The Miami Herald
Wed, Feb. 02, 2005

Ecuadoreans cry for help in a region prone to HIV

The incidence of HIV and AIDS on the southwest coast of Ecuador is much higher than in the rest of the nation.


GUAYAQUIL, Ecuador - In this city, it sometimes seems as if AIDS sneaks up on people.

The illness was already ravaging her neighborhood, but Michele Alvarado had never really heard anyone talk about it before her husband came down with tuberculosis and hepatitis B two years ago. Hospital doctors then found he was HIV-positive.

''It was terrible,'' a tearful Alvarado remembered. 'They said, `He's got HIV and he's going to die.' That was it. There was no psychological help at all. I cried. He cried.''

Five days later he died, at age 29. Alvarado, 27, learned a few weeks later that she also had contracted HIV, the virus that causes AIDS. She slipped into a deep depression and contemplated suicide.

Alvarado and her husband are just two of the victims of a medical condition that is more prevalent along the southwestern coast than in other parts of Ecuador for reasons that aren't clear. This city and the poverty-stricken provinces around it are host to 80 percent of the 6,000 HIV cases reported in Ecuador from 1984 to 2004 -- with Guayaquil alone home to 60 percent.

''If we don't get programs of prevention and education going . . . we're going to have a generalized problem that parts of the Caribbean and Africa do,'' said Dr. José Prado, the director of the government's AIDS program along this part of the coast.

The reasons for the high AIDS concentration are many and complicated. Guayaquil, a port city of more than two million people, is an economic hub that attracts men and women from all over the country to work. As such, prostitution is high, bar life vibrant and promiscuity common, health experts say.

''Here there are a lot of young people who are single and looking for work,'' explained Angel Valencia, head of the U.N. AIDS program in Guayaquil. Valencia said about 20 percent of the registered cases of HIV in Ecuador are day laborers and another 20 percent are maids.


Mario Morales, for instance, used to paint interiors and spend most of his free time in bars. His drinking, he said, led to philandering and eventually AIDS.

''To use a condom was taboo,'' he said, referring to the mid-1990s, when he was diagnosed with HIV. ``I was ashamed to go to the pharmacy to ask for a condom.''

Condom use between spouses is even less frequent -- one of the many reasons health experts say the latest victims in this scourge are housewives. Cheating husbands often bring home the virus to wives who do not demand they use protection, victims and doctors say.

For her part, Alvarado said she lived in ignorant bliss.

''I always tried to be the best wife and mother,'' she said. Her husband, on the other hand, told her he thought he had contracted the virus from a male prostitute.

The lack of awareness and absence of a concerted government response makes it hard to grasp the gravity of the problem. The stigma attached to having the illness makes it equally difficult to spread the word about its dangers.

''They only go to the hospital when they're at a very advanced stage, because of the discrimination attached to the disease,'' said Dr. Lilly Márquez, who heads a consortium of 21 nongovernmental organizations fighting AIDS through education and health programs.

Ecuadoreans with HIV have reason to fear. Many lose their jobs, their friends or their families. Some lose all three.

María Luísa Ronquillo, a 31-year-old with HIV, said her mother and brother ridicule her and her children, three of whom are HIV-positive. She says she got HIV from her former husband.

'My mother says, `You're a plague. Your kids are a plague,' Then my brother says, 'Don't bother. She's gonna die any minute now.' ''


Ronquillo, Alvarado and Morales are in support groups now. They meet regularly with each other and Márquez to talk about how to raise awareness about the condition and secure funds for treatment.

Up until recently, they felt as if they were yelling into the wind. For years, authorities did little to help the sick and seemed embarrassed to admit AIDS was even a problem.

But the situation may be starting to change.

Morales and a group of others have successfully sued the government for medical support, and the Health Ministry regularly provides low-cost drugs now. International donors recently gave the government a $14 million grant to fight AIDS over five years.

Still, Prado and others say that it's only a fraction of what's needed to stop the scourge. He believes Ecuador must combat AIDS through sex education programs, most of which have no funding and await government approval.

''We have to reach out to the youngest generation because they're the ones who are getting infected,'' he said.

In this area, he added, the dangers of unsafe sex are often learned on the street, sometimes the hard way.