HIV infections are on the rise in Chile, and lots of infected people don’t know it

By Codi Hauka, Natalie Walters, Peter Mothe, and Konstantine Roccas

When Ana found out that she was HIV positive six years ago, she had never heard of the virus before.

She was living in a rural community in Chile’s southern region of Araucanía, and as a member of the Mapuche indigenous nation, her understanding of health clashed with Western medicine.

“Mapuches have this expression, ‘uesá kutrán’—evil diseases brought by the huinca,” says Ana, using a term for non-Indigenous people.

The fact that HIV is seen as an outsiders’ virus prevents many HIV-positive Mapuche people from accessing care. This is especially true in Araucanía, the heartland of the Mapuche nation, where experts say that one in four people living with the virus do not know they have it.

Ana — who did not want her real name used because of the stigma associated with HIV in her community and in Chile — lived with the virus for two years before she learned of her diagnosis. Although she is now on antiretroviral treatment, she still hasn’t told anyone in her family or community that she is HIV positive.

“We live in tight communities and I would hate for my family to be ostracized,” she says.

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The HIV stigma isn’t an issue only for the Mapuche people. It’s a problem across the entire country, and is causing a surge in new cases of HIV.

Over the past decade, new cases have doubled. Today about 25,000 people are being treated for the virus in Chile, and officials estimate that another 14,000 may be living with HIV without knowing it.

While this number may still be small when compared to neighboring countries, experts worry about the accuracy of government data. They say that as many as 50,000 people could be living with HIV in the country.

“Policies are very weak,” says Carlos Beltrán, a leading immunologist and head of SIDA-Chile, an organization dedicated to stopping the spread of HIV. He says that stigma, along with outdated policies for diagnosis and treatment, is leading to the spike in new cases.

“Prevention is based on public campaigns that promote the use of condoms but the penetration of these campaigns in the population is very low,” he says.

While health care in Chile is free and universal access to antiretrovirals is guaranteed by law, treatment doesn’t adhere to the latest international guidelines. Chile also does not offer rapid testing or provide mobile clinics, which are standard approaches to diagnosis in other parts of the world, including in nations is Sub-Saharan Africa.

Dr. Beltrán is concerned that authorities don’t recognize that Chile is entering a pivotal moment in its fight against HIV, and that if policies don’t change course the virus will continue to spread.

“We do not see that the authorities are aware of the time we are living in and the need to urgently move in terms of access to diagnosis and treatment,” he says.

Poor diagnosis and treatment strategies are not the only problem in Chile. Sex education is lacking to the extent that in 2015 the nation’s policies were ranked the worst in Latin America by Planned Parenthood International.

This is crucial because sexual transmission is the primary means through which HIV is spread.

“When the question finally came up of what schools in Chile had sex education, that answer was very, very few,” says David Palma Diaz, a doctor and sexual health researcher for Fundacion Iguales, a Santiago-based LGBTQ organization.

This is having a significant impact on new diagnoses in people 19 and under. According to a report by the Ministry of Health, the number of new cases registered between 2009 and 2014 in this age group was 74 percent higher than in the previous five years.

“If today’s it’s 74 percent and everything stays the same, in 5 years the number is going to double,” says Palma Diaz.

Nowhere is the rising problem of HIV more evident than in the northern city of Arica. Infection rates here are the highest in the country, and young people under the age of 19 are four times more likely to be diagnosed with HIV than their peers elsewhere in Chile. This is partly because condom use in Arica is among the lowest in the country.

The spread of the virus here is so concerning that local health authorities started a controversial campaign called “Arica has HIV.” Part of this regional approach included outfitting a clinic in downtown Arica with the equipment to test for HIV.

It is one of only two places in the entire country where someone can walk in without an appointment and get an HIV test.

“We have a big awareness problem here in Arica. This is, in part, why people are not using condoms,” says Liliana Muñoz, an outreach worker at the clinic. Part of her work involves implementing intervention strategies — in this case, handing out condoms at nightclubs.

“There’s still a lot of prejudice. Stigmatization and discrimination are the main deterrents when it comes to taking the HIV test in the region,” says Muñoz.

Government officials admit that their response to HIV has been weak. In a 2013 report submitted to UNAIDS, Chile’s national HIV program gave itself a four out of 10 when grading its prevention strategies.

“The Ministry of Health has a commitment with the health of all of Chile, so policy needs to consider the needs and rights of all the population,” says Irene Escribano, a leading official from the National Program for the Prevention of HIV/AIDS.

She says that the virus generally affects marginalized populations, like young people and indigenous groups, making it hard to bring them into treatment and contributing to the spread of the virus.

“This population is hard to introduce to all the available resources of the country: diagnosis, access to antiretroviral treatment, and other services that improve quality of life,” says Escribano. “We need to bring those people who live with HIV and don’t know it into the healthcare system.”

One person who is actively bringing people into treatment is Ruth Antipichún, who is a traditional Mapuche healer. She has partnered with a public clinic in Lampa, a town on the outskirts of Chile’s capital city of Santiago, to provide an intercultural approach to HIV/AIDS treatment.

This treatment blends traditional Mapuche healing practices, like the use of medicinal plants and spiritual ceremonies, with anti-retroviral treatment. She believes this is the best way to connect HIV-positive Mapuche people with doctors, while also retaining a connection to their traditions.

“Our Ñuke mapu [Mother earth] has something for any kind of disease of our bodies,” says Antipichún. “[Nature] is there to help with the symptoms of HIV/AIDS.”

This approach is a step towards breaking the stigma that is still so strongly associated with HIV in indigenous communities in Chile.

Ana is adamant that unless attitudes change towards talking about HIV, the government’s policies will not improve and HIV will continue to spread throughout the country.

“If [the government] doesn’t funnel resources to this,” she says, “I can’t see how we can overcome this disease as a society.”