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GUATEMALA
HIV/AIDS could spread among indigenous communities
Louisa Reynolds
7/30/2009
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Poor culturally-insensitive health care and some religious officials stand in the way of stemming HIV’s spread.

The highland town of Almolonga is known as "The Miracle City." More than 30 years ago, this Mayan Quiché town of about 20,000 people was gripped by disease poverty and alcoholism.

But in the mid-1970s, some 90 percent of its inhabitants became evangelical Christians and radical changes occurred. The town´s 34 cantinas were closed and replaced by churches. Almolonga became clean and prosperous and famed for its giant vegetables, especially carrots. However, this seemingly idyllic town has become blighted by the threat of HIV/AIDS. In recent months since the beginning of 2009, the Health Ministry has registered 14 cases in Almolonga. If the problem is not seriously addressed, misinformation and cultural taboos could increase the risk of contagion.

Almolonga´s mayor has pledged to begin an awareness-raising campaign on the importance of using condoms, but evangelical churches have adamantly rejected the idea and insist that fidelity within marriage is the only way to prevent the spread of the disease.

Evangelical pastor Mariano Xicará, admits that the number of HIV cases in Almolonga is on the rise but says that due to their religious beliefs many people mistakenly think that their family members died from diabetes or as a result of practicing witchcraft. (One of the first things the evangelical churches eradicated in Almolonga, along with the cantinas, was the worship of patron Saint Maximón, a syncretic cult in which Catholicism merged with the worship of the Mayan god Mam).

Last years, the Health Ministry reported 144 new HIV cases in Quetzaltenango. To date, there a total of 1,551 HIV-positive citizens live in the department. A report published by the National Center for Epidemiology and the National Program for the Prevention and Control of Sexually Transmitted Diseases, shows that Quetzaltenango has the 8th highest number of HIV sufferers in the country, with 206.71 cases per 100,000 inhabitants.

According to Violeta Isabel Ixtacuy López, who heads the National Program for the Prevention of HIV/AIDS in Quetzaltenango, most of those infected are young people aged between 15 and 25.

HIV/AIDS and immigration
Although most HIV cases are reported in predominantly urban departments such as Guatemala (35 percent of all cases) and Escuintla (10 percent), a steady increase in rural areas is causing concern, especially as it is feared that many cases are mistakenly reported as pneumonia, which means that the real number could be even higher.

Since Quetzaltenango´s first HIV case was detected in 1989, the local health authorities have focused their efforts on the municipality of Coatepeque, where there are 602 cases to date. This town is part of the route used by undocumented emigrants to reach the town of Tecún Umán, in the northern department of San Marcos, on the Guatemalan-Mexican border.

In the northern department of Huehuetenango, where emigration to the United States has increased rapidly in recent years, there are 148 cases of HIV, 105 of which have already developed into full-blown AIDS registered, 18.13 per 100,000 inhabitants.

Many community leaders, such as Saturnino Figueroa, mayor of San Juan Ixcoy, in the northern department of Huehuetenango, also close to the Mexican border, are trying to raise awareness of the issue.

"After people migrate, they come back with sexually transmitted diseases such as AIDS, which has already caused a number of deaths. A young man comes back from the United States infected with the disease and has sex with a number of women. All the women in the community want this man to marry them because they think he will give them material goods. Then, these women have sex with other men and that´s when it becomes a threat to the population. It´s an issue that few people are willing to talk about because it involves a person’s honor and people prefer to remain silent," he says.

Cross-border migration makes women especially vulnerable to contagion, as many emigrant women fall prey to prostitution networks operating in border towns such as Tecún Umán.

The lack of access to contraception in rural areas is another problem and increases the risk of transmission from mother to child. Currently only one in four HIV patients in Guatemala are female, but the number has grown in recent years. However, health authorities have yet to determine whether this means that more women are being infected or whether statistics are higher because more women are being tested.

Culturally appropriate healthcare
Mayan psychologist Ángel Soval works for an HIV/AIDS clinic in Quetzaltenango financed by the Global Fund, the only health center in Guatemala that offers a culturally appropriate service for the indigenous population. The clinic is currently treating 470 patients and has given antiretroviral treatment to 325 since it was set up two years ago.

"In conventional clinics, doctors wear a white coat and are up there but I try to be a community advisor. People see me as an equal," says Soval. One of the clinic´s greatest achievements has been training community members to become health advisors.

Almost half of all public health workers in the country are located in the department of Guatemala, where just 22 percent of the population lives. However, just 43 percent of all health workers cater to the remaining 10 million Guatemalans who live in rural departments.

The lack of good quality healthcare in rural areas explains the lack of HIV/AIDS programs in Mayan languages. "We´ve overlooked the indigenous population," admits Mariel Castro, director of the National Program for the Prevention of HIV/AIDS.

Álvaro Pop, president of indigenous organization Naleb clearly illustrates why culturally appropriate healthcare is so important: "There´s a relationship of power between a doctor and patient that inevitably subordinates the patient. In a rural area where we have a non-indigenous male doctor and a female Quiché speaking patient, you´re going to have serious problems."
—Latinamerica Press.


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Indigenous communities, like Almolonga, are particularly at risk of HIV´s spread. (Photo: Louisa Reynolds)
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