Misery Without Borders
KaraPlatoni.com HIV and the migrant farmworker.

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At 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 men.

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 African Americans.

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 otherwise.

• • • •

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 HIV risk."
"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 for prevention.
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 to cross."

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 workers.

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 flowers."

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 and lawsuits.

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 squeezed first.

"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 on."

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 money."

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 your life."

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 and cheap.

"They're taking this custom back of shooting drugs, and you have a
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 na•ve 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 virus.

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 are married.

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 dress.

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 next."

The problem with having a border is that you start to believe in it.


Originally Published: February 16, 2001, East Bay Express

All content copyright Kara Platoni. Please contact for permission before reproducing.