BOCA CHICA, Dominican Republic — Saturday is date night in this fading beach town where paunchy American men promenade down the main drag at twilight, their arms draped proudly around lithe young local girls.
As most of these couples literally don't speak the same language, silence prevails over dinner before a night of intimacy that will cost the men about $50 American.
The commercial sex trade that brings these couples together throngs the streets, fills the restaurants, keeps occupancy up in beach hotels during a slow season.
It is a buyer's market on this impoverished island — where the U.S. sends money to fight the HIV/AIDS epidemic, but with strings to keep it from anyone who doesn't condemn sex work.
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A woman who asks to be called Julia joined the girls lining the street here as a teenager. She hoped to make her living as a waitress, Julia says, but when that didn't cover food and rent, she sold sex after her shifts ended.
"People come to the city with dreams and learn there is nothing for them here," says Martha Butler de Lister, a physician and former national AIDS director who now works in Santo Domingo with charitable organizations. "They end up selling happiness."
Julia doesn't anymore, since she found out she has AIDS.
LA HAINA — Now Julia is back where she came from, in a turquoise-painted shack, covered with children's handprints in white paint, where both sunlight and rain pour through the gaps between the boards covering the roof.
She doesn't know what she would have done after her diagnosis, she says, if it weren't for the women of MODEMU, Movimiento De Mujeres Unido (Movement of United Women). It is an organization of sex workers and former sex workers like herself.
Watch video profiles of Jocelyn
A woman named Jocelyn from MODEMU helps Julia get her medicine and tells her she can't work anymore.
That is only one way some of the people hit hardest by the virus that leads to AIDS have taken a role in fighting the epidemic here.
Organized sex workers also have taken to the front lines in a search for solutions, participating in vaccine trials and teaching condom use, with some support from drug companies, nonprofit organizations and their own government.
One source from which they don't get money, though, is the U.S. President's Emergency Plan for AIDS Relief, which sent $6.4 million to fight the epidemic here last year, but with stipulations that preclude anyone who doesn't condemn sex work from getting the money.
Critics of that policy say the pledge has caused organizations to pull away from helping women who are both at the highest risk for catching the virus and in the greatest need of support.
"It's widely misunderstood," U.S. global AIDS coordinator Ambassador Mark Dybul responded recently.
While critics refer to the policy as an "anti-prostitution pledge," Dybul said, the policy aims to help women by taking a stand against a trade that he calls "damaging to gender equality."
He added that PEPFAR money supports 120 programs that provide care and support services to women who are sex workers.
"There's a disconnect," he said.
If there is, it works against vulnerable women, said Jodi Jacobson of American Jewish World Services, an organization that assists grass roots groups and which, she said, has turned down a U.S. faith-based initiative grant rather than take the pledge. She added that the policy is vaguely worded.
"There's a requirement that people sign and adopt a policy opposing prostitution, whatever that might mean," she said. "Also, there's a requirement that you not promote prostitution, whatever that means."
The result, she said, has been that organizations shy away from helping sex workers, fearing that it will cost them money.
"I would say Ambassador Dybul hasn't spoken to people affected directly by the pledge."
SANTO DOMINGO — Beachfront hotels and flashing casino lights are the façade for a deeply divided and largely impoverished country, human rights activists here have said, pointing to the bateyes, former sugar cane plantations where imported Haitian laborers toiled for several decades for little more than subsistence, until even that money ran out.
But disparities are on display closer to the tourist destinations, too, along the Malecon seafront strip and the dim streets surrounding the colonial district where scores of streetwalkers wait for customers, and in gas stations where teenagers hop into cars driven by strangers.
Sex work is essentially legal here and institutionalized to the point that a recent law requires that "cabanas" — hotels that rent rooms by the hour — have two condoms in each room.
On the higher-priced end are bikini-clad women with dancers' bodies who line up in the blink of disco lights at take-out brothels behind pricey casino hotels. They will spend the night with a customer for about $85 American.
On the more desperate end are women who visit the nearby penitentiary, where HIV rates are estimated to be as much as five times higher than those on the outside. There Wednesdays and Sundays are conjugal visiting days, when prisoners hang sheets over their bunks and sex workers serve prisoners for about 150 pesos, less than $5. Some try to serve enough men to leave with 1,500 pesos.
"Sometimes they say they'll pay 100 pesos and then only pay half," said a childlike young woman on a recent visiting day. To make money the rest of the week, many women who visit the prison also work the streets serving tourists, says Grace Butler de Mejia, who runs Fundacion Genesis, which works with the American nonprofit Health Through Walls to bring condoms to the prison.
"This is an international problem," de Mejia says.
LA DUQUESA — To understand how a woman can bring herself to such a place, one must look at the alternatives, said Sonia Pierre, an activist for the rights of Dominican women of Haitian descent.
"The women who do sexual work in jail come almost exclusively from the bateyes," Pierre said recently. "More than 12 years ago, the sugar companies began to pull out. Because now there is no work, bateyes are places of women and children."
Ten minutes from the center of Santo Domingo, a garbage dump replaced sugar cane fields as a source of livelihood for the residents in Duquesa, a quarter-mile-long settlement off the road to the new airport.
Here, a series of philanthropic efforts turned a one-room schoolhouse into two rooms. It still doesn't draw many children, though, because they can better improve their immediate existences by diving in the dump.
There among rotting garbage, medical waste, industrial chemicals including battery acid and mercury, children find toys and treasures in what other people threw away — a handful of drinking straws, bits of metal, plastic and glass that they can sell.
