AIDS in Amazonia: An unresolved issue

In the collective imagination, Amazonia is a huge green expanse bathed by the incomparable river that lends it its name, a region of adventure, indigenous cultures in their pure state and nature. Very few people associate this zone with sociocultural isolation and a shortage of health-related means and infrastructures. This is why some illnesses are more complex to manage there, including HIV-AIDS.

Precisely because of its unique features, this is one of the zones in the world where it is the most difficult to treat diseases like AIDS. For example, in Peru, the Awajum people and other Amazonian communities affected by HIV have retained certain customs and traditions which reflect their geographic isolation and exclusion from the national development process. This means that their social and economic vulnerability and their lack of access to social services is a constant.

Some years ago, the UN, through UNAids, established a Comprehensive Plan with the goal of strengthening the local capacity to better respond to the AIDS epidemic, as well as to harmonize the actions of the UN agencies and other associated organizations in order to optimize the use of technical and financial resources and support the local governments' priorities. It also sought to reinforce inter-sectoral action and to mobilize new resources and associations to support local responses to AIDS. However, the epidemic is still raging.

HIV-AIDS: A complex disease in Amazonia

"More than 200 indigenous peoples are affected by the HIV virus". This is one of the headlines of so many news stories that have recently appeared in the media in this region. According to information from the Health Network of Condorcanqui, 77% of the cases reported in the Amazon region are in indigenous people.

Throughout the history of the indigenous communities, especially the people originally from South America's Amazonia region, illnesses, especially epidemics, have been the leading cause of death and have sometimes virtually exterminated entire peoples. HIV is the latest epidemic, and because of its unique features it can put at risk the very existence of these communities, which today are struggling under precarious conditions to survive and reap the benefits of development while retaining their close ties to their rich Amazonia culture.

What is more, the economic status of families compounds the situation: many young people abandon treatment because of the lack of support  they receive from the healthcare centers that treat the disease in this region.

In the Awajum community in Peru, healthcare services are extremely precarious. This is one of the reasons why the communities have developed their own healthcare system which is aligned with their world view. Even today, most of the members of the community still treat illnesses with their own system, which is based on self-healing, the use of medicinal plants and traditional therapies. They also interpret the causes and consequences of the illnesses in their own way, which is closely tied to the natural environment and magical conceptions. In these regions, medicine men are still the "medical authorities".

Prevention and education: Unresolved issues

The outbreak of HIV in these communities has led to a reconsideration of the diagnostic, treatment and monitoring options and of the interpretation of the traditional phenomenon of health/illness. The unique features of this disease (a virus with no initial symptoms and the appearance of the first symptoms up to ten years after infection, treatments with no permanent cure, high mortality rate if the right treatment is not administered) are casting doubt on the credibility of the efficiency of Western healthcare services and are reinforcing magical explanations and inappropriate measures, such as disdaining the use of condoms.

As Mario Tavera, a health expert from UNICEF-Peru explains, "it is crucial to strengthen the institutional response to HIV-AIDS, which includes prioritizing access to treatment and comprehensive care of the individuals living with HIV to avoid the high mortality rates today. These interventions have to be appropriate to the cultural and geographic context of these communities, otherwise they will be unsuccessful. This leads to trust in the healthcare system, which fosters access and adherence to treatment, diagnosis and preventative measures."

According to some figures, most of the infected people are men between the ages of 14 and 25 with a very active sex life. Obviously, not all of them are aware of prophylactic protection, others are aware of it and do not use it, and the vast majority have traditional lifestyles.

For example, in Peru, especially in the provinces of Condorcanqui and Datem del Marañón, establishments do not provide adequate care given the cultural context of these communities in both preventive and awareness-raising aspects, or in the comprehensive management of the affected people. "There is still a hegemonic biomedical vision from the predominant culture," notes Mario Tavera.

In order to encourage appropriate prevention and communication in the local context, UNICEF-Peru has focused on supporting the design of a culturally adapted information, education and communication (IEC) strategy in order to implement preventative and healing healthcare actions through a professional who is an expert both in education and communication and in anthropological issues, in order to have technically appropriate dissemination and awareness-raising materials targeted specifically at Amazonian communities.

The report entitled Challenges posed by the HIV epidemic in Latin America and the Caribbean , published by UNAids, the Pan-American Health Organization and UNICEF, confirms that some of these strategies have been effective.

Education and prevention are associated with:

• A rise in the use of condoms, the desire to be HIV tested, a drop in stigma and discrimination, a rise in self-esteem and more honesty when addressing the cultural and social barriers to healthy sexual practices.
• Community development and capacity-building to combat the epidemic.
• A rise in community participation and training of the community members as educators, which is essential to stopping the epidemic.

Probitas' action

Likewise, it is necessary to strengthen the healthcare systems in the region, specifically the clinical laboratory services in order to improve early diagnosis, treatment and monitoring of ill patients. For this reason, in collaboration with Probitas Foundation as part of the "Global Laboratory Initiative" (GLI) program, a training program has gotten underway for the healthcare teams at the healthcare facilities within the Condorcanqui and Datem del Marañón Network in providing comprehensive care for people living with HIV/AIDS.

Last October, 14 healthcare professionals (doctors, nurses, obstetricians, psychologists and laboratory technicians) were trained in four specialized centers in Lima. A study was also conducted on the explanation systems, therapeutic courses and the adaptation of the technical norms of comprehensive care for people with HIV/AIDS to the reality of the indigenous people.

Furthermore, in order to adapt the laboratory equipment of these networks and strengthen the local diagnostic and monitoring capacity, the Probitas Foundation also performed a needs assessment to identify the infrastructures and equipment that were needed in line with the National Institute and the Regional Directorate of Health, which are in charge of provide assistance in implementing and operating the national network of laboratories.

Therefore, on December 1, 2014, 27 years since the first World AIDS Day, where people from all over the world join forces to raise awareness of HIV/AIDS and show international solidarity, the Probitas Foundation and UNICEF are joining their own efforts to work with local actors to bring all the advances in diagnostics, treatment and comprehensive support for people affected with HIV/AIDS to the middle of the Peruvian Amazon.