Fabián Medina Cabrera

Fabián Mauricio Medina has developed an economic model that improves the quality of life for people living with HIV and AIDS by reintegrating them into the workforce and linking them to vital health benefits.

Medical advances have made it possible for people with HIV/AIDS to live for longer than was previously possible. Living well with a potentially terminal disease, however, requires access to the best healthcare available and a supportive social structure, both of which are related to gainful, productive employment. In Colombia, Fabián helps people with HIV/AIDS reintegrate into the workplace–a step fundamental to their pursuit of healthy, meaningful lives. His program sets up small businesses that teach marketable skills to people with HIV/AIDS, making them feel useful, providing them with an income, and linking them to healthcare services. Fabián also involves his clients' families in the businesses to help restore family ties that may have been damaged by the revelation of an HIV infection. And where necessary, he sets up homes where those who remain estranged from their families can live in an environment of affection and encouragement. By creating a model employment environment that demonstrates that people living with HIV/AIDS can productively contribute to society, Fabián is challenging prevailing attitudes toward the illness and establishing a social place to advocate for better public healthcare and services.

According to UNAIDS, Colombia now has the third highest rate of HIV infection in Latin America, behind Brazil and Mexico. Although antiretroviral medications are available in the country, Colombia has opted not to allow production of generic drugs as Brazil, India, and South Africa do, thus putting these life-prolonging drugs financially out of reach for most Colombians. Health insurance companies do pay for medicines, but many HIV/AIDS patients cannot afford coverage; even for those who can, the rising rate of infection may prompt providers either to go out of business or to turn away potential new policyholders. As a result, employee benefit packages offer the most reliable health coverage for HIV/AIDS patients, coverage made affordable through employer and state cost-sharing.
Many people with HIV/AIDS, however, find themselves unemployed and thus unable to access this kind of health coverage. Although companies cannot legally fire employees simply for becoming ill and Colombian law protects an individual's right to privacy regarding disclosing infection, in practice many people with HIV/AIDS do lose their jobs as a result of their status. Moreover, in the weak economy, employers dismiss full-time employees in favor of contract workers without benefits. Beyond their physical health, the high unemployment rate among those living with HIV/AIDS also contributes to their stigmatization, affecting both their social acceptance and their mental and emotional well-being.

Fabián's organization–Fundación San José Obrero–prepares people with HIV/AIDS for new sources of livelihood and advocates for their employment and viability as contributing members of society. By reconstructing their daily routine with a productive, gainful job at its center, Fabián helps HIV-positive individuals and those living with AIDS in Bogotá reintegrate into the mainstream with both social support structures including family, coworkers, and others living with HIV/AIDS, and with access to crucial medical assistance through a health benefits package.
The core element of Fabián's strategy is linking people with HIV/AIDS to small businesses, beginning with a weaving enterprise, through which he trains them in textiles, employs them, and in many cases links them to other businesses for longer-term jobs. Employees produce high-quality, woven products and various other handmade items, which Fabián sells at Colombian and international markets, including Swiss and Brazilian. Besides much needed income and a sense of contribution among a team of coworkers, Fabián's program offers access to healthcare realized through joint employee and employer contributions to state health benefits. As this initiative continues to grow, develops a market presence, and increases its revenues, Fabián plans to pay into additional social security benefits, including a pension that group members can leave to their immediate families upon death.
Understanding that his program by itself cannot train and employ all people with HIV/AIDS, Fabián is using the model employment atmosphere created through the weaving business to advocate for more acceptance within the mainstream workplace. Through seminars held at companies where the participants usually include board members, executives, and office administrators, Fabián conducts activities geared toward eliminating the stigma attached to people with HIV/AIDS. Having already held seminars in 20 companies and with new workshops being planned, Fabian has evidence that these efforts are achieving success in overcoming the discrimination that often confronts people with HIV/AIDS. In one workshop, after listening to his coworkers say that they would accept someone with HIV or AIDS, an employee stood up and said that he was both gay and living with AIDS. The man was not only able to come to terms with his identity within the workplace but also able to continue to work there. As a result of Fabián's workshops, several people who had been working in the weaving microenterprise have been contacted by their former employers and invited to return to their old jobs with full job security and health coverage.
Jobs provide more than just income and benefits. Because employment is often a key to social acceptance in Colombia, working helps people with HIV/AIDS reconnect with their families. Fabián fosters the reintegration of the family by incorporating family members into the microenterprises to work alongside their HIV-positive relatives. For cases of family estrangement, however, Fabián has set up small group homes in which the residents and their children construct an environment that emulates a family unit. These living arrangements–as well as Fabián's family reintegration initiatives–have had a profound effect on the participants' behavior, self-esteem, and personal outlook. Like the health insurance program, residents share the expense of the group houses with the foundation, which contributes 10 percent of operating costs.
Within five years, Fabián plans to establish new microenterprises and group homes in Baranquilla, Medellín, Cali, and several border towns–all areas of high vulnerability for an epidemic spread of HIV/AIDS. Although the Bogotá pilot strategy was to draw estranged people to the group homes first and then involve them in the microenterprise, Fabián intends to focus on the job-training and microenterprise components during expansion, using profits to open houses only when completely necessary. Having already gained interest for his project in three new cities through promotional events and appearances with program beneficiaries, Fabián has entered the early launch stage of a new graphic arts initiative in Cali.
A major component of Fabián's strategic plan for the coming years–fundraising events and outreach to high schools and universities–will garner new customers for the small business, attract investors, and increase public awareness of the issues surrounding HIV/AIDS. Fabián has also worked with the Global Health Fund for the Fight Against AIDS, the National University, and UNAIDS to advocate for larger health subsidies and sanctions against companies that do not abide by Colombia's laws protecting people living with HIV/AIDS. Fabián projects that his work will affect 10,000 people annually per program site.

Through missionary work in high school, Fabián became aware of and sensitive to Colombia's most pressing social needs. In 1987 he lived in a semirural zone in the Department of Antioquia. After identifying alcoholism as one of the greatest threats to public health there, he formed three Alcoholics Anonymous groups for men, one for women, and one for teens. He focused not only on the impact of his programs but also on the sustainability of the initiatives, identifying and training neighbors as project managers and staff before he returned to Bogotá.
In 1988 Fabián first learned about HIV/AIDS and almost immediately became committed to the issue. After a full year of research, he cofounded the Colombian League to Fight Against AIDS, an organization that focused primarily on prevention. Two years later Fabián established the Eudes Foundation to provide legal aid to HIV/AIDS patients. Seeing that the economic, social, emotional, and health issues of people living with HIV/AIDS were not yet being addressed through reintegration to the workforce, Fabián created the Fundación Darse in 1994 as the first organization dedicated to this approach. Currently, he is continuing these efforts through the recently founded Fundación San José Obrero.