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Shawn Smallman is vice provost for instruction, dean of undergraduate studies, and professor of international studies at Portland State University.

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Smallman shows how the varying histories and cultures of the nations of Latin America have influenced the spread of HIV/AIDS there. Examining cultural issues and public policies at the country, regional, and global levels, he discusses why HIV has had such a heavy impact on Honduras, for instance, while leaving the neighboring state of Nicaragua relatively untouched, and why Latin America as a whole has kept infection rates lower than other global regions, such as Africa and Asia. Smallman draws on the most recent scientific research as well as his own interviews with AIDS educators, gay leaders, drug traffickers, crack addicts, transvestites, and doctors in Cuba, Brazil, and Mexico.

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Smallman shows how the varying histories and cultures of the nations of Latin America have influenced the spread of HIV/AIDS there. Examining cultural issues and public policies at the country, regional, and global levels, he discusses why HIV has had such a heavy impact on Honduras, for instance, while leaving the neighboring state of Nicaragua relatively untouched, and why Latin America as a whole has kept infection rates lower than other global regions, such as Africa and Asia. Smallman draws on the most recent scientific research as well as his own interviews with AIDS educators, gay leaders, drug traffickers, crack addicts, transvestites, and doctors in Cuba, Brazil, and Mexico.

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THE AIDS PANDEMIC IN LATIN AMERICA

The University of North Carolina Press

Contents

Introduction...................................................1CHAPTER ONE The Caribbean: Cuba and Haiti.....................19CHAPTER TWO Brazil............................................67CHAPTER THREE Mexico and Central America......................113CHAPTER FOUR Spanish South America............................165Conclusion.....................................................203Notes..........................................................221Bibliography...................................................259Index..........................................................283

Chapter One

For twenty-eight-year-old Noremia Duarte Perez the worst part about being HIV-positive wasn't the illness but, rather, that she was separated from her son. The state had confined her to a sanatorium, and HIV-children could not be with their parents. Noremia's family found it difficult to deal with the boy's questions. Clara Perez, Noremia's mother, had worked hard to prepare him for his trip to the sanatorium: "The first time he visited his mother he asked why he couldn't live with her since she had such a nice little house? I drilled into him that she was living at a school and that children couldn't live there." Noremia's illness devastated Clara Perez: "For several weeks I was sick. I had to see a psychologist since I was feeling suicidal." But she had rallied because she believed she had to be strong for her daughter. Noremia knew how difficult her situation was for her family, but she carried a double burden in that she not only had to live with the disease but also had to keep secret the fact that she had deliberately injected HIV-positive blood: "My mother is terribly shaken too, but I've never told her about the self-injection. No-one would ever forgive me for that. I mean I have a child." Her father still thought that her fianc hadn't told her that he was HIV-positive. Noremia herself couldn't understand why she had done something that brought such suffering on her family: "I regret it terribly. I'd like to beat myself black and blue for what I did." And she worried endlessly about her son and how he would deal with his mother's illness and what she should tell him, because she had seen what this information could do to other children: "At the home, I have a girl friend with a nine year old boy. She told him that he had the disease and he tried to hang himself." Somehow both Noremia and her friend-whose son survived-continued and tried hard to make a good life for their families.

Noremia and her friend weren't alone. Throughout Cuba between 1989 and 1992 perhaps more than 200 people deliberately injected themselves with the virus. Some of them, like Mercedes, had seemed almost desperate to become infected: "I injected myself with blood eight times. I didn't test positive. One day Ivan and I got into an argument and broke up temporarily. When I saw him again he told me that he injected himself. One month later Ivan was positive and I was still negative. Then he gave me a shot of his blood and one week later I was positive. I was confined to the sanatorium." Like Noremia, Mercedes lamented her decision.

Early in my reading on HIV/AIDS in Latin America I came across a book by Marcos Cueto that referred to "a mosaic of infections" in the region. I loved this phrase, which captured the fractured nature of the epidemic. But certainly in no part of Latin America would this description be more apt than in the Caribbean. It is typical for works addressing the Caribbean to begin with a sentence such as "To construct a coherent overview of the Caribbean is extremely difficult because of the region's profound geographical and cultural diversity." This diversity is reflected in the varied presentations of the HIV/AIDS epidemic: from Puerto Rico, where the disease is often spread by iv drug users and where shooting gallery owners announce that their needles are "almost new," to Haiti, which has a widespread epidemic driven by unprotected heterosexual sex, to Cuba, where a quarantine and education program have managed to contain the epidemic, which is becoming increasingly focused in the homosexual community.

With its hundreds of islands, contested history, and cultural complexity, this region does not fit neatly into a history that focuses solely on Latin America. But it was here that a widespread heterosexual epidemic was first discovered outside Africa, and some countries now have HIV-positive rates that are surpassed only in Africa itself. Unless current trends are reversed, in the future AIDS may sharply decrease life expectancy in the region and lead to a corresponding rise in child mortality. Ties of trade, tourism, and migration link the region to the rest of the Americas. Any consideration of HIV in Latin America must address the Caribbean. This chapter will focus on two countries in particular: Haiti, which has the highest HIV-positive rate in the Americas, and Cuba, which has the lowest. Despite the obvious differences between the two countries, the perception and response to the epidemic in each was shaped by its relationship to the United States as well as its particular political culture. Thus the region demonstrates the extent to which international context and local culture continue to shape the development of this epidemic.

* Haiti

During the early years of the HIV/AIDS epidemic, Haiti was depicted abroad as a barbaric land where inhuman rituals might have introduced the virus into people. These beliefs in turn reflected long-held stereotypes of Haiti not only in the United States but also in the West. It might seem surprising that such a small country-one-third of the island of Hispaniola, which it shares with the Dominican Republic-once caused fear throughout the Western hemisphere. Today the island has more than 7 million people inhabiting an area the size of a small New England state. The majority of Haitians live either in a single city (Port-au-Prince) and its suburbs or in rural communities straining under the weight of land shortages, high unemployment, and environmental degradation. Yet this small nation once terrified elites in the Americas, who constructed an image of Haiti that has influenced popular perceptions of this country until the present.

Haiti won its freedom in an uprising that began as a slave rebellion in 1791 and continued as a war for independence until 1804, when the nation escaped from the control of European powers under the leadership of Jean-Jacques Dessalines. Haitian independence terrified national leaders from Brazil to the United States, where plantation owners feared that this example might inspire their own slaves to rebellion. Worried that if Haiti proved to be an economic and political success then the entire model of slavery in the Western Hemisphere would be threatened, the United States withheld diplomatic recognition from Haiti for fifty years. Accordingly, Haiti was isolated from birth and was generally depicted in the United States and Europe as a place of cannibalism and voodoo.

Haiti faced immense challenges after defeating France militarily as well as repelling invading forces from both Spain and Britain. The plantation agricultural system collapsed as freed slaves refused to work the land for others. The island had been left without any administrative structure, and there were bitter divisions...