What’s behind the alarming spike in HIV infections in Panama?

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In May, USF College of  Public Health alumna and research professor Arlene Calvo participated in a National Public Radio interview about the rise in HIV infections in Panama. What follows is an excerpt of that story.

A short man with a ponytail peeks through a crack in a sheet-metal fence, calling out to see if anybody’s home. His name is Dario Garcia and he is checking on some people with HIV to make sure they’re taking their meds.

Dario Garcia, who lives in Panama, volunteers to visit people who are HIV-positive to see whether they are taking their medications. Garcia himself is HIV-positive. “I feel alone,” he says. “I believe the most support I have now is from others who have been diagnosed.” (Photo by Jacob McCleland, NPR)

Garcia walks through the muddy yard, past chickens and scrawny dogs, to the cinder block house.

Inside, he finds two men, both indigenous and HIV-positive. At first, they want to talk to Garcia. Then, they spot someone outside — a neighbor or a family member. They clam up. One man backs into the corner of the room. If he could dissolve into the ash-gray wall, he would. Nobody else in the household knows they have HIV, and the men are afraid to be overheard. Garcia quickly changes the subject. A few minutes later, he leaves.

“I still find people with this fear that others will simply hear the word ‘HIV’ spoken around them,” Garcia says in Spanish. “They automatically shut down and don’t talk.”

Garcia, who holds a law degree, is a volunteer for a nongovernmental organization called Viviendo Positivamente, or Living Positively. He says the stigma surrounding HIV is strong. And he knows this firsthand — he, too, is HIV-positive.

“The greatest discrimination that exists for a person with HIV is in their own family,” Garcia says.

Garcia is an ethnic Ngabe, the largest indigenous group in Panama, and he is heartsick about the crisis his people are facing. In other parts of the world, the rate of new HIV infection is on the decline. Here, it’s spiking. About 150,000 people live in the Comarca Ngabe-Bugle territory, and AIDS is the now the second-leading cause of death there, accounting for more than 8 percent of deaths. Approximately 2.5 percent of people who live in the Comarca Ngabe-Bugle carry the virus.

What’s behind the spike

Arlene Calvo, a research professor at the University of South Florida’s Panama City campus, says HIV was unheard of in Ngabe territory until recently. The first case wasn’t identified until 2001, decades after the virus first ravaged other parts of the world. And now that it’s here, it’s entrenched.

Arlene Calvo, a research professor at the University of South Florida, says the lack of access to health care is one of the biggest barriers to controlling the outbreak. (Photo by Jacob McCleland, NPR)

“It went from having just a few cases to after a few months having 100 identified cases, and probably a year after that having over 500 cases,” Calvo says.

Calvo says there are likely many more Ngabes with HIV who haven’t been detected, and others are so sick when they are first diagnosed that there’s no way to arrest the disease.

“You have to understand that this is a very rural area, not comparable to rural U.S.,” Calvo says.

The terrain is rugged and mountainous, and many communities aren’t connected by roads. Some villages don’t have electricity or running water. Blood tests must be administered in a hospital by a lab technician, which can mean an eight- to 10-hour trip for the patient, much of it on foot. Calvo says the lack of access to care is one of the biggest barriers to controlling the outbreak.

“Even if you’re healthy, it is very difficult,” Calvo says. “Imagine being sick and trying to do this.”

Many Ngabes with HIV get antiretroviral treatment at a clinic in the little town of San Felix. The doctor here, Cesar Gantes, says the No. 1 reason HIV has exploded among the Ngabe people is the lack of economic opportunity in their communities. Many indigenous men lead nomadic lifestyles, traveling to work at coffee harvests on plantations in western Panama, Costa Rica and Nicaragua. They contract HIV while away, then bring it back home.

Except from National Public Radio. Click here for the full story.