Researchers on both sides of border urge fast action
By Cheryl Clark
UNION-TRIBUNE STAFF WRITER
March 2, 2006
Tijuana, long thought to have a relatively small prevalence of HIV infection, is on the cusp of an alarming AIDS outbreak rivaling those experienced by many major U.S. cities, including San Diego, with as many as one in 125 people ages 15 to 49 now infected.
That's the conclusion of a new report from the University of California San Diego and Mexican researchers, who predict a public health crisis in Tijuana if steps aren't taken quickly.
The researchers looked at current infection rates in groups engaging in low-to high-risk behaviors and compared them with similar statistics from the 1990s. The findings were then extrapolated to the 686,000 people in Tijuana ages 15 to 49. It was concluded that 1,803 to 5,472 in that age bracket are infected, or up to one in 125 people.
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โThis suggests we may be on the verge of a major HIV-AIDS outbreak in Tijuana,โ said Steffanie Strathdee, chief of UCSD's division of international health and cross-cultural medicine and the principal author of the report.
โHIV prevention efforts and treatment should be a priority in the border region, but no one has been paying attention to this problem,โ she said. โInterventions to reduce ongoing spread of HIV are urgently needed.โ
The rate of one in 125 mirrors the rate for the same age group in San Diego County, according to statistics from the county Office of AIDS Coordination and the San Diego Association of Governments.
The UCSD and Mexican study was co-written by Kimberly Brouwer, a UCSD assistant professor, and several researchers with Mexico's AIDS prevention agency in Mexico City. It was published in the February Journal of Urban Health.
The study found the following increases in infection since the 1990s:
Among female sex workers, infection went from five per 1,000 to 48 per 1,000, or 4.8 percent of sex workers.
Among injection drug users, the rate went from 20 per 1,000 to as many as 65 per 1,000, or 6.5 percent of drug users.
Among men who have sex with men, the rate increased from 12 percent to 19 percent.
Among pregnant women, generally considered to be in a low-risk category, HIV infection rates rose from one per 1,000 to 11 per 1,000, or 1.1 percent.
โNo one ever guessed we would see a prevalence rate of 1 percent in pregnant women,โ said Strathdee, who said the findings โalarmedโ both U.S. and Mexican researchers doing the study. โThat's when UNAIDS (the United Nations AIDS program) says a problem is becoming a generalized epidemic.โ
With little money to test and counsel those infected, much less provide treatment, the problem is destined to get worse before it gets better, she said.
Tijuana had been thought of as not in danger of an AIDS epidemic because of the perception that it has relatively few intravenous drug users and gay men, several San Diego AIDS experts have long acknowledged.
But Strathdee said the warning signs are becoming more evident in part because of the city's growing number of infected sex workers.
In her report, she mentioned a 2004 study that โfound that female sex workers in Tijuana seldom negotiated the use of condoms, had a low knowledge regarding the proper use of condoms and did not like to use condoms with clients because they were perceived as uncomfortable.โ
Strathdee said: โPeople don't have an understanding of the level of risks that are going on. In this city, prostitution is quasi-legal and there are 6,000 to 10,000 intravenous drug users. It also is a major drug-trafficking route.โ
Tijuana men who have sex with men do so on both sides of the border, which she described as easy to cross.
Dr. George Lemp, director of the state-funded Universitywide AIDS Research Program, said there have been hints that HIV infections have โbeen expanding among Mexican migrants in California,โ where studies have noted a โtremendousโ increase in high-risk behaviors.
โThis new Tijuana study is further evidence that concern is warranted,โ Lemp said. โThere needs to be more collaborative effort between Mexican local and federal governments and California government and academic institutionsโ to identify and control the spread.
Terry Cunningham, head of the county Office of AIDS Coordination, agreed with the need for more collaboration.
โWe've always considered the possibility that there can be an increase in Tijuana AIDS infections,โ he said, adding that his office will โlook at the study more closely and see how we can collaborate with our partners across the border.โ
Mexican agencies that participated in the research included Centro Nacional para la Prevencion y Control del VIH/SIDA in Mexico City and the Instituto Nacional de Salud Publica of Cuernavaca.
http://www.signonsandiego.com/news/mexico/tijuana/20060302-9999-7m2hiv.html