Chile: Whether the government organization CONASIDA only helps terminally ill patients; availability of health care to HIV-positive homosexual men; whether medication is being denied to HIV-positive individuals based upon their sexual orientation; whether positive results of HIV tests are reported by doctors and hospitals to the government and to the patient's employer; treatment of HIV-positive individuals by employers; legislation preventing the dismissal of HIV-positive individuals; attitude of the general population toward those who are HIV-positive (1997 - present)

General Information on HIV/AIDS in Chile

The AIDS epidemic in Chile has hit mostly homosexual and bisexual men in urban areas, although the rate of increase in infection is higher in women than in men (Chile Dec. 2001, 5). Figures provided by CONASIDA show that there are 3,741 people living with AIDS and 4,392 people living with HIV in Chile (IPS 26 Feb. 2001), although Csar Herrera, president of the non-governmental organization Vida Optima (Optimal Life), says that the real figure is actually higher (ibid.). According to CONASIDA statistics, "of the country's known HIV cases, 89.7 percent affect men" (UPI 1 Dec. 2000). The 2001 epidemiological bulletin published by the Ministry of Health's National AIDS Commission stated that AIDS is now the second leading cause of death for young Chilean men from Santiago between the ages of 20 and 44 (UPI 18 Aug. 2001). In Chile HIV/AIDS has been perceived as a "'gay man's' illness" (ibid.). According to Alberto Roa, director of Opusgay newspaper, "70 percent of HIV-carriers in Chile are gay" (IPS 13 June 2002).

Health Care Available to HIV-Positive Individuals

Decreto de Ley 368 of the Ministry of Health extends to every person born in Chile, who is living with HIV, the right to free care by the government (VIHSIDA en Chile 19 July 2001). This includes medical attention, medicine and control exams every three months (ibid.). In a speech marking the passage of the December 2001 AIDS legislation, the President of Chile said that this new bill "requires the government to subsidize the cost of the triple therapy cocktail medication" used in the treatment of AIDS patients (Santiago Times 6 Dec. 2001). The President added that, in 2002, the budget for the "triple therapy cocktail" would increase by 30 per cent, allowing the government to give free medication to treat HIV/AIDS to a [translation] "large part of the patients in the public system who need to be treated with this method" (Chile 4 Dec. 2001a). But Vasili Delyllanis, a spokesperson for Vivo Positivo, a non-governmental organization of HIV-carriers, stated that the government's plan is "unrealistic" and added that "'the government only budgets US $2.2 million for HIV/AIDS and it won't even spend US $1 million on a prevention campaign'" (Santiago Times 6 Dec. 2001).

Between 1996 and 1999 the budget for HIV therapies increased by 320 per cent, allowing more people to benefit from better quality treatments (Chile Dec. 2001, 13). But in September 2000, it was estimated that only 50 per cent of those who needed treatment were receiving it; that is, only 750 patients had received the "double therapy cocktail" (biterapia) and the same number had received the "triple therapy cocktail" treatment (triterapia) (ibid.). The President estimated that, despite the increase in funds, 400 people who need the "triple therapy cocktail" will not be able to access it in the public health care system due to a lack of resources (ibid., 4 dec. 2001a). According to Inter Press Service (IPS), this means that at least 2,241 patients will have to pay US$714 a month for treatment when the minimum wage in Chile is US$178 (IPS 26 Feb. 2001).

