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HIV/AIDS and the Dominican Republic: A look at a Pandemic
Working in conjunction with these governmental organizations are international NGOs which have taken on the responsibility of helping to fight the disease. Present in the Dominican Republic is Amnesty International, which deals with the rights of people who are infected. The World Health Organization, UNICEF, the American Peace Corps, USAID, UNAIDS, and FHI (Family Health International) are also present in the country, lending their support.

The World Bank, USAID and other donors have provided funds to the Dominican Republic. Also, the Dominican Republic has been approved for a 47 million dollar grant from the Global Fund to Fight Aids, Malaria, and Tuberculosis, (Global Fund), adding much needed financial support. Additionally, in 2004 the US government gave 6.2 million dollars to the Dominican Republic for HIV prevention and treatment.

Legal issues have unfortunately plagued the national response to HIV/AIDS, though there are laws related to HIV/AIDS in the Dominican Republic. Specifically there is law 55-93, La Ley Sobre el SIDA, but enforcement is uneven and inconsistent. This law is supposed to protect people who are infected by the disease from being discriminated against, but more often than not discrimination occurs in the workplace, at school and in communities all around the country.

In the Dominican Republic it is unlawful to test someone for the purpose of employment. It is also illegal to dismiss someone from their job if they are in fact HIV positive, but the reality is often different. In addition, laws of privacy are in place to protect patients’ rights, but this is also rarely upheld, as the results of HIV tests are seldom kept private.

Apart from being an issue of legality, HIV/AIDS is also a human rights issue. Once a person in the Dominican Republic has tested positive for the disease the person can be ostracized by his or her community, rarely receiving the same rights as he or she used to enjoy previously, almost immediately becoming a second class citizen. Research by Amnesty International suggests that human rights violations occur in particular relation to rights to health, non-discrimination, privacy and information, which in itself is a hindrance to the HIV/AIDS health objective.

Fortunately there are many initiatives in place to help stop the spread of AIDS. Because the sex worker industry is held responsible for many of the AIDS cases reported, the Dominican government has begun support of a “100% condom use” program, modeled on a similar program in Thailand, to ensure usage of condoms as a means to suppress the spread of the disease. Along with this campaign there have been mass media AIDS education campaigns in order to get information out to the public. The film Daniela, which chronicles the struggles of young women affected with AIDS, was screened on national TV, providing a different context with which to relay information about HIV/AIDS.

Much of the help in coordinating these campaigns comes from Conecta. Conecta is also continuing the work done by IMPACT, which has helped in reducing the transmission of AIDS from mothers to children at birth.

Peer education and communication activities are helping to reinforce the message of AIDS prevention, and helping to change the behavior that leads to HIV/AIDS infection. There has also been the creation of RedPav centers, through Conecta, that provide counseling for patients who have been diagnosed with the disease, something that was almost non-existent in the Dominican Republic.

Dissemination of information is a crucial factor in the fight against HIV/AIDS. ‘Lack of information about where and how to access antiretroviral treatment is often a barrier to accessing medication.’ Though there is the possibility of free effective treatment through government funded programs, policy makers, social workers and doctors often encounter patients who are dying from the disease. This is also due in part to the high cost of a doctor’s appointment; therefore many patients are excluded from getting help for their condition.

Centralization is also a key issue in the future fight against the disease. An AIDS patient needs to travel to clinics for treatment several times a month, which becomes very costly. Lack of access to these necessary medicinal materials in the clinics and hospitals away from the center of Santo Domingo have caused countless unnecessary deaths. "While the government is receiving lots of funding from the donors for HIV/AIDS work and treatment, people are dying only thirty minutes away from Santo Domingo, with its shiny private hospitals. In the last two years, [I have] seen many, many people die needlessly for lack of medicines.”

Quality within the health care system is also a cause for concern. There is only one CD4 machine in the public sector, (“a CD4 count machine measures the amount of CD4 cells - that normally protect a person from infection - and is the most common way of determining if someone needs to take antiretroviral medicines.”) and it is located in Santo Domingo. Furthermore, HIV/AIDS tests, viral loads, liver function tests, and all surgical procedures have to be referred to larger, better equipped hospitals, extending the duration of a patient’s treatment. More frustrating is that there are at times limited medical resources available to a clinic. Doctors report waiting anywhere between two and four months for essential antibiotics, which can be a hazardous period of time for infected people.

But there have been advancements in the quality of treatment of HIV/AIDS patients. Antiviral drug provisions, through programs funded by the William Jefferson Clinton Foundation and the World Bank, and USAID, through Conecta, have provided access for 700 patients currently requiring treatment. Also, Global Fund will provide treatment for an estimated 8,000 people, approaching the estimated 10,000 people clinically eligible for treatment. And to combat the increase of orphaned children due to HIV/AIDS small non-governmental grants have helped over 1,000 children and 250 families. In addition, because of the opportunistic nature of TB, the Dominican government signed several agreements to collaborate on HIV and TB cross-border prevention programs with Haiti in 2004.

Awareness of the issue at hand is being raised by the variety of organizations present in the Dominican Republic. In addition, identification of the necessary improvements to the medical situation is ongoing, and can only lead to increased responsiveness towards the disease. Finally, commitment to finding efficient and effective solutions in accordance with international health guidelines is imperative for success in the fight against HIV/AIDS in the Dominican Republic.


Sources:

http://web.amnesty.org

http://www.usaid.gov

http://www.smartwork.org

http://www.who.int
 
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