(September 2005) Both Mexicans who migrate to the United States for work as well as many Mexican migrants returning home are increasingly engaging in high–risk behaviors that put these groups at heightened vulnerability to HIV infection—especially since they are often outside the reach of conventional HIV prevention programs.
Two new studies from the California–Mexico AIDS Initiative—a joint program coordinated by the Mexican Secretariat of Health and the University of California Office of the President—show rising rates of HIV infection among Mexican migrants within Mexico and in California. The studies found that 0.6 percent of Mexican migrants tested in California and 1.1 percent of adult rural migrants surveyed in Mexico were infected with HIV, with the latter figure more than three times higher than the infection rate reported for the general Mexican population ages 15 to 49.1
While the sampling for both studies focused on people in high–risk venues such as bars, researchers are still concerned about the figures. "Based on the information we now have about migrants' sexual behavior, it appears that there is a greater possibility that the number of cases of AIDS will grow," says Dr. Carlos Magis, director of research at Mexico 's National Center for the Prevention and Control of HIV/AIDS (CENSIDA). "This new information highlights the need to invest in prevention services for communities in the United States and in Mexico."
Migrants Report Substantial Levels of High-Risk Behaviors
Previous research has shown that Mexican migrants in California display high–risk behaviors and are potentially vulnerable to an HIV epidemic. In a 2004 study of 71 male participants representative of Mexican migrant communities, researchers at the University of California 's University Wide AIDS Research Program (UARP) found no HIV infections. But the researchers did find substantial levels of behaviors that put people at risk of contracting the virus, according to UARP epidemiologist Melissa Sanchez. (UARP and CENSIDA administered the two new studies.)
About 10 percent of the men in the study reported sex with males, while 11 percent received money for sexual favors and 51 percent had used at least one illegal drug in the 12 months prior to the survey. Fifty–eight percent of the migrants reported unprotected vaginal sex in their last instance of intercourse with casual partners, while 85 percent reported unprotected vaginal sex with steady partners.
The migrants also reported that 25 percent of their sex partners were sex workers. And 20 percent of those surveyed reported sex under the influence of drugs or alcohol in their last instance of intercourse. Finally, chlamydia trachomatis—a sexually transmitted infection (STI)—was also detected among 3.2 percent of the migrants surveyed who were living and working in California. (Those people with STIs have been clinically proven to be at elevated risk of contracting HIV.)
Increased Vulnerability Among Originating Communities
As Sanchez and other UARP researchers track the behavior of migrants in California, Magis and his colleagues are studying migrants in five Mexican states with high migration rates: Oaxaca, Michoacan, Zacatecas, Jalisco, and Mexico state. Their findings indicate that, while HIV/AIDS has not yet become prevalent among the general Mexican population in these states, there has been an increase in AIDS cases associated with drug use in cities along the border with the United States, as well as an emerging pattern of increased heterosexual transmission.2
Earlier studies confirm these findings. According to a 1998 report by two researchers at the Colegio de Mexico, migrants tend to change their sexual practices because of their transient lifestyles and exposure to U.S. culture.3 For example, the number of sexual partners can increase among men as they travel from place to place. Loneliness, isolation, lack of women, and entrance to a more permissive society can also mean that male migrants have sex with male partners and/or with prostitutes who are regularly intravenous drug users.
In 2000, 12.7 percent of all AIDS cases registered in Mexico involved people who had previously lived in the United States.4 And according to a 2004 report prepared by Magis and other Mexican researchers, the majority of migrants' high–risk sexual behavior occurs when they are in the United States, where the prevalence of HIV/AIDS is greater—0.6 percent of the total population versus 0.3 percent in Mexico.5
Magis says CENSIDA is particularly concerned about the spread of HIV/AIDS in rural Mexican areas. Health services are scarce in many of Mexico's rural communities, and the available services are not equipped to handle the specific treatment and prevention required with HIV/AIDS.6 According to the 2004 report, the proportion of people with AIDS who had lived in the United States was higher among people living in rural areas (less than 5,000 inhabitants) than in urban areas (more than 500,000 residents). The two states with the highest rates of HIV/AIDS cases whose population has a pattern of residence in the United States are Michoacan and Jalisco, both with rates greater than 20 percent.7
The Challenge of Prevention and Treatment for Migrants
Authorities on both sides of the border have found that tracking, reaching, and treating migrants with HIV/AIDS or who are at risk of contracting the disease is exceedingly difficult. The population is mobile, and services and outreach strategies vary widely between and within the two countries.
