The San José Hospice. San Pedro Sula, Honduras, Jan/Feb 1993.

This is one of a series of photographic essays which document the principle transmission route of the HIV/AIDS epidemic from the city’s brothels and street sex workers into the wider population of San Pedro Sula, Honduras.

Introduction

This three year project originated from a trip I made to visit my sister, a doctor working with Jospice International, a UK based Catholic charity which was based in San Pedro Sula, Honduras, during January/February 1992.

I intended to produce stock agency photography images illustrating the general health-care activities she was involved with such as child inoculation programmes, midwifery and health clinics. A couple of days before my departure a woman and her child arrived at the clinic saying that her husband had just died from an AIDS related illness and the local undertaker was demanding extra money to bury him, money she did not have and could we help her. She said that such was the stigma of AIDS that undertakers were reluctant to bury people who had died from the disease and would only consider burials by paying a premium.

I made further inquiries with local health workers who predicted that Honduras and in particular San Pedro Sula was in the early stages of a potentially devastating HIV/AIDS epidemic. It was at this point I decided to return the following year to document what I found in order to record and publish the reality of contracting the HIV virus, in the hope that my photographs and text may positively reshape public opinion and help drive research for a cure.

HIV is a virus that attacks the bodies immune system. When untreated, the person’s immune system will eventually be completely destroyed, making it impossible to fight infections and diseases. AIDS refer to a set of symptoms and illnesses that occur at the very final stage of HIV infection. Without modern antiretroviral drugs available today contracting HIV in 1993 made death a certainty.

By January 1993 HIV infection rates were starting to spike, the principle transmission route for the HIV virus up to this time was predominantly between sex workers and their regular clients in the city’s brothels. Unlike other regions where the HIV virus was limited to high-risk groups, the virus in San Pedro Sula was gaining strength and was bridging rapidly from the city’s sex workers into the wider heterosexual population.

Tradition machismo culture in Honduras had normalised the behaviour of young men visiting brothels, making the purchase of sex socially acceptable among certain sections of the population. I personally met a man who said he took his sixteen year old son on his birthday to visit a brothel to make a man of him, he considered this to be normal behaviour.

Although sex work is legal in Honduras, brothel ownership and pimping is illegal. Lack of enforcement of these government laws has created a profitable business model for brothel owners, particularly when young women are entrapped into sex work to escape rural poverty.

It was generally accepted that the HIV virus originated from North America, partly due to the massive influx of US troops during the early 1980’s, which stimulated the commercial sex industry, but principally from transient migrant workers being infected by homosexual transmission in San Francisco, US.

The first recorded case of HIV/AIDS in Honduras was in 1985. Since then (2026) the estimated number of people diagnosed in Honduras with HIV is over 45,000 and 20,000 people dying from AIDS related illnesses, with San Pedro Sula being at the epicentre.

The San José Hospice

I visited Honduras again in January 1993 basing myself at the San José Hospice, San Pedro Sula. The hospice had opened in 1991, however by 1993 it was specifically devoted to the care of HIV/AIDS patents. The hospice is run by Jospice International a UK based Catholic charity.

Before the hospice opened many HIV/AIDS patients had been abandoned by the health authorities, their families and left to fend for themselves on the city streets. Often described as the living dead, these people had already suffered exclusion, lack of understanding, ignorance and fear from their fellow citizens. Most were never visited by family or friends at the hospice and were buried in unmarked graves.

Contracting the HIV virus in 1993, meant a swift and certain death, no antiretroviral drugs or therapies were available at this time. As the general health of these patients in Honduras was low, many died quickly from opportunistic infections such as tuberculosis (TB) and pneumonia caused by the breakdown of their bodies immune system. The hospice at this time could provide basic medication, safety, care and spiritual support for the patients.

Every patient gave permission to be photographed in the hope their images would put a human face to the HIV/AIDS epidemic and they would not be forgotten. I am grateful to the patients who trusted me to record their suffering and advocate their plight to a wider world.

The tragic reality of contracting the HIV/AIDS virus in 1993 meant that when I returned to visit the hospice a year later in April 1994 every patient at the hospice I had photographed and befriended had died.

Notes from my diary Jan/Feb 1993

“…I visited the hospice today for the first time, it’s located on the outskirts of San Pedro Sula. I was so shocked that I sat in silence trying to take it all in, the patients reminded me of concentration camp victims. The smell of diarrhea and sickness pervades every room at the hospice and even into the central courtyard… some of the side effects of the ineffective antiviral drug zidovudine (AZT). As I wondered around I glanced into a side room where dozens of poorly made wooden coffins of different sizes were stacked up…”

“… the hospice reminds me of a closed community or leper type colony that has been deliberately located out of sight and therefore out of mind of the resident population. The hospice employs an elderly night watchman armed with a rusty machete, I did think this was unnecessary as the population of SPS are fearful, even repulsed by the sight of the hospice patients, therefore making a potential intrusion or robbery at night unlikely…”

“…there is a certain irony that the infectors/carriers live side by side with the infected, yet I detected no animosity whatsoever between the two interconnected groups. Such is the closeness of this community of sufferers that the strongest patients help to dig the graves of their fellow patients and friends as they die…”

“…at dusk as the day cools, beautiful young men and women with arms and legs like sticks emerge from their rooms and walk around like shivering ghosts wondering if this will be the last sunset they will ever see. However it’s not a miserable, hopeless place, everyone grips onto whatever life they still have left in them, despite the pain they are in. They all pray they will be saved, hope pervades this place, they all refuse to give into death… what strength they have …”

These photographs/text have been used worldwide by agencies, charities, university libraries and archives to record, illustrate and publicise the HIV/AIDS epidemic in San Pedro Sula, Honduras. 1993-95.

