By Anna Maria Barry-Jester

I first met Cesar Alva on a gray winter afternoon in downtown Lima. He wore a knit stocking cap over a thick head of hair, drawing attention to his slight underbite and jaundiced eyes. Alva lives with his parents, a retired housekeeper and construction worker, in a neighborhood at the center of Peru’s swelling capital city. He is HIV-positive.

He’s not sure how, or when, he got the virus, but after he was diagnosed in 2001, his parents spent most of their tiny pension taking him to doctors and buying him medicines on the black market.

That first year, Alva was hospitalized for several weeks during a particularly sick period. After he was discharged, he learned that he’d contracted tuberculosis in the hospital; in the years that followed, he got TB again, as well as toxoplasmosis, a parasitic infection, in his brain. Both diseases commonly strike the compromised immune systems of people with HIV, and they came with high price tags for treatment, costs Alva’s family had to cover. He couldn’t afford to take antiretroviral treatment regularly, and he says a doctor told him his immune system defenses were way too low. “There’s not much left we can do,” he remembers the doctor saying.

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Image: Jericho: CC BY 3.0

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