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Science 28 July 2006:
Vol. 313. no. 5786, p. 489
DOI: 10.1126/science.313.5786.489
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News

PERU:
Universal Access: More Goal Than Reality

Jon Cohen

LIMA AND IQUITOS, PERU--As much as Peru has taken a leading role in conducting HIV/AIDS research, the government has lagged when it comes to offering antiretroviral treatment to infected people. Peru didn't begin providing free antiretroviral treatment to all in need until 2004--8 years after neighboring Brazil--and did so only after being prodded by a grant from the Global Fund to Treat AIDS, Tuberculosis, and Malaria. "They have pushed us to work faster," acknowledges Pilar Mazzetti, the minister of health. "We've taken a long time to have a response."

Some 7000 people now receive anti-HIV drugs in Peru, up from 2000 a mere 2 years ago. Robinson Cabello, who runs the Via Libre clinic in Lima and in years past helped his patients sue the government for access to anti-HIV drugs, says up to 20% of people who need antiretroviral drugs immediately still do not receive them. And outside Lima, which is home to about 70% of the infected people in the country, the problem is especially acute.

Take Iquitos, a jungle city in the north of the country that has a high HIV prevalence in men who have sex with men. The main hospital has repeatedly run out of anti-HIV drugs for the 110 people receiving the treatment. "The last 2 months, we didn't have enough drugs to support our patients," says Cesar Ramal Sayag, head of infectious diseases at the Regional Hospital of Loreto. Sayag says he also has to wait several weeks to receive results of tests for CD4 white blood cells--which must be air-shipped to Lima--and that government rules do not allow him to start patients on treatment without that information. "The national program will continue this way for 10 years, and they won't change," says a frustrated Sayag.

Figure 1 Late stage. Milton Ramírez needs antiretroviral drugs, but he must wait for test results before he's eligible.
Across town at the Hogar Algo Béllo, a hospice run by a Catholic priest, a 22-year-old gay man named Milton Ramírez is suffering from untreated late-stage AIDS. Ramírez has been ill for 2 years. And although two separate tests have confirmed his HIV infection, his blood was drawn to measure his CD4 cells just a few weeks ago, and his doctors are still waiting for results before they can treat him.

Marco Calixtro, a doctor in town at Asociación Civil Selva Amazónica, is part of the team that cares for Ramírez and other patients at the hospice. "It's pathetic," Calixtro says. Calixtro of course knows all about the government's promise to provide antiretroviral drugs to everyone in need. But, he says, "when we look at a problem like Milton, it seems like all this stuff we hear isn't actually real."

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