Migration, health and HIV/AIDS in 14 rural cities in Bolivia
G.V. Ross Quiroga, People Living with HIV from 14 Rural Cities in Bolivia
Bolivian Network of PLHA, Executive Council, La Paz, Bolivia
Background: Bolivia has a concentrated HIV epidemic. It has an endemic TB epidemic, high rates of STIs, maternal and child mortality. A landlocked country located in the middle of South America, acts as a corridor between the Atlantic and Pacific coasts. Bolivian ethnic groups practiced migration as a mechanism for food security. Exchange of products from the Andean region, the valleys, the coast and the Amazons is an ancient practice. Some of the newly infected PLHA are from these cities. There are 9 ART centers in the whole country.
Methods: With ethnographic methodologies, 14 rural cities were analyzed. In-depth interviews with PLHA were conducted. Participant observation to describe the factors that locally prompt the expansion of the HIV epidemic was conducted. 5 of the 14 cities were located in the border with Brazil. Local informants included PLHA, public health officers, union members, and residents. A methodology of mapping access to ART was used with PLHA.
Results: The real expansion of the HIV epidemic in rural Bolivia is not documented, sometimes registered only as TB deaths. Levels of stigma and discrimination against PLHA in rural Bolivia are high. Internal and international migrations are effective methods for HIV expansion. Different economies are pulling in and off people, also the sub economy of cocaine. Bolivian people complete 3 or 4 migratory cycles in a year. Prevention messages, HIV free rapid test and ART, available with the Global Fund, are not accessible, several PLHA travel to the capital cities or Brazil to receive ART. The HIV epidemic reached rural cities, small villages and communities on the road which are on the middle of migration stops and destinations. Local health infrastructure in general has many challenges.
Conclusions: Bolivian AIDS Program, donors and civil society must prevent the greater expansion of the HIV epidemic in rural Bolivia as a priority.
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