San Diegans may know Belize as a popular tourist destination for its diving, sports fishing, and exotic wildlife. But health officials say Belize has something else: the highest per capita HIV infection rate in Central America.
Under a special journalism fellowship, KPBS Health Reporter Kenny Goldberg traveled to Belize to find out why.
In the lush interior of Belize, just off the side of a dirt road, lies a one-bedroom shack with a tin roof.
Here, 39-year-old Lydia Spain lives. She used to be a prostitute on the streets of Belize City. Today, Spain is broke and has HIV. She recently got of prison, where she says being HIV positive was rough.
Lydia Spain: "I wanted to commit suicide about three times. Because the people in the prison they used to discriminate us, and they put us in a cell apart from others. And so we have to bathe in our cell and we can't come out of our cell and walk in the dining room like what we want, and it was hard for us."
Spain says life on the outside is no picnic, either.
Spain: "Because I don't have no one to help me, and I have no job or nothing. And when it's night it's cold, and I'm getting sick now."
According to the World Health Organization, Spain is one of an estimated 5,300 Belizeans who are living with HIV. In a small country like Belize, that represents nearly two-and-a-half percent of the adult population.
That's nearly double the per capita HIV infection rate of neighboring Guatemala, and eight times the rate in Mexico. In fact, it's the highest rate in Central America.
Dr. Paul Edwards is the director of HIV/AIDS programs for the Belizean Ministry of Health.
Dr. Paul Edwards: "Most Belizeans have heard about HIV/AIDS, they are cognizant of the scientific transmission of this disease. However, incorporating that knowledge into their sexual activity, that is a challenge."
Dr. Edwards says Belize has a very macho culture, where males tend to have more than one sexual partner. He admits that's not unusual in Central America. But he says Belizeans tend to be sexually active especially young people.
Edwards: "A survey that was done in 1999 demonstrated that most high schoolers, almost 90 percent or a little bit more, had engaged in sexual activity before having completing high school, that is was consensual, and more than 90 percent did not use any method of contraception or prevention as such."
It's believed there are other cultural factors that contribute to the high HIV rate in Belize.
At the Benque Viejo border crossing, trucks carry goods back and forth between Belize and Guatemala. And that's not the only kind of traffic.
It's said to be almost a rite of passage for young Belizean males to go over to Guatemala and have sex with a prostitute.
Local resident Fernando Romero says the going price is only $9. He claims Belizeans know about the risks of contracting HIV.
Fernando Romero: "Well, we are aware, but we are careless, that's the word that we would use, you know. Because sometimes we just go there and we do not protect ourselves the right way, then we come across here, back to Belize, and there is where we start all over, and we go with our girlfriends."
Belize is a poor country, where one-third of the population makes less than two-thousand dollars a year. Health officials say poverty plays a roll in the spread of HIV.
Nineteen-year-old Kayla Myvett lives in Hattieville, about 30 miles inland from Belize City.
Myvett says young women in Belize want material things, but often can't afford them. She says older men offer to help for a price.
Kayla Myvett: "Most older males, they try to, I don't want to say take advantage of the younger females, but you know, they notice that young girls, they have needs and they have wants, and you know they desire things. And they feel like if, maybe if I go to her and you know, give it to her and she might give in to me and have sex with me, or something like that, you know. And I've experienced it."
The World Health Organization says women in Belize are becoming infected with HIV at a much younger age than men. And recently, more women than men ages 15 to 34 have tested positive for the virus. The WHO says that has serious repercussions for women in their reproductive years.
That's why efforts are underway to educate young Belizeans about HIV prevention.
Cherene Valerio: "Okay what is HIV? HIV as Cathy mentioned is a virus, it only lives in a human host."
In the town of San Ignacio, Cherene Valerio with the Belize Red Cross talks with a group of local teenagers about HIV.
This three-day seminar is aimed at turning teens into peer educators, so they can talk to their friends about how to protect themselves against HIV and other sexually transmitted diseases.
Valerio argues kids aren't the only ones that need to hear this information.
Valerio: "It's unfortunate that every single time you come out and you want to do sessions, people keep saying young people, young people. I keep saying, everybody. Because this is not a fight for just young people. It's a fight for all the people who are involved with the changes, the decision-making, and life that we live in our country."
Belizean officials say the government is politically committed to battling HIV. Officials tout a National AIDS Commission and an increase in sex education in schools.
Dr. Paul Edwards says Belize has recently seen a decrease in the number of new HIV infections.
Edwards: "Instead of projecting that almost upward increase, it almost appears that we're starting to plateau off. That is a good indication and hopefully then in the next, three, four, five, six seven years, it starts decreasing."
However, Edwards concedes the actual number of HIV cases is unknown.
The majority of Belizeans don't know their status, because stigma and discrimination remain high. And in a small country where most people know their neighbors, Belizeans find it hard to believe that test results are confidential. Kenny Goldberg, KPBS News.
