8280: Sun-Sentinel on AIDS in Haiti & DR 06101: Slavin (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: pslavin@unicefusa.org

Sun-Sentinel (Fort Lauderdale, FL) 

June 10, 2001, Sunday, 

LENGTH: 3116 words 

HEADLINE: 'PROSTITUTES AT LEAST CAN PROTECT THEMSELVES. MARRIED
WOMEN CAN'T.' 

BYLINE: TIM COLLIE FROM HAITI; MICHELE SALCEDO FROM THE DOMINICAN
REPUBLIC 


Dieula Jean learned she was infected with the AIDS virus the way so many other 
women in the
Caribbean do. She gave birth. 

On a windy, rainy night in 1999, suffering from fever and severe breathing 
problems, Jean delivered her
fifth child at home, a 12-by-12-foot shack in Carrefour, a seaside slum of 
Port-au-Prince, Haiti, where
the country's first AIDS cases emerged among bisexual men in the early 1980s. 

"It was raining and I was soaking wet. I had already spent a lot of money for 
medicine. I went to the
hospital and they told me I had bronchial problems,'' recalls Jean, 32. "They 
tested me and told me my
blood was bad. 

"I had only one partner. My husband. I had nobody else,'' she says. "When they 
told me that I was
infected, I was shocked. Because I could see my husband was very healthy. He 
didn't look like a sick
person." 

Refusing to get tested, her husband abandoned her and the children for another 
woman. 

Jean survives by selling food she cooks in her flimsy shanty, just a few 
hundred yards from the beach, in
a rough area ringed by deep ditches, barbed wire and the rusted-out wrecks of 
automobiles. 

One neighbor who had HIV was burned out of his home by a group of toughs who 
worried that he
could spread the disease by sharing well water. 

"The people around here went after him,'' she says. "I don't want that 
happening to me." 

She suffers from intense headaches and a deep cough, but she's confused by the 
description of her
condition. Her blood is bad, yes, but what will make it better? A local AIDS 
group is attempting to help
her find medicine. But the help is sporadic and the doctors she deals with are 
mostly rude and
unsupportive, Jean says. 

"I go to the doctor and all I get are these prescriptions," she says, holding 
dozens of slips of paper and
small bags of medicine to treat her symptoms. "But they don't give me food. 
They don't give me money
to buy this medicine. I can't eat medicine and I can't feed it to my children." 
Jean doesn't know whether
her children carry the virus because she doesn't have the $ 10 for the tests or 
the money to travel to a
clinic. 

As the AIDS epidemic moves swiftly over the Caribbean's varied terrain -- rural 
villages, urban slums,
seaside tourist haunts -- it is spreading to women in greater and greater 
numbers. Men infected through
multiple sexual encounters or intravenous drug use are bringing the virus home 
to their wives and
girlfriends. 

That is further complicating the efforts to prevent and treat the disease. A 
woman infected by her
husband is much more reluctant to seek help for fear of being labeled 
unfaithful, or even worse, a
prostitute. Young women working as servants, shop girls and seamstresses often 
find themselves forced
to have sex with their employers. 

These barriers, coupled with the lack of quality health care for women in 
particular, may keep many
women from getting tested -- until the virus erupts into full-blown AIDS. Then, 
with little access to
expensive treatment, it's often too late to stave off symptoms that could have 
been lessened by medicine
and food. In turn, they are passing the virus on to their children in startling 
numbers. 

Clinics throughout the Caribbean have launched prevention campaigns to warn 
women, but curtailing the
spread of AIDS involves far more than providing information. The poor often 
lack the resources to put
any information to use. 

Many women, for instance, don't know they can infect their infants through 
breast milk. But once they
learn, they face another problem: the lack of food. If women don't breast-feed 
their children, they must
have alternatives such as formula and clean water, which often are beyond their 
means. 

In the Dominican Republic, Nene Vicente de Barillo and her family, living in a 
half-constructed house in
Santo Domingo, all have full-blown AIDS. She nurses her 4-month-old son, 
unaware of the danger.
Even if she knew, she doesn't have the money to buy formula -- or the clean 
water to mix with it. 

Two months ago, her youngest still might have had a chance. A newborn who tests 
positive for HIV will
sometimes retest negative in 18 months. A high-protein diet often will fortify 
the immune system enough
to stave off AIDS. But babies breast-fed by HIV-positive mothers are 
continually reinfected. 

Her husband, Rolando Barillo, was building the house for a man in the United 
States. When Rolando fell
ill he couldn't work and the owner stopped paying him. 

