Colombia: Venezuelan Migrants and the Challenge of Adhering to HIV Treatment
Adherence to treatment is a major challenge for any medical treatment, but in the case of HIV it takes on new dimensions. “Taking antiretroviral drugs makes the difference between life and death,” summarizes Dr. Sandra Ávila, consultant for AHF Colombia.
In general, adherence implies that the person follows the treatment in the form and dose that the doctor indicated, in order to have the expected result. In HIV infection, antiretroviral therapy (ARV) works by controlling the multiplication of the virus in the blood, to prevent further damage to the body’s defense cells.
But when a person does not follow their treatment with good adherence (ideally, more than 95% adherence, explains Dr. Ávila), they can face consequences. One of them is that the virus becomes resistant to the drug and it stops being effective. This allows the advance of HIV and can lead to a series of diseases that make up the syndrome known as AIDS.
Faced with this scenario, it would seem logical for people with HIV to adhere as closely as possible to their treatment to avoid complications, but in reality, it is not that simple. “I have always thought that HIV is not a purely clinical issue, but that it encompasses many dimensions,” says the doctor.
Migrant People with HIV
According to the Office of the United Nations High Commissioner for Refugees (UNHCR), Colombia is the country that has received the most migrants and refugees from Venezuela. One million 744 thousand Venezuelans resided in Colombia at the end of last March, of which the majority (approximately one million) were in an irregular situation.
Based on this reality, AHF Colombia’s work is essentially focused on migrants from Venezuela to provide them with HIV care services. In part, people who already had an HIV diagnosis migrated seeking treatment in Colombia because their country was not providing it on a continuous basis.
Due to the structure of the Colombian health system, which operates through collaboration between private entities and the government, people in an irregular migratory situation cannot access services. That is why AHF Colombia offers them not only ARV treatment but also treatment for related infections and lab tests, as well as care in the areas of psychology and social work.
At the end of June, the organization was serving 1,850 people with HIV, most of whom were migrants, but new users arrive every day.
Factors Influencing Adherence
In her experience with this migrant population, Dr. Ávila identifies several factors that influence adherence to HIV treatment. She divides them into individual, social and economic factors.
Individual factors play a role, he believes, with acceptance of the HIV diagnosis. It is important that the person takes responsibility for their diagnosis, assumes it, and to the extent that the health personnel make them a partner in the treatment, better adherence is achieved.
Among the social factors, the doctor cites stigma and discrimination, elements that “today still continue to set the standard that people cannot make their diagnosis known.”
For example, migrants have to share spaces with many people and it is difficult to have privacy. In addition to this, today it is very easy to research on the Internet what a drug is for, so many of them choose to change the packaging of their treatments or remove the labels as a strategy to not reveal their serological status.
This is also influenced by the fact that, in Latin American countries, the population most affected by HIV is that of sexual diversity (such as gay men and trans women), and the stigma that still weighs on non-heterosexual people also limits adherence to treatment.
As for economic factors, this is the main motivation for the migration of Venezuelans to Colombia: the search for employment and resources. “They are highly vulnerable people” in this regard, says Dr. Ávila, commenting that many of them eat only once or twice a day and that they often face the dilemma of deciding between eating or taking their medications.For all this, the doctor looks at HIV from a broader perspective. “Behind HIV there are, at times, power relations, abuse, stigma, discrimination, and if you don’t have a good social support network, this also influences a lot. The issue of adherence is something that must be seen from many areas. “
Successes and Challenges
Contrary to what is believed, the doctor has observed that the migrant population has good adherence to treatment. In addition, AHF Colombia is concerned about retaining them, that is, monitoring their treatment regardless of whether people continue to move, either within Colombia or to other countries. To achieve this, it links with the rest of the AHF region offices and channels people who continue their journey there.
Other strategies that have been implemented in the context of the COVID-19 pandemic are teleconsultation and home delivery of medicines.
AHF Colombia’s seven service centers cover a large part of the country’s territory, but there are still regions from which it is more difficult to go to a center. For people who live in the most remote areas, appointments are scheduled at intervals of three or four months and enough medications are delivered for that time in the visits, thus avoiding that the person has to travel to go personally when it is not essential.
On the other hand, among the main challenges facing the organization is the sustainability of the treatment, that is, maintaining continuity with the available resources. This has been achieved so far thanks to strategic alliances such as the one that allowed Brazil to donate ARV drugs, so the regular supply has not had to be interrupted.
The other challenge, Sandra Ávila concludes, is the process of regularization of Venezuelan migrants in the country. A few months ago, the Colombian government issued a decree by which temporary stay permits will be granted, which will allow them to be linked to health services. AHF Colombia will support this process – as it does now with legal migrants – but it is expected to be a slow transition.