INTRODUCTION
By Sergio Santamaría

          Since its appearance in 1981, the AIDS pandemic has become a scourge of humanity, destroying human life in its wake without regard to gender, age, religion or race. To date we do not know with certainty its origins nor have we found a cure or vaccine. Scientists around the world have only come up with palliatives to prolong a little the lives of AIDS patients, but nothing which can really improve this situation.
          The rulers of the great powers in our world, each year committing fewer resources to this disease, while each year spending more for wars and killing. The governments of developing countries, like Mexico, can only copy these negative policies, and further fail to control the advance of AIDS.
          The state of Oaxaca, one of the poorest in the country, now more than ever, must face this reality.
          In the following analysis, using graphics by the Frente Común, we ask you to reflect, with us, on the data and numbers provided by the Secretary of Health and by the State Council on AIDS (COESIDA), government institutions whose responsibility it is to oversee the spread of this disease and to take measures toward its control. We at the Frente Común are trying to provide a greater clarity to this information, which is the right of all citizens to know with complete transparency the situation of HIV/AIDS in Oaxaca.
          We reject the government’s whitewash of this information, insist that our population be informed of the magnitude of this problem, and call upon our society to strengthen the fight against AIDS.

- Sergio Santamaría

October 2004

A NECESSARY ANALYSIS

By Bill Wolf
 

          According to the office of the State Counsel on AIDS (COESIDA), there are 369 persons classified as patients who are receiving attention in their AIDS Clinic. This number represents an increase of more than double in the last two years alone. We at the Frente Común Contra el SIDA consider that the staff of COESIDA deserves recognition for their work and for making this clinic one of the finest in Mexico.
          However, to get a more complete overview of the situation, it is necessary to read between the lines of the official statements and figures put out by the government health agencies, now reporting over two thousand cases of AIDS in Oaxaca.
          First, it is important to remember that the numbers we receive are counting only what is called “full-blown AIDS,” that is persons who have developed the symptoms of the disease and do not include persons with the HIV virus in their bodies and who have not yet developed symptoms, that is, HIV Positive. The number of persons who are HIV positive is likely much higher than the first.
          To have an estimation of that number, we can compare some of the national statistics to those of the state of Oaxaca. For example, Doctor Jorge Saavedra López, Director of the National Counsel on AIDS (CENSIDA), reports some 22,500 cases of AIDS in the country and estimates between 116,000 and 177,000 persons who are HIV positive. This represents a number some 500 to 780 percent higher than that of the reported cases (See GRAPHIC No. 1)
Applying these percentages to Oaxaca, with 2,298 AIDS cases reported, we could be talking about between 11 and 18 thousand Oaxacans who are HIV positive.

Under-reporting of AIDS Cases

          Second, it is very likely that the number of AIDS cases reported by the Oaxaca Secretary of Health is far below the reality of such cases. How far below? It is impossible to know. However we can get some idea by noting the reported AIDS cases by health district in the state of Oaxaca. We see that those areas of the state with a high number of reported cases are the very areas where non-governmental organizations (NGOs) are at work, drawing attention to AIDS and watching that the health system is, in fact, aware of AIDS. In those areas of the state with little of no reported cases, there are no organizations nor efforts to acurately count AIDS cases.
          Another example of under-reporting can be seen in the area of the Isthmus of Oaxaca, where the state health system reports 527 AIDS cases reported, while the NGO, “Gunaxhii Guendanabani, in the city of Juchitán, has counted fully 630 cases in their community.
          In the Frente Común, we believe that currently those areas most rural, most marginalized and most wanting in health services, are exactly the areas with the fastest growth in AIDS cases not reported. They are precisely the areas with the least cases reported by the Secretary of Health: Tuxtepec (12%, the Mixteca (7%) and the Sierra (4%).

          As of June 30, 2004, the official statistics report 2,298 cases of AIDS; these are “accumulated cases” since 1986 in the state. Recently the office of COESIDA reported that 1,338 of those have died and that 951 of those are living, as of July 12, 2004. (See GRAPHIC No. 2)

GRAPHIC 2. The Secretary of Health of Oaxaca has announced that to the date June 30, 2004, there have been 2,298 reported cases of AIDS in Oaxaca. The Office of COESIDA reports that 1,338 of these have died. SOURCE: Secretary of Health, Oaxaca, “archives of the program,” June 30, 2004 GRAPHIC: Frente Común Contra el SIDA, Oaxaca, A.C.

Where are those other cases?