In 1997 Chile became part of the United Nations international AIDS project (UNAIDS) to facilitate access to HIV/AIDS treatment (Chile Dec. 2001, 11). This project led to negotiations between pharmaceutical companies and the private and public sectors to reduce the cost of treatment and to discuss the means of distribution (ibid.). On 15 June 2001, an agreement was reached that would allow 80 per cent of the people under the public health care system to receive treatment (ibid.). This meant that the government could provide 2,600 "triple therapy cocktails" to HIV-positive patients (ibid.). However, commenting in mid-2002, Roa, the director of Opusgay newspaper, said that "only 60 per cent" of HIV-positive individuals have access to the "cocktail therapy," although he saw this as "'a big advance, if we consider that Chile is not exactly a developed country'" (IPS 13 June 2002). Contrastingly, the Public Health Minister, Osvaldo Artaza, said that "84 percent of those living with HIV receive the triple-therapy AIDS cocktail free of charge"(ibid.). He added that the new Universal Access to Explicit Guarantees plan (AUGE), which was designed for people living with the 56 diseases classified as "catastrophic," should hopefully allow all HIV-positive individuals to receive anti-retroviral drugs, "'in the private as well as the public sector'" (ibid.).

A February 2001 IPS news report also noted that, although the international standards for HIV treatment set the level of lymphocyte count at five hundred, drug therapy in Chile was only given to those whose lymphocyte counts were below three hundred, "a level at which a risk of death is already present" (26 Feb. 2001).

Reporting in 2002, World Markets Analysis said that, because of the "high costs of treatments for fatal illnesses" such as HIV/AIDS, a black market for pharmaceuticals had emerged in Chile (26 Nov. 2002). The President of the Chilean Pharmaceutical Chamber, Jorge VAfA(a)liz [sic], estimates that approximately 20 per cent of the medical black market concerns the trade of illegal HIV/AIDS drugs (World Markets Analysis 26 Nov. 2002). Health officials worry that this may be putting people's lives at risk, but "unless a greater number of patients are permitted to receive free drugs or financial assistance for drug purchases, many people will be left with no other choice than to procure the drugs as cheaply as possible on the black market" (ibid.).

According to Rodrigo Pascal, leader of Vivo Positivo, the health care coverage provided by the National Health Fund (Fonasa), the government insurance company, "is somewhat better than the service offered by private companies" (Santiago Times 14 Aug. 2001). Yet he adds that Fonasa's bureaucracy makes the service very slow when delivering the results of medical exams (ibid.). Patients often wait four to five months to obtain medical results which normally should take two weeks (ibid.). Pascal also says that both the private and public health system do not distribute the medication properly and treatments are often delayed because the medicine does not arrive at the hospitals on time (ibid.).

Discrimination Against HIV-Positive Individuals

According to the International Gay and Lesbian Human Rights Commission (IGLHRC), homosexual prisoners who are HIV-positive do not receive adequate health care and are isolated from the other inmates (IGLHRC May 1998). Infections are treated with penicillin without regard for the effect this will have on their immune system (ibid.). The inmates are charged US$30 for tests that are usually free in hospitals, yet the gay prisoners are confined and not allowed to work to earn money like the other non-HIV inmates (ibid.). There have been various legal actions against the penal system to attempt to get proper medical attention and better living conditions for the homosexual, HIV-positive inmates (ibid.). No update on the legal actions taken could be found among the sources consulted by the Research Directorate.

Specific funds for HIV education campaigns were set up to establish projects, in collaboration with non-governmental organizations, targeting the homosexual community and the adult sex workers, the "vulnerable population" (poblacion mas vulnerable) (Chile Dec. 2001, 13). There were three education campaigns which targeted the homosexual community: between 1997 and 2000 two separate campaigns set up to reduce the risk of HIV/AIDS contamination each covered a part of the Chilean territory, although together they did not cover the whole country; and in 1999 a programme was set up in the cities to change people's attitudes towards HIV/AIDS and homosexuality (ibid.).

