Visiting an HIV-Clinic in Guayaquil (Part II)

By Emmanuel M. von Arx, KF16, Guayaquil (Ecuador)

One of the great joys and privileges of being a Kiva Fellow is to go along with loan officers when they are meeting Kiva borrowers and new clients. One of my most memorable outings was a visit of an HIV-clinic in a public hospital in Ecuador´s largest city Guayaquil. In the first part of this blog post I recounted how I drove with Nahin Alvarado from Banco D-MIRO´s headquarters on Guayaquil´s Isla Trinitaria to the HIV-clinic at Hospital Abel Gilbert. Nahin is the bank´s loan officer specializing in HIV-positive and/or disabled clients who have the right to receive a discount micro-loan. And Banco D-MIRO is the only micro-institution in all Ecuador to provide financial products especially for these two long-excluded client groups.

While Nahin is presenting the bank´s special loan products to the patients in the HIV- clinic´s crowded waiting room, Franklin walks towards me. A strong man in his forties, Franklin is the leader and community organizer of FUSAD (Frente Unido por la Salud y los Derechos – in English: United Front for Health and Rights), a self-help and support group for HIV-positive people, based at the hospital and well known for the professional education courses they provide to their members.

Franklin tells me: “Even though it is illegal, many patients are getting fired from their job once their boss finds out about their HIV-status. For those people we provide an alternative by teaching them how to become independent in a new line of work.” FUSAD organizes month-long training classes in which HIV-positive patients are taught how to design and tailor clothes, create jewelery, and provide cosmetic treatments. When I tell Franklin about Kiva and this blog, he immediately asks me to publish his email address, so people around the world can directly get in touch with him and his organization in case they have questions, wish to make a connection, or want to provide support to FUSAD. He can be reached at ongfusad@hotmail.com.

Franklin is still talking to me in the waiting room, when Christian joins our discussion. Christian is the public face and main community organizer for CEPVVS, the Ecuadoran Coalition for People Living with HIV/Aids which also has the most comprehensive website on HIV in Ecuador that I could find.

I immediately follow Christian when he asks me to accompany him outside, so that the loud TV doesn´t interfere with our conversation. As we step out of the shed-like building of the HIV-clinic, the noise is almost as earth-shattering outside as it was in the waiting room. A crew of garbage men is in the middle of cleaning up the mountain of rubble and trash – including the prosthetic leg – that struck me when Nahin and I were walking towards the clinic earlier in the morning. Christian and I sit down on a bench and he tells me about CEPVVS.

CEPVVS is a non-profit organization whose staff and members are all HIV-positive and are working towards improving the quality of life for HIV-positive people with focus on human rights, civic participation, effective leadership, and overall development. CEPVVS works in 15 provinces all over Ecuador, and Christian belongs to a team of three trained counselors and community organizers who work in and around Guayaquil – a city of over 3 million inhabitants. He, too, is very interested in hearing back from people around the world and exchanging experiences through the Internet and email, asking me to publish his email address in this blog post: jamebond22@yahoo.com

We have barely sat down when Christian begins to tell me his story and encourages me to recount it here: In 1997 he first learned that he was HIV-positive. “I must have gotten it from my girlfriend. She always told me that she was HIV-positive, but my love for her was greater than my fear of getting infected.” Now, 14 years later, he has a 5 year old HIV-negative daughter who doesn´t know about her father´s infection. For many years, Christian has been working for CEPVVS without pay or official assignment. Only recently, four months ago, did he first receive a stipend. I am not surprised to hear that his stipend is so small that it won´t allow him to keep working for the organization for much longer: This month, in November 2011, Christian ends his work with CEPVVS – as he told me – “to get a real job in order to be able to provide a better life for my daughter.” His successor will be Franklin, assuming a second position in addition to his work with FUSAD.

While talking with Christian about medical treatment options that are available to HIV-positive people in Ecuador, I quickly realize that he is extremely well informed. As he tells me: “The Ecuadoran State pays for your medication once you are known to have a T-cell count of under 350 cells/mm3. In the past the threshold used to be 200, but the government recently raised it, which is good.” [In the United States, by comparison, doctors recommend to start treatment if the T-cell count dips below 500 cells/mm3.] Yet, as Christian emphasizes, the problem is that the medication supply is neither permanent nor secure. “Hospitals often run out of medication and patients can´t help but wait a couple of days for a new delivery to arrive. Another issue is the high price: I know patients who receive medication from the State, but don´t use it for themselves. Instead, they sell it on the black market as a way to pay for food and school books for their children.”

Despite his expert knowledge, Christian was surprised about the numbers that I had found on CIA – The World Fact Book. A comparison between Ecuador and two developed western countries – the United States and Switzerland – reveals that the HIV adult prevalence rates are pretty similar:

These rates translate into the following absolute numbers of people (adults and children) living with HIV/AIDS:

The principal difference is in the number of HIV deaths:

Whereas in Switzerland about 100 out of 18,000 HIV positive people died in 2009 (a rate of 0.55% of all those infected), this number is 17,000 out of 1.2 million (1.4%) in the United States and 2,200 out of 37,000 (or a shocking 5.9%) in Ecuador. I ask Christian about an explanation, wondering: “Is this because the application process or requirements to receive free medication from the Ecuadoran government is very cumbersome?” “No, not at all,” Christian answers. “It´s much more because people just don´t know – or don´t want to know – that they are HIV positive. They will only go to see a doctor and get a blood test when they are very ill and show symptoms of full-blown Aids. At that stage it is often too late and impossible to reestablish a patient´s health.” He goes on to tell me of a case he witnessed recently: “In Ecuador, women normally learn about their HIV status during their pregnancy, when they undergo their first blood test. Even knowing that their wives are positive, I know men who are simply too scared to take the exam for themselves. Instead they continue with their lives as if nothing happened…”

At that point, our discussion is cut short: A doctor rushes out from the HIV-clinic towards us, calling for Christian to urgently attend a pregnant woman inside the building who is on the edge of breaking down. Christian rushes back in to support her.

As I follow him with my eyes, I become aware for the first time that during our conversation all the debris has been loaded onto a garbage truck – the previously obstructed walkway to the HIV-clinic is now clean and spotless. But for how long?

My thoughts are soon interrupted by Nahin who comes out of the clinic, exhausted but satisfied. Today twelve people have entered their contact information on his mailing list in order to receive information on Banco D-MIRO´s special discount loan products – twelve people who may get their first chance to access a micro-loan since their infection, getting new hope to grow their existing business and to secure the future of their spouses and children. Despite this success, Nahin stays realistic when he tells me: “Out of these twelve people, at best six fulfill the requirements for a loan. They need to have an existing business and be able to repay their loan – otherwise their application is not going to be approved. Out of these six, probably three will have a bad credit history or existing debt that keeps them from receiving a loan. At best, there are 2 or 3 people on that list who will become clients of Banco D-MIRO and potentially Kiva-borrowers.” How sobering! But then I remember my many past encounters with borrowers of Banco D-MIRO, thinking to myself: “Even if just one micro-entrepreneur ends up getting a chance to realize her or his dream, then all was worth it!” Looking at Nahin, I know that he has the same thought…

Emmanuel M. von Arx is a Kiva Fellow working with Banco D-MIRO in Guayaquil, Ecuador. Banco D-MIRO focuses on clients who have long been excluded from the traditional financial system for reasons that include culture, sex, race, poverty, disability, and illness. To learn more, please visit Banco D-MIRO´s partner page on Kiva or become a member of the lending team of Banco D-MIRO, the only provider of special financial services for HIV-positive and disabled clients in Ecuador.