AIDS epidemic is decimating Warao people

The indicators of the Orinoco Delta surpass the world average. Doctors believe these indigenous people are facing a much more aggressive strain that threatens the survival of an entire population. The authorities, meanwhile, have kept silence about this case. Here is the first installment of this investigative report.
Este reportaje se encuentra disponible también en:
Delta
Amacuro.
- The day Monsignor Felipe González asked the inhabitants of San Francisco de
Guayo - an indigenous village located in the Orinoco Delta, at the northeastern
corner of Venezuela - to describe what people felt before they died, they all
began to name: "diaraya" (fever), "sojo" (diarrhea), "botukataya" (weight
loss), "botobotoya" (weakness), "ataearakateobo" (dizziness). None
of them mentioned the disease that encompasses all these symptoms. "Gentlemen,
you are dying of AIDS", the priest said. In San Francisco de Guayo, as in other
nearby communities, many people of the Warao ethnic group do not call HIV-AIDS
by name but by the symptoms they experience.
Luis
José Rodríguez, a doctor in the area, has had to give similar explanations to
those of the priest. Warao natives only notice the sudden presence of the
disease when the body begins to decompose. Rodriguez, 26, is doing his rural
work practices in Guayo. He accommodates his glasses and continues in front of
the computer, reviewing the list of cases of HIV patients, he is very aware of
the episode because he recently gave the news to a patient from Jeukubaca,
another community of the Antonio Díaz municipality in Delta Amacuro. "She
received the news as if it was nothing", he recalls. "I asked her: 'Do you know
what HIV-AIDS is?'. And she said: "No, I don't know". Reviewing this patient's
history, they found that her former husband had died of HIV.
Pilot test
San
Francisco de Guayo was one of the eight communities - the others were Jobure de
Guayo, Jobure Island, Jobotoboto, Ibute, Usidu, Guayo, Jeukubaka, Ibuiruina -
where at the end of 2011, Dr. Julián Villalba and other researchers of the
Venezuelan Institute of Scientific Investigations (IVIC) and the Institute of
Biomedicine of Universidad Central de Venezuela elaborated the research study
"HIV-1
Epidemic in warao amerindians from Venezuela: spatial phylodynamics and
epidemiological patters
(2013)",
which resulted in 55 indigenous people having the Human Immunodeficiency Virus.
The
specialists were alarmed because 9.55% of the inhabitants of eight communities
had contracted the virus. The highest prevalence in the world so far corresponds
to a remote region: sub-Saharan Africa, with 5% of its population. The world
average for 2013 - the latest figures available from the World Health
Organization - was 0.8% in adults between 15 and 49 years, slightly higher than
the Venezuelan population in the same range for 2005. Regarding the latter
figure, some national health authorities state that it is 0.56%.
Genetic
analysis of the virus's genome also suggested that the HIV epidemic in the Warao
communities would double every 10 months. The prevalence of the virus was more
significant in men (15.6%) compared to women (2.6%), all aged between 18 and 30
years. And the most affected community was Usidu (21.6% seropositivity).
The
warao that were found positive in the IVIC study were infected with HIV-1
subtype B, which is the most common in Venezuela; and there was only one case of
a woman with HIV-1 subtype C. This had already been reported in another study
entitled "Evidence
of at Least Two Introductions of HIV-1 in the Amerindian Warao Population from
Venezuela
(2012)".
This
work was presented at meetings with the vice-ministers of health Miriam Morales
and Claudia Morón, in 2012 and 2014, respectively. Of these health authorities,
only Claudia Morón continues as vice-minister of Collective Health Networks. At
that time, the officials assured that they would act, that a part of the
institution already knew about the problem, and that they should plan a field
research. In 2015 some specialists of these studies and anthropologists were
commissioned to carry out another HIV study in Warao populations:
Determinantes sociales (Fundacredesa), which hasn’t been yet published. They
also met with representatives of the Ombudsman’s Office to discuss the
situation. It is only known that after this they traveled to Tucupita, met with
authorities and held seminars with community leaders.
Since
then, however, nothing has changed. As the waters of the Orinoco River continue
to flow, there are new stories of indigenous Warao people living with HIV. Over
time, doctors have warned that new carriers of the virus carry in their blood a
more aggressive variant that is killing them in five years or less. No entity is
ensuring that everyone has access to treatment: "I have lived seven years here,
I have heard that they have HIV and I have not seen them receive treatment. Four
or five die every year", said Luis Tocoyo, a teacher at a school in Jobure,
another community with a high prevalence in HIV cases.