That was more than a year ago, and now the couple live amid the construction 
rubble with their three
children, ages 4 months to 9 years, as well as Nene's elderly mother. 

"There is no money because my husband can't work," Nene explains. "We depend on 
the community,
whoever stops by." 

Both have avoided telling their families that they are infected, even though 
Nene's mother knows
Rolando is seriously ill. Shame prevents them from turning to either family for 
help. 

They eat on the days that the neighbors have rice or beans to spare or when 
community outreach
workers from St. Simon the Apostle church visit them with food. There are days 
the family doesn't eat
at all -- except for the baby, who is breast-fed. 

Nene suspected the cause of her husband's illness when he became unable to 
work: "He had a lot of
women in the street that I didn't know about. I think that's how he contracted 
the virus." 

With the help of church outreach workers, she had all three children tested. 
All came back positive. 

"Whether one dies or not is in God's hands. But while God decides whether he 
wants someone or not,
one does what one can," she says. 

Between 25 percent and 30 percent of HIV-positive mothers will pass the virus 
to their children, either
during pregnancy, during delivery or through breast-feeding. 

Providing baby formula to HIV-positive mothers is the most expensive of the 
four pilot programs the
Dominican government has initiated. And it is a priority throughout the region 
for UNICEF, the United
Nations International Children's Education Fund 

"Prevention is one of the first lines of defense," says Leila Kahn, UNICEF's 
program director in
Jamaica. "When you get mothers who are HIV-positive, it's important to limit 
the transmission to
children. ..." 

One way to do that is to provide expectant mothers with Nevirapine, an 
anti-retroviral pill that will
knock the virus out of a newborn baby if taken by the mother within four hours 
of the onset of labor.
The pills cost about $ 4 each -- not a prohibitive expense compared to other 
AIDS drugs, but still
formidable in poor countries. In Africa, at least eight countries are now 
offering the drug to women in
hospitals and maternity clinics. 

In the poorest countries, such as Haiti, little effort is being made to halt 
mother-to-child transmission.
Typically, a man takes ill and is treated. But unless she comes in on her own, 
doctors and missionaries
are too overwhelmed to locate that man's wife for testing, much less his four 
or five children. 

"We've been trying for two years to implement a system to get (the 
anti-retroviral drug) AZT to
pregnant women, but that's been next to impossible," says Vivianne Cayemites, a 
World Health
Organization official in Haiti. 

"And that's just for one drug that can help prevent the spread to infants," 
Cayemites says. "It is very
difficult to do anything like this when you don't have a functioning health 
system." 

Because the first incidents of AIDS were linked to gay men in the United 
States, the notion that HIV is
contracted through homosexual sex persists throughout the Caribbean. Even in 
educated circles a
person will question the notion of contracting HIV through heterosexual sex -- 
even though that is the
dominant means of transmission in the Caribbean. 

But while a decade ago there were seven men infected with HIV for every woman 
with the virus, today
that ratio has shrunk to nearly 1-to-1. 

It's what AIDS experts refer to as the "feminization" of the epidemic, 
intensified by the harsh realities of
life for women in developing countries. Women who work outside the home often 
make far less than
men and those who are in the home have little control over earnings. 

In countries with high unemployment rates, men who earn money are desirable 
mates. That provides
numerous opportunities for the virus to spread. Women tend to be more open than 
men to learning
about HIV. But most, like Nene, like Jean, have few options for protecting 
themselves even from their
husbands. 

"I'm in the world of women, where you give all for your family and do nothing 
for yourself," says
Francisca Rosario, 33, an HIV-infected outreach worker in the Dominican 
Republic. 

"If you ask your husband or partner to use a condom they accuse you of being a 
prostitute, because in
this country only prostitutes know about condoms and how to use them. Or they 
accuse you of having
had relations with someone else. Prostitutes at least can protect themselves. 
Married women can't." 

Perhaps, but the women who still are most ravaged by the virus are sex workers 
concentrated in urban
slums throughout the Caribbean. 

Prostitution was one way that AIDS entered the Caribbean. In the early 1980s, 
the first victims of the
epidemic were young men catering to gay European and North American tourists in 
Haiti. 

While sex workers in many countries often seem to be informed about AIDS, 
studies make it clear that
they routinely suffer from diseases, such as herpes and gonorrhea, closely 
linked to the transmission of
HIV. They also are vulnerable to rape, which can leave them and their 
assailants unprotected from the
virus. 

In Haiti and Guyana, almost half of all sex workers in some areas have tested 
positive for the virus,
according to the Pan American Health Organization. 

