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Nilsa Hernandez. August 2018. © 2018 Human Rights Watch
By Tamara Taraciuk Broner and Kathleen Page

The Spanish version of this article will soon appear online and in the printed version of

Nilsa Hernández smiled as she handed us each a plate of home-cooked rice and beans. It was hot and humid in Boa Vista, Brazil’s Northern Roraima State, and Nilsa was living in a small house with colorful curtains for doors. She was proud to welcome strangers, though. We sat on plastic stools and a wooden bench in a dirt-bare yard under the cooling shade of an old tree. Uprooted at age 61 from her home in Venezuela’s Bolívar State, Nilsa has found both a refuge and a calling.

She tested positive for HIV 13 years ago and started taking antiretroviral medications nine years later. Like many other Venezuelans, she received treatment without interruption until two years ago. At first, there were shortages of one or two of the three types of medicine she took, but by mid-2017, none of the medication for HIV she needed was available. In January 2018, she used the money she had saved to move across the border to Brazil.

Nilsa is one of the thousands of Venezuelans living with HIV who cannot get proper treatment at home. Venezuela is the only middle-income country in the world where large numbers of HIV patients are forced to interrupt their treatment as a result of widespread shortages of antiretroviral medicines.

These shortages are part of a much broader problem. Outbreaks of measles and diphtheria are rising, according to the limited available data, and the number of cases of malaria and tuberculosis are the highest they’ve been in 30 years. Surging malnutrition compounds the health crisis, making Venezuelans both more susceptible to infectious diseases and more prone to complications when sick.

Of the 79,000 HIV+ people registered to receive antiretrovirals from the public health care system, a shocking 87% are not getting them. What’s more, 15 of the 25 antiretroviral medicines that the government used to provide have been out of stock for more than nine months, the report noted, and medicine to treat infections are in short supply.

To make matters worse, another report by the Pan American Health Organization, UNAIDS and the Venezuelan Health Ministry says that newly identified HIV cases increased 24% between 2010 and 2016, and AIDS-related deaths by 38%. During this period, new HIV infections decreased by 18% and AIDS-related deaths by 34% worldwide, according to UNAIDS.  

The report noted that, in 2016 alone, there were 6,500 new infections reported. The actual number is undoubtedly higher. Many health centers are no longer able to test for HIV, even pregnant women, or to test blood for transfusions. Condoms are too expensive for most people. Lack of treatment is not only causing deaths that could be prevented, but also fueling transmission itself. People with HIV who are getting optimal therapy are very unlikely to transmit it to others, but without treatment, sexual partners, and even the babies of mothers with HIV, can be infected.

When Nilsa first arrived in Boa Vista, she lived on the streets, like many fleeing Venezuelans. One day, she told a Brazilian journalist that her dream was not only to find treatment for herself but to help others who are living the same nightmare. The journalist helped her rent the humble home where she hosted us. She also helped Nilsa set up a project called “Brave People For Life” (Valientes por la Vida), which supports Venezuelans living with HIV, who move to Brazil seeking treatment. To fund her project, Nilsa sells ice-cream in the street.

While Nilsa’s project is exceptional, we witnessed many gestures of solidarity during the days we spent interviewing Venezuelan migrants in Brazil—people sharing blankets, food, stories, and advice. 80% of the 3 million people known to have left Venezuela since 2014 have stayed in Latin America and the Caribbean, and the massive wave of migrants has especially swamped border regions. Some 650 Venezuelans a day cross into Brazil, a Brazilian general at the border told us.

Most find themselves unable to move out of remote Roraima. The distances are huge: a two-lane road is all that connects the state to a big city, Manaus, almost 1,000 km south of the border. Few of the Venezuelan migrants can afford the long road trip. So Roraima has struggled to absorb the tens of thousands who have arrived so far.

Venezuelans are being driven from their country by a maelstrom of interlocked catastrophes—severe food and medicine shortages, a ruthless government crackdown, violent crime, and hyperinflation. All they hope for is to return to the lives they once had. But until something changes drastically, they are forced to scrape by abroad, helping each other as best they can.

Nilsa has already provided shelter and guidance to 60 newly arrived valientes. Thanks to the antiretroviral treatment she receives from Brazil´s public health care system, she feels hopeful and full of energy again. Now she’s striving to buy a freezer so she can make and store her own ice cream—and thus help more people. She never stops dreaming.

Maybe that’s why she keeps her smile.

Tamara Taraciuk Broner is a senior Americas researcher covering Venezuela for Human Rights Watch and Kathleen Page is an associate professor and medical doctor at Johns Hopkins University.

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