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six in the morning in Oakland's Fruitvale district, a rooster in someone's
yard begins to strut and crow. There is no other sign of dawn. The sky
is black and low, and cold water runs off the eaves from a rainstorm that
just blew through. A crowd of men huddles in the darkness in front of
Los Mexicanos, waiting for the bakery to start selling bread and coffee.
Across the street, in the parking lot outside of public health center
La Clinica de la Raza, high beams sweep the lot, then extinguish. Outreach
workers Guadalupe Yañez and Viviana Rodriguez emerge from the car
into the January drizzle, trundling bags of groceries into a portable
building that serves as headquarters for the clinic's Project TRUCHA-the
letters stand for "Together Reaching Users, Combating HIV/AIDS."
The clinic runs another program that reaches out to those at risk for
HIV, called Proyecto Hombre a Hombre, which targets men who have sex with
The two are part of a handful of regional programs tailored to Latinos
and, more specifically, to some of the East Bay's most overlooked residents
-migrants from Mexico and Central America who come north seeking temporary
work as day laborers and farmhands. Researchers, epidemiologists, and
outreach workers who work with the migrant population now believe that
migrant laborers compose one of the newest and most alarming high-risk
groups for HIV infection. Extreme poverty, transiency, significant linguistic
barriers, and harsh living conditions all contribute to a culture that
encourages risky health behaviors but has few resources to treat-or sometimes
even diagnose-those who fall sick.
Overworked government health agencies on both sides of the border are
just beginning to recognize the potential hazards of an infected migrant
workforce; after all, they say, look what happened in Africa, where truck
drivers and migrant workers spread the virus unwittingly from town to
town and from country to country. Most poignantly, recent HIV outbreaks
among women in rural parts of Mexico and Central America suggest that
migrant laborers, upon returning home, are already spreading HIV inadvertently
to wives and girlfriends, hastening the inroads of the disease in remote
communities that are ill-prepared to handle an outbreak.
By the end of the year 2000, HIV had already infected 36.1 million people
worldwide; 21.8 million more had died of AIDS, the final stage of the
viral infection. Once considered a disease that primarily affected gay
men-at least in the West-HIV infection rates are now soaring among women,
youth, and communities of color, preying upon the poorest of the poor.
The increase in the number of HIV-positive women, often infected by a
male sex partner who had previously used intravenous drugs or had sex
with other men, has also led to a rise in pediatric AIDS cases. From a
world-health standpoint, the transition couldn't be more worrisome; HIV
has shown itself able to jump class, racial, sexual, and geographic borders
with the greatest of ease.
In the US, the virus' shift to heterosexual transmission was a stealthy
one, aided by the fact that sex between men-including those who consider
themselves straight-is more secret than unusual. Also, reluctance to discuss
intravenous drug use-not to mention cultural mores that discourage women
from negotiating either condom use or when and how sex takes place-put
the female partners of HIV-positive men at additional risk. This trend
has so alarmed the Joint United Nations Programme on HIV/ AIDS (known
as UNAIDS) that in 2000 the organization released a report specifically
dealing with men's role in the spread of HIV. The report noted that because
of differences in anatomy, men are twice as likely to spread HIV to women
as the other way around; they are also likely to have more sex partners
and, because of greater economic and social mobility, to spread infections
to new communities. Specificially, the report cited prisoners, soldiers,
and migrant laborers as traditionally all-male groups likely to spread
HIV among themselves and, through travel, to other populations. "Without
men," the report continued, "HIV would have little opportunity
to spread. Over seventy percent of HIV infections worldwide are estimated
to occur through sex between men and women."
The idea that migrant workers traveling between the US and Mexico could
carry the virus to their rural hometowns plays neatly into this theory.
But at this point in time, alarmed health workers are having to make their
case more on anecdotal evidence than on statistics. California's migrant
workers are notoriously difficult to study; it's hard to track people
who don't have social security numbers or permanent addresses. Anywhere
between 35 and 50 percent of the state's migrant workforce is in the country
illegally. The passage of Proposition 187 in 1994, which would have made
undocumented workers ineligible for most public education, health, and
social services and which required employees of public agencies to report
illegal aliens to the INS, discouraged many migrants from seeking health
care. Although Prop. 187 was ruled unconstitutional in 1998, few undocumented
workers today are willing to approach clinics for the tests and treatment
they desperately need, much less participate in surveys.
The few studies of migrant workers that have been done have found hugely
varying HIV infection rates-between zero and thirteen percent. This suggests,
more than anything, that the sample populations studied have been small
and nonrepresentative. More general information from the Centers for Disease
Control shows that Latinos living in the US are disproportionately affected
by the growing HIV/AIDS epidemic-they represented nineteen percent of
the new infections in 1999 although they comprise only thirt een percent
of the total population-and that's counting Puerto Rico.
