National Agenda : Prostitution, Prejudice Fuel AIDS Epidemic in Honduras : It has Latin America’s highest case rate. But only a handful of volunteers are dedicated to helping victims.

The man had died around midnight, and 12 hours later, the hot tropical sun beating steadily, Helen O’Connor was in a hurry to get to the cemetery.

She loaded this latest victim of AIDS into a wooden coffin and onto the back of a pickup truck for delivery to the ever-after. O’Connor, a nurse from England, would say a prayer over the grave, and that would be it. Because in a country where AIDS still carries a damning stigma, this man’s family had long ago abandoned him.

Spread by a flourishing prostitution industry and a culture that places little value on marital fidelity, AIDS has reached staggering proportions in Honduras, where beleaguered health care workers, worried government officials and a frightened, impoverished society are woefully under-equipped to handle the epidemic.

Honduras now has the highest rate of AIDS cases in Latin America, according to the Pan American Health Organization--nearly twice that of Brazil and approaching those of some Caribbean nations. With about 15% of Central America’s population, Honduras accounts for 60% of the isthmus’ AIDS patients.

And nowhere is the crisis more evident than in San Pedro Sula, Honduras’ bustling second-largest city, a boom town thriving on sugar and banana trade that is now derisively known as the AIDS capital of Central America.

Despite the magnitude of the health crisis that the acquired immune deficiency syndrome presents, only a handful of Honduran and foreign volunteers here are dedicated to caring for those afflicted with the disease. It is a fight not just against the ravages on the human body, but against prejudice, ignorance and poverty.

“There is a lot of fear,” nurse O’Connor said. “People don’t want to be around AIDS victims, much less care for them. Most of them have nowhere to go.”

So where they end up going is a place such as the San Jose Hospice, sponsored by the St. Joseph’s Hospital Assn. of Liverpool, England. Hidden on some undeveloped property on the city’s outskirts, the sparse shelter offers spiritual reinforcement and basic maintenance care to ease the suffering of those waiting to die.

Eleven British nurses care for about 30 patients at a time. “There are a lot of people still out there” who do not get any sort of treatment, O’Connor said. “The disease is spreading like wildfire. People here know it kills you, but there’s a lot of ignorance about how it’s caused.”

In contrast to the United States and other first-world countries, roughly two-thirds of Honduran AIDS patients and those with HIV, the virus that causes AIDS, are heterosexual. Just over half are women--some prostitutes, some women infected unknowingly by their husbands. And a growing number are children.

In San Pedro Sula, health officials are now finding that nearly 4% of pregnant women with no other risk factor--women who are neither prostitutes nor intravenous-drug users--are infected with HIV. It is a frightening statistic that graphically illustrates how AIDS is moving through the general population, say officials at the Pan American Health Organization.

“If we take into account that it takes 10 years for HIV to go into AIDS, this tells us that in a few years, no matter what is done in Honduras, there will be many, many cases of AIDS that will require medical attention, social care and psychological support,” said Dr. Fernando Zacarias, who heads the Pan American Health Organization’s AIDS program for Latin America.

“The impact on the economy, if only through the loss of productive young people and workers, (is devastating),” Zacarias said. “The situation is only going to get worse.”

Experts believe the HIV virus was probably introduced into Honduras in the late 1970s, earlier than the rest of Central America, because of brisk international commerce on the country’s Caribbean Coast. Sailors and merchant marines flocked to and from Honduras’ ports, where prostitutes were readily available.

“Commercial sex workers and intense international trade make fertile ground for sexually transmitted diseases, including AIDS,” Zacarias said.

Prostitution continues to flourish, entrapping teen-age girls and boys desperately seeking ways out of poverty as men routinely solicit their services. As in many Latin American cultures, Honduran men are reluctant to use condoms. And women, says Dr. Carlos Lopez, usually don’t know how.

Lopez and his volunteer staff run this city’s only clinic dedicated full-time to caring for AIDS patients. Down a rutted dirt road and in a house deliberately unmarked, the clinic was opened to give people a place they could seek treatment discretely, Lopez said. It operates with the help of charity and international agencies.

Six metal cots fill one room. This is where the patients, mostly women and some children, come for medication, nutrition, blood transfusions and relief.

Lopez’s clinic, which opened three years ago, handles a caseload of 626 patients, including 23 children. More than 160 have died. Honduras, with a population of about 5 million, has officially registered 2,700 cases of full-blown AIDS. But underreporting is believed to be widespread, and about 50,000 Hondurans may be infected with the virus, Health Ministry officials say.

“We are very worried,” Lopez said. “The multiplication of the disease grows and grows. Statistics do not begin to capture the problem.”

Lopez and his volunteers have begun visiting the scores of brothels in San Pedro Sula, plus factories, schools and military posts, to campaign for the use of condoms and to educate Hondurans on the disease and how it spreads.

The government, working with a budget dwarfed by the number of the sick, recently shifted its focus from encouraging monogamy to encouraging condom use in extramarital sexual contacts. In addition to promiscuity, the existence of a large transient population has also contributed to the increase in AIDS cases. Migrant workers who move from the coastal ports south into Honduras’ vast banana plantations may be carrying the disease, experts say.

And many Hondurans blame the presence of U.S. troops during the 1980s, when Honduras was used as a staging ground for U.S.-backed rebels fighting the government of Nicaragua. However, Zacarias and others said that, while American GIs who frequented Honduran whorehouses may have infected some prostitutes, this was not likely the dominant cause for the current levels of the disease.

At a small, former hospital next to the downtown San Pedro Sula morgue, a group of nuns from the Mother Teresa of Calcutta Order also cares for AIDS patients.

Kevin Carroll, a Dominican brother from Chicago, said a patient’s life expectancy is much lower than it would be in a developed country because drugs are difficult to come by. AZT, for example, is available but its cost is prohibitive.

“We can get Tylenol,” he said.

Carroll said that ignorance, superstition and denial still play the greatest role in fanning the disease.

“They are where we (Americans) were 20 years ago,” he said. “They know you get it from sex, but they also think you get it from water and breathing” near someone who is sick.

As he spoke, a 22-year-old wisp of a woman flitted out of one of the wards, curious to see a rare visitor to the hospice. Wearing a thin, stained gown, she spoke softly, saying she had arrived at this place four months earlier.

She said she had AIDS and tuberculosis, having caught the latter because of the former and the former because of a promiscuous husband.

“My husband was too much of a womanizer,” she said simply.

At the San Jose hospice, a 26-year-old former prostitute who has AIDS is most pained by the two young children she will leave behind. She said she decided to spend her last days trying to educate her former colleagues.

“I go to a lot of the brothels and give talks,” she said, somber-faced and shaking slightly as she sucked on a cigarette. “They pay a lot of attention. Oh, there are some people who don’t believe this. But most of them do. They see me crying, and they become sad.”