Letters to the editor

I sit here observing all the accusations and finger pointing at Tony Blair and George Bush for their decision to remedy a dangerous situation in Iraq. The world needs to take off the blinders and see the weapon of mass destructions, for He was there.

If the United States and England, over the past dozen years, hadn't persevered, what would be the situation in Iraq today? It is easy to answer from Saddam's past of two local wars, mass gassings of his own people and his numerous attempts to acquire weapons that would guarantee his position as he would choose to dictate it in the world. It is at him, a man, not a device, I would point the finger as the weapon of mass destruction.

Some would shout, let the UN take care of it. Answer that question for yourself and be honest in your heart; do you trust the UN? Just remember the man, Saddam Hussein has been the weapon of mass destruction for more time than the world should have allowed. The world should be ashamed of itself for allowing this to happen and for not seeing this weapon of mass destruction.

Dr. Gladis Guerrero
Director, National AIDS Program
Panama

Dear Dr. Guerrero:

I hope that all is well in Panama and that the preparations for the Third Central American regional conference are moving along well.

I am writing to you as a result of the telephone conversation that I had with you on Monday July 7th. As you may recall we discussed the situation related to access to ARV's for People in Panama who are covered by the Panamanian Health Ministry. You informed me that about 160 individuals (out of about 500 who may need them) currently receive free anti-retrovirals through the Health Ministry's program.

A physician from Panama had called me a few days before our conversation to inform me that any person with HIV/AIDS in Panama who needs anti-retrovirals from the Health Ministry, (which are provided free) must first pay $100 for a CD4 test. In the case that the person cannot afford to pay, they will be referred to a social worker for an "economic evaluation" to see if they can be excluded from paying all or part of the cost of the CD4 test. But the waiting period for such an evaluation to take place may be up to six weeks or even more. If a person has arrived at the hospital/clinic already symptomatic it seems unfair to put them through this process, as well as clearly dangerous to their health.

From my recollection of our telephone conversation you did recognize that the above facts are true. You said that a CD4 test in Panama costs $100, even though the Ministry has its own equipment, but that the price is so high because of the costs of the "reactives." You also agreed that people with AIDS may have to wait for an unspecified time for an economic study to be completed by a Social Worker, if they wish to avoid paying the $100.

My source in Panama did inform me that people have actually died while waiting for the socio-economic study to be completed, but I have no first hand confirmation of that.

Please also note, Dr. Guerrero, that before sending a "public letter" such as this, that I did attempt to resolve this situation by telephone in a private conversation, but you gave no indication to me that you would be willing to consider changing the policy in question.

I will now express my own opinions regarding this matter:

1) If the Panamanian Health Ministry is willing to invest up to $2000 a year (or more) to treat a person with ARV's it seems a shame to not invest the additional $100 necessary for CD4 testing so that every person can begin treatment as soon as possible.

2) Even if CD4 testing were not available, WHO guidelines for scaling up anti- retroviral access in resource poor settings, indicate that if a person has tested positive for AIDS and is clearly in a symptomatic stage of the disease, that treatment should be initiated even without the availability of CD4 testing. A much less expensive test, total Lymphocyte Count, may also be utilized.

3) Sick people who are seeking treatment should receive it without unnecessary delays and costs. Most people who would arrive at the AIDS clinics run by the Health Ministry in Panama may already be too sick to work, and be economically stressed. They are also frequently poverty class of individuals who are not eligible for the benefits of the Panamanian "Social Security" system which does provide free testing as well as free ARV treatment to those individuals who are enrolled in the system. Panama has a "two tiered" health care system, in which individuals employed by large companies or by the government itself, are enrolled in the Social Security System which is also government run.

However, the majority of Panamanians such as agricultural workers, domestic workers, street vendors, other members of the informal labor force, as well as those who are unemployed are not eligible for coverage by the Social Security System. It seems contradictory that those who are economically better off should have access to free testing, both CD4 as well as Viral Load, whereas those who are poorest, must pay $100 for a CD4 test, or wait for a socio-economic study to be completed.

4) The Agua Buena Human Rights Association is dedicated to improving the situation of Access to Treatment for People Living with HIV/AIDS in Central America as well in many countries in South America and the Caribbean region. We see it as our role to point out situations which seem incongruent with best practices related to scaling up treatment access, and for us, every death of a Person with AIDS because of not receiving medications is an unnecessary tragedy.

We recognize that there have been many successes in Panama with regarding to scaling up treatment access, and we congratulate the Health Ministry for these successes.

However, until universal access is achieved and injustices are overcome we feel that we need to take a pro-active role in pointing out those areas where changes are needed. We hope you can understand this.

We will be awaiting your response and the Agua Buena Human Rights Association is willing to support in any way possible any actions that the Ministry of Health can develop in order to resolve this critical situation.

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