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Chapter 4: Immigrants As immigrants struggle to talk to a doctor, take a pill or even admit they're ill, they face daunting roadblocks: Different culture. Different language. Different beliefs.
When all hope had vanished, she found reason to live again.
Judith Sarmiento Rivera sits nervously in a small room at Prince of Peace Catholic Church in Miami, where friends help her dress for her wedding day.
"Make me beautiful, the way you always do," she tells the friend doing her makeup.
Today she will marry Jorge Rivera, who as a seminarian was sent to give her religious instruction.
Why would a man, yearning for a priest's pure life, marry a divorced woman, a mother of two with a virus that can infect him, too?
Judith wondered the same thing.
So many things in life can be simply explained, but not love. And not faith.
Jorge didn't question his attraction to the woman he decided to romance. He knew. Something more powerful and merciful than anything on Earth led him to abandon his lifelong dream of priesthood to care for one woman.
"The hand of God," he says simply.
In June 2001, the couple, who share an apartment in Little Havana, were married in a civil ceremony. Now they're marrying again in a Catholic church so Jorge can take communion, an important ritual in his life.
Before the ceremony, Judith's friends help her into a white dress dotted with lace flowers. On her fingers: faux nails painted with tiny white flowers.
Don't leave them on long, a friend cautions. You can't risk an infection.
Judith understands the warning. About five years ago, an HIV-related infection stole her vision. Now that she's dressed, her friends serve as her mirror because she only sees shadows.
The infection wasn't inevitable, but after being diagnosed in 1996 she refused treatment for the virus.
"I didn't know what it was," she says, then adds, "I didn't want to accept it. I felt well. I was working."
Judith's initial reluctance to seek help isn't unusual. Some immigrant women are often frighteningly powerless. Even when infected by their husbands, many are afraid to speak or act.
Some husbands are legal U.S. residents, crucial in helping wives gain residency. Many provide the only paycheck. Wives who challenge their men often fear beatings or abandonment and wind up on the streets.
Judith, who navigates her way through life speaking Spanish, knows how hard it is for other immigrant women. Her first husband, who was here legally, split in '98 while she was hospitalized for an HIV complication, she says. Her South Florida relatives turned their backs, too.
She remembers being alone, lying in a hospital bed, watching her dreams vanish. Now she'd never get her two Honduran-born children into the States.
But when Jorge, 38, came into her life, everything changed.
Today, Judith dares to dream again. She has a new life with a new man who calls her his queen. When she was inches from death, he nursed her. When she balked at taking medicine, he insisted.
Every morning, before heading to his office-cleaning job, Jorge makes the sign of the cross in front of his wife's face: May God keep you safe for another day.
Now, her Puerto Rican-born husband is helping in another way. He's trying to change her illegal status through marriage, so she can bring her children to the States one day.
Immigration problems still complicate her life, though not her medical treatment. Because AIDS threatens everyone, treatment is usually available, despite legal status, but funding is never a certainty and paperwork can be daunting.
For now, Judith's biggest hurdle is working her way into the outside world. She has no work authorization or Social Security number. And that limits what she can do. So for the time being she volunteers with Hispanic AIDS Awareness, an outreach program in Miami.
She talks to schoolchildren about HIV and answers their frank questions, telling them that she and her husband use condoms. She's also a lifeline for HIV-positive friends and spends hours on the phone, counseling or just listening.
Judith understands her time on Earth is a gift, and she wants to share it.
"I want to help my people," she says. "I dream and I have a lot of goals."
The couple even talk of having children one day, using artificial insemination to protect Jorge from the virus.
But at this moment, their thoughts are only of each other. With the wedding about to begin, a friend takes Judith's arm to guide her and they walk toward the church entrance. Processional music fills the church where 20 or so people wait, then stand as Judith enters and joins Jorge at the altar.
A bright orange light from the sunset comes in through the windows as Jorge makes the sign of the cross in front of Judith's face.
Judith smiles at her groom as he lovingly caresses her hands in his.
Then they promise to love and respect each other, all the days of their lives.
It's a hard life in a new land, with unfamiliar ways and a strange disease.
After a day in the fields, Elifranc Joseph returns to the bare, concrete room where he lives in Belle Glade, $20 pay in his pocket for picking oranges.
Joseph has no steady job, no phone, not even a kitchen in his makeshift apartment. He does have hundreds of dollars worth of HIV pills stashed in little brown paper bags atop a broken refrigerator.
His apartment is lighted by a single naked light bulb dangling from the ceiling. His place is so crammed with salvage -- three broken TVs, plastic flowers, stereo speakers -- there's barely room for Joseph.
Most of the stuff he collects from flea markets, garage sales, even trash cans goes to Haiti for a friend to resell, then Joseph gets a cut. He makes a few dollars picking citrus, too, back-bruising work under a scorching sun, but Joseph has little choice.
"We start off early and by noon, I'm sweating and shaking," he says. "I have to lie down next to a tree. Even if I died, they wouldn't care. They would just call the police."
Joseph talks of working for "the white man" in a matter-of-fact voice. He speaks in Creole, a French dialect linked to Haiti's history as a French colony.
Like many immigrant men, he understands his precarious place on American soil. In their own country, it's more of a man's world. But in the States, virtually every American man, woman and child has more protection and power than the newly arrived immigrant. It's a painful culture clash.