"I use a condom 100 percent of the time, to protect myself from HIV," says 
Lucia, a 29-year-old
prostitute in the Dominican Republic. "Every three months, I take a test. Life 
doesn't last long." 

She is on the street, standing on a corner near several government buildings, 
every night but Sunday. 

"My family doesn't know what I do. I hide my work," Lucia says. She makes up to 
2,500 pesos a night,
about $ 150, the equivalent of the monthly minimum wage. The money supports the 
family of four --
Lucia, two young daughters and her grandmother. "I don't share what I do with 
anyone, not friends, not
neighbors. The only one who knows is the friend who brought me here to the 
street." 

Lucia says she took to the streets after one of her children became seriously 
ill and her ex-husband
refused to pay the medical bills. She continued in prostitution to pay her 
children's school fees. 

"Everything depends on how a child is raised," Lucia says. "I work so I can 
give them an education, I
send them to private school, so they don't have to do what I'm doing. So 
they'll have better
opportunities. I'm doing what I'm doing for my children." 

In recent years, new forms of what's generally called "sex tourism" have drawn 
schoolchildren, wives
and university students into bartering sex for tuition, rent and food. These 
new sex workers don't fit the
traditional definition of professional prostitutes, experts say, but rather are 
part-timers who use sex to
supplement falling incomes. 

In the Dominican Republic, young women, looking like they're dressed for prom 
night, can be found in
many hotels and around casinos. They openly negotiate hourly or nightly rates 
in the lobbies. Santo
Rosario, executive director of COIN, an organization formed to protect the 
rights of sex workers,
estimates there are 100,000 women in the Dominican Republic who literally sell 
themselves. They range
from streetwalkers to las chicas biper -- girls who work in offices but have 
clients who beep them when
they want service. 

In Cuba, young women and men often prowl outside restaurants and hotels 
frequented by tourists.
Many are simply looking for companionship with well-paying foreigners that may 
lead to sex. Others
negotiate sex quickly and then retreat with their customers to apartments they 
share with other
prostitutes. 

Working the streets on a recent Tuesday evening in Havana's Chinatown, a 
20-year-old prostitute
named Claudia is offering herself to tourists -- tonight only -- for less than 
half the regular fee. 

Usually it's $ 70 for sex, but she'll take as little as $ 30 -- about what a 
tourist to the Caribbean would
pay for a good meal in a fine restaurant. Tomorrow is her daughter's fifth 
birthday and Claudia wants to
buy the girl a nice outfit or perhaps get a portrait taken at a local studio. 

Business is slow, however, and Claudia and a friend named Rita keep a wary eye 
on a police officer just
down the street. Claudia, a single mother who has supported her family this way 
for five years, makes a
good-enough living to risk dying on Havana's sometimes violent streets. 

Besides, she's careful. Very careful. She uses condoms without fail. A customer 
couldn't pay her enough
not to, she says. 

"So far I haven't found any tourists who don't want to use them," Claudia says. 
"They could offer me $
200 to do it without a condom and I wouldn't take it. That's my life. I'm not 
playing with it." 

Claudia doesn't carry condoms, but keeps them at an uncle's house in Old Havana 
where she takes
customers. The uncle charges the tourists $ 10 on top of Claudia's fee. 

Claudia became a prostitute shortly after giving birth because she couldn't 
make ends meet. Then just
15, she observed an older cousin who worked the streets, picking up on the best 
techniques for
approaching men, speaking to them. Then one day she went out on her own. 

Although she can make more money in one night than most government workers in 
Cuba make in
several months, Claudia never manages to save anything. 

"When I have all the comforts that I need, so my daughter doesn't have to do 
this work, then I'll retire,"
she says. 

Rita, who is working alongside her under a neon sign advertising lunch 
specials, says she too uses
condoms. Both are irritated when asked if their occupation puts them at risk of 
contracting the AIDS
virus. 

Rita insists she's well informed because her aunt works in an AIDS laboratory 
testing blood. She's
questioned her aunt several times to find out whether the disease can be spread 
through open sores in
the mouth or bloody gums. 

This sparks a brief disagreement between the two young women. Rita says the 
virus can be spread
through mouth sores, but Claudia says she's wrong. 

"Listen to me and stop fighting. It can be transmitted through the mouth -- 
that's blood, too!" Rita says. 

In the 12 years since the Dominican Republic started its first AIDS hotline, 
Maria Cristina Valentin has
seen a shift in the kinds of callers, from mostly men to half men and half 
women. 

"Many people who call think it's only transmitted by homosexuals," says 
Valentin, a psychologist. "Many
call to find out how it's transmitted and what precautions they can take to 
prevent it. We're hearing more
from married women who don't know whether their husbands are having sex outside 
the home." 