The 2001 legislation on HIV prohibits discrimination against HIV-positive people (Santiago Times 6 Dec. 2001). Article 5 of Ley No.19.779 states that the HIV/AIDS test is confidential and voluntary, but a regulation will establish the conditions under which testing will be compulsory with the results to be disclosed to the sanitary authorities (Chile 4 Dec. 2001b). (No reference to whether or not the regulation is in place was found among the sources consulted by the Research Directorate.) Article 7 prohibits the making employment or promotion, both in the private and public sector, conditional on the results of HIV/AIDS testing (ibid.). The sanction for violating article 7 is a fine paid to the government "without prejudice to the liability of damages caused" (sin perjuicio de la responsabilidad por los daños causados)The legal actions must be brought before the local police court in the affected person's place of residence without prejudice to the competence of the employment court and customs or criminal tribunals (sin perjuicio de la competencia que corresponda a los juzgados del trabajo y al tribunal aduanero o criminal respectivo, en su caso) (ibid., Art. 12).

CONASIDA's objectives for 2001 were to broaden the coverage of HIV/AIDS infected people who receive treatment, to offer a better quality of treatment and to diminish discrimination (Chile Dec. 2001, 3). The Health Minister, Michelle Bachelet, claiming that "prevention and non-discrimination are social vaccinations for the epidemic," said that Chilean society in general must learn to be more accepting of individuals living with AIDS (Santiago Times 7 Dec. 2001). Vivo Positivo states that discrimination is "very present in all aspects of everyday life" (en terminos concretos se discrimina ampliamente en todos los ambitos de la vida civil) (Vivo Positivo n.d.). According to a government survey, in general, discrimination against people living with HIV/AIDS has diminished: in 1998, 75 per cent of the population said that they were [translation] "willing to share" social places such as the workplace and school with people living with HIV/AIDS (Chile Dec. 2001, 12). In his 2001 speech, the President of the Republic said he found worrisome the fact that, according to a survey carried out by "la Fundacion Ideas," 30 per cent of the population, a "significant percentage" (un porcentaje tan significativo) thinks that people living with HIV/AIDS should be kept away from the rest of society (ibid. 4 Dec. 2001). According to the President, this explains why discrimination occurs and why it excludes people from the workplace (ibid.).

In a July 2002 IPS article, HIV-positive women complained of "violations of rights of employees, discrimination in schools against the children of people living with HIV, and discrimination in access to healthcare" in Chile (IPS 10 July 2002). Erica Espinoza, a representative for the international community of women living with HIV, in Chile, and advisor to Vivo Positivo, said that "when it emerges that a woman tests positive for HIV, she is laid off, or she is demoted and her salary is cut, to push her into quitting" (ibid.).

According to AIDS activists' health experts, "discrimination against HIV/AIDS patients by private and public health insurance providers is a problem plaguing the Chilean health system" (Santiago Times 14 Aug. 2001). The "most common form of discrimination" appears in the denial of access to the medication needed to treat the disease, but there have also been complaints of doctors being encouraged by medical insurance providers to declare HIV-positive individuals as disabled, therefore preventing them from working and maintaining their insurance coverage (ibid.). Vivo Positivo maintains that it is difficult to obtain proper attention in the health care sector, even though CONASIDA and non-governmental organizations have made strong efforts to sensitize people about HIV/AIDS (Vivo Positivo. n.d.). The main cause of discrimination is the homosexual orientation of some HIV-positive people and misinformation on how HIV is contracted (ibid.).

According to Vivo Positivo, discrimination in the private sector is a complicated situation because laws favour employers (Vivo Positivo n.d.). A majority of employers ask their employees to undergo HIV testing in laboratories that are affiliated with the company (ibid.). Out of a fear of losing their job, the employees undergo the testing, but the results are sent to the employer first (ibid.). If the tests are positive, the employee is then fired under a different pretext such as "company necessities" (las necesidades de la empresa) (ibid.). Employees have no legal arguments to fight such a decision since there is obligation on the part of the employer to specify what is meant by "company necessities" (ibid.).

