Visiting an HIV-Clinic in Guayaquil (Part I)

By Emmanuel M. von Arx, KF16, Ecuador

“Don’t be scared to shake the hand of a client with HIV or to drink out of his glass. You cannot get infected that way.” This was the message that Nahin Alvarado repeated over and over during a training session in September with a group of twelve new and somewhat incredulous loan officers of Banco D-MIRO, when I first met him. A loan officer himself, Nahin has been with Banco D-MIRO for more than two years, focusing on two very special client groups who – not just in Ecuador – have long suffered from discrimination and lack of access to financial services: HIV-positive and disabled micro-entrepreneurs. The moment I heard Nahin so forcefully speak up on behalf of HIV-positive clients, I knew that I wanted to spend a day with him in the field.

A few days later, it finally happened: On an early Tuesday morning we drove with his private car from D-MIRO’s headquarters on Guayaquil’s Isla Trinitaria to the nearby Abel Gilbert Public Hospital where Nahin was expected to make his bi-weekly visit at the local HIV-clinic. I took advantage of the 20-minute car ride to ask him questions about Banco D-MIRO’s engagement with HIV-positive borrowers. The bank prides itself to be the only micro finance institution in all of Ecuador to provide discount loans to HIV-positive borrowers. Thanks to a grant by the FAHU Foundation and financial support by Banco D-MIRO itself (and thus indirectly by Kiva), Mision Alianza, and Care, HIV-positive borrowers at Banco D-MIRO receive a 10-percent discount on their loan´s interest rate: instead of 26% interest per year they pay 16%. And more importantly, they are welcomed with open arms as clients of Banco D-MIRO. Even those of you who don´t speak Spanish will be able to sense Nahin´s enthusiasm for both his clients and his work in the following brief interview which he granted to me after our hospital visit:

'

The Ecuadorian constitution explicitly prohibits discrimination against HIV-positive people. Yet, many sources confirm that Ecuadorians with HIV or Aids do feel discriminated (see this document on the social and cultural impact of HIV and Aids in Ecuador and a recent study on the stigmatization and discrimination of HIV-positive people in Ecuador). All the prouder I am for Kiva to work with Banco D-MIRO.

Once we arrived at the hospital, Nahin and I walked around the main building, past a mobile hospital tent, toward a shed-like flat house which turned out to be the HIV-clinic. On our short walk we had to climb over piles of garbage and rubble which obstructed the way and would have made it almost impossible for a patient in a wheelchair to reach the center. I distinctly remember seeing a sole prosthetic leg lying amidst the pile of trash on the street.

Inside the center, I am glad to report, conditions were visibly better: the large waiting room was orderly and clean, albeit overcrowded, with most people´s attention focused on a loudly blurring TV in the front. Nahin was immediately greeted and welcomed by several doctors and community organizers.

The waiting room contained four rows of narrow seats, most of which were occupied by about 40 patients waiting for their turn to receive treatment, medication, or counseling. Other than their HIV status, they seemed to have little in common: frail grandmotherly women were sitting next to trans-gender sex workers; babies with their mothers next to teenagers; teenagers next to strong middle-aged men. All of them (except for the prostitutes) were dressed very informally; clearly all of them were poor; yet, as Nahin told me, with the exception of the youngest children, all of them were working, some of them as employees, many others the owners of their own micro-business, selling groceries, cleaning shoes, building houses, or fishing crabs.

After turning down the volume of the TV to get the patients´ attention, Nahin stood in the front of the waiting room to give a short speech: “Good morning to everybody, especially to those who don’t know me: I am Nahin from Banco D-MIRO and I am here to talk to you about a special loan product that we offer for HIV-positive clients.” As he talked, he passed out brochures of the bank and ended his speech by saying: “I am going to walk through the rows, stopping at each one of you, so you can talk to me about your personal financial needs.” As he walked from person to person, he was often asked them same questions which he kept answering calmly and clearly: “What are the preconditions to get a micro loan?” “You need to have an existing business and a guarantor.” – “What loan amounts can I get?” “From 300$ to 3,000$ dollars, depending on your payment capacity.”

I felt particularly touched by several patients who were asking: “How quickly can I get the loan? How long do I have to wait?” “Once you submit all your documents, you can expect an answer from the bank´s credit committee within 24 hours. After that, the loan is being paid out immediately.” Time as the essence for so many here, as they fear their own time running out too soon.

As Nahin walked through the rows, answering everybody´s questions, he encouraged all interested people to add their names and contact information to his mailing list. Within a half hour, he had collected the names of twelve patients… no, not just patients: twelve micro-entrepreneurs who dream of realizing their goals, expanding their business, working towards a better future of their families, leaving savings as a safety net for their children and their spouses, and finally getting access to financial services – all that with the help of a micro-loan. Yet, as Nahin told me, many people shy away from signing up due to the fear that their data may get mishandled and that loan officers could inadvertently reveal their clients´ HIV-status to their unsuspecting spouses or children.

To protect the borrowers´ privacy and safety, Banco D-MIRO obviously will never disclose the HIV status of its borrowers or any other features that could put them at risk (see the SMART Campaign which has been endorsed by most Kiva partner organizations). Yet, I have heard that early discussions are in the works to anonymize D-MIRO´s HIV-positive borrowers (e.g., by blurring their photos or/and changing their names) if they agree to be listed on Kiva. This is already being done – mostly for political reasons – with clients of other Kiva field partners, among them Ameen s.a.l. Yet, while these negotiations are taking place, please know that every Kiva loan to a borrower of Banco D-MIRO supports its HIV-positive clients at least indirectly: Your loan is provided to Banco D-MIRO interest-free – that means the bank can use all the income generated with your loan to expand its financial services to under-served and “risky” clients, including those with HIV, young and inexperienced entrepreneurs, and student loans. Currently, Banco D-MIRO serves about 290 HIV-positive borrowers with a discount loan, making for a total loan amount of almost $100,000.

As Nahin walked through the rows of waiting patients, I had a fascinating conversation with two men and community organizers in the waiting room… But more on that in the second part of this blog post.

Emmanuel M. von Arx is a Kiva Fellow working with Banco D-MIRO in Guayaquil, Ecuador. To learn more, please visit Banco D-MIRO´s partner page or become a member of the lending team of Banco D-MIRO, the only provider of special financial services for HIV-positive and disabled clients in Ecuador.