In the glow of casino lights around the Dominican Republic's tourist districts, streetwalkers wait for customers.
Behind the walls of Haiti's grossly overcrowded National Penitentiary, infectious diseases go uncounted and untreated.
On the island these countries share, two hours from American shores, the rates of the virus that leads to AIDS are the highest in this hemisphere.
But while the US has sent more than US$100 million dollars to fight HIV and AIDS on the island of Hispaniola in the last three years, those tackling the epidemic among sex workers and prison inmates there do it without US help.
Working with limited resources against seemingly insurmountable odds, those fighters on the frontlines of the epidemic contend that if AIDS is not confronted in these settings, the battle against it won't be won.
A tourist looking for sex in Santo Domingo can walk to a brothel behind the priciest hotel where a night with a stranger costs about US$85, or save money and walk in the other direction to pick up one of the streetwalkers lining the seawall strip.
This impoverished island is a buyers' market where women sell sex to tourists, businessmen, sailors and prison inmates - and where HIV rates among sex workers are estimated to be at least triple the general population's nearly 2 percent rate.
Commercial sex is essentially legal here, where law requires hotel rooms rented by the hour be supplied with two condoms.
It is also entrenched enough in life here that sex workers organized a group - Movimiento de Mujeres Unida (MODEMU) - more than a dozen years ago to help each other.
Among those at the highest risk in the HIV epidemic, they have taken a role in a search of solutions, participating in vaccine trials and teaching condom use, with support from drug companies, nonprofit organizations and their own government. They don't get money from the US, which last year sent US$6.4 million through the President's Emergency Plan For AIDS Relief (PEPFAR) to fight the epidemic here.
That is because a stipulation written into the terms of US foreign aid says anyone who doesn't condemn sex work can't get any of the money.
Critics call the policy the "anti-prostitution pledge" and say it keeps help from those who need it most.
"It's widely misunderstood," US global AIDS coordinator Ambassador Mark Dybul responded recently.
PEPFAR funds 120 programs that help sex workers, offering care and vocational training, he said.
Critics counter the language of the pledge is so vaguely worded that it scares organizations away from providing services to sex workers.
The pledge would be a difficult one for the retired and still active sex workers who make up MODEMU to take.
"We talk with the women equal to equal to get across our message. I say 'us' to a sex worker," said Juliana, a retired sex worker who preaches condom use to friends still working at brothels.
She is one of the founders of MODEMU and has recruited friends who are still active for vaccine trials and outreach work. One of her friends is a woman named Jocelyn who supports three children by serving sailors who arrive on ships from around the world. She also goes from town to town, demonstrating condom use to fellow sex workers and emphasizing sex workers must never negotiate whether to use them.
"Not for US$200, not for US$500!" she says.
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