After Fiona, Needs for People With HIV and LGBTQ People in Puerto Rico Remain Dire…

By Juan Michael Porter II | The Body

This month, media attention given to Puerto Rico’s ongoing plight paled in comparison to the pomp and circumstance surrounding the corpse parade of England’s former monarch. Watching this coverage unfold, one might think the United States were still subjugated colonies of Great Britain, even as one of this country’s own territories received only marginal concern in the wake of a devastating storm.

Queen Elizabeth II died on Sept. 8, resulting in wall-to-wall coverage that had nothing to do with national interest. Ten days later, as news channels breathlessly covered the run-up to Elizabeth’s funeral, Hurricane Fiona made landfall in Puerto Rico, unleashing catastrophic flooding and landslides, knocking out power across the island, and putting the health of thousands of people living with HIV (PLWH) at risk.

Immediate Needs in the Wake of Fiona

Pedro Julio Serrano, a human rights activist and president of the LGBTQ+ social justice organization Puerto Rico Para Todes, told TheBody that as of Sept. 22, 70% of the island was without power, 40% was without running water, and “the government has been incapable and criminally negligent in not making sure that we have the proper resources to recover.” (As of Sept. 27, almost 10 days after the storm hit, half a million structures were still without power.)

Fiona’s violent incursion occurred one day before the five-year anniversary of Hurricane Maria, from which the island has not completely recovered. Puerto Rico’s post-Maria recovery has been stalled in large part due to mismanagement of federal funds, government corruption, and a refusal to invest in on-the-ground community-led organizations.

Serrano explained that these losses disproportionally affect PLWH, many of whom lack employment and transportation due to HIV stigma and homophobia. He quoted the saying, “pueblo pequeño, infierno grande”―literally translated as “small town, big hell”―which is a reference to how, especially in less-urban areas, everyone knows everyone’s business. Because of Fiona, Serrano said, many PLWH may have lost their access to medication, services, and “the only place that they can fully be themselves without facing discrimination.”

With an eye on helping historically marginalized communities, Serrano stated that for people on the U.S. mainland who are eager to help, it’s best to donate money directly to local community organizations on the island—and to avoid donating to international groups like the Red Cross, which might not use the funds as intended by the person making the donation.

Local organizations that TheBody has confirmed are helping provide services across Puerto Rico include:

  • Fundación Pisadas de Amor, a nonprofit that assists older adults and connects them to essential services.
  • Puerto Rico Para Tod@s, a social justice organization that fights for equal rights and inclusion of LGBTQ+ communities across Puerto Rico.
  • Taller Salud, a feminist organization that improves women’s access to care and reduces violence within the community.
  • True Self Foundation, which promotes social mobility, educational access, and comprehensive well-being in LGBTQIA+ communities.
  • Waves Ahead, an organization that provides mental health services as well as HIV testing, case management, and sexually transmitted infection (STI) prevention education to older adults, female-led households, people without sustainable housing, and PLWH.

Concerns for Trauma and Care Access in Rural Areas

Wilfred Labiosa is executive director of Waves Ahead, a nonprofit that provides mental health and HIV services to historically marginalized populations. The organization has branches in San Juan, Cabo Rojo (in Puerto Rico’s southwest), and Maunabo (in the southeast).

During a visit to Maunabo in the wake of Fiona, Labiosa said that the devastation reminded him of “the precarious mental health situation all of us have been living with since Maria hit.” What compounds that strain is that many people in Puerto Rico’s mountains have been cut off by landslides or—even after roads are cleared—loss of transportation due to ruined cars.

Though 71% of the island’s population lives in urban areas, that still leaves a significant proportion of people in need, in areas that are difficult to navigate or reach. For example, Labiosa said that smaller pharmacies have already reached out to request that Waves Ahead send them supplies.

Thus far, Labiosa has not been able to visit Cabo Rojo―which is on the coast, 14 miles west of Sabana Grande―because its mayor is still trying to clear the roads. But he has been told by his colleagues that Waves Ahead’s location there was so badly damaged by the hurricane that staff were forced to relocate their operations to a local hotel. Based upon previous experiences, he believes that it will take months for the area to start receiving electricity again. But the good news is that they are still able to provide services for people in the area.

