Costa Rica is the first country in Central America to break through the oppressive system. In May, Panama followed suit. Presently, court action is pending in El Salvador and Guatemala. "Costa Rica has been [a] very easy [country in which] to establish a national AIDS program because the health system was very well-developed, "says Dr. Gisela Herrera, Infectious Diseases Specialist at the Costa Rican Ministry of Health, Department of AIDS Control. "Whereas in Honduras, where the epidemic is terrible, the health system has a lot of problems. To establish a large AIDS program is difficult because you have to work on the infrastructure first. Here in Costa Rica the difference with the rest of Central and Latin American countries is the Caja, the social security system, which covers one hundred percent of the population. Even if you are not employed you are covered. Our health system is more like the Canadian system that covers the whole population. America has more of a private system."
Homosexuals still lead in the number of HIV infections, however the heterosexual community is not far behind. Heterosexuals never worried about AIDS because until recently, it was largely a gay disease, a familiar refrain in America several years ago. "In terms of education it has been very hard to try to give the message that everybody is at risk," says Herrera, pointing out that the number of HIV infections dropped in 1998. Dr. Herrera is hopeful that the epidemic has stabilized and even reached a plateau.
"Nobody's getting the message because there's a big increase in [infected] women, and the virus is growing at a rate you wouldn't believe," says Mabel Morvillo of AGADES (Associated Group Direct Action for People With AIDS). An AIDS organization that began in 1996, AGADES was born out of the need to support family and friends coping with a loved one who had died of AIDS and was formed when the grieving parties banded together. The group provides a direct connection between the PWA and multifarious services for housing, jobs clothing, medicine, counseling, etc. The organization mandates that personal attention and human contact be rendered to its clients and works with them on their individual needs. AGADES is privately funded, operating out of eight employees' homes. Presently, they have a client load of twenty. Alvaro Borasse of AGADES adds, "This is a very macho society [although] it looks very open. It's very machista. There is a big male bisexual population here who keep on having sexual encounters which risks the female population enormously. And the people who need the most information are the heterosexuals, although it's still a gay disease."
The first condom campaign began in 1987 and helped introduce AIDS as a public issue. "We made a good negotiation with the Catholic Church, which predominates. We could promote in a very free way condoms on TV, radio, on billboards," says Herrera. Did the Catholic Church accept this? "Well, we negotiated under the table. Okay?" Herrera says as she chuckles. "They were not promoting the condoms. They were against the campaign but they didn't prohibit it." She says that in 1998, Honduras and Guatemala were both eliciting abstinence and fidelity for prevention of AIDS, due to the countries' rigid Catholicism. Apparently, Costa Rica has a more intelligent and evolved Archbishop (there are rumors he is gay). According to the bulletin board section of "The Gay and Lesbian Guide to Costa Rica" Web site, a priest who lived in a suburb of San José died of AIDS last year and was often heard to make the comment that he knew perhaps two priests in Costa Rica who were not gay. Several years ago, there was a scandal in the media about the former Archbishop and his relationship with a priest. To date, there are other priests living with AIDS who fear expulsion from the church if they reveal their illness.
Although AIDS awareness is high in Costa Rica, that does not mean that attitudes and practices follow suit. Just because the people have the information doesn't mean they will modify their behavior accordingly. Many people still take risks by avoiding condom use. Herrera and the Department of AIDS Control is currently involved in a new campaign of prenatal testing for pregnant women, and promoting HIV testing among all sexually active groups, besides continuing their prevention work in the schools while promoting more formal AIDS education in the classroom.