This is one of the better bateyes, said Pierre, who grew up in one and organized her first protest about conditions there at the age of 13. Bateyes around Haina, San Cristobal, are worse, she said.
Even for rural Dominicans not of Haitian descent and outside of bateyes — life is hard, offering few opportunities for women struggling to support their families, Pierre stressed.
LA HAINA — By contrast, the rooms behind the Sea Man Bar, in this industrial port town where girls have sex with sailors for prices running from $15 to $20, are a haven, with roofs and running water.
The joking, squabbling and camaraderie of a girls' dormitory prevail here, where women decorate their rooms with rosaries, pictures of the Virgin Mary and snapshots of sailors.
Con suerte — with luck — they can make $500 a month, they say. More often they earn less than half that. When not enough ships come in, some make nothing at all.
Ships from around the world dock in this town, with a weekly manifest showing visits from Miami, Savannah, Houston, New Orleans, as well as ports in Europe, South America, Asia.
Some of the children of women who work here reflect this diverse range of origins, with fathers from Haiti and the Philippines.
Jocelyn, a mother of three with a beatific smile, points to her 9-month-old son and says his father is from India.
A sex worker who also has recently found a niche in HIV-education, Jocelyn says she always uses condoms, except with the fathers of her children.
Fellow sex workers watch her children for her, when she travels to other nearby towns with a tote bag filled with condoms and an anatomically correct model to roll them onto, showing other sex workers how to insist on, or if necessary, cajole, a thin layer of protection.
"People will offer them $100 to have sex without a condom," she said. "I tell them, 'No! Not for $200, not for $500!'"
The girls at the Sea Man Bar can knock on her door at 1 o'clock in the morning to get condoms, she says; she keeps big bags full of them in the cramped, crowded two rooms across the street that she shares with six other people.
She gets paid for outreach work during funded projects now but stays in touch with the women she visits when she is not getting paid. That way, she says, she won't have to start over when she is called upon to look for new women to recruit for a vaccine trial.
Watch video profiles of Dr. Ellen Koenig
Jocelyn herself participated in one of the first trials for an anti-HIV vaccine run by Dr. Ellen Koenig when her friend Juliana recruited her.
The trial gave her access to health care, vitamins and information on how to avoid getting sexually-transmitted diseases, including HIV, she said. It also gave her a chance to hit back at the epidemic that affects people she knows.
Now when she meets women who have the virus or need treatment for other sexually transmitted infections, she sends them to "Dr. Ellen."
She kisses her fingers and raises them to the sky when she says "Dr. Ellen."
SANTO DOMINGO —Dr. Ellen Koenig, who runs the Instituto Dominicano De Estudios Virologicos — IDEV — didn't set out to be a physician.
"The HIV epidemic made me a doctor," she says.
Koenig, an American who grew up in Delaware, had a degree in microbiology when she married a Dominican, and he invited her to join him "in paradise," she says.
"Then AIDS started."
One of her brothers, Dr. Jay Levy, was involved in the earliest work to identify a virus. He suggested that she look for signs of the illness on the island.
The blood samples she and a team of local university students gathered later showed the virus was present in the Dominican Republic in the early 1980s.
Koenig began to diagnose people with the HIV virus and, frustrated she could do nothing to help them, went to medical school, completing her degree in 1991 at the age of 50.
As the new medicines to manage AIDS became available, though, only the wealthiest patients could afford them.
"We lost a lot of patients because they didn't have the money," she said. "The only way I could see out was clinical trials."
The women of MODEMU were willing to help, Koenig says. Women recruited through the group have since participated in a series of vaccine trials.
"These are the heroines of today's epidemic. They realize it is their challenge," Koenig said.
Like others who have faced the epidemic since its beginnings, Koenig believes a vaccine that will either prevent infection or keep the virus from progressing is the best hope for containing HIV. Then, she says, the women of MODEMU, who have continued to find volunteers, will be proud.
"I keep telling them, you one day will say to your children, 'I helped to make that vaccine possible.'"
LA HAINA — In the meantime, stipends for recruiting and outreach work allowed Jocelyn to buy a stove top, a refrigerator, a television, a couch and two chairs for the crowded apartment where two double beds were the only furniture for seven people. Her friends say her career as a sex worker had slowed to the point that she hadn't had a customer in four months.
Juliana, who through her work with MODEMU recruited some of Koenig's first trial participants, lives with her two children in a solid, tidy two-bedroom house decorated with religious regalia, and says she is retired.
She socializes with active sex workers. On a recent visit to the rooms behind the Sea Man Bar, she rummaged pointedly through the toiletries cluttering a friend's dresser and, with an expression of satisfaction, held up a condom she found there.
She had a beer downstairs with a friend who still works the local prison on visiting days and who fills her straw purse with condoms to give other women working there. She, too, gets stipends for outreach work through MODEMU.
With money from the government AIDS office, the group operates locally now from a sparsely equipped office on a noisy corner in the middle of Haina.
The office provides vocational and literacy training, as well as outreach workers to connect HIV-infected women with services and to make sure they know that they can't work anymore.
"We talk with the women equal to equal to get across our message. I say 'us' to a sex worker," Juliana said. Many want a better life, she said, pointing to the response she gets when she recruits for vaccine trials.
The future she and the others worry about stretches beyond their immediate needs, she said.
"I have a daughter who is 15, and I'm afraid."
- Staff photographer Gary Coronado and staff researcher Melanie Mena contributed to this story.