When Richard Stern and his friend Victor Cortés arrived from San José on 15 May 1998, they came to my apartment and presented me with a handsome plaque. It sits in a prominent place in my apartment and reads:

30 April 1997

Thanks to a $1,000 donation from Mr. Warren Allen Smith and another $1,000 anonymous donor who does not live in the Americas and who wishes to remain anonymous, Costa Rica's gay/lesbian Association Triangulo Rosa will sponsor a new program coordinated for and by People Living With Aids.

A Costa Rican person living with AIDS, Guillermo Murrillo, will assume coordination of the project on May 1st. Guillermo was diagnosed as HIV+ six years ago.

The project will function with the following objectives:

1) To provide a source for accepting and channeling complaints about discrimination and human rights violations such as frequently occurs here in hospitals and on the job. We will also provide follow-up on the complaints to see if the situations are being remediated.

2) To offer an information center about medications, their effects, and whether or not they are available privately and publicly and where.

3) To facilitate an organized program of consciousness raising in Costa Rican legislators and health care program adminsitrations here about the importance of the new medications, and continue actions that Triangulo Rosa has already begun of calling attention to this theme, and pursuing all legl and administrative avenues to obtain access to these medications.

4) To provide a space and regular series of meetings for HIV+ people to organize and empower themselves around issues of human rights and medications. This includes empowerment-oriented workshops as well as more didactic issues about nutrition, health, medications, etc.

"The empowerment of the AIDS-affected community," said Triangulo Rosa President Francisco Madrigal, "has been one of our goals during the past several years. Now, thanks to Mr. Smith's generosity, we will have the opportunity to implement this program."

"This is an opportunity for me to leave my regular job," stated Señor Murillo, "and pursue full time the goals of helping our community to gain access to the new medications that are not paid for by the government here. The AIDS community here has been up until recently a community of victims without hope, and the goal of this program is to continue to teach AIDS-affected people that we can take control of our own lives, and work to change the horrible human rights abuses that we face here in Costa Rica."

Mr. Smith indicated that he made the donation in honor of his Costa Rican lover, Fernando Vargas, who died of AIDS in 1989.

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30 September 1997

In a historic decision for people living with AIDS in Central American countries, Costa Rica's Supreme Court has issued rulings in two separate cases ordering the government-funded National Health Care System to pay for retrovival AIDS medications for four separate plaintiffs.

The ruling is expected to open the door for several hundred Costa Ricans, most of them gay men, to receive these medications.

The first ruling was handed down on Tuesday, September 23rd, and involved William Garcia, a psychology graduate student who is seriously ill with AIDS. William filed his petition August 28th, asking that the Health Care Agency known as the Caja Costarricense de Seguro Social (CCSS), provide him with a "cocktail" recommended by two physicians, Javier Moya and Giselle Herrera. The cocktail included AZT, 3TC, and Crixivan. If purchased separately the medication would cost William over $800 per month. He currently is unemployed, far too ill to work, and the same CCSS had denied him a pension. Living with a brother and a sister-in-law, he has no savings and no income whatsoever.

Dr. Herrera, who also is Director of Costa Rica's AIDS Control Department, argued in her letter to the Judges that "clinical data indicates that William's disease is in an advanced state, with a large amount of viral replication, which favors the development of various opportunistic infections, as well as wasting syndrome, which would probably cause his death in a question of months. With retroviral medications, patients even in an advanced state of disease devlopment can recover and be reintegrated into the work force." Dr. Herrera also pointed out that AIDS has now become the leading cause of death by disease in Costa Rica, account for 143 deaths in 1995, the latest year for which data is available.

Arguing against the medications, Dr. Julieta Rodriguez of the CCSS, indicated these medications are not included in the official list of approved treatments, and would not meet the critera for being approved because of the lack of data about them as well as their severe side effects. She also mentioned the price tag of $900 per month and indicated that the CCSS does not have funds for these medications. Other affidavits filed in the cae indicated that prices would drop by as much as 50 percent as the pharmaceutical companies are offering whose discounts if the CCSS will buy the new medications in quantites. The government is also exempt from the import taxes placed on medicines.

Without commenting on the arguments, the Supreme Court Justices ruled that the

CCSS must immediatley supply the plaintiff, William Garcia, with the combination of retroviral therapy which is appropriate to his clinical condition, according to the prescription of the medical personnel in charge of his case.

The second case was decided on Friday, September 25th, and involved an appeal filed by Guillermo Murillo, AIDS program coordinator for the gay/lesbian association Triangulo Rosa, and two other Persons Living with aUDS. Their case had been filed last August but may have been considered after Garcia's case, because none of the three is currently severely ill. Again, the Judges ordered the CCSS to provide appropriate medical treatment to the plaintiffs.

There are about 1,200 diagnosed cases of AIDS in this small central American Republic of 3,000,000. An estimated 10,000 people are asymptomatic carriers. The impact of the Court's decision on the situation of AIDS victims in other Central American nations is unclear, but it is expected that activists in these countries will study the Costa Rican decision and strategies used by the Triangulo Rosa patient group..

AIDS activists here were supported by a generous donation from Warren Allen Smith of New York, whose Costa Rican lover died of AIDS in 1989.

The Washington Blade (Washington, D.C.) has carried a full-page news story about how Costa Rica's Supreme Court on September 23rd ordered the government health care agency to begin providng William Garcia with the now available "cocktail" of AIDS medications.

The Court's historic decision represented success for Dr. Richard Stern, Health Coordinator of Association Triangulo Rosa, a leader in the fight, and to lawyer Marco Castillo, a gay activist who filed the legal petitions that resulted in the victory.

Stern and Castillo were pictured, along with Guillermo Murillo, the group's HIV+ director of patient empowerment. Also, the report included a photo of Garcia, the psychology graduate student whose "wasting syndrome" revealed that he now weighed only 80 pounds.

Garcia was quoted:

You hide it from your friends and family generally, until you get so sick that you can't hide any more. You expect rejection and you are afraid.

He added, inasmuch as 95% of the population pays into the social security system and therefore has access to the services the health agency offers

Our government says that we have the right to health care. And I think they were denying it to me because I am gay and because I have AIDS, not because they can't afford it.

However, Garcia was elated at the thought that he now might have "a chance to make it," to live. "I know what I have done will help others because they will see that you can fight for what you are entitled to and that you can win.

Señor Garcia died soon after the Supreme Court's decision. Moralists are sure to start investigating who in the church, the state, and the Establishment at large could have made different decisions, and earlier.

Over 300 Costa Ricans who are HIV-positive currently are receiving the cocktail of medications.

Señor Guillermo Murillo, the first publically to come out of the closet as well as to describe his being HIV-positive, works 18-hour days on behalf of the many individuals similarly afflicted.

Dr. Richard Stern remains the powerhouse behind the group's efforts.

Attorney Marco Marco Castillo has worked wonders to change the nation's legal responsibilities.

The Church and State, however, have changed little.

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Additional donations are welcome and can be sent to "Patient Empowerment Fund" of Triangulo Rosa, Apartado 1619-4050, Alajuela, Costa Rica. Tel: (506) 223-1370. Fax (506) 223-3964.

E-mail: <rastern@sol.racsa.co.cr>.

Click here to read international reactions to the Costa Rican program.

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