With his mother long dead and his father off with a new family, nobody comes to visit Carlos, 27, as he sits blinded by AIDS and awaiting death in a charity hospice.
His father, who left him alone to care for his grandmother until she died, won’t let him near his home, mistakenly believing he will infect his family by sharing their toilet, Carlos explains, the hurt spilling out of his sightless eyes.
Typical of the kind of Honduran now catching the virus, the boyish-faced former factory worker is neither sexually promiscuous nor an intravenous drug user. He caught HIV from a steady girlfriend who got it from a former lover.
Faced with one of the fastest-growing AIDS epidemics in the Western Hemisphere, church volunteers in this desperately poor Catholic nation are turning their backs on the Vatican’s anti-condom stance, which is being upheld by new conservative Pope Benedict.
“It’s a minor sin,” says Wendy Guerra, head of “Program Open Door” in the sweaty city of San Pedro Sula. Hers is one of an army of Catholic-run AIDS prevention programs in tiny Honduras, home to some 60 percent of Central America’s AIDS cases.
“As a Catholic charity we can’t hand out condoms but we give advice about them and make sure people know where to get them,” said Catherine O’Leary, a British nurse who runs the San Jose Hospice which took in Carlos when an AIDS-related disease blinded him.
A bustling industrial city that sprung up with the banana industry a century ago, San Pedro Sula crawls with prostitutes after dusk, thanks to a handful of nearby ports, and has so many HIV carriers it is dubbed Central America’s AIDS capital.
With its chronic poverty, sprawling sex industry, violent crime gangs and macho culture, Honduras has been an easy breeding ground for the virus. Some 70,000 Hondurans are living with HIV/AIDS, nearly 2 percent of the adult population.
Among gay men and sex workers, the HIV rate is 10 percent.
Aid groups say that with the virus now spreading fast among the general public, which is less informed about the risks than sex workers, education on AIDS prevention is urgent.
“The thing is to try and save lives, which is just as important as focusing on unborn lives,” said Guerra, explaining why she quietly advises HIV carriers to use condoms.
According to the United Nations, more than half of new HIV infections everywhere are in the 15-26 age range, with women most hit. In Honduras, where a married man without lovers is an oddity, 90 percent of newly infected women are housewives.
The widespread poverty in Honduras means few have access to healthcare and there is no social network for AIDS sufferers.
Rita, 45, sits on her bed at the San Jose hospice clutching a cancerous growth that covers most of her face and groaning with pain. She has nowhere else to go, with one son in jail, one dead of AIDS, another emigrated and no close family.
She could have caught HIV from her ex-husband’s wanderings, or like countless women here she may have been forced through poverty to trade sex for food, shelter or services.
“We don’t ask about their pasts; we’re not here to judge,” says O’Leary. “But often you’re talking about young people who’ve just had a couple of sexual experiences, or women so poor they use sex as a means of bartering.”
With women so vulnerable in poor nations, AIDS prevention groups in Central America say promoting condoms is not enough.
“Our global message is ABC: Abstinence, be faithful and condom use, but for many Honduran women abstinence is not an option. Their partners aren’t faithful and they are powerless to demand they use a condom,” said Thoraya Obaid, executive director of the U.N. Population Fund, on a visit to Honduras.
“We need to build their characters and self-worth to be able to say no and invest in female prevention methods like female condoms.”
ABSTINENCE OR PROTECTION
Even if they caught on, female condoms would go against the Catholic Church, which has held sway in Honduras and Latin America since Europeans invaded five centuries ago.
Some 85 percent of Hondurans are Catholic, and many were rooting for their liberal, poverty-fighting Cardinal Oscar Andres Rodriguez Maradiaga to become Pope last month.
In a tiny chapel at the San Jose hospice stands a wooden cross completely covered with the handwritten names of the roughly 500 people that have died there, almost all of AIDS.
While life is almost bearable in the sunny grass courtyard with O’Leary’s cheery presence, the patients here now may have been spared their death sentences with the right precautions.
“Priests can make a big difference on issues like this. Nobody wants the church to change, but when you work in this field common sense prevails,” O’Leary said.
“You can’t tell people not to have sex, so you have to teach them to protect themselves. The condom issue is about what you use them for. Anything that might stop one person getting AIDS has to help.”
Revision date: July 5, 2011
Last revised: by Jorge P. Ribeiro, MD