AIDS in Honduras: Invest now or pay later

Story and photos by Allen Clinton
CARE staff

SAN PEDRO SULA, Honduras -- Outside 44-year-old Juana Fidela's room in the Mario Catarino Rivas public hospital, an overhead light flickers and goes out. She has become accustomed to being relegated to the shadows.

Wearing a dingy nightgown and flip-flops, she sits watching passersby outside her third floor window. They can't see her watching them. Her roommate also has resigned herself to the obscurity. Dying from AIDS, her roommate lies in bed, still and silent, a wet towel across her sunken cheeks and eyes. She doesn't want to see anyone anymore.

AIDS patient Juana Fidelia stares from the window of a hospital in San Pedro Sula, Honduras.

"I wish the peace of life would return, but it won't," Fidela says. "It will only get worse before it all ends."

Fidelia has spent much of the past two weeks sitting and twisting a simple ring around her little finger. A priest gave her the ring to remind her she is not alone. Fidelia says she is. Five years ago, her partner died from AIDS in the same hospital. Fidelia has no family nearby. She has no friends.

Dying in a muggy, dimly lit hospital is the harsh reality facing so many AIDS patients in Honduras.

Striding down a hallway that links rooms filled with patients and their flat, glassy stares, Dr. Tito Alvarado moves like a general going into battle. As one of three HIV/AIDS specialists in Honduras, he is on the front lines. As Alvarado talks about HIV prevention with Diana Sabillon, a nurse with CARE, he admits his troops face demoralizing obstacles.

"Honduras has a taboo," Alvarado says. "You can't talk about it (AIDS), because people don't understand the disease. It's recognized very, very late. Awareness is needed - and a lot of it - or AIDS will blow up in our faces."

Alvarado diagnosed the country's first HIV case in 1982. He has been in the trenches since. Hondurans with HIV or AIDS know Alvarado is an important and loyal ally. He advocates tirelessly for the resources to treat his patients with dignity.

"It's unethical to deny patients medication, but because of the expense, we do not have the resources to treat them," Alvarado says. "It is a tragedy that the poor have to suffer even more because of their poverty."

Dr. Tito Alvarez says it is critical to make the AIDS fight a top priority.

San Pedro Sula is the AIDS capital of Central America. The city has all the conditions that contribute to the unchecked spread of the virus: the population is under-educated; access to condoms is limited; a thriving sex trade is supported by the world's ocean-going vessels docking at Puerto Cortes, Honduras, Central America's largest port. In addition, San Pedro Sula's industries, particularly its textile factories, have lured tens of thousands of people from the impoverished countryside, making it the nation's second largest city with nearly 1 million people.

Honduras accounts for 17 percent of Central America's population. In contrast, the nation has 60 percent of AIDS cases in the region. And San Pedro Sula is home to 60 percent of Hondurans with AIDS. The city has been burying more than 100 people a week because of AIDS.

In Honduras, it is estimated that for every HIV/AIDS case recorded, there are at least three undocumented cases, fast-approaching 100,000 infected people in this nation.

For the past 18 months, Sabillon and eight other CARE specialists in San Pedro Sula have been in the thick of it. They have visited with hundreds of doctors, patients, businesses and organizations in an effort to launch an HIV/AIDS education program. So far, the group has started pilot projects with a handful of local interest groups and two corporations, Chiquita Brands and Cargill.

Spread the word, not the virus

In nearby La Lima, Chiquita Brands is known locally through its subsidiary, the Tela Railroad Co. The company has spent the past year recuperating from Hurricane Mitch's devastating effects on its banana farms and working with CARE to set a strong HIV/AIDS awareness example in the business community.

"We have to do something to help our staff understand HIV and its causes, and provide a model for others," says Jimmy Zonata, Chiquita's human resources and labor relations manager. "CARE has helped train more than 80 volunteer counselors in five farm communities. They are teaching other staff members and their families about prevention through fidelity, abstinence and condom use.

