Monday, March 21, 2011

HIV on the streets

Ever since I attended an HIV/AIDS seminar hosted by the Ministry of Health and learned that Ecuador has one of the lowest HIV rates in Latin America, I hadn’t given the matter much thought, despite the confession of one of the sex workers that her son had recently been diagnosed as HIV positive. Apparently, the HIV rates are higher on the coast, particularly in the province of Guayas, home to Ecuador’s most significant city of commerce, Guayaquil, due to its bustling port. Indeed, the sex worker’s son who is HIV positive lives in Guayaquil. I have no idea how he contracted the disease, but he fits my profile of who might be a vulnerable target, simply because he’s from the coast. Terribly ignorant, I recognize. I simply do not associate Quito with HIV/AIDS despite the fact that I work with a very vulnerable population, in which sex workers often don’t use condoms simply because their clients pay them double. The contraction of HIV/AIDS through dirty needles would be rare given the low rates of heroin consumption here. As a neighbor of Colombia, Ecuadorian drug consumers usually stick with various forms of cocaine (the most common form found on the streets is “base” which has a similar effect as crack, but is actually the unrefined form of cocaine, the leftovers of the chemical component before coke is refined—different from crack, which is the chemical transformation of processed cocaine). Therefore, I would deduce that rates of HIV spread mostly through unprotected sex.

My ignorance about the existence of HIV/AIDS rates in Quito was quickly laid to rest when I found out that a very young sex worker died from AIDS last week in the neighborhood where I work. I didn’t know her personally, but apparently she had been working in the sex industry for many years despite the fact that she was only 23 years old. I found the circumstances of her death heartbreaking as I learned that she died alone, in one of the hotels where she worked. Apparently, when she discovered her positive status she didn’t follow a medical regime to prevent the onset of AIDS, she simply lived her life as before, perhaps in denial of her condition. To a gringa like myself, where in my country HIV is no longer viewed as a death sentence due to the accessibility to the appropriate drugs needed to prevent the onset of AIDS related illness, it came as a shock that she simply surrendered to her fate. Actually, “shock” is not the correct word since I have been working on the streets for long enough to know that many sex workers don’t have the resources or the knowledge of how to work the incredibly bureaucratic medical system to receive effective care. Quite frankly, if I were diagnosed with HIV here I wouldn’t know how to start treatment either (but I would have the privilege to simply jump on the next plane home and receive the very best treatment possible). No, indeed, it wasn’t shocking, just sad.

I don’t know the circumstances surrounding her contraction of HIV, but I would guess that she was a drug consumer simply because sex workers who are supporting a habit are more willing to have unprotected sex. Undoubtedly, their addictions cloud their judgments and the temptation of extra money is an appealing offer when their lives depend on their next fix. Certainly my casual conversations with different women indicate that non-addicts are more likely to refuse clients who seek unprotected sex. I would even say that my friends on the streets who are not addicts religiously use condoms, no matter how perilous their economic conditions. Most of the women know the tricks of the trade and are able to remove themselves from situations where a client might insist on not using a condom. Rape of course is another matter entirely. I haven’t broached this topic with any woman yet, and not one woman has confessed to me that she has been raped in this line of work, even though I realize it must happen frequently (a matter to be discussed in another entry). But since negotiations (price, what acts will be performed) with clients happens on the streets even before entering the hotel, a woman can maintain a firm stance on condom use since the client can simply move from woman to woman on the corner until he finds someone who will acquiesce. And again, the women who acquiesce are usually addicts who aren’t necessarily thinking about their long-term health.

Not only did I learn of the death of a sex worker last week, but I also discovered that another sex worker (whom I’ll call Carmen), someone I’m close with, and her partner are also HIV positive. I wasn’t surprised given the extraordinary self-destructive and reckless life Carmen leads, but it saddened me because I don’t think her fate will be any different than the woman who died last week. Indeed, it’s somewhat of a miracle that Carmen has survived thus far in life, despite her twenty-odd years, given the fact that she was a street kid, fending for herself since she was a young child. Street kids often don’t make it to adulthood, so in some ways Carmen has already been lucky. Similar to the woman who died last week, neither Carmen nor her partner are seeking treatment to manage their positive status. They are both base addicts who seem to live in the moment so perhaps treatment seems irrelevant, as they don’t ponder their long-term fates. Among all the sex worker addicts, Carmen stands out as the most vulnerable, not just because her addiction seems worse than others, but because of how her long term existence on the streets has marked her as a person. She is tougher (more guarded) than the rest and therefore took me more time to break through her shell. Once I did, I realized that that she’s in desperate need of love and nurturance. Now that I know she is HIV positive, its puts her constant illnesses into perspective. Carmen is always sick. Sometimes this is due to drug withdrawal, but sometimes she disappears for days in the hotel, suffering through a “cold” as she tells me. She is constantly shaking, again, perhaps the affects of drugs, but her disturbingly thin frame causes me to worry even more now. I would never intervene in her fate unless explicitly asked, but in some ways I don’t think she really cares if she’s dead or alive—she has always seemed among the walking dead, regardless of how heartbreaking that is to me. I say a little pray for Carmen whenever I see her on the streets—that she may find peace one day, in this world or the next.

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