          As mentioned, the office of COESIDA reports 369 persons which are classified as patients, that is, receiving attention in their AIDS clinic. At the Frente Común, we ask: And the other 582 persons (of the total 951 cases “living”)? Where are they, and what attention are they receiving?
          We know that some cases are being seen in the Social Security Institute (IMSS) and some others in the Workers Security Institute (ISSSTE), however the type and quality of attention available in these two institutions is not known and not reported by the Secretary of Health.
          It is also possible that some persons are receiving attention through the health system of PEMEX (the national petroleum company) and some others through the health system of the military. We ask: How many of the reported 528 cases are receiving inadequate attention? How many are receiving none?
          It is impossible to say. We can only intuit that there is a large number of AIDS cases in Oaxaca who are not receiving the attention they need. (See Graphic No. 3.)

GRAPHIC 3. The office of General Direction of COESIDA has announced that during the month of June 2004, there were 369 persons “classified as patients.” The Secretary of Health of Oaxaca has not provided information about the other 566 reported cases of AIDS, “living” in Oaxaca. SOURCE: Office of the General Direction, COESIDA, Oaxaca, July 12, 2004 GRAPHIC: Frente Común Contra el SIDA, Oaxaca, A.C.

Some receive medicines, others no

          Additionally, we note that the office of COESIDA reported that 272 of their 369 “patients” are receiving medicines against AIDS, the so-called “antiretroviral” drugs. These drugs are given in combinations (usually of three) the well-known “cocktail of three” and should not be interrupted in their application. The office of COESIDA has given us information about the various combinations of drugs which they use, but not about how many patients are receiving a full compliment of three, explaining that variations in the application of these drugs is providence of the doctors to “judge the progress of the disease in each patient.”
          It is worthwhile to recall that two years ago the Frente Común was permitted by the Secretary of Health to survey the full number of cases of AIDS patients in COESIDA, finding that only 41 percent were receiving a correct combination of antiretroviral drugs while COESIDA was insisting fully 100 percent of its patients.
Further, we ask: and the 97 patients who are not receiving any antiretroviral drugs?
          The office of COESIDA informs us that their situation can be that some of the persons classified as patients “do not require” these medicines, and that it is a decision of their doctors.
          In addition, the factor may be financial. There are two tests which are part of a required protocol; first, the “viral load,” which measures the concentration of the virus in the body, and, second, a test called “CD4," measures lymphocytes in the body. These two tests must be done in Mexico City and are very expensive: $1,650 and $720 pesos, respectively. Together some $2,370 pesos. The frequency of these tests is also a decision of the doctor but can be every six months, and can be required of the patients for receiving their medicines.
          We at the Frente Común believe it is important to know how many AIDS patients of COESIDA are not receiving their medicines for lack of money, for waiting for test results, or for “not required.” With the information we have been given, it is impossible to know. (See Graphic No. 4.)

GRAPHIC 4. The office of COESIDA, Oaxaca, has reported that during the month of June, 2004, there were 272 of their “patients” who were receiving some medicine against AIDS. It has not reported how many of those are receiving the combination called “cocktail of three.” Of the other 97 “patients” who are not receiving medicines against AIDS, it has not reported how many do not “merit” these medicines, nor how many are awaiting the studies, “viral load,” and/or CD4. SOURCE: Office of the General Direction, COESIDA, Oaxaca, July 12, 2004 GRAPHIC: Frente Común Contra el SIDA, Oaxaca, A.C.

          Viewing these many pages of reports and statistics, provided by the Secretary of Health of Oaxaca and by the office of COESIDA, our initial observations are clear: there is much AIDS in Oaxaca (much more than the 2,298 “reported” cases), and there are many persons with HIV/AIDS in Oaxaca who are not receiving the attention they deserve (many more than the 582 “unknown” and the 97 “patients not receiving antiretroviral drugs” in COESIDA).

Who are they?

          But we should not be left just considering these cold numbers: “2,298" is an abstract representation which is used to speak of human lives. Every one of these numbers represents a life, a human being. They are parents, uncles, daughters, neighbours, farmers, housewives, lovers, teachers and pet owners. They are Zapotecs, Mixtecs and Chatinos. He is the fisherman in the river. She is the young mother of three in the corner store. He is a little boy. He is a soldier. She is a little old lady.

          The needs of each of these lives are enormous. AIDS medicines are costly. There is a great lack of resources in the areas of education, public service, ecology, and in the health system in general. It is the responsibility of our government officials to assign priorities to our limited resources.
          We believe that efforts to counter the advance of HIV/AIDS in our community should be the highest priority of our government. Timely and complete medical attention to persons with HIV/AIDS should be the greatest urgency of our health system.
          Comprehensive information and prevention of this virus should be the maximum importance to our population. It must involve those responsible for education and public protection. We must work with civic organizations and with press and electronic communications media, each sector of our society assuming their responsibilities.

          As Nancy Mayagoita, Voice of the Frente Común Contra el SIDA said some 10 years ago: “... this is the responsibility of everyone in Oaxaca.“

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- Bill Wolf
Technical assistance: Ayax Cruz