Chiquita employees Francisco and Angela Romero counsel teens on AIDS prevention.

"When you see someone die from AIDS, it makes you think about your own future. The high volunteer participation level in this education program mirrors this concern," says Zonata.

Chiquita knows that two of its 3,000-plus staff in Honduras are HIV positive, says Dr. Ernesto Montoya, head of Chiquita's hospital in La Lima. One is 35-year-old Nancy Bonilla, who is in her 16th-year working on the banana farm. Her husband, disowned by his family, died of AIDS last month. Five years ago, he passed the deadly torch to his wife.

"When I found out that I was HIV positive, I thought it was the fault of every person who has ever had the disease," says Bonilla, wiping a stream of tears. "I couldn't accept it. When I visited my family, they told me to eat from paper plates and use a plastic fork. We all misunderstood the disease."

Bonilla eventually decided she must help challenge the public's denial and tell her story so others could learn the truth about the virus. She frequently exchanges letters with Christina Saralegui, a well-known Spanish TV talk show host. Bonilla hopes she soon can appear on the show - before it is too late.

Nancy Bonilla wants others to learn about the dangers of AIDS and how to prevent them.

A 15-minute drive to the industrial town of Villaneuva is the site of ALCON, a subsidiary of the U.S. corporation Cargill. There, nurse Maria Sarmiento is giving an employee condoms.

"Honduran men are reluctant to use them," she says. "And women usually don't know how. With help from CARE, we are able to provide information our staff can understand."

Of Cargill's 1,650 employees, 80 percent are men. In addition to distributing condoms, Sarmiento shows videos in the employee cafeteria, provides group and private HIV/AIDS education sessions, and often slips brochures into the hands of staff members.

Bruce Burdette, Cargill's director of Honduras, offers his company's view: "AIDS is a threat to our employees. A threat to our company. A threat to the community. It can rob a country of its future. This project lets us be better neighbors and involve our employees and their families."

Cargill has 102 employee volunteers helping to raise awareness about AIDS.

Rolando Ramirez of Cargill doesn't want others to make his friend's deadly mistake.

Rolando Ramirez is a bulky man who drives a forklift for Cargill, loading bags of animal feed onto trucks. He also volunteers with Sarmiento when she gives group sessions. "Some laugh at me, but I don't care," Ramirez says, shrugging. "I had a good friend die of AIDS last year. It was 100 percent preventable. I want others to learn and live a long life."

Back in San Pedro Sula, in the heart of the city's central park, a round, white building stands out because of its location. The sign above the double-door entrance reads "COMVIDA," an acronym created by blending the Spanish words for communication and life. With city support, COMVIDA opened its doors to the public in 1994, offering theater and music festivals, and providing outreach to schools and colleges.

"People think they know what AIDS is, but most of them don't," says Norma Galindo, who spent seven years working with street children before becoming COMVIDA's director. "It's not an invention of wives or organizations to keep men from going astray. It's a real and fatal disease that there is no cure for."

Galindo has teamed with UNIECF and CARE to reach out to young mothers and their children.

Rosa Gonzales, 36, is HIV positive. So is her 5-year-old daughter. Her husband, Allan, who turned 31 this summer, has AIDS. Now balding and frail, he didn't think he'd make it this far. As husband and wife, they have been working with COMVIDA to form what has become a 170-member support group, called Grupos de Autoapoyo en Honduras. Its members have HIV or AIDS.

Allan works on the group's monthly newsletter from the seclusion of their apartment. Rosa, still full of energy despite the virus, participates in COMVIDA activities and gives informative talks in Honduras.

"If your spirit is high, if you continue to live for a reason, then you last," says Rosa Gonzales, animated far beyond images of other people with the virus.

For Rosa and her colleagues, the motivation is there. But they have a huge barrier to overcome.

"We want to help people to understand, but how?" she asks, rapidly raising her open palms in the air. "There's a lot of discrimination in this country."