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THEIR BEST SHOT: The Needle Exchange and Harm Reduction Program is one way the county is trying to battle the most recent twist in the HIV/AIDS epidemic: a spike in the number of undocumented immigrants who are infected.

Edge of Epidemic

HIV-positive undocumented workers are at the center of a brewing health crisis in Santa Clara County and throughout the state

By Andrea Riordan and Colleen Watson

IT'S RARE to find anyone in California's heated immigration debate at a loss for words, but there's a new twist on the situation that almost no one is talking about: HIV. While the numbers have yet to reach epidemic proportions, HIV among undocumented immigrants is on the rise.

Statistics about undocumented workers are difficult to come by, but the trend is reflected in the general Latino population. Ten years ago, Latinos accounted for 26.6 percent of AIDS cases in Santa Clara County. By 2005, that number had jumped to 41.9 percent. Similarly, in Los Angeles County five years ago, 50 percent of AIDS cases were Caucasian and 25 percent were Latino. Now those numbers have reversed.

HIV and AIDS experts throughout California are beginning to acknowledge the problem, and state funding for AIDS organizations is relatively robust, but the task of educating and treating an ever-growing undocumented immigrant population is daunting.

Santa Clara County's Needle Exchange and Harm Reduction Program, which is operated by the Public Health Department's HIV/AIDS Prevention and Control Program, reports that from July of last year through June, they contacted a total of 2,564 clients. Of these, 30 percent were Latino.

Lydia Guel, director of HIV Services for Community Health Partnership of Santa Clara County, knows the difficulties of reaching out to the Latino population. CHP offers workshops, case management and community outreach programs that are geared toward transgendered women of color and Latino men with same-sex partners. These groups have higher rates of infection and less access to health care than the general population. Many are undocumented, don't speak English and are distrustful of the police and authority.

"We have a team of outreach workers that go out to the community, they go out to the streets and out to the bars, where these people are. They hand out condoms and information, and try to get them to go to health services," said Guel. "There are a lot of sex workers in the community that we deal with on a regular basis. And our outreach team can meet them where they are."

The CHP outreach team has their work cut out for them. AIDS workers report that there is no real protocol for educating a man or woman from a small town in Mexico. They describe the problem as similar to the one faced by health-care workers at the dawn of the epidemic.

In much of Mexico, HIV and AIDS are still surrounded by enormous stigma. While Mexico is working to bring its HIV awareness into this century—even hosting the 2008 International AIDS Conference in the capital—most undocumented immigrants who come here to work have very little knowledge of HIV or how to keep from getting it.

'I Lost My Life'

Pablo Rodriguez says that when he crossed the border 22 years ago, at the age of 18, and settled in Northern California, he knew only vaguely about protection. He says he had never had sex with a man before coming to the United States, although he had thought about it. Rodriguez (who asked to be interviewed under an alias) says he was isolated without his friends and family, and began to drink heavily. He soon met and moved in with a man, but hid the fact that they were lovers. He says his partner never told him he was HIV-positive.

"I lost my life, the one that I knew," Rodriguez says. "I have worked here everywhere. The fields, the factories, the houses. I made it all the way here, and now I live with this. I live with this in all of my life."

Rodriguez, who lives in Watsonville, is now on anti-retroviral medication. He says he can't go back to Mexico.

But many migrant workers do return, again and again. In 2000, data showed that up to 26 percent of HIV cases in parts of Mexico had lived in the United States. Health officials believe many of them contract the disease while here—where they're often lonely, struggling, far from family and constantly on the move. These factors can result in high-risk behaviors.

Maria Hernandez, epidemiologist with the University of California's HIV/AIDS Research Program (CHRP), says migrant workers are more likely to change their behavior and sexual activity if they don't have a family or social network here. This also often prevents them from getting tested.

In a survey sponsored by CHRP, as many as one-third of day laborers questioned in Los Angeles said they had been propositioned by men to be paid for sex. Up to one-10th said they had accepted. According to surveys carried out by CHRP in Fresno and San Diego counties this year, as many as one-fifth of migrants reported they had used crystal meth (although they call it cocaine).

Whose Responsibility?

Dr. George Lemp, an epidemiologist and the director of CHRP, says the United States needs to accept the bulk of the prevention responsibility, since the immigrants are often contracting the disease here, not in Mexico.

It's pretty much the only option. Mexico's Ministry of Health last year cut its funding for educating migrants from over $1 million to a paltry $150,000. In October, however, the Secretary of Health upped funding for HIV prevention programs.

The coalition between the Mexican National Center for HIV/AIDS Prevention and Control (CONTRASIDA) and the California Department of Public Health's Office of AIDS would like to see more funding go toward educating migrants before they leave Mexico. "Preferably prepare them six months to a year before they head out," says Dr. Lemp.

Mexico implemented a federal program in 2001 called "Vete Sano, Regresa Sano" (Leave Healthy, Return Healthy), which is supposed to do just that. But it's clearly not enough.

At home, family and local traditions create a comforting rhythm and provide an identity for workers. Uprooted, they put in long hours of intense labor, and afterwards many drink, abuse drugs or find solace in a casual sexual partner.

But the fear of deportation makes migrant workers less likely to get help when they're sick in the United States. Even when a person knows where to get treatment, there is always the fear of being deported.

According to Dr. Jennifer Hirsch, professor of public health at Columbia University, the HIV epidemic in migrant workers is part of a larger problem with U.S. immigration policy. "The public health programs can fritter away at the edges, but it's an immigration policy problem before it's a health problem," she says.

Women Don't Know They're at Risk

The number Latino women contracting HIV from their partners is also rising, both here and in Mexico.

"HIV in Latina women and Asian pacific-islander women is going up, and that's because of perceived risk," says Guel.

These women often have only one partner and don't think that they are at risk for HIV, so they don't get tested. The clinic routinely tests Latina women for HIV when they come into the clinic for an unrelated reason. Undocumented women often discover they are HIV positive because of routine testing during a pregnancy.

"All women who go in for labor and delivery, we need to know what their HIV status is," Guel says. "If we know that she's positive, we can significantly reduce the rate of transmission to the child."

The word "epidemic" is tricky. But right now, in a rural area of Mexico where there were zero cases of HIV, even one is great cause for concern.

"Mexico is sitting on the same tinderbox of an AIDS epidemic that China and India were 10 years ago," says Dr. Lemp. "But with binational efforts, it could be stopped. In Mexico we're hoping to prevent what China and India have now after years of denial: full-blown epidemics," Rodriguez recognizes that his medical condition is complicated by his status as an illegal.

"I am not here, really, in this country," he says. "I am invisible and I can't get the support I need. I see others around me with the same situation and they can get more help because they are legal.

It is lonely."

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