"We try to reach them once they return to Mexico, but the policies are always changing in the other places where these migrants are," Magis says. "These migrants might work in California, but they may cross the border in Arizona through the desert. California and Arizona's policies are different from each other and different from ours, which reduces the overall effectiveness."
According to Charlene Doria–Ortiz, executive director of the Center for Health Policy Development in San Antonio, migrants with HIV/AIDS are at a disadvantage when treatment protocol varies between states in terms of what medications are provided.
"When migrants come in for treatment or services—if they come in, since many of them are afraid that using the health care system could get them deported if their status is in question—they may not know exactly what kind of treatment they had somewhere else, which can make it hard for practitioners to resume effective treatment," says Doria–Ortiz. She adds that some states' resources for public health are depleted more quickly than those in other states, making it harder for those former states—particularly Arizona, New Mexico, and Texas—to maintain outreach and prevention programs.
Magis adds that other factors also increase migrants' chances of contracting HIV/AIDS. "They don't speak the language, their migratory status hinders their access to health services, they think that health services are only available to legal immigrants, and they develop drug and alcohol addictions while they are away from home and isolated," he says of these populations.
Beginning to Address the Problem on Both Sides of the Border
Despite these challenges, health authorities on both sides of the border have begun to address the issue and find ways to combat the problem. For instance, the Border Planning and Evaluation Group (BPEG) at the University of Texas–El Paso (UTEP) is working with health care providers and capacity building programs to find solutions in treatment and prevention in Texas.
"The solutions have been few and far between over the last 10 years," said Rebeca Ramos, a public health specialist with BPEG. "We focus on building capacity among health care providers and alternative outreach programs, including peer–led programs."
The Promovisión Program—a collaborative effort between UTEP, the United States–Mexico Border Health Association, and the Centers for Disease Control and Prevention—uses Spanish–speaking community health workers (called Promotores) to act as liaisons between HIV/AIDS patients, at–risk migrants, immigrants, and health care providers.
And in Mexico, the National Institute of Migration has begun to show AIDS education videos on buses to migrants traveling to or in and around the border. Many other outreach programs operate at a local level there, such as the Bi–National AIDS Advocacy Project (PROCABI) in Tijuana, which provides antiretroviral drug treatments and other services to AIDS patients in the Tijuana–San Diego border zone.
Magis and other researchers believe that prevention services would be most effective if offered in the United States. "The prevention should be offered where the risk exists because there you can catch it before it happens," he says. But other experts such as Doria–Ortiz believe that cross–border coordination is equally important.
"What we need is something like the empowerment zones that have been developed for economic development purposes by the federal government in the United States—but for public health along the border," Doria–Ortiz said. "Right now there is very little coordination on surveillance, measuring, prevention efforts, and treatment interventions, and neither country can provide much in the way of services."
Eliza Barclay is a freelance journalist based in Mexico City.
- A summary of the two studies is available at the University Wide AIDS Research Program website (http://uarp.ucop.edu), accessed on Aug. 24, 2005.
- Carlos Magis–Rodríguez et al., "HIV/AIDS Risk Factors for Injection Drug Users in Tijuana," BC Revista Salud Fronteriza 2 (1997): 31–4.
- Carlos Magis–Rodríguez, Enrique Bravo–Garcia, and Pilar el Rivera, "AIDS in Mexico in the year 2000," in The Mexican Response to AIDS: Best Practices, ed. Patricia Uribe and Carlos Magis–Rodríguez (Mexico City: National Council for the Prevention and Control of AIDS, AIDS Angles Series, 2000): 13–26.
- Carlos Magis–Rodríguez et al., "Migration and AIDS in Mexico: An Overview Based on Recent Evidence," Acquired Immune Deficiency Syndrome 37, Supplement 4 (2004): 1–11.
- Magis–Rodríguez et al., "Migration and AIDS in Mexico: An Overview Based on Recent Evidence."
- V.N. Salgado de Snyder, "Migracion, sexualidad y SIDA en mujeres de origen rural: Sus Implicationes Psicosociales" (Migration, Sexuality and AIDS Among Women of Rural Origin: Psychosocial Implications), in Sexualities in Mexico: Some Approximations From the Social Science Perspective, ed. I. Szasz and S. Lerner (Mexico City: El Colegio de Mexico, 1998): 155–71.
- Magis–Rodríguez et al., "Migration and AIDS in Mexico: An Overview Based on Recent Evidence."