Mario Calvo and Albert Espinoza have been friends for more than two decades. Both in their forties (they wouldn’t reveal their exact ages), the two met on the streets of San José, when their lives were nothing like they are today.
In the 1980s, the two Costa Rican men worked as transvestite prostitutes on street corners and in local brothels. Back then little information was available about the health risks of their profession, and much less about a new mysterious disease that was killing their friends.
As the years passed, both men eventually changed their lifestyles, entering into stable relationships. Separately, they both discovered they had AIDS.
Ten years ago, the two men started working together again, this time in Hogar Nuestra Señora del Carmen, an HIV and AIDS care home in western San José.
At about the same time Calvo and Espinoza were diagnosed with AIDS, in 1998 the Costa Rican Social Security System (Caja) began offering AIDS patients antiretroviral drugs. The move aimed to address a 1997 peak in AIDS-related deaths. That year, AIDS claimed the lives of an average of 4.8 of every 100,000 people in Costa Rica. Ten years later, that number decreased to 3.5.
Improvements in access to treatment helped save Calvo’s and Espinoza’s lives. Instead of dying at the care home, they now manage it.
Still, HIV and AIDS patients face many difficulties in Costa Rica. Nuestra Señora del Carmen is one of the three care homes in San José. People go there to escape the social stigma still attached to the disease.
“We work like family. We have no one but ourselves, so we take care of each other as much as we can,” Calvo said. “The San José Archidiocese helps us with administrative matters, and we mostly take care of house chores and help other patients with their medication and mobility.”
Calvo and Espinoza said they are both in good physical shape, although they suffer side effects from their antiretroviral medication. Most days they keep busy taking care of the house and its 10 residents, many who are too sick to help out.
The residents of Nuestra Señora del Carmen come from different backgrounds. Some are heterosexual men; others are housewives infected by unfaithful husbands. One resident is a mentally disabled woman who was raped by her father and brothers as a child and ended up with HIV. Espinoza acts as her protector, helping her with everything from personal hygiene to doctors’ appointments.
According to 2007 figures from the Pan American Health Organization, in Costa Rica 84.2 percent of HIV infections were contracted through sexual intercourse.
The age of newly diagnosed patients ranged mostly from 25 to 39.
Hogar Nuestra Señora del Carmen is an example of the challenges that Costa Rica still faces when assisting people with HIV and AIDS. Most of the home’s residents say they became a “burden” on their families after they were infected with HIV. The home’s phone rings daily with calls from new patients or their family members. “We even get calls from families who have the resources to care for their loved ones with HIV; they just want to get them out of the house,” Calvo said.
Although Costa Rica’s public health care system has made advances in the past decade in HIV and AIDS treatment, the Caja still does not provide HIV patients with a single-medication treatment option. Patients are prescribed a daily cocktail of antiretroviral medication that causes several side effects. Many residents at Hogar Nuestra Señora del Carmen suffer from lipoatrophy, an allergic reaction that causes the loss of subcutaneous fat tissue, and other setbacks.
“I have started to notice that my short-term memory is at risk,” Espinoza said. “I’m afraid that my HIV medication is leading to Alzheimer’s [disease]. Plus, I have been dealing with severe depression my whole life, and the medication that I take can lead to even more depression, a situation that results in an additional pill cocktail to regulate my mood.”
The care home also serves as a welcoming center for patients from remote areas of the country. It offers accommodations and meals to patients traveling to San José for doctors’ visits or to pick up medication. To live there, residents must be up-to-date on prescriptions, be registered in the Caja and keep regular doctors’ appointments.
The home receives no government funding, and residents depend on donations from neighbors and church groups. Some residents design jewelry to help make ends meet. Church groups sell the jewelry in San José under the name “Arte por la Esperanza” (“Art for Hope”).
“The worst symptom in the fight against AIDS is discrimination. We have little or no access to jobs,” Calvo said. “My dream is to have a job market that specializes in people with HIV and AIDS.”
For more on Hogar Nuestra Señora del Carmen, call 2220-2287 or 2290-2477, or visit them on Facebook.