Dalia Acosta

Unique situation increases sex workers' risk of STDs

HAVANA — An 18-year-old sex worker in the Cuban capital says that over the past two years, the foreign tourists she frequents have used condoms "maybe four times at the most."

Her Italian, Spanish or Mexican "friends" (she flatly rejects the description of them as "clients") would be offended by the idea, she says.

"How could I demand that they use a condom? They would think I don't trust them. I could never do that," explains Aloyma, the name she gives, who walks up and down Obispo street, in the centre of Old Havana, every day, seeking out foreign tourists.

"What I'm looking for is a guy with money who wants to marry me. Until that happens, I have to survive," she says, to explain why she does what she does.

Aloyma does not consider herself a prostitute. "I'm a fighter," she says.

Studies carried out among small groups of sex workers in Cuba since the early 1990s have found that an overwhelming majority of them do not insist that their customers use condoms.

The reasons for that lie in the peculiarities of the sex trade in socialist Cuba, and the widespread rejection of the condom as something that inhibits pleasure.

Most prostitutes in Cuba offer affection and company without time limits to any foreign tourist, rather than sex for a specific period of time at a pre-established rate, as occurs in most countries.

For Cuba's sex workers, every foreigner with dollars represents a potential lasting relationship, which could continue throughout the tourist's entire visit, be maintained later by mail, and even turn into a possible route for leaving the country.

Prostitution, which was virtually eliminated in Cuba in the 1960s, after the 1959 revolution, began to re-emerge in 1990, with the start of the worst economic crisis faced by the socialist government of Fidel Castro, and the opening of the country to foreign tourism.

In Cuba, there are no official statistics on the number of people involved in the sex trade.

But a study carried out up to November 2000 in Old Havana, to which IPS had access, focused on a group of 17 female sex workers, 41 percent of whom were between the ages of 15 and 19.

The study found that seven of the women had been infected with a sexually transmitted disease (STD) at some point, while one of the women tested positive for HIV, the AIDS virus. The most frequent STD was gonorrhea, followed by syphilis and the human papilloma virus (also known as genital warts).

These women "are unaware of the health risks posed by the diseases," and enter into sexual relationships "without the slightest awareness of the need for protection" on the part of either of the parties involved, says the study.

According to experts, most prostitutes in Cuba use condoms very infrequently, and when they do so, it is on the request of tourists, rather than on their own initiative.

The government's Health Statistics Yearbook 2000 shows that 19,067 cases of gonorrhea were reported that year, along with 9,199 cases of syphilis — rates of 170 and 82 per 100,000 inhabitants, respectively.

But the latest studies by the Sanatorio de Santiago de Las Vegas, a health centre that specialises in the treatment of people with HIV/AIDS, indicate that female sex workers are protecting themselves, despite views to the contrary.

The resurgence of prostitution "has not been accompanied by a large number of women testing positive for HIV," Dr. Jorge Perez, the director of the Pedro Kouri Institute of Tropical Medicine, told IPS.

Some 30 people who engaged in prostitution were detected between January and November 2001 in Cuba, said Perez. And "in that group, the number of men infected with HIV was much higher than the number of women," he added.

As of November 2001, 3,775 cases of HIV/AIDS had been reported in this Caribbean island nation of 11 million, 1,460 of whom had already developed full-blown AIDS, and 998 of whom had died, including 57 who died of causes unrelated to the disease. Of the total 2,777 people living with HIV, 77.9 percent are men.

The most common route of HIV transmission in Cuba is gay and bisexual sexual relations.

Authorities' concern about the spread of HIV among prostitutes and gays led to the announcement in August 1997 of a prevention campaign targeting those two groups.

Maria Isabel Dominguez, a researcher at the government Psychological and Sociological Research Centre, reported that 116 sex workers testing positive for HIV were detected in the first half of 1997.

Five years later, the Public Health Ministry's Centre for Prevention of STDs-AIDS is working closely with the gay community in Havana.

But it has been a bigger challenge to establish ties with female sex workers.

"It has been very difficult," said one of the prevention centre's experts, Maria Julia Fernandez. "They hide, they are afraid of being included in that high-risk group, of being controlled and monitored. It is very difficult to break into that group. But we are trying to do things."

Although prostitution is not penalised by law in Cuba, women who engage in such behaviour can be forcibly admitted to "rehabilitation centres", as they are seen by the government as potentially "dangerous elements," with possible links to criminal activity like drug dealing and pornography.

The penal code defines "dangerous elements" as people with a tendency to engage in criminal activity or "anti-social" behaviour that runs counter to socialist morals and disturbs the community.

Against that backdrop, there are few health initiatives directly targeting female sex workers. However, prostitutes enjoy the same access to full health coverage, free of charge, that is available to the entire population.