Nicaragua Sees Gradual Rise In HIV Numbers

August 5, 2011

(Credit - A Look Askance/Flickr)

Nicaragua continues to fare better than its Central American neighbors when it comes to HIV/AIDS. But that doesn’t mean there is no cause for concern. The illness has already killed nearly 900 people since it was first detected in Nicaragua in 1987 and, though government interest in the problem has certainly grown in recent years, so too has the number of reported infections.

In the past year, more than 1,300 Nicaraguans were officially diagnosed as carriers of HIV, bringing the national total of people living with the virus to 6,122, according to the Ministerio de Salud (MINSA). During that same period, 45 people died from the illness.

The Joint United Nations Program on HIV/AIDS (UNAIDS) puts the total number of HIV cases somewhat higher – 6,900 as of 2009. Overall, that amounts to an HIV prevalence rate of 0.2% in Nicaragua, well below the overall Latin American average of 0.6%. The adult prevalence rate in the US and Canada is estimated at 0.7%.

MINSA head Enrique Beteta released the government’s latest HIV statistics May 18 during a “solidarity” march held in support of Nicaraguans living with HIV and AIDS. The Managua event was co-organized by MINSA; the Comisión Nicaragüense del SIDA (CONISIDA), a public-private partnership formed in 2000; and the Asociación de Personas con el VIH y el SIDA (ASONVIHSIDA), a non-profit organization. The collaborating groups held a similar event last November.

Beteta told reporters that the current government – led by President Daniel Ortega of the Frente Sandinista de Liberacion Nacional (FSLN) – is committed to “restoring rights to people affected by HIV and AIDS.” It is also making a concerted effort to control the spread of the disease, distributing a million condoms a year and offering free HIV tests nationwide (160,000 so far this year). Nicaragua can still “contain the epidemic by focusing on education and information,” said Beteta.

Compared to its Central American neighbors, Nicaragua has reason to be optimistic – or at least to count its blessings. Its 0.2% HIV prevalence rate is the lowest on the Isthmus. El Salvador, Guatemala and Honduras, by contrast, have prevalence rates of 0.8%. Together, the three countries have a combined 150,000 people living with the virus, according to the most recent UNAIDS Global Report.

An estimated 20,000 people are HIV-positive in Panama, where the prevalence rate is 0.9%. And in tiny Belize, the prevalence rate is 2.3%, the highest in Latin America. Even Costa Rica, Central America’s wealthiest country, has a higher rate (0.3%) and more HIV cases (nearly 10,000) than does Nicaragua.

Everyone’s Problem

The 1980s civil war and concurrent US-led embargo against the Sandinista-controlled country may explain in part why the HIV/AIDS epidemic was relatively slow to reach Nicaragua. Since the first cases were detected in 2007, however, the disease has spread –at an increasingly accelerated pace.

A 2010 report by the state-backed institution Profamilia notes that between 1993 and 1999, Nicaraguan health workers diagnosed an average of 22 new HIV cases per year. Between 2000 and 2004, the annual average of new cases was 131. As Health Minister Beteta noted during last month’s solidarity march, new cases tabulated in Nicaragua over the past year totaled 1,338.

Increased efforts by the government and its NGO partners to make HIV tests more widely available – in health clinics, but also via testing drives – may be part of the reason the official HIV tally has risen so sharply of late. Simply put, more testing means more positive diagnoses.

MINSA offered hundreds of HIV tests during the recent solidarity march. A week later, a group called Fundación Xochiquetzal tested more than 1,000 students in Managua’s Universidad Nacional Autónoma de Nicaragua.

Those kinds of activities are likely to push the official HIV tally up higher still, especially if UNAIDS is right to assume that half of the people carrying the disease in Nicaragua have yet to be diagnosed. ASONVIHSIDA President Arelys Cano, herself a carrier of the virus, suspects the real HIV count is higher still – somewhere in the 27,000 range.

Most can agree too that the disease is spreading, though how quickly or broadly is hard to say. What is clear is that Nicaragua, despite its relatively low infection rate, is still very much at risk. It may compare favorably with its Central American neighbors in terms of raw HIV/AIDS numbers, but Nicaragua shares a striking resemblance with those harder-hit countries when it comes to the socioeconomic and cultural conditions that helped facilitate the spread of the disease in the first place.

Like Honduras, Guatemala and the other countries on the Isthmus, Nicaragua is an extremely poor country. Education is limited, especially in rural areas. Complicating matters further is Nicaragua’s high incidence of sexual violence as well as the presence of Catholic and chauvinistic cultural mores that discourage condom use.

“We hear men saying, ‘I don’t use condoms because they’re uncomfortable,’ or ‘I’m a man and I can have five or six women,’” ASONVIHSIDA’s Cano explained in a November, 2010 interview with journalist Mauricio Miranda. “Having this chauvinistic culture encourages the spread of HIV. We can’t really expect to change his tastes, but we can educate. If he wants to have seven women, then he should use a condom with those seven women.”

Statistics suggest Cano’s concerns are well founded. No longer a disease that affects primarily sex workers and homosexual men, HIV is spread in most cases by unprotected heterosexual activity, according to UNAIDS. As such it is becoming increasingly “feminized” in Nicaragua. The relation of HIV-positive men to women is now 2-1, down from 9-1 in the late 1980s.

“Statistics suggest that female sex workers know they’re in danger, they know that when they sleep with a man they need to use a condom. But housewives have no idea what can happen, nor what their husbands are up to. So there’s no prevention taking place,” said Cano.

Risk Of A “Silent Epidemic”

Government authorities insist they have made huge strides in tackling the HIV/AIDS epidemic: helping organize activities like last month’s solidarity march, making tests more widely available, and dramatically improving treatment options.

When the Ortega-led Sandinista government returned to power in 2007, Nicaragua had just three health facilities equipped to offer antiretroviral therapy (ART), a process that involves a “cocktail” of drugs that suppress that HIV virus and stop the progression of the disease. The country now has 32 such facilities that together treat nearly 1,300 patients, according to MINSA.

Authorities have also committed to drafting – and approving – a new HIV prevention law. On June 2, the current head of the unicameral Asamblea Nacional, Dep. René Núñez of the FLSN, signed an agreement to that effect with United Nations Population Fund (UNFPA) representative Junko Sazaki. The UNFPA promised the Asamblea US$13,000 in seed funding to help develop the new legislation.

But as Nicaragua’s spiking number of HIV cases illustrate, even more resources are needed if the country hopes to keep the epidemic from reaching levels already present in nearby Honduras and El Salvador.

On the education side, efforts need to be made to teach prevention techniques, to explain that Nicaragua – despite its relatively low numbers – is still a high risk area, and to show that that virus can affect anyone, married housewives included.

“Even though the country has a national HIV action plan, various organizations and activists supporting the people who live with HIV/AIDS show that progress [to control the disease] has been modest. People still don’t realize that this epidemic is everyone’s problem. Instead they stigmatize particular segments of society,” Douglas Quintero of Farmamundi, an international NGO with offices in Nicaragua, explained in an interview late last year with EFE.

To slow the spread of the illness, Nicaragua – for all the progress health authorities have made – also needs more testing, according to Quintero. Without timely diagnoses, Nicaragua is at high risk of facing a “silent epidemic,” he said.

“The situation is especially risky when combined with [Nicaragua’s] a false sense of security, high level of sexual violence and high poverty level, something that’s reflected in the U.N.’s human development index, where we’re ranked in second to last place in Latin America.”

(This article originally appeared June 23 in LADB)


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