THE EASIEST THING
“That is the easiest thing to wish for in the whole world, my girl! You can come up with something better than an easy escape!” The HIV-positive woman says this with a wide smile and then rolls her head back in robust laughter. She is speaking to a thin girl slouched over in a rocking chair, her arms drooping sadly over the sides. The girl is also HIV-positive. She has just vaguely announced to the room that she wishes for death. She is tired of the waiting, tired of anticipating the end. It has become too sad.
And so it is that the current attempts at AIDS education on a small Caribbean island called Roatan are slowly battling the defeatist attitudes that once prevailed amongst the dying. The largest of the three so-called Bay Islands, Roatan is officially a part of Honduras, sitting slightly to the north. It is renowned as an increasingly popular tourist’s paradise. White, sandy beaches meet warm turquoise waters under clear skies and palm trees. Seafood restaurants line the ocean-front as cruise-ship goers and backpackers lean sleepily on lawn chairs and sip a Salva-Vida, one of the two local beers offered for less than a dollar. It is a true utopia.
What most tourists are not aware of, however, is the growing AIDS epidemic that is currently sweeping across this idyllic little sand patch in the midst of the ocean. Honduras as a whole claims the largest HIV-infection rate in the Western Hemisphere. The World Health Organization estimates that by 2001, approximately 11,800 AIDS cases had been reported in Honduras. In this year alone, the estimated number of deaths due to AIDS is 3,300. The estimated number of children under 15 who had lost one or both parents to AIDS-related deaths by the end of 2001 is 14,000.
Perhaps most disturbingly, approximately 27 million dollars in medical aid for AIDS alone, donated by the Global Fund, currently lays stagnant with the Honduran Health Ministry. The reason for its inertia? Lack of trained physicians who know how to use antiretrovirual drugs—although the one-day training could be provided by the Health Ministry, the under-paid, over-worked physicians of Honduras would not be paid for their time. This is currently the single reason cited for lack of available AIDS drugs in Honduras.
In response to these alarming statistics, and the increasingly observed number of AIDS-related diagnoses and deaths on the island, ‘Familias Saludables’ (FS) was founded in Roatan by a Canadian-born social worker named Valerie Nelson. “It seemed like a building burning down with people inside...how could we see this and not decide to stop and help extinguish the flames?” she says. Nelson estimates that the current HIV-infected rate may be as high as 10% of individuals living on Roatan, though accurate rates of HIV exposure are difficult to come by, for several reasons. First, only an estimated one in ten positively infected people in Roatan get tested prior to getting full-blown AIDS. One reason for this is simply the fear of knowing--getting an HIV-positive diagnosis is “like a death wish”, Nelson states, on an island with little medical support, meager sanitation facilities, and poor nutrition. While the estimated time lapse between diagnosis of HIV to death of AIDS in the developed world is at an average of nine years, it is about six months in Roatan.
Another reason is the humiliating stigma attached to being identified as an AIDS patient. In Roatan, AIDS is usually associated with deviant behavior—prostitution, promiscuity, or simply put, bad luck. Current knowledge about how the virus is transmitted is scant. While some retain fairly accurate information about its cause due to some sincere governmental attempts to provide some health education, there still exists a stubborn impression that the virus can be transmitted through touching, using the same bed linens, or even living in the same home. For these reasons, few people on the island are willing to risk their social standing as a decent individual by coming forward and getting tested. Admitting contraction of HIV in Roatan is like announcing a positive diagnosis of leprosy: individuals have been known to be entirely disconnected from their family unit, their loved ones, and the communities in which they have spent the entirety of their lives, mostly due to gross misinformation about HIV transmission.
One of the primary functions of FS is to challenge this misinformation with its own slew of educational tools and community-oriented curriculum. In turn, this has been achieved by the increasing recognition of Nelson’s organization as a sincere attempt at eradicating one of the biggest health nightmares to ever hit Roatan. She remains unabashed in her desire to attract islanders to her office in a concerted effort to gain trust and exposure amongst the islanders, and to her program as a resource for people living with AIDS. “Everyone needs someone to listen to them”, she announces one day, after dozens of people, mostly women, come in and out of her busy office to talk about their health, their poverty, the meanderings of their boyfriends, or simply the weather. Scores of small children come tip-toeing into her office after school, asking softly for stickers, candy, or simply delaying the process in an effort to sit in Valerie’s cool office and play with the toys on her desk. In just under a year, she has become a highly-respected matriarch of sorts on the island, a woman who has been widely rumored by local merchants to have single-handedly raised condom sales significantly in the little port town of Coxen Hole.
The key seems to lay in the fact that Nelson maintains the necessity for culturally specific understandings about sex and AIDS that differ greatly from her own culture’s, or even from the mainland’s . Promiscuity is accepted, though not discussed openly. Infidelity is rampant, though most would deny their participation in it. Almost none of the women who she has worked with who are pregnant or already have children are married. In fact, most islanders would be hard-pressed to remember the last time a formal marriage was held in Roatan. They are expensive, laborious, and often short-lived when enacted.
For now, Valerie accepts that these are island-specific, deeply embedded behaviors that will not likely change soon. Although a vital component of her work is the perpetuation of safer, culturally-acceptable sexual practices and more reliance on abstinence as a livable option for young people, it is important that FS maintain some sense of what is possible now, while the HIV-infection rate climbs from moment-to-moment, from choice-to-choice.
Knowing that a change in cultural attitudes towards sexual behavior is a long-term goal with years of headway to be made, FS has specifically focused on two groups: pregnant women and children. Children, she says, because their minds are malleable; because they are being raised in a different world than their parents and are educable in a way that their elders are not. Pregnant women because they are “the hosts of the only people whose lives we can truly make a huge difference in transmission” of the HIV virus. What many people are unaware of is that pregnant mothers who are HIV-positive can increase their chances of giving birth to an HIV-negative child if they take a course of antiretroviral medication called Videx. The generic form of AZT, the most popular and well-known of the antiretroviral treatments for AIDS, the retail price of Videx is currently about 450 US dollars a bottle, while the generic wholesale price would be about 20 dollars. Videx can be given to pregnant women before giving birth to their child, during labor, and to the infant itself after it is born, and increases the chances of the child being healthy by as much as 45%.
Currently, FS is providing Videx to healthy, HIV-positive pregnant women, free HIV testing for pregnant women in local clinics, and an infant formula-donation program through several large supermarkets located on the island in an effort to provide a safe alternative to infected breast milk. According to Valerie, FS has had several “success babies” in the year that she has been there, with several infants of HIV-positive women testing negative after six months of support, formula and education. She states that it is “a direct way of preventing HIV transmission to the most vulnerable group currently exposed to the virus”.
Whatever the statistics may be on paper, whatever the ‘2004 Projections’ and Outlook Plans may say in the dense folds of progress reports submitted by health organizations around Latin America, it is clear that many people are dying of AIDS in Roatan. Not a person is unfamiliar with someone who has died of AIDS-related causes. Not one individual seems unafraid of the possibility that deaths due to AIDS will climb exponentially over the next few generations. As stigmas are eroded, as islanders begin to feel confident in their entitlement to a long and healthy life, the battle against AIDS continues to ensue, claiming small victories along the way.