One theory is that the epidemic began with prostitutes serving the US military community based in Comayagua and spread rapidly as a result of lack of prevention strategies and extreme promiscuity. The epidemic is about 85 percent heterosexual in Honduras. Additional factors contributing to the spread of AIDS include extreme poverty, lack of access to health clinics and lack of knowledge about methods of prevention. Women, abandoned by their husbands and heading impoverished households are vulnerable to the sexual whims of their often promiscuous male partners. On the hillsides that tower over downtown Tegucigalpa the tenements of clay and brick appear deceptively scenic from the city below until one gets close and sees that they are really makeshift hovels built over unpaved streets without sewer systems or running water.
Women descend to the polluted river that runs through town to wash clothes.
These tenements teem with children and although AIDS is rampant, tuberculosis, dengue fever and cholera may pose even greater threats. Padilla recognizes the need for the patients themselves to begin to organize, but pointed out that the death of several of the more activist patients during the past year dealt a severe setback to the group. Some of Padilla s patients are in a study conducted by the pharmaceutical company Merck, Sharp and Dohme, and they have access to ARVs as well as viral load testing. Padilla tries to help patients find sources to obtain medications for opportunistic infections and has been quite successful in obtaining donated medications from international sources. Average daily high temperatures are in the mid 90's.