By David Abel | Globe Correspondent | 12/28/1999
JARABACOA, Dominican Republic - The gushy ballad lilting from the radio as the compact car cruises slowly down the street does not attract the women as much as William's whistling does.
Two girls in skin-tight clothes, idling beside a wooden shack, smile back at him. And William, a recently married 30-year-old whose wife is expecting a child in February, explains why a married man is entitled to a few girlfriends.
"A man needs more than one woman," says William, a sales clerk who would be identified only by his first name. "The women understand. We have our needs."
If some women turn a blind eye, health officials do not. Infidelity, they said, is one of the leading reasons for the spread of AIDS in this poor Caribbean nation, which has one of Latin America's highest percentages of people carrying HIV.
In private, some married men compare their mistresses to branch offices, while their wives are the main office. If he has the means, a man here might provide his "sucursal" - in Spanish, literally, a "branch office" - with a home, an allowance, and even children.
Although the practice is widespread, and women are well aware of it, many wives are in the dark about their husbands' lovers. And for health officials trying to control sexually transmitted diseases, the prevalence of surreptitious affairs makes it even harder to fight diseases such as AIDS.
"The main victims, and the fastest-growing class of AIDS victims, are married women," said Martha Butler, director of the National Program of Control of AIDS and Sexually Transmitted Diseases. "The problem is that they think they have nothing to worry about. Married couples don't use condoms."
Although Dominican Health Ministry studies have found that more than 50 percent of men have extramarital affairs, Butler said, the surveys may understate the reality. A similar study in 1996 by the University of Chicago found that 22 percent of men in the United States admit having affairs. But people tend to lie when asked if they have had sex outside of marriage.
Few Dominicans receive sexual education. And according to a study released in October by the Health Ministry, 44 percent of boys and 36 percent of girls have had sexual intercourse by age 14. So few used condoms, the survey found, that at least 78 percent of the girls became pregnant, most of them in isolated rural towns such as Jarabacoa.
But what troubles health officials most is that 84 percent of teenagers surveyed said they believed they could not catch AIDS.
"People are just not conscious about the disease; they think they are invulnerable," said Carmen Capell, director of a health clinic in Santo Domingo that treats AIDS patients. "The guilt lies with the state. We have to educate people more, and that starts in the schools. But it's something taboo. People here are just embarrassed to talk about it."
Since 1986, more than 4,750 Dominicans have reported being infected with HIV, and hospitals across the country have recorded more than 4,890 AIDS patients, according to the Health Ministry.
Today, more than 100,000 people, 2.8 percent of the 8 million Dominicans, carry HIV. By 2005, the number is expected to climb to at least 3.3 percent of the population, and an increasing number of them will be married women. The Dominican figures compare to a worldwide adult HIV-infection rate of 1 percent for adults and 0.76 percent in the United States.
Furthermore, international agencies believe the AIDS problem is much worse than the Health Ministry reports."We are sure there are many people going around with AIDS and they don't know it," said a United Nations AIDS official in the Dominican Republic who asked not to be named. "We feel underreporting is as high as 60 percent."
The incidence of AIDS in the Caribbean is second only to that in sub-Saharan Africa, where the virus has been reported in about 8 percent of the region's population, according to a recently released UN report. Nearly 2 percent of the Caribbean region's population is HIV-positive; Southeast Asia, with less than a 0.7 percent HIV-positive rate, has the next-highest percentage of carriers.
In the Dominican Republic, where nearly as many women as men are now HIV-positive, infidelity, ignorance, and the church's opposition to condoms are among the main reasons for the climbing AIDS rate, health officials here said.Prostitution is another. The Health Ministry estimated more than 200,000 women and men work as prostitutes. They mainly operate off the nation's booming tourism industry, which grew nearly 10 percent in the first eight months of 1999, according to government statistics.
Officials, however, said prostitution is only a small part of the problem, as most of the prostitutes have been educated to use condoms. The real danger, they say, is for those who think they have nothing to risk.
"Most Dominicans have extramarital affairs, that's a big problem for AIDS here," said Francisco Ferreira, director of education for COIN, a private group that counsels prostitutes on the dangers of AIDS. "This is part of the machismo culture, and it's something very difficult to change."
Cruising through Jarabacoa, William points out where the local prostitutes meet their men. But he laughs when asked if he has sought their services.
"I've got the magic; I don't need prostitutes," he says. "Girls love me. If I get bored, I'll find another."
David Abel can be reached at dabel@globe.com.
Copyright, The Boston Globe
