Part I:
Havana. Like many prostitutes who ply their trade in the darkened bars and discos near tourist hotels here, María says she does not go out every night. But whenever money gets tight and her 12-year-old son is hungry, she puts on a red miniskirt, puts rouge on her lips and heads for El Conejito bar, a thinly disguised rendezvous point.
"Most of the tourists come to look for girls, tobacco, you know, the things they cannot get in their country," she said. "They say the Cuban girls are very hot."
María, who is 36 and insisted that her last name not be published, said she worried about contracting AIDS and forced her clients to use condoms, every time. She is knowledgeable about the disease, having learned about it through the government's anti-AIDS program, and she was tested twice during a stint in jail last year for prostitution. Since then, she said, she voluntarily gets tested regularly at the free health clinics.
A decade after an economic collapse forced thousands of young women and men into prostitution, Cuba has become something of an anomaly in Latin America: a destination for sex tourists where AIDS has yet to become an uncontrollable pandemic.
Cuba has the lowest infection rate in the Western Hemisphere, less than 0.1 percent of the population, according to the World Health Organization. The infection rate in the United States is six times that in Cuba, and Cuba's rate is far below that in many neighboring countries in the Caribbean and Central America.
That is not to say the disease is not spreading in Cuba, and some outside the government say a thriving sex industry has contributed to its spread. On July 3, 1998, the Cuban government said 1,980 people had tested positive for the virus that causes AIDS since 1986. Since 1998, 3,879 more have been discovered to have the virus, according to statistics released by health officials; in just six years, the number of newer cases has nearly doubled.
"I think the epidemic has kept growing," said the Rev. Fernando de la Vega, a Roman Catholic priest at the Iglesia Montserrat, who runs a program for people with AIDS at the Iglesia Montserrat in Old Havana. "We have to face facts. There is a portion of tourists, mostly Europeans, who come to Cuba for a good time, and a good time includes sexual activity."
Cuban health officials acknowledge that the number of infections has increased, as in most countries, but they say the overall rate is very low for a population of 11 million.
"Prostitution is not an aggravating problem in the epidemic," said Dr. Rigoberto López, the director of the National Center for the Care of Persons with HIV-AIDS, adding that only a handful of the 280 patients he cares for at the main sanitarium for AIDS patients in Havana, known as Los Cocos, are former sex workers.
For more than a decade, the government has run an intense public-education campaign in schools and on state-owned television and radio stations, promoting the use of condoms and informing people about how H.I.V., the human immunodeficiency virus, is transmitted. The system of free primary care clinics in Cuba, a Communist country, has also led to the early detection of the virus in many people, Cuban and United Nations officials say.
In the early 1990's, Cuba quarantined people with the virus, and those discovered to be infected are still required to stay three to six months in one of Cuba's 13 government AIDS sanitariums, where they receive treatment and counseling on how to survive with the virus and how to avoid passing it along. Once they leave the hospitals, the patients are closely monitored in their homes by social workers, officials say.
A decades-old United States embargo on selling Cuba many medical supplies has crimped the country's ability to provide drugs to patients, but the government has replicated some advanced retroviral medicines used to fight AIDS, providing them at no cost. This, too, has slowed the epidemic.