An exhibition featuring photographs from the San José Hospice and Hotel Fanny from 1993 was purchased by the Untied Nations Population Fund (UNFPS) and exhibited at the International Conference on Population and Development in Cairo in 1994.

Panos Pictures and the World Health Organisation.

A selection of photographs were used in the C4 documentary film, the Bar Girl, the Catholic the Pimp and the Priest (1995) which documented the ‘debt’ system which entraps girls into sex work.

In 2007 photographs were used The American Foundation for Aids Research (amfAR) in New York to help fund and promote their work. The resulting DVD was narrated by Elizabeth Taylor and Edward Kennedy.

During July 2026, 100 digital captioned photographs, diary excerpts and texts from all the projects listed below were acquired by the University of California San Fransisco digital Calisphere library for long term preservation, academic study and public accessibility.

Links to other associated web pages:

[HON 01] Father Jim Barnett performs the ‘last rights’ for a dying patient. Father Jim is an American Dominican Friar that regularly visited the hospice providing spiritual support for the patients and staff. He is an exceptional person who has devoted his life to the needs of the poor and sick. He had recently been forced to leave El Salvador after death threats were made against him whilst campaigning for civil rights and trade union reform. He is now semi-retired and resides at Purdue University, Indiana, USA.

[HON 02] Father Jim visits patients in the men’s ward.

[HON 03] José Maria in the hospice canteen. José is in denial of his HIV status believing he has been miss diagnosed and will be able to return home soon. He died 2 months later in March 1993.

[HON 04] José listening to a Michael Jackson tape.

[HON 05] José Maria and José Angel Estrada keep warm up on a rare cool day.

[HON 06] Yenni is a Honduran volunteer carer who works in the children’s ward. The baby contracted HIV through mother-to-child transmission during her pregnancy. The young girl in the bathroom, age 13, has severe learning difficulties is also HIV positive. It is assumed she contracted HIV from sexual abuse by unknown persons.

[HON 06A] Raul Enrique Hernandez’s sister holds his hand.

[HON 07] Honduran nurses in the hospice dispensary.

[HON 08] Honduran nurse helps a patient drink water.

[HON 09] Ramon Ernesto Chaves uses a damp towel to help himself keep cool during the afternoon heat.

[HON 10] Hospice patient Samuel Portillo.

[HON 11] Samuel Portillo and Carlos Bautista. Carlos is holding a visiting relative’s child.

[HON 12] Suyapa Rivera Y Familia, age 21, is visited by her sister and niece. Suyapa contacted HIV from her husband who has since died from AIDS. She draws great strength from bible readings and bears no grudge against her husband. She said, ‘my life will finish before it has started’.

[HON 12A] Ignacio Vasquez has dressings to protect his sore and infected nipples, he prays to the statue of the Virgin Mary to be healed and for spiritual strength.

[HON 13] Ignacio Vasquez and his friend Carlos Baubista.

[HON 14] Dario removes his shirt to keep cool from the afternoon heat, revealing the devastating effect AIDS has had on his severely compromised immune system. Dario died from pneumonia seven days later.

[HON 15] Dario.

[HON 15A] Júlio César in the hospice courtyard. Júlio was a merchant seaman who worked on the banana boats from the coastal port of La Ceiba, frequently sailing to the US and European ports. He died in February 1993.

[HON 16] Júlio César was a merchant seaman who worked on banana boats from the coastal port of La Ceiba, frequently visiting Liverpool and US ports. He died in February 1993.

[HON 17] The hands of Júlio César. His white finger nails are indicative of a failing immune system.

[HON 18] Young man under the sheets.

[HON 19] Newly arrived patient in the TB isolation room.

[HON 20] Gracie (front) is a house wife and mother, she has her hair brushed by her new friend a former sex worker Teodora Cabrera in the women ward. Gracie contracted HIV from her husband who as since died, he had been infected with HIV from a sex worker in one of the city’s brothels. Both women died in March 1993.

[HON 21] Gracie struggles with nausea, pain and sickness, all side effects of the mostly ineffective first generation antiviral drug zidovudine (AZT). Gracie died during March 1993.

[HON 22] Olga Mejia Escobar is a 33 year old former sex worker. She had been abandoned at a local hospital and brought to the hospice. She had no family and was never visited by anyone.

[HON 23] Olga and Gracie in the women’s ward. Olga died several days later on the 8th February 1993.

[HON 24] Digging Olga’s grave at a cemetery on the outskirts of San Pedro Sula. This work was carried out by a grave digger employed by the hospice, Carlos Baubista and myself.

[HON 25] Carlos Baubista and grave digger. Carlos was one of the strongest patients from the hospice and helped with much of the grave digging. Such was the effort needed to dig the grave through hard, dry earth, a guard was placed overnight to stop the grave being stolen and used for another deceased person. Olga was buried the following day.

[HON 26] After the burial, Carlos Baubista places the only grave marker on Olga’s grave.

[HON 47] Myself and a patient at the San José Hospice, February 1993.