A more aggressive strain
A
person with HIV can be infected for eight to ten years without any symptoms and
yet transmitting the virus. Someone infected with the most common strain in
Venezuela, HIV-1 subtype B, could live that long without treatment, but the
Warao are experiencing symptoms of AIDS in less than five years.
Flor
Pujol, biologist at the Laboratory of Molecular Virology of the Venezuelan
Institute of Scientific Research (IVIC) and one of the researchers of the study
"The
evolving HIV-1 epidemic in Warao Amerindians is dominated by an extremely high
frequency of CXCR4-utilizing strains
(2015)",
explains that in the samples of the warao, Dr. Héctor Rangel, from the same
laboratory, analyzed the covering of the genome, which is the part where the
virus binds with its receptor to the co-receptors, and the result was that 90%
of the samples were X4, a more virulent strain of the virus. Those affected with
this strain manifest symptoms more quickly. In the Warao this transition to the
deadliest virus occurs faster. This can occur when the person has been infected
by more than one strain of the virus. Cases like this have been detected in Cuba
and the research was published in EbioMedicine under the title of "CRF19_cpx
is an Evolutionary fit HIV-1 Variant Strongly Associated With Rapid Progression
to AIDS in Cuba".
The Warao, in addition to having a more aggressive variant of the virus, have
high prevalence of tuberculosis, hepatitis B, among other diseases that further
gloom the situation.
In
the studies mentioned above, it is highlighted that one of the subgroups of HIV
found in the patients of the Orinoco Delta is made up of people from the
communities of San Francisco de Guayo and Usidu, and the other subgroup by
inhabitants of Jeukubana and the Jobure Island. Based on this information,
migratory movements and transmission routes were determined through the
phylogenetic history of the virus: A route called GU probably began in San
Francisco de Guayo in 2005, from there the virus spread to Jobure Island, Jobure
de Guayo and Usidu. Then from Usidu it passed towards Jobure de Guayo,
Jobotoboto and Kuberuna. And another route, called JE, perhaps started in
Jeukubaka also in 2005, from where it spread to Cambalache (Bolívar State),
Jobure Island, Nabasanuka and Usidu. Finally, from Nabasanuka there was a
transfer towards Caño Yeri. Apparently, the connection between both transmission
routes is minimal.
Phylodynamic
analyzes suggest that the virus was introduced into Warao populations in early
2000. After going through its initial phase of slow growth, it reached San
Francisco de Guayo and Jeukubaka around 2005. It has been ten years since it
began its exponential growth phase of expansion.
In
2007, the Venezuelan Red Cross had identified 15 cases of HIV in the communities
of San Francisco de Guayo, Murako, Jobure, Jobure Island, Murako, Ajimurina,
Merejina, Kuamujo, La Mora and Guayaboroina. At that time Dr. Oriana Contreras
worked first as a rural doctor in the Guayo hospital and then supporting a
project of the International Red Cross, which deepened the search for serious
diseases. Thus, she found AIDS, but also some cases of syphilis. The authorities
of the Delta Amacuro Regional Health Directorate then began to discredit her as
a professional until the very day of her departure.
At
the end of the project, Contreras was vetoed by the regional health director for
that time, Luis Beltrán Gómez. He told her that she could exercise no further,
that she should not have reported the case. "How was I going to face the
authorities of the Ministry of Health in Caracas?", Contreras recalls eight
years after that scene.
According
to Pujol, the virus entered the community almost fifteen years ago and has
evolved very quickly. The scenario, as she well knows, is devastating: the
magnitude of the epidemic, the speed with which it is being transmitted and
especially the aggressiveness of the strain.
The
community in front of Jeukubaca disappeared two years ago. Many of its
inhabitants died of AIDS, as confirmed by a list with the statistics of deaths
kept by the Guayo hospital. Most of the deceased were men and the remaining
women left the place.
One
of the inhabitants of Jeukubaka reported through TaneTanae, a local media
outlet, that half of the parishioners in his community have died with clear
symptoms of AIDS: "Narciso, an aunt of mine, her son Jesus, her daughter-in-law
Amelia and now another son, Rafael, all died... Avilio, a grandson, Jaime, his
father, and cousins ??Juan Méndez, Julio and Elio, they also died; the latter
was the head of the community".
Fr.
Ernesto "Kiko" Romero, recently appointed vicar of Tucupita, said that he once
spent 40 days in a community and there were 12 deaths among young people with
HIV. "The Ministry of Health is prohibited from saying that there are cases of
HIV and indigenous people do not call HIV by name, but they call it
tuberculosis, diarrhea. I repeat it in all the homilies", says the priest.
