POPULATION-CUBA: Rise in Prostitution Causes STDs to Soar

By Dalia Acosta Reprint | | Print |

Dalia Acosta

HAVANA, Nov 20 1998 (IPS) - The increasing incidence of sexually transmitted diseases (STDs) among sex workers looks set to become a severe public health problem in Cuba, according to a senior official of the Ministry of Public Health.

“There has been an increase in these types of diseases, including AIDS, among people who engage in prostitution, both women and men,” said Rigoberto Torres, an epidemiologist who heads the Ministry’s STD and AIDS (Acquired Immune Deficiency Syndrome) programme.

Official reports reveal that the incidence of gonorrhea in Cuba increased 147 times between 1970 and 1995, while the 1990 syphilis rate was 12 times as high as 1970″s.

Despite the increases, though, the percentage of the population infected with STDs was still quite small.

There is no official data on prostitution in Cuba, but the weekly Juventud Rebelde – the official newspaper of the Union of Communist Youth – said in its latest edition that the high rate of STD infection was confirmed at a health center for prostitutes.

The sex trade reemerged in Cuba at the beginning of this decade along with the growth in tourism – which brings in more than one million visitors a year, though the phenomenon has not reached the proportion it has in other countries.

Prostitution is not a crime according to the Penal Code, but persons who engage in it can be arrested for endangering society or sexual harassment (against potential clients).

In the past few months, the health center at La Lisa, a town in the outskirts of Havana, has seen hundreds of prostitutes who were brought there for checkups before being returned to their families, usually far from the capital.

According to Juventud Rebelde, these women “are found accosting foreign visitors in tourist centers”. Seventy percent come from the provinces and the vast majority lack a residence permit for Havana. “The worst sign in the laboratory analyses is that out ten prostitutes, at least two test positive for syphilis,” according to the newspaper.

“They are young, very young, and they look old, both inside and outside,” said Herminia Sherman, a nurse with 25 years experience who works at the center. “They are 17, 20 years old, and have vaginas that look like they have had 10 children.”

Official sources report that last year, for each 100,000 inhabitants there were 143.3 cases of syphilis, 307.6 of gonorrhea, and 11 HIV infections.

According to ‘Salud en el Tiempo’, a publication of the Health Ministry’s National Office on Statistics, the incidence of syphilis increased from 7.2 cases per 100,000 inhabitants in 1970 to 86.8 in 1990.

The increase in cases of gonorrhea has been even more acute, moving from 2.8 per 100,000 inhabitants in 1970 to 201.1 in 1980, and then reaching its most critical level in last three decades with 411.7 cases per 100,000 in 1995.

The rate of HIV infection and AIDS cases also underwent a significant increase, from 2.6 per 100,000 inhabitants in 1990 to 11 per 100,000 in 1997, reaching a cumulative total of more than 2,000 cases since 1980.

While female prostitutes are more visible than their male counterparts, the historical trend has been for more men than women to be infected with STDs.

The incidence of syphilis per 100,000 inhabitants in 1997 was 147.6 for men and 138.9 among women. The difference for gonorrhea was even greater: 475.2/100,000 for men and 138.1/100,000 for women. And there were 16.9 HIV/AIDS cases for every 100,000 men as against 4.9 for every 100,000 women.

Maria Isabel Dominguez, a researcher at the Center for Psychological and Sociological Research of the Academy of Sciences, said that during the first half of 1997, 116 cases of HIV infection were detected among sex workers.

Speaking at an international conference in Havana, Dominguez said that although the numbers were still very small in relation to the total cases of infection, there is a serious upward trend, as in the same period in 1995 only 55 similar cases were reported.

Last December, the United Nations AIDS Program (UNAIDS) earmarked 95,000 dollars for the prevention of the disease among high-risk people in Cuba, including prostitutes.

“Anywhere in the world, prostitution can generate serious health problems if it is not controlled by public health policies,” as these people “have very high-risk sexual behaviours because of their indiscriminate and often unprotected relations”, Torres said.

Ninety percent of prostitutes that pass through the health center have clients who do not use condoms, either out of ignorance or sexist attitudes. The centre tries to investigate the chain of transmission of STDs and carry out epidemiological control, but this is often impossible.

One of the most critical cases was that of a young woman in a very advanced stage of syphilis, who in the past months has had sex with five Cuban men and 106 tourists. In many cases, she only knew their first names.