we have to try and diagnose everyone who is living with HIV/AIDS, and extend treatment to them.”

But to do that, the stigma surrounding the disease must be fought, he added.

 
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