Delta \r\nAmacuro<\/I>. \r\n- The day Monsignor Felipe Gonz\u00e1lez asked the inhabitants of San Francisco de \r\nGuayo - an indigenous village located in the Orinoco Delta, at the northeastern \r\ncorner of Venezuela - to describe what people felt before they died, they all \r\nbegan to name: \"diaraya\" (fever), \"sojo\" (diarrhea), \"botukataya\"<\/I> (weight \r\nloss), \"botobotoya\"<\/I> (weakness), \"ataearakateobo\"<\/I> (dizziness). None \r\nof them mentioned the disease that encompasses all these symptoms. \"Gentlemen, \r\nyou are dying of AIDS\", the priest said. In San Francisco de Guayo, as in other \r\nnearby communities, many people of the Warao ethnic group do not call HIV-AIDS \r\nby name but by the symptoms they experience.<\/p>\n\n\r\n\n
Luis \r\nJos\u00e9 Rodr\u00edguez, a doctor in the area, has had to give similar explanations to \r\nthose of the priest. Warao natives only notice the sudden presence of the \r\ndisease when the body begins to decompose. Rodriguez, 26, is doing his rural \r\nwork practices in Guayo. He accommodates his glasses and continues in front of \r\nthe computer, reviewing the list of cases of HIV patients, he is very aware of \r\nthe episode because he recently gave the news to a patient from Jeukubaca, \r\nanother community of the Antonio D\u00edaz municipality in Delta Amacuro. \"She \r\nreceived the news as if it was nothing\", he recalls. \"I asked her: 'Do you know \r\nwhat HIV-AIDS is?'. And she said: \"No, I don't know\". Reviewing this patient's \r\nhistory, they found that her former husband had died of HIV. \r\n<\/p>\n\n\n
San \r\nFrancisco de Guayo was one of the eight communities - the others were Jobure de \r\nGuayo, Jobure Island, Jobotoboto, Ibute, Usidu, Guayo, Jeukubaka, Ibuiruina - \r\nwhere at the end of 2011, Dr. Juli\u00e1n Villalba and other researchers of the \r\nVenezuelan Institute of Scientific Investigations (IVIC) and the Institute of \r\nBiomedicine of Universidad Central de Venezuela elaborated the research study \r\n\"HIV-1 \r\nEpidemic in warao amerindians from Venezuela: spatial phylodynamics and \r\nepidemiological patters \r\n(2013)<\/A>\", \r\nwhich resulted in 55 indigenous people having the Human Immunodeficiency Virus. \r\n<\/p>\n\n\r\n\n The \r\nspecialists were alarmed because 9.55% of the inhabitants of eight communities \r\nhad contracted the virus. The highest prevalence in the world so far corresponds \r\nto a remote region: sub-Saharan Africa, with 5% of its population. The world \r\naverage for 2013 - the latest figures available from the World Health \r\nOrganization - was 0.8% in adults between 15 and 49 years, slightly higher than \r\nthe Venezuelan population in the same range for 2005. Regarding the latter \r\nfigure, some national health authorities state that it is 0.56%. \r\n<\/p>\n\n\r\n\n Genetic \r\nanalysis of the virus's genome also suggested that the HIV epidemic in the Warao \r\ncommunities would double every 10 months. The prevalence of the virus was more \r\nsignificant in men (15.6%) compared to women (2.6%), all aged between 18 and 30 \r\nyears. And the most affected community was Usidu (21.6% seropositivity). \r\n<\/p>\n\n\r\n\n The \r\nwarao that were found positive in the IVIC study were infected with HIV-1 \r\nsubtype B, which is the most common in Venezuela; and there was only one case of \r\na woman with HIV-1 subtype C. This had already been reported in another study \r\nentitled \"Evidence \r\nof at Least Two Introductions of HIV-1 in the Amerindian Warao Population from \r\nVenezuela \r\n(2012)<\/A>\". \r\n<\/p>\n\n\n\n This \r\nwork was presented at meetings with the vice-ministers of health Miriam Morales \r\nand Claudia Mor\u00f3n, in 2012 and 