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Modern plague ravages urban Eskimos

An Aids epidemic is threatening to wipe out the Inuit of Greenland, reports Katherine Butler
THEY congregate most mornings on the timber stairway by the Brugsen supermarket. First two, maybe three, then others appear from nowhere, clutching plastic carrier bags of bottled beer, to help them put in another day on the streets of Nuuk.

They look too young to be down-and-outs. Women and men, some hardly 40, though their faces are already craggy and weather-beaten. But the same faces are there every day, huddled in an alcoholic haze to shield them from the Arctic winds. Sometimes they go down to Nuuk harbour for a change of scenery; the unluckier ones weave their way to to the new Aids treatment centre at the general hospital.

Everyone in Nuuk calls Queen Ingrid's the sanatorium, a relic of the days when tuberculosis was the big killer in Greenland. Today, the letters which instil fear in this polar outpost of the kingdom of Denmark are not TB, but HIV.

New findings based on four years of research into the disease in Greenland are "alarming" according to Morten Winthereik, a Danish doctor at Queen Ingrid's. He is now convinced the potential for a full-scale HIV epidemic is dramatic and is calling for urgent research into the strain of the virus seen in Greenland.

More than eighty cases have been confirmed in the Inuit population, which numbers only 50,000. Many more are thought to have gone unrecorded as victims flee their small, enclosed community for the anonymity of Denmark.

The pattern of infection is worryingly different from that in Europe, where rates are stagnating or starting to fall. Dr Winthereik says: "If you look at the size of the population and then the rate of increase here, these figures are alarming".

Dr Winthereik began studying the trends in 1994 when doctors in Sisimiut, 200 miles north of Nuuk, reported an explosion in new cases. In 1993, there were only two known cases of HIV in Greenland. The following year there were seven and in 1995, 14. Every year since has seen an increase in cases, concentrated mainly in Sisimiut and the capital.

Comparisons show that the spread, at 25 per 100 000, is three times faster than in Europe. The development of the virus into full-blown Aids is also faster in Greenland, sometimes as short as six months.

HIV's introduction into the Inuit population of Greenland dates from the late Eighties when man presumed to have been bisexual who had contracted the virus in Copenhagen - several thousand native Greenlanders live in Denmark - returned to Nuuk.

What marks out the infection in Greenland is that transmission is almost exclusively heterosexual. Women account for 45 per cent of the total known cases. This pattern and pace of spread makes the Greenland comparable to Africa as far as Aids is concerned, doctors say.

Unlike the typical HIV profile elsewhere in Europe, members of the known HIV community here exist on the lowest possible rung of the social ladder, heavily reliant on alcohol and handouts from the Danish-financed welfare system. Many speak little or no Danish, which keeps them isolated socially and educationally.

Medical care is free and the drug therapy available at Queen Ingrid's is now on a par with that in Denmark, but doctors have experienced huge difficulties in tracking down potential HIV-positives because of the particular social group involved and their "relaxed" sexual habits.

"We are talking about a group where to have multiple sexual partners is common," Morten Winthereik says, adding: "Partner notification and testing should be the biggest weapon in stalling the spread but it is not easy here."

While the known cases are, by and large, confined to the street drinkers, an identifiable group of unemployed homeless alcoholics aged between 40 and 50, the fear is that huge swathes of younger Greenlanders for whom casual sex is a way of life, could be wiped out as the disease spreads.

Sexual behaviour in the capital is described by Dr Winthereik as "high risk". Saturday nights in Nuuk are almost a tourist attraction, such is the intensity of the nightlife and the scale of alcohol consumption.

"Everyone drinks, you can't go anywhere, so you party," says Inga Kasser, a young reporter at KNR, the local broadcaster.

But it is not far from Nuuk's watering holes to the graveyard. The community buried its latest victim of Aids last week. Jakob, a 35 year old man was infected in Copenhagen and came home to die. He was what those studying the disease in Greenland call an "import". He did not match the typical profile. For a start he was younger than most of those infected here.

By contrast, Piitar, who learned he was HIV-positive a few months ago, is 46, and some sufferers are even older. The oldest known case is a 59- year-old man.

Like most of Greenland's HIV positives, Piitar is unmarried but heterosexual. There is no gay community in Greenland and most homosexuals go to live in Denmark anyway. He hangs around Nuuk with a group of drinking pals in which the virus is endemic. Piitar was only remotely acquainted with HIV when he showed up at the "Sana" (sanitorium) complaining of persistent symptoms of what he thought was flu. He was coughing, had lost weight and was showing eczema-like skin eruptions.