Alameda County health providers and AIDS activists in the Latino community
were so disconcerted by what they were seeing that they formed a group
called SalvaSIDA, which published a report in 1999 warning about the volatile
combination of low educational attainment, misinformation about AIDS,
cultural norms that discourage frank discussion of homosexuality, anti-immigrant
sentiment, and a lack of health services and insurance. These factors,
warned the report, could result in an infection rate that would make the
CDC's estimate look puny. After all, they noted, government studies usually
announce the arrival of epidemics after the fact, since they tend to count
only full-blown AIDS cases, not those infected with HIV. That means that
a significant growth in a population's rate of infection can occur before
the alarm bells start ringing. "When we're talking about [current]
AIDS cases, we're talking about populations that were infected ten years
ago," says LeRoy Blea, AIDS director for the city of Berkeley, which
has an outreach program similar to La Clinica de la Raza's. "[Latinos]
are not showing up in the statistics among AIDS cases simply because it's
a growing epidemic in Latino populations."
The data from Mexico isn't much more conclusive, but the results are worrisome.
The Mexican government admits that its HIV/AIDS stats are so outdated
and inaccurate that there may be anywhere from 43,000 to 160,000 active
cases of HIV and AIDS combined. "There's not a lot of good research
in Mexico; they don't have a lot of resources," says UC Berkeley
social welfare professor Dr. Kurt Organista, who has studied migrant health
for the last decade. "But if you look at reports in the late 1980s,
they started to see these patterns where the HIV infections and AIDS cases
were highest in the states that had the highest out-migration to the US-Michoacán,
Jalisco, Baja California. What they were seeing was pretty large-between
twenty and thirty percent of the AIDS cases were in people who had been
living and working in the US for some period of time." In the state
of Michoácan, health officials now distribute cards to returning
migrants asking, "Did you have sex with someone you met on the other
side?" and recommending that returning workers take HIV tests.
But if we don't yet have hard numbers, certainly after twenty years of
studying AIDS we should be able to recognize warning signals-and these
abound at migrant campsites. Risk factors include the frequent solicitation
of prostitutes, a reluctance to use or carry condoms, inaccurate ideas
about how HIV is contracted, syringe-sharing among IV drug users as well
as those who inject theselves with antibiotics and vitamins (a common
practice in Mexico), and, in the predominantly male farmwork setting,
sex between men. An even better indicator of high HIV risk, though, is
the transmission rate of other STDs, which are easier to test for because
they don't involve an invasive blood draw. Studies throughout California
in the '90s observed breakouts of syphilis, chancroid, and other infections
at migrant campsites. Last year's UNAIDS report states that a person with
an untreated STD is six to ten times more likely to pass on HIV to a partner;
a person with genital ulcers caused by syphilis, chancroid, or herpes
is an astonishing ten to three hundred times more likely to do so.
Berkeley's AIDS director LeRoy Blea points out that in the early '90s,
Bay Area health officials reported similar concerns about infection risks
for African-American women, but had no numbers to back up their observations.
"We'd been hearing for ten years that African Americans were at risk
because we'd been hearing anecdotally that people were infected but not
being tested," says Blea. "Now they're one of the fastest-rising
groups of new HIV infections in the country."
Today, in Alameda County, African Americans are five times more likely
to be diagosed with AIDS than whites or Latinos, and they make up 62 percent
of the women diagnosed with AIDS and 69 percent of the pediatric cases,
despite representing only about 18 percent of the total population. In
1998, Alameda County took the remarkable but clearly warranted step of
declaring a state of emergency regarding the spread of the HIV virus among
Through a strange twist of fate, it was the national attention to Oakland's
skyrocketing HIV rate that provided a clue to the fact that surrounding
rural areas might also be at risk. The county's emergency declaration
prompted the federal government to fund a project in Oakland last summer
called the Rapid Assessment, Response, and Evaluation of HIV Risks (RARE)
study. Completed in just a few weeks, a RARE study is often used during
viral outbreaks in Third World countries. Instead of tallying infections,
the study is designed to provide a snapshot of some of the ways in which
the virus is being passed. In this case, it showed that Oakland-because
it is both a regional transit hub and a nexus for the trafficking of both
sex and drugs-was the locus of much high-risk behavior that could easily
result in spreading HIV to the surrounding suburban and rural communities.
Among other findings, the RARE study concluded that prostitutes-always
a high HIV-risk group-take BART trains to the ends of the lines, where
they are picked up and brought to work at migrant camps in the surrounding
farm communities. If anyone had believed that the Bay Area's migrant farmworkers
lived in isolation from the health risks of the urban core, here, at last,
written in black and white on government stationery, was a reason to believe
In the TRUCHA office, Rodriguez
heats up a giant urn of coffee and prepares a cooler of lemonade; Yañez
sets to work slicing lettuce, tomatoes, cheese, ham, and jalapeño
peppers to make sandwiches. Although they follow a weekly schedule of
going to day-laborer pickup spots, where they hand out condoms and HIV
prevention information, today they're putting in an extra appearance.
They've prepared a short survey to test their clients' HIV awareness;
the sandwiches are a treat to encourage people to fill it out. "True
or false," the survey asks. "Couples who are married have no
"AIDS is a virus that can be prevented by a vaccine."
"You can recognize a person who has AIDS just by looking at them."
