Garífuna AIDS Prevention Project - Honduras

The project's central strategy is reaching community members through networks of volunteers. The programme implementers, Dr. Nestor Salavarría and Dr. Manuel Sierra, hired 2 fellow physicians and 10 AIDS awareness promoters from the community, who in turn recruited volunteers known as "multipliers" from different social and age groups. "The idea was to identify and mobilize local resources and to create empathy and awareness of the problem," says Sierra. "Those children and teenagers and others who were trained would continue to train others of the same interest and same age." AIDS awareness meetings are held for groups such as teenage girls, young men, and concerned mothers.

Multipliers spread the message that AIDS can strike anyone who fails to take the necessary precautions. Part of changing the Garífuna's mindset about HIV/AIDS has involved teaching ways that AIDS is not spread, such as by sharing a cup with someone who is HIV-positive or using the same toilet. This strategy is designed to debunk myths that have stirred fear, stigmatisation, and denial.

Staff members from the Buen Pastor Clinic, of which Salavarría is the Director, developed AIDS educational materials with input from the community, based on the special circumstances faced by the Garífuna. Involving the communities' own members was a strategy to sustain the programme even after grant monies were exhausted. "What was remarkable was that when we visited the communities with our own NGO resources," says Sierra, "most of the multipliers we trained are continually doing activities in spite of the absence of funding. They were really highly motivated."

HIV/AIDS.

The Garífuna villages that dot Honduras' northern seacoast have the highest incidence of HIV/AIDS in the country. AIDS is a growing threat to these members of Honduras' largest minority: the cumulative rate of AIDS cases among these descendants of Africans and Amerindians is nearly 15 times the national rate. More than 8% of adult Garífuna test positive for HIV, 4 times higher than the national average. Sierra's studies found that some Garífuna communities had a cumulative incidence of AIDS cases greater than 2,000 per 100,000 inhabitants, compared with 134 per 100,000 at the national level. He also found that only 20% to 40% of sexually active Garífuna men regularly use condoms. "This epidemic is decimating their population," says Salavarría.

Organisers note that for 2 centuries the Garífuna's Afro-Caribbean culture meant that they subsisted primarily through fishing and farming, later growing bananas as a cash crop and selling mahogany. But in recent decades, the Garífuna's search for work has increasingly taken them to the Honduran cities of La Ceiba or San Pedro Sula and even as far as London and some cities in the United States. When Garífuna migrants return home, as many do, they often bring HIV/AIDS. A recent study found that 1 of 5 commercial sex workers in San Pedro Sula are HIV-positive; New York City, where the greatest number of Garífuna emigrants end up, has more AIDS cases than any other USA city, according to the Centers for Disease Control.

One researcher who has studied attitudes towards HIV/AIDS among the Garífuna found that most residents were able to identify the causes and symptoms of AIDS. The problem, he says, lies more with their perception that only people of low moral standing are at risk. "People seem to be denying the link in infection, that people who they know, who are close to them, could be infected." This culture of denial means that hardly anyone in communities like Trujillo or Limón "dies from AIDS," at least officially. A physician at Limón's local clinic, where records reveal only one death from AIDS, acknowledges that doctors and nurses often yield to pressure to mask the true cause of an AIDS death, protecting the reputation of the deceased and his or her relatives.

For most Garífuna with AIDS, the $180 per month for single-drug therapy is out of reach; the preferred "triple therapy" (over $1,000 a month) is simply not an option for the vast majority. "Right now, most of the Garífuna with AIDS who receive treatment get it from family members who are living in the United States," says Sierra.