Kelly Sans Culotte


Death by Bureaucracy in Panama
International agencies silent about bungled HIV/AIDS treatment.
By Richard Stern and Guillermo Murillo

Workers get by during a transportation strike in Panama City.

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MAY 28, 2004. Seven hundred people living with HIV/AIDS have been without anti-retroviral treatment in Panama for over two months due to bureaucratic "errors."

Most get their medicines through the Panamanian Ministry of Health at one major inner city hospital. The patients there are among the nation's most impoverished people.

In the meantime, more than a thousand middle and upper class people living with HIV/AIDS continue to receive their therapy, overseen by the government-run, but semi-autonomous, Social Health Institute.

After a brief hiatus, their treatment was quickly resumed when two Panamanian NGO's, Genesis and PROBIDSIDA, wrote in April to Health Minister Fernando García demanding an end to all anti-retroviral therapy interruptions. The protest had no impact on the care of those at the bottom of the economic ladder, who must rely directly on the Health Ministry.

This is a typical situation in the many Latin American countries which, like Panama, have a divided health care system: the poorest people depend on health ministries that offer them little or no health care.

"Human Error"
On May 21, Dr. Gladis Guerrero, Panama's national AIDS program director, blamed the problem on "human error." According to her, the Health Ministry simply failed to buy anti-retrovirals for the 700 people in its programs.

Dr Guerrero would not say when they expected to have them, only that she hoped that it would be "as soon as possible."

Just six months ago, when the third Central American AIDS Conference was held among Panama City's five star hotels and skyscrapers, the country was praised by officials from the United Nations Aids program (UNAIDS), the Pan American Health Organization (PAHO), and the World Health Organization for its efforts to combat the epidemic.

Now that the limelight has shifted elsewhere, the Panamanian government seems to be cutting corners at the expense of the country's poorest people. This segment of the population faces overwhelming social and economic obstacles, and has little influence on government policies. The international agencies, already busy espousing new programs at innumerable press conferences, haven't uttered a word of protest.

In fact, except for the fruitless gesture by the Panamanian NGO's, there has been virtually no public outcry over suspension of treatment for the poor, even though both government and international officials are aware it contributes to the development of resistant strains of AIDS, not to mention the inevitable deterioration and death of those without access to treatment.

Fifty other Panamanians with advanced AIDS who depend on the Health Ministry for health care have completed the onerous bureaucratic procedures needed to qualify for anti-retroviral therapy. Many of them have already died while waiting for medications that have never arrived.

Speak Out Now
Dr. Peter Piot, Director General of UNAIDS, and Dr. Mirta Roses Periago, Director of PAHO, should condemn this blatant human rights abuse that violates the HIV/AIDS treatment protocol developed by the various UN agencies, and singles out as its victims the most defenseless members of Panamanian society.

Although failure to place individuals on anti-retroviral therapy should be condemned, it may be even more problematic to start treatment, and then interrupt it for months. This constitutes a serious public health problem, and for some it leads inevitably to death.

If UNAIDS and PAHO continue to maintain "neutrality" around such blatant abuses, they will lose their moral credibility. Worse, they will be accomplices of the authorities abusing an entire class of already marginalized individua

Richard Stern is Director, Guillermo Murillo Assistant Director of the Agua Buena Human Rights Association in San José, Costa Rica. They work to improve access to treatment for people living with HIV/AIDS in Central America.

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