LIMA, Peru (AP) _ Efrain Porras lay on the floor of a crowded shantytown clinic, his face twisted with pain. An intravenous tube fed serum into his arm. A bedpan lay by his side.

Porras said he was unsure how he contracted cholera. Maybe it was the untreated water he mixed with his drink or maybe, he said, it was the raw fish he ate.

''Of course, I heard all the warnings,'' said Porras, who lives in a mudbrick house in the shantytown of Marquez. ''But after a while I just wanted to live a normal life.''

The cholera epidemic that has killed more than 1,000 Peruvians continues to spread rapidly, health officials say.

Although the death rate fell dramatically in response to newspaper and television health warnings in February, it has soared again. Many recent victims, doctors say, are people who simply got tired of almost three months of boiling their drinking water and not eating their usual foods.

''It's the same thing that has happened with AIDS,'' said Dr. Patrick Reycru, a member of a French relief team. ''People are willing to take a chance in exchange for a little gratification.''

Health officials said they were bracing for an outbreak among children who returned to school this week for the first time since the epidemic began in January. The normal school holiday in Peru is from November until April.

The Health Ministry is urging schools to build new latrines and to purify water in schools' cisterns. More than half of Peru's public schools lack running water and sewers.

Many doctors thought cholera would be limited to the coastal cities where it first broke out in January.

By Feb. 24, only three people a day were dying from cholera, down from a daily average of eight earlier in the month.

But the disease began to spread up into Peru's impoverished Andean mountains, where doctors are often days away by foot and only one in five people drinks treated water.

By early March, the death toll had jumped back to 10 people a day. Now, the figure is more than 20 deaths a day and the epidemic has spread to Ecuador, Colombia, Brazil and Chile.

In Brazil, acting Health Minister Luiz Romero Farias told reporters Thursday that the first confirmed Brazilian case, a 23-year-old man living in the town of Santa Rosa on the Peruvian border, had been hospitalized with the disease.

Dr. Horacio Lores, an epidemiologist with the Panamerican Health Organization, said cholera will probably kill at least 1,600 Peruvians and sicken some 280,000 before it burns itself out.

''The epidemic is now behaving very much according to our original projections,'' Lores said. ''For a while it seemed the outbreak would be much less severe, but I believe there has been a weakening in the intensity of preventive measures.''

The latest figures show that 1,088 people have died, out of nearly 150,000 confirmed cases. Three out of four cholera victims show no symptoms of the disease, which could mean some 3 percent of Peru's 22 million people have now been infected.

The lax attitudes toward cholera have spread to all sectors of Peruvian society.

Cholera bacteria are passed on mainly by food and water contaminated by the feces of victims. Tests have proven that many fish caught in Peru's sewage- filled coastal waters carry the disease.

Nevertheless, expensive restaurants and curbside food stands again serve ceviche, a popular dish made of raw seafood and lemon juice.

Swimmers and surfers have returned to Pacific beaches, where the ocean is often visibly polluted by sewage outflow.

Many anti-cholera posters have been torn down. Newspapers bury articles about the epidemic on back pages. The Health Ministry runs fewer cholera warnings on television.

Many health experts blame a government campaign to protect exports of fish and fresh fruits for leading people to believe the epidemic was under control. The government says the epidemic has already cost Peru $300 million.

President Alberto Fujimori led the campaign by eating ceviche on television.

''Certain comments that contradicted Health Ministry warnings definitely encouraged the epidemic,'' Lores said.

Peru's extreme poverty also has helped the epidemic resurge, health experts say.

Former Health Minister Carlos Vidal in February asked the state-owned oil company to lower the price of kerosene, the fuel most commonly used by poor people to boil the water they drink.

The oil company refused, saying it was already operating at a loss. Many people now say they have no money to buy kerosene.

Juana Ramos, who lives in Marquez with her four children and her husband, said she has tried very hard to avoid cholera.

''For two months I boiled every drop of water my family drank,'' Mrs. Ramos said. ''Now I can buy kerosene only for cooking food. The water we drink comes straight from the well.''