August 17, 2007
WAITING GAME
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Acevedo Vila, who appointed Delgado in July |
When Gov. Anibal Acevedo Vila appointed Jorge Delgado Rivas as an assistant to Puerto Rico's Secretary of Health in July, Rivas became the first Puerto Rican government official expressly charged with overseeing the territory's response to its appalling AIDS epidemic. The territory's AIDS rate is almost double that of the U.S. Advocates applauded the appointment: Although he had been living in California, Delgado is from Puerto Rico and has HIV.
Despite the optimism surrounding his appointment, Delgado is sticking to the story that desperate AIDS advocates have wearied of hearing, especially concerning Puerto Rico's AIDS Drug Assistance Program (ADAP). "There is no ADAP waiting list," Delgado told the Update in his first mainland interview. "At one point we had a waiting list in February and March but $8 million dollars were allocated. That list does not exist anymore."
Puerto Rico's poor record-keeping makes Delgado's statements difficult to confirm or deny, but they don't square with on-the-ground Puerto Rican activists like Jose Colon, who risked his life when he briefly refused to take his HIV medications to protest Puerto Rico's ADAP waiting list. According to the Latino Commission on AIDS website, "Patient advocates estimate there are 131 patients on the waiting list, but definitive data is hard to come by."
After the Update informed Colon of Delgado's statements, the bed-ridden activist made a few quick calls to five AIDS groups and put together a list of 65 people who were not able to receive AIDS medications. "If you have patients who are not getting their medicine on time, that's a waiting list," Colon said. Colon would not reveal the names of the organizations that he spoke to because such groups fear retribution by the Puerto Rican government. "They're scared to death," Colon said.
"The difference is the culture"
Informed of Colon's findings in a follow-up interview, Delgado admitted that some Puerto Ricans with HIV/AIDS don't get medications because they are waiting for their requests to be processed, but he doesn't consider them to be on a waiting list. "If we are talking about people waiting to be processed by Medicaid or other systems, then yes, there is that," Delgado said. "But I've been to pharmacies and people are walking out with medications."
Delgado's murky statements are no more illuminating than the Puerto Rican Health department party line. According to the National Association of State & Territorial Directors' August 16 ADAP Watch "Puerto Rico reported being uncertain about future cost containment measures, including waiting lists, based on actions that the Puerto Rico Department of Health is currently taking."
"He's a government official appointed by the governor. The governor's official is not going to go and admit a problem of that scale," said Housing Works' Robert Cordero, who met with people living with HIV/AIDS on a fact-finding trip to Puerto Rico in June. "He's got to come in and tow the party line."
Delgado does acknowledge that there is a "crisis" in Puerto Rico. One of the steps in his nine-point plan to solve that crisis is to create a phone line for patients to call if they can't get their meds. "It's especially for addressing the waiting list, since some people say there is one, and some say there's not," he said. Delgado also wants to computerize health records—Puerto Rico's infrastructure still needs to be modernized to fit the Health Resources and Services Administration's standards and adequately disperse funds. "The difference is the culture. Yes, we are U.S. territory, but we still are Latinos, the way we work and provide services," Delgado said.Spiraling crisis
During the last three years, Puerto Rican activists repeatedly pleaded with the Puerto Rican Department of Health, the governor and the Puerto Rican state legislature to deal with the funding mismanagement that was preventing Puerto Ricans with HIV/AIDS from receiving care. The crisis only became well-publicized on the mainland this December when the F.B.I. raided four San Juan Health Department offices, seizing 400 boxes of documents in a criminal investigation into possible misuse of Ryan White Title I grants. HRSA cut back funding until Puerto Rico complied with its regulations.
In January fed-up activists contacted HRSA "to immediately intervene to prevent the entire system from spiraling out of control." In February the Latino Commission on AIDS and the National Minority AIDS Council hosted a meeting in D.C. between Puerto Rican AIDS activists and Congressional aides in an effort to jump start Congressional intervention. Finally, after growing criticism, a New York Times cover story, mainland activists visits to Puerto Rico, and Congressional calls for an investigation, Acevedo Vila announced the overhaul of the HIV/AIDS program, including $78 million to streamline the treatment program and Delgado's appointment.
Delgado seemed perfect for the job: Not only does he have HIV, the Associated Press incorrectly described him as a "California physician." Advocates like Colon and Latino Commission on AIDS executive director Dennis deLeon, who couldn't be reached for comment before press time, spoke optimistically about him. In fact, Delgado is not an M.D. but holds a Ph.D in administration from a non-accredited school in New Hampshire called Berne University, now located in St. Kitts. While Delgado says he has worked in the Los Angeles County School District helping it distribute funding, his only AIDS-related experience has been volunteering at a handful of AIDS service groups.
Is Delgado the man to oversee a $78 million infusion into care for people living with HIV/AIDS in Puerto Rico? Cordero says he's still hopeful Delgado can make a difference. Despite misgivings about Delgado's ADAP waiting-list denials, Colon thinks Delgado has already had a positive impact. "We can't expect Delgado to be an angel. He still has to deal with the bureaucracy here," Colon said. "But he listens. And I wholeheartedly give applause to a person living with AIDS who is trying to understand what the whole process is."