Undoubtedly,
what is happening in the indigenous communities of the Orinoco Delta is an HIV
epidemic. There, all the elements encompassing the term are absolutely
fulfilled: disease spread over a certain period, in a specific geographical
area, which simultaneously affects many people and exceeds the expected number
of people. The prevalence of the virus for these communities is far higher than
national and even international standards.
From Cambalache to Guayo
Most
of those infected arrive at the hospital already in the last stage of AIDS,
where one of the symptoms is a non-stop diarrhea. "When they arrive with a
chronic diarrheal syndrome that is more than a month old, one asks, are you
married? 'Yes'. Concubine? 'Yes'. What is your husband's name? Does he live with
you? Many, many times the husband is in Bolívar, he is in Cambalache", explains
Dr. Rodríguez.
Cambalache
is a landfill located in the state of Bolívar, about 260 kilometers from San
Francisco de Guayo, where many of the Warao who go to this place return with
HIV. This is the case of a young woman who was hospitalized. Now she has a
six-month-old son, also infected, and her husband stayed in Bolívar: "He comes,
finds another woman and infects her", explains the religious sister Ilvia Rosa,
who belongs to the Tertiary Capuchin congregation, present in Guayo from 1951.
Prostitution
and drug trafficking are commonplace in this garbage dump. In fact, it was
reported in the same study, HIV-1 Epidemic in warao Amerindians from
Venezuela: spatial phylodynamics and epidemiological patterns (2013), that
53% of HIV-positive individuals in Delta Amacuro had visited this community.
There is speculation that these trips to Cambalache are the cause of the
widespread propagation of the virus among the Warao population. Another place
where they acquire the virus is the city of San Felix, also in the state of
Bolívar.
The
anthropologist Luis Felipe Gottopo explains that the transmission and spread of
the virus may be related to the exodus to Tucupita, Ciudad Guayana and Barrancas
from a part of the Warao population after the cholera epidemic that broke out
between 1992 and 1993. At that time at least 500 warao lost their lives.
Another
hypothesis points to ships that transport goods related to the mining industry
and whose routes cross or approach the Orinoco Delta. "Do you see those boats?",
asks Jacobus de Waard, a Dutch biotechnologist who currently runs the
Tuberculosis Laboratory at the Institute of Biomedicine of the Universidad
Central de Venezuela, while one passes in front of him. "They bring
tuberculosis, HIV, hepatitis and a week without sexual activity. They enter
without any sanitary control".
Many
of the sailors come from the Philippines, an Asian country, and go through these
locations in search of sex. It seems likely that warao people imported the virus
from one of these places and that when they returned to the Orinoco Delta,
proliferation began.
"Ten
years ago, Guyana was the country with more HIV cases in Latin America, now they
have more control, but we don't know what's going on at the border", notes
Jacobus. Pujol also reaffirms that they do not know what strain of the virus is
circulating in Guyana.
A non-stopping epidemic
Samples
were taken for a new study in July 2015. After analyzing the HIV tests applied
to 666 Warao individuals, aged 15 to 50, from the 15 communities located in the
radius of the San Francisco de Guayo hospital (Guayo, Usidu, Ibute, Jobotoboto,
Jobure Island, Jobure de Guayo, Guayaboroina, Teikuburojo, Jeukubaka, Ibuiruina,
Murako, Kuamujo, La Mora, Merejina and Jabana de Merejina) belonging to Padre
Barral parish, the doctors found a prevalence of 7% (48 cases), which continues
to be higher than the estimated in Venezuela and in the rest of the world.
The
doctors also concluded that the communities with the highest prevalence of HIV
infection are Jobure de Guayo, Usidu and San Francisco de Guayo; that men are
more prone to infection than women and that the highest prevalence of HIV is
found in the 15 - 24 age group. Mortality of HIV infection in the last 8 years
is high and the prevalence of HIV infection in the studied communities has
persisted over the last 3 years.
At
the same time, the group that worked in the 11 communities located within the
radius of the Nabasanuka hospital (Arawabisi, Bamutanoko, Bonoina, Burojosanuka,
España, Kuarejoro, Kuberuna, Manakal, Nabasanuka, Siawani, Winikina) in the
Manuel Renaud parish, carried out the tests of HIV to 361 waraos from which 6
were positive (4 men and 2 women) for a prevalence of 1.69%. The figure is
significant considering that these are more remote communities that had
apparently been without any cases until 2012. It is also the first time that HIV
cases associated with TB (tuberculosis) have been detected in Manuel Renaud
parish, which means that people have both diseases, since having HIV makes them
more susceptible to acquire other illnesses.
