Venezuela’s ill haunted by shortages
Woman with HIV forced to cope without the drug that was helping her stay alive
CARACAS, Venezuela — The wheezing bus pulled in late from the slums, so Carmen Hernandez was practically jogging toward the clinic now. It had opened 20 minutes ago, and she needed to be early. Late meant lines, and the 49year-old mother of five couldn’t wait. She was wasting away. Her high cheekbones were protruding more, and the headaches were getting worse. A fearless tough talker, she didn’t flinch at the crackle of gunfire on her street. But this was different. She’d dropped eight pounds in four weeks. She was scared.
“I should be at the clinic already,” she said, her voice on edge.
That would be the state infectious disease clinic, where a doctor in July had said the words that meant Venezuela’s chronic shortages had finally ensnared her. With the economy collapsing, many things were hard to find.
But this was her Viraday, the HIV drug keeping her alive.
“We have none left,” the doctor had told her. “Try again in August.”
So an hour after first light one August morning, she was doing just that. Her eyebrows furrowed as she approached the clinic’s gates.
Doctors inside were struggling to cope with a surging HIV/AIDS crisis that experts fear could become the worst in Latin America in years.
In a country where a six-pack of condoms — which can prevent transmission — costs almost a full day’s minimum wage, the number of newly infected patients was jumping.
Surging prices and shortages of medicines and food, meanwhile, were hitting those already infected, with devastating consequences.
A grinning guard at the gate sized up Hernandez. She couldn’t afford breakfast, but she had managed blue eye shadow and a dash of fuchsia on her lips that matched her skintight leggings. His smirk said he knew she was not from around here — a middleclass district. This woman was pure Catia, one of the capital’s toughest slums.
“What are you looking for today, my love?” he said.
She took a second, hugging herself in a knockoff Adidas jacket that hid the loose skin from her rapid weight loss.
“Viraday,” she said. “I need Viraday.”
Living with the world’s highest inflation rate and a repressive government, Venezuelans are facing an imploding health system.
During the 14-year rule of President Hugo Chavez, a charismatic socialist who died in 2013, oil-rich Venezuela was praised by health experts for its HIV prevention programs and free treatment.
But the national health system is now buckling as years of government mismanagement and corruption, coupled with lower oil prices, have plunged the economy into chaos. Authorities import many drugs, including antiretrovirals, at discounted rates via the Pan American Health Organization.
The local currency is in free fall, putting those cutrate drugs, as well as basic imported medical supplies such as needles and saline, increasingly out of reach.
Amid the cascading medical crises is the spike in complications from HIV/ AIDS. Free HIV tests have been mostly unavailable since November. Pinched by costs, prevention programs offering free condoms ceased last year. Amid pill shortages, otherwise healthy carriers like Hernandez are going weeks, sometimes months, without antiretroviral drugs.
As a result, Caracas’ largest hospitals are scrambling to cope with an influx of both newly infected and deteriorating HIV patients, their emaciated bodies evoking the distressing images that defined the virus in the 1980s.
“We used to have about one or two HIV patients a day; now we have four and five, up to 25 a week,” said Maria Eugenia Landaeta, head of infectious diseases at Caracas University Hospital, one of the capital’s largest medical centers. “We’ve had too many patients die because we can’t offer treatment.”
According to statistics from the United Nations’ AIDS agency, based on information from Venezuela’s health ministry, the number of AIDS-related deaths in the country surged 25 percent to 2,500 between 2010 and 2016, even as they fell 12 percent on average across Latin America.
Many Venezuelan medical experts think the numbers could be even higher.
Newly diagnosed infections in Venezuela fell slightly during the same period, easing to 6,500 from 7,000 annually, according to the figures.
But shortages of medication, the lack of tests and the disintegrating economy, experts say, appear to be sharply worsening the HIV crisis now, making the country an outlier in a region making gains against the virus.
Severe shortages of HIV drugs go back to at least April, doctors say. But before July, the state clinic Hernandez counts on had supplied her with the combination drug Viraday, known as Atripla in the United States. Its powerful compounds act against the enzymes that causes the HIV infection to spread.
“When they told me they ran out, I left, sat down on the street and cried,” Hernandez said. “I couldn’t stop. People passed by and stared.”
The government of Nicolas Maduro, Chavez’s anointed successor, has rejected offers of international humanitarian aid. Nonprofit groups say Venezuelan authorities have refused even small-scale help.
Hernandez was diagnosed with HIV in 2013. Her husband had left her, she said, plunging her into a depression eased by men and liquor. She had no idea who gave her the virus.
One morning in early August, Hernandez made another trip to the clinic. After being waved in by the guard, she rushed toward a pharmacy window in a small courtyard. She took a clipboard and signed in.
She sat down on a bench, chewing her lip and watching as patients were called to the window.
One man asked for a different HIV drug. “No, we don’t have it, sorry,” a doctor said. The patient closed his eyes and sighed.
The next man — an older patient — was looking for the same drug.
“Nothing, sir. Hasn’t arrived,” the doctor said.
“Hernandez, Carmen,” a doctor finally called out from the window. She rushed forward. “Viraday,” Hernandez said.
No, they didn’t have it. But they did have the generic.
The doctor told Hernandez she was lucky. Only 500 monthly doses had arrived for 2,900 patients.
“What happens to the patients who come next week?” Hernandez asked.
The doctor looked down, shaking her head.