Guatemala/ART: MSF priority goes to low-income patients

In Guatemala, 67,000 people - of which 4,800 children - live with HIV/AIDS (source: National STD and HIV/AIDS Prevention and Control Programme, 2002). There is not much attention given to HIV/AIDS in the country: antiretrovirals are available, but they are so expensive that the vast majority of patients cannot afford them (the treatment costs around 10,000 quetzales a month, and the average income is 1,000-1,500 quetzales a month).

Political will is also lacking - only two state-run health centres offer consultations for HIV/AIDS patients: the San Juan de Dios hospital and the Roosevelt hospital in Guatemala City. Around a thousand patients are treated by the only two doctors working in these two hospitals.

Guatemala has a social security system which gives people the right to free health care, including ARVs for AIDS patients. But only 15% of the population is covered by the system. This is why MSF decided to offer treatment in priority to AIDS patients with very low income.

In March 2002, MSF opened a clinic in Guatemala City offering antiretroviral treatment and monitoring for AIDS patients. The clinic is called "Yaloc" - which means "to fight" - and offers the mostly indigenous patients a comprehensive form of care (medical, psychological and social). It offers HIV-positive patients medical consultations, psychological counselling and social support.

MSF offers free access to triple therapy to patients whose CD4 counts have dropped below 200/mm3 or who are in stage 4 of the disease (WHO criteria). Around 20-25 consultations are conducted every day. At the end of October, 155 adults were treated with ARVs in Yaloc, and MSF treats a further 160 in other hospitals in Guatemala City and Coatepeque. MSF plans to double the number of patients under ART next year, and to include children in the programmes.