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George Soriano, The Tico Times, vol III, number
38, September 26, 1997.
[Reprinted with permission.]
Costa Rican AIDS patient William García won a second chance at life this week, when the Constitutional Chamber of the Supreme Court (Sala IV) set a groundbreaking precedent by ordering the Social Security System (Caja) to pay for costly retroviral medication that could return him to good health.
The Caja, which has claimed for two years that it cannot afford to purchase the "cocktail" — a mixture of Crixivan, 3ZT, and AZT known to return 80 percent of AIDS patients to good health — must begin paying for García’s therapy immediately. The 28-year-old psychology graduate student, counseled by Triángulo Rosa (a non-profit local gay and lesbian organization), had petitioned the Sala IV to protect his right to receive the lifesaving medication.
"The Caja argued that the ‘cocktail’ isn't a cure," said Marco Castillo, García’s lawyer. "But in the U.S., there are patients taking these medicines who have gone months with zero virus in their blood. The cocktail makes the difference between a sick person and a working person."
The medications relieve symptoms of the disease and boost the patient’s immune system.
Although the text of the ruling won’t be available until next week, sources close to the case said the high court’s decision hinged on testimony from García’s physician, Dr. Javier Moya, who convinced the judges of the urgency of the case.
"It’s imperative that William receive a combination of retroviral medications as soon as possible," Moya said. "Without them, he’s expected to live six months or less."
Castillo, who has worked with AIDS foundations since 1986, called the case "an important precedent" for all AIDS patients, and told The Tico Times he now expects to win a second suit demanding that the Caja pay for retroviral cocktails for 300 AIDS patients with T-cell counts lower than 200.
Triángulo Rosa’s plans to take García’s case to the Inter-American Human Rights Commission were preempted by the Sala IV’s favorable ruling, and spokesman Richard Stern told The Tico Times his organization is awaiting the high court decision on Castillo’s second suit. No court date has been set.
Historically, the Caja has maintained that budgetary constraints have prevented it from making the drug available. However, controversy brews about whether the lack of funds is rooted in discrimination against AIDS patients, 70 percent of whom are gay men. Currently, the Caja pays for AZT only for pregnant women infected with HIV, the AIDS virus, to protect their unborn children from infection.
"If AIDS were a children’s disease, the Caja would find the money," charged Jacobo Schifter, director of the Latin American Institute for Prevention and Education in Health (ILPES), a non-governmental health organization.
"We fought to bring AZT to Costa Rica through the Sala IV years ago, but since it wasn’t a cure, the Caja didn’t have to buy it," he added.
According to Schifter, government institutions have failed to administer prevention or treatment for AIDS, never reaching out to high-risk groups.
"The Ministry of Health’s prevention approach has traditionally been to be ‘faithful and monogamous’, and they are sending that message to women, because they’re easier to contact," said Schifter.
However, according to experts, sexual practices and the use of birth control in heterosexual relationships are most often determined by men, who may not be monogamous. Ministry of Health officials agree, but explained that past AIDS prevention campaigns aimed at older Costa Rican males were "a wasted effort".
"Men make those decisions, but they are more resistant to the information," said Dr. Gisella Herrera, director of the Ministry of Health’s AIDS prevention program. "We’re trying to give women the skills to convince their partners about the risks, and create a sense of vulnerability which (the men) don’t feel."
The government splits its resources to fight AIDS between the Ministry of Health, which runs prevention programs largely funded by the European Economic Community, and the Caja, which is in charge of treatment.
According to a Caja study, providing all AIDS patients with medication would take seven percent of the total annual budget assigned to the purchase of pharmaceuticals, costing the institution $1.8 million a year. That estimate would increase as the number of patients increases.
"While treatment for other diseases, such as cancer, can be very expensive, the Caja invests only about two years of therapy, depending on whether it is successful. But it’s facing a lifetime of drug therapy for every patient with AIDS," explained Herrera.
There are 1,192 AIDS patients in Costa Rica. Four thousand more are infected with HIV and thousands more are believed to be carrying the virus but have not been tested, according to Stern.
Herrera noted that the Caja’s budget was cut during the present administration, sacrificing several programs. Patients needing transplant surgery, for example, now must seek treatment in other countries, she said.
"We can’t keep up with technology," said Herrera. "So while medical care (here) is among the best in Latin America, of course there are some things we just can’t do."
Developing strategies to give AIDS sufferers a political voice, Herrera said she hopes the Caja will come to realize that a lifetime of contributions from future professionals such as García that will be lost if they die far outweighs the cost of their treatment.
One of the first AIDS patients to be in the public eye, García has sacrificed the support of some of his family. He said he hopes to set an example for other AIDS patients to fight for recognition from the government and not bow to social pressure to keep quiet.
García, a graduate student at the University of Costa Rica who received a scholarship for his education, also believes discrimination played a significant role in the government’s failure to provide for his care.
"I paid Social Security, and I'm a citizen of a democratic country that promised to provide me with health care," said García, who now weighs 85 pounds. "And now, I need their help to live."
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