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EL SALVADOR
Creativity and advocacy to prevent the spread of HIV
Edgardo Ayala
3/24/2017
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Information regarding the prevention of sexually transmitted diseases is disseminated through theatre plays and school campaigns.

They live bearing the weight of two epidemics: poverty and HIV, but María Ventura and her daughter Carolina González refuse to give up. Quite the contrary, they have gone through great efforts to better understand their condition as HIV positive, and to show a fighting attitude in life, in a country that has made substantial headway in the fight against the epidemic, but that also faces important challenges ahead.

“Before, I thought this was as far as I would live… But here I am, confronting life… It’s not easy but we live on,” said Ventura, 43, to Latinamerica Press, at her home located in the Tempisque canton, municipality of Guacotecti, in the central department of Cabañas.

A portrait of Juan Antonio Mejía, her husband and Carolina’s stepfather, hangs on one of the walls in Ventura’s home. He was also HIV positive and died last year. Since then, the burden of running the home has all fallen on her, and whenever she has the resources she leases a plot of land that she cultivates on her own to plant corn and beans.

Both women are members of one of the two support groups promoted by the Committee Against AIDS (COCOSI), the sole nongovernmental community organization that has worked since 1999 in HIV, Sexually Transmitted Diseases (STDs), and gender based violence, among other issues, in the cantons and villages nearby Sensuntepeque, the capital of Cabañas.

The other group is made up by inmates of the Penitentiary Facility in that city, who receive talks and attend workshops on how to live life in a dignified manner, by teaching them that their rights must be respected, and how prevention is the key to tackle the virus.

“Condoms were not allowed to be brought in the penitentiary back in 2011, and cases increased to five that year. This alerted the Ministry of Health [MINSAL] and jointly we advocated for condoms to be allowed in,” Carmen Jovel, coordinator of the Accompaniment and Mitigation program of COCOSI, told Latinamerica Press.

This organization is based in the Santa Marta canton, jurisdiction of Ciudad Victoria, in Cabañas. It works in coordination with the Comprehensive Prevention Community Center of MINSAL, based in the area, which keeps records of the cases and coordinates treatment for those affected.

Vertical transmission
Through the years, COCOSI has had to resort to creative methods to disseminate information on how to prevent the transmission.

This issue, as well as the stigma suffered by HIV positive persons, and teen pregnancy, is informed through simple theatre plays that are performed in rural communities where the most vulnerable groups are people of sexual diversity, the activist added.

“That initiative has given us good results,” Jovel explained, “because art should also communicate and inform on these issues.”

This preventive effort also reaches schools by means of constant work with the student body, teachers and parents. That effort has kept under control the propagation of the virus in the department,  which presents the lowest rates.

The institution also covers the travel and transport costs so that people can get to Sensuntepeque for their medical checkup in the hospital.

At national level, this Central American nation of 6.3 million people has made great strides in the last few years to confront and contain the pandemic that recorded over 33,000 cases of HIV and AIDS between 1984 and 2015, 72 percent of which were catalogued as infection, and 28 percent as AIDS or HIV in an advanced stage, according to the National Report on the Status of HIV in El Salvador, published in April 2016.

According to Doctor Ana Isabel Nieto, chief of the HIV/STD Program of MINSAL, of the infected population, 63 percent are men and 37 percent women, and is concentrated in adults of key sectors, as transsexual women, sex workers, and the category known as men who have sex with men (MSM).

The mentioned report highlights the strategy for the elimination of vertical transmission, that is, mother to baby during pregnancy, childbirth or breastfeeding, as an achievement in the subject of prevention, as this has been reduced by 94 percent since 2001.

The campaign to eliminate this form of infection was intensified in 2010 and was included in the treatment protocol that “all pregnant women undergo two HIV tests in order to prevent this type of transmissions if they tested positive,” Nieto added.

The recommended measures to prevent vertical transmission are an adequate antiretroviral treatment to the mother, control during pregnancy, programmed cesarean delivery (to prevent the rupture of the amniotic sac that protects the fetus from the infection) and bottle-feeding.

If that provision had existed when Ventura got pregnant, she would not have transmitted the virus to her daughter, now 26.

The above mentioned report points out that there are 14 Sentinel Surveillance Clinics for the integral treatment of STDs in 11 of the 14 departments of El Salvador, created as part of the prevention strategy. They have specific prevention, diagnostic, attention and treatment services available.

There are also other 14 Comprehensive Prevention Community Centers in seven of the departments with the highest occurrence of HIV, administered by civil society organizations. The test to detect the virus is free of charge.

Shortage risk
Retroviral care is provided free of charge to some 10,000 people in the 20 hospitals in the country. However, according to agencies of the United Nations that number should reach 17,000, said the MINSAL official.

So there are about 7,000 people who are not receiving the therapy, “but who, for different reasons, are also not requesting the service,”  she added.

In absolute terms, the average rate of detected cases dropped in three per 100,000 people from 2008 to 2014, and the mortality rate went from 5.6 per 100,000 people in 2006 to 3.5 in 2014, according to the mentioned report.

Also, in recent weeks, different organizations united in the Sustainability Alliance for the Response to VIH have warned of a shortage risk of antiretrovirals if the government does not pay the US$1.8 million debt owed to the Pan American Health Organization (PAHO) for the purchase of this medicine.

Although the shortage risk is real, the head of the HIV/STD Program said that if the debt is not settled due to the severe financial crisis facing the country — payment that is absolutely necessary to deal for a new purchase of these drugs for this year — there are other mechanisms available that would allow obtaining the medicines, such as loans or donations from country governments in the region.

“Whenever this happens, countries call on other countries to see which countries are willing to loan or donate; we work together this way, and people sometimes do not realize all the juggling we have to do in order to get all we need,” she said.

One of the challenges to overcome in the preventive issue, she reiterated, is the lack of sex education provided to children and young people in schools.

Teenagers, she said, start their sexual life at 12, but they have no idea of the risks that they are exposed to, because these subjects are still taboo. The objective is that they start becoming aware of this subject so that they assume their sexuality in a responsible manner.

The HIV prevalence rate in young people borders 6 percent and detected cases only appear when young pregnant girls are tested for HIV, not because they go voluntarily to be tested.

Meanwhile, in Tempisque canton, Maria Ventura and her daughter Carolina face life with energy and determination despite the adversities. While holding the portrait of her deceased husband, Ventura says she feels happy “for the support I have received; I have now learned to look after myself.” —Latinamerica Press.


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María Ventura and Carolina González, HIV-positive mother and daughter, have learned to manage daily life with much hope. /Edgardo Ayala
Latinamerica Press / Noticias Aliadas
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