When you think of an AIDS epidemic, faraway places like Africa and Asia usually come to mind. But experts say Tijuana is teetering on the brink of an HIV/AIDS outbreak. Since the city shares the busiest border crossing in the world with San Diego County, infection rates on this side are spiking too. Full Focus reporter Amita Sharma has the story.
Medical workers across the globe have long known that poverty breeds disease and Tijuana is no different. And according to researcher Stephanie Strathdee at UCSD, the number of men and women between the ages of 15 to 49 who are infected with HIV in Tijuana may be as high as one in 125.
Steffanie Strathdee, Chief of the Division of International Health and Cross-Cultural Medicine at UCSD: The bad news is that while we've seen rates stabilize in the United States and San Diego for the most part, we're seeing an increase in Tijuana, and this is a dramatic increase from decades ago.
Part of that increase, Strathdee says, comes from a fear of violating societal taboos.
Steffanie Strathdee : In Latino culture it's well known that men who have sex with other men may not identify as gay or bisexual. And this means that they're very hard to target for prevention programs because if we go to a gay bar and we post fliers and hand out condoms, they may not be situated in a way that they're going to think that it matters to them.
But there is another factor contributing to the spread of AIDS in Tijuana, and that is prostitution. Many prostitutes don't require their clients to wear protection. That's because their clients, many of whom are American, are willing to pay more if they don't have to wear condoms.
Steffanie Strathdee : About 95 percent of the female sex workers we have studied have children, and when you have mouths to feed and you're living in a desperate situation and someone offers you more money to have sex without a condom, everyone feels that they have a price and that price may mean that they compromise their health.
What it also means is that others in the region will pay a price as well. Forty-two thousand people travel from Tijuana into San Diego County everyday. Some cross for work, others for shopping, and others to visit friends, family and lovers. And since HIV needs no passport, the spike in cases in Tijuana is being felt locally. Last year, the South Bay Region accounted for 16 percent of the AIDS cases in the county; that's almost double what it once was.
Theodore Katsivas, M.D., San Ysidro Health Center: We have from three up to eight new patients each month, most of whom are from the other side of the border.
Dr. Theodore Katsivas treats patients with HIV and AIDS at the San Ysidro Health Center.
Theodore Katsivas : Something that needs to be noted is that the patients who come to this clinic actually have the ability to cross the border. Unfortunately, most of the cases I suppose are actually seen across the border are people who will not be able to cross or are a marginalized population that are mostly at risk and also are not able to cross the border. So what we're seeing is the tip of the iceberg, really.
Katsivas says those who do make it to the San Ysidro Clinic say they're scared of revealing their condition to healthcare providers in Tijuana.
Theodore Katsivas : They cannot be very open about their status and that they often visit providers on the other side of the border and they feel very scared in telling them that they are HIV infected. So providers on the other side of the border do not have, cannot make informed decision on their care ... so they treat them without knowing that they're HIV infected which can be a problem.
That sense of stigma isn't helping matters, says Rosana Scolari who directs HIV services at the clinic.
Rosana Scolari, HIV Services Director at San Ysidro Health Center : I think culture plays a really important role in terms of the spread of the disease in general because there is a sexual silence that comes with being part of the Latino community that acts as a barrier to of course talking about sex within your family, talking about sexuality, and with that it kind of acts as a barrier to talking about HIV and AIDS.
Take Jorge Franco, who didn't want his face to be shown for this report. The 46-year-old gay man says he doesn't discuss the fact that he has AIDS because people are still afraid of it.
Jorge Franco, AIDS Patient : You feel the rejection of the people. No one likes to be rejected and even more so if you're a young man. If people know you have the disease, people won't touch you very easily.
It's a message that Francisca Ruelas, who also didn't want to be seen, echoes.
This 64-year-old grandmother from Chula Vista found out two years ago she had AIDS when she went to renew her health insurance and had to take a saliva test. For her, there was little mystery in how she got it.
Francisca Ruelas, AIDS Patient : I'm what we call a decent woman. I've never been with any other man but my husband. So my husband gave it to me.
Ruelas says she doesn't know whether her husband got the disease from a mistress, a prostitute or even a man. But she's certain he got it during a liaison in Tijuana. She has spent a lot of time in therapy working through her anger and fear. Today, even as AIDS ravages her eyesight and she can no longer work as a caregiver to disabled veterans, she's forgiven her husband.
Francisca Ruelas : He's asked for forgiveness. He's apologized. He gets worried when I'm depressed or when I get sick. He feels really guilty. That's why I take my medicine and take care of myself so we can both be happy because we have kids and grandkids.
But Ruelas still feels sad when she thinks about how AIDS is spreading through the Latino community on both sides of the border. That growth of AIDS cases is why HIV prevention through education campaigns, condom promotion, access to testing and treatment has to be made a top priority says UCSD's Strathdee. But even those efforts won't work, she says, unless the United States and Mexico work together.
Steffanie Strathdee : We have people from San Diego who are traveling to Tijuana on a regular basis. We have people from Tijuana traveling to San Diego on a regular basis. These populations are one metropolis and as a result we really need to have a coordinated response to HIV prevention, and it really needs to be done urgently or this epidemic will spiral out of control as has been seen in other settings.
