Already Reeling Venezuela Faces a New Challenge: An HIV Outbreak—Public Health Watch

In October 2016, Human Rights Watch first described Venezuela as being in the midst of a “humanitarian crisis”—and things haven’t gotten any better in the nearly 2 years since.

The government of President Nicolas Maduro has stifled dissent, sometimes using violent means to do so. Vital medicines are in short supply. Food and some basic necessities are scarce and, when available, are sold at exorbitant prices. Indeed, throughout the South American country, inflation has far outpaced wage growth. And, then there is the matter of refugees, with the nation’s poor crossing the border in droves into neighboring Colombia, seeking food, medical care, and, ultimately, better lives.

Now there are reports suggesting that there is an outbreak of HIV/AIDS among an isolated population of indigenous peoples, according to The New York Times. An estimated 40 people have died as a result in a remote village with approximately 200 residents in the Orinoco Delta region of eastern Venezuela, not far from the Brazilian border, in just the past few years alone. Although Venezuela’s HIV/AIDS prevention and treatment program was considered “world-class,” the paper reports, under Maduro’s predecessor Hugo Chavez, who died in 2013, the same cannot be said of the current infrastructure.

“As the great tuberculosis (TB) researcher George Comstock used to say, ‘TB anywhere is TB everywhere,’ and the same is true for HIV,” Chris Beyrer MD, MPH, Desmond M. Tutu Professor of Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, and professor, Epidemiology, International Health, Health, Behavior and Society, and Nursing, Johns Hopkins School of Medicine. “Treatment in both diseases saves lives and prevents onward transmission, and that’s why it’s so essential” to address the emerging problem in Venezuela.

According to Dr. Beyrer, who is also director of the Johns Hopkins Training Program in HIV Epidemiology and Prevention Science, the outbreak in Venezuela is hardly a new thing for the continent. In fact, the city of Iquitos, in the Peruvian Amazon, has an ongoing outbreak among men who have sex with men, and at its height, in the early 2000s, incidence was increasing at a rate of 3% per year.

However, what makes the latest HIV/AIDS news out of Venezuela so troubling is the current political and social climate. The World Health Organization (WHO) estimates that as many as 130,000 are living with HIV in Venezuela—and, unfortunately, they have been among the hardest hit by the political instability in the country. An NBC News report from August 2017 indicated that shortages of antiretrovirals there have resulted in treatment interruptions for thousands. That report said that those living with the disease in Venezuela have “no hope” of getting the treatment they need.

And, UNAIDS, or the Joint United Nations Program on HIV/AIDS, indicates that the drug shortages are only getting worse. New diagnoses of HIV are up 24% in Venezuela since 2010, and HIV/AIDS-related deaths have increased by 8% over the same period.

“This is how to restart an epidemic,” Dr. Beyrer noted. “The majority of patients in the country who were on antiretrovirals have had to stop treatment, and of course HIV comes very quickly back to very high viral load levels in essentially all of these patients.”

Making matters even worse, he added, once off therapy, patients can transmit the virus to their sexual partners, creating new cases. Sources have told Contagion^® that several organizations are working on the ground to provide needed antiretrovirals, including Aid for AIDS International and Medicos del Mundo (MdM), but that more help is needed.

“Venezuelans are now going to Brazil and other neighboring states to get antiretrovirals,” he continued, adding that the international community needs to support these countries with additional funds and resources. “The Maduro government must allow unfettered access to [HIV-related organizations], including the Global Fund to Fight AIDS, TB, and Malaria, and I would argue that an emergency fund for the provision of antiretrovirals should be considered. The epidemic [there] is not that large, at present, so this is very much within the existing budget framework of the Global Fund and the US President’s Emergency Plan for AIDS Relief, and others. New WHO Director-General Tedros Adhanom should make an emergency diplomatic mission to Venezuela and call for change to avoid immediate loss of life and worsening of the epidemic. He has the bully pulpit and should use it.”

Here’s hoping the world is listening.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.