Alejandro Acosta, a sexual health advocate and contributor to TheBody, explained that people “in all of these mountains and towns are completely cut off from any services.” Acosta rode out Fiona in Sabana Grande, a municipality in the southwest that was devastated by Fiona. Since the storm passed, he has faced intermittent access to electricity and running water.

Acosta said that things were fine for his neighbors with HIV who had cars and jobs, and who were able to make the 40-mile drive east to the municipality Ponce to get their medications and visit their doctors. But he said he is worried about young people who lack transportation or “who might not want to go to an LGBTQ organization because HIV is still treated as taboo in Puerto Rico.”

Acosta explained that stigma, misinformation, and living “in the countryside without any knowledge of sexual health” means that some believe “there’s no monkeypox (or STIs) in Puerto Rico except in San Juan.” Even for those who know the facts, being isolated and afraid to reveal their condition deprives them of emotional support.

He said that, in the past, this has meant watching some people—including “at least two in their 20s”—die from complications of untreated HIV because they “didn’t want to engage in the treatment process.”

It is situations like this that are exacerbated during crises like Hurricane Fiona. But help has often been hard to find.

A Recent History of Failing Puerto Rico

In President Biden’s initial disaster relief plan for Fiona, 23 of Puerto Rico’s 78 municipalities were excluded. Though the plan was updated on Sept. 24 to reduce that number to 10, Labiosa told TheBody, “It is incomprehensible that local governments on the west part of the island were not [immediately] included as recipients of emergency funds.”

When asked why Biden’s initial announcement excluded so many municipalities, he blamed racism, classism, ageism, and homophobia. Historically, corruption has also been responsible.

In 2019, the Center for a New Economy (CNE), Puerto Rico’s first policy think tank, published a report that determined that the bulk of [U.S. federal disaster funding earmarked for rebuilding after Hurricane Maria was improperly invested in mainland organizations. This, even though the Stafford Act, which guides how the federal government responds to disaster, states that preference should go to local firms when awarding emergency response contracts.

Contrary to this guidance, CNE found that by August 2019, far from investing dollars into Puerto Rico’s local economy, $4.89 billion had been awarded to U.S. mainland firms, compared to $0.66 billion that had been awarded to firms in Puerto Rico.

This failure to invest in firms with local ties to, or understanding of, Puerto Rico’s specific needs was also reflected in the initial humanitarian response to Maria’s devastation. In 2020, the U.S. Homeland Security Office of Inspector General reported that FEMA mismanaged $257 million in commodity distribution during the response to Hurricanes Irma and Maria, with contract costs overrunning at “about $179 million and at least $50 million in questioned costs.”

In early 2021, Puerto Rico’s Gov. Wanda Vázquez was ousted from office after, among other acts of corruption, it was discovered that a government-run warehouse in the southern city of Ponce contained expired baby food and water dated from 2017, as well as other unused emergency supplies.

Labiosa told TheBody that Puerto Rico has not been rebuilt over the past five years and was therefore unprepared for Fiona because of this faulty leadership—which included allowing “private companies to get away with murder” by charging higher fees than their local counterparts, without delivering the promised work.

He also held the federal government responsible for “treating us like third-class citizens” and failing to “develop an infrastructure from the ground up by helping small community-based organizations to mobilize and bring aid.” Or, to follow the oft-quoted rallying cry from freedom movements, “Nothing about us without us!”

As the Island Struggles, the Mainland Response Stumbles

Puerto Rico’s history with failed federal investment hardly factored into recent national coverage, which lingered on images of washed-away bridges and devastation―or was supplanted by tabloid-style coverage of supposed rifts between Elizabeth II’s granddaughter-in-law and England’s funereal revelers—rather than focusing on people who are fighting to survive Fiona.

This included ignoring the need for humanitarian and medical aid, particularly for Puerto Rico’s most vulnerable populations, which include PLWH. According to the Centers for Disease Control and Prevention, an estimated 17,300 PLWH reside in Puerto Rico, making it one of the top 10 U.S. states or territories with the highest rates of HIV prevalence.

