By Margarita Martinez
Tuesday, September 17, 2002
Colombian women in relationships they thought were monogamous are the country's fastest-growing population being infected with HIV. While many have remained quiet, the lack of medical care has compelled others to bring lawsuits.
BOGOTA, Colombia (WOMENSENEWS)--An exploding number of lawsuits seeking access to government-subsidized health care here has revealed an alarming trend: Women in ostensibly monogamous sexual relationships are the fastest-growing population in Colombia being infected with HIV.
"In the past two years, the number of lawsuits has grown 400 percent. An increasing number of those lawsuits have been filed by women," said Felipe Vallejo, director of the Corporacion de Lucha Contra El SIDA (Association for the Struggle Against AIDS) of Colombia.
Between January and June, 513 such lawsuits were filed. The lawsuits seek access to health services that have been denied by public or private systems, which typically refuse to pay for the expensive treatments. In some cases suits have been filed to gain admittance to government programs (61 percent of Colombians are covered by a government-subsidized health plan or a private insurer).
"My (private) company was causing all kinds of problems to avoid paying for the treatment," says Julia Jimenez, HIV-positive since 1999. "Finally, with the lawsuit, the company was obligated to pay for some of the drugs I needed."
The courts have mostly favored patients such as Jimenez. Of the 23,000 HIV-positive Colombians officially documented by the Ministry of Health, a mere 5,300 were treated for AIDS in the first six months of this year.
Moreover, in a country of 42 million people, authorities acknowledge that the reported number of HIV cases is low, either because people don't know or because they prefer not to reveal their status. The actual number of infected people may be up to 10 times higher.
Before 1990, one Colombian woman was infected for every 15 men. But over the last decade, that proportion has shrunk to one to four, according to Dr. Wilson Castro, medical director of the Eudes Foundation, which operates one of the largest AIDS centers in the country for terminal patients.
Much of the information about the women--such as whether they have a stable sexual partner--has only recently been included in the official statistics. In addition to the lawsuits, reports from support groups for women with AIDS and health workers suggest that women in what they thought were monogamous relationships are increasingly victims of the disease.
One of those support groups is Girasol--"sunflower" in Spanish. Based in Bogota, the Girasol Foundation assists 600 women.
"The majority of women in the group are housewives who were infected by their partner--maybe 60 percent," said Miriam Cossio, 26, Girasol's coordinator. Cossio was infected by her husband, who died in a car accident before he knew he had the disease.
Cossio is from San Jose del Guaviare, a Southern town famous for its plantations of coca, the base for cocaine. The plantations often attract leagues of prostitutes, also at high risk for HIV. She says that women in general are too ashamed to ask their partners for an exam when they start a sexual relationship and often are reluctant to insist that their male partners use a condom.
The silence works in both directions. The desperate economic situation in Colombia has forced some men to prostitute themselves while trying to maintain stable homes, Castro says.
"Women infected by their partners, who have decided to become male prostitutes, is one of the main sources of infection that I have seen recently in the office," he says. "In my experience, some men prefer to take the risk of infecting their women, rather than suggest that they use a condom or wait because they don't want to confess they had a relationship with someone else."
In a society that promotes female chastity, women find it harder to come forward when they discover they are infected, often preferring to stay quiet and ask for help later than men do.
"It took me years to tell my family. I only did it when I felt I absolutely didn't have any other way than ask for help," says Cossio.
AIDS treatment is particularly costly in Colombia. A year of the standard cocktail of three antiretroviral medications can cost over $3,600, while the annual per capita income of Colombia is about $2,000, according to figures of the World Bank.
President Alvaro Uribe, who assumed power six weeks ago, hasn't said how the government will try to prevent and treat AIDS. Critics worry that social spending across the board will be sacrificed to Uribe's priority of building up the military to fight leftist rebels waging a 38-year war.
Patient advocates say that they will encourage government officials to promote prevention messages for women in monogamous relationships--a category that was once considered almost risk-free.
"In the difficult situation of Colombia, we need to make a greater effort to make room for social spending that includes prevention campaigns with an emphasis on women that didn't exist before," said Vallejo from the Corporacion de Lucha Contra El SIDA. "We have to unify forces, not divide."
Margarita Martinez is an Associated Press reporter in Bogota, Colombia. She graduated from the School of Journalism at Columbia University.