San Diego Writer Examines HIV Epidemic In Tijuana

This is KPBS midday edition. I Maureen Cavanaugh. People who are being treated properly for HIV infection can be controlled where it's undetectable but when the virus is not treated and not only progresses and infects people but it is also spread. Among high-risk populations in Tijuana HIV infection is often not really treated. And the frequent result is unnecessary suffering and death. The plight of those infected with the disease is a subject of a new book called tomorrow is a long time. Tijuana's unchecked HIV and AIDS epidemic. Reporter Jon Cohen wrote the brook and the photographs were taken by Malcolm Linton and Jon Cohen is my guest and welcome to the show. Think so much for having me. San Diego and Tijuana are linked in many ways but what's the difference between the progress of the HIV/AIDS in Tijuana and its relative control in San Diego? In San Diego we have a university that is central to responding to the disease. And there's a public health department that works with the University. And there's an awareness here of how to best approach the disease. Tijuana has a lot of migrants moving their constantly and a lot of people being deported from the United States. There is a university that is involved and a health department but it's not as coordinated and it's not a repost -- robust response and San Diego has more criticism by what it can do better. What is the scope of the epidemic in Tijuana? Tijuana and Mexico in general does not have a huge HIV-AIDS epidemic but Tijuana is about three times more than in the country as a whole so the general population nears what we have in the United States but when you look at high risk groups, people like gay men, people injecting drugs, people who are selling sex, the infection rate skyrockets and it goes to the neighborhood 20% of some groups. In the general population of the United States to give you something relative is about half of one percent. So you and photographer Malcolm Litton focused on people who were both at high risk and had limited resources to get treated in Tijuana. Where did you find most of those people? We began by working with the team from UCSD that was doing research there and they introduced us to people they were working with. And mock them and I have covered HIV in about 30 countries together and we wanted to sit still in one place. And journalism makes you rush from place to place all the time and I sometimes have trouble remembering the story I did yesterday or last week. We want to see what happened over time with people and we followed about 100 people in the book tells the story of 25 or so to show everything that happens. Some people get better, some people who are uninfected became infected, some dodged the bullet come --, some people died. You focused a lot on the canals of where a lot of people who were deported from the US and who had no place to go and no resources, nowhere to go in Mexico sort of found themselves wound up in rather awful conditions. The Mexican government to the canals were many of the pictures were taken in tomorrow was a -- tomorrow is a long time and as you say different outcomes affected a lot of the people you followed, did you know what happened to those people that you photographed in the canal? After the book came out had the pleasure of taking the book to Tijuana and giving it to the people who are in the book. We tracked down most everyone. A lot of people were forced into rehab programs which for the most part did not work and did not have them. A number of people live on the streets, a number of people living new shantytowns. What the government called the cleaning of the canal, it did move people out of the canal but it did not necessarily help those people. You mention UC San Diego and it's working or in San Diego but you also worked with researchers from UC San Diego who are working in Tijuana. Can you tell us about their projects to help HIV-infected people? Yes they have a binational teams live Mexican doctors, nurses, researchers who live in Tijuana and work with the San Diego-based people. And they have research projects looking at how the virus is moving around, they have clinics they run with med students both from [ Indiscernible ] the medical college in Tijuana and you it -- UCSD and they do some rogue clinics where they set up tables and help people who are in need one day a week. There is a public health system in Tijuana. There are good people working there. I don't want to tar with two white of a brush. But the supplementary things they are doing is very important because they are reaching people were called marginalized in the world of science and in plain English their hated. Their hated for lots of reasons. And what's wonderful to see as they are being treated like human beings. By these research groups and the medical students working with them. I'm speaking with Jon Cohen and he and photographer Malcolm Litton have produced a book called tomorrow is a long time, Tijuana's unchecked HIV/AIDS epidemic. Let's talk and meet some of the people that we will meet in this book. You worked with a woman named Sophia. She turned her life around after living at the canal. Can you tell us about her? Her name is actually Susie and Susie was someone who had been using heroin since she was a teenager. She's in her 50s now and she ended up, she looked in the canal for her eight years with her little son and she got off heroin, she's clean, she's HIV-infected and been on drugs for over a decade and is undetectable and she works with UCSD as an outreach worker. She's an inspiration for a lot of people who are down and out living in horrible situations because she really has picked herself up by the bootstraps and made a good life. And her son is doing well also and Susie is healthy. She shows people that you can live with the virus. And she also educates people about how she got off heroin and she is very nonjudgmental which is incredibly important when you are doing this kind of work. Malcolm and I saw a lot of things that would shock and maybe 45 people -- maybe horrified people but what we learn from Susie is not to rack -- react much of anything. And she doesn't. Susie lived with a certain amount of shame about her past quite some time and she also was the bridge that a lot of health workers used to make the