"People who use injection drugs, prostitutes, and homosexuals are
the only people who can be infected by HIV."
It will be an informal survey, one that the clinic does every few months
to help the staff figure out how they need to adjust their approach. Each
of the questions expresses a common misperception about how the HIV virus
travels; each statement is something the staffers have heard from their
clients. Other misconceptions about transmission that turn up in migrant
worker studies are these: that HIV can be passed during casual contact
such as kissing or sharing food; that it cannot be transmitted by oral
sex; that people who have HIV always know that they are infected. Perhaps
most shocking was one survey conducted by UC Berkeley's Kurt Organista,
in which half of the respondents believed that one could contract HIV
from the HIV test itself; this belief alone has serious repercussions
By eight o'clock, the rain has let up and the sky is a sullen gray.
Rodriguez and Yañez load up a wobbly cart with the sandwiches,
drinks, a canvas backpack full of packets of condoms, surveys, and all
the pencils they can crib, and set off down the street, matching black
quilted jackets zipped up to their chins, their long dark ponytails bobbing
in unison. When they reach the corner where perhaps a hundred day laborers
are waiting to be picked up for work, the men begin to clap and holler
greetings. Some of these men are long-term Fruitvale residents, some are
just passing through between harvest seasons in outlying farming communities.
There's a high degree of overlap between farmworkers, service-sector workers,
and day laborers, and whenever anyone wants to pick up a quick construction
or gardening job, he comes to this spot.
Quickly, the two young women distribute the food, paper cups, and surveys;
when the sandwiches are gone, they circulate through the crowd, offering
pencils and answering questions. When someone comes to turn in his survey,
the women go over each of the questions orally, making sure the respondent
has circled the answers he truly intended to circle. Other men come up
to ask about where they can find a doctor or get legal advice; Rodriguez
uses the backs of extra surveys to draw maps back to the clinic.
After the food runs out, interest in the condoms and surveys is sporadic.
People are more focused on scanning the horizon for approaching vans,
although work is slow today because many construction jobs have been rained
out. As one man reaches into the backpack for a packet of condoms, someone
standing nearby calls, "You still use that crap?" The man blushes,
but he still puts the condoms in his pocket. "Aww," says the
heckler. "You use those and you can't feel anything."
A yellow Hertz truck rumbles by slowly. A dozen men run out into the street,
shouting, touching the van with their hands. The driver takes his hands
off the steering wheel and shrugs, palms out. No jobs. Sorry.
Only a map will tell you that
the US-Mexican border is a line that runs from San Ysidro, California,
to Brownsville, Texas. People who work with the migrant population will
tell you that the real border is much more diffuse, that the two nations
share a population of two to three million laborers who move fluidly between
countries, pushed by Mexico's faltering economy and pulled by America's
thriving agribusiness sector. In recent years, the 1994 passage of the
North American Free Trade Agreement (NAFTA), which established thousands
of jobs in the maquiladora (manufacturing) zone along the border, and
the problems caused by Mexico's currency devaluation in 1995, added incentives
for Mexico's poorest citizens to go looking for work up north. "The
border is very, very porous," says Organista. "We're starting
to use the word 'transnational' now because for migrants who go back and
forth, the border is not that relevant to their lives. It's just something
Workers heading north from Latin America tend to cross the border in three
different streams-one headed toward the Eastern seaboard, one to the Midwest,
and one toward the Pacific coast. Each stream has its own demographics;
the Eastern stream is largely composed of workers from Puerto Rico and
the Caribbean and tends to include entire families; the Western stream
is predominantly male and almost exclusively Mexican.
With its temperate climate and excellent irrigation system, California
is the nation's agricultural powerhouse. In 1999, the state's farms pulled
down $26 billion in revenues -three times the amount the entire American
film industry made that year. More than fifty percent of all US vegetable
production and forty percent of its fruit comes from California; the volume
produced of each has doubled during the last thirty years. This abundance
is made possible largely because of cheap labor from Mexico: California's
farm industry employs somewhere between 600,000 to 1.1 million migrant
The state has had an up-and-down relationship with Mexican labor, largely
depending on the robustness of the state's economy. "All through
the 20th century we allowed Mexican labor to come over as we needed it-during
WWI and II, we were really big on importing lots and lots of Mexican labor,"
says UC Berkeley's Kurt Organista. "Of course when the Great Depression
came, we were really into how we were going to round up these illegals
and kick them out. We've used that labor force at our disposal and we
continue to do that. Every now and then Pete Wilson or someone like that
will get everyone all riled up about it, but nobody's talking about how
we need these two to three million people to harvest mushrooms and pick
Mexican migrants, so often characterized by politicians as indigent loafers
who soak up social services intended for American citizens, are the raw
fuel that powers the state's economic engine. Without them, there would
be no strawberries in Watsonville, no wine in Napa, no garlic in Gilroy.