Surprisingly, the silence regarding the needs of PLWH in Puerto Rico extends beyond the media to organizations like AIDS Healthcare Foundation (AHF), the largest HIV/AIDS nonprofit in the world. Though it operates a location in Carolina, Puerto Rico (in the northeastern part of the island), AHF took over a week to release any updates or messages about the island. This even as it tweeted condolences and thanks to Elizabeth II on Sept. 19, as reports of Fiona’s devastation were coming in.

On Sept. 22, TheBody asked AHF Communications Director Ged Kenslea about the radio silence and was told, “We were the first ones there with disaster supplies.” During a subsequent interview, AHF’s Regional Director of Miami and Puerto Rico Silvana Erbstein explained that as a result of Hurricane Maria, “We were more than prepared.” Their clinic was open the next day, and operations were “business as usual,” she said.

According to Erbstein, AHF’s Puerto Rican branch is located in the municipality of Carolina and was not as hard hit by Fiona as the south of the island. In terms of support, she said that AHF paid for two cargo planes to deliver supplies and generators to the island, which were used to help their clients as well as their local community partners.

When asked how southern Puerto Rico was faring, Erbstein stated that she did not know because AHF does not have community partners in that region―but she added that the organization planned to send “one of our [supply] containers to a big hospital there.”

In a separate interview concerning AHF’s decision not to post public information about the medical situation in Puerto Rico, AHF’s National Director for Communications and Community Engagement W. Imara Canady explained that the organization’s marketing team was waiting for “information that’s been shared from our medical team there,” but in the meantime, they “also do a lot of things through our social media, particularly Instagram and Twitter,” and that messages would go out “if not today, sometime this week.”

On Sept. 26, AHF Puerto Rico’s Facebook page released a video of staff members delivering supplies to a location in the south of the island. But the main organization has yet to acknowledge that Hurricane Fiona occurred on any of its other social media channels.

The Broader Push for Rights and Recognition in Puerto Rico

Whether it’s mainland silence, federal failures, or local corruption, Puerto Rico’s problems predate this current crisis. As an example, Serrano named homophobia within government services―a problem that persists even though former governor Ricardo Rosselló, who served prior to Vázquez, was forced to resign in 2019 after it was revealed that he had exchanged homophobic, sexist, and other offensive text messages with members of his inner circle.

For Serrano, addressing these issues includes holding police officers responsible for discrimination, violence, and harassment against the LGBT community, particularly “our trans brothers and sisters.” He also called for greater training in instances of same-gender domestic violence, which he said often ends with police officers walking away without providing assistance.

But he said that one cause for celebration is Puerto Rico’s “bill of rights for people living with HIV that allows people who are discriminated against [because of the virus] to file a complaint and seek monetary reparations.”

In 1995, under laws that govern the commonwealth of Puerto Rico, legislation was drawn up to protect people diagnosed with HIV/AIDS from discrimination. This legislation was passed in 2000 as Bills 522 and 523 with what Serrano calls “pretty wide-ranging” powers of enforcement. The bills are some of the first of their kind that Serrano has seen during his 28 years of living with HIV.

He said that law has already helped him: After falling ill with pneumonia, Serrano said his hospital tried to deny him access to his medications, but because “the law specifically says that if you are in a hospital institution, they need to provide those lifesaving medications, I was able to push back and say, ‘No. Give me my meds.’” Faced with his awareness of his bill of rights as a PLWH, the hospital complied.

That is why Serrano says it is important for PLWH to know what the laws say so that they can protect themselves. As Puerto Rico begins to rebuild itself yet again, he, Acosta, and Labiosa hope that people will remember the lessons learned from previous disasters, such as the essentiality of empowering local community organizations to lead the way; hiring local contractors to rebuild the island; and using existing laws, including Bills 522 and 523, to protect the rights and dignity of PLWH.

One hopes that the U.S. media cycle will learn some lessons from its dehumanizing approach to breaking news and white-centered stories. Instead, it appears as though it has already moved from a death in England to a new storm, Ian, bearing down on Florida—all while continuing to ignore the needs of its own citizens on an island well off the coast of the continental U.S.’s southernmost state.

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