The repression of homosexuality pushes many gay men into double lives, marrying for appearances but having sex with transvestite prostitutes. Pretending that they aren't gay makes them more likely to infect their wives. Guatemalans generally see AIDS as a gay disease. After it kills a loved one, families often prevail on physicians to call the cause of death a more socially acceptable affliction such as tuberculosis. The shame also discourages HIV testing.
Poverty drives many gay men and street children to become prostitutes.
It also ensures that HIV detection rates are low, and that most of those who test positive don't get treatment to lower their viral counts and minimize danger to others. In April 1998, Guatemala had 2,800 known AIDS cases, with another 100 diagnosed each month. Discrimination against HIV-positive persons is widespread in the workplace, residential neighborhoods and even hospitals. Some of them apparently also receive protease, the other ingredient. Some 30 individuals have means to purchase the medications, and another 50 are taking part in a Merck study that provides the drugs.