Farmwork was a dangerous gig
before the threat of HIV made its way to the migrant camps, and it isn't
getting any easier. In 1987, farmwork took the lead as the nation's most
hazardous occupation, beating out even notoriously scary occupations like
mining. In California there are 20,000 disabling injuries on farms annually,
and of course that's not counting the innumerable aches, pains, rashes,
and eye problems caused by backbreaking labor, exposure to pesticides,
and glare from the sun. Workers suffer from lack of fresh water, lack
of bathroom facilities, and inadequate housing; in Southern California,
where employer-supplied housing for farmhands is in short supply, some
workers live in "spider holes," or trenches dug into the ground,
while others make themselves shelters of cardboard and mattresses.
A truly astonishing report released just months ago by the California
Institute for Rural Studies (CIRS) found that most migrant farmworkers
have extremely limited access to health care. Among the report's findings:
70 percent of the workers had no health insurance, 32 percent of the men
said they had never been to a doctor or clinic in their lives, and half
of the men and two-fifths of the women said they had never been to see
a dentist. The study, which was based on complete physical exams of nearly
a thousand randomly selected farmworkers, also found a prevalence of high
cholesterol, high blood pressure, obesity, anemia, and tooth decay. "The
irony is inescapable; that the fruits of their labor provide us with such
health, yet their health status suffers in ways that most Americans would
never tolerate," the study's authors conclude.
How could a population so crucial to the state's economic vitality be
in such poor health? There are dozens of factors-the geographic isolation
of many farms, a distrust of the US medical system and linguistic barriers,
including the fact that many migrants speak indigenous Indian dialects
rather than Spanish. But the biggest reason is simply that nobody is forcing
employers to take care of their workers. Agriculture is largely free from
government oversight, and within this system growers sidestep direct responsibility
for their employees by hiring labor contractors to do the hiring and firing
of work crews. These middlemen then become the legal employers of the
farmworkers; it's a neat trick that protects growers from liabilities
Growers, says Dr. David Lighthall of CIRS, can be "nasties"
about providing housing and health insurance, but part of the reason for
their cost-cutting is that they're literally low on the food chain. With
the exception of vintners, most growers don't sell food directly to consumers-they
sell to processors and grocery stores. This means that growers must accept
bids offered to them by larger entities, who usually have plenty of sources
to choose from. When external factors increase the cost of production,
like the hike in energy rates or the minimum wage's jump to $6.25 this
year, growers have to trim back expense, and usually labor benefits get
"When the minimum wage goes up, McDonald's raises the price of hamburgers-they
can pass that price on to you because all their competitors are facing
the same costs," says Lighthall. "But if you're producing an
agricultural commodity and selling to a wholesaler, broker, or grocery
store, you've got a whole bunch of competition out there, and they might
be in other countries. It's like a bid at an auction. People offer you
a price and you have to decide whether to take it or not. They're price
takers, not price makers."
In fact, he says, despite bumper crops, California's farmers believe they
are in a crisis right now-the collapse of the Asian economy a few years
back depressed exports to Asia, international competition threatens to
undersell them, the influx of cheap Mexican labor encouraged growers to
start planting labor-intensive crops like strawberries that some of them
now regret, and bigger producers are rapidly swallowing up the small farms.
The upshot is that while for consumers the price of California produce
stays nice and low, growers feel increasingly under the gun, and as long
as they feel financially unstable, the living conditions of migrant farmworkers
are unlikely to improve. "When you walk into the grocery store and
you buy some table grapes or raisins or lettuce or cauliflower or almonds,
you're not really paying the full price," Lighthall says. "Somewhere
there's a farmworker who maybe didn't have health insurance or maybe got
hurt on the job; these are the external costs that aren't being passed
Don't wait for federal regulation -US labor laws barely acknowledge that
farms exist. In the 1930s, Congress laid the cornerstone of American workers'
rights by passing the Fair Labor Standards Act and the National Labor
Relations Act, which guaranteed minimal employment standards and collective
bargaining rights for workers.
Both laws exempted farm labor. Farmworkers are also excluded from the
FLSA's mandatory overtime pay rule, as well as the Occupational Health
and Safety Act of 1970 (better known as OSHA), which protects workers
from unsafe conditions and remunerates them for on-the-job injuries. Even
child labor laws get bent to accommodate agribusiness-kids can start working
on farms at age twelve, but not in other industries until age fourteen.
Only in California do farmworkers have the right to unionize, and that's
thanks to the mighty struggle of the United Farm Workers. In essence,
the country reaps all the benefits of having a colossally large and productive
workforce without any of the responsiblities of having to care for one.
Instead of regulating farm labor, the government has chosen to example,
Migrant Head Start and a migrant job training program-all run by different
departments. These programs were designed to be temporary-unbelievably,
their drafters thought farmworkers would be replaced by machines during
the '70s -but the programs are still around today, although they're often
criticized as disorganized and redundant.
In 1962, Congress took a stab at more direct action by passing the Migrant
Health Care Act. As a result, today there are about four hundred federally
funded health clinics, but studies show that fewer than twenty percent
of farmworkers ever use them. "Access to health care is an issue,"
says Dr. Juan Ruiz, acting chief of California's Office of AIDS. "Most
of the farmworking men work long hours and by the time they get off work,
all the clinics are already closed. Usually the clinics are located at
a distance, so the workers have to travel and they don't have transportation
to get there. And they're afraid that if they get any services they may
be reported [to the INS]. I think that's the biggest fear-being sent back."