2014, respectively. Of these health authorities, \r\nonly Claudia Mor\u00f3n continues as vice-minister of Collective Health Networks. At \r\nthat time, the officials assured that they would act, that a part of the \r\ninstitution already knew about the problem, and that they should plan a field \r\nresearch. In 2015 some specialists of these studies and anthropologists were \r\ncommissioned to carry out another HIV study in Warao populations: \r\nDeterminantes sociales<\/I> (Fundacredesa), which hasn\u2019t been yet published. They \r\nalso met with representatives of the Ombudsman\u2019s Office to discuss the \r\nsituation. It is only known that after this they traveled to Tucupita, met with \r\nauthorities and held seminars with community leaders. <\/p>\n\n\r\n\n Since \r\nthen, however, nothing has changed. As the waters of the Orinoco River continue \r\nto flow, there are new stories of indigenous Warao people living with HIV. Over \r\ntime, doctors have warned that new carriers of the virus carry in their blood a \r\nmore aggressive variant that is killing them in five years or less. No entity is \r\nensuring that everyone has access to treatment: \"I have lived seven years here, \r\nI have heard that they have HIV and I have not seen them receive treatment. Four \r\nor five die every year\", said Luis Tocoyo, a teacher at a school in Jobure, \r\nanother community with a high prevalence in HIV cases. \r\n<\/p>\n\n\n A \r\nperson with HIV can be infected for eight to ten years without any symptoms and \r\nyet transmitting the virus. Someone infected with the most common strain in \r\nVenezuela, HIV-1 subtype B, could live that long without treatment, but the \r\nWarao are experiencing symptoms of AIDS in less than five years. \r\n<\/p>\n\n\r\n\n Flor \r\nPujol, biologist at the Laboratory of Molecular Virology of the Venezuelan \r\nInstitute of Scientific Research (IVIC) and one of the researchers of the study \r\n\"The \r\nevolving HIV-1 epidemic in Warao Amerindians is dominated by an extremely high \r\nfrequency of CXCR4-utilizing strains \r\n(2015)<\/A>\", \r\nexplains that in the samples of the warao, Dr. H\u00e9ctor Rangel, from the same \r\nlaboratory, analyzed the covering of the genome, which is the part where the \r\nvirus binds with its receptor to the co-receptors, and the result was that 90% \r\nof the samples were X4, a more virulent strain of the virus. Those affected with \r\nthis strain manifest symptoms more quickly. In the Warao this transition to the \r\ndeadliest virus occurs faster. This can occur when the person has been infected \r\nby more than one strain of the virus. Cases like this have been detected in Cuba \r\nand the research was published in EbioMedicine under the title of <\/I>\"CRF19_cpx \r\nis an Evolutionary fit HIV-1 Variant Strongly Associated With Rapid Progression \r\nto AIDS in Cuba\"<\/A>. \r\nThe Warao, in addition to having a more aggressive variant of the virus, have \r\nhigh prevalence of tuberculosis, hepatitis B, among other diseases that further \r\ngloom the situation. <\/p>\n\n\r\n\n In \r\nthe studies mentioned above, it is highlighted that one of the subgroups of HIV \r\nfound in the patients of the Orinoco Delta is made up of people from the \r\ncommunities of San Francisco de Guayo and Usidu, and the other subgroup by \r\ninhabitants of Jeukubana and the Jobure Island. Based on this information, \r\nmigratory movements and transmission routes were determined through the \r\nphylogenetic history of the virus: A route called GU probably began in San \r\nFrancisco de Guayo in 2005, from there the virus spread to Jobure Island, Jobure \r\nde Guayo and Usidu. Then from Usidu it passed towards Jobure de Guayo, \r\nJobotoboto