connection between people who are living in abject misery and poverty and very high risk behavior to the idea that there was a different kind of life. Yes and I think people need to see the example from someone who they can relate to. And Susie is just, the outreach workers critical in an HIV program ever. That person who is living with the virus, been through what another person who is going through. It's hard to get on medication and take it every day. All of us know that who's ever had in almonds, and antibiotic perception they didn't finish. If you have HIV you have to take your meds every cycle day for the rest of your life. If you don't have a place to live and don't have food, and don't have money it's hard to take care of your health. And Susie is that type of inspiration who says to people you can do it. Jon how are people treated for HIV-AIDS in marijuana -- in Tijuana? They do offer care but it's unfortunate that they -- but their offices are in our from downtown and it's hard to get there and cost money. Their blood samples aren't evaluated at the center, they are shipped to Mexico City which is an absurdity but that's the way it works. So you have to come back to find out how the monitoring is going of your treatment. The doctors that care for people at Tijuana general and the AIDS clinic there are competent people and good people in the meanwhile and they are under resourced and they are struggling. They are overwhelmed and having a lot of deportees coming in who don't have proper documentation and the government requires that you be a clear Mexican citizen to get the free care. Sometimes people fall through the cracks that way. And we document in the book people who wait for months for treatment who are dying. And there's a hospice in Tijuana that we spent a lot of time at Atlas Morris --@[ Indiscernible ] or people are still dying from AIDS and its unconscionable to this 2015 and we have medicine ends it's a manageable disease by saw people dying one -- in a way that is all 30 years go on a four star covering the disease. Whilst doing the book? Tells about some of the other people? There's a very interesting and complicated man named [ Indiscernible ] also goes by [ Indiscernible ] and he was a gay Mac -- gay man who sold sex in the day and in the evening he transitioned into a transgender woman who sold sex of yet three personalities and was complex but he grew up in Wisconsin for the most part one was born in Tijuana and he's completely bilingual but most of the interviews were in English and people with switch to English. He was completely fluent in English without an accent. He ended up, he was uninfected when we met him and living a very high risk life smoking a lot of crystal meth and most of his clients were Americans. You have to keep in mind that virus does not respect borders and it's moving back and forth and he ended up being arrested for possession of crystal methamphetamine and we met him back in prison there and we were working in prison Monday and he happened to have an arrest and was living there and he was tested in prison and turned out to be infected with HIV and was put in a cell with other HIV-infected people in prison. You say that Tijuana is the example of a place were HIV AIDS epidemic could be virtually eradicated, how? There's a big push right now to end AIDS around the world with all the new tools that exist. The drugs not only keep you alive, when the virus becomes undetectable in your blood you essentially become, not completely, it's not as you -- as though you can't transmit but it's hard if your treated properly. You can also take drugs if you're on it acted in preexposure prophylaxis to protect yourself. Testing can be ramped up aggressively to figure out who needs treatment. There are all these tools that exist today to bring epidemics to an end and it's not going to illuminate the virus but it will break the back of the epidemic and Tijuana reflect many places around the world that have a very fractured response. And because of that the stream of ending AIDS which the United Nations has put forward as a possibility by 2030 is nothing more than a dream. In the research for this book, there's San Francisco and New York are both going to put that into practice the kinds of prophylactic and aggressive treatment and try to eradicate AIDS in their cities. Yes both San Francisco and New York have blueprints for how they are going to end AIDS and very aggressive projects. And they're making progress. You can see it. I think that Tijuana is an example of what most places look like. Most places don't look like San Francisco and New York and the advantage to an epidemic in a place like Tijuana is because the virus is concentrated in the specific groups, you can more easily target those for testing and treatment. And for people who are using opiate drugs you can help them get on to substitute drugs like methadone and give them Clint -- clean needles and syringes and get them into rehab programs are robust, healthy programs. Does have works in other parts of the world remarkably well. My sense is in Tijuana and in many places where I have worked there's just no real strong advocacy and leadership. Taking the bull by the horns. In the United States we have an enormous -- and normal sleep powerful gay activism act up with the famous group but it's a very organized political body that assailed the response and the self-criticism in this country was relentless. On all levels. From researchers and even from government employees were unhappy with how things were unfolding. That's what's missing in most of the world and what's missing in Tijuana. There's almost an allergy to self-criticism. And I think, if countries and cities really want to stop them and really want to bring it to a halt they will do what San Francisco and New York are doing and they will say what can we do better? At the images in the book and what you write in it John -- Jon are really very powerful and I want everyone to know once again it's Jon Cohen and photographer Malcolm Linton and the book is named tomorrow is a long time, Tijuana's unchecked HIV/AIDS epidemic. Thank you so much Jon. Remember to join us at five and 630 tonight for KPBS TVs evening edition and we will be here tomorrow at noon for another KPBS midday edition on KPBS FM. I Maureen Cavanaugh and thank you for listening.