Testing for HIV is almost routine now in Nuuk and the suspicions were quickly confirmed. But Piitar's initial sense of shock and shame have passed. He hardly seems to care. "I have many problems," he says. Alcohol is expensive but he drinks heavily, stocking up at the supermarket when he has money. He is weary of blood tests so does not always bother to show up for check-ups. Is he practising safe sex now? "Sometimes," he says.

Piitar's reactions are typical. He has probably not altered his behaviour. And he will not become dependent on the medical system until he is in the chronic final stages of Aids. He laughs at the idea of support groups or counselling or even telling members of his family in south Greenland: Inuit men do not talk about their feelings.

This silence about HIV in Greenland is part of the problem says Morten Winthereik. "HIV is a very ugly affliction but we have got to start thinking about it like any other infectious disease." He wants to see research into why it develops more rapidly here (in one case it took just six months from diagnosis to full-blown Aids) to establish whether it is the same virus which is being cloned and whether there is any pre-disposition which makes Inuits more susceptible. "If we could identify it then we would know if new cases were the same."

Annual alcohol intake, although significantly down on the levels it rose to during the Eighties, is still high and Greenlanders themselves admit their tendency towards hedonistic and self-destructive behaviour.

"This is a cultural trait. We are guided by instant gratification," admits Mikaela Engell, a senior health official at the home rule government.

Sexually-transmitted diseases such as chlamydia and gonorrhoea are common even among the young, and the abortion rate of one in every two pregnancies confirms the suspicion of Gunnar Palisgaarde, Greenland's chief medical officer, that "nobody uses condoms".

Doctors here agree the spread of HIV is exclusively heterosexual in contrast to other Eskimo communities, for example in Canada where intravenous drug use is the main HIV transmission route.

"I have both men and women dying of Aids in my department. This is heterosexual transmission," Dr Palisgaarde says.

Modernity in Nuuk, the capital of a country which has no connecting roads because settlements are dotted around a glacier covering 85 per cent of the landmass, has brought bingo halls, video stores, a cinema - showing Titanic this week - mobile phones and higher living standards. But persistently high rates of murder, domestic violence, sex abuse, alcoholism and suicide reflect the extent to which the Eskimo people are still coming to terms with the profound societal transformation they were forced to adopt in just one generation.

A controversial Danish experiment in the early 1960s closed many outlying villages and primitive settlements and forced thousands of people into Nuuk. Many ended up in "Blok P" a soulless high-rise housing development. Unable to cope with the psychological switch from a hunting, fishing, bartering existence to the cramped conditions of flat-dwelling and wage- earning shift work in the fish factories or social welfare, they turned to alcohol and other forms of escape.

Aqqaluk Lynge, a leading figure in the movement for Eskimo rights, sums up the loss of identity suffered by indigenous men in particular as "a human disaster". Long dark winters and short bursts of summer when the sun hardly goes down, were easier for indigenous people to cope with when they were hunting and fishing in harmony with the seasons.

This loss of a traditional role for a deeply proud self-sufficient people is blamed for a suicide rate which has increased steadily to the point where a week does not pass without a hanging or a shooting. "The transformation of the society is too fast for some and not fast enough to meet the expectations of others," according to a polar epidemiologist, Peter Bjerregaard, who has carried out exhaustive research into the high mortality rates in Greenland.

Although it sometimes goes hand-in-hand with heavy drinking, suicide is rarely associated with clinical depression. "Young men hang or shoot themselves when they believe they no longer have a useful role. It is not a cry for help. In the old days people would go up into the mountains to die if they believed they had no role in the community," says Mikaela Engell.

Lung cancer and other health problems, meanwhile, are exacerbated by high tobacco consumption. Eighty per cent of the population smoke. Heart disease has increased with the encroachment of processed foods into the traditional whale and seal meat diet.

The Greenland administration, which won home rule from Denmark in 1979, has been tackling the problems with an impressively frank and open attitude.

Jonathan Motzfeldt, the Premier, himself went public some years ago to announce he was checking into a drying-out clinic and this is thought to have been a big factor in helping others to mend their ways. People were deeply suspicious of Alcoholics Anonymous at first but it is slowly gaining a foothold and police chief Jorgen Meyer says there has been a steady fall in the violent crime rate as educational levels improve. "We have empty spaces in the prison," he says.

But dealing with HIV will require a cultural transformation which has not even begun. Health minister Marianne Jensen has ordered the setting-up of a telephone help line next month to offer counselling. Condoms are to be given out free and safe sex leaflets distributed. Nuuk's overstretched doctors are hoping it is not too late.