Often, when men learn their wives are HIV-positive, they leave them. "When a 
man is infected he
receives a lot of support from his family," says Cesar Castellanos, executive 
director of REDOVIH, the
Network of People with HIV in the Dominican Republic. "When a woman is 
infected, she doesn't have
the same support, because it's generally believed she acquired the virus by 
'bad behavior.' And if a
woman is infected and the man isn't, after a few months he leaves her." 

As difficult as it is for a woman to live under the stigma of HIV, the shadow 
it casts over her children
can be devastating. Castellanos tells of two children who were rejected from 
school even though they
tested negative for the virus. Their mother tested positive. 

"She had to work selling goods on the street to support her children," he says. 
"This situation repeats
itself many times here. Normally, women receive less money for the same work as 
men to begin with.
When it is known a woman is HIV-positive, she can't find work at all. This is a 
society where women
live through their men. And the men never think they're the ones who have 
brought the virus into the
house." 

While early outreach programs focused on sex workers of both genders -- they 
are a high-risk group
for the disease -- advocates now are shifting their emphasis to all women. 
Studies suggest that women
over 30 find it difficult to speak with their partners about using condoms, 
Castellanos says. For women
under 30, it's easier -- for a time. 

"They protect themselves until they fall in love," he says. "The moment they 
fall in love, it changes." The
condom comes off, as a way of proving one's love or a desire to be as intimate 
with a lover as one can
be. 

That is how Francisca Rosario contracted the virus. A virgin when she married 
at 20, she was widowed
before she was 30. 

When she began dating again, she asked her new partner to take an HIV test. He 
agreed, but in the
Dominican Republic results usually aren't available for several weeks. Her 
lover insisted he couldn't wait,
so great was his desire for her. 

Rosario couldn't resist his entreaties. But several weeks later, her own 
results came back positive. She
was shocked to learn she had contracted the virus from her late husband. The 
new man in her life
thought she was being disingenuous. 

"I never had relations beyond my first husband," she says. "He (her new 
partner) didn't believe I didn't
know I was positive." 

Angry, Rosario set out to get better help for women like herself. She became an 
outreach worker
assigned to a United Nations-funded program in the Dominican Republic. Because 
of her efforts and
those of others, AIDS-based activism is slowly emerging in the region. 

Working with the outreach program, counseling people whose blood tests 
positive, was one of the ways
she changed her life, she says. 

"When I learned I was HIV-positive, I started to see things differently. I 
started to think and I was
nervous about what I thought. Now I'm living the way I want to live. 

"I'm happy to be HIV-positive," she says. "I'm doing things I never did before 
-- small things, like
playing with my children or having a meal together. It's a blessing, really. 
And many women view it the
same way." 

Many, but not all. Suicide rates have risen throughout the region, among men as 
well as women who
learn they are HIV-positive. 

"It's a heavy weight to survive," Castellanos says. "We don't have special 
programs for women. There's
no campaign for prevention among women. We're trying to do what we can, but 
there's much to be
done." 

GRAPHIC: PHOTOS 6, HILDA M. PEREZ FROM THE DOMINICAN REPUBLIC; DROPS OF
DANGER: Nene Vicente de Barillo, of Santo Domingo, Dominican Republic, nurses 
her 4-month-old
son, Algeni, unaware that infants can be infected through breast milk. She, her 
husband and three
children have AIDS.; A TOUCH OF HOPE: Rolando Barillo caresses his 3-year-old 
son, Francis. He
has not worked since falling ill with full-blown AIDS more than a year ago and 
there is no money for
food for the family.; AMID THE RUBBLE: Barrillo rests in the bed he shares with 
his entire family.
They live in the half-constructed house he was building when he became too ill 
to work.; THE
TOURIST TRADE: A prostitute solicits a tourist in Boca Chica, a beach well 
known for the sex trade,
about 20 minutes from Santo Domingo. An estimated 100,000 women in the 
Dominican Republic sell
themselves.; FOR THE CHILDREN: Marisa, 23, left, is a prostitute who has worked 
La Duarte
Avenue, a main strip in the poorest part of Santo Domingo, for 11 years. She 
and her friend come out
almost every night. "My children are the reason I do it," says the single 
mother of four. "I insist on
wearing condoms, always." MIKE STOCKER FROM HAITI; ABANDONED: Dieula Jean's 
husband
left her and their five children when he found out she was infected with HIV. 
She lives in a shantytown in
Carrefour, Haiti.