Changing attitudes to HIV and AIDS saves lives on Nicaragua's Caribbean coast

27 November 2007

Related pages: Nicaragua country profile | Millennium Development Goal 5: HIV & AIDS

 

A decade ago, for people living on the Caribbean coast of Nicaragua, an HIV-positive test result meant an imminent death sentence. That is no exaggeration: in this region of Central America, the mortality rate due to HIV and AIDS was 100%.

But, thanks to the efforts of DFID and others, ten years on the situation is significantly different. Now, the HIV/AIDS mortality rate within this part of Nicaragua (known as the South Atlantic Autonomous Region - "RAAS" in Spanish), stands at only 2%. This dramatic improvement has been achieved by widening the provision of life-saving drugs, increasing access to HIV testing, and reducing the stigma and discrimination that have long surrounded HIV and AIDS.

Taking the fear out of seeking help

More patients in RAAS are getting life-saving antiretroviral drugsImage courtesy of Chris de Bode/Panos Pictures


“I still remember the uproar in Bluefields after we learnt about the first HIV case in the region,” says Sandra Bolaños, a nurse and counsellor at the Regional Centre Association Information and Counseling on Sexually Transmitted Infections (ACRIC-RAAS). “It was the case of a 40-year-old man. He came from Pearl Lagoon,” she recalls.

At a time when only a few had access to HIV test, getting tested was difficult. Fear of AIDS, and the stigma that came with being HIV-positive, also stopped people from discovering their status.

“Nowadays people are more respectful of those who are HIV-positive, especially family members,” says Graciela Argüello, a counsellor at ACRIC-RAAS, which is a non-profit organisation sponsored by DFID since 2004.

The involvement of religious leaders has been fundamental in bringing about change. Reverends, pastors, priests and community leaders have come together in a regional network to work collectively against HIV and AIDS. Also, by preaching against discrimination, they have encouraged more people to seek information and counselling.

“Christian churches and religious leaders are committed to the struggle against HIV and AIDS. Without them, we couldn’t possibly have come this far,” acknowledges Doctor Yanet López, the external linkMinistry of Health’s HIV and AIDS Regional Program Coordinator.

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Early testing makes a difference

Changing attitudes is vital to increasing the uptake of HIV services. ACRIS-RAAS now performs HIV testing in the region's eleven municipalities, and gets retro-viral medication to those that need it. It also feeds back to the Ministry of Health, sharing its knowledge and experience.

And the figures speak for themselves, with an average of 50 people seeking a test in 2006, compared to only one six years earlier. In every month of 2007 so far, over 80 people have sought HIV testing and counselling. A key outcome of this is the early detection of the disease, which can make a real difference to a patient's health.

Out of 24 HIV cases detected in RAAS in 2006, four were of pregnant women. All received medical treatment to minimize the risk of HIV transmission to their babies. Because their mothers overcame their fear and, early on, sought psychological advice and medical assistance, the babies tested negative. Far from being a minor achievement, there are valuable lessons to learn here for the local community - about the importance of being tested - and the Ministry of Health - about the necessity of follow-up care.

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Action from across society

DFID Central America's work on HIV and AIDS in Nicaragua is framed by the Accelerated Answer to HIV and AIDS Programme (for which £1 million funding has been provided between February 2006 and November 2008, administered by the external linkUnited Nations Development Program). The programme supports the prevention and control of the disease, and complements the regional HIV Programme, which makes use of Brazil’s technical expertise.

One of the programme's key aims is to make prevention initiatives more effective by getting the public and private sectors to work together. It is especially important to involve civil society organisations that, traditionally, have not been active in this area. Bringing together a diverse range of organisations is also a core objective of the national and regional commissions on HIV and AIDS. In this way, the Catholic Church has been included in efforts to tackle the sense of shame that long existed around the disease. Banishing ignorance, and reaching a wide audience with the message of tolerance, is crucial to reducing the spread of HIV and AIDS.

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Key facts

  • Extreme poverty in Nicaragua concentrates on the Autonomous Caribbean Regions, with up to 36% of the population affected. According to Poverty Map 2001, 30.8% of RAAS' population live in extreme poverty. In rural areas the figure soars to 76.5 %.
  • According to the National Census 2005, the illiteracy rate in RAAS is the highest in the whole of Nicaragua (36.3 %). The national rate is 20.95 %.
  • The South Atlantic Autonomous Region (RAAS) is also one of the most culturally diverse regions of Nicaragua. Almost a quarter of its population (24.2 %) identifies itself with an ethnic minority or indigenous community.
  • The HIV and AIDS Incidence Rate for 1987-2006 places RAAS as the third most affected province in the country, with 48 cases per 100,000 inhabitants, just behind Managua (66.9) and Chinandega (65). Based on 2006 reports exclusively, RAAS has the highest incidence rate in Nicaragua.
  • In 2006, regional health authorities reported an average of two new HIV cases per month. Ten years earlier the average was less than ten per year.
  • Present tendencies show most new HIV cases in RAAS are within the 15-25 age group.