In fact, perhaps because of the virulency of anti-immigrant sentiment,
only a fraction of migrant workers who are in the country legally take
advantage of programs that are available to them, including unemployment
insurance, food stamps, or Medicaid.
This means you can have some very, very sick people working on farms,
who will pretend to be well in order to put off seeking medical services
or, worse, to keep from being fired. Some researchers relate horror stories
of undocumented laborers who, after growers discovered they were HIV-positive,
were dismissed from work and then driven back over the border. "People
come here to work, and they will work until they die or cannot move,"
says Alfonso Rodriguez, an epidemiologist for California's Office of Border
Health. "They might have diabetes, tuberculosis, or any infectious
disease or injury, and they don't want to worry about that because they
worry that they will lose their jobs and have no money to send home. Usually
they try to wait until they go home to deal with health situations."
In a community where poor health and a suspicion of medical service providers
are the rule, can the spread of a virus, any virus, be hard to imagine?
Now it's time to talk about
sex. There is no other way to discuss the spread of HIV. Despite the all-out
lack of statistics about migrants' infection rates, there have been several
in-depth studies done about Sex on the Farm. The crux of those studies
is this: everything that can happen in the biggest of cities can and does
happen out in the fields.
There's a Spanish phrase, caer en vicios, "to fall into vices,"
that migrant farmworkers use to describe the temptations that await in
the United States, away from wives and girlfriends. Throughout the world,
America has the image of a sexual Disneyland; American sex workers are
considered capable of teaching you positions and practices that amateurs
in other countries know nothing about. For gay and bisexual men, the opportunity
to shed small-town taboos and explore their sexual identities is a tremendous
freedom. Those from rural backgrounds, on the migrant route up through
California, are likely to meet more and different people than they ever
would have met at home. "One of the biggest risks for immigrant populations
is just living in the United States," explains Berkeley's LeRoy Blea.
"In large urban centers there's more opportunity for infectious diseases
like HIV to spread rapidly because you can have more sexual partners."
And while sometimes farmworkers go into the city, particularly during
the off-season, more likely the city comes to them.
Long before the RARE study put it on paper, entrepreneurs had figured
out that there was money to be made by supplying lonely, bored farmworkers
with booze and girls. Benito Francisco-Hernandez, who now works for La
Clinica de la Raza's TRUCHA program, grew up as a migrant farmworker,
following the seasons across the United States. He remembers that as a
child, he used to be sent to neighboring towns to bring back girls. Because
most farmhands are paid in cash, sex workers from urban areas learn when
the harvest seasons are, and they time their visits to coincide with payday.
"It's kind of like gold mining," says Francisco-Hernandez.
From his position at the clinic, he knows that prostitutes from the Bay
Area regularly work in migrant camps; they consider it a well-paying gig.
But when asked how many tricks a woman would turn during a farm visit,
he shakes his head. "That's a question that blows your mind,"
he says. "There's some girls that go out there, and they stay the
whole season, two, three months. In that time they make a killing. They
can go in and make enough money to buy a car, or come back and buy an
apartment, but they have to go through a whole lot of men to do that.
For the average out there in the field, men will pay like twenty dollars
per trick. There are some girls who go only for the weekend, around the
time when [the farmworkers] get paid. Over the weekend they work through
like sixty, seventy men."
This kind of client turnover has researchers worried, particularly because
all studies report that migrant men are reluctant to use condoms with
sex workers; they complain about loss of sensation, feeling less manly,
and, interestingly, that part of the reason they pay for a prostitute
is so that someone will receive their ejaculate. Sex workers report that
men may offer them more money to have sex without a condom, or may simply
take their business elsewhere if the worker insists on using one. In addition,
minimal sanitary conditions on the farm mean that the women rarely have
time to clean themselves between customers. In fact, they may service
several men simultaneously-in his research, Berkeley's Organista describes
this as a male bonding ritual, after which the men refer to themselves
as hermanos de leche, or "milk brothers." At least one health
expert has speculated that in this circumstance, even an HIV-negative
sex worker could transmit the infection among her clients.
The remoteness of many farms, as well as undocumented workers' unwillingness
to leave camp, contributes to the fact that a relatively small number
of female sex workers service an extremely high number of men. Fernando
Sanudo, health promotion director at the Vista Community Clinic in Southern
California, says that during his thirteen years of observation, he's seen
an increase in the types of businesspeople who have learned to ply their
wares among the camp crowd. Years ago, he says, it would just be lunch
trucks that would drive into camp and sell food to workers. Now, he says,
these trucks are grocery stores on wheels, bringing in food as well as
injectable vitamins and antibiotics. It wasn't a huge stretch for pimps
to start bringing women in vans, usually right around payday.
