By Catie Duckworth
Council on Hemispheric Affairs
Affecting 0.3 percent of the population, HIV is only half as prevalent in Mexico as it is in the United States. However, experts have noted an increase in cases in Mexico following the implementation of the North American Free Trade Agreement in 1994.
Researchers have linked HIV/AIDS in Mexico to migration since these rates only recently started to rise. In the 1980s and early 1990s, studies showed that between 41 and 79 percent of Mexicans with AIDS had spent time living in the United States. Unfortunately, these statistics have not been updated since 1992, highlighting a lack of attention to this serious issue.
Increased migration from Mexico to the United States has corresponded with a 7.8 percent annual increase in HIV diagnoses along the U.S.-Mexico border. At this rate, in the next 15 to 20 years the number of AIDS cases may overwhelm Mexico’s limited capacity to address them.
Both Mexico and the United States, therefore, have a joint responsibility to increase their efforts to combat AIDS. Mexico needs to uphold its promise to treat every AIDS case in the country while, across the border, the United States must expand the health care services it provides for migrant workers, especially AIDS treatment for farm workers.
Cultural Perceptions Affecting Infection Rates
Most migrant farm workers are men, many of whom left wives and girlfriends behind in Mexico. Their attempts to deal with loneliness and harsh conditions on the farms often lead to high-risk behaviors associated with HIV infection. George Lemp, director of the University of California’s AIDS research program, has noted among Mexican migrant workers in the United States rates of infection have increased with drug consumption, multiplicity of sex partners and utilization of sex workers.
Language barriers, cultural misunderstandings, and insensitivity on the part of health care professionals can impede efforts to provide preventative education for migrants once they successfully migrate to the United States. Many migrant workers who seek services through government-funded health clinics often have a very limited Spanish vocabulary and must rely on a third party translator. At times, when health workers attempt to use Spanish with the migrants, it is often in a disrespectful manner.
Men living at the farming camps often become embarrassed when volunteers from free health clinics visit to distribute condoms, and most refuse to take them. In many clinics, nurses make little attempts to communicate in Spanish with workers and have been known to simply throw condoms in men’s faces yelling “condones, condones!”
Such approaches fail to get the point across to the workers about the importance of protection. They also illustrate how even on the rare occasions when health professionals use Spanish words they may still be ineffective in conveying the role of condoms in disease prevention. Training health care workers to increase their Spanish health vocabulary and comprehensively articulate the risks of unprotected sex would break down the communication barrier between the farm workers and the nurses.
Additionally, a study on perceptions of AIDS prevention among Hispanic men in California found that many participants believed that the farther north one is, the higher his or her chances of contracting HIV. Therefore, even though some men in the study did report using condoms in the United States, their usage was sporadic and they did not believe it was necessary to do so with their sex partners in Mexico.
The pattern is that workers then carry the virus back to Mexico, where they do not wear condoms with their wives out of fear of admitting to their infidelity and having to face the societal consequences. According to the aforementioned study on perception of AIDS among Hispanic men, some males said they would prefer to commit suicide rather than live with the disgrace of being HIV positive.
Commenting on his reservations for getting tested, one participant in the study even claimed, “The fear of knowing we have it. All of us, after we were married [experience it] …we remain blind, wondering if we have it. To be blind or to know?” Clearly, many deem it better to live in ignorance than with an HIV positive diagnosis.
This negative mindset stems from the fierce taboo and misconceptions surrounding AIDS in Mexico as well as the rest of Latin America. The strong Catholic tradition in the region stigmatizes contraceptives, and therefore condom use, meaning that when migrants return to their own village neither they nor their partners use condoms.
Due to this Vatican-ordained stigma, most men reject HIV/AIDS testing when they return home from the United States and they often infect their partners with continuous unprotected sexual activity.
Health Care Opportunities Not Cutting It
On both sides of the border measures have been taken to improve migrant health, such as the Vete Sano, Regresa Sano (VSRS) program in Mexico. The VSRS program claims to draw attention to every single HIV/AIDS case detected. However, little evidence exists to confirm the effectiveness of such efforts.
Furthermore, as of 2002, there were approximately 50,000 known AIDS cases in Mexico with an additional estimated 150,000 individuals living with HIV. In 10 to 15 years, when these potential HIV positive cases turn into AIDS, Mexico may not be able to fully combat these cases as promised.
In Mexico, government and private sector employees have access to free health care through social security programs, including the necessary treatment required for AIDS treatment. However, informal sector workers do not reap the same benefits, leading to an uneven distribution of health care.
According to a national survey in 2000, 60 percent of the population lacked access to social security programs. Clearly, the Mexican government should focus its health care reform efforts on providing the greater part of the population with the proper tools to combat this plight.
Mexican migrant farm workers usually have far less health care coverage than their counterparts in the United States. About half of all migrant and seasonal workers in the United States are undocumented and the median annual income for these farm workers is $6,250 USD with 85 percent of them remaining uninsured.
Therefore, expensive medical care, including AIDS treatment, is normally out of reach. Additionally, due to a lack of information about available options, inconvenient hours, and the fear of deportation, only about 20 percent of migrant workers utilize the health care services of free clinics.
The free clinic that services migrant workers in South Central Pennsylvania, for example, is only open one evening a week, severely limiting options in case of emergencies. Additionally, the services available invariably turn out to be very minimal; free clinics most often do not even offer basic services such as dental care, let alone AIDS treatment.
Washington should seriously consider increasing the resources available to these clinics so as to widen the services that can be offered. By doing so, the United States would in turn be providing further health benefits to its own citizens.
An AIDS epidemic among Mexican migrant workers is a matter of health concern for citizens on both sides of border. These workers are not only taking the disease home to their wives in Mexico, but they have the potential to spread the disease to their sex partners in the United States, many of whom may be permanent residents or citizens.
On the other side of the border, even though Mexico has been noted for effectively tackling treatment of AIDS in the past, it could be unlikely that it will be able to do so in the future. The relatively low number of AIDS cases in Mexico does not guarantee there will not be increases in the infection rate in the future.
With the drug war appropriately at the top of the national agenda, Mexico is unlikely to allocate the resources necessary to treat the problem of HIV/AIDS. Even though the drug war is now of primary focus in Mexican politics, the country also needs to begin to focus on other aspects of its citizens’ wellbeing, including increased health care options.
If an AIDS epidemic is truly brewing in Mexico, the responsibility to attack it should not remain on one side of the border when the disease originates on the other and has the potential of harming both sides. Both the U.S. and Mexico must step up in a united front against AIDS.
Catie Duckworth is research associate at Council on Hemispheric Affairs