Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.

Reuters NewMedia, Inc. - Monday, 30 December 1996.
David Koop

Booming prostitution, an ingrained culture of machismo and widespread ignorance about the disease make Nicaragua fertile ground for the AIDS explosion experienced by its Latin American neighbors years ago, activists said.

"Nobody here thinks of AIDS prevention and that is dangerous. The numbers could rise very soon, very rapidly," Dr. Alejandro Sanchez of the United Nations Development Program in Nicaragua told Reuters.

Nicaragua, with 4.2 million inhabitants, has only 82 confirmed AIDS-related deaths and 131 reported cases, according to Panamerican Health Organization statistics. This is less than nearby Belize, with one-twentieth of its population.

While official AIDS statistics are dubious because of rampant underreporting, Nicaragua's AIDS rate is clearly very low, Sanchez said. "This was due to the Sandinista revolution, since the borders were practically closed in the 1980s and we had no relations with the United States or other countries."

The 1979-1990 left-wing Sandinista government fought a bloody eight-year civil war against U.S.-backed Contra rebels and faced a U.S. economic embargo, meaning that only a few Cuban and Soviet advisers ventured to Nicaragua, Sanchez said.

SANDINISTA DEFEAT OPENED DOOR TO AIDS

But the Sandinistas' electoral defeat in 1990 by free-market President Violeta Chamorro ended Nicaragua's isolation and opened it up to the world again. And with this new openess came AIDS.

Sanchez said he found his first patient in 1990, and he had to travel to the remote northern region of San Juan de Rio Coco, near the Honduran border, to reach her. He then left the country and when he came back in 1992 he found he had 25 cases to treat in Managua alone, and the numbers have since continued to climb.

He said most people with AIDS were not registered with the Ministry of Health, preferring to remain anonymous rather than face exposure by state institutions they did not trust.

At the bar of a Managua club, Veronica, a slender 18-year-old prostitute who said she had sex with four or five men a night, said she knew about AIDS prevention but most of her customers did not. "They never want to use condoms. They think AIDS is a homosexual disease, that they can't get it from a girl. They still don't see it as affecting them," she said.

MACHO ATTITUDES WORSEN AIDS PROBLEM

Activists agreed that AIDS awareness in Nicaragua is dangerously low and macho attitudes and poverty make condom use infrequent. "There are virtually no AIDS awareness programs, condoms are scarce and sex education is banned from the classrooms," women's rights activist Josefina Pao said.

Pao said machismo that glorifies men with a large number of sexual conquests has sharpened the problem.

But more disturbing still is popular ignorance of the disease and the reaction to people with AIDS. Sanchez recalled one of the first cases in 1991, in the southern city of Rivas near the Costa Rican border, in which neighbors burned down the house where a 24-year-old man with AIDS lived.

"His family was completely marginalized. The children couldn't go to school. The family couldn't work," Sanchez said.

He said almost all his patients have suffered discrimination. The worst case was in the town of Bluefield on Nicaragua's Atlantic coast where a woman with AIDS was kept in isolation by her drug-addict husband and his family.

"They kept her in a cardboard shack at the back of the yard like a monster. She was covered in sores, she never washed, she defecated where she slept. They threw her food from a distance. She died that way," he said.
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