"The growers are aware that these types of activities take place
and don't support them, but on the other hand, they know that they don't
necessarily want the workers to leave the campsites, especially if they're
undocumented," says Sanudo. "So they turn their backs. The pimp
will go in with the pretext of selling music cassettes -that's [farmworkers']
only form of entertainment, along with radio. Then they say, 'By the way,
we also have beer.' And then after a couple of beers, the ladies come
out, and that's how the whole affair occurs."
Numerous reports emphasize the influential role that alcohol consumption
plays in facilitating high-risk sexual encounters, particularly when sex
occurs between men. Hugely stigmatized and denounced by the Catholic Church
as a sin, homosexual behavior still happens. "At the honky-tonks
you know what's going on; people aren't just drinking beer. They're looking
for some kind of little relationship or just an experience," says
Francisco-Hernandez. "It goes in a lot of different ways, not just
men to women, but also men to men. Guys come looking for a girl but it
happens to be a bar where there are only men, and a few beers after you
start looking kind of good, and they're winking at each other and they're
like, 'All right, bro.'"
Sanudo agrees that in migrant camps, male-to-male sexual behavior is often
a function of loneliness. "They are isolated, many times sharing
a room and close quarters with another male, especially on a cold day,"
he says. "These guys are human and they want the closeness, they
want to feel something. It may occur that after a few beers they may engage
in activity that happens to be sexual, but they don't see it as engaging
in sex with another man-it was more something that happened. They never
refer to themselves as hetero, bi, or gay; you're either male or female."
Some men consider themselves completely straight, despite the occasional
sexual encounter with other men. Men who play the "top," or
dominant role, consider themselves to be performing as men and see their
male partners as "women." Some men believe that having sex with
other men is actually a way to stay faithful to their wives.
Then there are others who consider themselves obvio, a slang word
for effeminate or obviously gay, and for them, for the first time in their
lives, they may be valued, rather than derided, for their looks and sexual
orientation. "Here are these young men who are sort of coming to
grips with their own sexuality. They're glad to be away from these small
provincial towns in Mexico," says Organista. "Some of them are
excited to be able to explore their sexuality here. Now you put that in
the context of migratory labor, where there's all these men with limited
access to women, with wives and girlfriends back home, and these men become
another sexual outlet. They may have sex with men who are otherwise straight,
or maybe other men who are exploring their sexuality. They could be very
popular; people would be hitting on them, maybe not paying them but buying
them lunch and taking them out and maybe on occasion [having] sex for
Some of these behaviors are more common than others; in his 1997 study,
Organista found that 44 percent of his male respondents reported having
sex with prostitutes while in the US, but fewer than 3 percent admitted
to having sex with other men. However, he suggests that the latter number
is too low; many of his respondents were reluctant to admit some of their
most private sexual practices. State figures as well as studies conducted
by community AIDS service organizations [ASOs] back him up.
Of course, there are many migrant workers who don't engage in sexually
risky behavior. Sex is just one way of contracting HIV.
Chris Catchpool sits in the cab of his truck, looking out through the
windshield at the blackened ruin of what used to be Casa Segura, the Fruitvale's
needle exchange. In the early hours of the first day of the new year,
someone apparently opposed to the idea of allowing drug users to swap
their used syringes for new ones lit a fire in the second-story kitchen.
The fire burned through offices, counseling rooms, racks of donated used
clothes, the clinic where addicts could get treatment for abscesses, the
bathroom and shower facilities that Catchpool himself had just installed.
What the fire didn't destroy, the subsequent winter rains did; the charred
structure now smells too bad to enter. Casa Segura staff still perform
the weekly needle swap in the front parking lot, but the community facility
Catchpool worked so hard to build is gone.
Alameda County health officials estimate that about a third of all AIDS
cases are associated with injection drug use. For example, the majority
of heterosexually acquired AIDS cases among women are attributed to sexual
contact between the woman and a male injection drug user.
Doing outreach work in the Fruitvale district since 1993, Catchpool has
had a ringside seat for the comeback of heroin; he believes that since
so much of the drug is grown in Mexico, it tends to show up here in Spanish-speaking
communities first. "Look at the Mission District, the biggest cop
spot in Northern California," he says. "Look at the Fruitvale,
look at LA, San Diego -you'll see that heroin is really pouring into the
Latino communities in the same way that crack poured into the black community.
That doesn't mean that only Latinos are using heroin; here in Oakland
our largest [heroin-using] population is African American, no doubt about
it. But there is a lot of heroin being introduced into the Latino community,
and the day laborers are one piece of that community being introduced
to that stuff."
While confidentiality precludes the Casa Segura staff from asking too
much about their clients' backgrounds, Catchpool knows that the needle
exchange serves a slice of the neighborhood's migrant labor force. And
he's getting worried that heroin is an attractive escape for people who
are struggling financially, yet who often have money in their pockets
because their employers pay them in cash. "I think there's an illusion
of 'el grande norte,' that they're going to find work," he says.
