The Hidden Cost of AIDS
The pernicious plague, now spreading misery around the world at an alarming rate, may also plunder the global economy over the next decade
Heavy weight. The government cannot handle the burden that business is passing along. Already, the city of Sao Paulo needs to triple its number of available beds for AIDS patients to 1,000. AIDS doctors and nurses are so underpaid--with annual earnings of $7,800 and $2,400 respectively--that 60 percent of the health-care workers trained by the state of Sao Paulo for AIDS work have left their jobs. Nevertheless, hospital costs for AIDS patients average more than $20,000 per year, according to Hesio Cordeiro, dean of the University of the State of Rio de Janeiro. And a new program that offers the drug AZT free to all HIV carriers will cost $25 million in its first year alone. "The system as a whole is going to fall if they don't reform it," says Dr. David Salomao Lewi, director of Sao Paulo's main public AIDS clinic. "We've seen only the very beginning, and we're having trouble dealing with it already."
DOMINICAN REPUBLIC Cutting bitter lives short
Enara Jean-Baptiste's eyes glitter feverishly in the windowless, 10-by-8-foot barrack room on a Dominican sugar cane plantation that he shares with three other Haitian cane cutters. Chronic diarrhea has confined him to his bunk bed for the past five months. His arms and legs are as thin as sticks. These are the classic tropical symptoms of AIDS, but the once sturdy 28-year-old has no idea what disease is killing him and no public health official has shown any interest in testing his blood. As a companion cooks a thin soup of beans and dumplings over a smoking charcoal pile on the floor, he reviews the nine years since he left Haiti, unwittingly revealing the probable source of his inevitable demise: His girlfriend from several years back used to sleep with other cane cutters for money.
Haitian cane cutters like Jean-Baptiste are the backbone of the Dominican Republic's sugar industry, the nation's largest export earner. Local Dominicans refuse to endure the grueling, low-paid work, so the plantations must search out cutters in dirt-poor Haiti, on the western side of the Caribbean island they share. But the sugar plantations' worker communities, called "bateyes," are scorpions' nests of AIDS. HIV infection rates among the 250,000 people who live in the bateyes average about 9 percent, but the rate in one batey approaches 20 percent. Despite a chronic labor shortage that contributed to the decision to close three of 12 government-owned sugar mills in recent years, employers show no sign of concern over the epidemic that is sweeping through their work force. "AIDS has had no impact on the sugar industry," says the State Sugar Council's chief of social welfare programs, Argentina Taveras. "There may be isolated cases, but there is no epidemic."
Exporting disease. Such a willingness to ignore reality stems in part from the fact that AIDS is concentrated within the foreign Haitian community; the Dominican population has less than a 1 percent infection rate. Haitians, who are already more likely to carry HIV when they arrive, greatly increase their risk of the virus the longer they remain in the bateyes, where women forced into prostitution by the scarcity of jobs and itinerant single males create an infectious breeding ground. But the exceptionally high HIV rates among Haitians should give little comfort to Dominicans, who often havesexual relations with Haitians. As Dr. Ernesto Guerrero, head of a local AIDS institute, puts it, "The bateyes are a bridge for HIV spread." One Dominican, Domingo Fernandez, recently became the sixth man in a month to die of AIDS-related symptoms in the batey of Mata Mamon, a dozen miles outside Santo Domingo. As two candles lit his shrouded body, the silence was repeatedly pierced by the wailing of his pregnant wife, a Haitian.
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