In addition discrimination against people living with HIV, the transsexual president of Traves-Chile, Silvia Parada, states that "'homosexuals and trans-gendered persons suffer the greatest discrimination'" (IPS 11 Oct. 2002). Parada says that "'there is social discrimination, including discrimination in the labour market'" (ibid.). The coordinator of the Interdisciplinary Centre of Gender Studies in the social sciences department of the University of Chile, Maria Elena Acuña, stated that "'this country is discriminatory, because 'difference' is frequently transformed into inequalities that undermine the integrity of individuals, often stunting their aspirations'" (ibid.). She believes that Chile needs "the creation of laws and statutes that safeguard personal, social and cultural integrity" (ibid.).

With respect to the question of whether HIV test results must be reported, Csar Herrera says that the requirement that physicians report every HIV case to the Health Ministry is not strictly enforced (IPS 26 Feb. 2001). Furthermore, he added that private clinics are not required to report to the government (ibid.).

This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim to refugee status or asylum. Please find below the list of additional sources consulted in researching this Information Request.

References

Chile. December 2001. Ministerio de Salud. Comision Nacional del Sida (CONASIDA). "Politica de prevencion y control del VIH/SIDA."

_____. 4 December 2001a. Gobierno de Chile. "Ceremonia de promulgacion de la Ley sobre el Virus de Inmunodeficiencia Humana y beneficio fiscal para enfermedades catastroficas. Discurso del Presidente de la Republica." [Accessed 1 May 2003]

_____. 4 December 2001b. Ministry of Health. Ley N 19.779. [Accessed 1 May 2003]

Inter Press Service (IPS). 11 October 2002. Gustavo Gonzales. "Chile: Gays Advocate Legal Reforms to Fight Discrimination." (NEXIS)

_____. 10 July 2002. Gustavo Gonzales. "Chile: Women with AIDS Complain of Pervasive Discrimination." (NEXIS)

_____. 13 June 2002. Gustavo Gonzales. "Health-Chile: Aids Prevention Key Focus of First Gay Newspaper." (NEXIS)

_____. 26 February 2001. Tamara Vidaurrzaga. "Health-Chile: AIDS Funding Falls Short." (NEXIS)

International Gay and Lesbian Human Rights Commission (IGLHRC). May 1998. "Chilean HIV-Positive Prisoners Die While the State Continues to Deny Them Medical Care." [Accessed 6 May 2003]

Santiago Times. 7 December 2001. "Vina Del Mar School Expells Student Sick with AIDS. Chile Grapples to Deal with Health Epidemic." (Global News Wire/NEXIS)

_____. 6 December 2001. "Chile to Develop Generic AIDS Medication. The Government Adopts New Measures to Uphold HIV/AIDS Legislation." (Global News Wire/NEXIS)

_____. 14 August 2001. "Questions About Insurance Companies and Discrimination." (Global News Wire/NEXIS)

United Press International (UPI). 18 August 2001. Jennifer Pribble. "AIDS Spreading in Chile." (NEXIS)

_____. 1 December 2000. "AIDS Programs Get OK." (NEXIS)

VIHSIDA en Chile. 19 July 2001 "Hospitales publicos." [Accessed 7 May 2003]

Vivo Positivo. n.d. "Discriminacion por vivir con VIH/SIDA." [Accessed 7 May 2003]

World Markets Analysis. 26 November 2002. Tanja Sturm. "Black Market for Medicines Burgeons in Chile." (NEXIS)

Additional Sources Consulted

IRB Databases

Unsuccesful atempts to contact the non-governmental organizations Vivo Positivo and MOVILH (Movimiento de Integracion y Liberacion Homosexual)

Internet sites, including:

Amigos Contra el SIDA

BBC news

Bureau of Citizenship and Immigration Services

Centro nacional para la prevencion y control del VIH/SIDA

Country Reports on Human Rights Practices 2002, 2001, 2000

Gay Chile

Gay Today

Global Gayz

Human Rights Internet

Human Rights Watch

International Lesbian and Gay Association (ILGA)

Las Ultimas Noticias [Santiago]

Movimiento de Integracion y Liberacion Homosexual (MOVILH)

Opusgay

Pan American Health Organization

UNAIDS

Search engines:

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