In Haiti, Joseph is father to six children by six women. In Belle Glade, he is father to two sons, 6 and 7, with Gessie Pierre, 36, whom he met shortly after she came from Haiti. For Haitian men, multiple sex partners and multiple children equate with money and power, explains Haitian-born Thomas Cherizard, a Belle Glade counselor who works with people infected with the virus.
Disastrous thinking in an AIDS epidemic.
Pierre insists that Joseph gave her the virus, but says the boys aren't infected and don't know their parents are. Joseph claims she infected him, though by his own account he tested positive at least two years before their paths crossed.
Joseph, as well as Pierre, faithfully take their pills and appear healthy. Some Haitians, wary of high-tech medicine, turn elsewhere for help.
In Haiti, religion plays a powerful role in time of sickness. The supernatural prevails, and people often look to vodou in hopes of finding a cure. Some blame their illness on spells, cast by neighbors, friends or deceased loved ones prompted by jealousy or as punishment.
In Belle Glade, a poor, rural area hard hit by the epidemic from the beginning, some even blame the infection on their job, cutting the sugar cane that surrounds the city like a heaving green sea.
Some Haitians diagnosed with HIV use such terms as "san-m pa bon [my blood is not good]," explains Carole Démesmin, a mambo, or Haitian vodou priestess, who practiced in South Florida before moving to Chicago. "Or they will tell you, 'I went to the doctor. They told me I have AIDS, but at the same time I know someone who didn't like me. I had a dream, and in my dream someone was trying to hurt me.'"
Démesmin offers only treatment for symptoms, no cure. She suggests a tea made with Haitian herbs to reduce cramps and anal irritation. Or a drink from yucca flowers to curb diarrhea.
Like many immigrants, Joseph travels back and forth to his country. At least one study shows that the AIDS virus is America's least desirable export, with people becoming infected here, then seeding the virus worldwide, where it continues its murderous spread. Today nearly 42 million people globally are infected with the virus; roughly 20 million already have died.
But Joseph doesn't believe he's spreading it on his trips back to Haiti. None of his six children or their mothers are infected, he insists, though one of the women died recently. He is concerned that his Haitian relatives will discover he's positive because it appears he has never told anyone.
"A lot of people are afraid of AIDS," he says.
On paper, at least, U.S. immigration policy doesn't allow people with a communicable disease that affects public health to get a visa or even come to this country. But exceptions exist, and, as Joseph proves, laws don't stop the flood of immigrants, sick or healthy.
Joseph believes in the pills that have kept him alive but doesn't understand the medicine's limits. He shuns wearing a condom with her, Pierre says, subjecting them both to new, harder-to-treat strains of the virus.
Yet in one vital way, Joseph isn't typical of many Haitians who carry the virus. He admits he's infected and takes the pills with remarkable discipline. He even encourages others to do the same.
"They say you are a bad person, a bad friend, to bring it up," he says.
But every morning, he faithfully places pills in a recycled plastic lid and knocks them down like a shot of whiskey, chased with water from the plastic jug next to his bed.
He knows the pills make a difference. The difference between life and death
He loved his wife so much, he saved her from the truth.
From the hospital bed where she lay dying, Margarita Monroy looked up at her husband and spoke:
"What did the doctor say?"
Juan Carlos Riascos pauses now, sitting in the comfort of his Miami home, recounting the last days of his first wife's life.
She was asking about their daughter, he explains. Sick as she was, her thoughts focused only on their child, then 2 1/2. The question left Riascos momentarily speechless. He hadn't checked back with the doctor for test results. He was overwhelmed; his thoughts a jumble. The last few weeks were a blur of desperate moves numbed by stunning grief.
As Margarita had grown sicker, the three flew from their home in Bogota, Colombia, to a New York hospital, hoping someone could help.
But no one could.
Now her only wish was to go home, to die in her own bed in her own country among her own people. But by the time their plane landed in Miami she was too sick to continue. Her fever raged. As days passed, Riascos could only watch her life drain away in a Jackson Memorial hospital room.
How had it come to this? He, a college-educated man from a fine Colombian family. Only a few years earlier, he had circled the globe, doing business in multiple tongues. He was a successful man. Then he'd settled down, marrying a beautiful young woman from his hometown.
AIDS? Why, that's a gay man's disease, he'd always thought, and paid no attention.
Riascos picked up the phone and dialed. On the end of the line, a doctor quietly spoke. She was very sorry to tell him the virus was now killing his daughter, too.
"She has AIDS," the doctor said.
For a moment, Riascos couldn't speak. He couldn't think. For certain, he couldn't imagine what desperate course his life would take.
That in a matter of days, his wife would be dead.
That a month later, he'd leave Bogota for good, settling in Miami because his country offered no medicine, no hope. That he'd pay thousands of dollars for drugs he could get no other way and guess at the dosage for his daughter, never knowing if the drugs would kill her or save her.
That within three years, Miami doctors would send his daughter home twice to die -- her body wasted, pale flesh clinging to tiny bones, a feeding tube jammed into her soft flesh.
That he'd beg to get his daughter into an experimental drug program for children, but she wouldn't qualify because she wasn't born in this country and had no Social Security number.
That, finally, miracle drugs would give his daughter a whole new life.
But all that was far off in a future Riascos couldn't even imagine as he sat in the hospital room by his dying wife. He didn't know then that he'd do all this and more so his daughter could live another day.
He only knew he loved his wife so much he would protect her now in the only way he could.
Riascos put down the phone and looked into her anxious face.
"How is she?" his wife asked again.