Tijuana's AIDS epidemic a threat to U.S.

TIJUANA, Mexico — Half a dozen prostitutes swarm Angel Cabrera's car as he inches along the traffic-choked streets of downtown Tijuana on a balmy Friday evening.

"Muchacho," they beckon. "Come here, handsome!"

It isn't just the women in four-inch heels. Cabdrivers, bar bouncers and the 60-something lady hawking sodas on the corner all want what Cabrera is carrying: condoms, thousands of them. All gratis.

When President Felipe Calderón opens the 17th International AIDS Conference in Mexico City on Sunday, he can rightfully boast that his country has one of the lowest HIV rates in the Americas. The percentage of people living with HIV/AIDS in Mexico is half that of the United States and one-third that of Guatemala, El Salvador and Panama, according to the most recent statistics from the United Nations agency UNAIDS.

But in Tijuana, a chaotic border city of 1.5 million people, the HIV infection rate is nearly triple the national average, and it has been rising steadily for more than a decade. Today, about one in every 125 adults in the city is infected with the virus that causes AIDS.

And with Mexico's border cities serving as funnels for workers and goods traversing the two countries, Tijuana's AIDS crisis poses a direct threat to the United States.

"I call HIV the uninvited hitchhiker," said Steffanie Strathdee, a leading AIDS researcher at the University of California's Division of International Health and Cross-Cultural Medicine.

A survey by university researchers found that 64 percent of 116 HIV-positive Tijuana residents crossed into the United States at least once a month. Nearly half of men having sex with men in Tijuana and 75 percent of those in San Diego reported having partners across the border. And of 1,000 prostitutes interviewed in Tijuana, 69 percent had U.S. clients who crossed the border for their services.

One of the busiest border crossings in the world, Tijuana is the front line of Mexico's war against AIDS — and Cabrera is an unlikely foot soldier. A former drug addict with an old bullet wound in the back, he now spends his days and many nights distributing condoms and clean needles to almost anyone who will take them.

His daily patrols along the city's cacophonous tourist strip, filthy alleyways and concrete canal tunnels are known in academic parlance as "harm reduction," an effort to curtail risky behaviors such as needle sharing and unprotected sex that have helped fuel Tijuana's exploding epidemic.

Harm reduction is emerging elsewhere around the globe as a central strategy in slowing the spread of HIV. The U.S. government opposes clean-needle initiatives, though some local governments and charities fund smaller programs.

But in Mexico, a heavily Catholic, conservative country, the government has quietly supported controversial measures such as condom and needle distribution to catch the epidemic before it extends deeper into the country.

"Before, it was taboo to even talk openly about condoms," said Jorge Saavedra, chief of Mexico's AIDS office. "Groups still oppose condom use, but at least we can mention the word."

The shift came after a sustained push by health leaders to discuss condom use in a scientific context, rather than focusing on moral implications. Saavedra's own story became part of the narrative. He is gay and HIV-positive and not afraid to talk about it, a startling approach for a Mexican official.

He argues that needle exchange, like condoms, is a public-health strategy.