"Folks get up here and they're broke, they're standing on the day-laborer
spot-which is a meat market-and it's not a very pleasant thing to do,
sitting out there hoping to get picked up. I started to see heroin introduced
to these folks, and at first I heard it was offered to people for free,
like, 'Hey, man, it's rough out here, it's cold, snort this' and folks
started to get strung out. When you think about it, they're holding sixty
or eighty dollars cash in their pockets, and they don't have a place to
sleep. You've got almost a captive market there of folks who are really
under the radar, and heroin is a very efficient drug in that sense. It
takes away aches and pains, feelings of cold and loneliness and depression.
It's also a very overwhelming, powerful substance that will take over
Although the piquete, or vitamin shot, is a common practice in Mexico,
shooting heroin is not-it's a practice Catchpool is afraid migrants are
learning here and bringing back home. He's not alone in that concern-this
September, health officials from Mexico and the United States sponsored
"The Border that Unites Us," a conference in Tijuana that discussed
this very trend. At the conference, Mexican HIV service workers, including
priests and nuns in habit, learned harm-reduction techniques from their
US counterparts. Earlier studies had noted the high rate of HIV infections
among prostitutes, some of them with their own drug addictions, who work
in border towns through which migrant workers pass. Now shooting galleries
are adding to that risk; Catchpool suspects that heroin shipments that
can't get moved north are dumped at the border, making the drug plentiful
"They're taking this custom back of shooting drugs, and you have
country that's growing that very drug," Catchpool sighs, gazing steadily
through his windshield. "Poor Mexico," he says, quoting early
20th-century dictator Porfirio Diaz, "so far from God and so close
to the United States."
When discussing HIV, it's easy
to get caught up in arguments about human behavior, about what people
should or should not do. But the bottom line is this: HIV is a virus,
and multiplying is what viruses are built to do.
When you think about it this way, it's extraordinarily nave to have
ever believed that HIV would remain ghettoized within the gay community
in this country. If the spread of the infection to women, youth, and various
communities of color has taught us anything, it's that HIV is at home
in virtually any ghetto. It's been handed from one marginalized population
to the next, and there is every reason to think that it will continue
to seek new ones. After all, a virus with nowhere left to go is an extinct
Benjamin Bowser is a sociology professor at Cal State Hayward who served
as a codirector for Oakland's RARE study; he says that the biggest mistake
health officials make is assuming that any community is isolated or self-contained.
The RARE study pointed out how badly researchers had misjudged HIV's infectious
potential by thinking that high-risk groups simply passed the virus around
among themselves. "We've had fifteen, twenty years of HIV research
and thousands of studies, but one of the least-asked questions is, 'Who
do you do this with?' because we always assumed it was blacks doing drugs
with blacks and gay men having sex with other gay men," says Bowser.
"We felt really stupid because we'd made this assumption."
"Oakland is a center of a kind of sexual tourism traffic from other
parts of the Bay Area. The major money being made by the selling of drugs
and the offering of sexual favors is made by people coming into Oakland
from outside. So the high-HIV-risk behavior that we're seeing in these
pockets is not confined to these pockets. The thing with sexual behaviors
driven through drug abuse is that they cross race, class, ethnicity, and
geographic boundaries. Because of their own exclusiveness, people think
that viruses observe the same exclusiveness: if you don't socialize with
these people, you can't get whatever they've got. But the problem is that
somebody is bringing whatever is over there over here."
In other words, your neighbors' health affects your health, even if you
think you have nothing in common with them. Health in the cities affects
the suburbs and the farm communities. Health in Oakland and San Francisco
affects the health of people hundreds of miles away. And health in the
United States affects health in Mexico. People often think of HIV transmission
as a single chain, in which one person passes the virus to the next person,
who then passes it to someone else. In reality, the transmission process
is more like nuclear fission, in which one connection sets off a reaction
throughout a whole network.
It meant something for the world's AIDS epidemic when San Francisco AIDS
experts announced last month that the rate of new HIV infections among
the city's gay men had more than doubled since 1997. It meant something
for the world's AIDS epidemic when Cal-PEP (which stands for Prostitutes
Educating Prostitutes), an Oakland-based health organization that reaches
out to sex workers, IV drug users, and other high-risk groups, found this
January that the number of people testing HIV-positive had tripled since
their last testing period six months earlier.
It means something that many Bay Area HIV outreach workers say that because
of the advent of HAART (highly active antiretroviral therapy) drugs, they
now have to convince high-risk individuals that AIDS is lethal, not a
chronic and manageable health condition, that much of their intervention
is now designed with the assumption that their client may already be HIV-positive.
And it means something that service organizations like La Clinica de la
Raza, Casa Segura, Cal-PEP, and Berkeley's public health department saw
this coming; that this time around, we don't have to wait until people
start dying of AIDS to know that a new high-risk group for HIV has emerged.
How will Mexico deal with an influx of workers who return to their communities
either carrying HIV or coming home to die? Even top health officials admit
the nation is truly unready to handle an epidemic; until a few years ago,
only three of Mexico's 32 states had AIDS education and prevention programs.
Treating HIV is expensive: the average cost for a year's supply of triple
combination therapy with protease inhibitors is over $10,000.