HIV
weakens the immune system. According to the World Health Organization, "infected
patients are up to 50 times more likely to suffer from tuberculosis in their
lifetime". Not surprisingly, most TB cases in HIV-infected people are registered
again in sub-Saharan Africa, where 80% of TB patients are also likely to be
infected with HIV.
After
analyzing the results, the doctors determined: the highest HIV prevalence is
found in the age group between 22 and 50, most people with HIV (5) had made
trips outside their community and 4 reported having had contact with multiple
partners. As for the sexual tendency, 3 they said they were heterosexual, 1
homosexual and 2 bisexuals. None had tuberculosis.
The
communities with the highest HIV incidence were Nabasanuka (3 cases representing
5% prevalence), Burojosanuka (2 cases representing 6.6% prevalence) and
Bamutanoko (1 case representing 5.26%). They are strong evidence that what is
happening in the Orinoco Delta is an epidemic, and it's putting the survival of
an entire indigenous people at risk.

Many of the sailors come from the Philippines, an Asian country, and pass through these locations in search of sex. It seems likely that warao people imported the virus from one of these places and that when they returned to the Orinoco Delta, proliferation began.
"Ten
years ago, Guyana was the country with more HIV cases in Latin America, now they
have more control, but we don't know what's going on at the border", notes
Jacobus. Pujol also reaffirms that they do not know what strain of the virus is
circulating in Guyana.
A non-stopping epidemic
Samples
were taken for a new study in July 2015. After analyzing the HIV tests applied
to 666 Warao individuals, aged 15 to 50, from the 15 communities located in the
radius of the San Francisco de Guayo hospital (Guayo, Usidu, Ibute, Jobotoboto,
Jobure Island, Jobure de Guayo, Guayaboroina, Teikuburojo, Jeukubaka, Ibuiruina,
Murako, Kuamujo, La Mora, Merejina and Jabana de Merejina) belonging to Padre
Barral parish, the doctors found a prevalence of 7% (48 cases), which continues
to be higher than the estimated in Venezuela and in the rest of the
world.
The
doctors also concluded that the communities with the highest prevalence of HIV
infection are Jobure de Guayo, Usidu and San Francisco de Guayo; that men are
more prone to infection than women and that the highest prevalence of HIV is
found in the 15 - 24 age group. Mortality of HIV infection in the last 8 years
is high and the prevalence of HIV infection in the studied communities has
persisted over the last 3 years.
At
the same time, the group that worked in the 11 communities located within the
radius of the Nabasanuka hospital (Arawabisi, Bamutanoko, Bonoina, Burojosanuka,
España, Kuarejoro, Kuberuna, Manakal, Nabasanuka, Siawani, Winikina) in the
Manuel Renaud parish, carried out the tests of HIV to 361 waraos from which 6
were positive (4 men and 2 women) for a prevalence of 1.69%. The figure is
significant considering that these are more remote communities that had
apparently been without any cases until 2012. It is also the first time that HIV
cases associated with TB (tuberculosis) have been detected in Manuel Renaud
parish, which means that people have both diseases, since having HIV makes them
more susceptible to acquire other illnesses.
HIV
weakens the immune system. According to the World Health Organization, "infected
patients are up to 50 times more likely to suffer from tuberculosis in their
lifetime". Not surprisingly, most TB cases in HIV-infected people are registered
again in sub-Saharan Africa, where 80% of TB patients are also likely to be
infected with HIV.
After
analyzing the results, the doctors determined: the highest HIV prevalence is
found in the age group between 22 and 50, most people with HIV (5) had made
trips outside their community and 4 reported having had contact with multiple
partners. As for the sexual tendency, 3 they said they were heterosexual, 1
homosexual and 2 bisexuals. None had tuberculosis.
The
communities with the highest HIV incidence were Nabasanuka (3 cases representing
5% prevalence), Burojosanuka (2 cases representing 6.6% prevalence) and
Bamutanoko (1 case representing 5.26%). They are strong evidence that what is
happening in the Orinoco Delta is an epidemic, and it's putting the survival of
an entire indigenous people at risk.
(*)
This report is the first of four installments conducted during the Diploma of
Investigative Journalism, which is offered by the Institute of Press and Society
(IPYS) in alliance with the Universidad Católica Andrés Bello
(UCAB).