Darwin Zerpa is among those who have fled to Peru to get the antiretrovirals he needs. Now he counsels others with the virus

By day it is one of Lima’s grandest squares. By night the Plaza San Martín becomes a magnet for nightclubbers and bag-snatchers, as well as a haunt for male sex workers and their clients.

It is here just before midnight that 29-year-old Darwin Zerpa and other volunteers set up shop. Pulling up in an out-of-service ambulance and folding out a table on the pavement, they mark out a spot where passersby can get HIV finger-prick test results in less than 10 minutes.

Under the capital’s dim streetlights a diffident group of mostly young men gathers. Shoulders hunched and heads down, they queue for the HIV test while Zerpa explains how the virus is “transmitted 95% through sexual activity” but also via blood and breast milk.

Zerpa is an HIV-positive Venezuelan who works as a counsellor with the Aids Healthcare Foundation (AHF). He migrated to Peru in 2017 after he was invited to take part in a conference for the UN Jovenes Positivos network, which fights against the exclusion of young HIV-positive people.

“I came to Peru because I wanted to live,” says Zerpa, who began antiretroviral treatment in his home city of Mérida in 2015 when he found out he had the virus.

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But by 2017, Venezuela’s healthcare system had all but collapsed and antiretrovirals, which had been administered free of charge, could only be found on the black market costing up to $500 a pill (£380), recalls Zerpa. The price is totally out of reach for the vast majority in the country, where the minimum wage is around $30 a month.

“I spent six to seven months without taking any retrovirals,” explains Zerpa, who used to work as an HR manager for a fast-food restaurant chain.

“Due to a stomach bug, I weighed 35kg. I couldn’t even walk and I had to use a wheelchair.

“My doctor told me, ‘Darwin, you have two options: you can stay here and die or you can try to leave and find a solution to stay alive.’”

Facebook Twitter Pinterest Administering HIV finger-prick tests in Plaza San Martín, downtown Lima. Photograph: Dan Collyns

Zerpa considers himself one of the lucky ones. He dedicates himself to helping his fellow HIV-positive Venezuelans who are entitled to free treatment in Peru if they can register and bypass a series of bureaucratic hurdles.

“I feel happy here, I can help my compatriots. We’ve been given this opportunity. We are just asking that [Peru] doesn’t shut its doors to the rest,” he says.

Close to half the male sex workers seeking HIV tests in the square are Venezuelans, AHF counsellor Percy Cuba estimates. Two years before there were practically none, he says.

It is not clear how many people who are HIV positive or have Aids are among the more than 3 million who the UN refugee agency says have fled Venezuela since 2015.

According to UNAids an estimated 120,000 Venezuelans were living with HIV in 2016; there were around 6,500 new infections and 2,500 Aids-related deaths.

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Venezuela already had one of the highest rates of HIV infection and adolescent pregnancy in Latin America before its economic collapse in 2014. Since 2010, new HIV infections increased by 24%, according to UNAids.

The country’s health ministry stopped publishing health data in 2017 after an official report pointed out a spike in infant and maternal mortality rates, for which the health minister was immediately sacked.

The Venezuelan Pharmaceutical Federation estimates Aids-related deaths have more than doubled as a result of an 85% shortage of medicines in the country.

In little more than a year, the number of Venezuelans migrating to Peru has quadrupled, many attracted by the country’s growing economy, the availability of unregulated work and softer entry requirements.

As of February 2019, more than 688,000 Venezuelans were officially registered as living in Peru, making it the second largest recipient of migrants after Colombia even though Venezuela and Peru do not share a border.

The possibility of free antiretroviral (ARV) treatment is proving to be a major draw for Venezuelans living with HIV.

“What worries us is that [HIV positive] people are migrating to Peru for the sole reason that they cannot continue their treatment in Venezuela,” says Dr Carlos Benites, who leads Peru’s HIV and Aids control programme.

In contrast to Colombia, where migrants need temporary residency to access health insurance, Peru has a public health system that guarantees free treatment for foreigners and nationals with the virus, he says.

“So far the HIV-positive Venezuelans have been easily absorbed into the system,” Benites adds. He says figures from December 2018 show 1,338 Venezuelans were receiving free ARV treatment in Peru. Of those more than 80% (1,095 patients) are in Lima and the nearby port of Callao.

According to Benites, about 72,000 people are HIV-positive in Peru, which has a population of close to 32 million, of whom 57,000 are receiving treatment.

But as UNHCR predicts the number of Venezuelans in Peru could more than double to 1.4 million by the end of the year, there are concerns that the country’s healthcare system could be put under strain.

The director of AHF for the Andean region, Dr José Luis Sebastián, says many of the HIV-positive Venezuelans now fleeing their country are particularly vulnerable.

“At the beginning of the migration it was middle-class people, students, professionals … but in recent months, much poorer people are arriving who don’t have much understanding of how to treat their condition and are desperate because of the situations they’ve faced getting here. They arrive looking for antiretroviral drugs.”