"From what we have heard from the farmworkers, some of these guys
who have tested positive have preferred to stay here because they know
they would never get any treatment in their rural community," says
Sanudo. "They have told us that when someone has tested positive
the whole community had to get them to leave for fear they may infect
somone else. It's still very primitive."
"Talk about The Scarlet Letter. It could be A for AIDS instead of
adultery," Catchpool agrees. "People don't want to treat them
and they don't know about HIV and the community ostracizes them. It discourages
people from getting tested. There's such a huge amount of shame bound
up in having this disease in Mexico."
This shame is the very reason researchers are so worried that women in
rural Mexico and Central America may be next in line for HIV transmission.
People who are afraid they will test positive won't get tested. And as
Organista points out in his research, although men can be persuaded-reluctantly-to
use condoms with sex workers, they are much less likely to use them with
their wives or girlfriends. Insisting on condom use would almost be an
admission of infidelity, he says, particularly when their primary partners
are likely to already be using nonbarrier forms of birth control. "Imagine
coming back home from Gilroy after six months and saying, 'I'm going to
use a condom,'" says Organista. "Well, why would you do that?"
Perhaps Marco can help.
Marco is the protagonist of a fotonovela, or picture storybook, called
Tres Hombres Sin Fronteras, or "Three Men Without Borders,"
which is being used to carry a safe-sex message to migrant laborers. It
follows a popular Mexican storytelling formula, in which three characters
are confronted with the same problem. One goes about solving it the right
way, one plays the villain, and the third-with whom the reader is supposed
to identify-waffles between the two, finally making the correct decision
in the end. Marco and his friends Sergio and Victor are migrant workers-or,
as the subtitles put it, "three men who leave their town in search
of opportunities, [but] they confront danger!" Danger, of course,
means catching STDs, and keep in mind that all three of our protagonists
Victor, in the role of the good guy, abstains from sex altogether. Sergio
has sex with other men as well as female prostitutes; we later learn that
both his wife and child in Mexico become infected as a result. Marco,
wracked with indecision, has the good fortune to run into a prostitute
named Karla, a big-haired brunette wearing an off-the-shoulder floral
number who tells him they should use condoms to protect them both from
venereal diseases. "When you get AIDS, there isn't a cure for that,"
she explains. The final frame shows Karla's well-manicured hand passing
a foil-wrapped packet to Marco. "OK!" says the last subtitle.
Tres Hombres Sin Fronteras is one of the several creative ways
in which outreach workers are learning to promote HIV awareness among
migrant workers. Created by Sanudo's Vista clinic in conjunction with
researchers at UC Irvine, it's designed to reach a largely illiterate
audience, and is accompanied by a companion piece, Marco Learns to Protect
Himself, which teaches men how to use and dispose of condoms. Combined
with radionovelas-similar stories broadcast over the radio-and group health
discussions, it's extremely effective; people who were given the educational
materials tested higher for HIV knowledge and dramatically increased their
use of condoms with sex workers.
Tres Hombres Sin Fronteras plays on a radical solution, which is
that sex workers themselves may be the most effective HIV educators if
armed with the right information and given the support of local health
agencies. "The majority of the men we talked to had learned to use
a condom through a sex worker," says Sanudo. Given the general reluctance
to use condoms at home, getting migrant workers to use them when they
engage in high-risk activities should at least reduce some risk to their
primary partners, as well as to the sex traders themselves. "If you
want to get these men to use condoms you have to focus on their secondary
casual sex partners in the US: other men and prostitutes," agrees
Organista. "You've got to get them to do the safe-sex behavior here
in the States."
Throughout the state, other social service agencies are trying equally
innovative approaches. Costume shows at drag bars frequented by migrant
laborers sometimes have safe-sex themes; in one show, a Monica Lewinsky
character is scolded for not having insisted that the President wear a
condom-if he had, there would have been no tell-tale stain on the blue
Of course, there is still the tried-and-true formula of better HIV testing,
condom distribution, and peer education. In areas where women make up
a more substantial portion of the migrant population, researchers suggest
that outreach workers specifically target women, since they are more likely
to supervise their families' health than men. For more male-dominated
groups, they suggest that educators try tapping into the notion that condom
use is something men can do, if not for the sake of their own health,
then to protect the women in their lives. In all of these scenarios, outreach
workers and researchers agree, the federal governments of both Mexico
and the United States would be best off playing the role of the piggy
bank, providing a funding framework for health education, but letting
more knowledgeable and culturally sensitive community-based organizations
take the lead in designing and administering the programs and services.
Migrant laborers have long been subject to all the health and economic
privations that come from being the invisible hands that make American
industry prosper; HIV is just the latest and most virulent threat to their
well-being. But if a virus can be passed from one marginalized population
to another, so can information about treating and preventing it, provided
we can overcome the cultural assumptions that make rural Mexico seem so
very far away from the health hazards of big American cities. Benjamin
Bowser puts it this way: "The big collective public health error
is the assumption that you can have an epidemic among one group of people,
and it will stay there. But if you allow it to fester, sooner or later
it will jump the barrier, and infect one group and then the next and the
The problem with having a border is that you start to believe in it.