The day Juan * finally decided to go to the hospital, he had already run out of pills that keep him healthy. He woke up very early to leave home, in San Juan de Miraflores, towards the Loayza Hospital, where he has been receiving treatment for two years.
There were many fears he was facing that day: he was afraid of contracting COVID-19 and bringing the disease home, he was afraid of running out of pills and his immune system going weak, and he was terrified that some military man would stop him on the street and be forced to reveal that he was living with HIV.
I knew I would probably have to show the care card that says ‘HIV’ in red letters and expose yourself to the inquisitive eyes of people who do not know much about this evil.
We met Juan on Alfonso Ugarte Avenue, in front of the Loayza Hospital, on Monday, April 13, a day after the government announced the extension of the quarantine. “I have taken the train and two cars to get there. Only a policeman asked me for my pass and I explained that I was going to the hospital and he let me continue. I was scared because there are still very prejudiced people ”, the 24-year-old, who wears a double mask, blue surgical gloves, sunglasses and a black cap, says with relief. It’s about eight in the morning.
He and some 5,000 people with HIV receive care at the hospital, which now also cares for patients with COVID-19, says a doctor who works there. At each appointment he collects 90 pills, enough for three months. This free treatment is essential for those who live with this disease: prevents the virus from creating more copies and weakening your immune system, until reaching the AIDS phase. Today living with HIV is not synonymous with death only if you take effective and timely treatment.
The delivery of therapy (HAART) has not stopped at this hospital, as El Comercio found. However, services such as external consultations yes they have been suspended in hospitals of the Ministry of Health (Minsa) and EsSalud. They determine the health status of the person with HIV and start the procedure to start treatment. It is the first step.
There have also been problems in accessing medication in provinces, according to various patients reported to this Journal. Many of them needed to change medications due to an allergic reaction, others newly diagnosed had to undergo viral load and CD4 tests to start their treatment and some had to resume it.
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“Until new notice”
We accompany Juan to the Infectious Medicine ward, where he regularly receives antiretrovirals. He is already “undetectable”, that is, the number of copies of the virus in your body is so low that it cannot affect your immune systemWith this, you can face any illness and lead a relatively normal life. HIV is “asleep” in his body.
A long line forms outside a small window where a nurse appears, reading the names of patients aloud. One by one, they approach to receive their recipes. “I hope they take care of me and give me the pills. We always make an appointment a month in advance, but now I could not come. I called the hospital, but they didn’t tell me, that’s why I came straight, “explains Juan.
A nurse, covered in a light blue protective suit, welding glasses, mask and gloves, approaches those waiting in line. He collects the control cards from each patient and says: “They will be attended, but only for delivery of pills. No dating. “ Juan breathes relieved, but a young man calls the woman and explains that she had an appointment to change medication due to an allergic reaction, has been without treatment for a month. “We only deliver pills, there are no appointments until further notice, perhaps until October”answers the woman as she walks away. Those who heard the request encourage the young man to follow and claim it.
“There are two problems when they don’t receive medication: the first is that the disease will slowly reactivate; the second is that when they start taking the medication again they no longer respond to it because they have become resistant ”, explains the doctor César Cárcamo, HIV specialist and researcher at the Universidad Peruana Cayetano Heredia (UPCH).
“That has consequences: the person will increase the risk of acquiring any disease and even of dying depending on how long you have stopped the medicine. Furthermore, it can transmit the virus again ”, add.
The Driving Group for Surveillance in Antiretroviral Drug Supply of Peru (Givar Peru) has also received cases of people with HIV with problems of access to medicines.
“We are currently reporting between three and eight cases to the Ministry of Health. This is happening much more since quarantine. So far there are more than 100 that we have reported and there is another percentage that we have been able to solve. “, says Marlon Castillo, coordinator of Givar Peru.
