Mexican migrants
vulnerable to AIDS outbreak

High levels of drug use and unprotected sex make Mexican migrant workers vulnerable to a devastating future wave of HIV infections, a new survey suggests. Sex work by Mexican migrants who can't find standard day labor raises their AIDS risk even higher.

"Basically, if they maintain these high-risk behaviors, and HIV is introduced into the population, it's only a matter of time before HIV infection takes off," University of California AIDS Research Program Director George Lemp said.

The University of California Office of the President is a leader of the California-Mexico AIDS Initiative, a broad-based binational effort to address HIV issues among Mexican migrant workers. The initiative began in 2001. The first phase--interviewing migrant workers in California in Mexico--is nearly complete. Lemp shared early findings with PlanetOut.

Researchers discovered that HIV infection rates remain relatively low among Mexican migrant workers, but could quickly spike under current conditions. One in four male migrants interviewed said he uses cocaine or crystal meth. One in three male migrants does not use condoms when having sex with other men, and unprotected sex is even more common when migrants go to sex workers.

Among interview subjects who have gay male sex, about 3 percent tested positive for HIV, compared to about 25 percent of all gay men in large U.S. cities. The official HIV/AIDS rate in Mexico is half that of the U.S., or .3 percent.

Health experts worry about the risk of HIV infection both among migrant workers themselves and their families. Migrants could cause a secondary wave of infections when they return to their home towns in Mexico, a trend that has already begun, study results suggest.

"Women in remote villages are getting HIV in ways that don't make sense, so it must be getting brought back," Lemp said.

Two California cities were selected as study areas: San Diego and Fresno. San Diego represented border towns, and Fresno inland rural areas. Vista Community Clinic did the interviews in San Diego. Planned Parenthood of Mar Monte did the interviews in Fresno. Mexican health officers conducted surveys in five cities in Mexico. Mexican participation has been suspended since Mexico's presidential election in July 2006, but is expected to resume after the new administration settles into office.

Sex activity

Mexican migrant workers often have sex without condoms, the survey found. Condom use varied by sex practice.

Most of the people surveyed in the California-Mexico AIDS Initiative were men, as most migrant workers are men.

Men who have anal sex with other men reported not using condoms about a third of the time, both with "casual partners" and "main partners" (those terms were not precisely defined).

Men who have anal sex with women said they do so without protection in about three out of four cases -- 69 percent of the time during sex with casual partners, 76 percent of the time with main partners. Lemp said anal sex between men and women was "not infrequent." During vaginal sex, respondents said they use no condom 93 percent of the time with their main partners, 19 percent of the time with casual partners.

Researchers found that 15 percent of straight migrant men have sex with sex workers, as do 21 percent of bisexuals; the bisexual men said they usually go to female sex workers. Bisexual respondents said they use no condom during vaginal sex with sex workers a third of the time.

Drug use

Male migrant workers reported high levels of drug use. About 30 percent of gay and bisexual men in the study reported using either cocaine or crystal meth, and about 21 percent of straight men. Only 1 percent of women reported using cocaine or crystal meth.

Interview subjects tended not to clearly distinguish between cocaine and crystal meth, Lemp said. Researchers have started asking how much respondents spent on their drugs, as they can deduce the drug by price; a dose of cocaine costs about four times more than a dose of crystal meth.

About 7.5 percent of migrants said they use injection street drugs. "That's a fairly high number," Lemp said.

Some of the drugs injected by migrants are not illegal, but can still transmit HIV. Migrant workers sometimes take vitamins or antibiotics intravenously to fortify their health, researchers found. Well-meaning people will share their vitamins and antibiotics with neighbors. They may not recognize the danger of reusing needles without sterilizing them, and inadvertently pass along viruses.

Vulnerability hypothesis

Maria Hernandez, an epidemiologist for the University-Wide AIDS Research Program of the University of California, coordinates the migrant worker interviews. She works with two local organizations -- Vista Community Clinic in San Diego and Planned Parenthood of Mar Monte in Fresno--whose members go to migrant worker camps and city street corners with her to interview people. v In many cases, Hernandez found the migrants' living situation dire. "It was really interesting to see that there are just a lot of people that don't have a lot of cushion being here (in the U.S.)," she said. "They're just one week away from not having a place to stay, or not having any money."

"They have very precarious living conditions," Lemp elaborated. "People are living in holes in the ground, in tents in the hills, or just wrapped in garbage bags to keep dry. Starvation is a real threat. They're exposed to extreme temperatures and pesticides in the fields, and jostling to get jobs."

Hernandez and fellow researchers formulated a "vulnerability hypothesis." They suspect that the precarious nature of migrant life makes people more likely to become involved in dangerous activities like unprotected sex and intravenous drug use. People with fixed homes and jobs in high-security buildings are less likely to be exposed to such temptations, Hernandez suggested.

"Their environment offers them these high-risk opportunities more than people who have more stability," Hernandez said.

One temptation that has recently drawn researchers' attention is sex work as a means of earning money, usually with other men. Paid sex can, obviously, transmit HIV.

Hernandez blamed the phenomenon of migrant workers turning to sex work in part on the "vulnerability hypothesis." Most of the men who reported having sex for pay said they are not gay and do not wish to sleep with their customers, but do so out of desperation. Usually they go to street corners looking for work as day laborers; later in the day, when no customers pick them up for construction or garden work, they accept invitations to have sex for money. Sometimes they're hired under false pretenses and coerced into sex, sometimes violently.

One possible solution to the "vulnerability hypothesis," Hernandez says, is to make migrants less vulnerable. For example, day laborers can be provided public pick-up centers where they can more easily find safe work, and where it's more difficult for people to take advantage of them.

When day laborers are driven into back alleys, they're more likely to find themselves in compromising positions, Hernandez said.

Hernandez criticized efforts to drive day laborers out of their usual pick-up spots without providing alternatives, in an effort to "clean up" a neighborhood where day laborers are seen littering and possibly causing more serious trouble. "It doesn't do anything to address what they felt the problem was," Hernandez said. "It just increases the riskiness of the situation." A better approach might be to literally provide more garbage cans, Hernandez said.

The next phase of the California-Mexico AIDS Initiative is to protect migrants against HIV risks. Organizers are seeking partners to use $300,000 already dedicated to that purpose. Hernandez proposes addressing problems in the socioeconomic environment where migrants live, rather than focusing solely on the end behavior.

"It's not necessarily helpful to go to these people and say, 'Oh, you're gonna change your behavior; next time you're gonna use a condom,' when they have no control over their next meal," Hernandez said.