Science Magazine 28 JULY 2006 VOL 313 SCIENCE www.sciencemag.org482 drugs, up from 200 three years earlier. But the national AIDS committee, CONASIDA, estimates that the drugs are reaching only about one-third of those with advanced disease. No convincing studies explain how the virus made so much headway in Honduras, but theo- ries abound. Epidemiologist Manuel Sierra, who headed the Ministry of Health study of the Gari- funa and now works at the National Autonomous University, says in most countries in the region, the virus entered through gay men and then “incubated,” which means it took a long time t o bridge into other communities. The first AIDS cases in Hon- duras were also gay men, he says, but HIV quickly spread through heterosexual sex, both in the Garifuna com- munity and the country at large. “The main d i fference between Honduras and the rest of Central America is the incubation period,” posits Sierra. A key distinguish- ing factor in Honduras, he contends, was the country’s role during the Cold War. Sierra notes that when the first AIDS cases were detected in the early 1980s, the Cold War was raging, and U.S. military person- nel were flooding into Honduras in an attempt to influence the civil wars in neighboring Nicaragua, El Salvador, and Guatemala. “Honduras was the center used by the United States to fight all the countries,” says Sierra. The influx of soldiers—including Nicaraguan con- tras who staged attacks from Honduras—led to a boom in sex workers, which in turn played a “major role,” he says. César Núñez, a Honduran epidemiologist who heads the multicountry PASCA study of HIV prevalence in high-risk groups in Central America (see p. 480), says this is “a good hypothesis.” As in other countries, prisoners are another driver of the epidemic in Honduras. A Ministry of Health study found a prevalence of 7.6% in prisons. “That’s the ideal population to spread the virus,” says Sierra. “You have spouse visits, lots of homosexual sex, low access to con- doms, and lots of HIV.” Núñez and Sierra say rampant migration has also played a central role. In particular, the country has a large num- Mission Possible: Integrating The Church With HIV/AIDS Efforts TEGUCIGALPA AND JUTICALPA, HONDURAS—Throughout heavily Catholic Latin America, few topics have riled those working to slow the spread of HIV more than the Vatican’s opposition to condoms. Many HIV/AIDS workers have also decried what they see as the tendency by many denominations to treat as outcasts the two groups especially hard hit by the epidemic: homosexuals and sex workers. But in Honduras especially, church leaders are now trying to become part of the solution with stepped-up efforts that aim to slow HIV’s spread and help the infected. These church representatives are not, by any means, advocating the use of condoms, as Maryknoll sisters in Guatemala do with sex workers and other at-risk people they help (see p. 480). But representatives from four denominations are working with the United Nations Population Fund (UNFPA), which is famous for promoting family planning, in the year-old Interreligious Committee to contribute to Honduras’s national strategic plan for confronting its HIV/AIDS epidemic. “This is the first time we’ve worked with faith-based organizations, and the nice thing is we put our position on the table,” says Alanna Armitage, who heads the UNFPA office here. “We would not work with them if we couldn’t talk about condoms or they said they weren’t effective. There’s no more time to fight on this.” The representatives from the Episcopal, Evangelical, Adventist, and Catholic churches do not speak with one voice about condoms; some think, for example, that they should be promoted if one partner in a marriage is HIV-infected. Nor do they exactly embrace homosexuality. “We don’t have a specific program with homosexuals, but where we work, there are people with HIV/AIDS, and we treat them like anyone else,” says Elvia Maria Galindo, a committee member speaking for the Episcopal church. “We’re all sinners.” But Javier Medina, a gay activist here, charges that the religious community—particularly Evangelicals—have fanned the rampant homophobia in the country. He points to marches held by Evangelicals that protested the government’s decision in 2004 to officially recognize his group, called Kukulcán, and two other gay organiza- t i o n s . “ T h i s c re a t e d m o re hatred toward us,” says Medina, adding that a few dozen gay men have recently been killed in hate crimes and that his group has received death threats. This does not reflect the opinion of other denominations, however, says Carmen Molina, the committee’s Catholic representative. Although Padre Alberto Gauci, a Franciscan, does not condone homo- sexuality, he’s fervently trying to help thwart HIV at a men’s prison in Juticalpa, 3 hours from the capital. Gauci, who favors flip-flops, jeans, and T-shirts and looks more like an aging hippie than a clergyman, is on a somewhat quixotic quest to build a new prison in Juticalpa, where he runs an HIV/AIDS orphanage and hospice. The prison, built more than 100 years ago for 90 inmates, currently holds more than 400 men who sleep at least two to a bunk. More than 5% are known to have AIDS. In December 2005, no HIV tests or anti-HIV drugs were available. “The church has to play a role because people have lost all hope with politicians here,” says Gauci, a native of Malta. “Illness is spreading in the prison in a very accelerated way.” Gauci supports his efforts by running a bakery and occasionally staging horseraces and dogfights on the grounds of his compound. “Gambling is not a sin if you’re raising the money for good things,” shrugs Gauci. Now that’s working in mysterious ways. –J.C. Crossing the divide. Padre Alberto Gauci provides many HIV/AIDS prevention and care services in Juticalpa. Above and beyond. Honduras has more HIV-infected patients than any country in Central America. They frequently fill the beds at Tegucigalpa’s Torax Hospital. HIV/AIDS: Latin America & Caribbean Published by AAAS o n A p ril 5 , 2 0 2 1 h ttp ://scie n ce .scie n ce m a g .o rg / D o w n lo a d e d fro m http://science.sciencemag.org/ Mission Possible: Integrating the Church With HIV/AIDS Efforts Jon Cohen DOI: 10.1126/science.313.5786.482 (5786), 482.313Science ARTICLE TOOLS http://science.sciencemag.org/content/313/5786/482 CONTENT RELATED file:/content/sci/313/5786/news-summaries.full http://science.sciencemag.org/content/sci/313/5786/467.full http://science.sciencemag.org/content/sci/314/5796/52.1.full http://science.sciencemag.org/content/sci/313/5786/481.full PERMISSIONS http://www.sciencemag.org/help/reprints-and-permissions Terms of ServiceUse of this article is subject to the is a registered trademark of AAAS.ScienceScience, 1200 New York Avenue NW, Washington, DC 20005. 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