Back from the U.S., and spreading HIV in Mexico

Photo by: Adriana Zehbrauskas
Source: International Herald Tribune, July 16th, 2007
Author: Marc Lacey

http://tinyurl.com/29r3kt

PUEBLA, Mexico: Cres has spent almost half of his 32 years working in the United States, in the fields of California and Texas and the factories of Chicago and New York. His wife and three children were with him some of the time. But he was alone for long spells, sending money back to build the rural home where he now spends his days, his strength evaporating.

"I don't know how or where or when I got it," said Cres, the only name he would allow himself to be identified by. He paused whenever his pregnant wife entered the darkened room. "I don't have any idea who it was with. I don't want to know. I just want to go ahead with my life."

Mirgant workers like him go to the United States with dreams of new prosperity, hoping to bring back dollars. But they are bringing back something else as well, HIV and AIDS, and they are spreading them in the rural parts of Mexico least prepared to handle the epidemic.

As immigration reform founders in the United States, the expanding AIDS crisis among the migrants goes virtually unaddressed on both sides of the border. Particularly in Mexico, AIDS is still shrouded by stigma and denial. In the United States, it is often assumed that immigrants bring diseases into the country, not take them away.

But AIDS is spreading quickly in rural Mexican states with the highest migration rates to the United States, researchers say. The greatest risk of contracting AIDS that rural Mexican women face is in having sex with their migrant husbands, a new study found, a problem that is compounded by the women's inability to insist that their husbands use condoms.Research has shown that migrants have more sexual partners than those who stay at home. For women, life on the road brings with it risks of rape and sexual abuse. For many migrants, being displaced from their homes and families is a lonely experience, one that prompts them to form new relationships in the United States. Adding to the problem, both Mexico's northern and southern borders have become magnets for prostitutes and drug dealers, drawn by the flow of migrants north.

"Migration leads to conditions and experiences that increase risks," said George Lemp, an epidemiologist who runs the University of California's AIDS research program and is studying the spread of the disease among migrants. "Migrants are vulnerable. They are isolated. They are exposed to different sexual practices. They have language barriers to services and there is a lot of depression and loneliness and abuse."

AIDS has not yet exploded in Mexico and is focused mostly among sex workers and their clients, drug users and gay men, experts say. The AIDS rate here is still considerably lower than that in the United States, nearly half as low, according to UN statistics published in 2006. Based on 100,000 inhabitants, the United States has 4,023 cases of HIV or AIDS compared with 1,681 in Mexico, according to United Nations.

Yet the high-risk behavior that various surveys have documented among many Mexican migrants worries researchers. "Our concern is it could take off in this population in the future," said Lemp, who is leading a joint U.S.-Mexican study of migrants and AIDS.

The first AIDS cases diagnosed in Mexico in 1983 were found among migrants, researchers say. Since then, studies have continued to show that migrants to the United States make up a significant percentage of those contracting the disease. The link between migration and AIDS fluctuated between 41 percent and 79 percent in the 1980s and early 1990s, studies have shown. But since 1992, Mexico has not comprehensively reported the migration history of those with AIDS.

Still, recent studies are revealing the risks that migrants face. A study financed by the California-Mexico AIDS Initiative found that more than a third of the migrants at job-pickup sites in Los Angeles had been solicited for sex by men seeking partners. About a tenth of the men, desperate to earn a living, have agreed, the study found.

Many migrant husbands are "networking sexually among populations with higher HIV prevalence rates, having limited access to preventive or curative health services, and frequently dealing with the social isolation of the migrant experience by seeking comfort in sexual intimacy," Jennifer Hirsch, a professor of public health at Columbia University, said in an article on the issue published in June in the American Journal of Public Health.

She found that unfaithful migrants husbands who were otherwise devoted to their wives were often the highest risk. They were more likely, she said, to seek sex with prostitutes while in the United States and less likely to have long-term relationships with other women. The risks were compounded because the subject of unfaithfulness is frequently taboo within relationships, avoided unless the straying spouse humiliates the other.

"Men's long absences lower the reputational risk of infidelity by ensuring that it occurs far away," she wrote.

A doctor at Puebla General Hospital, Indiana Torres, said that 22 percent of the 1,000 or so cases of HIV and AIDS that her clinic handles could be traced to migration, mostly to the New York area. A new more spacious clinic is under construction to handle the load. "They think that because it's the United States, it's safer," Torres said. "It's their fantasy, and it's not true."

One of the women in the emergency room at the hospital, a 25-year-old mother who did not want to be identified, described how her husband had infected her after returning from a long stay as a migrant worker in Washington State.

She found out she carried the virus only after giving birth to a baby girl who was born with HIV and died. An older daughter also has the virus. She and her husband have since separated.

Doctors say routine screening for HIV is not common, and many find they carry the virus only after births or going to hospitals for other reasons.

"I don't know what's going to happen now," the woman said through tears and an oxygen mask to aid her breathing after she was admitted with a possible tuberculosis infection, a result of her weakened immune system.

Mexico provides anti-retrovirals to even those poor migrants without health insurance but the challenge for them is reaching the cities where the drugs are dispensed. The cost of public transportation strains their budgets. Taking time off from work for doctor's visits is another challenge.

The government has also slowly begun to acknowledge the problem, sending health workers into the countryside to visit returning migrants and teach them about the risks they face on the road.

One program is called "Go Healthy, Return Healthy."

Government health workers are focusing their prevention efforts not just on returning migrants but on those who intend to go. A variety of approaches have been used, from comic books to soap operas. The messages focus on the causes of AIDS, the benefits of condoms and the dangers of sharing needles.

But the stigma surrounding AIDS in Mexico is such that even migrants who had contracted the virus dismissed the notion that extramarital affairs played a factor.

Another HIV-positive migrant, a mother of three named Ana Maria who is now taking anti-retroviral drugs courtesy of the government of Mexico, had gone to the United States with her husband, and worked long hours in a fast food restaurant and hotel in Chicago. She, too, found out she carried the virus after giving birth to one of her children at a Chicago hospital.

"Many people get infected there and then bring it back here," said Ana Maria, who is in her early 40s. "I don't know how we get infected but it could have been in the hospital there."