“The provisions for the delivery of medications are not being complied with for at least three months. Some are taking pills for only 20 days or a month. So they have gone to the hospital more than once, and that is exposing them “, Castle alert
Another group that has been affected are foreigners with HIV who were visiting Peru and who had to stay in the country: “There are foreigners with HIV who were stranded by the quarantine who did not have any type of insurance and ran out of medicine. We have been able to solve some cases with the Minsa ”.
El Comercio requested an official pronouncement from Minsa for the series of reports of the special ‘COVID-19 Collateral Victims’, but received no response.
Newly diagnosed at higher risk
Franco * is a 21-year-old man who, days before the start of his social immobilization, received a news that still worries him: he is HIV positive. He was unable to go to counseling or start his antiretroviral treatment because the process has been suspended, both in private clinics and in Minsa and EsSalud hospitals. And he fears that because of his compromised immune system, he is at greater risk from COVID-19.
“I was diagnosed with HIV a few days before quarantine and when I call the clinic they tell me that they only attend emergencies ”, says Franco, who will wait until this period of immobilization ends to begin the procedure in EsSalud.
“The problem [con los pacientes recién diagnosticados sin tratamiento] is that the disease continues to progress and that they can transmit the disease to another person – explains Dr. Cárcamo-. The problem they do not have is developing resistance because they have not received medications before. ”
The representative of Givar Peru assures that people in this same situation have sought the help of this organization: “We have many cases of people who were diagnosed shortly before quarantine and who are not receiving their medication because there is no doctor who can prescribe the treatment. Furthermore, not everything is enabled to test CD4 and viral load. The INS [Instituto Nacional de Salud] I was doing those tests, but now everything is focused on COVID. So many people knowing their diagnosis are not receiving medication, and they are the most vulnerable. “
“We are asking Minsa a quick care guide for these people to be provided with standardized initial medication and then they can be tested for viral load and CD4. What we have is a completely weakened system in which people with chronic diseases do not have access to medicines. ”Castillo says.
El Comercio contacted EsSalud to find out when the outpatient service will resume. Through its press office, the entity indicated that these are still suspended by order of the Minsa to prevent the spread of the new coronavirus and that reprogramming will be done once compulsory social isolation ends.
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After about two hours, from the open window in the infectology area, a nurse says Juan’s name. He approaches and receives his recipe. It is around 11:30 in the morning. Now you have to wait in another line of people that line up at the door of the medicine dispensary, this time a little smaller.
“I had a viral load test scheduled [para saber si seguía siendo indetectable], but the lady told me that for now none of these exams will be done ”.
The young man who followed the nurse now talks to three of them at one of the doors of the infectious disease ward. He looks worried. Juan, for his part, is calmer. Now cross the city to get home.
* The names have been changed at the request of the interviewees, to preserve their identity.
Data:
- If you need help and you are insured by EsSalud, you can contact line 411-8876 and dial annex 11
- If you need advice in general, AHF Peru activated help lines for people with HIV. CLICK HERE.
- If you need to report problems in accessing medications, you can contact GIVAR Peru at the email [email protected] and at the phone numbers 4839317 and 2660746.
* El Comercio maintains free access to content on COVID-19
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What are the symptoms of the new coronavirus?
Among the most common symptoms of COVID-19 are: fever, tiredness and dry cough, although body pain, nasal congestion, runny nose, sore throat and diarrhea have been detected in some patients. These discomforts can be mild or appear gradually; However, there are cases in which people become infected, but do not develop any symptoms, said the World Health Organization (WHO).
In addition, the entity announced that 80% of people who acquire the disease recover without taking special treatment, 1 in 6 cases develops a serious illness and has difficulty breathing, older people and those with underlying medical conditions ( high blood pressure, heart problems, or diabetes) are more likely to develop serious illness, and only 2% of those who contracted the virus died.
Who are the people most at risk from the coronavirus?
Because COVID-19 is a new coronavirus, according to global reports, older people and those with pre-existing medical conditions such as high blood pressure, heart disease, or diabetes are the ones who develop severe cases of the disease. more often than others.
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