and Kuberuna. And another route, called JE, perhaps started in \r\nJeukubaka also in 2005, from where it spread to Cambalache (Bol\u00edvar State), \r\nJobure Island, Nabasanuka and Usidu. Finally, from Nabasanuka there was a \r\ntransfer towards Ca\u00f1o Yeri. Apparently, the connection between both transmission \r\nroutes is minimal. <\/p>\n\n\r\n\n Phylodynamic \r\nanalyzes suggest that the virus was introduced into Warao populations in early \r\n2000. After going through its initial phase of slow growth, it reached San \r\nFrancisco de Guayo and Jeukubaka around 2005. It has been ten years since it \r\nbegan its exponential growth phase of expansion. <\/p>\n\n\r\n\n In \r\n2007, the Venezuelan Red Cross had identified 15 cases of HIV in the communities \r\nof San Francisco de Guayo, Murako, Jobure, Jobure Island, Murako, Ajimurina, \r\nMerejina, Kuamujo, La Mora and Guayaboroina. At that time Dr. Oriana Contreras \r\nworked first as a rural doctor in the Guayo hospital and then supporting a \r\nproject of the International Red Cross, which deepened the search for serious \r\ndiseases. Thus, she found AIDS, but also some cases of syphilis. The authorities \r\nof the Delta Amacuro Regional Health Directorate then began to discredit her as \r\na professional until the very day of her departure. <\/p>\n\n\r\n\n At \r\nthe end of the project, Contreras was vetoed by the regional health director for \r\nthat time, Luis Beltr\u00e1n G\u00f3mez. He told her that she could exercise no further, \r\nthat she should not have reported the case. \"How was I going to face the \r\nauthorities of the Ministry of Health in Caracas?\", Contreras recalls eight \r\nyears after that scene. <\/p>\n\n\n\n According \r\nto Pujol, the virus entered the community almost fifteen years ago and has \r\nevolved very quickly. The scenario, as she well knows, is devastating: the \r\nmagnitude of the epidemic, the speed with which it is being transmitted and \r\nespecially the aggressiveness of the strain.<\/p>\n\n\r\n\n The \r\ncommunity in front of Jeukubaca disappeared two years ago. Many of its \r\ninhabitants died of AIDS, as confirmed by a list with the statistics of deaths \r\nkept by the Guayo hospital. Most of the deceased were men and the remaining \r\nwomen left the place. <\/p>\n\n\r\n\n One \r\nof the inhabitants of Jeukubaka reported through TaneTanae<\/I>, a local media \r\noutlet, that half of the parishioners in his community have died with clear \r\nsymptoms of AIDS: \"Narciso, an aunt of mine, her son Jesus, her daughter-in-law \r\nAmelia and now another son, Rafael, all died... Avilio, a grandson, Jaime, his \r\nfather, and cousins ??Juan M\u00e9ndez, Julio and Elio, they also died; the latter \r\nwas the head of the community\". <\/p>\n\n\r\n\n Fr. \r\nErnesto \"Kiko\" Romero, recently appointed vicar of Tucupita, said that he once \r\nspent 40 days in a community and there were 12 deaths among young people with \r\nHIV. \"The Ministry of Health is prohibited from saying that there are cases of \r\nHIV and indigenous people do not call HIV by name, but they call it \r\ntuberculosis, diarrhea. I repeat it in all the homilies\", says the priest. \r\n<\/p>\n\n\r\n\n Undoubtedly, \r\nwhat is happening in the indigenous communities of the Orinoco Delta is an HIV \r\nepidemic. There, all the elements encompassing the term are absolutely \r\nfulfilled: disease spread over a certain period, in a specific geographical \r\narea, which simultaneously affects many people and exceeds the expected number \r\nof people. The prevalence of the virus for these communities is far higher than \r\nnational and even international standards. <\/p>\n\nA more aggressive strain<\/h2>\n\n\n